Reframe the Way You Look at Your Life

Marc Elliot was born with no large intestine, 4 feet of small intestines, and has Tourette syndrome.  Yet, he has learned to control the symptoms of his disease and have a great life with the classic Cognitive Therapy techniques of Reframing and Challenging Thoughts.

Bucket List


What is on your
Bucket List?

Everyone needs some type of “Bucket List”.  Long term goals and dreams keep us going…….
Here are some different ones I have found by doing a few searches:

From A TRAVEL blogger:

Visit every continent
Go sailing
Snorkel in the Great Barrier Reef
Go skydiving
Live outside North America
Live in Europe
Become fluent in German
Go mountain climbing
Visit Africa
Walk on the Great Wall of China
Visit the pyramids
Get my masters (currently working on it!)
Go paragliding
Ride a camel
Write a travel memoir
Get a book deal
Be an extra in a movie
Star in an asian pepsi commercial
Go into a jungle
Get a tattoo
Learn to surf
Visit Antarctica
Get married
Bike across a country
Have a beach wedding
Smoke hookah in Egypt
Party in Ibiza, Spain
Visit all of the world wonders
Dance in the rain, under the stars
Go skinny dipping
Eat a chocolate covered insect
Meet a member of the royal family
Learn to snowboard
Kiss a soccer player

What’s on your bucket list?

My Psychiatrist says I have Bipolar Disorder. What do I do now?

iStock_000017908199SmallI had two new patients last week who came in for therapy after being diagnosed by their psychiatrist with Bipolar Disorder.  In each case, the patient wanted to spend most of the session expressing his/her relief, sadness, grief, shock, etc. over hearing those words, “you have Bipolar Disorder.”  I often hear, “so this means that I am really crazy.”  Encouraging the patient to learn as much as possible about the disorder is a key part of the therapy at this stage.

The book I most often recommend to patients struggling with a new diagnosis of bipolar disorder (BPD) is Bipolar Disorder Demystified, by Lana R. Castle.  In her opening chapter Ms Castle identifies the following common myths and misconceptions about mental illness.  Patients often find it is helpful to talk about how these myths affect their ability to cope with their BPD.

  1. There is no good reason for the mentally ill to act so crazy.  They just need to learn some self-control.
  2. We all get depressed from time to time.  Positive thinking should be enough to turn things around.
  3. Lots of people think about suicide at times, but don’t actually attempt it.  Those who say they want to kill themselves are just seeking sympathy.
  4. People with mental illness come from bad families.
  5. The mentally ill are immature and self-absorbed.  They just need to grow up and become responsible.
  6. Talking about problems won’t solve them.  It only makes you dwell on them more.  Instead of yammering endlessly in therapy, these people should take action.

Ms. Castle goes on to list 10 more common misconceptions similar to the ones above.  She further points out that the use of the phrase “the mentally ill” reflects the language people often use when making such statements.  She does not (nor do I) condone the use of the phrases “the mentally ill” or ” the bipolar” or “the schizophrenic” .  We both prefer “a person with a mental illness” or “an individual with bipolar disorder” or “my sister who has schizophrenia.”  These phrases help to emphasize the fact that the person and the illness/disorder are separate.  The illness/disorder does not define the person.  The person learns to live with the illness/disorder.


If you have BPD, or love/know someone who does, think carefully about your assumptions and preconceived notions regarding the disorder.  Talk openly about your feelings related to the above myths.  These discussions are key to the process of dealing with BPD.  Some healthy, important steps in  coping with BPD are: 

  1. understanding the disorder – its symptoms, treatments, and possible causes
  2. grieving the impact the disorder has on you life
  3. committing to making adjustments (including medication and therapy) to make your life a long, happy, and productive one.
  4. Recognizing you may have setbacks, along with your major improvements, as you work through this process.

BPD is a difficult condition to deal with; however, the more knowledge and understanding you have of the condition, the better you will be able to manage your life.  I highly recommend Lana Castle’s book, Bipolar Disorder Demystified.

Therapy for Managing Depression, Anger and Aggression

Classic Cognitive-Behavioral Therapy models are based on the assumption that thoughts(cognitive processes) dictate feelings.  Those feelings then dictate behaviors (or actions).

450px-Fire-lite-bg-10Here is a basic example:
A fire alarm goes off in a hotel at night

Person A thinks:  some kids pulled the alarm and now I am awake!
Person A feelsanger at the kids andannoyance about being awake.

Person B thinks: there must be a fire, I must get out!
Person B feelsfear of being trapped in the fire, worry about how to escape

Person C thinks: I remember when my friends and I liked to pull the fire alarm.
Person C feelsunderstanding of kids having fun and comfortable to go back to sleep.

You CAN control you thoughts, which leads to the ability to have more positive feelings.

Christy Motta, MA summarizes a Cognitive-Behavioral approach to dealing with aggression below:

In the case of aggression, the individual must change the perceptions and beliefs that contribute to increased anger. In order to do this, the individual must: 1. Cope with arousal. The first step is to identify (observe) what is happening. The individual must become aware of when they are angry and notice the physical sensations and thoughts that accompany it.

