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  

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

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:

• the ability to identify realistic expectations and follow through with plans
• assertive and direct communication
• healthy problem solving and conflict resolution skills
• a positive view of self that includes self-compassion
• healthy emotion regulation and impulse control techniques
• flexibility and acceptance of change

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

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

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

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

How To Find A Therapist Who Is The Right Fit For You

It can take courage to acknowledge that professional treatment may be appropriate in order to effectively address symptoms, situations, and challenges that life throws at us.  The process of getting to this point may be difficult (and the hardest for some) however once a decision has been made to go to therapy, the next step of finding a therapist becomes the focus.  This step can be intimidating and overwhelming, especially for individuals who have not participated in any form of therapy before and do not know where to start.   

How does someone pick a therapist when there are so many to choose from? Although a therapist’s education, experience, and credentials are primary factors that most of us consider when researching our options, the most crucial aspect that contributes to therapy being effective is the quality of the therapist-client relationship.  In other words, a therapist’s training and interventions will not be effective if a strong, safe, and trustworthy therapeutic relationship with the client is not established first. 

Luckily there are some factors we can consider that will help assess whether a therapist is the right fit for us. Here are some things to think about during the therapist search:

• What qualities do you look for in a relationship? How would you know that you feel safe?
• How can you tell if your therapist is trustworthy and authentic?
• Are you looking for a therapist who specializes in the problem areas that you are facing?
• Are there specific treatment interventions or approaches you prefer a therapist to have training and experience in?
• Is your therapist in agreement with you about your goals of therapy?
• What specific characteristics do you prefer to have in a therapist (gender, age, sexual orientation, race, ethnicity, religion, language)?
• How do you feel about therapist self-disclosure? How much is too much or too little?
• What type of boundaries do you look for in a professional-client relationship?
• How do you prefer to communicate with a therapist in between sessions (phone, email, text)?
• When do you expect a therapist to be available for both appointments and communication/crises in between?
• How important is a therapist’s office location and how far are you willing to travel?
• Do you prefer a therapist to have a particular professional credential (psychologist, licensed marriage and family therapist, licensed clinical social worker, licensed professional counselor, psychiatrist)?
• Do you want to use insurance or are you willing/able to pay a therapist’s set fee? Do you need to be accommodated with a sliding scale?
• Do you have any special needs that may impact therapy (medical conditions, job, transportation)?
• Is a therapist able to explain what to expect in therapy as well as discuss what some of the potential risks are?
• How does a therapist address miscommunications or problems that come up within the therapy relationship?

This list of questions if far from exhaustive but includes some general areas of treatment that are recommended to think about.  Because all relationships are subjective, what one client may find appealing in a therapist another client may find to be a turn off. Sometimes this process may involve attending a few sessions with a therapist in order to determine if the relationship is worth investing in.  It may be as simple as paying attention to your gut feeling. Don’t become discouraged if a therapist turns out to be the wrong fit since each therapist’s personalities, expertise, and approaches are different.  

Most therapists (at least good ones) should be open and understanding about a client’s decision to discontinue therapy due to a poor fit and be willing and able to provide a list of other therapists who may better meet a client’s specific treatment needs.  Therapists should also be able to educate clients about alternative forms of treatment that may be effective in addressing a specific issue.

One more thing to consider is that like any professional discipline, therapists are regulated by state licensing boards, which are in place to promote ethical, sound, and safe treatment. Therefore when choosing a therapist, clients have the right and ability to review a therapist’s credentials in order to ensure that no complaints or disciplinary actions have been made against him or her.  This information is usually made available on most state licensing boards’ websites in which you can find a link labeled “verify a license.”

~ Cory Stege, M.S., LMFT

Taking Control Of Our Thoughts

Our thoughts can be very powerful and influential on how we feel and experience the world we live in.  We can often find ourselves in a rut when we allow our negative and unhealthy thought patterns to take over, which prevents us from being able to effectively cope with a stressful or uncomfortable situation.  For some of us, it can be easy to get caught in a pattern of rumination or catastrophizing when we are under stress however that type of thinking only makes things worse.  If we can learn to acknowledge our thoughts and direct them in healthy and realistic ways, our stress can be managed more effectively.  So how can we do that? 

