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Clinicians on the Couch: 10 Questions with Psychologist Deborah Serani

Clinicians on the Couch: 10 Questions with Psychologist Deborah Serani

In this brand-new feature, we interview a different therapist each month about their work. Below, you’ll learn everything from myths about therapy to roadblocks clients face to the challenges and triumphs of being a therapist to how therapists cope with stress. You’ll even gain insight on leading a more meaningful life.

This month we had the pleasure of interviewing Deborah Serani, Psy.D, a licensed psychologist who’s been in practice for over 20 years. Serani is the author of the memoir Living with Depression. She also writes the award-winning, syndicated blog Dr. Deb, and has even worked as a technical advisor for the NBC television show “Law & Order: Special Victims Unit.” You can learn more about Serani at her website.

1. What’s surprised you the most about being a therapist?

I’d have to say that I’m surprised how much I still enjoy going to work. Psychotherapy is as exciting to me today as it was the very first time I opened the door to greet my first client twenty years ago.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy?

I’m currently reading Dr. Kay Redfield Jamison’s Exuberance: the Passion for Life. Her work and writing always inspires me.

One of the greatest books related to psychology is Mitchell and Black’s Freud and Beyond. It looks at the beginnings of psychotherapy and the different schools that developed over time and the treatment goals of each school. A great read for anyone interested in being a therapist.

3. What’s the biggest myth about therapy?

There are many myths out there, but the one that I hear often is how “psychotherapy is just an expensive way to pay for someone to listen to you.” Well, it is true that you’re paying for someone to listen, but a psychotherapist’s skills go beyond that of ordinary listening.

When you’re in therapy, you’re working with an Olympic medal listener. People don’t realize that so much goes into becoming a psychologist — years of theoretical, practical and scientific training and hundreds of hours of clinical experiences.

As a client, you’re not just sitting and schmoozing in a therapy session. There’s a lot of specific, active work going on. That, combined with your therapist’s clinical objectivity, enables a client to get a balanced, unbiased frame of reference in treatment that is cannot be compared to the listening of a friend or family member.

4. What seems to be the biggest obstacle for clients in therapy?

Sometimes clients get stuck in the circular thinking of asking “why.” Like, “Why does this keep happening to me?” “Why can’t I fix this issue better?” “Why am I feeling this way?”

But there are times, especially during a crisis, difficult moments or a physical hardship, when “why” may not the best puzzle to solve. I teach clients that asking “what” does more.

What has directionality. Why offers no game plan. What offers solutions. So, the next time you find yourself in a bad place, ask yourself: “What can I do to make things better? And then once the crisis is over you can explore the why pieces to your life.

5. What’s the most challenging part about being a therapist?

So much multitasking goes on in psychotherapy. As a clinician, I’m listening, indexing my own thoughts, registering the client’s conflicts, sifting through feelings, and offering interpretations.

While that’s exciting and dynamic, it can be draining — emotionally and physically. The challenging part of my job is making sure to take breaks in-between sessions to refuel and rest. During these moments, I can usually be found catnapping on my couch, moving through a few yoga poses or surfing through the Internet.

6. What do you love about being a therapist?

I love that “Aha” moment when a client reaches a life-altering insight. Whether it comes from weeks of work or arrives in a split-second of awareness, it’s the greatest thing to witness. I know that soon after a client reaches this understanding, a transformational change is on the horizon.

7. What’s the best advice you can offer to readers on leading a meaningful life?

I’d tell readers that well-being is an art form. In order to find well-being and maintain it, you’ll need to understand your own genetic tendencies and how your life story shapes who you are. This biology and biography will be unique to you and only you.

Well-being also invites you to embrace holistic as well as traditional ways of living. And once you find what works uniquely for you, safeguard it, feel empowered by it and celebrate it.

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?

I wouldn’t change a thing. I love what I do, feeling privileged and humbled whenever someone allows me into the margins of their life. Being a therapist is a meaningful career. It heals as it helps, bridges the past to the present with meaning and purpose, and offers hope and change for the future. What could be better than that?

9. If there’s one thing you wished your clients or patients knew about treatment or mental illness, what would it be?

I’d wish that clients wouldn’t feel the sting of stigma. Mental illness is a real illness. It’s not a result of a weak character, laziness or a person’s inability to be strong. It’s a real medical condition. It’s important for everyone to know that that there’s no shame living with mental illness.

10. What personally do you do to cope with stress in your life?

I live with depression as well as specialize professionally in its treatment. It’s quite important for me to keep a balance to my home and work life. I eat well, exercise, make sure to get restful sleep, and try to get in as much sunshine as I can in a given day.

I’m consistent with taking my medication and delegate to others when things get too much for me to handle. Rounding out my routine is making sure to have social connections and meaningful interpersonal relationships — as well as quiet alone time when I need it. I practice personally what I preach professionally and this healthy framework keeps me in a good place.


New guidance on race and ethnicity for psychologists

Learning objectives: After reading this article, CE candidates will be able to:

  1. Discuss the goal and purpose of the new Race and Ethnicity Guidelines.
  2. Describe how clinicians, educators and researchers can develop racial and ethnocultural responsiveness.
  3. Discuss the importance of understanding bias and recognizing the influence of race and ethnicity in society.

For more information on earning CE credit for this article, go to www.apa.org/ed/ce/resources/ce-corner.aspx.

The United States is becoming increasingly ethnically and racially diverse, yet discrimination and bias remain pervasive, as do large disparities in wealth, health, poverty and incarceration among racial and ethnic groups.

The field of psychology is not immune to similar inequality. In 2016, the American Community Survey found that about 84% of the active psychology workforce is white, an overrepresentation compared with the national population, which is 76% white (2007–16: Demographics of the Psychology Workforce, APA Center for Workforce Studies, 2018). Psychological research is largely based on whiter, wealthier and more Western samples than the global population, with the majority focused on a fairly homogeneous slice of U.S. society (Arnett, J.J., American Psychologist, Vol. 63, No. 7, 2008).

