COUPLES THERAPY | MARRIAGE COUNSELING | PRE-MARRIAGE COUNSELING | ANXIETY | DEPRESSION | SAN DIEGO

Loneliness: Our Need To Connect

Feelings of loneliness are a natural part of our emotional experiences in which we internally feel disconnected or rejected from other people.  However when feelings of loneliness and isolation become chronic or severe, it puts us at risk for physical and emotional/mental health conditions such as cardiovascular disease, respiratory illness, cancer, gastrointestinal issues, cognitive decline, dementia, depression, and anxiety.  In fact, research has shown that loneliness is a predictor of premature death because it targets the same parts of our brain as physical pain does.  

In order to effectively manage feelings of loneliness, we must first understand the root, or cause of them because not all feelings of disconnection or isolation are the same.  According to happiness expert Gretchen Rubin, there are 7 types of loneliness states that we can experience:

New situation: When we find ourselves in new circumstances, whether it is at a new job, place of residence, school, or in another unfamiliar setting.

I’m Different: When other individuals with whom our core beliefs, traits, or preferences differ surround us.

No Romance: Regardless of the amount or quality of the relationships someone may have with friends or family, the void of having an attachment to an intimate or romantic partner can create feelings of isolation.

No pet: Some of us seek out connections or attachments to animals because of the type of experience it provides that human connections oftentimes do not. 

Insufficient time: Relationships with friends, family, or intimate partners can leave us feeling lonely or disconnected when we find that the time and attention we are receiving from them is not enough.

Shallow friendships:  Lack of meaningful or authentic interactions and experiences and the inability to trust individuals we spend time with.  

Quiet presence: The need or desire to have someone else around just to hang out or spend quiet time with. 

And of course, one of the most common triggers to states of loneliness and isolation is the loss after the death of a loved one or the end of a relationship.

Once we can identify the type of loneliness we experience, we are then able to direct our efforts into the appropriate channels for alleviating it.  Here are some suggestions to creating connections with others:

  •       Initiate and engage in conversations with strangers
  •       Make efforts to get to know your neighbors, co-workers, or other people you come across          on a regular basis
  •       Volunteer in a setting that you have a passion for
  •       Schedule social events with friends on a regular basis
  •       Try a new hobby or activity that may involve the presence of other people
  •       Get involved with creative arts
  •       Adopt a pet or volunteer at an animal shelter
  •       Carve out uninterrupted quality time for family and intimate partners on a regular basis
  •       Set healthy boundaries around social media use

~ Cory Stege, M.S., LMFT

Increase Your Relationship Satisfaction By Redirecting Your Mindset

Like most aspects of life, relationships go through highs and lows, which often correlate to how contented we feel about them at the time.  Because no one is perfect, it is normal to experience gripes and complaints about people we are in relationships with.  It can be easy to fall into a problem-focused mentality when we feel that our needs are not being met in the ways that we seek them to be.  This pattern of negative thinking can create distance, tension, and toxicity, which ultimately promote low levels of relationship satisfaction.  

Our thoughts, feelings, and behaviors are all interconnected which means when we are able to alter one of these parts of ourselves, the other parts will be influenced.  Therefore if we find ourselves ruminating and focusing on all of the things we do not like about our partner, we will experience negative feelings and behave in ways that exhibit our disdain.  On the other hand, by redirecting our perspectives and thoughts to focus on the positive aspects of people we are in relationships with, the degree of satisfaction and type of interactions we experience will improve, even in difficult and challenging circumstances. 

One challenge I give clients who are experiencing low levels of relationship satisfaction is to offset each complaint they have about his or his partner by identifying a strength or positive aspect of the relationship.  For example, one client complained about her husband’s tendency to work all of the time, causing her to feel lonely however this client was then able to challenge this grievance by acknowledging her husband’s loyalty and commitment to provide for her and their children.  

Here are some of the prompts I often use with clients to help redirect their problem-focused mindset about his or her relationship:

  • What is it about my partner that initially drew me to him or her?
  • If I was no longer with my partner, what would my life be lacking?
  • What are some exceptions to my complaints of my partner? In other words, identify specific times or instances of when I am feeling happy with my partner.
  • How does my partner express care or concern for me?
  • What traits or characteristics does my partner have that I find admirable or that I feel balances me out?
  • What are the strengths of my relationship?
  • How does my partner show me that we are a team?
  • What sacrifices has my partner made for me?
  • What values or goals do I share with my partner?
  • In what ways has my partner and I grown together?

The next time you are feeling like your relationship is in a rut or you feel like nothing is going right, challenge yourself to think about and answer the above questions.  Oftentimes shifting our perspective allows us to reestablish positive affect and feelings for our partners.

~ Cory Stege, M.S., LMFT

Sitting With Our Emotions

Certain emotions can be unpleasant and uncomfortable to experience, especially if the emotions are new or different than what we may typically experience.  Some of us may also experience certain emotions at high levels of intensity, which can feel overwhelming and seem challenging to deal with.  Therefore it is a common human response to want to avoid, minimize, or suppress emotions that we consider to be undesirable such as fear, hurt, anger, sadness, depression, or anxiety.  Pushing these emotional experiences down or pretending like they are not happening may be a temporary fix to promote our ability to function in the short term however these reactions just prolong the inevitable: the need to deal with the root of our emotions.  In fact, efforts to avoid or minimize feelings can have the opposite effect by actually intensifying symptoms or emotions.

