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Practical ways to relieve the pressure How to Avoid Parental Burnout With kids home for the summer, it may feel reminiscent of life during Covid-19. Trying to keep children occupied while continuing to work and take care of home and family responsibilities can stretch any parent’s mental, physical, and emotional resources. And not just during summer, or a pandemic. The regular day-to-day of kids picking at their dinner, battling bedtime, having homework meltdowns, squabbling with siblings and struggling with friendships can all add up, causing some parents to reach the point of burnout. But it doesn’t have to get to this point. Finding practical ways to relieve the pressure and preserve your energy can help reduce your burnout risk. What is parental burnout? According to the American Psychological Association, “burnout” is defined as physical, emotional, or mental exhaustion accompanied by: · decreased motivation · lowered performance · negative attitudes toward oneself and others It’s caused by a high degree of stress and tension, especially from extreme and prolonged physical or mental exertion, or an overburdening workload. If you can relate, you’re not alone. Most parents have experienced some level of exhaustion at some point, or many points, along the parenting journey. The type of exhaustion you experience may vary, depending on the age of your kid(s). Physical exhaustion is common during the younger years, while mental and emotional exhaustion are more likely during the ups and downs of parenting a tween or teen. But parental burnout goes beyond feeling worn out at the end of a rough day. The excessive or prolonged exhaustion takes its toll, especially when you have a lack of resources to deal with it. What are the symptoms of parental burnout? While burnout affects everyone differently, there are some common signs to look out for: · fatigue · physical or emotional exhaustion · irritability · emotional distancing from your child · lack of motivation · feeling alone · isolation or detachment from others · feeling helpless or hopeless · self-doubt · physical symptoms, such as headaches or muscle aches Unlike other jobs, the role of parent is one you can’t quit, which can leave some parents feeling trapped. As a result, they may resort to things like yelling, avoidance, neglect, or violence, even if they’ve never engaged in these types of behaviors before. This can lead to feelings of shame or guilt, which may result in unhealthy coping patterns, such as overeating or drinking. It becomes a vicious cycle of negative behaviors leading to negative feelings leading to more negative behaviors. Tips to prevent parental burnout While you can’t escape exhaustion altogether, there are some things you can do to avoid reaching the point of burnout. Let the little things go. It’s natural to want to be the best parent you can be. But when perfection is the goal, it’s easy to get stuck in a sea of “shoulds.” Research suggests parents who are perfectionists or put pressure on themselves experience higher rates of burnout. Try to remember there’s no such thing as “the perfect parent.” See how it feels to let go of some of the smaller things. Maybe the pile of laundry in the corner can wait another day, or you end up giving in to “just one more hour” of screen time. Sometimes a good day is good enough for today. And that’s ok. Take a parental “time-out.” It’s hard to meet your child’s social/emotional needs when you’re feeling wiped out yourself. If you can, step away for a brief period, especially when stress and emotions are high. Getting out of the house, or just in a closet for a few deep breaths, can help you return to the situation with calm and focus. Prioritize self-care. While it might seem like adding one more thing to your “to-do” list, self-care can soothe your nerves and recharge your battery, so you actually have more to give as a parent. Adequate sleep may seem elusive at times, but it can make a huge difference, along with getting regular exercise and prioritizing healthy foods. Fun is self-care, too, so do whatever speaks to your soul, whether it’s soaking in a warm tub, reading a novel, or spending a night out with your partner or friends. Ask for help. Of course, finding time for yourself is not so simple. When? How? Consider leaning on family and friends, or perhaps trusted members of your religious community. You may be surprised how willing they are to babysit or pitch in where needed, especially if they’re familiar with the demands of parenting. This also extends to your children. Enlist their help with chores to take some of the household duties off your shoulders. Finally, if you find it difficult to manage stress on your own, reaching out to a therapist can help you work through difficult thoughts and emotions, as well as find other ways to get the support and relief you need. Susan Fishman, NCC, CRC, Website Sources: https://www.apa.org/monitor/2021/10/cover-parental-burnout; https://dictionary.apa.org/burnout; https://www.psychologytoday.com/us/blog/the-ocd-monster/202105/7-tips-prevent-parental-burnout; https://link.springer.com/article/10.1007/s10826-019-01607-1

Swipe left or swipe right? Swipe left or Swipe Right? Millions of people make this decision on hundreds of different online dating sites every day. At the present time, there are over 8000 dating sites across the globe. Thirty percent of U.S. adults have used or are using an online dating site during their lifetime. (Pew Research Center, 2020) Why are these sites so popular? For one thing, they are convenient. Prior to the advent of online dating, people generally met potential dating partners through mutual acquaintances, at a local bar, a party or other event. These were face-to-face encounters, there were no “profiles,” and there were no screens or smart phones available to remotely find a soulmate. With online dating, the task of finding someone is much easier. For the equivalent cost of one or two nights out with friends, you can purchase a monthly subscription to a dating site that will do the work for you, so to speak. It will help you find “matches” without having to go through the hassle and effort that was once required AND from your own home or wherever you choose to log in. But how successful are these dating sites in finding you an effective match? In the United States, thirty-nine percent of users of these sites say they have found a significant-other that resulted in a committed relationship or marriage. (Pew Research Center, 2020) This is a substantial number of people! There is no doubt that for many, these sites pay off in terms of helping people find the results they are looking for. But does this success rate mean that using these sites is necessarily good for everyone’s mental health? The answer may surprise you: For one, many users of online dating sites spend excessive amounts of time simply looking at the sites. The act of scrolling and tapping that is often required is a core behavioral pattern that is often connected to smartphone addiction. The sites are designed so that we spend more time on them, engaging in behavior that is more likely to lead to addiction. (G. Bonilla-Zorita, 2020) Research shows that spending more time on the sites may also lead to higher rates of anxiety and depression. Those with social anxiety are more prone to developing these symptoms. For many people, online dating is not really about dating but about self-validation. Many people connect with others on these sites, not to date but for validation of their own self-worth. If someone’s self-esteem is hooked up with how others respond