With these factors in mind, APA has released its first updated guidelines on race and ethnicity since 2003. The Race and Ethnicity Guidelines in Psychology: Promoting Responsiveness and Equity were adopted by the APA Council of Representatives in August. They follow a separate document, Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality, adopted in 2017, that provided a broader umbrella view covering a wider cross section of identities than race and ethnicity alone.

The new Race and Ethnicity Guidelines are divided into four sections: fundamental, training and education, practice, and research guidelines. All are underpinned by the principle that considerations of social justice are inherent to an understanding of race and ethnicity, and the principle that issues of race, ethnicity, power and privilege are central to people’s life experiences, says Karen Suyemoto, PhD, a psychologist at the University of Massachusetts, Boston, and co-chair of the committee that developed the guidelines.

The guidelines also focus on developing psychologists’ racial and ethnocultural responsiveness—as opposed to the more common term “cultural competence.” Competence, Suyemoto says, implies a static goal to be achieved, or an immutable personal characteristic. Responsiveness, on the other hand, implies deliberate, continuous action.

“To be responsive you have to be continually changing, growing, understanding because our society is continually changing, too,” Suyemoto says.


Frequent headache Could it be a Brain Tumor?

Anorexia Nervosa

When was the last time you visited the Ophthalmologist?

Dislocated elbow

What are stress test?

DETACHING FROM OUR FALSE SELF

Humans are a troubled lot. Inundated by waves of fear and uncertainty, we welcome pain into our lives and needlessly suffer. Like psychotic shape shifters, we revisit the ugly past and daunting future, gradually driven insane by our own dark thoughts.

The cause of this insanity resides in our egoic monkey mind, a toxic creature feasting on conflict and disorder. It poisons our world view, antagonizes us, and makes our lives unbearable. Drowning ourselves in a sea of madness, we vacillate between yesterday and tomorrow, forcing some to the point of desperation. In her article, ‘Sobriety, Depression and Suicide,’ psychologist Deborah Serani documents the rampant enormity of the problem:

Though suicide is the most preventable kind of death, over 3000 people die by suicide each day. Mathematically measured another way, 1 million people each year die by suicide.

It is estimated that there are more suicide deaths worldwide then all deaths caused by accidents, natural disasters, wars and homicides combined. Serani, whose clinical specialty is depression, concluded that someone dies by suicide every 40 seconds.

Ongoing War
The reasons for this terrible crisis represent an innate part of the human condition. A war is being waged inside our minds with competing forces, both extreme opposites, fighting for total dominance. On one side is our true or spiritual self. It resides at our center, realized only through courage and self-awareness. On the other side lurks the false self, the waste product of a toxic ego and chattering monkey mind.

The false self, created by an ego that demands rigorous comparison and competition, is a role used to survive in a hostile world. The ego compels us to join the “rat race” driving many individuals to the zenith of competition, spinning on that never-ending hamster wheel, and working themselves to death. The ego controls the false self, instructing that we are better than others, dictating that we acquire materialistic goods, worn like military insignias, and deceptively greet the world with false pride. Tormented by its nagging and seductive voice, we are prevented from enjoying the bliss of the moment.

Our egoic mind thrives in the knowledge that misery loves company, and far too many suffer of this human plight. Depressed and angry, like charging stormtroopers, we view the world in warlike terms. We attack fear through anger. Feeling victimized, we blame others and seek retribution. Consumed with bitter resentment, we list everyone believed to have harmed us and mentally hurt them back. This weapon of righteous revenge, a churlish fantasy replayed over and over again, destroys our inner peace, while pleasing our monkey mind.

Conformity preaches
The biggest mistake we make is looking for answers outside ourselves. Because we feel flawed and empty, we look externally for completeness. Although happiness has been defined as intimacy with God and the experience of God’s loving presence, we devalue our sacred self by wandering elsewhere for such blessings. Theologian Thomas Keating writes about how we search erroneously for that elusive key:

“Everybody is looking for this key and nobody knows where to find it. The human condition is thus poignant in the extreme. If you want help as you look for the key in the wrong place, you can get plenty of it, because everyone is looking in the wrong place, too: where there is more light, pleasure, security, power, acceptance by others. We have a sense of solidarity in the search without any possibility of finding what we are looking for.”

“Know thyself,” Greek philosopher Socrates (470 – 399 BC), advised his students. Socrates’ instruction was not intended to be an easy task, but an arduous lifelong quest, searching for our sacred self. Another reference appeared during the 17th Century, when Shakespeare’s Polonius Laertes, “This above all: to thine own self be true.”

Author Shannon L. Alder was correct when she said, “One of the greatest regrets in life is being what others would want you to be, rather than being yourself.” Since birth, we are bombarded with messages that shape and define us. We want to please and be accepted by others, and place significance on what they think and say. Assuming behaviors which reflect the beliefs, superstitions, and values in our environment, we gradually adopt some or all of these variables, wrapped in our own unique cloak of experience and perception. Like mindless stick figures, we abdicate our power and willingly conform.

Conformity preaches that one should be like their peers, following rules, coloring inside the lines, being obedient, and not rocking the boat. But, being exactly like others is not being true to ourselves and, as we sink into the quagmire of conformity, we lose sight of who we are.

It takes courage to march against the maddening crowd and it is difficult to raise our voice in protest, especially when we are outshouted by the masses. Individuals like Copernicus, Gandhi, and Jesus Christ faced ostracism and death because of their non-conformity, yet, remained steadfast in their beliefs. American clergyman Ralph W. Sockman (1889-1970) stated it this way, “The test of courage comes when we are in the minority. The test of tolerance comes when we are in the majority.”

