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

Limerence: The Honeymoon Phase

Starting a new relationship can be exciting and leave us feeling like we are walking on water. Nothing can get in the way of the natural high we experience with a new partner and we tend to accentuate the affirming characteristics of this person even amidst some warning signs of concern.  We find ourselves spending the majority of our time daydreaming about what we hope this new relationship will turn into and may find it difficult to focus on other tasks.  We strive to spend every waking moment with our new partner and seek out signs that the feeling is mutual.   

This “puppy love” or more commonly referred to as the ‘honeymoon phase’ of a relationship is an actual phenomenon called limerence.  Limerence occurs at the onset of a new relationship in which falling for an intimate partner is easy and instinctive and lasts up to two years on average.  Limerence can be experienced in the following ways:

•    Strong sexual attraction
•    Obsessive thinking or infatuation
•    Emotional dependency
•    Yearning for reciprocation
•    Emphasis on positive characteristics which may be unrealistic or irrational
•    High degree of hope for future of relationship

Generally limerence is a normal, pleasurable, and thrilling phase for most of us however as you learned in the above characteristics, it can also be unhealthy or pathological because of the involuntary and intense emotions that may promote our judgment to be impaired.  Another challenge of limerence is that it ends at some point. The end of the honeymoon phase means that couples must maintain their relationship by focusing on other aspects besides the initial attraction that drew partners together.  This is when reality can hit and many relationships do not survive as a result.  

There are some strategies that new couples can implement in order to bolster the honeymoon phase as well as promote a smooth transition into the next relationship phase. These include:

•    Recognize that no relationship or person is perfect
•    Make efforts to be open and realistic to challenges or negative traits associated with your               partner
•    Express appreciation
•    Find healthy alternatives for meeting emotional needs outside of the relationship
•    Focus on establishing a strong friendship

~ Cory Stege, M.S., LMFT

Understanding Codependency

Codependency is often used to describe a type of person or relationship but what exactly does it mean? Originating from Alcoholics Anonymous, codependency was first used to illustrate how individuals in an alcoholic’s support system act to enable the addictive behavior rather than promote recovery from it.  This concept was developed after a pattern was identified among this population in which individuals sought acceptance and approval by focusing on and becoming engrossed in an addict’s behavior instead of being able to find healthier avenues for meeting their own needs. 

Over time, codependency became applicable to other dynamics outside of alcoholism and can generally be understood as a relationship in which one person enables problematic and unhealthy behavior in another person.  Codependency is a “dysfunctional helping” type of a dynamic that is the result of one individual’s inability to function on his or her own and instead relies on an ill, unhealthy individual’s behavior to build self-esteem and meet emotional needs.  Just as a drug addict becomes addicted to a substance, a codependent individual becomes dependent on the addictive behavior of another individual.

Codependent behavior is viewed as excessive and compulsive and results in individuals losing sight of who they are and what they need because of a preoccupation with the needs of someone else. Many codependent individuals confuse their behavior as caring and empathetic however most efforts to help are not a conscious decision in which consequences to one’s self are acknowledged.  An individual who is considered healthy is able to be attentive to his or her own needs while providing help to others in appropriate ways which is an ability that a codependent individual struggles with.

Codependency can occur in any type of relationship including intimate, family, work, friendships, or groups as well as to varying degrees of dysfunction.  Here are some common behaviors associated with codependent relationships:

• Poor boundaries
• Denial and deceitfulness
• Unhealthy communication
• High reactivity and conflict
• Instability
• Absence of trust
• Intimacy problems
• Power and control issues/manipulation
• Worthlessness
• Avoidance of being alone
• Resentment
• Excessive sacrifices made for other person
• Clinginess or enmeshment

Codependency that goes untreated has been found to put individuals at risk for depression, anxiety, substance abuse, addictive behavior, physical and psychosomatic illness, as well as other unhealthy behaviors.  However, codependency issues can be resolved effectively through a number of treatment methods that include psychotherapy, support groups, or psychotropic medication to treat co-occurring mental health disorders.