to them online, they may become dependent on a dating site to bring them the life satisfaction that they cannot find elsewhere. This may lead to depression as a person with this type of dependency is substituting online dating for finding healthier forms of happiness in their everyday lives. (G. Bonilla-Zorita, 2020). In addition, those who peruse these sites often develop what is known as lower conscientiousness. This trait leads to higher sensation-seeking and sexual permissiveness; patterns that are often self-sabotaging and can become dangerous, increasing the chance of physical and/or sexual abuse. (G. Bonilla-Zorita, 2020). Finally, there are pitfalls to online dating that are endemic to all social media connections: deceit and financial exploitation. Many online dates “complain” that the profile they are viewing is inaccurate and portrays information that is false in a variety of different ways that may lead to serious consequences. Is online dating worth it? The answer is yes, however, it is advisable to be aware of the pitfalls; extended use may cause serious mental health issues, including the possibility of smartphone addiction and may lead to a greater chance of risky behavior and deceit. It is very important to evaluate (with the help of a professional if necessary) what your motives are in pursuing online dating. Are you looking to meet someone significant or are you looking for self-validation and to improve your self-esteem? Are you using online dating sites to avoid other important areas of your life and more healthy development? If your real motivation is not actually to date but for other unhealthy reasons, you will be spending your money on something that probably won’t lead to finding a healthy relationship and it may ultimately bring you more unhappiness and general frustration towards meeting other people. David Steingart, LCSW

There's evidence that bio-genetics play a significant role in suicidal activity. Heredity, environmental factors, and epigenetics contribute to suicide risk. There is a 2.1 to 2.7-fold increase of suicide risk in relatives of suicide victims. Family suicide history should be considered a strong risk factor and heavily inform one's overall level of risk and safety planning. A family history of suicide is correlated with a 2.1 to 2.75-fold risk increase in relatives (e.g., Qin, 2003; Jang et al., 2002). When presented with this information, students and concerned parents have asked me, “Is suicide something genetic?” My answer is, “It depends.” As noted by Hoehne et al. (2015), “The heritability of suicide is well-established.” If, however, by “genetic,” one means the inheritance of a specific, self-destructive gene that pointedly leads to suicide, then no, that’s not been discovered. If someone means suicide is influenced by genetics, that’s a different story. A multifactorial blueprint To start, one might figure that such genetic influence is rooted in, say, depression, a disorder known for genetic factors that are highly correlated with suicidal activity. For example, Zai et al. (2012) wrote, “In a study of suicide records dating from 1880 to 1980 in an Amish community, Egeland and Sussex (1985) found 26 reported suicides that aggregated within four families who also had a high incidence of mood disorders….” They continued, however, “The authors also found other families that were affected by multiple mood disorders but had no history of suicidal behavior.” Next, add to this the statement from Diblasi et al. (2021), “Broadly, molecular studies suggest a complexity of suicide etiology that cannot simply be accounted for by depression.” Based on the above two researchers’ statements, it’s clear that genetics influence depression, and while some depressed people become suicidal, it’s more complicated than the influence of any inherited mood alone. The “ingredients” are perhaps best encapsulated by Kouter et al. (2019), who wrote, “[Suicide] is a result of the interplay between hereditary and environmental factors, tied together by epigenetics.” A survey of biogenetic factors In more recent years, increasingly-sophisticated medical technology has allowed researchers to examine specific aspects of brain anatomy and genes that contribute to suicidal activity. For example, Cha et al. (2017), citing Gosnell et al. (2016), provided: “The hippocampus, which is connected with the body’s stress response system and important in mood regulation and memory, has been found to be structurally abnormal in suicide attempters. The [dorsolateral prefrontal cortex] is involved in goal-directed behavior, decision-making, and emotion regulation and is also found to be structurally abnormal in suicide attempters.” Further, there is the ventral prefrontal cortex (VPC), which is important in “binding together the large-scale networks that subserve emotional processing, decision-making...” (Gage & Baars, 2018). The VPC seems influenced by molecular-level complications, illustrating the role of biological or genetic intricacies underlying some people’s suicidal activity. To expand, Leonard (2005), for example, noted postmortem studies of depressed people found that the VPC showed serotonin deficits. Serotonin is believed to be essential in controlling aggressive or impulsive behaviors (e.g., Popova, 2008). Leonard surmised this implies a dysfunction in the serotonergic system, for which “there is increasing evidence of a genetic basis.” This said, biological contributions quickly become more complicated, going from gray matter to microbiology. Readers interested in an in-depth review of molecular contributions may be interested in reading Turecki’s 2014 paper, The Molecular Bases of the Suicidal Brain. In brief, the author explained how early-life adverse environmental factors (epigenetics) can alter gene expression, which influences stress response associated with a lifetime susceptibility to suicidal behavior. As for the suicide-stress response link, O’Connor (2020) pointed out that hypothalamic-pituitary-adrenal (HPA) axis dysregulation is a particular culprit, which, as noted by Berardelli et al. (2020), disrupts healthy neurotransmission. To add to this more specifically, Oquendo et al. (2014) observed that an altered stress response seems responsible for downstream effects in the form of the aforementioned serotonin system abnormalities. If this seems overwhelming, bear in mind that it is only a glimpse of the research on the bio-genetic factors of suicide. In addition, is it chicken or egg? Do people with the above complications have more proneness to being depressed, a state of being that then interacts with those factors for a dangerous cocktail? Or does being depressed initiate some of the bio-genetic abnormalities that are correlated with suicide attempts? Clinical implications Outside of psychiatrists prescribing antidepressants, clinicians likely aren’t able to change someone’s bio-genetics. Further, antidepressants alone likely cannot alter such a complicated equation to eradicate bio-genetic risk factors entirely. There may also be cultural factors related to the family for clinicians to consider. For instance, Jang et al. (2022) discovered that South Korean survivors of suicide victims were three times more likely to die by suicide. Interestingly, this was especially true for wives whose husbands died by suicide. The best that clinicians can do is: 1) Always ask about a family history of suicide, and 2) if present, weigh it as a significant factor when deciding someone’s level of risk or the observation or safety planning required. If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness or suicide in readers or people they know. The information should not replace personalized care or intervention from an individual’s provider or formal supervision if you’re a practitioner or student. Anthony D. Smith, LMHC - Blog