Inspirational writer Madisyn Taylor believes that in order to remain true to ourselves, detachment is a necessary step to self-awareness. She wrote:

Cutting the cord can help you separate yourself from old baggage, unnecessary attachments, and release you from connections that are no longer serving you… By cutting the cords that no longer need to be there, you are setting yourself and others free from the ties that bind.

Profound Journey
The incessant blathering from our egoic monkey brain can be abolished, but only through self-control. We have the ability to control our thoughts and silence the voice of the false self. The Buddha taught that the source of this background chatter comes from the delusions of an uncontrolled mind. Buddha, the Able One, said, “It is not possible to control all external events but, if I simply control my mind, what need is there to control other things?”

Lao Tzu (601 BC – unknown) understood the importance of self-control and inner strength. As the first philosopher of Chinese Daoism, he observed, “Mastering others is strength, mastering yourself is true power.” That same message, revealing profound words of empowerment, has been passed down throughout the ages. These important reminders instruct us that we have the ability to control our thoughts, behaviors, and destiny. Psychiatrist Gerald G. Jampolsky emphasizes these sentiments in his book Love is Letting Go of Fear. He believes that instead of attempting to control the external world:

…we can control our inner world by choosing what thoughts we want to have in our mind. We all have the power to direct our minds to replace feelings of being upset, depressed and fearful with the feelings of inner peace.

Finding our way out of the confusing maze of the false self requires that we sever the cords that bind us and make an intentional break from the endless noise and competition. We need to stop being self-centered, and instead be centered in the self. Complete detachment is the road to enlightenment.

Ancient scholars knew that our lifetime journey encompasses one of transformation and self-discovery. It will be the most important calling we will undertake as we honor our Higher Power and discover our spiritual self. The Beatitudes, delivered in Christ’s Sermon on the Mount, instruct, “Blessed are the pure in heart, for they will see God.” Such spiritual vision allows us to revel in the peace dwelling within us and savor the bouquet of stillness.

We can replace the world’s madness with the love that dwells within. As we embrace our spirituality and breathe in the present moment, forgiveness and acceptance will fill our lives. We alone can make this journey and effect this change. Perhaps not today, and perhaps not tomorrow—but when the time is right, when we are ready, and Deo juvante (with God’s help).


A Psychological Tool for Managing Tinnitus: Creating Useful Narratives

Since tinnitus is not directly observable and its causes remain an enigma, 1 patients often create their own explanatory narratives. In some ways, tinnitus can come to resemble a verboten Rorschach inkblot that patients may keep private from hearing care professionals (HCPs).

Hearing care professionals know that factors like noise exposure, ototoxicity, or other physical traumas are responsible for tinnitus. However, the tinnitus patient can internalize more personal—and often negative and self-denigrating—explanations. And, sometimes, these explanations can get in the way of positively addressing the symptoms of tinnitus. This article looks at ways to bypass or overcome patients’ negative narratives and help them embark on the journey to better hearing care.

For example, John told me that he was trying to forgive himself for having tinnitus, as he was convinced that the clanging in his ears was divine punishment for having committed a transgression against God in a past life (an extramarital affair). Therefore, he compulsively prayed, often several times an hour. He hadn’t told this to his audiologist because “She would think I’m nuts.” As another example, Sue reported that “My audiologist told me that contributing factors to my tinnitus could be anxiety, ototoxic medicines, trauma to my ears or head, or a medical condition, but I know the real cause—my repressed anger.” Therefore, she began indiscriminately unleashing her anger at the slightest provocation.

Although many tinnitus sufferers accept the oft-cited “etiology unknown,” a subset of patients adopt self-blame explanatory narratives. Although these may cause feelings of guilt and shame, paradoxically, the perceived clarity of such narratives may be psychologically comforting.

For example, it is common for parents to blame themselves for having a disabled child, as in the case of a mother who was convinced that “My ambivalence about being pregnant caused my baby’s cerebral palsy. I feel horrible for this, but at least I know the reason.”

Self-blame explanatory narratives may also provide patients with a sense of control. To the extent that an individual believes oneself to have caused tinnitus, that individual may also attribute to oneself the power to actualize a cure, for example, by praying or expressing anger.

One’s stance of self-perceived empowerment is in contrast to common feelings of helplessness when learning that there is no cure. While up to 90% of tinnitus sufferers can obtain some relief, unfortunately, there is not yet a cure for tinnitus. 1 Hence, the prevailing bottom-line advice to tinnitus sufferers is that they must accept the impossibility of eliminating the phantom sounds in their ears.

Simply providing that well-meaning and cogent advice may be psychologically inadequate, at best, to help patients manage their tinnitus. I asked Sue whether she told her audiologist about the “real cause” of her tinnitus.

“No way,” she responded. “I nodded politely until he was finished lecturing me, because I didn’t want to hurt his feelings.”

A common patient psychological dynamic from their perspective:

  • The doctor explains how treatment will help, but points out there is no cure.
  • This makes me angry and scared, but I cannot show it because that will make the doctor talk more.
  • So, I’ll nod my head and plan my escape.

A common healthcare provider psychological dynamic from their perspective:

  • It’s clear that this patient needs help.
  • If I explain this thoroughly enough and convey my expertise, then the patient will trust me and accept my help.
  • I know I’m succeeding at this because the patient is nodding in agreement.

I doubt that Sue would have hurt her audiologist’s feelings. Instead, the audiologist perhaps would have countered her interpretation by citing medical evidence-based research, and then she would have continued to nod her head politely.

An important caveat: It is frequently impossible to disprove patients’ explanatory narratives, even though they may be medically indefensible. As human beings, we not only have the ability, but typically assert our right, to choose what we think—specifically how we story our experience.

