Psychology and Mental Health Notes

On Psychotherapy

2009-09-12T05:00:00.001-04:00

So you've never seen a psychologist? Are you wondering what happens in therapy and how a psychologist might be able to help you? The American Psychological Association has published an informative article on this very topic.

How to Find Help Through Seeing a Psychologist

10 Ways a Psychologist is Different Than a Friend

2009-09-01T21:30:00.001-04:00

While nothing beats a true friend, many who are unfamiliar with the mental health profession wonder how seeing a counselor is different from a good chat session with a great buddy. Here are some ways the two differ:

1. A psychologist has your mental health and well being in mind at all times, without personal biases or secondary motives to get in the way. Even the truest of friends may have difficulty remaining objective at times!

2. A psychologist generally aims to avoid advice-giving. She instead uses her professional knowledge to help you increase your coping and problem-solving skills and to help you carefully evaluate your situation and options so that you can find the answers yourself that are appropriate for your unique circumstances. In this way, you are the ultimate architect of your life, and you leave the therapy relationship with new skills to face new problems in the future.

3. You can disclose to a psychologist what might be too humiliating or embarrassing to discuss with a friend. Chances are, your concerns will not shock or offend a seasoned psychologist.

4. Your “secrets” that you disclose to a psychologist are confidential and generally protected by law. There are some exceptions to confidentiality, such as abuse/neglect, imminent risk of danger to yourself/someone else, and court subpoena (check your state laws).

5. No give-and-take is required. The psychologist is there to help you; no reciprocation is necessary.

6. A psychologist possesses specialized knowledge and skills to help you identify the problem areas in your life, work through your feelings, explore possible solutions, and initiate change. A psychologist is aware of and uses strategies that have been shown by way of scholarly research to work.

7. A psychologist can provide psychometrically sound testing to help determine the source of emotional or behavioral difficulties in your life.

8. You don’t have to worry about burdening or upsetting the psychologist the way you might worry with a friend.

9. Sometimes, friends can vary in the level of support they provide. Your friend might be going through her own problems and not be as available to you. In this way, a psychologist can be more predictable and stable as a source of support.

10. For a variety of reasons, many people feel “safer” discussing their problems with a psychologist who is removed from the situation and is objective.

On Change

2009-08-25T23:44:00.007-04:00

God, grant me the serenity
To accept the things I cannot change
The courage to change the things I can
And the wisdom to know the difference.

The ubiquitous serenity prayer: known to most everyone, particularly those familiar with 12-step groups. I have always found peace in its message – a sense of comfort in the reminder that although there is much over which I have no control, my burden is lessened.

Accepting the Things We Cannot Change

Have you ever felt as though you were carrying the weight of the world on your shoulders? Some of that weight likely involves situations and people that you try in vain to change, and come up feeling frustrated, anxious, and powerless. Could it be that you are seeking to control or change that which is effectively out of your hands? It can be difficult to recognize when we are fighting a losing battle. We become so entrenched in trying to change the unchangeable that we lose the ability to see the forest for all the trees.

Consider relationships. How many times have you experienced struggle in a relationship and found yourself pressing the other person to change a behavior or characteristic? You want your spouse to stop drinking, or become more attentive, or stop being verbally abusive. You may employ tactics such as confrontation, passive-aggressiveness, manipulation, bribing, or pleading. You may walk around on eggshells, fearful of doing something to set off unwanted behaviors. Accepting powerlessness when you are truly powerless over a situation is liberating. Take a realistic self-inventory of the people and situations over which you have been spinning your wheels and decide to set those burdens down. It frees up energy so that you can focus on that over which you do have control.

Finding Courage to Change the Things We Can

Suffering can be immobilizing, and resistance to change can be due to a variety of factors. You may resist changing a negative behavior, situation, or relationship because you fear that even worse consequences will result. You may feel powerless over things that are actually under your control, and you think, feel, or believe you are not in control. As in the previous guidance on taking inventory over what you cannot change, it can help to take a realistic look at your situation and evaluate what truly IS in your control.

If you are in a negative relationship and feel paralyzed, for example, determine whether there are options. You may not be able to change your partner’s behaviors or feelings, but you can choose whether to remain in that relationship. You can choose your responses to situations that are beyond your control.

Try this exercise: think of a situation or problem you have. Draw a line down a piece of paper and list the aspects you cannot change on the left hand side. Now list the aspects you do have control over on the right hand side. Also list the possible actions you can take to change the situation, even the actions you may not want to take right now. You may find that you have more control over the situation than you thought! Weigh your options and then decide what course of action is right for you.