When all the focus is on one person’s needs. Healthy relationships involve equality and mutual respect. When one partner has disproportionate power, their goals and desires may be prioritized over their partner's. Being in a powerless role can lead to self-silencing, over-apology, objectification, and negative emotions. A romantic relationship shouldn’t be a power struggle. While it may not be realistic to feel perfectly equal all the time, people in healthy relationships at least strive for this goal. Rather than trying to maximize their own power at their partner’s expense, they want one another to feel empowered to make decisions. Not all relationships follow this pattern, though. Sometimes the balance of power is heavily lopsided, with one person’s needs and goals taking priority. The powerful partner may benefit from this dynamic, but the powerless partner is more likely to suffer. Research has identified a range of negative experiences associated with being in a lower-power role, five of which are described here. If you relate to these, it could be a sign that there is an imbalance in your relationship worth examining. 1. You don’t feel like you can be yourself with your partner Powerful people may feel more free to express themselves, whereas those who lack power may feel pressure to tailor their behavior to the needs of others. One study found that romantic partners with less power (agreeing with statements like, “Even if I voice them, my views have little sway”) were more likely to hide negative thoughts and feelings during daily interactions with their partners, whereas their partners were unlikely to feel this constraint. Another study found that even just thinking about a time when someone else had control or influence over them made people feel that it was harder to be themselves and share their true feelings. 2. You’re always the one apologizing Power may reduce people’s motivation to apologize for their transgressions. In a series of studies, higher-power people were more likely to make “non-apologies,” for example downplaying the offense, making excuses, and blaming the other person. Those in low-power positions were more likely to make genuine apologies involving taking responsibility, expressing remorse, and making amends—perhaps even when they were not the ones at fault. Consistent with this pattern, research suggests that power may in some cases make people less likely to feel compassion for others’ suffering. 3. They can tease you, but you can’t tease them A third red flag is asymmetrical teasing. Teasing can be playful and harmless, but it can also be used to humiliate or belittle. Studies have found that people with higher power tend to tease others more frequently and in more direct and hostile ways. Those with lower power, by contrast, are less likely to tease in the first place, and when they do, it’s more likely to be delivered in a kind and polite way, presumably because they fear a negative reaction from the higher power person. 4. They treat you like an object Research suggests that powerful people are more likely to objectify others, evaluating them in terms of their usefulness (that is, how they serve the powerful person’s interests), and giving less consideration to the other person’s humanity. One set of experiments found that this objectification can be literal: when heterosexual participants were in positions of power, they were more likely to perceive images of opposite-sex people using cognitive processes similar to those used when perceiving physical objects, as if they were viewing a collection of parts rather than a person. Other research has found that the dehumanizing effect of associating people with objects can increase the risk of sexual exploitation. 5. You don’t feel good when you’re around them Power creates what researchers have called a reward-rich environment, one where people feel free to pursue their goals and feel confident that good things will come to them. Low power can instead create a threat-rich environment, where people have to stay vigilant to avoid negative outcomes or punishment and feel limited in what they can comfortably do or say. Put simply, having power tends to feel good while lacking power does not. In one study, when dating couples discussed topics related to their relationship, partners with less power felt more negative emotions, including shame, embarrassment, and discomfort, whereas their higher power partners had more positive emotions, such as pride, happiness, and amusement. Is There a Way Out? Power imbalances can create a vicious cycle where the negative consequences of the imbalance only serve to reinforce it: the more self-conscious and inhibited the lower power person feels, the harder it may be to stand up for themselves, and the more easily the powerful person is able to get their way in the future. Sometimes an imbalance can be rectified, especially if your partner is open to working on it, but other times ending the relationship may be the best course of action. This is especially true if there are signs of abuse. Research has found that a power imbalance is a risk factor for the development of intimate partner violence, making it important to identify and address this dynamic early on. Even if a power-imbalanced relationship does not involve abuse, it may still cause harm. Getting support from loved ones and mental health professionals can be helpful for regaining a sense of power and re-evaluating the relationship. For example, if your focus has been on what your partner wants and whether you’re doing a good enough job giving it to them, try turning the tables, and ask yourself what you want in a partner and a relationship. Does your partner have qualities that you value? Do you feel happy and fulfilled spending time with them? These may seem like obvious questions, but when all your energy is going towards trying to please another person, you may forget to ask them. While it’s laudable to value your partner’s happiness, you deserve someone who will do the same for you. Juliana Breines, PhD - Blog

Make it a focal point of your life. It's easy to forget the importance of our emotional health when we're caught up in the daily grind. But neglecting our emotional well-being comes at a significant cost, affecting our relationships, work performance, and overall quality of life. That's why it's critical to prioritize our emotional health and make it a focal point of our lives. This blog is resource to help you cultivate your emotional well-being and lead a happier, more fulfilling life. So, let's take care of ourselves - nothing is more important than staying emotionally healthy! Understanding Emotional Health Taking care of our emotional health means understanding and acknowledging our positive and negative emotions. It means effectively managing stress and anxiety and nurturing healthy relationships with us and others. Emotional health also involves coping with life's challenges and setbacks, such as loss or failure. Research shows that poor emotional health can lead to physical problems, such as lowered immunity, increased risk of heart disease, and other chronic illnesses. Therefore, it is vital to prioritize emotional self-care in our daily lives. The following sections will explore practical ways to manage our emotional health, from mindfulness practices to seeking professional help. We can live a happier, more fulfilling life by cultivating emotional health. Seeking Professional