The ways in which health-related maladies are understood and interpreted—the storyline—make a considerable difference to their effects in a person’s life. 2 This principle has important ramifications for the psychological management of tinnitus. According to a cognitive-behavioral framework, what we think determines how we feel, which then determines how we behave. In the examples cited above, both persons would have suffered significantly less had they not storied their tinnitus with themes of self-loathing. John attributed his tinnitus to divine punishment he felt guilty, so he compulsively prayed. Sue attributed her tinnitus to suppressed anger she felt internally “blocked,” so she spewed anger at every opportunity. However, the most debilitating psychological effect was their self-denigration when their strategies failed they admonished themselves for not trying hard enough and then tried more. This became a vicious cycle that not only failed to provide relief, but caused increased stress, anxiety, and depression which, in turn, exacerbated their experience of tinnitus.

In my experience, patients are often reluctant to disclose their unsubstantiated tinnitus-related narratives to the HCP, but will more readily disclose these narratives to a psychotherapist. 3-5 As one patient put it, “With my shrink, I’m supposed to talk about weird things.” Since John and Sue had only shared their private narratives with me, not their audiologists, one treatment goal would be to help them to allow their audiologists into their private hell instead of politely nodding their heads and planning their escape. This would improve rapport and pave the way for them to benefit by adhering to audiologic recommendations. And then, in collaboration with their audiologists, the goal would be to help John and Sue modify their debilitating explanatory narratives.

Author Toni Morrison stated this goal more succinctly in her book Song of Solomon: “Wanna fly, you got to give up the shit that weighs you down.”

Helping Tinnitus Patients Modify Their Negative Explanatory Narratives

1) Elicit a patient’s explanatory narrative. In addition to providing patients with evidence-based information about tinnitus, help patients feel comfortable sharing their personal, non-evidenced-based explanatory narratives. For example, you can say, “I’ll tell you about the causes and treatments, but many people have their own kind of personal theories—which may even seem silly or embarrassing—about the why and what to do about it. It would be important for me to know your ideas about this. Would you share them with me?”

2) Emphasize that one has the ability to choose a particular narrative. I think, therefore I am. Emphasize that, as human beings, we have the ability to choose what we think, how we story our experience, including about tinnitus. When there is no empirical truth out there to be found, we construct our own reality, or we “re-author” our life stories. 2

As an illustration of this dynamic, you can tell a patient about a child who was learning how to be an umpire and asks three umpires for their advice. The first umpire says, “I call them as they are.” The second umpire says, “I call them as I see them.” The third umpire says, “They are as I see them.” We are all “third umpires.”

3) Validate a patient’s narrative. This is important even though a patient’s narrative may be medically indefensible, unsubstantiated, and even seem preposterous. However, this does not mean you need to agree with it.

I once made an error with a patient who informed me he was scared because there were Martians behind the couch. I tried to prove him wrong by tiptoeing to the couch and quickly moving it. Although he admitted there were no Martians there, he said,“They obviously saw us coming and ran away!” In order to have validated his feelings, I should have said, “If you believe there are Martians behind the couch, you must be scared.” However, if he had asked me whether I agreed with him, I would have said no, and we would have agreed to disagree.

In the case of John, had he disclosed to his audiologist that his tinnitus was due to a past- life transgression, she could have validated it with, “Obviously, I cannot prove you right or wrong—I wasn’t there [smile]—but it sounds like you’ve thought a lot about it. I can now understand more why you pray so much.” (For a humorous illustration of validating one’s narrative, readers may access https://www.youtube.com/watch?v=XIJYO4u5iug&feature=youtu.be).

4) Introduce the concept of a useful narrative. If the veracity of a particular explanatory narrative cannot be proven, it behooves one to choose a narrative that is psychologically useful. As psychologist Deborah Khoshaba advised, “Be sure the story you wish to tell about what happens to you gives you many options from which to carve out the next chapter of your life.” 6 John’s audiologist could have safely ventured into the domain of his emotional functioning with a “bounded open-ended question” that would not have derailed the session and risked inadvertently “opening up a can of worms.” For example, “Could I ask you to give me a glimpse, a snapshot, in the short time we have, about how your belief about a past life event causing your tinnitus has affected you?” (As described in previous publications, 4 emphasizing the boundaries of time can be an effective way to prevent HCPs from inadvertently getting too deep into affective issues which should occur in a mental health setting.)

John disclosed to me how initially his explanatory narrative had given him a sense of control and offered him a cure for tinnitus by prayer. Feeling validated by me, he then chronicled how that initial comfort had morphed into him feeling “besieged” by an endless cycle of praying and self-condemnation for not praying hard enough or long enough. He admitted that this cycle took over his marriage, his parenting, his free time—in short, how it had subjugated his life.

I admitted that I did not have the wisdom, ability, or moral right to disagree with his narrative, but then I asked the key question: “Given that it can’t be proven or disproven, would you be willing to come up with a better one that’s more useful to you one that would help you live a more fulfilled life?” He nodded his head.

Discussion

This article advocates that hearing care professionals ask patients if they have personal explanations for why they have tinnitus in addition to providing them with evidence-based research. In some cases, simply providing that well-meaning and cogent information may be psychologically inadequate, at best, to help patients manage their tinnitus. It’s often what you don’t talk about that impedes treatment.

A reader response may be a version of “We have enough to do within our limited appointment times and those discussions are more appropriate within the rubric of psychotherapy.” My counter-response: The HCP eliciting and validating tinnitus patients’ explanatory narratives may:

  1. Improve your rapport and therefore increase adherence to your recommendations
  2. Provide a non-threatening impetus for patients to meet with a psychotherapist in order to elaborate and understand more how such narratives help or thwart their lives and to modify them accordingly
  3. Be an antidote to the patient head nodding/planning-an-escape syndrome, and
  4. Requires minimal time.