~ Cory Stege, M.S., LMFT

Love Maps: The Key To Relationship Foundation

Relationships can be viewed like houses: in order for them to be weather the elements and be long-lasting, they must develop by establishing a strong foundation first.  Without this, a house or relationship will experience cracks that can be detrimental (and expensive).   Relationship researcher, author, and expert Dr. John Gottman, has found that relationships that have 7 levels built into their relationship, which he terms “the sound relationship house”, tend to be emotionally intelligent couples.  So what does an emotionally intelligent couple look like? These types of couples are able to know and store the ins and outs of each partner’s world, which promotes friendship and intimacy and the ability to manage conflict and stress effectively.  To be emotionally intelligent also means that partners have the ability to be attuned to changing thoughts and feelings of one another as time goes on.

Dr. Gottman has termed this detailed knowledge about each partner’s life as “love maps.” Love maps allow couples to learn about the inner life of each partner, which strengthens connection as well as provides insight into how to couples can best support and love one another.  The more couples feel they know one another, the stronger their connection will be and thus they will experience their relationship as rewarding. 

Love maps include significant events and memories, hopes and dreams, fears, preferences, dislikes, etc.  Here are some examples of questions that elicits information that makes up a love map:

•       What is your partner’s most embarrassing moment?
•       Name your partner’s best friend.
•       What current stressors is your partner experiencing?
•       What is your partner’s greatest fear?
•       Describe your partner’s day yesterday.
•       What side of the bed does your partner prefer?
•       How does your partner like to spend their free time?
•       What is one thing your partner would change about their past?
•       What are your partner’s career goals?
•       What is your partner’s worst childhood memory?

The bottom line is this: get to know your partner! Couples who are friends tend to develop a deep bond, a strong level of intimacy, and the ability to handle stress and conflict in effective manners.

~ 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

The 'Do's and Don'ts' of Comforting Those Who Are Grieving

Loss is an inevitable part of life that each and every one of us will experience, whether it is related to the death of a loved one, the end of a relationship, or the loss of a job.  Even though grief and loss are experiences that impact us all, the process associated with it looks different for each of us.  This means that there is not a “right” or a “wrong” way to grieve or a specific length of time that grief should last. The nature of the loss, an individual’s support system, additional stressors, and typical coping styles are some of factors that make the process of grief unique to each person. 

It can often be challenging to support and comfort someone that we know who is grieving and we can find ourselves at a loss for what would be helpful to say or do.  Here are some tips for what we can do as well as what we can avoid in order to be supportive to those who are in the midst of grief:

 DON’T:

• Think about grief as a problem that needs to be fixed.
• Avoid or ignore someone who is grieving because you don’t know what to do or say.
• Tell someone ‘to get over’ their loss and move on.
• Put a time limit on grieving.
• Give unsolicited advice.
• Assume that someone who is grieving does not need your help or support because they don’t ask for it.
• Make statements like “it is for the best”, “everyone is in a better place”, or “everything happens for a reason.”
• Make any judgments about an individual’s grieving process.
• Ask detailed or intrusive questions about the nature of the loss unless the individual wants to talk about it.

DO:

• LISTEN! Offer an ear and allow the grieving individual to navigate conversations about his or her loss.
• Separate your own thoughts, beliefs, and feelings about grief from the individual who is grieving.
• Be available and contact the grieving individual regularly.
• Anticipate possible needs of someone grieving and offer to assist (cook, clean, etc.)
• Be patient with the individual’s pace of grief.
• Offer to ‘just be’ with the grieving individual. The mere physical presence of others can send a significant message of support.
• Initiate plans (meals, walks, movies, etc.) with the grieving individual and understand that he or she may decline.
• Validate and empathize with the individual’s thoughts and feelings associated with grief. 

~ Cory Stege, M.S., LMFT

Relationship Destroyers: The Four R's

What separates healthy, long-lasting relationships with relationships that fizzle is the absence of specific unhealthy and problematic behaviors and coping mechanisms.  In addition to Dr. John Gottman’s Four Horsemen that includes criticism, contempt, stonewalling, and defensiveness, there are four other predictors of the dissolution of a relationship: resistance, resentment, rejection, and repression. Otherwise known as the four R’s, these toxic behaviors support and promote ongoing and increasing tension within a relationship.  The four R’s can also be understood as defense mechanisms that individuals engage in to help manage painful or uncomfortable feelings associated with an interaction or relationship dynamic.  The problem with these unhealthy defense mechanisms is that they breed disconnection and negative feelings instead of achieving resolution and feelings of connection.

