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Overcoming the Stress of COVID-19 Pandemic

Posted on July 25, 2020 at 10:55 AM Comments comments (2281)

Thoughts on overcoming the stresses of COVID-19

We certainly live in a difficult time don’t we? The headlines tell us about the catastrophic number of deaths worldwide from the virus, which is now over 144,000 just in the USA. We are bombarded by discouraging news of an unseen danger that is unprecedented in its scope and unknown to science in the nature of its symptoms as well as treatment. The result is that for the first time in anyone’s memory we are all huddled in our homes while consciously avoiding social contact that was normal and comfortable for all of us. The question for me as a psychologist is “What is the best practice to cope with such widespread stress that effects all of our population?”

The first thing that we DON’T want to do is panic! There are very few situations that are best addressed by panicking. Although not everyone in America is panicking there are a large number of citizens who are suffering from COVID-19 related mental health issues. According to a May 26, 2020 article in the Washington Post written by Alyssa Flowers and William Wan approximately one third of all Americans are currently struggling with anxiety and/or depression that is related to the pandemic. They break the numbers down specifically to 10% struggling with anxiety, 9% with depression and the rest a combination of both anxiety and depression. A similar survey conducted by the American Psychological Association put the number for anxiety and depression totals at 11%.

Whether you believe either study, it is a huge problem in our society that is effecting upwards of 30 million Americans and worthy of being addressed. Two researchers writing for the Journal of Trauma Psychology: Shuquan Chen and George Bonanno of Columbia University (https://dx.doi.org/10.1037/tra0000685) studied psychological adjustment and resiliency during the pandemic. They noted that the stress came not just from the numerous unknowns about COVID-19 but the secondary stress of not working or working from home, homeschooling children or helping care for the aged, adapting to financial stress of dramatically reduced income, as well as fear of infection and possibly a painful agonizing death struggling and failing to breathe. Much of their work was based on previous studies of the SARS virus (Boanno, 2008) which was actually more lethal than CoVID-19 and what coping skills worked during that epidemic. Given what is known thus far in their studies the authors believe that approximately two-thirds of all Americans will remain resilient in the face of the pandemic and not just survive but may actually thrive in the fact of this danger.

Several findings from their studies are worth noting:

1. Those individuals who are able to remain optimistic despite the overwhelming negative news were much less stressed than pessimists.

2. Having strong social support and bonding with loved ones as well as friends was also a significant stress inoculative factor against stress. Drawing strength from other’s presence had a significant calming effect on individuals.

3. Staying informed about the details of COVID-19 was important in maintaining resiliency. This meant being current on what was being discovered about self-protection and yet not allowing themselves to be overwhelmed by too much information which would result in an uptick in anxiety and depression.

4. It was also discovered that having a playful attitude of “making the best of a bad situation” was very helpful. Individuals who could employ hobbies and games with their families seemed to fair much better as a result of “play” and distraction.

5. In addition to bonding it was found that building an online social media support group was helpful in building resiliency to stress. The study also found that among those individuals who actually contracted COVID-19 that it was essential that they mobilize social support, increase help-seeking behaviors, and maintain ongoing physical care in order to maintain resiliency. The study also found that maintaining a “flexible attitude” was very significant in maintaining health and resiliency. In other words deciding on an initial strategy (i.e. work from home) but being willing to periodically re-assess the situation and change when it seems to have become ineffective (i.e. mask up and go to the office two days a week).

In a study by American Psychological Association (APA) from the APA Monitor November 2016 issue, Lorna Collier wrote about a case study in which her client, who was brutally stabbed and left for dead, made a long recovery in therapy only to find that she was much improved. She not only recovered from PTSD, but more importantly, her quality of life was much improved in the areas of having a new found personal strength (she was much more resilient than she had previously thought), a deeper appreciation for her gift of life, and a new focus on wanting to give back to and help other people. Researchers Dr. Richard Tedeschi, and Dr. Lawrence Calhoun working with this phenomenon in the work published in 1996 in the Journal of Traumatic Stress have dubbed this result of working through trauma “Post-Traumatic Growth” or PTG. They described positive changes in five areas: Spiritual change, personal strength, a deeper appreciation of life, improved relationships with others and an openness to new possibilities in their lives.

What are some very practical coping skills that we can use to cope with the day to day reality of COVID-19 in our lives?

First of all, we all need to realize that as a nation we have survived national crises that were potentially lethal to every American and yet the United States is still the envy of the world. As proof simply consider how many others wish to immigrate here every year (8 million visa granted in 2019). As a nation, we fought off Nazi Germany, Imperial Japan and Fascist Italy in World War II in battles that claimed more than 60 million lives worldwide. We were totally unprepared for that war, but when Japan attacked Pearl Harbor we attacked back. The U.S. military was able to carry on an all-out war in both the Pacific and Atlantic Ocean as well as in Africa and later the European continent. Less than five years later we had beaten Japan, Germany and Italy to the point that they all surrendered unconditionally to the U.S. A and our allies. How did we do that amazing feat? We pulled together and realized that though we had our differences we’re still all Americans and have a stake in preserving our nation and all that it stands for.

Secondly, we need to take one day at a time and perhaps even one minute at a time. This is often referred to as “Mindfulness” training. It simply means quit worrying about things over which we have very little control and focus where you do have control…meaning what can we do right now? Fundamental to being able to limit our scope of awareness is the ability to self soothe. This means taking the time out periodically in our day to take a few minutes to breathe deeply and remind ourselves that we are doing fine at the moment. Sounds silly that we should want to reassure ourselves of our worth and well-being but it works well and is the foundation of prayer and meditative practices.

Thirdly, it is important to get some sort of physical release from tension. The book entitled “Younger Next Year” by Crowley and Lodge suggest that we can enhance and lengthen our lives by exercising an hour a day has good research support. However, if we don’t have that much time or energy we can all at least take a walk outside (or on a treadmill) in addition to taking up yoga, Pilates, or simple calisthenics. Whenever we physically exert ourselves we literally drain off the tension in our bodies that accumulates during the day.

Fourth, stay focused on achieving short term goals and reward yourself with at least acknowledging that we have accomplished something worthwhile. When I have managed to work on my website (a never ending chore) I acknowledge that I spent an hour on it whether I accomplished all I wanted to or not. There is some important satisfaction on achieving something by spending time on the project even if it isn’t perfect. Having a Fitbit on my wrist has given me some built in goals each day that has allowed me to lose 20 pounds over the past two years by having simple goals and getting feedback each day on my efforts to meet those goals. Over time nothing is more encouraging than meeting a goal and then the excitement of setting up a new goal.

