Ask the Therapist Ask our resident Psych Central therapists. 2016-06-26T11:35:47Z http://psychcentral.com/ask-the-therapist/feed/atom/ Kristina Randle, Ph.D., LCSW <![CDATA[Depressed by Masochistic Recurring Dreams Since Childhood]]> http://psychcentral.com/ask-the-therapist/?p=41569 2016-06-17T23:17:32Z 2016-06-26T11:35:47Z

My girlfriend has sexually masochistic dreams where she is engaged with another individual or multiple men. She is mostly in a helpless state being tied down or held down and molested in these dreams receiving physical abuse and pain. She has a history of childhood sexual abuse and these dreams have been there since childhood. Most of these dreams start by recalling the memory of the said child abuse where she goes back to being a helpless little kid. She has a self-blaming and self-victimizing attitude when depressed. I recently took her to a therapist and she is dealing with the issues and feeling much better in coping with it. I would like to have a second opinion on this issue.

Even though the therapy is working, any depression in her day to day life can trigger these dreams again. Prior to dating me, she was comfortable with these dreams and liked them as they have always been there from her childhood. However, ever since she became committed to me, she is having trouble letting go of her modesty and morality in her dreams and constantly fights back and thus turns it into a nightmare. This results in more lack of sleep and depression. She is primarily worried that she would not be able to resist to such forceful advances by another person and will like being abused in real life if she let go of her control in the dreams. She also has experienced hypo-arousal (freeze/shutting down) in one of those encounters in the past. Any exposure to such incidents usually puts her into a state of self-hatred and worthless and makes her feel like a whore. I am not there in person with her to support her as we are currently in a long distance relationship.

Since I have heard dreams are mind’s way of healing and relieving stress, I would like to know if letting the dream take its course and not fighting back (which she don’t mind if it wasn’t for me) is good for her. Will that affect her choices and sexual urges in day-to-day life?

Also, in bed, she wants me to do anything that is painful to her. She says that’s the only way she can truly feel and let go. She prefers to try some of the mild BDSM practices and I am okay to that. I would like to know if it is healthy to pursue such practices since she enjoys it.

A. She cannot control her dreams. No one can. Dreams happen to us. They are the product of the unconscious mind and therefore not something with which we, the conscious mind, can control.

You asked about her interest in BDSM. It may stem from her abusive childhood and if so, she may want to avoid practicing BDSM until she is no longer negatively impacted by the trauma of her abuse. She should be discussing these issues with her therapist. A sex therapist might also be helpful.

It’s good that she’s in therapy. Major improvements tend to happen slowly and if she is being helped, that’s progress. Therapy takes as long as it takes. It’s important to be patient and supportive.

I know that the two of you are in a long-distance relationship but if possible, you and she might try couples therapy. The advent of the internet allows for many unconventional types of psychotherapy. Couples therapy might help you to understand her trauma and to know how to best support her during this difficult time. Please take care.

Dr. Kristina Randle

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Dr. Marie Hartwell-Walker <![CDATA[I Can’t Stand to Be Touched]]> http://psychcentral.com/ask-the-therapist/?p=41206 2016-06-17T21:05:54Z 2016-06-25T18:45:42Z

From Finland: Hi, thanks for reading me.

As a child I was sexually abused, first a neighbor, then when I was 11 my father. When everything blow up, my father talked to me and explained that he had alcoholism, but now he was sober, and it’ll never happen again. My family continued as a normal family, until my mom finally divorced him several years later.

I developed bipolar disorder with psychotic features, and my adult life has been a roller coaster, but I get along with my both parents, as a normal relationship, the subject is rarely mentioned. I did not blame them for the past, but finding a way to get stable has been hard, and most of the times they have been absent in my crisis.

This last year I’ve been working with a new therapist, and she has helped me a lot with my “weird ideas,” and voices, etc. I’ve been doing a big effort to grasp the reality, my reality. As a result, I am getting more functional, and starting to desire things, like having friends, or maybe a boyfriend. But there’s an issue, I can’t stand being touched, that’s one of the reasons my relationships never work.

And with it, I’m feeling really angry, specially at my dad, because of what he did, I know is totally out of time, but is there, I can’t hardly see him, I can’t stand him, actually I’m moving to another state, to be far away from him.

I tried to talk to him. I was like, I understand it was your alcoholism, and wasn’t your intention, and you have changed a lot since then, but I feel it had consequences. He told me it was in the past, that I had to let it go, etc.

And now I don’t know what to do, I feel guilty for being so mad, but I am. I feel I’m being unfair. All I want to do is keep my stability and being able to relate to others, but don’t know how.
Help me please.