Resistance
Have you ever noticed that you feel annoyed, critical, or have the desire to distance yourself from your partner after he or she has said, done, or expressed a feeling that you do not like or agree with?  If so, you may be experiencing resistance, which in and of itself, does not end a relationship.  Resistance becomes a problem when a partner deals with these feelings by ignoring or minimizing it, which promotes the second R, resentment.  An effective way to cope with resistance is to acknowledge and share it with your partner in a respectful way so that a mutual process of resolution can take place.

Resentment
Resentment is the result of unmanaged feelings of resistance that is characterized by hostility, anger, and increased criticism.  Resentment prevents couples from emotionally connecting and creates distance within a relationship.  The longer a partner decides to manage his or her feelings through resentment, the more likely they will begin to engage in the next R, rejection.  However in order to prevent rejection from developing, couples must be open and honest in their relationships about the feelings that are contributing to tension so that opportunities to resolve them can be created. 

Rejection
Rejection occurs when resistance and resentment within a relationship go unmanaged and can be exhibited either actively or passively.  Active rejection occurs when partner makes his or her anger and resentment known through complaints, criticism and verbal abuse, threats to end the relationship, refusal to engage in activities or interactions with his or her partner, stonewalling, and efforts to create time apart from his or her partner.  Passive rejection is exhibited through indirect means in which a partner may not have awareness of it. Examples include losing interest in activities or interactions with a partner, spending more time at work or in other activities, fantasizing about being with others, engaging in an affair, ignoring, or challenging a partner. Rejection means that unmanaged tension has evolved into physical and emotional distance and often relationships end when rejection occurs. However if couples remain together through rejection but do not effectively acknowledge and resolve it, the fourth R, repression, occurs.

Repression
Couple’s who evolve into a repressed state as a result of unmanaged resistance, resentment, and rejection have become emotionally numb to one another as well as may begin to experience numbness in other areas of their lives.  Repression is a defense mechanism that couples engage in to help make their lives more comfortable with unpleasant feelings, which can often promote a false sense of satisfaction.  Therefore repression leads to the end of a relationship when couples bottle their unpleasant emotions over a long period of time and feel that too much distance has been created to come back from it. 

Hopefully it became obvious that the only way to avoid the Four R’s from occurring in a relationship is to:
1.    Acknowledge and take responsibility for any negative or unpleasant feelings when they occur; don’t wait and stew on it.
2.    Use assertiveness skills to share your true and honest feelings in an open and respectful manner.
3.    Verbalize the behavior or actions you would like you and your partner to engage in that you believe will effectively manage the negative feelings.
4.    Practice active listening and be responsive to when your partner speaks. 
5.    Negotiate and engage in a process of resolution with your partner. 

~ 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

Tips For Baby-proofing Your Relationship

Expecting a baby brings a multitude of emotions for couples that range from excitement, joy, fear, stress, and worry.  This significant life event will no doubt change couples’ lives in various ways and having an understanding about the potential impact a baby can have on a relationship is crucial for couples who want to prepare and promote a smooth transition.  

The needs within a relationship begin to change the second a couple learns about a pregnancy because of the biological instincts that are triggered.   When pregnancy enters the picture, women tend to highlight the need to nurture and protect the baby and thus the bonding process between mom and baby commences from the get-go.  For men, pregnancy promotes a need to be able to provide for the baby, which influences men to focus on work or other means of providing.  Because of this, men typically do not begin the bonding process until later into pregnancy or for some, after the birth of their baby.

Along with other competing needs that couples manage prior to childbearing, these innate pregnancy-related needs can accentuate areas of disparity between partners and have the potential to create tension, conflict, and disconnection if couples do not anticipate and manage them effectively.   Here are a few suggestions couples can consider to help “babyproof” and preserve their relationship:

·      Acknowledge and anticipate that your relationship is going to change.  Engage in ongoing conversations together about the specific areas of your relationship that will likely be impacted once baby is here (quality time, intimacy, finances, etc.) Once the areas have been identified, begin to brainstorm and problem-solve how each partner wants to manage them.

·      Develop regular self-care habits before baby comes. This includes eating healthy, engaging in some form of regular exercise even if it is taking a short walk, following healthy sleep hygiene, and staying connected to friends and family). 

·      Re-evaluate finances and create a baby-friendly budget.  Often times income for couples changes as a result of taking time off of work or when one parent transitions to being at home full-time.  Couples who can agree on and follow a budget that reflects the new needs of their family are less likely to experience stress and conflict.