In order to resolve negative and uncomfortable emotional experiences in a healthy manner, we need to be able to acknowledge in a non-judgmental manner any emotion that we feel in the moment.  This requires us to practice awareness of what happens for us emotionally, physically, and mentally at any point in time.  I commonly recommend for clients to create a ritual of checking in with him/herself throughout the day in which the following questions are answered:

·      What mood or feelings am I currently experiencing?

·      What physical sensations do I currently notice in my body?

·      What type of thoughts am I currently experiencing?

Once we are able to establish awareness of what happens for us from moment to moment, we can then practice the skill of acknowledging our experiences without placing judgment on them or trying to change them in any way.  For example, “I am feeling sad and don’t want to do anything.  I feel an emptiness in my heart and have no appetite.”  Instead of becoming critical of ourselves by thinking we should not be feeling sad and need to change it, which just adds to our sadness, we can learn to simply recognize our experience for what it is and allow ourselves to sit with it for as long as it occurs.  Even though it may not seem like it in the moment, sitting with our emotions can lead to healthy resolution, as it requires us to embrace and deal with our experiences.  This skill takes practice and patience but can be extremely rewarding and healing.

~ Cory Stege, M.S., LMFT

Bouncing Back From A Break-UP

Relationships can be satisfying and rewarding, especially when strong emotional and physical connections develop.  Unfortunately, these aspects of attachment can make the end of a relationship painful and challenging. Break-ups come with potential changes in our day-to-day activities and routines, emotional health, physical health, and social life.  The act of moving on with life may seem daunting and impossible for some of us after a break-up however there are some strategies we can incorporate into our lives that can promote growth and resilience during these difficult times.

  • Allow time and space to grieve.  The end of a relationship is a loss and should be experienced as such.  Healthy grieving involves feeling and experiencing each emotion that comes up as a result of the break-up and engaging in healthy coping skills such as journaling.
  • Lean on your support system.  In order to prevent isolation, reach out to friends and family on a regular basis who can listen and support you in ways that you need. 
  • Stick with your responsibilities. Just because a relationship ends, does not mean that our responsibilities also end. Continuing to follow through with regular tasks and routines can offer structure and promote positive feelings of accomplishment.
  • Establish a new normal. Think of this time as an opportunity to create a new life for yourself.  This is a time to be selfish in order to nurture your needs. Make plans that will you believe you can benefit from and consider participating in new hobbies or activities you may find enjoyable.     
  • Engage in regular self-care.  It can be challenging to remember to eat healthy, get enough sleep, and exercise when we are grieving or going through a transition however these activities of daily living are more crucial to attend to than any other time. 
  • Seek professional help. Receiving guidance and support from trained professionals in the mental health, medical, and legal settings can provide tools that we may not otherwise utilize on our own.  Professional help can provide objective support so that we are able to function and make sound decisions. 

Every relationship is different and each of us will experience a different reaction when going through a break-up.  However, regardless of the circumstances and our individual traits, we can all benefit when we take care of ourselves during loss and change.

~ Cory Stege, M.S., LMFT

Primary Versus Secondary Emotions

Emotions are powerful components that make up our moment-to-moment experiences and can be confusing and even scary if we do not understand them.  Without awareness of and insight into our emotional experiences, it can be challenging to manage and cope with uncomfortable and even painful feelings.  Therefore it is important to be able to identify and understand what emotions we have and the meaning behind them so that we can develop the appropriate coping skills to effectively manage them. 

We can think about our emotions in two categories: primary and secondary.  Primary emotions are the basic universal feelings that we experience in response to our instincts. Primary emotions are quick, immediate responses to a situation and do not require cognitive processing or learning.          

Secondary emotions are feelings that we experience as a result of how we process the meaning of people, places, and objects and involve memory and learning.  Secondary emotions are responses to the primary emotions we experience and can be felt for short or long durations. 

Primary                                 Secondary

Anger                                    fury, outrage, irritability, hostility, resentment      

Fear                                       anxiety, apprehension, nervousness, dread, panic

Sadness                                 grief, sorrow, gloom, melancholy, despair, loneliness, depression

Joy                                         enjoyment, happiness, relief, bliss, delight, pride, ecstasy

Shame                                    guilt, embarrassment, remorse, regret

Desire                                    acceptance, friendliness, trust, kindness, affection, love, devotion

Disgust                                  contempt, disdain, scorn, aversion, distaste, revulsion

Surprise                                shock, astonishment, amazement, astound, wonder

The relationship between primary and secondary emotions can be complex because secondary emotions often take over and mask our primary emotions.  Therefore the goal of managing our emotional experiences effectively requires the ability to identify the underlying, or primary emotions, of our more overt, or secondary emotional responses.  Once we can identify our instinctual or basic emotions, it can be easier to identify the needs we can aim to meet in those moments and situations so that it feels more manageable.

~ Cory Stege, M.S., LMFT  

Mindfulness As A Tool For Grief

When we experience some form of loss it usually prompts change to take place in our lives, which can be very difficult to cope with. Loss bears a mix of emotions, thoughts, and behaviors that are unique to each of us.  Unfortunately our society tends to place expectations on how we should react when we experience grief, which just adds to the stress of an already stressful situation.  Comments of ‘you should be over this by now’ or ‘you need to be strong’ minimizes the degree of the impact loss may have.  Comments like these can influence grieving individuals to think and feel like they are not coping very well despite the fact that what they are experiencing is normal.  This in turn can cause grieving individuals to alter their expectations of how they should be thinking, feeling, and behaving which can increase symptoms of depression and anxiety

One of the most powerful and effective tools we can turn to during times of loss is mindfulness.  Mindfulness prevents us from ruminating in the past or worrying about the future and instead allows us to focus on the present moment.  Mindfulness techniques can help grieving individuals to challenge and minimize the pressure of reacting or being a certain way because of mindfulness’ crucial aspect of being non-judgmental with whatever thoughts and feelings that exist at any moment.   In other words, mindfulness allows us to pay attention to, acknowledge, and sit with our experiences so that it just is what it is, instead of being what we think it should or should not be.