 

A: It’s not at all unusual for a person who has been sexually abused to have fears about being touched. It’s not inappropriate for you to continue to be angry. It’s not realistic or appropriate for your father to believe you can just “let go” of what he did to you. His explanation that “alcohol made me do it” is how he is avoiding his responsibility for hurting you. He still owes you a heartfelt apology.

You can’t afford to wait for that apology to get on with your own life. It may never come. Even if he did apologize, you still are left with the consequences of being abused by a man you trusted. The good news is that you can heal without his apology, permission or participation.

You’ve made marked progress in your therapy. I am so glad you found a therapist you can really talk to and work with. Your letter didn’t indicate why you wrote to us here at PsychCentral instead of talking to her about this issue. I’m guessing that discussions about abuse, touch and sex are particularly scary for you and your letter is a first step in dealing with them.

To me, your letter shows you are ready to go to the next level of treatment. You have done impressive and important work so far. You have allowed yourself to trust a therapist and become an active participant in your treatment. Your letter shows you to be intelligent and sensitive. My vote is for you to take a deep breath, find your inner courage, and talk to the therapist who has been so helpful to you. It might help if you shared your letter and this response with the therapist as a way to introduce the topic.

From what you told me about your therapy experience so far, I have every reason to believe that your therapist will help you manage these issues with sensitivity and good support.

I wish you well.
Dr. Marie

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Daniel J. Tomasulo, PhD, TEP, MFA, MAPP http://www.FormerChild.com <![CDATA[I Need Help with Depression, Anxiety, Insomnia and Suicidal Thoughts]]> http://psychcentral.com/ask-the-therapist/?p=41753 2016-06-17T21:03:06Z 2016-06-25T11:35:39Z

For the past two years I’ve been going to a therapist and have been diagnosed with generalized anxiety disorder, social anxiety and situational depression. Although it’s been going on since I was about eleven at least, that’s when I had my first major panic attack. I’ve tried a number of anti-depressants to treat my depression and anxiety, but they either didn’t work or the side affects were to severe. So now she put me on a “life style change”, where I am supposed to sleep more and exercise. I don’t know what to do anymore. My depression and anxiety have been so bad in the last six months I nearly throw up every morning from stress. I cannot seem to get out of bed, the very thought of facing the world every day makes me cry and debate my life. Furthermore, I cannot seem to sleep more than 4 hours, even with the melitonin my doctor prescribed me. My sleep deprivation has caused me to go into hysterics from crying and to laughing more than a few times. I’ve lost all interest in any activities I used to do in the past four years. I once danced, I quite that too now. I feel so emotionally disconnected from everyone. My family and friends notice it as well. Usually they’ll make fun of me or show real concern. Furthermore I wish I didn’t have the two friends I have. It’s stressful, I never do anything with them no matter how much they want me to. I feel like I’ll either be a bother or I just don’t want to do anything. I used to be an A grade student, I’d overload myself with advanced classes, now I’ve failed out of three of them. I just don’t see the point anymore. I hate myself. I cannot function in any social situation and now I can’t even seem to do any simple task anymore. Not to mention my weight changes, I’d go from binge eating to nearly starving myself because I just wasn’t hungry any more. It was so extreme for a few months, my weight got to a high of 135 pounds to a low of 117. In a week I lost ten pounds. Quite frankly I don’t know what to do, I’ve used support sites and they don’t seem to help. I feel like I’ve extended all my resources.

A:  Thank you for writing us. I admire the courage and persistence it takes to battle the symptoms you are having. As the sleep deprivation is likely to be a major contributor to undermining your progress, I would highly recommend a physical evaluation with a medical professional to supplement the therapy. Here is an article about how important sleep is in your overall well-being. A psychiatrist or general physician should be able to help.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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Kristina Randle, Ph.D., LCSW <![CDATA[Weird Problems]]> http://psychcentral.com/ask-the-therapist/?p=41566 2016-06-17T21:00:59Z 2016-06-24T18:45:09Z

Sometimes while I’m talking to friends or family I feel so strange and I feel like that person is strange for a while and I get the ideas of who this person is, I start to remember our memories and that this person loves me and we’ve done that and that together till I remember, I forget how I feel to my gf and I forget her, for while and I start to think fast and remember things and I have a headache.

A. These sorts of worries should prompt a mental health consultation. You have begun that process by asking your question to us at Psych Central, but I do not have enough information to provide a thorough response.

Consider writing back and being more descriptive about what’s troubling you. That would be helpful. In the meantime, consult a mental health professional in person. It is the most efficient way to approach these types of problems. Please take care.