Support Despite our best efforts to prioritize self-care and manage our emotional health, there may be times when we need professional support. Seeking help from a therapist or counselor can be a proactive step toward improving emotional well-being. It is essential to recognize that seeking professional support is a sign of strength, not weakness. Just as we would seek medical attention for physical health concerns, it is equally important to seek professional support for emotional health concerns. A therapist can provide a safe and confidential space to explore and process emotions, develop coping skills and strategies, and better understand oneself. Understandably, seeking professional help can be intimidating or stigmatized in certain cultures. However, it is essential to recognize that therapy is not only for those with severe mental health concerns. Therapy can benefit anyone, regardless of their emotional state. Taking the step to seek professional help can be challenging, but it is crucial to taking care of our emotional health. Doing so gives us the tools and support needed to navigate our emotions and live a more fulfilling life. Building a Support System Maintaining our emotional well-being is a complex and ongoing process. While practicing self-care and seeking professional help is crucial, having a support system can also make an immense difference. A support system may include family members, friends, colleagues, or virtual communities offering a listening ear, encouragement, and an overall sense of belongingness. These individuals can be precious during times of emotional distress or hardship. They can provide motivation when we feel demotivated and comfort when we feel vulnerable. It's essential to acknowledge that seeking help from others is not a sign of weakness but rather a courageous act of strength. A robust support system can aid us in maintaining good emotional health and providing comfort during challenging times. Here are some steps to building a support system for emotional health: Identify supportive and trustworthy individuals: Consider individuals in your life who consistently exhibit kindness, empathy, and understanding. These can be people you are close to, such as family and friends, or colleagues and acquaintances with whom you have a positive relationship. Communicate your needs: Communicating your needs with your support system can be helpful. Let them know what emotional support you need, whether a listening ear, advice, or someone to spend time with. Be selective in who you confide in. While it is essential to have a support system, it is equally important to be selective in who you confide. Choose individuals who have earned your trust and positively impact your emotional well-being. Prioritize reciprocal relationships: Building a support system does not mean relying solely on others to provide emotional support. It is essential to prioritize reciprocal relationships in which you also support others in your life. Consider joining a support group: Support groups can be a helpful resource for individuals facing similar challenges or experiences. They provide a sense of community and can provide invaluable support and perspective. Building a support system can take time and effort, but the benefits for emotional health can be substantial. With the correct individuals and resources, navigating emotional challenges can become more manageable and fulfilling. Warning signs to look out for Here are some common warning signs that your emotional health is at risk: Persistent feelings of sadness, anxiety, or emptiness Loss of interest in activities that once brought joy or pleasure Feeling isolated or disconnected from others Changes in appetite or sleeping habits Chronic fatigue, lethargy, or lack of focus Inability to manage stress or cope with daily challenges Increase in substance use or other self-destructive behaviors If you have experienced any of these warning signs, it is essential to seek professional support and build a robust support system around you. Taking care of your emotional health is a continuous process, and it's essential to be proactive in identifying potential risks and taking steps to maintain and improve your emotional well-being. Remember, self-care is not selfish, and prioritizing your emotional health benefits you and those around you. Final Thoughts To summarize, prioritizing our emotional health is crucial to leading a happy and satisfied life. It's essential to recognize any warning signs indicating risk and take immediate steps to address them. Building a solid support system and seeking professional help is essential to maintaining emotional well-being. One must understand that emotional health cannot be ignored or overlooked. By placing importance on our emotional health, we can lead fulfilling lives and positively impact those around us. Matt Guttman, LCSW - Website

4 considerations that may aid your therapeutic journey Taking care of your mental health is just as important as taking care of your physical health. Seeking professional help may sometimes be overwhelming, especially when considering the cost. We'll discuss the top 4 reasons why finding a therapist that takes your insurance may aid your therapeutic journey. Cost-Effective Using insurance to pay for your mental healthcare is a financial benefit that will likely save you money in the long run. Therapy sessions can be costly, averaging about $150 per session in the United States; even one session without insurance can be a significant expense. If you find a therapist that accepts your insurance, the cost per session can be significantly reduced, making it more accessible to the average person. Better Quality Care If you have insurance, you can choose from a pool of in-network therapists who have been vetted by your insurance company. It typically takes months for insurance carriers to verify a therapist’s education, training, and experience before allowing the provider in-network status. By finding a therapist paneled with your insurance company, you’ll likely save time searching for a quality provider and benefit from better care and outcomes. Long-Term Therapy Therapy is often a long-term commitment to achieve and sustain the outcomes we want. Paying out of pocket for services can add up and may be financially stressful. Finding a therapist that accepts your insurance ensures you continue receiving the treatment you need for longer without sacrificing your financial health. Consistency of Treatment The cost of each session may be a significant factor in deciding how often you see your therapist. If therapy is a financial burden, some people may skip sessions or choose to attend therapy less frequently. Attending weekly therapy sessions, however, is often crucial to the rapport-building process with your therapist, to your ongoing progress in treatment, and to successful long-term results. By finding a therapist that accepts your insurance, you may be better able to attend therapy consistently and set yourself up for therapeutic success. Overall, finding a therapist that accepts your insurance may offer financial benefits, ensure quality care, allow for longer-term therapy, and support regularity of treatment. Don't let the cost of mental healthcare prevent you from getting the help you need. Finding a therapist that accepts your insurance may be the first step to achieving your mental health goals. Reach out to your insurance company and start the journey to a healthier you today! The Resilience Center of Houston accepts many Insurance plans and provides therapy to children, teens, and adults with several locations in greater Houston.