Note: always a good idea to make goals small and achievable so that we aren’t discouraged and give up. Part of setting goals is daring to dream for the future and be specific about what you want to have happen. This is an essential skill that it taught in therapy.

Most clients come to therapy because they have focused almost exclusively on what they did not want to have happen and then spent most of their energy worrying about when this awful future will arrive.

It is much more healthy, and courageous, to dare to dream about a specific set of circumstances that we want for ourselves in the future and then break down the individual steps to make it happen and bring that future into existence. It is especially helpful if we have a faith and relationship with God and that we feel we deserve to be happy, healthy and capable of the pursuit of happiness.

Finally, there is always the option to obtain professional help. At this time in our history that professional help can be easily obtained over the internet via our computer using a variety of platforms (i.e. ZOOM, Doxy.me, Vsee, and Spruce to name a few) and with a variety of health professionals (i.e. psychologists, psychiatrists, social workers, counselors, Nurse Practitioners, physicians, and P.A.s). Telehealth provides the comfort of getting professional help and we never have to leave our homes or our loved ones. It has been proven to be as helpful as face to face contact and infinitely safer in terms of COVID-19. Hopefully this short review will be of help to all of us and we strive to not just survive but also thrive in this challenging time.

 

Michael Murrell Psy. D.

www.murrellpsychologicalservice.com

July 22, 2020

 

 

Simple Techniques for Reducing Anxiety

Posted on September 21, 2019 at 2:22 PM Comments comments (100)
I am often asked by new clients, "What is the best way to deal with anxiety?" My answer is always the same.  "If you study your thoughts and learn to change what you think about then you will solve your problems with anxiety".  I believe that is quite doable if the client is willing to learn to observe their thoughts for a time and become familiar with their own thinking patterns.  Only after becoming familiar with these patterns can they effectively begin to change them.  It comes down to this simple statement: Change your thoughts and that will change your emotions.

Certainly emotions are influenced by other things (ie. hormones and genetics), but most of the time emotions are responding to our thoughts. If we are pessimistic, cynical, and negative then we will view the world as threatening or unfriendly.  The result will be that we experience negative emotions such as anxiety, depression, anger, hate, even hopelessness and despair.  It is a clear response to our thoughts or perceptions and though the emotions that result may be powerful it doesn't mean that they can't be redirected if we first learn to redirect out thoughts.

There are two suggestions that I make to new clients. First is to do some reading on the subject of anxiety.  It was Sir Frances Bacon in 1597 who said, "Knowledge is indeed Power".  In other words, even a small amount of knowledge can be a huge advantage in solving the problem of controlling a client's anxiety.  So I ask clients to dedicate at least one hour a week to reading and practicing the exercises in the book that I heartily recommend on this topic.
It is entitled "The Anxiety and Phobia Workbook" by Edmund Bourne, Ph.D.  It has over 20 coping skills that it details and it goes into great detail explaining the importance of developing these skills to gain control over anxiety.  Not all of the skills he outlines work for everyone; but is important to try each one out to find the ones that do work for each client.  These become the topics for our discussions as I coach clients in how to best develop coping skills to reduce and then eliminate anxiety.

The second suggestion that I make to new clients is to learn the technique called Autogenics Relaxation Training.  It is a technique that elicits our naturally occurring Relaxation Response.  This is the exact opposite of the "Fight or Flight Response" (you can read about that in one of my other Blogs).  The Relaxation Response naturally calms clients down and sometimes even makes them feel comfortably drowsy.  It is a very slow response and requires some work to consistently get this response to activate in a predictable manner.  Like all good habits it takes at least 4-6 weeks to be ingrained as an effective coping skill.

Here's how it works.  First of all, it is necessary to become familiar with Abdominal Breathing.  Now, of course you have been breathing all your life (duh); however, this is a special type of breathing that requires you spend some time being mindful of how you breathe.  Mindful breathing simply means feeling your breathe go through your nose, sinuses, throat, chest and then deep into the vary bottom of your lungs.  It needs to be slow, gentle, and deep.  Try this for about a minute and you will begin to feel your body change ever so slightly to becoming more relaxed, or pleasantly warmer, or pleasantly feeling heavier or even pleasantly lighter.  Practice this several time a day so that you are more aware of your breathing and making the changes so that it becomes normal to do Abdominal Breathing.  This is something that you can work on long term, but for today just get the idea that this is the first thing to do in this little exercise.  The next thing I would like you to do is read the script below out loud to yourself when you are alone and won't be disturbed for 10 minutes or longer. By all means don't try this when you are driving or in a position when you have to be able to quickly respond to an event that requires your full attention (ie. babysitting, watching your TV or cell phone). You may eventually want to use this script to make a tape recording to play back to yourself so that you can do this exercise with your eyes closed for maximum effect. The use of this Augenic Script will seem silly at first and maybe even boring.  That's OK.  The purpose is to give you something to think about that is not going to cause you anxiety and may even feel nurturing and comforting to you.  The phrases are directed to your unconscious mind and may simply bore your conscious mind.  Here's the script.  When speaking the words imagine that you are talking to a child or someone who is very sensitive so that your words are soft and convey a sense of nurturing and encouragement.

My scalp is calm and relaxed.
My scalp is calm and relaxed.
My scalp is calm and relaxed.

My forehead is calm and relaxed.
My forehead is calm and relaxed.
My forehead is calm and relaxed.

My eyes are calm and relaxed.
My eyes are calm and relaxed.
My eyes are calm and relaxed.


My jaws are calm and relaxed.
My jaws are calm and relaxed.
My jaws are calm and relaxed.

My throat is calm and relaxed.
My throat is calm and relaxed.
My throat is calm and relaxed.

My neck is calm and relaxed.
My neck is calm and relaxed.
My neck is calm and relaxed.

My shoulders are calm and relaxed.
My shoulders are calm and relaxed.
My shoulders are calm and relaxed.

My spine from my head to my tail bone is calm and relaxed.
My spine from my head to my tail bone is calm and relaxed.
My spine from my head to my tail bone is calm and relaxed.

My heartbeat is calm and relaxed.
My heartbeat is calm and relaxed.
My heartbeat is calm and relaxed.

My lungs breathe easily and deeply.
My lungs breathe easily and deeply.
My lungs breathe easily and deeply.