Here are a few mindfulness strategies that can help us to acknowledge our thoughts and feelings in the present moment in a nonjudgmental manner:

  • Body scan: Take a moment to notice what feelings and sensations you are currently experiencing starting in your toes, calves, knees, thighs, hips, abdomen, chest, shoulders, neck, cheeks, eyes, and scalp.  Then notice what types of thoughts you are having as you try to focus on your body and allow yourself to just sit there for a few seconds and focus on your breathing. If any judgmental thoughts or worries come into your mind, allow yourself to let them go and bring your attention back to your body. 
  • Breathing exercises: Focus solely on your breathing by taking 4-5 deep breaths
  • Use your five senses:  Sight: Identify 1-3 objects you can see. Sound: Focus on the sounds/noises you hear. Touch: Feel something within reach and identify the texture. Taste: Do you notice any specific tastes in your mouth. Smell: Pay attention to any odors you may pick up on.

~ Cory Stege, M.S., LMFT

The Importance Of Boundaries In Psychotherapy

Psychotherapy is a process that involves a unique relationship between the therapist and client and it stands apart from those relationships we engage in with family, friends, and intimate partners.  Emotional intimacy is unavoidable due to the nature of a therapeutic relationship in which a client shares personal experiences with a therapist.  Because of this, there is potential risk of harm to a client if professional boundaries are not established and maintained.  So what exactly does “professional boundaries” in therapy mean?

Professional boundaries are guidelines that allow for appropriate separation between the physical, emotional, social, and psychological aspects of a client and a therapist.  Professional boundaries should be clear but have the ability to be flexible given that each therapy relationship is different.  The one aspect of a therapeutic relationship that remains the same in all cases is that the therapist has the responsibility to ensure and maintain the wellbeing of the client.  This is one of the main reasons why professional boundaries must exist and without them, blurred lines can lead to exploitation and harm done to the client.

Clients like to know what they can expect from a therapist regarding roles and responsibilities with therapy, which can promote feelings of safety and security.  This means that therapists need to be upfront with clients about policies that govern the therapeutic relationship.  Here are a few examples of professional boundaries that are relevant in psychotherapy:

·      Dual relationships

·      Therapist self-disclosure

·      Touch

·      Fees/bartering

·      Gift giving

·      Contact outside of office

·      Confidentiality and releasing information

·      Attire in session

·      Use of language

Depending on the setting, location, and client or therapist factors, certain situations or boundary crossings are unavoidable and do not necessarily lead to negative effects on the client.  Each therapist’s approach and philosophy will dictate the type of boundaries they establish with clients.  Some of this information is generally made available in a therapist’s informed consent form that is provided to the client at the outset of therapy however it is always recommended to have a discussion about any unknown or gray areas that may apply.

~ Cory Stege, M.S., LMFT

The Dating Dilemma Following The Death Of An Intimate Partner

The loss of an intimate partner or spouse comes not only with the process of bereavement but it also presents the question of whether a future romantic relationship is desirable.  Grief is a very idiosyncratic process, which means it affects each individual differently and has no instruction booklet for how to navigate it.  The same goes for the decision to form new intimate partner relationships after a romantic loved one has passed on. For some, seeking out a new relationship can offer solace and comfort in the face of pain. For others, the loss of a significant love may cause avoidance of new relationships in order to prevent the pain and discomfort of subsequent losses. 

For individuals who engage in a new romantic relationship, it can be common to experience a sense of guilt that stems from the idea that they are being unfaithful to the deceased partner.  There may also be a fear that the deceased partner may be forgotten once a new relationship is established.  Understanding the reason for the desire to date again can shed some light on feelings that become triggered and provide insight in whether being in a relationship is truly desirable.  Individuals who successfully develop new romantic relationships and are not just filling a void following loss have the ability to both honor and let go of the deceased partner. 

One significant factor that contributes to finding this healthy balance is the ability to minimize the amount of comparison between the deceased partner and the new romantic partner. Love and longing for the deceased partner can grow over time which can lead individuals to feel like they are unable to experience love like they did when their partner was alive. However it can be helpful to acknowledge that being in a new relationship means new circumstances exist and thus the feelings and experiences associated with it will be different than those felt with a deceased partner. 

There is also the question of how soon is it okay to start dating again? Depending on whom you ask, the answer will be different and like grief, there is not a right or wrong answer.  Some individuals fall into a new relationship immediately whereas others wait years to do so. Unfortunately our society tends to place a spotlight on individuals who are grieving to see how they are coping and whether we feel it is appropriate or not.  However what truly matters is what feels right and brings comfort to the bereaved.