Personal perspective: It’s OK to admit you’re not OK. Bipolar disorder can strike anyone, regardless of gender, race, education, or class, from pre-teens into our sixties. It is an equal opportunity disorder and can, at its worst, destroy lives and health, marriages and families, careers, friendships, finances, and more. Many people with bipolar disorder are not as fortunate as I was. Between 25 to 50 percent of the five million or more people with bipolar disorder in the U.S. attempt suicide at least once. Eight percent succeed in killing themselves, and the suicide rate for people with bipolar is four times higher than the general population. Although it’s not known how many active-duty military may have bipolar disorder, data suggests that some 700,000 veterans live with it. [1, 2, 3] Deciding to publicly share my bipolar disorder story is a serious matter, but something I had to do. I argue that seeking mental health treatment should be destigmatized and dealt with the same way our culture deals with cancer, diabetes, or a broken leg. With physical illnesses, we tend to recognize the symptoms, get medical help, recover, and get on with our lives. We don’t (usually) blame or shame the sick or injured person for their malady. In most cases, we love, support, and help them get well. Yet with mental illnesses, we often wait for people to fail before we get them the help they need. How is it that failure—often with permanent family, legal, social, career, or academic consequences—tends to be the first and only indicator of brain maladies? How can we change this? In my view, we need more scientific research on bipolar disorder and other mental illnesses, brain health broadly, and the “invisible wounds of war.” We must identify the genetic early warning markers, find the causes, understand the disease mechanisms, and develop preventive medications and better recovery treatments. We need earlier identification of symptoms and even potential cures. This research is vital for our society—especially, I believe, our veteran population and our serving military. Moreover, how can we accommodate people who have these maladies so they can continue their careers? There are some examples of the medical and academic professions finding ways to do so. Professor of psychiatry Kay Redfield Jamison of Johns Hopkins University, for example, has suffered from severe bipolar disorder for decades, yet figured out how to manage it and perform at a world-class level as both a psychiatrist and a scholar. Could other professions perhaps follow suit? Millions continue to suffer. Worse still, their suffering is compounded by the stigma many members of our society continue to attach to brain maladies. By some grim coincidence, I found myself finally healthy enough to begin to tell my story during the worst public health crisis of our time. But even when the pandemic is over, our mental health crisis will remain, and even appears to have worsened. What You Can Do If you or someone you love is demonstrating the warning signs of bipolar disorder or another serious mental illness, go get medical help immediately. Engage your medical professionals—understanding that bipolar is difficult to diagnose, can blend in and interweave with other brain maladies and personality traits, and can take years to properly diagnose and treat. Read, study, and learn all you can about bipolar and mental illness in general. Engage fully in this effort. Knowledge is power. Once you are prescribed medication and treatment, stick to it and maintain an informed dialogue with your doctor and therapist. Steel yourself to be compliant for life. Bipolar disorder never takes a break, and neither can you. Like me, you may find yourself in a “forever war” that you cannot quit or walk away from, without potentially disastrous results. Be strong and help stop the stigma! The good news, though, is that bipolar disorder is a treatable medical condition. With proper treatment and a determined attitude, it's possible for many people with bipolar disorder to live successful, happy lives. It takes courage and strength to admit you need help, to get it, and to walk the road to recovery. I am not ashamed or embarrassed to be a bipolar survivor and thriver. In fact, I am thankful and proud to have survived this toughest of battles—with the support of my wife, family, friends, the VA, and grace—and to be thriving once again, with the unexpected gift of a great new life. References: 1. NIH “Undiagnosed Bipolar Disorder: New Syndromes and New Treatments”, Ira D. Glick, MD. 2. NIH Suicide attempts in bipolar I and bipolar II disorder: a review and meta-analysis of the evidence 3. Office of Research & Development USVA Gregg F. Martin, PhD - Website - Book

A Personal Perspective: Therapy won't save you. That doesn't mean it's not worthwhile. Let me start by saying that I love therapy. I’m a therapist and was an enthusiastic therapy client for years before becoming one. For me, therapy is fun. (Whatever impression that gives you of me is probably accurate.) When I decided to become a therapist, I knew it would be challenging–and it is! But it’s a challenge I feel suited for. I enjoy sitting with people in their hardest moments. I love existential questions and feel energized by brainstorming with my clients as they grapple with life’s greatest hurdles. I believe most people could benefit from therapy, and therapists do enormous good and alleviate much suffering. Now that I’ve gotten that out of the way, here’s my less likable take: Therapy won’t save you. It won’t solve your problems, make your life easy, and keep you from ever experiencing anxiety, self-loathing, or despair. It won’t do that for me, either. That’s because therapists aren’t miracle workers. We can’t pluck you from a broken society and place you somewhere safe. We can’t make you immune to the complicated realities of being a person; the best therapists know this. If a therapist implies that therapy can solve all your issues, maybe think twice about working with them. They might be a teensy bit out of touch. It’s not that life has to be torture or that there’s no way to improve our well-being. If you’re struggling with depression, anxiety, or any other mental health symptom, I strongly encourage you to reach out to a professional. Therapy can almost certainly offer some relief. Still, no matter how much healing we do, we must live in the earthly realm. If you haven’t noticed, things have gotten pretty weird here. Most of us living in the United States have to fight almost every day to meet our basic needs. We’re lonely, overworked, and worried about the future. Many therapists are in that fight alongside their clients. Plenty of us deal with the chronic pains of prejudice, poverty, and disability. We drink unsafe water. We live in fear of guns. We keep cutting our own bangs, even though they have never once