My abdomen is calm and relaxed.
My abdomen is calm and relaxed.
My abdomen is calm and relaxed.

My right arm from my shoulder to my fingers is calm and relaxed.
My right arm from my shoulder to my fingers is calm and relaxed.
My right arm from my shoulder to my fingers is calm and relaxed.

My left arm from my shoulder to my fingers is calm and relaxed.
My left arm from my shoulder to my fingers is calm and relaxed.
My left arm from my shoulder to my fingers is calm and relaxed.

My right leg from my hip to my toes is calm and relaxed.
My right leg from my hip to my toes is calm and relaxed.
My right leg from my hip to my toes is calm and relaxed.

My left leg from my hip to my toes is calm and relaxed.
My left leg from my hip to my toes is calm and relaxed.
My left leg from my hip to my toes is calm and relaxed.

In the center of my being I am calm and relaxed.
In the center of my being I am calm and relaxed.
In the center of my being I am calm and relaxed.

In my Heart and Soul I feel the warmth of God's Love for me.
In my Heart and Soul I feel the warmth of God's Love for me.
In my Heart and Soul I feel the warmth of God's Love for me.

I accept and love my Self just as I am right now.
I accept and love my Self just as I am right now.
I accept and love my Self just as I am right now.

And so it is becoming more and more true as I repeat these words.
And so it is becoming more and more true as I repeat these words.
And so it is becoming more and more true as I repeat these words.

This is the end of the exercise.  It will not initially feel as powerful as it does later after you have practiced it at least twice a day for a week.  Like anything else "Practice makes Perfect" and you will become infinitely more effective initiating the Relaxation Response the more you practice it.  Incidentally this exercise works well as a Night time Meditation to use before bedtime or in the middle of the night should you awaken.

Let me know what you think of this by writing me at [email protected]  Enjoy!









Improving you chances of a good outcome with your first Therapist.

Posted on January 13, 2018 at 3:27 PM Comments comments (330)
I am often asked by friends and acquaintances how they should go about finding a mental health professional to work with that will be helpful to them.  The following is a list of suggestions that in my opinion greatly improve the probability of a successful outcome so you get the help you need.

1.  You may choose to work with a variety of different types of therapists that can be of service if you are experiencing emotional distress.  You may wish to find a Life Coach on your own who specializes in whatever area you have a need.  There are Life Coaches who will help you with weight loss , or overcoming grief, or simply making the transition to retirement.  Many of these folks have some formal training and perhaps a related life experience and may do be very helpful.  One drawback in working with a Life Coach is that they are not as well educated, licensed, or held accountable as those mental health professionals who have gone through a formal graduate school for several years, been subjected to rigorous academic training, and often studied as an intern under a professional mentor for several years before taking their state licensure examination which is generally very rigorous and requires an excellent knowledge of the field one is about to be licensed in.  It is my strong suggestion that you choose to work with a licensed professional social worker, counselor, psychologist, or psychiatrist.  These licensed professionals are in most cases imminently well qualified to provide help in their areas of specialization.  You can verify their academic qualifications by contacting the Missouri State Licensure board and check to see if they are in good standing because of their academic training as well as checking to see if there have ever been any complaints against them filed with the state.
2.  Your therapist needs to have specific training and experience in the area of your need.  For example there are therapists who work strictly with children and many have certifications in "play therapy" that gives them tremendous skills in communicating with and treating children who may not be capable of talking coherently about their issues.  Like wise there are psychologists who specialize in working in court on Forensic cases and spend time testifying in court after they have done a great deal of study and evaluation of their client.
3.  It is usually best to find a therapist who has themselves had some personal issues that are similar to your own that they have overcome.  For example, it is widely known that recovering alcoholics with a long history of sobriety make very good drug and alcohol counselors because they have fought that battle for sobriety and have great empathy as well as insights as to what really works.  Likewise psychologists like myself, who has battled and overcome anxiety issues, are well suited to work with clients with similar issues because the empathy and compassion that the psychologists feel comes from their own painful experiences and the development of their own coping skills out of their trial and error find things that worked well for them.
4. Your therapist needs to have some sort of accessible reviews available to you from their past client's experience with them.  There are a number of online services that review healthcare professionals.  One of the better known ones is www.healthgrades.com.
5. Your therapist should have a good bedside manner. That means that they can  tell you the truth in a way that does not offend or terrify you to the point that you cannot act on the information in a constructive manner.  A good principle is to find a therapist that is honest and yet very kind and careful in the manner that they say things that are important to your learning.
6. Your therapist should explain how "confidentiality works" and your rights as a client under the H.I.P.P.A. laws so that none of your personal information can  be exposed to your physician, family, or the public 
without your written consent.
7. You therapist needs to explain to you that they do have the responsibility as a "mandated reporter" to report to authorities any statement that you make that would indicate that you intend to hurt yourself, another adult, a child, or an elderly person.  If you make such a statement to your therapist expect that they will have to alert authorities that you have become a potential danger to yourself or others.
8. Your therapist needs to focus on what specifically you want to accomplish in therapy.  If for example you are having  five panic or anxiety attacks a week and you want to dramatically reduce these to only one or none per week be sure to state that as a goal.  The more clearly your stated intention or goal is worded the better the therapist can help you reach your goals.
9. Your therapist needs to take a thorough history of your past including your childhood and your family of origin in addition to those successes and challenges you have had as an adult.  It is very helpful to fill out an inventory of your symptoms, how long you have had them, and then do some objective testing to establish a diagnosis.  Just as you do with a physician on your first couple of visits your therapist needs to establish a baseline of information in getting to know what is normal behavior for you and what specifically you want to change.
10. Working with a therapist is a "team effort" in that both of you will need to work hard to communicate with each other and work together to find what coping skills work best for you.  In truth it is a matter of trial and error.  Your therapist may know 50 coping skills to help you solve your problem but you will have to work together to see which ones fit your needs best and are the most effective for you.  One size does not fit all clients.
11. You will want to have a therapist that you feel cares about you and one that you can trust.  You need to feel free to ask any question that comes to mind (there are no stupid questions) and you need to feel that you can identify with your therapist in some significant manner (perhaps you are about the same age, the same sex, similar socioeconomic lifestyles have lived in the same area, have similar recreational interests etc).
12. Therapists are not god like in any manner.  They don't profess to know everything about you or exactly what you need to do to overcome your issues.  However, they should be skilled in working with you to help you find out what works best for you.  As a result they will probably ask you to do quite a bit of reading and work outside the client session.  This may include keeping a journal, reading a specific book or workbook, or having very specific homework assignments.  There will be moments of joy at having overcome a long standing bad habit but there may also be moments when you feel frustrated and want to quit therapy altogether.  It may be one of the hardest things that you try to do in your life but when you are done most clients look back and thank their therapists for sticking with them and encouraging them to find the answers that they were sinking by pushing themselves past their fears and trying some totally different approaches to their problems.
13.  Certainly feel free to talk to your therapist if you think that they are pushing you too hard and making too many demands on you to perform in the therapy session when you really just need to come in and dump all your frustrations on a kind and compassionate listener.  There are times in therapy to push as a client and their are times in therapy where you simply need a "safe place" to unload the emotional pain of our life.  It is very important that you discuss this topic with your therapist so that both of you can pace the intensity of the work in therapy so it compliments but does not complicate the rest of your life outside of the 50 minutes you talk with your therapist.
14.  Lastly, if you have been to a therapist for six sessions and don't feel that you are making any progress ask for a referral to another therapist.  Conversely if you have been seeing a therapist for several years and you are hearing the same old thing from your well known therapist you may also need to ask to be referred to another therapist simply because you may have exhausted all the information that that particular therapist has to offer.
15.  I hope that this has been of interest to you.  If you have more questions please email me at [email protected] or call the office at 417-881-1580.