There are numerous approaches and strategies that have been found to be effective in managing our thoughts.  One popular and easily applicable strategy comes from the cognitive behavioral model: thought stopping.   Just like its name, thought stopping involves conscious awareness and effort in putting a stop to a negative or unhealthy thought when it occurs and replacing these thoughts with positive and healthier thought patterns.  Here are steps we can take to accomplish this:

1. Recognize and acknowledge when you are engaging in negative or unhealthy thought patterns. This technique will not be effective without awareness of the ineffective or problematic thought process that takes place.
2. Once you notice your unhelpful and negative thoughts, visualize a STOP sign in your mind or yell STOP to yourself.  This step promotes interruption of the problematic pattern.
3. If talking to yourself is not successful, try using a tactile aid to help interrupt your thoughts.  For example, wearing a rubber band on your wrist and flicking it whenever you are thinking negatively can help to block and distract your bothersome thoughts.
4. Once you have blocked your thoughts, replace them with positive images or thought patterns that are healthier and more rational. Thought replacement can occur by challenging each negative thought by asking yourself whether your thought is accurate, realistic, or rational and then identifying or visualizing an alternative thought that is healthier and positive. 
5. PRACTICE! Just like most skills, this technique requires repetition, patience, and practice in order for it to become easier and rewarding.  

This critical skill has been shown to help individuals manage impulsive and compulsive behaviors more effectively as well as minimize the impact that stress and traumatic events have on our mental and physical health.  If we are able to learn how to make our thoughts work for us instead of against us, we will find that we can experience a significant decrease in stress, depression, anxiety, and physical illness.    

~ Cory Stege, M.S., LMFT

Embracing Criticism and Negative Feedback

Ask yourself what typical response (thoughts and feelings) you experience when you receive comments or opinions from other people about something you have done that are not positive or complimentary.  Do you become angry, hurt, and defensive or do you take the information, absorb it, and consider how you can use the feedback to benefit yourself and your relationships?  More often than not, most of us have a tendency to respond to criticism and negative feedback in the former way, especially when we associate criticism with past experiences of blame or rejection. 

Criticism can often be attributed to beliefs about how we view ourselves rather than on the behaviors or actions we engage in.  As a result, we often misperceive positively intended messages to be portrayed as disapproval and judgmental and we can miss out on opportunities for growth and understanding.  So instead of shutting down, becoming defensive, and distancing ourselves from people and situations associated with criticism, we can take steps that will help us acknowledge, evaluate, and consider areas of improvement we can focus on. 

1.     Separate the specific action or behavior the feedback is associated with from who you are as an individual.  Just because someone does not like how you did something does not mean they do not like you as person.  Challenge yourself to take a step back and identify what the feedback is about to avoid assumption-making and blowing situations out of proportion. 

2.     Consider negative feedback from different perspectives by asking yourself if it is true, not true, or partially true.  Consider the perspective of the individual you received the feedback from in order to help challenge your initial reaction.

3.     Determine the value of your relationship with the individual.  Some questions to ask yourself include: on a scale of 1-10, how important is this individual to you? How do I want this person to perceive me? What am I willing to do in order to maintain this relationship?

4.     Assess your needs associated with self-respect.  Clarify how you want to feel about yourself and the specific steps you need to take in order to achieve that feeling so that you are being fair to yourself and to others.

5.     Think before responding.  We typically respond differently when we act out of our emotions so in order to prevent ourselves from regretting something we have said or done, take time to identify how you are feeling and what your core values are.

6.     Respond with assertive communication.  Start by acknowledging the feedback you received and then use “I” statements to share your thoughts and feelings about it. 

7.     Elicit feedback in order to identify opportunities for growth. Whether you agree with the criticism you received or not, ask for specific alternative behaviors or actions you can consider taking in the future in order to improve your relationships and interactions with others.

~ Cory Stege, M.S., LMFT

Rejection: How To Embrace It

Throughout life we can find ourselves in situations in which we feel rejected which tends to occur most frequently in our romantic or social relationships or in our careers and professional lives.  When we experience rejection we are more likely to question ourselves, which can often result in self-doubt, low self-esteem, a decrease in motivation, and a fear of future rejection.  For most of us our initial instinct is to hide from rejection when it takes place because of the pain and discomfort that tends to come with it.  When we hide from rejection, we modify our beliefs and behavior in order to accommodate our fears, which prevent us from opportunities that we normally would consider seeking as well as reinforce our negative thoughts and feelings. 