~ Cory Stege, M.S., LMFT

Tips For Building Resilience

Have you ever wondered how some people are able to manage traumatic situations and adversity better than other people? What separates those individuals from people who struggle with bouncing back from unwanted change?  The answer is: resilience.  Resilient individuals are able to learn, develop, and implement specific strategies and coping skills that allow them to respond well to life’s challenges and stressors.  Resilience is not genetic or a part of our personalities but rather is a skill that can be learned by anyone.  Resilience looks different from person to person however there are some common aspects that can be helpful to understand.

Resilient individuals tend to maintain loving and supportive relationships that help to combat feelings of isolation during daunting times.  In addition to the presence of positive relationships, resilience is associated with healthy cognitive and emotional tools that any individual can build.  

Some of these tools include:

So what can we do to develop these tools? Here are some intentional actions we can take to build resilience:

  1. Engage in regular self-care. This means nurturing our physical, emotional, and social needs on a daily basis.
  2. Consider the bigger picture of situations in order to promote perspective.
  3. Initiate regular contact with others. This includes staying in touch with support systems as well as forming new connections.
  4. Focus on your locus of control.  Let go of things you cannot change and direct your focus to those factors that you can take action on.
  5. Accomplish one thing everyday that promotes progress, even if it seems small.
  6. Practice positive and hopeful thinking.  Reciting affirmations can promote positive feelings and experiences.  
  7. Allow yourself to feel your emotions, no matter how painful or strong they seem.
  8. Consider how challenges can be opportunities for growth.
  9. Give to others. This can give us a break from focusing on ourselves and promote gratitude in our lives.
  10. Laugh. Seeking out humor can offer relief from physical and emotional pain.
  11. Practice assertiveness with others to communicate your needs.
  12. Practice mindfulness by being aware of thoughts, feelings, and sensations in the present moment without placing any judgment on them.

Ideally we will actively engage in these behaviors prior to being faced with a crisis so that the emotional and cognitive tools associated with resilience are already established.  However, because adversity strikes at any moment, we may not have these skills in place but that does not mean we cannot build them during tough and trying times.  Oftentimes therapy or support groups can offer individuals assistance with these skills when going through a difficult time.

~ Cory Stege, M.S., LMFT

 

Journaling: A Tool For Grief

When life throws us curveballs that pose significant impact on our lives as grief does, it can often leave us feeling helpless and overwhelmed.  What do we do with the thoughts and feelings that accompany trauma and loss? We may not always feel comfortable sharing our experiences with other people for various reasons however we need to be able to find an outlet that allows us to manage our grief in a healthy manner.  Loss and trauma imprints some form of emotional, physical, and psychological distress that will seep into all aspects of our lives if we do not honor and express it. 

Journaling is a very simple, yet powerful tool that can allow us to identify and process our grief experiences in a confidential and safe way.  Journaling can also serve as an instrument to tell our story, which we can choose to look back and reflect on in order to uncover insight to our struggles and growth from them. Like grief, everyone’s experience will be different which means that there are no rules or right or wrong way to journal.  However you choose to write or express yourself is up to you.

Journaling can be done in either formal or informal manners depending on our needs and preferences.   Some of us may prefer to just write down words or phrases that come to mind whereas others may prefer to follow some type of structure or prompt.  Some people establish a ritual in which they journal at the same time each day or week whereas other people carry their journal with them and use it whenever it seems relevant to them.  Since journaling is for you and about you and your experiences, establish your desires and expectations of it based on that.

There may be times when we experience a block or feel stuck in how we can express our thoughts and feelings so here are some prompts related to grief that may help get the juices flowing or may be beneficial to those of us who prefer structure to our writing:

Today I feel…

I remember when…

What I have learned is…

My life has changed by…

The first time I…

My support system includes…

What brings me joy is…

The most difficult time of day is…

My fondest memory is…

I am grateful for…

Like most tools and coping skills, the more we practice and use a journal to express and process our experience, the more likely we are to reap the benefits of it. 

~ Cory Stege, M.S., LMFT

The Three Pillars Of Self-Compassion

It can be common practice for us to be empathetic and understanding of other people when they are going through a difficult time or are struggling however when it comes to applying this practice to ourselves, unfortunately it does not come as naturally.  Many of us allow our critical voice associated with our self-expectations to take over when we are experiencing stress, failure, or significant challenges which ultimately just adds to our struggles.  This can be particularly common with individuals who are in some form of a caretaker role as well as for those of us that expect self-perfection and nothing less.  This type of self-judgment can lead to feelings of isolation, depression, anxiety, and physical illness. 

The ability to practice self-compassion takes conscious effort and awareness on an ongoing basis in order to shift our core beliefs about who we are and the world we live in.  Self-compassion promotes elevated levels of overall wellbeing that include happiness, gratitude, satisfaction, optimism, resilience, effective coping and self-care, and rewarding relationships.

To achieve self-compassion, we must develop three life skills:

Self-kindness

The ability to be supportive, understanding, and loving to oneself especially during trying and difficult times.  In other words, being kind to oneself involves the ability to cut oneself some slack.

Mindfulness

The ability to be aware of thoughts, feelings, and sensations in the present moment without placing any judgment on our experiences or trying to change them.

Connectedness

The ability to relate to other people and recognize that everyone goes through challenges, stress, and difficult times, which reinforces that we are not alone.

Here are a few tips that can help promote self-compassion:

  • Avoid comparing yourself to other people.
  • Reframe your mistakes as opportunities for growth.
  • Practice healthy eating and exercise habits.
  • Maintain regular contact with supportive relationships.
  • Be honest with yourself.
  • Prioritize your needs and do not ignore them.