·      Develop a plan for managing sleep deprivation.  The first few months of parenthood means sleep will be one of the first lifestyle changes to significantly decrease in quality.  Sleep deprivation can lead to moodiness, a decrease in cognitive functioning, illness, and conflict between partners.  Couples who are able to establish a plan for taking turns or accommodating one another during late night sleeplessness tend to tackle this transition more effectively.

·      Address the elephant in the room: sex.  Sex and intimacy are the most common aspects of a relationship that are hit hard once a baby enters the picture.  For women, their bodies are healing and going through physical and emotional changes from pregnancy, childbirth, and breastfeeding and their main priority is focused on taking care of the baby.   Because men are not directly impacted by the biological changes that women are, they tend to focus on feeling needed as well as desired by their partner in the capacity of both partner and father.   Thus, the needs of each partner conflicts and leads to feelings of rejection and disconnection.  In order to prevent or resolve these relationship hazards, couples are encouraged to renegotiate what their intimacy needs are and how they can be met.

As I have addressed in a previous article about the benefits couples experience by engaging in premarital counseling to help them be successful, there are also many benefits couples can obtain by participating in pre-baby therapy. Incorporating some of these tips into an expecting relationship can create and promote opportunities for growth and connection instead of tension and distance.

~ Cory Stege, M.S., LMFT

Rid Yourself Of Toxic Feelings Through Forgiveness

Being in a relationship means that at some point there will likely be times when we experience feelings of hurt and betrayal as a result of feeling like our expectations or boundaries were violated in some way.  This can happen in our relationships with an intimate partner, friend, family member, or coworker and can influence us to varying degrees depending on our thoughts about the betrayal as well as how we decide to manage it. 

According to the Merriam-Webster dictionary, to forgive is defined as an action “to give up resentment or stop feeling angry” (2017).  It is imperative to debunk the assumption that forgiveness is a process we go through for the individuals who have hurt us but rather forgiveness is a choice we can make in order to improve and change things for ourselves.  When we feel hurt and betrayed by others, we are likely to experience feelings of anger and resentment, which are emotions that have the potential to prevent us from experiencing what we want.  Holding onto these negative feelings have a more direct and negative effect on the individual doing so, rather than on the individual we are angry with.  To forgive does not mean that we are condoning or ignoring behavior that caused hurt but rather it is an avenue for gaining peace within our hearts and minds.  

Here are some steps we can take to help us promote forgiveness in order to gain relief and resolution within ourselves:

1.     Acknowledge what happened.  In order to better understand what you are thinking and feeling, identify triggers to your hurt, anger, and resentment. Sharing your experience with an objective person or journaling so that you can express yourself instead of bottling your thoughts and feelings can assist with this step.

2.     Ask yourself what you want to have happen.  Being able to identify what you believe will help you feel better can direct your focus to productive problem solving rather than ruminating on an event in the past. 

3.     Identify constraints that may prevent you from letting go of your anger and resentment.  Look for reasons you are using to justify your negative feelings and challenge whether they are rational or not.

4.     Ask yourself how you are benefiting from holding on to your anger and resentment.  It can be helpful to remind yourself that forgiving does not mean condoning but rather it can alleviate toxic feelings.

5.     Consider different perspectives of your anger and reframe your needs.  It can be beneficial to empathize with the individual who hurt you as well as use meditation or spirituality to gain a healthier outlook on how you would like to manage your relationships.

6.     Decide to let go.  Even though you may never forget how someone hurt or betrayed you, you have the power to decide how you want it to affect you.  Don’t allow your anger and resentment to be in control. 

~ Cory Stege, M.S., LMFT

Suicides In The Military: On The Rise

Sadly the number of self-inflicted deaths for active duty military members, reservists, and members of the National Reserve continued to increase in 2016.  Although the statistics for suicides in the military are not yet out for the entire year of 2016, the Department of Defense reported 110 suicides in the first quarter and 103 suicides in the second quarter of 2016 (DOD Defense Suicide Prevention Office), which means that there could be close to 400 military suicides just last year.  These statistics are significantly more than any training or combat-related deaths in the military in 2016.