Dr. Kristina Randle

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Dr. Marie Hartwell-Walker <![CDATA[I Don’t Know How to Repair the Relationship Between Me and My Mom]]> http://psychcentral.com/ask-the-therapist/?p=41184 2016-06-17T20:59:01Z 2016-06-24T11:35:15Z

From a teen in Canada: When I was younger, my mom and I used to get along great. I don’t mean just the regular every little girl gets along with her mom. She’d always be on my side whenever my dad would yell at me unfairly, and she was always the first to defend me. And when I got diagnosed with Aspergers Syndrome when I was twelve, she was so supportive.

However, over the past year or so, all that has changed. Every time I make a mistake, she’s on my back about it. I’m getting less than a 85 average, she grounds me. I disagree with her or something she’s said, all of a sudden she’s calling me defensive and easily insulted. If my first thought isn’t to go help her with whatever she’s doing, I’m lazy, and if I need some money for a school function or if I don’t want to give up the TV to my little brother every time he asks, I’m selfish. We get into fights all the time now, and I’m not sure what I can change to make things better.

My little brother blames me when she’s in a bad mood because of the fights. My dad divorced her years ago, so he’s rarely around to help me out, and my step-dad refuses to get involved most times, and when he does, he’s always threatening to punish me or something (earlier this week, he told me that if I don’t stop giving her attitude, he’d take my laptop outside and drive over it with his truck).

I know I’m far from the perfect daughter, but is there anything specific I can change? After high school, my mother has insisted that I move in with her instead of going into the residence at my university (she doesn’t think I’m responsible enough) or continuing to switch between her and my dad’s house every few weeks, and I don’t want to spend the next couple of years of my life getting into constant fights with her.
Is there advice you can give me at all?

 

A: I’m impressed that you want to fix your relationship instead of just going away angry.

I wish I had a better idea of what changed since you were small. I can only guess that your mother sees you on the brink of adulthood and is very anxious that you won’t be able to handle being out in the world on your own. Is it possible that she has doubled down in correcting you in order (in her mind) to get you ready to be on your own? Her tactics aren’t working. But her intentions just might be honorable.

You didn’t mention whether you have had a mature, honest talk with her about what has changed. Have you been able to approach her calmly, without anger, to talk about your relationship and your future? Such a conversation is likely to go better if you are able to approach it from a position of curiosity and concern, rather than upset and anger.

There is absolutely no reason to fight with her. Fighting only indicates to your mother that you are immature. Even if what she says invites you to fight, you don’t have to accept the invitation. If things start to get heated, end the conversation gracefully. Instead of getting mad, say something like, “I’ll have to think about what you said” or “Your perspective is important to me. I’ll think about it.” Then do think about it. Under her anger may be fear or anxiety and/or valid points. When you are calm and have thought it through, ask her if you can go back to the conversation.

In the meantime, do all you can to show yourself to be the mature, thoughtful and competent person you know yourself to be.

I do suggest you do some homework before having further discussions about where you will live next year. If finances are part of the problem, is there a way for you to get some financial help? Many schools have work-study jobs or employment opportunities to help with expenses. In addition, find out what support services are available for people with Aspergers. Come up with a financial plan as well as a plan for using services. Then present your plan to your folks. That will shift the conversation from being an argument to a mature conversation about how you can be successful living at school.

I wish you well.
Dr. Marie

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Daniel J. Tomasulo, PhD, TEP, MFA, MAPP http://www.FormerChild.com <![CDATA[Am I Becoming an Attention Seeker?]]> http://psychcentral.com/ask-the-therapist/?p=41751 2016-06-22T18:02:29Z 2016-06-23T22:45:29Z

From Germany: I am 21 years old and currently in my third year of studies. Last semester, I was having a hard time dealing with stress and loneliness and my own behavior started to scare me. Whenever I was alone –which was the case very often- I would keep talking to myself or singing. When I forced myself to stop, it just went on in my head and got really tiring. So I decided to go to the psychological consultation offered at my university. The first appointment was very helpful because I really needed someone to tell me whether I was going crazy. The psychologist told me it was my choice whether I wanted to come again or not, and we set an appointment for a month later. Back then, I thought it was a good idea to give myself the feeling that I was seeking help and also to feel a bit encouraged/“pressured” to follow his advice before the next time. Since I was no longer in that hysterical state, the second session felt a bit unnecessary. I don’t like it when I keep complaining to others (although very often I feel that I need to do so) and of course I admitted that I was feeling a lot better. Nonetheless, I agreed to have a third session another 2 months later, so that I wouldn’t be “all on my own” from then on.
However, the thought keeps bothering me that I am just seeking attention. In fact, it makes me feel super-attention-seeking, just writing that. I used to be a good student at school, and now this kind of recognition is missing at the university. I keep involving myself in voluntary work, but the only reason it makes me happy is that it gives me acknowledgement from others. When I go to a doctor (which I rarely do) now I somehow enjoy being the center of attention. And that really bothers me.