~ Cory Stege, M.S., LMFT

Moving: Tips To Effectively Managing The Process

Being amidst the chaos of moving has reminded me about the value of stability and comfort as I try to navigate the stress that comes with relocating.  Up there with death and divorce, moving is considered to be one of life’s most stressful experiences because it involves change.  Change requires us to go outside of our day-to-day routines and comfort zones and adjust to new circumstances, which is not always easy.  Whether we are moving across town or across the country, there are some strategies we can incorporate into the moving process that may help make the transition somewhat smooth and stress-free.  Here are some of them:

Create a task list

Moving can be overwhelming when we think about everything that needs to get done beforehand as well as afterwards.  Writing down these tasks can help organize the process so that it feels more manageable.  Once we have a list of to-do tasks, we can put timelines on them to promote realistic planning and follow through.

De-clutter

Moving presents us with a great opportunity to get rid of clutter and other items that have lost purpose for us.  Therefore before the packing process begins, take some time to clean out and organize what to keep versus what to toss.

Utilize resources

Most of us know what it can be like to move, especially if we feel like we are doing it alone.   Do not hesitate to ask friends or family for help and be open to any way they may be able or willing to be of assistance.  Hiring a moving company or other services may help take some of the load off.

Take care of yourself

During times of transition, it is even more important for us to pay attention to ourselves.  This means ensuring that we are getting enough sleep and eating a balanced diet.  It also means that we may need to take breaks during the process in order to refuel and energize. Go for a walk or a run or meet up with friends for a meal.

Be aware of your emotional needs

For some, moving is a choice however for others, it can be a decision that has been made for us.  Moving can bring a multitude of emotional reactions from joy and excitement to sadness and fear.  Whatever the experience is for you, allow yourself to be mindful and respectful of your feelings, which is a crucial coping skill for navigating change.

Practice patience and flexibility

More often than not, unexpected events occur during a process that we place so much emphasis on planning and organizing.  Things will happen that are outside of our control and will affect us in some way. In order to prevent us from adding more stress to our already full plate during this time, consider being flexible by going with the flow.  If possible, we can also direct our focus to tasks that we do have control over to help us cope.

Set a realistic time frame

When planning a move, try to be realistic about the amount of time it will take to pack up, move, and then unpack.  Timeframes for moves vary depending on the type as well as other factors that may be unique to each situation.  Allow enough time on both ends of the move to complete the to-do list.

Allow other duties to wait

We find moving to be stressful in part because of the pressure we place on ourselves to continue fulfilling our typical responsibilities and jobs at the same time.  Take time to consider whether it would be beneficial to take some time off from work.  Choose which duties you can let go of temporarily to allow yourself time and energy to focus on the move.

Get to know your new neighbors

Being a new place can be exciting or scary depending on the reason and circumstances of the move.  Establishing new relationships in an unfamiliar neighborhood can make a transition more manageable and rewarding.

Develop new routines

Moving to a new location may present obstacles to maintaining our schedules and routines because of changes in commutes, settings, and availability of services.  This may mean that we need to be creative about changes we can make to our days in order to ensure that we can still participate in the activities we enjoy.

~ Cory Stege, M.S., LMFT

What Psychotherapy Is And Is Not

Despite the growing number of individuals who participate in some form of psychotherapy today, a stigma still lingers regarding the process.  Like most industries, therapy has evolved over the years from the early days of Freud's psychoanalyzing and the common practice of lobotomies to the current growing field of evidence-based treatment models.  Even though more of us are accessing therapy-related services, some people remain hesitant to participate in it as a result of the presence of myths and misconceptions.  It is important for clarification about what therapy is today as well as reasons people seek it out.  

First let’s look at what psychotherapy IS NOT:

•    Only people with “serious” issues or who are considered to be “crazy” or “weak” go to                   therapy.
•    All therapists act the same and use the same techniques.
•    If you can just talk to friends, family members, or co-workers then therapy is not necessary.
•    Therapy will only be helpful if the therapist has gone through the same life experiences.
•    Therapy is expensive.
•    Therapy is long-term.

What psychotherapy IS:

•    A safe, supportive, and confidential process in which self-exploration and self-care can take           place.
•    Any technique or intervention that is used to improve an individual’s physical, mental,                     emotional, and interpersonal functioning.
•    Can provide support as a simple sounding board or treatment of serious mental illness. 
•    Anyone can benefit from therapy, regardless of age, race, socioeconomic status, or level of             functioning.
•    Therapy services are offered at low fee, insurance, and private pay rates. 
•    Therapy can be effective in both short and long-term durations.

Regardless of the specific reasons individuals seek therapy, the benefits of it are staggering. There is simply nothing better we can do than to set aside uninterrupted time to focus solely on ourselves.  

~ Cory Stege, M.S., LMFT

Which Type Of Therapy Is Right For You?

Making the decision to engage in therapy can be a difficult and overwhelming process, especially for those of us who are not familiar with the different forms of therapeutic approaches that are commonly offered today.  Like most things in life, what some people find helpful and effective other people may not.  Determining what style and treatment approach may work the best for you is just as important as finding a therapist who is an appropriate fit for your needs.   Below is a summary of the most common forms of therapy used today, which are all evidence-based treatment models that have been shown to be effective in treating mental health conditions. 