2. Replace problem thoughts with thoughts that are helpful in dealing with PROVOCATION. “This could be rough, but I can deal with it” “easy does it” “Live and let live” “Stick to the issues. Don’t take it personally.”

3. Modify problem thoughts to those that are helpful in dealing with CONFRONTATION. “keep my cool, walk away, take a time out” “I don’t need to prove myself” “There’s no point in getting mad”

4. Change appraisals and reflections AFTER A CONFRONTATION.

a. Unresolved: “They don’t have to agree” “let it go” “don’t take it personally”
b. Resolved. Label (Describe) what happened. Praise self.

People frequently need some external limits in order to identify their aggression as a problem and begin actively working on modifying their thoughts. Probation, the risk of losing housing and the risk of losing important valued relationships are common consequences that get people thinking about their aggression.

How to YOU choose your therapist?

women smilingOnce you make the decision to pursue counseling, you must then decide WHICH therapist to call.  Many people ask friends or family members for recommendations, others search the internet, and still others use the old-fashioned yellow pages.  No matter how you choose, that first session is your opportunity to see if you have found a therapist who will meet your needs.

Dr. John Grohol, CEO of PsychCentral, writes 
The four most important attributes of a good therapist are:
1. A good therapist is positive and empathetic.
2. A good therapist is professional, courteous, and respectful.
3. A good therapist recognizes her strengths and limitations.
4. A good therapist is genuine.

As you meet and talk with your therapist the first time, look for these characteristics. Here are some suggestions of questions you could ask as you are determining if your therapist has the four key criteria listed above:

  1. How are you licensed? What are your training credentials? Do you belong to any professional groups?
  2. How would you describe your treatment style? Many different treatment styles exist. Different approaches may be more or less appropriate for you depending on your situation and needs.
  3. What kind of evaluation process do you use to recommend a treatment plan?
  4. What are the measurable criteria you use to assess how well treatment is working? Can you give me a few examples?
  5. Do you use published clinical practice guidelines to guide your treatment planning? How?
  6. What psychotherapeutic approaches and tools do you use?
  7. How do you decide which approach is best for the patient? Do you ever use more than one approach? When?
  8. How will you work with other medical providers, such as psychiatrist, who may also provide care?
  9. How often will we meet?  How long will treatment last?  How do I know when treatment is complete?

Think about how well you will be able to relate to the therapist as she answers these questions.  You want to achieve the best possible match in order to have the greatest chance of meeting your goals.

If you would like to ask me any of the above questions, or learn more about my practice.  Please contact me.

Five ways you can help your teen with PEER pressure

How does Peer Pressure affect your teenager?counseling-adolescents

Adolescents often have several groups and layers of friendships.  They may have a couple of close friends, different larger groups of friends with common interests, and friends who come in and out of their lives.  Friendships during the teenage years tend to be fluid and changing over time.  Teens most often choose to spend time with others of the same age and background and select friends from the same ethnicity, gender, and socioeconomic status.

Peer friendships can provide some of the most healthy and happy experiences for a teenager.  Strong peer-to-peer relationships help teens develop important skills of communication and compromise.  In a positive environment, adolescent friendships can be one of the most important developmental experiences in your child’s life.

Unfortunately, situations exist where peer influence and peer pressure can lead a teenager to choose unhealthy and unsafe behaviors.  In these cases, parents want to help guide their child to make positive choices.  Some effective strategies recommended by adolescent development experts Dr. B. Bradford Brown and Dr. Laurence Steinberg are:

1.     Nurture your child’s self-esteem.  An adolescent with a positive self-concept and strong since of self worth is less likely to be influenced by outside influences.

2.     Encourage your child to form positive relationships with other adults.  These relationships can help a teen learn good models for healthy relationships.  Encourage your child to spend time with a teacher, counselor, or relative who you believe who be a positive mentor to your child.

3.     Encourage diverse relationships.  Parents who model diverse friend relationships in their own lives help teens learn to do the same.  Encourage your child to create friendships across ethnic, gender, and socio-economic or religious lines.

4.     Teach your child specific skills to make good decisions and resist negative behaviors.  Adolescents need to be taught methods to properly analyze a situation first, and then make a decision.  The most basic concept is the cost vs. benefits analysis.  Teach your child to evaluate the positive outcomes with the negative outcomes of several possible scenarios.  Be specific with respect to consequences for behaviors.

5.     Teach your teen exit strategies and ways to say “no” to negative pressures.  Preparing your teen in advance for ways to deal with specific circumstances will help when they are faced with a “real life” situation.  Role-play examples of common peer pressure moments such as being offered alcohol or drugs.  Help your child prepare positive responses that are comfortable for them.

Remember, peer relationships can be one of the best experiences for your child’s healthy development.  Following the above recommendations will put your child in the best possible position to avoid negative influence and make positive choices.

For more detailed information on the above, consult the following sources:

Brown, B. B. (2004). Adolescents’ relationships with peers. In R. M. Lerner & L. Steinberg (Eds.), Handbook of Adolescent Psychology, 2nd edition (pp. 363-394). New York: Wiley.

Friendships, cliques, and crowds. In G. R. Steinberg, L. (2005). Adolescence. New York, NY: McGraw-Hill.