John came into my office one day with a beaming smile. He told me that he “took a deep breath” before finally telling his audiologist that he used to think his tinnitus was divine punishment for having had an extramarital affair in a past life. She did not exude a demeaning attitude, as he had feared, but instead validated his feelings with, “I now understand why you disagreed that it was probably caused by a severe blow to your head.” John then told me that he and his audiologist had “the best session ever” and agreed on a revised tinnitus narrative: that its cause was “a severe head trauma that happened in one of my past lives.”

Most importantly, John no longer felt culpable and therefore no longer viewed tinnitus as a just punishment. Toward the end of that “best session ever,” he informed his audiologist that he would begin the Tinnitus Retraining Therapy (TRT) that she had suggested many times before.

Citation for this article: Harvey MA. A psychological tool for managing tinnitus: Creating useful narratives. Hearing Review. 201825(3):22-24.

Mazevski A, Beck DL, Paxton C. Tinnitus issues and management: 2017. Hearing Review. 201724(7):30-36.

White M, Epston D. Narrative Means to Therapeutic Ends. New York City, New York: W.W. Norton & Company1990.

Harvey MA. The psychological benefits of audiologic care. ADA Feedback. 200516(3):10-13.

Michael A. Harvey, PhD, ABPP, is a clinical psychologist who works in private practice in Framingham, Mass. His most recent books are The Odyssey of Hearing Loss: Tales of Triumph and Listen with the Heart: Relationships and Hearing Loss, both published by DawnSignPress.

CORRESPONDENCE can be addressed to HR or Dr Harvey at: [email protected]


Support for helplessness

No matter how helpless a person may feel in their life, there is always a way out. Seeing a therapist can be incredibly beneficial, as they can teach you how to cope with the stress and trauma that routinely lead to helpless feelings. Additionally, a therapist can help you identify behaviors and negative thoughts that lead to helplessness and replace them with more positive ones.

In addition to seeing a therapist, there are many mental exercises you can do on your own to work through any issues with learned helplessness. Psychology Compass identifies 3 powerful ways to “unlearn” learned helplessness. They are:

  1. Adopt an optimistic explanatory style – View and explain the events that happen to you as externally-related as opposed to an internal fault of your own, temporary instead of long-lasting, and specific to a situation rather than all-encompassing.
  2. Reframing negative situations using the ABC Method – Describe the event as objectively as possible, explain what your default interpretation was, think about the actions that led to these beliefs, and dispute the automatic reaction.
  3. Use the SMART method to gain control – Goal-setting can be a powerful tool for changing behavior. 9 Setting goals that are specific, measurable, achievable, relevant, and timed can lead to life-changing results.

The Best Way to Break Awful News to a Kid, According to Reddit

Breaking bad news to our kids is awful. A divorce, a serious illness, the death of a pet, the death of a family member . there are all kinds of difficult things they will experience in their lives that we can’t fully shield them from. We have to tell them because if we don’t, someone else will and it’s always better for it to come from us. But what’s the best way to break really bad news to a child?

That’s the question that Reddit user u/HowToExplain12 asked about an especially heartbreaking situation. Their 12-year-old daughter’s friend had been shot and killed, along with her friend’s siblings and mother. The shooter was the friend’s father, who also shot and killed himself. U/HowToExplain12 was at a loss for how to explain such a violent and traumatic situation, but knew they had to find a way. That’s when u/Lexi_St-James came in with some of the most thoughtful suggestions I’ve ever heard. And their advice can be used in a variety of difficult circumstances.

U/Lexi_St-James starts with this:

So I have worked in hospice and used to be a counselor (albeit addiction counseling).

Regardless of the person’s age, there is always an age-appropriate way to discuss the “tough” topics (ie, death, sex, drugs, illness, divorce, etc.).

For a 12-year-old, tell her that you found out something that is really sad and you want to talk to her about it.

From there, they suggest sitting outside or another calm, safe location—but not in a sacred place like her bedroom, because she may associate the location with the news from that point on.

Sit facing her, with your shoulders parallel to hers in a stance that suggests openness, and hold her hands. Start with the most basic detail first. In this case, that her friend and her friend’s family have died. Allow her time to process that, ask her how she feels—reiterating that whatever she feels is normal and okay—and focus on her words and her emotions.

From there, she will ask questions as she’s ready to process the information. If she asks how they died, u/Lexi_St-James says to start with the victims (her friend, their siblings and their mother) and say they were shot with a gun that gun was held by another person. Continue to fill in the rest of the details as succinctly as possible as she asks more questions.

After she is done sharing, ask her if there is anything she wants to do to commemorate (her friend).

Point is, you let them lead the conversation. Only give her information she asks for. Keep your answers short and only answer what she asked.

How a Stuffed Animal Can Help Kids Grieve

When my father died suddenly six years ago, I wasn’t prepared for the waves of grief that washed…

If you are also grieving, psychologist Deborah Serani writes for Psychology Today that it’s also important to practice and model self care. And you should always be ready to reach out for additional professional help, if necessary.

One thing that is important to note among all of u/Lexi_St-James’ good advice is one part I’ve left out that the American Psychological Association warns us about: attributing violent acts to mental illness. Unless you definitively know that mental illness was the true cause of the act, attributing violent acts broadly to “mental illness” may serve to further stigmatize it.

In a case like this, it’s likely better and more accurate to say that sometimes people do really bad things and we don’t always know why.