Cognitive Behavioral Therapy

This form of therapy targets maladaptive thought patterns (thoughts, beliefs, attitudes) that lead to problematic behaviors and negative emotions.  The goal of CBT is to identify, challenge, and reframe dysfunctional thought patterns and associated behaviors into healthier, more realistic ways of thinking.  CBT has been proven to effectively treat anxiety and depressive disorders, eating disorders, personality disorders, chronic pain, chronic psychosis, and substance use disorders in adults.  CBT can be completed in 12 sessions or can be a precursor to long-term therapy.

Dialectical Behavior Therapy

This form of therapy is a modified version of cognitive behavior therapy that focuses on building an individual’s emotional and cognitive regulation skills in order to decrease negative reactions.  DBT involves identification of triggers that prompt destructive reactive states as well as assessment of when specific coping skills can be implemented in a series of thoughts, feelings, and behaviors in order to minimize maladaptive behaviors.  The coping skills involved with DBT include reality testing through acceptance, distress tolerance, relationship effectiveness, emotion regulation, and mindfulness.  Research has shown DBT to be effective treatment for borderline personality disorder, self-harm behavior, suicidal gestures, and substance abuse. 

Acceptance and Commitment Therapy

ACT is type of therapy that combines cognitive behavioral therapy and mindfulness interventions in order to promote awareness and acceptance of uncomfortable feelings without negatively reacting to them.  Instead of minimizing or avoiding negative feelings, ACT aims to teach individuals to embrace all feelings and focus on responding in desirable and valued behaviors.  ACT has been found to be effective in treating anxiety and depressive disorders and addiction. 

Mindfulness

Mindfulness-based therapy encourages conscious awareness to internal and external experiences in the present moment without judgment.  Research has shown mindfulness to be effective in treating anxiety and depression, stress, and addiction. 

Motivational Interviewing

This form of therapy is a client-centered, goal-directed approach that focuses on resolving ambivalence by eliciting and building intrinsic motivation in order to promote change.  MI offers individuals an avenue to look at all aspects of a problem or behavior in order to help clarify whether change would be beneficial. MI is generally brief and time-limited and has been found to be effective in treating behavioral issues, substance abuse/dependence, gambling, and relationship issues.

EMDR

Eye Movement Desensitization and Reprocessing targets distressing memories and symptoms associated with traumatic experiences through an 8-phase approach. EMDR works by stimulating the brain’s natural adaptive information processing systems through sensory input with the use of a sequence of eye movements during recollection of painful memories.  EMDR is generally used to treat PTSD and other trauma-related conditions.

Psychodynamic

This form of therapy focuses on eliciting and resolving unconscious thoughts and feelings in order to reduce maladaptive functioning.   Interventions associated with psychodynamic therapy include dream analysis, free association, working with resistance and transference, and working through unpleasant memories. Psychodynamic is typically long-term therapy and has been found to be effective in treating depression, somatic disorders, and interpersonal problems.

Client-centered talk therapy

This form of therapy focuses on providing a safe, empathic, and supportive environment in order for individuals to express his or her true thoughts and feelings without judgment in order to discover solutions and answers on his or her own.  This therapy is appropriate for individuals who may be experiencing chronic stress or are unsure about the source(s) of his or her presenting concerns.

This list of therapy approaches is far from exhaustive and there are a number of alternative treatment modalities that are also used in therapy settings.  I always encourage clients to interview potential therapists about the type of treatment approach(es) he or she may use and have a discussion about whether a certain type of therapy is an appropriate match for the reasons therapy is being sought.

~ Cory Stege, M.S., LMFT

Grief: Empowerment Through Self-Care and Rituals

Loss is a natural part of life that we each will experience in one form or another throughout our lifetime.   The end of a significant relationship, the loss of a job, a change in social status, or the death of a loved one a few examples of how grief may enter our lives.  Loss can be sudden and unexpected or prolonged and anticipated however the manner in which it manifests and affects each one of us cannot be predicted.  Although research has indicated that grief tends to follow 5 primary stages that include denial, anger, bargaining, depression, and acceptance (Kubler-Ross, 1969), how grief exists from person to person is vastly differently from duration and intensity and the degree to which it affects an individual’s level of day-to-day functioning. 

The reason that grief is idiosyncratic is the result of specific factors related to each of our unique tendencies and personalities, degree of self-care before and after a loss, level of external and internal stressors prior to a loss, pre-existing mental health or medical conditions, social connections, and degree of resiliency.  The presence and ability to be resilient in the face of hardship or adversity is a primary determinant of whether an individual will cope effectively while grieving, despite the aforementioned factors that exist prior to a loss. 

One of the common aspects of grief is the sense of feeling like our world is out of our control because the familiarity we once knew before a loss may no longer exist.  When we feel out of control, we feel helpless which has the power to negatively infiltrate our thoughts and feelings, making it difficult to function.  In order to counteract our feelings of helplessness associated with grief, we can direct our focus and attention to aspects of our lives that we do have control over.  Here are two examples of how we can take control of our lives after loss:

Self-care, or the ability to purposefully engage in daily activities that nurture our physical, mental, and emotional selves, is one manner in which individuals can build resiliency after a loss.  Self-care begins with identifying and addressing our basic needs by intentionally engaging in healthy eating habits, sleep hygiene, physical exercise, and social engagements.  Creating and maintaining a routine to follow can be effective an effective strategy for developing healthy self-care habits as well as provide us with a sense of structure and accountability. 