Srategic Self-Hypnosis: The Past aids the Present

Posted on October 3, 2014 at 12:10 PM Comments comments (175)
One of the first things that I found as a psychologist who specializes in working with anxiety clients was that they focused on the most negative moments in their lives and obsessed about them.  I don't in any way mean this in a judgmental fashion because I have been in outpatient therapy myself for anxiety on several occasions.  My point is that it seems that a significant portion of the client's lives were spent thinking negatively about themselves, other people, or the expectations of the future.  As I have written about before, I believe strongly that our thoughts control, for the most part, our emotions and negative thinking inevitably leads to negative emotions.  Part of my initial interview with a client is to give them a homework assignment to thoughtfully make a list of their 8 best moments and their 8 worst moments.  I ask them to write a paragraph about each moment with details of what happened to make it so memorable.  I ask that they include their thoughts, emotions, sensory experiences (ie. images, sounds, smells) and all the important details that come to mind. 

In our next meeting I may ask them to go over the worst moments in some detail.  I should add that going over the worst moments may be too painful for some clients with severe anxiety disorders and so I sometimes delay this topic with them until a few sessions later.  Doing this exercise allows the client to quickly communicate to me the nature of the events that have shaped their manner of thinking and often it is immediately evident that they have a negative thinking pattern because of the traumatic or painful events of their past.  This is particularly evident for those clients who have abusive childhoods and early on in life begin to believe that they are in some way flawed, inadequate, unlovable or undeserving of success.  As we discuss the worst moments list I can observe their emotional experience and tell pretty quickly if they have "worked through" the emotional material or if they are still "stuck" in thinking about it.  If they are tearfully talking about it then I know we need to address it sometime in the therapy process.

During the second meeting I make a point to discuss their best moments list and spend a greater amount of time focusing on their positive experiences in their lives.  It is amazing how a person with anxiety seems to forget that they have been a success at anything in life.  Severely anxious clients seem to have dismissed any moments in their past which involved personal success in goals that they accomplished (and often only fleetingly enjoyed) or in the moments of their past when they felt a deep peace or sense of well-being.

Before I end the second session I will ask them if they would like to learn a simple technique that will give them immediate relief from anxiety.  Stupid question right?  They came for exactly that purpose, but it is important to give the client a sense of control so I never try something new in therapy without asking permission.  So we begin Strategic Self-Hypnosis training by having them place one hand on their stomach and the other on their chest.  I ask them to breathe deeply moving the hand on their stomach so they begin to do yogic or abdominal breathing for 12 breaths. While they are deeply breathing I ask them to just notice the movement of air into their nose, sinuses, chest and lungs.  As they focus on the movement of air I ask them to notice whether they are beginning to feel warmer, lighter, heavier, or just sleepy.  My suggesting that they will feel one of these four sensations is the hypnotic suggestion that they will then do outside of the therapy sessions on their own.

Clients will almost always smile during this exercise and note that they are feeling more comfortable in just a few breaths.  I then ask them to use their imagination to visualize a door of any size, shape, design, or texture that they like and to see on the door the words "Best Moments".  As they are becoming accustomed to visualizing the door I then ask them to imagine opening the door on one of their best moments and feeling themselves back in that situation that they are remembering.  I ask them to continue to deep breathe and to stay with the image deepening and making it more vivid with each breathe.  After perhaps five minutes I ask them to open their eyes and to right down what they experienced.  In the majority of cases, the clients reported a substantial reduction in anxiety and muscle tension in the very first trail of Strategic Self-Hypnosis.  This simple experience has been the first step for many of my clients in developing their own custom set of coping skills that they employ on a daily basis to overcome anxiety by simply changing the way they are breathing and the content of what they are thinking about.  You may want to try this at home, not while driving of course, and see what kind of results you have in changing your emotions and the sensations of your body.

Understanding Depression and it's Treatment Video

Posted on December 9, 2013 at 7:47 PM Comments comments (436)
As you may or may not know we have a big problem with depression in this country.  It has been estimated that on any given time there is between 10%-20% of the total U.S. population is suffering from some form of depression or another.  Here is a video that summarizes some of the basic characteristics of Major Depressive Disorder.  I hope this cartoon gives you some insight as to the symptoms and treatment of this disorder.  The most important take home message is to be aware that if you have these symptoms you may need to have a check up from your health care professional.  Usually your primary care physician can give you a short paper and pen test that will screen you for depression.  Unfortunately depression often increases for many people during the holidays.
Merry Christmas to all of you.  
Blessings, Michael Murrell, Psy.D.