Finding the courage to change comes after you determine what you need to change. On another piece of paper, write the action you want to take at the top. Then draw another line down the page and write the potential positive results of taking action on the left side. Will taking action remove you from an unhealthy relationship? Could it result in a better job? Open you up to more opportunities? Improve your self-esteem? Then list the possible negative outcomes of the action on the right side.

Once you’ve done this, if you decide to make the change you’re considering, formulate a plan of action. Be specific. What will you do? What will you say? How will you act once you’ve made this change? It might help to talk to a counselor or other trusted individuals close to you as you explore this.

Achieving the Wisdom to Know the Difference

This is perhaps the most important piece – how do we accept what we cannot change and change the things we can if we don’t know which is which? This speaks, in part, to the concept of locus of control, which refers to our beliefs regarding why things happen as they do. This concept can be thought of as a continuum, ranging from internal to external locus of control.

If you have an entirely internal locus of control, you believe that you are ultimately in control over your experiences and circumstances. You believe that what happens in your life is the result of your own efforts. This mindset is commonly thought of as psychologically healthier because you feel more in charge of your life and what happens to you. Just be careful not to take responsibility for too much – because, as mentioned, you may not be in direct control over the actions of others, or over random events that might arise that derail your efforts. For example, if a person with a strong internal locus of control works hard to climb the corporate ladder, then gets laid off due to massive budget cuts, it can be difficult not to blame himself.

If your locus of control is entirely external, you are convinced that your experiences and circumstances are outside your control. You believe that you are utterly powerless to change any negativity that comes your way. You may have adopted a victim mentality. These individuals risk depression and anxiety, as an entirely external locus of control contributes to feelings of hopelessness. You may lack motivation to follow helpful advice from concerned friends and professionals because, inside, you truly believe that you cannot affect the outcome. The messages that you give yourself may contribute to this unhealthy way of thinking. “Bad things always happen to me.” “Nobody will hire me with my resume, so why bother trying?” “I’m stuck in this relationship.” What messages do you tell yourself that keep you immobilized? Chances are, some of this self-talk is untrue and prevents you from gaining the courage to change.

Learning to objectively decipher the difference between what we CAN and cannot change is a crucial key to achieving a strong sense of self-worth, a positive attitude, and happiness!

P.S. I have chosen to enable the ability of readers to comment on my posts. I look forward to hearing from you!

On Stress

2009-08-15T21:38:00.003-04:00

Stress is a fact of life. We have positive ways of dealing with stress, and we have negative ways. I thought I'd share some of my own personal positive stress-reducing tactics. I encourage you to make your own list of healthy stress-reduction techniques and refer to them when you're tempted to resort to your negative or counter-productive habits.

My personal top ten ways to reduce stress:

1. Exercise
2. Abdominal breathing
3. Reading
4. Writing down my thoughts
5. Warm bath
6. Listening to music
7. Decorating or home improvement projects
8. Talking to someone close to me
9. Listening to comedy on satellite radio
10. Stretching

What are yours?

On Forgiveness

2009-08-04T20:00:00.002-04:00

“He who cannot forgive breaks the bridge over which he himself must pass.”
–George Herbert (Welsh poet, orator, and priest)

Have you ever been baffled by one of those stories where someone forgives someone else for something seemingly unforgiveable? For example, a mother forgives the drunk driver who killed her teenager. A man forgives the stepfather who molested him as a child. Did you find yourself infuriated and perplexed, wondering, “How in the world could they forgive that person? Are these people insane?”

More likely than not, these individuals forgave in the sense of ceasing their own anger and resentment. It was for their own healing. Forgiveness in the sense I am describing today is not about making it “okay” or removing the responsibility from the person who did something heinous or hurtful. It’s not about condoning or excusing a horrible act. In fact, forgiveness is not really about the other person at all. It is about the forgiver.

You have probably felt vengeful toward someone who has wronged you. You may have thought to yourself, “If only I could punish that person, or make him or her feel as badly as I feel, I would feel better.” The truth is, revenge does not promote healing, and it rarely lessens the sufferer’s pain. This is not to say that people should not be held accountable for their actions, but expecting to feel better after “settling a score” is largely unrealistic.