Like most challenging situations, we can learn to effectively manage instances of rejection so that we benefit and grow from it.  Here are some steps we can take to embrace rejection when it happens to us:

• Identify and acknowledge your thoughts and feelings associated with rejection in order to evaluate and clarify the meaning of it. Journaling can be an effective tool to help you do this.
• Focus on the affirmation that rejection does not mean failure and use it to help you reframe your beliefs about the situation.  For example, if you are not offered a job that you interviewed for consider specific areas of improvement that may help you learn and grow from so that it better prepares you for the next opportunity.
• Focus on the effort you put in to something, not on the end result.  Just because a situation does not work out in your favor does not mean that there were not positive aspects of the situation that you benefitted from.  Being able to focus on your positive traits will combat self-doubt, lack of motivation, or a decrease in self-esteem.
• Get out of your comfort zone.  In order to challenge your fears of rejection, consider opportunities that require you to take small risks.  This may include initiating conversations with strangers or approaching a potential employer directly to propose how you may be a good fit for them. The more often you put yourself out there, the more likely your fears will decrease.
• Look for opportunities of rejection.  Rejection tends to have the most impact on individuals who experience success and positive feedback on a frequent basis because their view of themselves is being challenged.  Consider situations that you are likely to receive honest feedback from that may not always be positive in order to learn and grow from it.
• Be patient with yourself.  Change does not occur over night so try to be compassionate with yourself during this process.

~ Cory Stege, M.S., LMFT

Can't Make Up Your Mind? What To Consider When Feeling Ambivalent

Do you ever find yourself feeling stuck because you know you should change something in your life but you’re not quite sure you should take action? Have you ever considered ending a relationship, quitting a job, or making a lifestyle change but question whether that would be the right choice? Throughout our lives we are faced with situations that motivate us to consider making changes with the hopes of improvement.  However many of us experience some form of worry or fear about the unknown that change can bring, which prevents us from moving away from what we know, even if it is a negative situation.  This experience describes ambivalence, which can be defined as a state of mixed or conflicting thoughts and feelings about a situation, person, or thing. 

Ambivalence is associated with the change process and generally exists within the second stage of change, the contemplation stage.   During this stage, we have recognized that something is a problem for us and that we need to make a change however we are concerned about the potential implications of following through with it.  Usually we find ourselves going back and forth between our desire to make a change and our fear of changing.  We can find ourselves “catastrophizing” or thinking in a worst-case scenario mindset when we allow our fears to take over.  What if we end up regretting our decision to change because we either feel like a failure, it causes problems with others, or the situation does not improve? These are common fears that pop up for us when we are ambivalent. 

We can feel stuck in our ambivalence for long periods of time because time is usually required to achieve some form of resolution.  However there are some questions we can ask ourselves to help us clarify our willingness and intentions of making a change:

• What do you want to have happen and what potential benefits do you hope to achieve by making a change?
• Can you identify any potential constraints to being able to make a change?
• How might your life be different if you make a change?
• What might your life look like in a year if you don’t make a change?
• What are the factors that are motivating you to make a change?
• How do you feel about significant changes you have made in the past?
• What positive attributes, strengths, or traits do you have that you believe will help support you in making a change?
• On a scale of 1-10 (1 being not important and 10 being extremely important) how important is making a change to you? What would it take to make it extremely important?
• What are you willing to do to make a change?

It can be helpful to write out answers to the above questions as well as to organize your thoughts in a way that can help you compare and negotiate with yourself. I always encourage my clients to refrain from making a decision when they are feeling emotional and to instead take some time to evaluate and consider all aspects of their ambivalence before making a choice.

~ Cory Stege, M.S., LMFT

Tips For Surviving The Stress Of The Holidays

We are officially in the throes of the holiday season which is generally a time for joy, excitement, love, and occasions spent with friends and family.  The holidays have also been notorious for being a source of stress for some of us because of the pressures of gift-giving, traveling, family dynamics, time away from work, etc.  It can be easy to get caught up in all of the stress of the holiday season to the extent that it can prevent us from being able to enjoy it and focus on the true meaning of what this time of year bears.  Therefore it seems appropriate to offer some helpful tips for managing stress over this holiday season:

1.    Be aware of your triggers.  In order to be able to effectively manage our stress, we need to identify the specific events/situations that tend to promote or cause it.  It can be helpful to think about what was stressful for you during previous holiday seasons as a strategy for knowing what your triggers may be.  Once we know what our triggers are, we can plan for them by thinking about potential coping skills we can implement when we become triggered.                                                       
2.    Know your limits.  We often feel like we are stretched thin during the holiday season when we think about our time, energy, and finances.  There is a high potential for us to go overboard on planning get-togethers, buying gifts, traveling, and fulfilling traditions that can take time and energy and this can leave us feeling burned out or stressed.  In order to avoid this, we can be realistic and honest with ourselves about how much time, energy, and money we can budget for this time of year.  This means that we might have to say ‘no’ to some activities/invitations and uphold a budget for spending money on gifts and traveling so that we don’t end up regretting our decisions after the holidays end.                                                                                                                                            
3.    Engage in self-care.  The holidays are a time for us to focus on other people which can make it easy to forgo our own needs.  It may feel selfish for us to focus on ourselves during this time of year however if we don’t take care of ourselves, we likely will not do a great job of giving our full attention to those we love and care about.  Engaging in self-care activities is extremely vital to surviving the holidays which means we should aim to:

•    Maintain a consistent sleep-wake schedule so that we are getting adequate rest
•    Maintain a healthy diet
•    Engaging in regular exercise (20-minutes of walking a day can do wonders!)
•    Balance social time with alone time

4.    Find an outlet.  One of the most effective stress management tools we can develop is figuring out what activity we can engage in that allows us to release any negative thoughts, feelings, or tension that we carry around from day-to-day.  Having an outlet is a way for us to gain mental, emotional, and sometimes physical clarity.  Some examples of healthy outlets include:

•    journaling
•    painting
•    working out
•    listening to or playing music
•    playing or watching sports
•    yoga/Pilates
•    meditation
•    prayer

5.    Live in the moment.  Amidst all of the busyness of the holidays it can be easy to  get caught up in the chaos and lose sight of what is happening right in front of us.  When we worry about the future or ruminate on something that has happened in the past, it prevents us from living in the moment and instead promotes stress, anxiety, and depressive symptoms.  Therefore one strategy (which requires practice) is to be mindful about what is happening in the here-and-now and focusing on enjoying the moment.  Since the only control we have is on what is happening in the moment, that’s where our focus should be.

For most of us we have heard about these tips before and for some of us, we practice and incorporate these skills in our daily lives during the entire year.  However when the holidays roll around, it is even more crucial for us to put ourselves first by staying on top of our stress so that we experience this time of year as truly joyful, relaxing, and positive.  Happy holidays!

~ Cory Stege, M.S., LMFT

Setting SMART Goals

Goal setting is a healthy and effective tool that we can use to identify and visualize areas of life we want to develop and improve upon.  Whether we are focusing on our physical, emotional, or mental health or are thinking about our relationships or professional life, goal setting can help us focus and organize our thoughts and actions and promote hope and motivation to better ourselves and experience a more rewarding and fulfilling life. 

There are specific guidelines that we can follow in order to set realistic and attainable goals that can help set us up for success.  These guidelines are outlined in the SMART acronym, which makes it easy to remember which factors should be considered when setting goals. 

S:      Specific: Goals need to be identified in specific, not vague, terms.  In order to identify the details of the goal, answer the questions of what, where, why, when, who, and how much?  For example, what do you want to accomplish? Why do you want to accomplish this goal? What resources do you need to accomplish it? What requirements are needed to accomplish it? Are there any constraints or anticipated challenges to doing so? If so, how are these constraints going to be managed?           

M:     Measurable: In order to determine whether our goal has been met or progress has been made towards it, we need to be able to measure it.  The use of numbers, quantity or degrees of quality, completed tasks, and other units can be used to help us judge our progress.

A:      Achievable: In order to set ourselves up for success we need to think about our goals in realistic terms.  This means that we need to be mindful of our locus of control, resources, and the steps required to meet the goal.  It is important to avoid setting goals that are too high or complex that can end up making us feel like a failure.

R:     Relevant: When we think about a goal we need to answer whether it is consistent with other goals we have (both short and long term) as well as if it aligns with our overall vision of what we are working towards.  Deciding if a goal is relevant can be answered by considering if it is worthwhile, has value, and is appropriate considering the time and resources available to achieving it. 

T:      Time-bound: Effective goal setting involves regular reviews and revisions as well as a date, timeline, or schedule that we can follow to help us evaluate whether we are making progress or have achieved our goal.  Consider how long it will take to achieve the goal, when you will work on it, and what date you would like to complete it by.