Very Sensitive People are often Clients

Posted on November 22, 2013 at 1:24 PM Comments comments (179)
For quite some time I have been aware that many of my clients all had something in common that lay well outside of what was a conventional diagnosis of anxiety or depression.  Many of them were deeply emotional people who had an exquisitely high level of sensitivity not just to stressful situations but also to other people's sufferings, to music, art, and literature. In fact, a number of them were in fact artists, writers, and musicians who used their extraordinary sensitivity to not just appreciate the beauties of the world around them but to add their own contribution to the milieu they so much enjoyed.  Several of my clients have written books of poetry, fiction, and one worked as a videojournalist who traveled the world making documentaries.  The problems these clients all encountered was that they were basically introverts trying to adapt to an extraverted world.  The terms introvert and extravert were originated by Dr. Carl Jung, a famous Swiss psychologist who wrote extensively about these differences in personality in the early part of the 20th Century.  In 1921 he wrote the book, Psychological Types, in which he developed his ideas about the basic types of personality that he found to be common to populations all over the world. Those of you who have taken the modern psychological test known as the Myers-Briggs Inventor are familiar with his thinking and perhaps are acquainted with your own inherent personality tendencies along the introvert-extravert continuum.  Dr Jung believed that one third to one half of all peoples were introverts.  By this he meant that they were somewhat reserved, often thought long and hard before speaking, and tended to need a significant amount of "alone time" in order to recharge their psychological batteries.  This did not mean that they were anti-social but rather they needed more time away from people (crowds were particularly draining for them) and time spent doing things they enjoyed alone or with a very small group of friends.  Many famous people have been known to be introverts: Albert Einstein, Eleanor Roosevelt, Bill Gates, and Jung himself.  What makes this an issue in therapy is that in American society we do not, as a culture, value introversion.  On the contrary we much more prefer to value extraverts and their aggressive drive to dominate, interact, get things done, and their fun loving "can do" attitude which is in the heart of every T.V. commercial and magazine ad.  Our cultural icons in business, sports, and celebrities in general tend to be extraverts.  On the other hand, the people who often make the greatest contributions to the long term good to our society are the introverts.
 
It is not that either the introvert or the extravert is all good or all bad; it is just that the  introvert in our society is not particularly valued.  This is particularly a problem in the public school system in which introverts, however smart they may be, are often the target of bullies and much more aggressive children.  Unfortunately this difference among school children can leave scars on the introvert because they are viewed as unathlectic, unpopular, and nerds. Interestingly introverts are often drawn to extraverts for marriage because, just as Ying and Yang, each offers the other person some different perspectives and strengths. This makes for many fascinating conversations but can also lead toproblems in the relationship.  Family and relationship counseling is often needed to help build a bridge of understanding betwee the introvert and extravert when they form an intimate partnership.  For more information about my work with highly sensitive people, who make up most of my practice, I recommend a couple of excellent books.  The first is "The Highly Sensitive Person: How to Thrive When the World Overwhelms You" by Elaine N. Aron, Ph. D.   The second book is "Quiet" written by Susan Cain, J.D.   In "Quiet" the author, on page 13 offers some interesting questions that allow the reader to make a judgment as to how frequently they think as an introvert.  Some of the questions have to do with issues like: how much do you try to avoid conflict, how often do you spend with a very close cirlce of friends,  do you tend to favor listening or talking, do you like to do work that allows you to dive in so there are few outside interruptions or distraction, do you often feel drained by interactions with other people, and do you often let the phone calls go through to voicemail?  Both of these books are written to those people like myself who are basically introverts but must live in a society that doesn't necessarily value or understand quiet, sensitive people. Much of my work centers around helping my client determine what is their personality type, what specific issues they want to work on, and then providing training in the appropriate coping skills.  Many times it is simply a matter of teaching someone who is an introvert to take time out for themselves without feeling guilty and to stop trying to be something they are not genetically wired to be.  Self-acceptance and self-esteem development go hand in hand in providing a solid platform to do mindfulness training, relaxation training, biofeedback, and E.M.D.R. therapy.  All of these approaches teach the introvert to value their rich inner world and to create a boundary with the outer world that tey often find rude, loud, and insensitive.  Our clinic offers coaching via phone and e-mail for those individuals who are not geographically able to access our services in person.

The Two Most Important Elements in Counseling

Posted on July 5, 2013 at 11:35 AM Comments comments (535)
Much has been written about counseling, coaching, and psychotherapy.  For someone seeking help from a professional the quest to find the right person who is a good fit can be confusing and frustrating.  Most clients have health insurance and they may search a long list of psychologists in vain because they all seem to be offering essentially the same service.  So what makes the difference? What makes counseling with psychologist A a better experience that psychologist B?  The answer based on many research studies may be surprising.  It is not technique, nor it is price, nor is it the degrees that the psychologist holds. Simply stated it is the trust that is established between the psychologist and their client and the strong hope that their problem can therefore be solved.
 
Let me also qualify the above statement by quickly adding that there are many coping skills (ie. journaling, progressive relaxation, EMDR, cognitive behavioral therapy, support groups) that add to the quality of the counseling experience and hasten recovery, or perhaps discovery, of the empowered true self.  Many of these coping skills are found in self-help books.  However, many of my clients have read many self-help books but never been able to accomplish lasting change until they started working with a psychologist who would help them hold themselves accountable for maintaining their new habits of thinking and feeling.
 
For many clients seeking treatment they come because something or someone in their lives has caused them to lose trust.  It may be that they no longer trust other people in general.  It may be they no longer understand or trust themselves.  It may be that they don't trust anyone or anything and are hopeless that anyone can help them..  In the later case, these clients are often in a more desperate psychological condition and may become very withdrawn from others.  The later group is more likely to become an addict and suffer from hopelessness that could lead to suicide.
 
I often tell clients when they enter counseling that I may not be a good "fit" for them and that I am more than willing to refer them to another professional that they would be more comfortable with than myself.  The two most important elements for the client is that they first of all feel as comfortable as possible sitting and talking with their potential psychologist.  Secondly at the end of the first meeting they must also have come to the belief that what they are suffering with is "treatable" and can be cured.  If these two things do not happen after the first session or two then it's time to go shopping again and interview another psychologist.
 
Why is trust so important? Why has it be demonstrated over and over again in clinical studies as the most important element in healing and recovery from a mental disorder?  It is because the client must have developed the confidence in their psychologist that they can tell them anything at all, no matter how embarrassing, and that they will not be judged harshly but rather they will be understood and accepted as a fellow human being quite capable of error (aren't well all?).  This confidence that  the client is totally and completely accepted is absolutely essential for a full recovery from anxiety, depression, trauma, or relationship issues.  It really doesn't matter what the diagnosis, it is still the trust level between the psychologist and client, and the client's ability to hold onto hope, that significantly determines the success or failure of the course of treatment.
 