Queerability

There are many reasons clients decide to end therapy. According to clinical psychologist Deborah Serani, Psy.D, &ldquoSometimes they&rsquove reached their goals. Sometimes they need a break. Sometimes the connection with their therapist isn&rsquot there.&rdquo Sometimes they notice a red flag. Sometimes they&rsquore about to face a new fear or realize a new insight, said Ryan Howes, Ph.D, a clinical psychologist and author of the blog &ldquoIn Therapy.&rdquo

&ldquoWhatever the reason, it&rsquos vital to bring it into your sessions as soon as you feel it,&rdquo said Serani, author of the book Living With Depression. Howes agreed. Wanting to end therapy is a critical topic to explore, he said. And it could be as simple as telling your therapist, &ldquoI feel like it&rsquos time to end therapy, I wonder what that&rsquos all about?&rdquo

Therapy gives people the opportunity to have a positive ending, unlike most endings, which tend to be negative, such as death and divorce, Howes said. An end in therapy can be &ldquomore like a bittersweet graduation than a sad, abrupt, or complicated loss. Ideally, you can have a satisfying closure to therapy that will help you end relationships well in the future.&rdquo

That&rsquos because our relationship with our therapist frequently mirrors our relationships outside their office. &ldquoWe often unconsciously recreate dynamics from other relationships with our therapist,&rdquo said Joyce Marter, LCPC, a therapist and owner of the counseling practiceUrban Balance. &ldquoProcessing negative feelings can be a way to work through maladaptive patterns and make the therapeutic relationship a corrective experience. If you avoid this conversation by simply discontinuing therapy, you will miss this opportunity for a deeper level of healing resulting from your therapy.&rdquo

Tips on Ending Therapy

Below, clinicians share additional thoughts on the best ways to approach your therapist when you&rsquod like to end therapy.

1. Figure out why you&rsquod like to leave. According to Jeffrey Sumber, M.A., a psychotherapist, author and teacher, the best way to end therapy is to delve into why you&rsquod like to leave. Ask yourself: Is it &ldquobecause I feel disrespected, stuck or incompatible or [am I] actually feeling uncomfortable dealing with certain things that the counselor is pushing me on?&rdquo It&rsquos common and part of the process of changing problematic patterns, he said, to feel triggered and even angry with your therapist.

2. Don&rsquot stop therapy abruptly. Again, it&rsquos important for clients to talk with their therapists, because they may realize that their desire to part ways is premature. Even if you decide to leave therapy, processing this is helpful. &ldquoA session or two to discuss how you feel and what kinds of post-treatment experiences you may go through will help ease guilt, regret or sadness that often arises when wanting to stop therapy,&rdquo Serani said.

Plus, &ldquoHonoring the relationship and the work you have done together with some sessions to achieve closure in a positive way can be a very powerful experience,&rdquo Marter said.

But there are exceptions. Howes suggested leaving abruptly if there are ethical violations. He reminded readers that you&rsquore &ldquothe boss&rdquo in therapy:

If there have been significant ethical violations in therapy &ndash sexual advances, breached confidentiality, boundary violations, etc. &ndash it may be best to leave and seek treatment elsewhere. It&rsquos important for clients to know they are the boss it&rsquos your time and your dime, and you can leave whenever you want. If the violations are serious enough, you may want to tell your therapist&rsquos boss, your next therapist, or the licensing board about them.

3. Talk in person. Avoid ending therapy with a text, email or voicemail, Marter said. &ldquoSpeaking directly is an opportunity to practice assertive communication and perhaps also conflict resolution, making it is an opportunity for learning and growth.&rdquo

4. Be honest. &ldquoIf you feel comfortable and emotionally safe doing so, it is best to be direct and honest with your therapist about how you are feeling about him or her, the therapeutic relationship or the counseling process,&rdquo Marter said.

When offering feedback to your therapist, do so &ldquowithout bitterness or judgment,&rdquo said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. &ldquoAfter all, this person will be working with others in the future, and your thoughts may change his or her style, and help them to better serve their clients in the future.&rdquo

&ldquoA good therapist will be open to feedback and will use it to continually improve,&rdquo added Christina G. Hibbert, Psy.D, a clinical psychologist and expert in postpartum mental health.

5. Communicate clearly. &ldquoYour best bet is to be as direct, open, and clear as possible,&rdquo Hibbert said. Articulate your exact reasons for wanting to end therapy. Hibbert gave the following examples: &ldquo&rsquoI didn&rsquot agree with what you said last session and it makes me feel like this isn&rsquot going to work,&rsquo or &lsquoI&rsquove tried several sessions, but I just don&rsquot feel like we&rsquore a good match.&rsquo&rdquo

(&ldquo&rsquoNot being a &ldquogood match&rsquo is a perfectly good reason to terminate therapy, since so much of it has to do with a good personality fit and a trusting relationship,&rdquo she added.)

6. Be ready for your therapist to disagree. According to Serani, &ldquoIt is not unusual for a therapist to agree with ending therapy, especially if you&rsquove reached your goals and are doing well.&rdquo But they also might disagree with you, she said. Still, remember that this is &ldquoyour therapy.&rdquo &ldquoDon&rsquot agree to continue if you truly want to stop, or feel persuaded to keep coming for sessions because your therapist pressures you to stay.&rdquo

7. Plan for the end in the beginning. &ldquoEvery therapy ends, there&rsquos no reason to deny this fact,&rdquo Howes said. He suggested discussing termination at the start of treatment. &ldquoEarly in therapy when you&rsquore covering your treatment goals, why not talk about how and when you&rsquod like therapy to end? Will you stop when you&rsquove achieved all your goals? When the insurance runs out? When and if you get bored in therapy?&rdquo

Again, therapy can teach you valuable skills to use for your other relationships. According to Marter, &ldquoEven if after expressing your negative feelings, you choose to end the therapeutic relationship, you can rest assured that you took good care of yourself by advocating for yourself in a way that was direct and honest. This is a skill you can bring with you to other relationships that are no longer working for you.&rdquo