looked good. If anything, our experience engaging with the hardships of the modern era is part of what makes us good at what we do. A good therapist will draw from their own history as well as their education. They won’t try to act like they have it all figured out or are above you in some way. They won’t gaslight you into believing things make sense or that life would be easy if you just made the right choices. They will teach you to find and build community so you won’t have to lean on them alone. They’ll validate your struggles and efforts to survive because they will have struggled in some way too. They’ll assist you in accepting the bitter truths of living in a time when the sky is sometimes on fire, and many good people are having a very hard time. A good therapist will help you see that you’re not struggling because you’re weak, doomed, or a terrible person. You’re just living in a pretty tough place. They’ll help you understand your thoughts and feelings so you can embrace the power you do have to make your life more manageable and meaningful. A good therapist will get to know you. They’ll help you figure out what problems can actually be solved and which you’ll just have to live with. They’ll teach you skills that apply to your unique situation with its particular pitfalls and possibilities. They’ll help you make the most of a less-than-ideal situation and hopefully help you feel good about being alive, even now, smack dab in the middle of this wild, messy, beautiful world. Chelsea Harvey Garner, LMHP - Website - Book: A Pity Party Is Still a Party: A Feel-Good Guide to Feeling Bad

First, never forget that the decision to change is theirs alone. If there's something you wish your partner would change, think carefully about why it's important to you. Rather than complaining to your partner, let them know what your experience is. Challenge yourself to see the situation through their lens, so you have conversations that honor them. As a therapist, I tend to focus on self-empowerment. I want my clients to succeed, and by far the easiest way to succeed is to make sure your aspirational goals are 100% within your own power. That’s why I encourage my clients to quickly let go of pseudo-goals. By that, I mean goals that are actually about their partner changing. Pseudo-goals sound like “I want my partner to go to the gym, so I’ll be more attracted to them” or “I want my partner to want to have sex more often.” Goals like those aren’t goals at all; they are wishes for something outside of yourself to change, which, of course, is not within your control. Goals that are outside of your locus of control are a near-guaranteed ticket to frustration and disappointment—and a great way to irritate your partner as well. That doesn’t mean you shouldn’t have wishes or desires that may involve hoping your partner will change in some manner. It’s perfectly natural to have these feelings and thoughts! Nonetheless, for the sake of avoiding frustration and disappointment, it is very important to realize those are wishes, not actually something you can control. So what options do you have when there is something you wish your partner would change? First, think carefully about why the change is important to you. Getting clear about this will help you initiate a meaningful conversation with them in which you honestly express what you miss, wish for, or desire. Let’s imagine, for example, you notice that they spend a lot of time getting sucked into their screens. Do you miss their undivided attention? Prefer no devices at mealtime so you can experience a tech break? Or something else entirely? Think it over until you have gotten clear about what this means to you on a deeper level than merely a complaint. Plan to focus on your feelings, preferences, and desires, and then also make time and space to get curious about what they think, feel, and want about the same issue. Plan to really put yourself in their shoes and understand it from their perspective as well as express yourself to them. When you are ready, initiate a conversation. Rather than complaining about their behavior, let them know what your experience is, and why the issue feels important to you. I highly recommend being direct and non-judgmental. I also suggest focusing on what you want, rather than what you don’t want. Compare these examples: “I really miss having meals with you where we talk with one another about our days, and generally have a break from screens and devices; it gives me a really lovely feeling of connection with you, and also creates a nice still-point in my otherwise busy day.” “You know I hate it when you are on your phone during dinner; it’s so disrespectful. Why do you keep on doing that even though you know I hate it? How hard is it to just put down your phone?” These are two ways of expressing the same wish, but you can probably imagine that they’re likely to land very differently. The first frames the issue in positive terms, focusing on what the speaker really wants, and reaches out to the loving, compassionate part of the listener that really wants to connect with their partner — whereas the second version is likely to put the listener on the defensive right off the bat. The next part of the conversation involves asking what their experience of this issue is: What do they think, feel, prefer, or want? What is important to them about it? What do they want you to understand about their perspective? Really challenge yourself to see the situation through their lens, so ultimately you have had conversations that honor both of your perspectives equally. These phases of the conversation are for the purpose of getting to know one another (and yourselves) better with regard to the issue. That’s not the same as problem-solving, so slow down a bit and don’t worry about finding a solution right away. Focus on gaining an understanding of what this is all about for each of you. For instance, maybe you’ll learn that they’ve been feeling much more stressed than usual at work, and find themselves reaching reflexively for their phone as a quick and easy way to self-soothe — and then, when they start to feel your irritation that they’re looking at their phone instead of at you, it makes them feel even more stressed, and then even more likely to get sucked into the screen. Taking your time to truly understand the dynamics at play in the situation can help disarm some of the negative feelings you may both be having, and when your partner feels heard, they’re much more likely to be open to trying something different. There may even be something you want to do differently yourself. If you want to move to a problem-solving phase, I suggest you do that in a separate conversation. You might ask if they are interested in working with you to come up with a solution that works for both of you. I recommend asking before diving in because if your partner