~ Cory Stege, M.S., LMFT

The Benefits of Meditation and Visualization

Most of us lead busy and hectic lives that require time, attention, and effort towards work, children, relationships, and trying to squeeze in a social life and alone time. The demands that come with each of these significant areas of life can be challenging to juggle at times and can often lead to stress, anxiety, depression, insomnia, relationship problems, and health issues when we don’t manage them effectively.  Along with self-care skills, boundary setting, and other coping skills, meditation and visualization have been found to have multiple benefits on our mental and physical states and help us tackle our day-to-day lives in healthy ways.  

People often confuse meditation and visualization as the same process however they are in fact different.  Meditation is a process that aims to quiet the mind by directing it to a specific mental state that generally involves the ability to be fully present without allowing any external distractions to impede. Visualization is generally started through some form of meditation and is a process in which our minds repetitively send out commands to our physical and mental states to follow so that we end up making the messages a reality.  For example, when we focus on the belief that we are in a calm and relaxed state, we have the ability to train our bodies to believe that it is actually calm. This is very effective when we experience stress and anxiety since it helps to alter the physical sensations that are associated with it.  

When meditation and visualization are done on a consistent basis, we can train our minds and bodies to work for us instead of against us.  Here are some other benefits associated with these two practices:

•    Promotes emotional balance
•    Improves immunity fighting cells
•    Reduces blood pressure
•    Reduces insomnia
•    Promotes mental clarity
•    Strengthens mind-body connection and communication
•    Reduces somatic symptoms (headaches, stomachaches, muscle tension)
•    Improves circulation
•    Increases fertility

Like most skills, meditation and visualization takes time and practice to master however the benefits that can be reaped are extremely powerful.  Utilizing tools such as guided meditation and visualization or simple breathing exercises can be very effective to help start training our minds and bodies.  

~ Cory Stege, M.S., LMFT  

Understanding The Change Process

Has anyone ever told you that you have a problem, whether it is a specific behavior, pattern of interaction, or coping mechanism but you don’t see it? Have you ever considered making changes in your life but are not sure it is worth it? Or have you decided that a change in your life is necessary in order to function more effectively?  Whatever the reason or motivation is, change does not simply occur overnight or in one step but rather takes place in stages over some period of time. 

Usually we are not willing to acknowledge that we need to consider making changes in our lives until it is apparent that our current decisions and behaviors are causing more harm than good where the consequences outweigh the benefits.   However, the process of change can begin before we are consciously aware of it and can evolve into action-oriented phases, which makes up the stages of change.  Read more about each of these stages:

1.     Pre-contemplation: The first stage of change involves lack of acknowledgment that a problem exists.  A person who is in the pre-contemplation stage of change often engages in defensiveness that he/she engages in any problematic behavior, especially when other people are telling him/her that they are.

2.     Contemplation: The second stage of change involves some degree of awareness and acknowledgement that a specific behavior causes some form of consequences.  A person who is in the contemplation stage of change is able and willing to think about a problematic behavior however they are ambivalent about making any changes.

3.     Preparation: The third stage of change involves a commitment to change a specific behavior.  A person in this stage of change is actively gathering information about his/her options for steps they can take towards achieving change. 

4.     Action: The fourth stage of change involves the implementation of specific steps towards achieving change.  A person in the action stage of change is using his/her motivation and willpower to overtly engage in various techniques that will result in change.

5.     Maintenance: The fifth stage of change involves the continuance of the new behavior or change.  A person in this stage of change maintains a commitment to avoid his/her previous problematic behavior by actively engaging in specific relapse prevention or other techniques in order to sustain the new desired behavior.

6.     Relapse: The sixth stage of change involves re-engagement in the problematic behavior.  This can be a natural part of the change process and does not always indicate regression however the evaluation of triggers should be conducted as well as a plan for more effective coping skills should be established.

The timetables for each stage varies from person to person depending on the behavior being changed as well as an individual’s support system, access to resources, strengths/resiliencies, and other stressors that may be present during the process.  Some common problematic behavior involves addiction, patterns of interaction within relationships, and poor coping mechanisms and the reasons and motivations for making changes differs from person to person.  People can often achieve successful changes in behavior on their own however some situations may indicate that professional help may be needed in order to provide support and guidance in navigating the change process. 

~Cory Stege, M.S., LMFT

The Art of Boundary Setting

Most of us strive to establish and maintain healthy, long-term relationships with our intimate partners, friends, family, and co-workers and one of the most important, if not the most important, skill to achieve this relationship goal is to identify, implement, and uphold clear and direct boundaries.  So what are boundaries in the context of relationships?  Boundaries are the physical, mental, emotional, and spiritual limits we each identify in ourselves that indicate what we are able to tolerate as well as what causes us to experience feelings of resentment, stress, and discomfort.   Usually when we experience resentment or discomfort in our relationships it is because we are allowing ourselves to be pushed outside of our comfort zone and can be warning signs that we need to evaluate how we are managing these interactions so that we can make changes to better suit our needs. 