Forgiveness is a gift you give to yourself. It cleanses you of the soul-stealing, health-harming emotions of anger, resentment, and bitterness. These emotions can grow like a cancer, eating you up inside and taking over your life. You might put up a wall with other people in your life in the hope that it will protect you from being hurt again. It can result in a reduced ability to trust even trustworthy people, leaving you alone and consumed by hatred. How can you possibly heal if you cannot let go of that pain? When you develop the capacity to forgive, you release the hold that the person, the wrongful act, has over you.

Before you embark on a journey toward forgiveness, make sure you’ve recognized and worked through your negative feelings as best you can. Denying any looming anger and bitterness and attempting to “force” forgiveness is inadvisable. Beyond this, the first step toward forgiveness is recognizing what it is and what it is not. Knowing that it is about YOU and that it can help you heal is a step in the right direction. As with many self-improvement concepts, it is a process rather than an event. Do not feel discouraged if you cannot let go of the painful emotions right away. Here are some exercises that may help nudge you down the path of healing:

1. Write a letter to the person who hurt you. Tell the person how the act affected you. How do you feel about the act? How do you feel toward the person who hurt you? Then tell the person that you intend to take steps to let go of your negative feelings (e.g. hate, revenge, resentment) so that you can reclaim your power and begin to heal. I do not suggest that you send this letter… it is for you.

2. Engage in some self-talk. Ask yourself whether your negative feelings will right the wrong that someone has done to you. Will plotting revenge really undo what has been done? Will seething anger toward the offender result in anything positive? Answer these questions honestly, and remind yourself that letting go of the painful feelings is the only way to free yourself.

3. Practice deep breathing, relaxation techniques, and/or meditation. Resources on these topics abound, and perhaps in a future post I will address them. For now, know that these techniques can help you deal with anger and bitterness.

Note that these suggestions do not include steps toward repairing any relationship with the person who wronged you, if that is even possible or desired. That is a whole different topic and is beyond the scope of this post. Finally, if you find you are having trouble taking steps toward forgiveness, please consider seeking help from a therapist with experience in this area.

On Gratitude

2009-08-01T16:50:00.001-04:00

Merriam-Webster defines “gratitude” as “the state of being grateful; thankfulness”, with “grateful” being defined, in part, as “appreciative of benefits received.”

If you are searching for happiness, peace, or even contentedness, a good place to begin is with the concept of gratitude. Everyone, no matter their current circumstances, can find reason to be grateful. Seeking out the gratitude within is not an event; it is a process. It is an exercise and expression of self-love. It is a reframing of life that frees the soul little by little.

Here is an exercise in gratitude to get you started:

Sit quietly and think of something simple that could be your “object of gratitude”. Some ideas:

· A stranger let you pull ahead of them in traffic today.
· You received an unexpected call or email from someone and they asked how you are doing.
· Your child drew a picture for you.
· A pair of cardinals visited your birdfeeder this morning.
· It rained today. Or… it didn’t rain today.
· Your favorite ice cream was on sale.
· You received a compliment on your shirt.
· A family member you’ve been worried about seems to be doing better.
· Your neighbor waved as you drove by.

Choose just one object of gratitude and focus on it. Take a deep breath and let it out slowly. Close your eyes if you like. Imagine that event or circumstance for which you are grateful, and take another deep breath. How do you feel when you think of only that one thing that you’re glad happened, or the one part of your life that’s going right today? Do you feel appreciative? Humbled? Lighthearted? Renewed? Are there any negative feelings such as embarrassment or jealousy? If so, acknowledge them and then refocus on the positive feelings. Give yourself permission to feel good about it. Give thanks in your mind for the gift, whether to yourself, another person, God, or even just serendipity. Allow yourself to smile. Continue to focus on that one thing, and if a competing thought trickles into your mind, simply acknowledge it and then return to your gratitude exercise. When you feel as though you’ve fully experienced gratitude for that one object, you may stop focusing on it and pat yourself on the back for doing something good for yourself today.

You may repeat this exercise for as many gratitude-deserving objects as you would like, as many times a day as you like. I encourage you to take a couple of minutes of your day, every single day, to give yourself the gift of experiencing gratitude.

What are you grateful for right now?