Its a tremendous feeling unlike in the beginning as an ayurveda doctor when you come to many of the patients getting cured almost completely when compared to their initial sufferings , the gain of confidence in themselves after the treatment, since many of them already have given up on life after the streotypical allopathical approach that had harmed more if not healed , the patients feel as though cheated depressed, but when after taking treatments they say “I have never ever in my life come across such a type of treatment”.
For a treatment which is four thousand years old..to survive the modern inventions and discoveries in an era of genomes, one simple thing to understand is that these were the ways our body was meant to be treated. No other treatments even naturopathy or even physiotherapy can give such results or can even claim to. That is the greatness of Ayurveda !
Each and every concepts that ayurveda putsforward are practically perfect, in theory it may be found defective for a rational mind. Ayurveda can reduce pain , now cancer is also treated by ayurveda .
Its fulfilling as a doctor when you can treat a disesase without affecting the body. Feels good. May be I will be able to contribute a significant bit in developing my science. I dream where in ayurveda only ayurveda is done ! With only knowledge of modern sciences.

9 Ways to Take Care of Yourself When You Have Depression

By MARGARITA TARTAKOVSKY, M.S. Associate Editor 9 Ways to Take Care of Yourself When You Have Depression“Depression is an illness that requires a good deal of self-care,” writes psychologist Deborah Serani, PsyD, in her excellent book Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing. But this might seem easier said than done, because when you have depression, the idea of taking care of anything feels like adding another boulder to your already heavy load. Serani understands firsthand the pain and exhaustion of depression. In addition to helping clients manage their depression, Serani works to manage her own, and shares her experiences in Living with Depression. If you’re feeling better, you might ditch certain self-care habits, too. Maybe you skip a few therapy sessions, miss your medication or shirk other treatment tools. According to Serani, as some people improve, they get relaxed about their treatment plan, and before they know it are blinded to the warning signs and suffer a relapse. Because skimping on self-care is a slippery slope to relapse, Serani provides readers with effective tips in her book. As a whole, the best things you can do to stave off relapse are to stick to your treatment plan and create a healthy environment. I’ve summarized her valuable suggestions below.

1. Attend your therapy sessions. As you’re feeling better, you might be tempted to skip a session or two or five. Instead, attend all sessions, and discuss your reluctance with your therapist. If changes are warranted, Serani says, you and your therapist can make the necessary adjustments. Either way, discussing your reluctance can bring about important insights. As Serani writes: Personally, the times I skipped sessions with my therapist showed me that I was avoiding profound subjects — or that I was reacting defensively to something in my life. Talking instead of walking showed me how self-defeating patterns were operating and that I needed to address these tendencies.

2. Take your meds as prescribed. Missing a dose can interfere with your medication’s effectiveness, and your symptoms might return. Alcohol and drugs also can mess with your meds. Stopping medication altogether might trigger discontinuation syndrome. If you’d like to stop taking your medication, don’t do it on your own. Talk with your prescribing physician so you can get off your medication slowly and properly. Serani is diligent about taking her antidepressant medication and talks with her pharmacist frequently to make sure that over-the-counter medicines don’t interfere. With the help of her doctor, Serani was able to stop taking her medication. But her depression eventually returned. She writes: …At first, it was upsetting to think that my neurobiology required ongoing repair and that I’d be one of the 20 percent of individuals who need medication for the rest of their lives. Over time, I came to view my depression as a chronic condition — one that required me to take medication much like a child with diabetes takes insulin, an adult with epilepsy takes antiseizure medication, or someone with poor eyesight wears glasses…

3. Get enough sleep. Sleep has a big impact on mood disorders. As Serani explains, too little sleep exacerbates mania and too much sleep worsens depression. So it’s important to keep a consistent sleep and wake cycle along with maintaining healthy sleeping habits. Sometimes adjusting your medication can help with sleep. Your doctor might prescribe a different dose or have you take your medication at a different time. For instance, when Serani started taking Prozac, one of the side effects was insomnia. Her doctor suggested taking the medication in the morning, and her sleeping problems dissipated. For Serani, catnaps help with her fatigue. But she caps her naps at 30 minutes. She also doesn’t tackle potentially stressful tasks before bed, such as paying bills or making big decisions. (If you’re struggling with insomnia, here’s an effective solution, which doesn’t have the side effects of sleep aids.)

4. Get moving. Depression’s debilitating and depleting effects make it difficult to get up and get moving. Serani can relate to these effects. She writes: The lethargy of depression can make exercise seem like impossibility. I know, I grew roots and collected dust when I was anchored to my depression. I can still recall how getting out of bed was a feat in and of itself. I could barely fight gravity to sit up. My body was so heavy and everything hurt. But moving helps decrease depression. Instead of feeling overwhelmed, start small with gentle movements like stretching, deep breathing, taking a shower or doing household chores. When you can, add more active activities such as walking, yoga or playing with your kids or whatever it is you enjoy. It might help to get support, too. For instance, Serani scheduled walking dates with her neighbors. She also prefers to run errands and do household chores every day so she’s moving regularly.

5. Eat well. We know that nourishing our bodies with vitamins and minerals is key to our health. The same is true for depression. Poor nutrition can actually exacerbate exhaustion and impact cognition and mood. Still, you might be too exhausted to shop for groceries or make meals. Serani suggests checking out online shopping options. Some local markets and stores will offer delivery services. Or you can ask your loved ones to cook a few meals for you. Another option is Meals-on-Wheels, which some religious and community organizations offer.

6. Know your triggers. In order to prevent relapse, it’s important to know what pushes your buttons and worsens your functioning. For instance, Serani is selective with the people she lets into her life, makes sure to keep a balanced calendar, doesn’t watch violent or abuse-laden films (the movie “Sophie’s Choice” sidelined her for weeks) and has a tough time tolerating loud or excessively stimulating environments. Once you pinpoint your triggers, express them to others so your boundaries are honored.