Rituals are actions or activities that we engage in with the purpose of promoting a sense of comfort and familiarity during times of chaos and stress. Rituals can be done either publicly or in private and provides meaning and perspective in powerful ways.  Examples of public rituals involve funerals, obituaries, and memorials.  Private rituals may involve prayer, talking to the deceased out loud or in our heads, or maintaining activities and routines that were done prior to a loss.  For example, widows or widowers may continue to go to places that were a significant part of his/her life with a spouse prior to a loss. 

~ Cory Stege, M.S., LMFT

The Benefits Of Following A Routine

Creating and implementing a routine, whether it is on a daily, weekly, or monthly basis, is one of the most important tools and coping mechanisms that we can do in order to promote a healthy well being.  So what exactly is a routine? Routines are healthy behaviors or activities that we consciously engage in over and over again to the extent that it becomes a habit. We tend to engage in these activities because we find them to be enjoyable or to have a positive impact on our lives in some way.  Examples of routines include exercise, showering/grooming, meals and eating habits, social interactions/contact, reading, journaling, cleaning, etc.

Routines have a cumulative effect in that the single occurrence of one behavior or activity may seem small however over time, the benefits are significant.  Routines help to promote organization and structure to our days, which can provide us with a sense of control, familiarity, and stability in our lives.  With routine we can anticipate what we can expect to some degree, which promotes a sense of direction.  Stressful times can bring chaos and feeling out of control however continuing to implement a routine can make these trying times more manageable. 

Like most activities or skills that requires practice, building healthy routines can take time however once mastered, our ability to become more efficient with our time takes place.  These behaviors and activities become automatic and eventually we can engage in habits without having to think about it, making us better at managing our days.  The increase in proficiency with routines also makes it less likely for us to feel like we have to rely on our motivation or determination to get something done.

Incorporating routines into our lives also results in a sense of accomplishment on a regular basis and helps to build our self-esteem and self-worth.  Confidence in our ability to complete tasks that may seem daunting increases and we can alter our core beliefs about our capabilities. 

Some other benefits of routines include balanced self-care, higher quality of sleep, and a decrease in physical or mental illness.  Some of the most successful individuals have shared tips that they believe contribute to their achievements and following a routine is almost always included.  For individuals who are looking to create a routine, consider starting with just one activity or behavior that will be realistic and achievable to engage in on a regular basis.  

~ Cory Stege, M.S., LMFT

Simple Ways To Date At Home

Over the years of working with couples, I have found that the majority of couples express a desire to go on dates in order to feel more connected.  This makes sense since most couples build an emotional foundation through dating and the process and effort it involves.  In the beginning stages of dating or courtship, we are more likely to plan and follow through with dates than we are later on in a relationship which is a typical pattern that most couples experience.  

As I discussed in my previous article on limerence, otherwise known as the ‘honeymoon phase’, the adrenaline and excitement that a new relationship offers significantly influences our motivation and willingness to be creative and open to participating in regular dates.  Unfortunately, limerence has an expiration date, which is often associated with changes we experience with the onset of more responsibilities in our relationships that tend to come with a typical progression.  The stressors and responsibilities that come with children, work, caring for older family members, financial obligations, and other factors are common reasons couples slowly decrease the frequency of going on dates.  

Couples often feel fatigued and stretched thin emotionally, physically, and financially and the thought of having to plan and follow through with a date can feel like an insurmountable task that is often easier to forgo.  Over time couples may find themselves going through the motions of sticking to routines and managing day-to-day tasks, which often creates distance if the relationship is not being nurtured. 

Time, energy, and money are the primary constraints that couples I work with say prevent them from going on dates despite their interest and desire to do so.  In order to manage these constraints effectively, I assist couples with identifying creative ways they can date without having to leave their home, pay for a babysitter, or put in energy to get dressed up.  This requires a minor shift in how couples think about what it means to go on a date and the ability to change the meaning of how time is spent at home together.  Here are some ideas for “dating at home”:

•    Unplug from technology for an hour and catch up on the “highs and lows” of the week
•    Have a picnic in the living room or outside
•    Exchange massages or foot rubs
•    Listen to favorite or meaningful songs
•    Karaoke (YouTube has channels)
•    Put a puzzle together
•    Dance lessons in your living room (YouTube helps with this too)
•    Reminisce over photos from the beginning stages of your relationship, engagement, and/or wedding photos
•    Talk about your dreams and goals for the next 5, 10, and 20 years together
•    Take turns cooking a meal from a different culture
•    Plan a vacation or trip together
•    Order take out and watch a movie
•    Stargaze together

Most couples engage in some of these activities on a regular basis however they don’t tend to think about them as dates because they don’t leave the house.  I encourage couples to have a discussion about what date activity they are going to engage in at home each week.  When couples begin to label these activities as dates, it creates more opportunities for connection that seem easy and realistic to follow through with.   

~ Cory Stege, M.S., LMFT

Growing Your Emotional Bank Account

As I have discussed in previous articles, research has indicated that relationships that fail tend to possess negative defense mechanisms that are manifested both overtly and covertly when conflict or concerns arise.   These relationship killers include criticism, contempt stonewalling, and defensiveness (Gottman, 1997) and are associated with the tendency to turn away from a partner and his or her needs, which ultimately destroys any emotional connection.  

Emotional connection is one of the primary motivators we use to seek out and maintain relationships however the needs that each of us associates with emotional connection varies, making relationships complex.  When we enter into relationships, we make what Dr. John Gottman calls bids for emotional connection (1997) to our partners, which is a mutual process.  We can decide to either embrace and accommodate these bids or turn away from and reject them.   When we choose to turn towards our partner’s bids for connection, we send the message that we care about his or her needs and thus strengthen the relationship foundation.  When couples actively seek out opportunities to accommodate each partner’s emotional needs, the ability to manage and resolve conflict increases due to elevated degrees of contentment.  