feels cornered or pressured, they are unlikely to be flexible or creative in the problem-solving process. That’s just human nature; to stretch and grow, we need to feel safe enough to get curious about possibilities that are outside of our comfort zone. Nobody does that well when they’re feeling guarded, judged, or attacked. Getting stuck in a battle of wills will most likely lead your partner to double down on the behavior you’re talking about. Here’s an idea of how you might go about having this conversation with your partner: Let go of the expectation that you will be able to control your partner’s actions. No matter how you express your request, it’s possible that your partner will just say “no.” Make your peace with that possibility; they have just as much of a right to make choices as you do. Get clear on what you’re asking. If all you can think of is a complaint, go deeper and see what’s underneath it for you. This topic is important to you for a good reason; figure out what is most important to you about it before you start talking about it with your partner. Frame it in positive terms. Talking about what you want to experience is a much better motivator for change than complaining about what pisses you off. Be open to hearing their perspective, including learning why they don’t want the same thing you do. If it turns out you have a big difference of opinion, don’t get in a fight or dig in; instead get curious. Ask questions. Learn more about what’s going on for them. Feeling heard will put your partner at ease, and you might learn that there are aspects of the issue that you hadn’t considered. You might also discover that there are ways you can help that you hadn’t realized before–and the process of thinking through the issue might give your partner a chance to reflect on what is and isn’t working for them. Release the actual decision-making to the person making the change. Remember, you can only change yourself, and your partner can only change themselves. You can inspire someone to change, and you can request someone change, but you can’t make anyone besides yourself change. Honor and appreciate one another. Engaging in deep conversations like these is an act of love, respect, and courage. Even if you haven’t entirely resolved the problem (yet), don’t forget the importance of honoring one another and the process of showing up authentically and becoming better teammates with the kinds of challenges we all face. You get major props from me for taking part in this deeply challenging yet rewarding process. Martha Kauppi, LMFT, CST-S, Website - Book: Polyamory: A Clinical Toolkit for Therapists (and Their Clients)

While each family is different, there are some common elements that can contribute to a healthy family environment. Respecting opinions and personal needs, as well as showing respect, are all part of healthy family systems. In isolation, one or more of these characteristics not being a part of your family is not in itself dysfunctional. Whenever I conduct trainings or start working with clients who are beginning their journey in recovery from family trauma, I like to go over some basic characteristics of healthy families. If we do not know what is healthy, it's difficult to identify what was unhealthy. These may sound easy to identify, but in truth, many of us are unaware of what makes a family healthy—or normal. Words like “healthy” or “unhealthy” have become so commonplace, but few of us could describe the characteristics required to use these words in relation to families. Thus, I focus on these six to give a foundational understanding to build from. Here are six common characteristics of healthy families or social systems: 1. Respecting healthy emotional and physical boundaries. Children and other family members have privacy, and all members understand and respect that. In healthy families, parents do most of the emotional work with their children by modeling empathy, self-control, and appropriate behaviors in response to emotions or stress. The role of children is to learn. 2. Seeing each family member as an individual with an opinion. Everyone is allowed to have an opinion and all family members should respect and allow those opinions to be expressed as long as they are respectful, even if adults make the final decision. In families where there is little room for differing opinions, it is common for children to grow up into adults who do not know who they are. When you are always taught how and what to think, it is normal to not know how to do this for yourself. 3. Setting consistent, fair, and age-appropriate rules and expectations. All families have rules and it would be normal to find homes with different sets, but rules that are inconsistent or not age-appropriate create an environment of confusion and chaos. Children are still growing and learning, so a caregiver’s expectations of them should not be the same as their expectations of themselves or other adults. 4. Meeting each person’s needs appropriately. All members are concerned with the health and well-being of others, but in an age-appropriate way. Parents provide emotional care for the children; not the other way around. As best as they can, other members also seek to meet their other family members' needs. 5. All members of the family feel safe and secure. Children in healthy families feel safe learning, growing, and making mistakes. They have a healthy understanding of mistakes and understand that they will not challenge or threaten their security or safety. Love is unconditional. 6. Expecting mistakes and forgiving them in a healthy way. The family members understand that we are all humans learning and growing. Conflict is handled in an appropriate and safe way, with adults modeling appropriate ways to manage disagreements and disputes. These families explore mistakes to understand and improve, instead of shaming people for them. Children understand that they will be punished for unacceptable behavior, but that they will also be forgiven for making mistakes, instead of having them held against them for years after. Take a moment to think about your family history and if you remember any of the above characteristics. Often, people who experienced family-of-origin trauma will not have these experiences. This list can just give you an idea—if none of them took place in your home, that might be a sign that things were at least somewhat unhealthy. In isolation, one or more of the above characteristics not being a part of your family of origin is not in itself dysfunctional. For example, different households might have different ideas about whether and how the children can express their opinions based on individual family dynamics, like culture, generation, and other factors. All of the above items do not have to exist together, either, for a family to be healthy. Kaytee Gillis, LCSW-BACS - June 15, 2023 - Website - Book: Invisible Bruises: How a Better Understanding of the Patterns of Domestic Violence can Help Survivors Navigate the Legal System