7. Avoid people who are toxic. Toxic individuals are like emotional vampires, who “suck the life out of you,” according to Serani. They may be envious, judgmental and competitive. If you can’t stop seeing these people in general, limit your exposure and try having healthier individuals around when you’re hanging out with the toxic ones.

8. Stay connected with others. Social isolation, Serani writes, is your worst enemy. She schedules plans with friends, tries to go places she truly enjoys and has resources on hand when she’s somewhere potentially uncomfortable, such as books and crossword puzzles. If you’re having a difficult time connecting with others, volunteer, join a support group or find like-minded people online on blogs and social media sites, she suggests. You also can ask loved ones to encourage you to socialize when you need it. Living with Depression

9. Create a healthy space. According to Serani, “… research says that creating a nurturing space can help you revitalize your mind, body and soul.” She suggests opening the shades and letting sunlight in. There’s also evidence that scent can minimize stress, improve sleep and boost immunity. Lemon and lavender have been shown to improve depression. Serani says that you can use everything from essential oils to candles to soap to incense. She prefers lavender, lilac, vanilla and mango. If you’re sensitive to fragrance, she recommends diluting essential oils, buying flowers or even using dried fruit. You also can listen to music, meditate, use guided imagery, practice yoga and even de-clutter parts of your home a little each time. Serani’s last point involves empowering yourself and becoming resilient. She writes: By learning about your biology and biography, following your treatment plan, and creating a healthy environment, you don’t allow anyone to minimize you or your depression. Instead of avoiding struggles, you learn from them. You trust your own instincts and abilities because they are uniquely yours. If you experience a setback, you summon learned skills and seek help from others to get back on-point. If a person’s ignorance on mental illness presents itself in the form of a joke or stigma, you clear the air with your knowledge of neurobiology and psychology.


How to control the overwhelming fire hose of news

Having trouble keeping up with news that seems to be flowing out of Washington with even more fire-hose ferocity than usual? If so, you’re not alone.

Almost 7 in 10 Americans (68 percent) feel worn out by the amount of news there is these days, according to a Pew Research Center poll in June.

That was notably higher than the 59 percent who reported feeling exhausted by the high amount of election coverage, compared with 39 percent who said they liked having so much news.

That’s not surprising, considering how much news President Donald Trump and his administration have produced, much of which they would rather not have made.

Just think, for example, of some of the recent fleeting stories that, in the pre-Trump era, would have dominated headlines for days.

In the past week, for example, The New York Times reported that, shortly after Trump fired FBI Director James Comey, the bureau launched an investigation to see if the president was working on behalf of the Russian government. He angrily denounced the report and the Times (“Fake news!”).

Yet, considering this was about a president who, among other questionable episodes, once cheerfully shared classified documents with Russia’s ambassador during a closed-door Oval Office meeting, news of the FBI background probe left me feeling more relieved than shocked.

But that news barely sank in before The Washington Post two days later reported that Trump had gone to extraordinary lengths to conceal details of his conversations with Russian President Vladimir Putin. The measures included his taking possession of his translator’s notes.

Meanwhile, the longest-running government shutdown in history was closing some offices and holding up thousands of paychecks in an impasse between the president and congressional Democrats over funding of a wall on the Mexican border.

It is worth remembering that Trump had agreed to a bipartisan funding plan but then reneged after he was ridiculed by Ann Coulter, Rush Limbaugh and some other conservative commentators for breaking his campaign promise of a wall. Sensing his base was crumbling, Trump demanded a wall or nothing. Senate Majority Leader Mitch McConnell, burned once already, refused to send anything to the Senate floor without Trump’s promise to sign it, if it passed.

Senate Democratic leader Charles Schumer and his fellow Democrat, House Speaker Nancy Pelosi, held tight to their “no wall” position in a modified version of Napoleon Bonaparte’s advice: Don’t interrupt your political rival while he is destroying his own approval ratings.

But, as if the real news were not anxiety-inducing enough, Trump and his enablers held fast to his alternative version of reality. He blamed Democrats for the shutdown after promising earlier to take the blame himself. As for the questions about his Russia relations, he held to his statements that the only election conspiracy with the Russians was not his but that Hillary Clinton’s campaign worked with a “deep state” of pro-Clinton FBI agents and others.

All of which reminds me of a Harvard study in 2017 that found China’s government pumping almost a half-billion fake comments into Chinese social network posts over a year. The posts in fact did only one thing, the researchers said: “shower praise on all things China.” Since the fake posts tended to emerge with events that might stir political unrest, the researchers reasoned that their sole purpose was to distract unhappy citizens from the temptation to organize “by stealing users’ time and mental energy.”

In similar fashion, the constant stream of tweets and statements from Trump that often have only a passing relationship to facts seems to be aimed at reassuring his base more than winning new converts. Pundits often speak of the “perpetual campaign.” Trump is making it a reality.

What can we do about “news anxiety,” which many in the psychiatric community say is a real malady, particularly in recent years? If you feel afflicted by it, mental health professionals advise limiting news or social media exposure, especially of the more sensational anxiety-inducing sort.

Psychologist Deborah Serani of Adelphi University, writing in Psychology Today, advised steering yourself away from sensational headlines and cable TV news and toward stories that offer depth, explanations and possible solutions to problems at hand.

That’s healthy advice. After reporting the latest scandal or atrocity, it is reassuring to know that there is a rational path out of the problem at hand, if only we can persuade our political leaders to follow it.


Watch the video: What If You Knew Depression as a Doctor + as a Patient. Dr. Deborah Serani. TEDxAdelphiUniversity (January 2022).