For many clients, having established this trust may take a great deal of time and some testing of the psychologist to check to see if they in fact can be trusted with the most intimate details of their lives.  In point of fact, much of what is discussed in the later conversations between psychologist and client will be personal information that the client has never dared discuss with anyone else!  They have generally not confided their deepest secrets, doubts, and misgivings with anyone because of their fear of being judged and rejected.  It is for this reason that it is impossible to judge how quickly counseling can resolve certain deep seated personal problems.  This past week, I had a new client ask me, "How long with it take for EMDR to fix my trauma so I can be my old self?" I smiled and said kindly, "That is entirely dependent on you and your ability to eventually trust me."   She laughed and admitted, "I don't trust anybody so it may take awhile."  Then we both laughed and that led to a good discussion of the topic that we are discussing in this blog.
 
Trust is not easily given to another person; this is particularly true if those people close to the client have proved to be unreliable or even abusive.  For the psychologist, I can tell you that it is a great honor to be sitting with someone and have them trust you with their deepest secrets and most embarrassing moments and to see them look over at you and find that you are giving them support and not condemnation.  My profession is deeply satisfying, not just because I am able to help people overcome their fears and develop a truly satisfying life; but it is doubly satisfying because I am trusted by others who feel safe enough to discuss and resolve problems that may have plagued them for years.  In some cases, one client who is in her 80s, for literally six decades of her life had never discussed how miserable her childhood was with an overbearing mother and an alcoholic father.  She had been in three miserable marriages because, in part, she had held that same view of herself as her abusive mother had repeated told her, "You don't deserve to be happy!"   It was only when she was able to discuss this long held belief adopted at a very impressionable age that she could recognize how her unconscious perception of herself had kept her in unsatisfactory relationships for all of her life.  It took a great deal of courage on her part, and patience on my part, for her to disclose and then change her deeply held self-perception.  When she realized that she could now, as an adult, quite simply change that negative self-definition (she had plenty of accomplishments to refute that false view of herself) then she broke down crying (actually a shed a few tears with her) because after six decades she was at last free.  She was free to define herself realistically as  worthy and empowered woman who could now make choices to fill her remaining years with joy.  She is choosing activities and interests that keep her challenged and gratified in ways she had never experienced before.  Why?  In part, because she found the courage to trust and hope for her own recovery.  I can tell you that it is very gratifying to see someone make these changes and to rejoice with them when they come to find their own power to create a life that they choose and reject a life based on the mistaken beliefs about themselves that they unwittingly incorporate from the negative figures who influenced their thinking in childhood.  Do I love my job?  Absolutely.

Understanding our "Fight or Flight Response" of our Limbic System

Posted on March 9, 2013 at 9:36 AM Comments comments (846)
Many of you have asked me to explain in more detail why we have anxiety issues and in furthering our understanding what are the basic strategies for controlling anxiety.  The most important element in controlling anxiety is to have a firm grasp of the physiology involved in the anxiety reaction that is often referred to in popular literature as "the fight or flight response".  I will give you a broad understanding of this important but very primitive reaction that we all possess by directing your attention to a specialized part of the brain known as the limbic system (it is the area colored in red in the illustration below).  The limbic system is a part of the brain that lies in the middle of our head a few inches behind our forehead.  It is composed of a number of smaller organs that together act as an alarm system that monitors anything outside our body that may pose a threat to us. 
 
Our five sense organs are highly attuned to anything that looks like, smells like, sounds like, tastes like, or tactilely feels threatening to us.  For that reason we involuntarily respond, even as infants, to loud noises or being suddenly dropped. The limbic system has a very powerful reaction our sense of being threatened.  If we feel that we are in danger, of any kind, the limbic system sounds the alarm and our body is immediately put on high alert.  It is the equivalent of a car alarm going off in a parking lot.  If someone tries to break into the car the alarm detects the attempted entry and sets off the car's lights and the horn starts beeping until the owner comes to investigate the situation.
Brain limbicsystem is important to undersand for clients if they are to be able to control their emotional reactions to stressful situations.We are physically prepared to "fight or flight" and we instantly have an enormous amount of energy available to us to either run away from danger, attack it head on, or if we don't know what to do to "freeze" and hope it goes away.  If you are familiar with the animal kingdom you see what happens when their respective limbic systems respond.  You may notice that predators (ie. lions, tigers, bears) all naturally go to the "fight" response.  Their prey on the other hand may go to the "flight" response (ie. deer) or "freeze" response (ie. rabbits). If you were to hook up the medical equipment to each of these animals you would find that all of them have the same kind of physiological activity that we experience as humans when we feel anxiety.  That is, our hearts begin to race, our breathing becomes shallow and rapid, our muscles all tense, we become easily startled and feel extremely tense to the point that all we can think about is how to resolve the perceived threat and find a safe place to calm down.
 
Our central nervous system goes on high alert (psychologists call this state "hypervigilance") and our endocrine system opens the flood gates of a number of powerful biochemicals, such as adrenaline and cortisol, that cause our hearts to race and muscles to suddenly tense. 
 
As we grow older our limbic system encounters other situations that it adds to the list of "dangerous or threatening" events.  This may include being punished for wrong doing by a swat on the bottom or being beaten up by the neighborhood bully on the playground at school.  Whatever the event may be, the limbic system adds that information to an emerging data base that remains in our unconscious mind for the rest of our lives.  As we continue to experience life we add new experiences, and new information, to the limbic data base of threatening situations.  This may include failures in taking an academic test or being rejected by our first attempts at romantic love.  Note here that the threat may not be a physical threat but rather a threat to our sense of well-being or our feeling that we are accepted and loved by others.
 
As we age we gather more and more data into the Limbic System information storage (which remains in our unconscious mind but instantly available).  The limbic system therefore begins to have a large number of situations that cause the "fight or flight" response.  This may include anxiety about taking tests, meeting new people, public speaking, taking elevators, being on high places, or spending time alone.  Notice that none of the list of situations listed above involve actual physical threat even though the limbic system response is a physiological one.  In other words, the limbic system is a "one trick pony".  Meaning that no matter what type of situation it is that we perceive to be threatening (meaning it may be a threat to us socially or psychologically) the limbic system always treats any perceived threat as if it were a potential physical threat to our very survival.  For this reason we over react to many things in our lives simply because this primitive part of our brain has encoded some aspect of the situation as being related to a past incident that caused us some level of emotional if not physical pain.
 