Cognitive restructuring can help you change your beliefs about health. People with health anxiety hold maladaptive beliefs about health and illness. Core beliefs influence how we interpret and react to symptoms and bodily sensations. Core beliefs aren't permanent; they can be changed. Cognitive restructuring is a CBT technique that can be helpful in reshaping maladaptive beliefs about health into adaptive beliefs. People with health anxiety have dysfunctional beliefs about health and illness. One common belief among health-anxious people is that they are weak and particularly vulnerable to sickness or disease. They might have the sense that their health is ‘barely hanging on by a thread.’ They are convinced that, because of their presumed weakness, any illness or disease that happens to come along will be what puts them in the grave. Now, I want to recognize that in some cases, people are actually dealing with serious or debilitating diseases and have compromised immune systems. And in those cases, of course, one may be particularly vulnerable to illness and the appropriate steps need to be taken to protect their health, as advised by their doctors. That said, many people who experience health anxiety and live with this assumption are not weak or vulnerable to disease to the extent they are assuming. And this belief causes them to live in fear of any and all diseases, naturally. Why? Because if they believe that any disease they get will be the end of their life, it is only natural to live in fear of it! Of course they are going to be startled by and concerned about any bodily sensation or symptom that pops up because they are convinced it could be the beginning of the end. The whole process can look a little like this: They hold the core belief that they are weak and vulnerable to disease, and therefore live in fear of disease because they believe they won’t stand a chance against it. This belief leads them to be hypervigilant and on high alert for any potential ‘threats’ (i.e. symptoms or bodily sensations). Any time they have a symptom or bodily sensation (even when it is neutral or benign such as due to normal body noise or anxiety), they fear it may be due to a serious disease. They then make biased interpretations of the symptoms or bodily sensations (i.e. engage in thinking errors). Their misinterpretations make them feel very unsafe and, therefore, they begin to do a bunch of things to feel safer (i.e. engage in safety behaviors like going to the doctor frequently, asking loved ones about symptoms, googling symptoms, incessantly pinching, poking or checking body parts or symptoms). So, how does one change this cycle? The goal is to recognize one's own physical strength, resilience and capability of coping with, treating or overcoming the vast majority of illnesses and diseases. This is where cognitive restructuring techniques can be helpful. Cognitive restructuring is a CBT technique that helps one to examine and challenge their thoughts and beliefs. In this case, one needs to examine the evidence of their belief, that they are weak, vulnerable and prone to sickness. This process allows them to pull out all of their assumptions (i.e. write them down) and evaluate the validity of each one. We often don’t question our beliefs but just assume they are valid. This is problematic because our beliefs are the lens through which we see the world around us. If one has illogical or faulty beliefs, they may be interpreting symptoms in a distorted and biased way without even realizing it. Challenging core beliefs When it becomes evident that a client carries this belief of being weak and vulnerable to disease, I suggest we take a few minutes to challenge it. Step 1: We write the maladaptive core belief at the top of the worksheet (I am weak, vulnerable and prone to sickness). Step 2: We then come up with a new, more adaptive belief (the goal is for them to learn to believe this more and more over time). Step 3: We assess the degree to which they believe both beliefs (0-100, with 100 being the strongest). Step 4: We make two columns, one to gather evidence for the old core belief and one to gather evidence for the new core belief. Step 5: We begin collecting evidence for the old, maladaptive core belief. Step 6: After we are finished, we go through the list of evidence and look for any potential thinking errors or inaccuracies. We write out the reframes next to each piece of evidence. Step 7: We then move to the right side to list out all the evidence that contradicts the old core belief and supports the new core belief. Step 8: As a final step, we look through all of the evidence on both sides and then assess the extent to which they believe the old core belief as well as the extent to which they believe the new one. If they believe the new core belief even a little bit more (and the old core belief a little less), even if it is only a 10-point difference, I would conclude the intervention was helpful. See the table below for a detailed example of the results of this activity. It’s important to keep a few things in mind when completing the core belief worksheet. 1. When you are identifying evidence for the old/maladaptive core belief, make sure you are including everything. Even if you know the piece of evidence is silly, you still want to write it down. You need to give yourself the opportunity to really challenge this and see how illogical it is. If you don’t, you still may carry it around in your mind as a truth, to some extent. 2. Make sure you document the extent to which you have both beliefs, before and after the intervention. This will help you to evaluate whether it was helpful. Importantly, don’t discount small changes in your belief after you do this. Even just 10 points can make a difference and mean the intervention was at least somewhat helpful. 3. You will not change your beliefs entirely during this one activity. Beliefs take time to change. Use this worksheet as a starting point. You will then work to build from there, slowly collecting evidence in your environment to support your new, healthy belief. In addition, you will want to continue to challenge any assumptions you make in your daily life that support your old belief. A few final comments There you have it! Try this activity out for yourself and see what you come up with. Cognitive restructuring can take time at first. But, as you continue to use these skills, it will take less and less time for you to come to these same conclusions. Remember this: Your thoughts and beliefs about health and illness are not facts! Evaluate their validity and try to come up with new conclusions. It takes work at first but is well worth the effort. Brittney Chesworth, PhD, LCSW - June 15, 2023 - Website