So how do we make sense out of these rising numbers?  It is an understatement to say that suicide continues to be a critical public health issue, both in the military and in the civilian communities.  Although there is not a single or clear cause or precipitant to suicide, there are patterns and trends associated with suicides in the military that have been identified over the years.   According to research conducted by the DOD DSPO (2016), some of the common factors linked to suicide include exposure to combat and life threatening situations during deployments and challenges with managing the significant transitions that active duty service members experience when they join the service as well as leading to and following deployments.  More emphasis is being placed on the latter as a risk factor of suicide since it has been found to result in substantial disruptions in service members’ interpersonal relationships.  Along these same lines, an individual’s degree of experiencing feelings of connection and belongingness to others within their community during times of transition can influence level of risk. 

It is important to acknowledge that a number of individuals in the military enter the service with pre-existing stressors and mental health issues that place them more at risk for suicide, especially after they experience some of the demands and stressors associated with military life. 

So what can we do to begin to reverse this trend?  For one, everyone can take accountability for knowing that we each have a critical role in preventing suicide, regardless of who we are or what we do for a living since suicide affects everyone.

Other steps we can take are:

1.     Recognize the warning signs to suicide in those around you. This includes listening and looking for:

•      an increase in substance use; isolation or withdrawal from support network
•     a significant change in behavior, especially after a loss, trauma, or life transition
•       reckless behavior
•       insomnia or sleeping too much
•       giving away personal belongings
•       calling/writing to people to say goodbye
•       researching or looking for ways to die
•       aggressiveness and rage
•       depression
•       Irritability/anger
•       Humiliation/embarrassment
•       Decreased involvement in activities and hobbies
•       Anxiety
•       Talk of severe hopelessness or being a burden to other people
•        Expressing pain and not having any reasons to live
•       Expressing suicidal ideation that the individual wants to kill themselves 

2.      Be willing to listen in a non-judgmental manner.

3.      Offer hope that there are options for getting help.

4.      Seek support from others who can provide resources or treatment.

If you or someone you know is experiencing suicidal thoughts or is at risk for suicide, use these resources below to access help 24/7:

Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Veterans Crisis Line: 1-800-273-8255 press 1

Crisis Chat for online emotional support: crisischat.org

Crisis Text Line: Text START to 741-741

~ Cory Stege, M.S., LMFT

Shame Versus Guilt

When we think about feelings we experience we typically categorize them into positive or negative and on a continuum: happy, sad, excited angry, fearful, etc.  Shame and guilt are two emotions that tend to fall into the negative category, as they can be uncomfortable and unpleasant to experience.  Shame and guilt often get confused as being the same emotion however they are in fact different.  It is important to be able to comprehend how these two emotions are both similar and different in order to better understand our experiences so that we can address and cope with them appropriately.

Guilt:  A feeling of remorse or regret that is associated with something we have done.  Guilt is a response we experience that is based on our behaviors and choices which typically involves the violation of values, beliefs, or standards of ourselves or of other people.  Because we are human and make mistakes, it can be expected and normal for each of us to feel guilty from time to time.  Guilt can influence us to consider making changes in order to avoid or prevent future instances of it.   

Shame: The feeling or perception of inadequacy when we think about ourselves in relation to others.  Shame is linked to our self-esteem, or how we view ourselves, and is associated with worthlessness and feelings of failure.  Shame is typically a response we experience when we feel insulted, put down, or blamed by significant people in our lives (parents, siblings, partners, friends, etc.) and we receive messages that we are bad or not worthy.

In other words, guilt = a feeling associated with something we did and shame = a feeling associated with who we perceive ourselves to be.

Now that the primary differences between shame and guilt have been identified, hopefully it makes sense for why each emotion needs to be treated differently. 

In order to resolve feelings of guilt we can examine the behavior that caused it, seek forgiveness from others as well as ourselves, and focus on clarifying our values in order to prevent poor choices from recurring.  In order to resolve feelings of shame, we need to peel back the layers that contribute to our core beliefs about the world and ourselves.  We can then begin to challenge and reframe our perceptions so they are more in line with how we want to be perceived. 

Guilt and shame can be very powerful emotions and if we allow them to go unmanaged, it can lead to irrational and unrealistic thinking, feelings of depression and anxiety, social isolation, substance abuse, and health problems.   Therefore if you experience feelings of guilt or shame or think they are negatively impacting your functioning, don’t hesitate to reach out to others to talk or consider seeking professional help.  

~ 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