As a result we get a large number of "false positives" in our daily lives.  That is we react to things that may or may not be at all threatening as if they were in fact life threatening.  It like having a car alarm that goes off every time someone may bump the side of your car in a parking lot with their car door or a shopping cart.  The car alarm misinterprets this as if someone is trying to break into and steal your car.  In other words, it over reacts in much the same way our own limbic system does.  In both cases the car alarm and your limbic system are taking no chances; they will try to protect you even though they are over reacting in the extreme.
 
The net result can be that you become afraid of so many things that are encoded in your unconscious limbic system data base that you feel anxiety so much that you are afraid to live. The limbic system is so very sensitive that it only requires an image of something threatening to get a "fight or flight" response.  For example, if you are watching a movie and there is violence you may notice that your limbic system has misinterpreted the images on the screen to be categorized as a threat.  When you are deeply involved in a movie, novel, television, video game, radio program, or even a conversation your limbic system is busy examining the content of the thoughts and images presented for any indication of threat. It is not just the external images of something threatening but even our own thoughts that can be the triggers of the "fight or flight" response.  For this reason we can wake up with nightmares when our unconscious mind is replaying a scary movie or perhaps a scary event in our own life.
 
Producers of drama know exactly how to push the triggers of the limbic system so that we get the partial arousal of the "fight or flight" response so that we experience it as stimulation. Consider your favorite adventure movie and remember what you like the best. If it the chase scene?  Chase scenes alert our limbic systems when we identify with the person being pursued and we experience some heightened alertness as we feel ourselves tense up. We may have that same rush of adrenaline when we voluntarily participate in sports involving some risk.  I think one of my exciting experiences is when I get to go snow skiing at night in the Rockies.  I feel the adrenaline rush when I am zooming down slopes at high speed sensing the danger but loving the intense feeling of being alive in a beautiful mountain night.  It is deeply satisfying to experience the beauty of the mountain, the risk of skiing at high speed, the feeling of controlled falling, and the pleasure of accomplishing something of an adventure. The difference between excitement of skiing and the unpleasant feeling that comes with being stressed out or anxious is one important element: the feeling of being in control.  Scientists have studied what determines the difference between what is exciting or thrilling and what feels dangerous is the feeling of being in control of the situation.  This is most obvious when you interview someone who enjoys a particular sport (skiing in this case) and then interviewing someone who is scared to death to attempt such a sport.
 
On the one hand life involves risk.  However, choosing the risk and overcoming the challenges that it entails is one of the great satisfactions in a life well lived.  The truth is we need to challenge ourselves to feel life more deeply.  It is not unlike what occurs when you practice weight lifting.  Lifting weights actually makes microscopic tears in the muscle fibers.  However, the muscles quickly rebuild themselves and after a couple of days rest the body has repaired them so they are stronger than they were before you weight lifted.  The repaired, and stronger muscle, is then subjected to weight lifting again and the process is repeated so that after several months the muscles are much stronger than they were prior to the practice of regular weight training. In the same manner our mind is built to need a certain amount of challenge, or stress, in order to function at it's optimum.  To totally avoid the stress of triggering the "fight or flight" system would be to live a very safe but ultimately boring existence and to rob yourself of the satisfaction of overcoming your fears.
 
As Emerson once said, "Life is an experiment.  The more you experiment the more you learn. So the more experiments you do the fuller your life."   If you view each risk you take to try to overcome your fears as an experiment,  then journal about and analyze then your can disconnect the limbic system's natural response to try to overprotect you from death and danger.  Taken to an extreme, your limbic system can keep you from being fully alive.

Understanding Ego State Therapy

Posted on February 2, 2013 at 1:43 PM Comments comments (275)
Ever wonder why you act differently when you are in different situations?  For example, let's suppose that you are at a party with close friends and there is allot of laughter; chances are you will feel free to laugh and tease each other much like you might have done as a child.  If you are in such a friendly nurturing atmosphere you might say, "I'm free to be myself today."  You might find yourself dancing around, making faces, telling jokes and in general having a good time. At the party you might think to yourself, "I feel really happy and excited to be with my friends."
 
Now contrast these emotions and behavior with what you would probably display at a funeral of a family member or close friend.  What is "proper behavior" at a funeral is very different than what would be appropriate normal behavior at a party wouldn't it?  At a funeral you would wear formal clothing, allow your sad feelings to be expressed in your emotional expression and behavior.  At the funeral you might be thinking, "I am so sorry that this happened; I hate that death has taken my friend that I already miss so much."
 
In a third setting, let's say that you are at work, you might find your emotions and behavior entirely different than at the two previously mentioned situations.  If you are at work then you are expected to do what?  Well get to work for one thing.  In other words, start using your mind to solve problems and provide a service to your employer.  If you are in a "white collar job" then you will likely be asked to sit in an office and solve problems for your employer.  If you are in a "blue collar job" then you may be asked to do more physical work.  In either case your work setting will expect a focused rational and disciplined effort on your part that engages a very different part of your personality than you would be expressing at a party or funeral. At work you may be thinking, "I've really got to stay focused on this task in order to make this deadline on time.  I'm feeling very anxious and tired but I've got to push myself to get this job done."   Notice how different your emotions and behaviors are in these three settings. 
 
What we have just discussed is that you are capable of acting in three completely different ways as you adapt to the various expectations of three different situations.  Had you been the patient of Freud he would have explained to you that you were engaging different sub-personalities or ego states.  The first ego state, at a party setting, would be expressing your very positive emotional needs for happiness and companionship. He referred to this ego state as the "Id". That is the part of your personality that is most concerned with expressing feelings openly and seeking pleasurable activities.
 
The second ego state, the one displayed when at a funeral, he would have labeled the "Super-Ego".  This is a part of your personality that you in effect downloaded in childhood from watching adults behavior in serious situations.  It is the sub-personality that contains all of your personal values and beliefs about what is ethical behavior.  It is the part of you most concerned with following the rules.
 
The ego state that you utilize in your work setting Freud called the "ego" or you might think of as your most rational self.  It is the part of you most concerned with making good choices and consequences in your thoughts as well as your behavior.  This is the part of your personality that you develop only after childhood.  You generally do have the developmental capacity to think logically until middle to late adolescence.  This means that until you reach the teen-age years, or perhaps even much later, you are not physically or psychologically developed well enough to make good decisions.
In therapy it is the "ego" sub-personality that the psychologist works with to gain better control of your emotions and behavior.
 