Living with Depression

2009-07-18T11:49:00.004-04:00

I would like to speak to readers who have either been diagnosed with a depressive disorder or simply suspect that they suffer from one. Depression is a disabling mental illness that affects every facet of life and health. It can interfere with your sleep, appetite, and sexual drive. It can contribute to pain, headaches, and gastrointestinal problems. It takes away your interest in activities you once enjoyed, saps your energy, and can leave you feeling worthless or guilt-ridden. Depression can destroy your marriage, wreak havoc on your career, and drive your friends away. It leaves you feeling as though you are on an island, alone in a sea of seemingly happy people. It can also result in suicidal thoughts and behaviors. Depression, if left untreated, can be a downward spiral, with its symptoms driving away needed supports when the sufferer needs them the most. Does any of this sound familiar?

If you have several of these symptoms, and they have persisted for at least two weeks, you may suffer from a clinical level of depression. It is crucial that you receive a proper diagnosis, as depressive symptoms can be explained by a variety of disorders, such as Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder, Substance-Induced Mood Disorder, Mood Disorder due to a General Medical Condition, Adjustment Disorder, and even Bereavement. Each diagnosis requires a specialized treatment approach.

For those of you who have lived with depression, you know that it is an illness just like diabetes or hypertension. You know that depression requires treatment (either medication, therapy, or both) and effort on your part to stay healthy. You may also know that despite your best efforts, a relapse into a depressive episode can and does happen.

For some, a depressive episode strikes like a lightning bolt, or perhaps a strong punch to the stomach. It leaves the sufferer doubled over in pain, helpless and frustrated. This is a depression that stings and stuns; it leaves its victim emotionally and physically debilitated.

For others, depression is like a black cloud off in the distance that creeps in slowly. These individuals see it coming, and the sense of dread sets in little by little as they watch the cloud growing and taking its ugly shape. The dread is for the storm they have weathered all too often, and it’s coming for them yet again. All too soon, the black cloud is overhead, and the storm shows no sign of subsiding.

A relapse can also be difficult to identify. Perhaps you’ve been living with this illness for so long that you’ve forgotten the difference between “normal” and “abnormal” sadness. After all, even people with depressive disorders that are under control with medication still feel symptoms of depression just like everyone else. It can be difficult to determine the source of the sadness and fatigue you’ve felt for the past several weeks or months. You struggle to come up with a reason. Is there a problem in my marriage I’m not facing? Am I unhappy with my career? Am I eating right? Or do I need a medication adjustment or a different treatment approach?

You’re not alone, though depression certainly makes it feel that way. First, go easy on yourself. A depressive episode is much like any other illness that taxes the body. You have to take care of yourself. You do need that sleep, and you do need to eat right and drink plenty of water. Sunlight and exercise can do wonders for your mood as well. Stay away from alcohol – it will only make things worse.

You also need help. For some, journaling can help them through a tough time. Writing down your feelings can be very therapeutic. Some people find comfort in good self-help books on living with depression. One I recommend is “Mind Over Mood: Change How You Feel by Changing the Way You Think” by Dennis Greenberger and Christine Padesky.

Rally your support system. It’s okay to tell trusted friends and family that you’re going through a depressive episode and that you need their support, but make sure that you’re not leaning too heavily on them at the same time. Depression can be taxing on people close to the sufferer as well. Assure them that you are taking steps to get through it, but you need to know that they are there for you.

Whether or not you are on medication for your symptoms, pay a visit to your physician. Make sure there’s nothing else going on that could be causing your symptoms, and talk to your physician about medical options for depression. Do your own research as well – simply educating yourself regarding the treatment options can be empowering in itself and give you hope and a sense of control.

Finally, if you haven’t yet sought psychotherapy, consider doing so. A psychologist or counselor can help you through your feelings as well as assist you in changing the thoughts and behaviors that may be keeping you from feeling better. There may also be a support group near you for sufferers of depression. Last, but certainly not least, if you find yourself thinking about dying or considering killing yourself, reach out for help immediately. Call a crisis hotline, go to an emergency room, or call 911.

Does My Child have ADHD?

2009-07-12T16:45:00.004-04:00

As a mother and psychologist, one of the questions I get asked most is, "Does my child have ADHD?" Perhaps your 12 year old son’s grades have dropped, and his teachers report that he cannot seem to remain on task. He talks incessantly, and seems to switch frequently from topic to topic. He complains that he finds his schoolwork boring and cannot focus. He’s also notorious for losing his schoolwork or other important items.