Here are some questions that can help you determine whether you can improve on your boundary setting skills:

1.     Do you feel guilty when you say ‘no’ to someone?

2.     Do you agree to things that you are not okay with just to please other people?

3.     Do you allow other people to treat you poorly without speaking up?

4.     Are you overly trusting of people you barely know?

5.     Do you expect other people to meet your needs at all times?

If you answered ‘yes’ to any of these questions, you may benefit from evaluating what areas you can consider making changes to. 

So what do healthy boundaries look like?  In order to establish and set limits in our relationships, we need to have self-awareness about our feelings and honor them as well as be clear about how we want others to treat us.  Healthy boundaries are associated with self-respect and the ability to make self-care a priority, even if these boundaries may not be the same for other people you care about or have to maintain a relationship with.   However, just having self-awareness and self-respect are not enough to actually doing the work of establishing and implementing healthy boundaries.  This important skill also requires open, direct, and respectful communication to verbalize and express your needs and limits to others.  This helps other people know where you stand and can promote awareness of what others can expect of you. Healthy boundaries also promote self-confidence, stability, being in touch with reality, as well as more satisfying and rewarding relationships.  

Boundary setting is an essential and vital aspect of establishing and maintaining healthy and fulfilling relationships however it is a skill that does not always come natural or easy to some of us.  Boundary setting takes ongoing practice and awareness in order for us to reap the benefits.  Professional help can be a source of support for individuals who may struggle with this crucial life skill by providing guidance and expertise to promote change.

~ Cory Stege, M.S., LMFT     

Reasons Why Owning A Dog Can Be Good For Your Mental, Emotional, and Physical Health

Service, emotional support, and therapy dogs are on the rise for providing support to individuals who suffer from some form of emotional, physical, or mental health condition however any average dog owner can reap similar benefits.  Whether we are experiencing stress, problems in our relationships, medical issues, or are just trying to take care of ourselves, owning a dog can help soothe our minds, relax our bodies, and promote a sense of companionship.  Here are some specific mind, body, spirit benefits that owning a dog can provide:

Physical activity:  Since most dogs require some form of exercise, owners are more likely to get outside and move.  Being outside and in the sun promotes absorption of vitamin D, which helps improve our mood as well as fight physical and mental health conditions such as depression, anxiety, cancer, heart disease, and obesity.  Exercise also produces endorphins, which are the “feel good” chemicals in our brains that helps to elevate our mood and mental states.  And of course, there are endless benefits of exercise on our physical health including healthy blood pressure, cholesterol, and circulation.  Because our physical and mental states are connected, if we feel good physically, we are more likely to feel good mentally.

Stress reduction: Dogs are not the only ones benefitting from being pet and cuddled by their human owners.  Research has shown that petting a dog in a consistent and rhythmic manner promotes production of the relaxing hormone oxytocin in both humans and dogs.  This effect results in a sense of comfort and helps to decrease stress, anxiety, as well as high blood pressure and a high heart rate.

Healthy distraction:  Engaging with a dog and focusing on the interaction can offer a break from the worries and stressors of the day.  This type of distraction promotes our attention to stay in the present moment, which can boost mood and decrease negative thoughts and feelings.

Companionship: Owning a dog lessens feelings of loneliness as well as prevents isolation since they get us out and about and can promote social interaction with other dog lovers.  Most dogs seek out contact and affection from their owners as well as provide a sense of unconditional love. Dog owners often find themselves venting and talking to their dogs since the chance of receiving negative feedback is small.  Sometimes just the physical presence of a dog can provide comfort, feelings of loyalty, and a sense of security.

Sense of Purpose:  Owning a dog comes with responsibility and the ability to take care of something besides ourselves.  When we are feeling depressed or are having negative thoughts about some area of our life, taking care of a dog can help us get out of our heads by focusing on the dog’s needs, which can be very rewarding.

 Owning a pet is not for everyone, so if you are considering bringing a furry friend home make sure you are in the right place and have enough time and space for them to prevent them from being more of a stress than a stress reliever.  If you are a current dog owner, consider how you can increase your awareness of these benefits in your daily interactions. 

~Cory Stege, M.S., LMFT