Most of you readers are familiar with the work of Dr. Sigmund Freud who was the founder of Psychoanalysis.  Although he died long ago, in 1939 at age 83, his influence was felt for many decades after he published his landmark book, "The Interpretation of Dreams" in 1899. He was a brilliant man born in what is now Czechoslavacia and later established his clinic in Vienna, Austria.  Freud's theories about how the mind worked changed the world of mental health treatment treatment. Prior to Freud the predominant psychological theories focused on the study of what was observed to be the ability of the human mind to learn and develop new habit.
 
What Freud described in his writings, and practiced in his therapy, was a novel approach to understanding the human mind.  His view was that all of your thinking was essentially an internal conversation between these three ego states or sub-personalities.  He viewed mental health problems as simply a lack of balance between these three parts: the Id, the Ego, and the Super-Ego.  He viewed the Ego in healthy personalities as being the most important of the three sub-personalities.  A lack of Ego strength in his view led to problems that were manifested in the patient's emotions and behavior.  If the Id was the most powerful of the three then the patient would be very impulsive and "act out" in order to satisfy their need for pleasure.  The Id does not have the rational capacity to understand or care about the consequences of your behavior.  Therefore it can be dangerous to let the Id be the dominant voice in your thoughts.  You may here yourself thinking, "I don't care about what happens later; I just want to do this right now!"  This can obviously lead to significant behavior problems.  When you have an overactive Id have problems with impulse control and often complain being of the negative consequences of their behavior.  When asked why you did something because your Id was in control you might find yourself thinking, or even saying out loud, "I just couldn't help myself."
 
Conversely if your Super-Ego is in control at the moment you will be focused on doing the right thing.  If you tend to be a perfectionist you know this experience well.  You will find it hard to accept anything less than perfection in your performance.  This may be manifested by workaholic behavior or simply the lack of balance between work and play.  If you were a client who are referred to me for anxiety issues you would probably have an overactive Super-Ego that doesn't allow you to ever enjoy relaxing.  You would be tired, depressed and anxious about your behavior if it fell short of your very best effort.  If you are a perfectionist you might hear yourself thinking, "I'm never doing enough. I will just stay at this task until it is perfect."  The problem is if you are a perfectionist you think this way about almost every task in your life.  Everything becomes a challenge that you feel driven to demonstrate and prove your worth by the high quality of your performance.  You would become, what psychologists often call, a "human doing" instead of a "human being."  Learning to just "Be in the Moment" and focus on what is happening in the present is very difficult for perfectionists.  Mindfulness meditation is a very good practice for perfectionists and you can find articles about this on the Internet.
 
The difference between high functioning individuals and those who suffer from anxiety or depression is that the high functioning persons have a balance so that each of the ego states is given appropriate expression.  For this reason journaling or keeping a diary is a good coping skill.  It allows you to read what you are thinking and feeling.  This allows you to see what each of your ego states is contributing to your flow of thought.  I hope this gives you some useful information about understanding yourself.  For more information I recommend the book, Ego States by Drs. Jack & Helen Watkins published by W.W. Norton Books and copyrighted in 1997.  This is a growing field within clinical psychologists who practice E.M.D.R. and the two fields of study are often used simultaneously in psychotherapy.

FEAR: False Evidence Appearing Real

Posted on August 1, 2012 at 8:15 PM Comments comments (1150)
Much of the work with my clients is directed at their understanding of the importance of introspection and thought monitoring.  By this I don't mean that my clients are supposed to withdraw from the world and spend all their time sitting under a tree like Budda without interacting with other people.  But the sad fact is that many of my clients suffer from crippling levels of anxiety and fear about what may happen to them if they "get a life" and move from simply surviving to thriving.  In other words getting back into the stream of life and enjoying doing things that they might have been afraid to do.  Much of their fear and anxiety is based on their past experiences in which they suffered some trauma that they seemingly cannot forget.  This keeps them stuck in what I call an "emotional foxhole" in which they can't get hurt by anyone but they aren't really free to live and enjoy their life.  One of the acronyms that I find helpful is to remind them that much of what they fear may happen in the future is based on events that happened to them in the past that they are no longer in danger of letting happen again.  Many individuals who as children or adolescents suffered from bullying, abuse, or frequent rejection have unconsciously assumed that they will always be bullied, abused, or rejected whenever they move out of their "foxhole".  However the fact is that as adults they have many more skills and experience than they did as children and they don't have to stand for any more abuse.  It is not the reality of their present situation that they are focused on but rather the unreality of feeling that they are still helpless, unassertive, and unsupported that keep them in the "foxhole".  In short, it is their fear that keeps them stuck. However, when  remind them that they can now as adults, walk away, call 911, learn to be assertive or even aggressive if needs be, it may not be possible in the clients mind to overcome their fear.  If you think of the perceptions of childhood or adolescence when most abuse occurred it was at a time when most of us thought only with our emotions and had not developed our logical ability to see things objectively.  It was a time when a part of our brain, the limbic system, was recording all of the events around us that were associated with being threatened (either physically or socially threatened) and this recording stayed with us for life.  So as a result anything that looked like, sounded like, smelled like, tasted like, or felt to the touch like a threat our limbic system reacted to with either flight, fight, or freezing our bodies.  Yet as children we were prisoners of our emotional perceptions and often took things personally that had nothing whatever to do with us. It was much safer for us as children to believe that "there's something wrong with me" than to begin to ponder whether our parents were the real problem.  Even if our parents were alcoholics and incompetent as parents it was dangerous for us as children to question whether our parents knew what they were doing.  We needed to believe that our parents were competent to be parents and that they knew what to do to take care of us.  Unconsciously as children we knew that we weren't developed enough to be able to fully take care of ourselves and become independent.  So we unconsiously made the decision that we would blame ourselves rather than our parents if our family was dysfunctional. It was too scary to think that our parents were incompetent.  For our own peace of mind as children we had to believe that our parents were God-like figures who knew exactly what they were doing.  If we began to question their competence at too young an age we would simply feel more anxious when we then realized how much at risk we were to be in a family run by very abnormal people who masquaraded as competent reliable parents.  So our learned emotional behavior for many children and later as adults was to live in fear.  The sad truth is that many of Americans, clients or not, live in a constant state of fear and are not even aware of it's impact on their emotional as well as physical lives.  So the next time you find yourself afraid in a situation that you intellectually know is an irrational fear from the past just remember this blog and what FEAR really stands for.
 

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