The answer to whether he suffers from an attention disorder is quite complex. Attention-Deficit/Hyperactivity Disorder is a diagnosis reserved for individuals with a disorder of the parts of the brain controlling attention, impulse control, and activity. As many already know, this disorder is often over-diagnosed and the medications used to treat this disorder over-prescribed. The truth is, the diagnosis of Attention-Deficit/Hyperactivity Disorder requires a complete psychological evaluation, including the administration of psychometrically sound assessment instruments. Even adults can suffer from this disorder and benefit from treatment of its symptoms.

What are the Diagnostic Criteria for ADHD?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (2000), the diagnostic criteria for Attention-Deficit/Hyperactivity Disorder are as follows. Please note that the DSM-IV-TR is not a collection of symptom checklists, but is rather a guideline for mental health professionals with specialized clinical training in assessment to use in diagnosing a mental disorder. It is not possible to self-diagnose any mental disorder.

A. Either (1) or (2):
(1) inattention: six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities

(2) hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often "on the go" or often acts as if "driven by a motor"
(f) often talks excessively

Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorders, or a Personality Disorder).

Note that the “hyperactivity” component is not required for the diagnosis. Many individuals suffer from inattention without symptoms of hyperactivity.

The Importance of the “Rule-Out”

One of the most important steps in diagnosing ADHD is "ruling out" other disorders that can have some of the same features. Oppositional Defiant Disorder, for example, can look a lot like ADHD, as can Obsessive-Compulsive Disorder, anxiety disorders, impulse-control disorders, depressive disorders, learning disabilities, and Conduct Disorder. Even a gifted child can appear to suffer from inattention in the wrong academic environment. It is crucial to get the proper diagnosis to avoid treating the wrong problem and possibly worsening the symptoms. I have often evaluated a child or teen for ADHD on the parent's request and learned that the child actually has another disorder.

How is ADHD Treated?

Medication is not the only option for ADHD, although many people with this disorder report significant improvement in their symptoms with medication. There is some evidence that certain nutritional changes can alleviate the symptoms. Individual and family counseling is sometimes needed to help cope with the disorder. Relaxation techniques can also be helpful. Changes in the way the child approaches homework and studying can be of tremendous help, as individuals with ADHD often learn better in short study sessions. A meeting with teachers and other school personnel can be useful to negotiate classroom accommodations.

Where Do I Go to Get My Child Evaluated?

A sound evaluation with a psychologist experienced in this disorder is the first step with attention problems. A psychologist can help arrive at the proper diagnosis, aid in treatment planning, refer to a physician for any needed medications, and can serve as a liaison between the parents and the school.

Welcome to your Raleigh, Cary, and Apex-area mental health blog!

2009-07-06T19:46:00.001-04:00

An introduction:

I am Mary Anne Etheridge, a licensed psychologist with offices in Raleigh, NC and Cary, NC. I provide counseling as well as psychological assessment and evaluation for children, adolescents, and adults.

As a therapist, I take a targeted, solution focus. Solution-focused therapy is a type of psychotherapy that aims to start working toward solutions to your problems right away in the therapy relationship. We will spend the early part of our sessions identifying the problem areas in your life: defining the problem and discussing how it has affected your life in negative ways. What makes my approach different than "traditional" psychotherapy is that we begin working toward your goals very early on. Change begins to happen with the very first session. We now know that therapy does not need to go on for many months or years to bring about relief and positive changes. Healing the hurt and righting the ship of your life can happen in less time than you may think! Despite being solution-focused, I take the time to get to know you and help you get to know yourself better. We will work through your hurt feelings or difficult situation as a team.

In addition to providing counseling, I also conduct psychological evaluations and assessment. I can test you or your child to determine the presence of a mental illness like Bipolar Disorder, Panic Disorder, Schizophrenia, or Major Depressive Disorder. Other common disorders I test for are ADHD (Attention-Deficit/Hyperactivity Disorder), Autism, Asperger's Disorder, and personality disorders. I offer psychoeducational testing, which includes testing for learning disabilities, intelligence or IQ, giftedness, kindergarten readiness, early entrance to kindergarten, and academic achievement (grade-level functioning). Because mental health is important for a good outcome to certain surgeries, I assess people's mental functioning prior to undergoing procedures such as cosmetic surgery or bariatric (gastric bypass) surgery. Finally, I provide forensic assessment for individuals who have a psychological issue related to some aspect of the law or court system.

My aim for this blog is to write about various mental health topics in the hope that readers will be able to apply the information to their own lives or the lives of someone they love. Please feel free to visit my practice website, www.etheridgepsychology.com and I welcome emails regarding my blog posts or if you wish to make an appointment. I look forward to hearing from you!