Embracing a partner’s bids for emotional connection does not require grand gestures (although those don’t hurt) but rather can be done through simple avenues of attunement, which is the ability to read our partners from moment to moment.  Here are some examples of ways couple’s can grow their emotional bank account:

•    Compliments
•    Hand-holding or affection when near one another
•    Provide undivided attention when talking
•    Text messages or phone calls to indicate thoughtfulness “just because”
•    Offer to initiate conversations when one partner appears stressed or upset
•    Join in on housework, chores, or other tasks  
•    Offer a jacket when one partner appears to be cold
•    Plan activities of interest that have been enjoyable in the past

Hopefully these examples show that simple, day-to-day behaviors can go a long way and if done regularly, these accommodations can help establish a robust relationship foundation, which will come in handy during times of tension and conflict.  

~ Cory Stege, M.S., LMFT

SOBER Breathing

I had the fortune of attending Foundations Recovery Network’s 2017 Innovations In Recovery conference last week and came away with a very useful skill that incorporates some of the mindfulness and breathing techniques I have previously shared.  Whether an individual is struggling with substance abuse/addiction, depression, anxiety, chronic pain, or stress, SOBER breathing helps to promote an increase in nonjudgmental awareness and grounding so that an individual has the ability to decide how he or she wants to use the information about their experience to their advantage.  

Mindfulness can be understood as “paying attention on purpose and with intention to the present moment without any judgment” (John Kabat-Zinn, 1994).   So how do we do this?  It can be helpful to understand the three primary aspects of our awareness that make up our experiences: thoughts, emotions, and sensations, also called the triangle of awareness.  

Thoughts: This area of awareness involves the type of “chatter” or talking that goes on in our heads.  

Emotions: Emotions can be understood as mental states and natural instincts we experience in response to our moods and circumstances. 

Sensations:  Sensations are our subjective perceptions of our physiological and physical states.

SOBER breathing is an exercise and coping mechanism that allows us to identify each of these primary areas of awareness without trying to change or judge them.  SOBER breathing promotes the use of our breath to ground us so that we can send oxygen to our brain in order to make better decisions with our actions.  Here is how it works:

S: Stop.  The first step is recognizing that we are being triggered or having a negative experience and being able to pause it.  Visualizing a stop sign, saying ‘stop’, or physically stopping what you are doing are examples that achieve this.

O: Observe: Acknowledge in the present moment each area of the triangle of awareness (thoughts, emotions, and sensations).  What specific thoughts are you having; what emotions are coming up for you; and what physical sensations do you notice in your body).  The key here is solely to acknowledge, not to try and change or judge your experience.

B: Breathe. Focus on your breathing as a way to center and ground yourself.  For example, inhale through your abdomen (not chest) for 4 counts, exhale through your mouth for 4 counts, and repeat 4 times.  

E. Expand.  This is similar to step 2 in which you scan your body as well as revisit your triangle of awareness in order to acknowledge your thoughts, emotions, and sensations. It can be helpful to start from your head and move down your body.  Note if anything has changed for you or if you notice similarities from step 2.

R: Respond. Now that you have increased awareness of your initial negative experience, make a decision about how you want to act.  It can be as simple as trying to be mindful of your triggers or taking action in a behavior that has healthy benefits (exercise, social interaction, journaling, relaxation techniques, etc.).

~ Cory Stege, M.S., LMFT

The Remedy For Contempt In Relationships

Contempt is one of the four primary relationship destroyers, or what Dr. John Gottman calls The Four Horsemen of the Apocalypse, and has been found through research, to be the most damaging.   Name-calling, sarcasm, passive aggression, mocking, and ridiculing are examples of the ways contempt is expressed and can result in partners feeling worthless, unloved, and loathed.   Contemptuous behavior is associated with a position of superiority as well as blatant disrespect.  When contempt is present in a relationship, it breeds tension and toxicity among partners, which can be challenging to recover from, especially if it left unaddressed.    

Contempt occurs when partners harbor negative feelings about one another over time and instead of addressing concerns as they occur in a healthy way, the negativity builds.  The focus is targeted on all of the things a partner does wrong, which promotes reinforcement of the negative thoughts and feelings within the relationship.  

Through years of work and research with couples, Dr. Gottman was able to identify 7 stages, or levels, that couples can work on in order to build and establish a strong relationship foundation, which he terms the Sound Relationship House.  The second level of the Sound Relationship House focuses on the process couples can navigate in order to eliminate contempt within a relationship.  This process entails couples to engage in a conscious shift in mindset from focusing on the negative aspects of a partner to acknowledging and highlighting the actions that a partner does that is right and positive.  This shift aims at developing the ability to filter out destructive thoughts and feelings so that feelings of respect, fondness, affection, and appreciation are promoted.       

Some examples of exercises couples can practice to promote fondness and admiration include:

  •     Identify at least 5 positive thoughts or traits about your partner for every 1 complaint or                 negative thought about him or her.
  •     Create a daily ritual of sharing at least one reason you appreciate your partner.
  •     Identify and share the reasons you initially became attracted to one another.
  •     Verbally acknowledge when a partner does something to meet your needs.
  •     Identify actions or traits about your partner that you admire.

~ Cory Stege, M.S. LMFT