I hate to see myself become this girl who is craving attention, yet trying to seem so shy and modest. That is not who I thought I was, but apparently this side of me was hidden somewhere all along.

A: Learning to ask for help is a virtue and a sign of strength — not weakness. Wanting to be recognized by others for your effort is as central to being human as it gets. The great American psychologist and philosopher, Williams James, said it best:“The deepest hunger in humans is the desire to be appreciated.”

You’ve done the right thing by talking about this to a professional at your university and I strongly recommend you keep doing the volunteer work as you maintain the counseling sessions.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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Dr. Marie Hartwell-Walker <![CDATA[My Father Showed Me How to Masturbate]]> http://psychcentral.com/ask-the-therapist/?p=41585 2016-06-22T18:03:40Z 2016-06-23T16:35:24Z

So I started masturbating when I was about 15. One time I was talking to my dad about–I was going through puberty so we talked about sex and body changes a lot around this time–and he told me about how he liked to masturbate by externally stimulating his prostate. I thought it sounded cool and so I asked him to show me how he did it. At first he demonstrated on himself, but I couldn’t find my own prostate when I tried it, and so he used his hand and did it for me. He only did it for a few seconds just to show me where it was. It felt really amazing, but I didn’t orgasm because he stopped once I started getting an erection and then left for me to finish on my own.

This was, more or less, the only contact we had that could be interpreted as sexual. Him doing this wasn’t weird to me, because my dad and I had always been close. We talked about everything, pretty much, and physical affection was normal, too. You know, we hugged every day, sometimes slept in the same bed, sometimes cuddled if we were on the same couch. But it was never uncomfortable or explicit. I never felt uncomfortable with anything he did, I’ve always felt it was just normal parent-child affection.

I guess I’m just asking for my peace-of-mind. I never thought it bothered me before, but recently I was telling a friend about it, and he was really shocked and said that it was “molestation”. I wasn’t so sure, but then I told another friend and she reacted the same way. If it really was molestation, I wonder if it would be better for me to acknowledge it, or more importantly address if it could be linked to any issues I have with my sexuality now.

A:  Yours is a complicated question. From what your wrote about the incident, I would agree that you were not molested. Your dad appears to have been instructing you — period. He didn’t get off on it. He left once you understood. It was not repeated.

This is the kind of thing that often happens in groups of pubescent boys who compare their erections and show off their ability to masturbate to climax. Unless there is a power differential, it is not abuse. It is how kids sometimes make sense of their changing bodies.

That being said: You allude to current sexuality issues. Since I don’t have a way to ask follow up questions, I cannot for certain reassure you that your experience with your dad isn’t linked to the current problem in some way. However, given what you shared in your letter, I suspect that the basis of the current problem is not connected to your dad but instead is linked to other issues of insecurity or anxiety or negative self-esteem that are grounded in other experiences.

I hope you will follow up this correspondence with a few sessions with a therapist who can hear your whole story. I do believe that everyone deserves the chance to have a satisfying intimate sex life with someone they love. A therapist will help you gain insight into the source of your problem and will provide the guidance you need to address it.

I wish you well.
Dr. Marie

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Kristina Randle, Ph.D., LCSW <![CDATA[I’m Worried I’m Developing Schizophrenia]]> http://psychcentral.com/ask-the-therapist/?p=41563 2016-06-22T18:02:15Z 2016-06-23T11:25:19Z

For the past 4-5 years I’ve been feeling what seems to be depersonalization. I’ve been able to function fine, I know I’m existing and I’m able to talk to my friends and family with no trouble (besides arguing with my family constantly) but along with this feeling of not being all there I’ve had this fear that I may be schizophrenic. It started when I was smoking pot all the time, it was all fun and games until I had a little too much and I had a panic attack. I had no idea what was going on, but it passed. A few months passed and the depersonalization got worse, I developed anxiety after that panic attack and I began to have horrific thoughts that randomly invaded my mind and as much as I tried to get rid of them they wouldn’t go away. There was a point where I was scared to be alone and scared of my own thoughts that involved hurting my family which I know I would never do, and I didn’t know what to do anymore so I let the thoughts happen. They passed and t
here was a point of clarity, but I still felt like I wasn’t all there.I thought I had a ruptured aneurism due to headaches I was having on a daily basis, there was even a point where I went to the emergency room cause I thought I had a brain tumor. I’m constantly looking into symptoms, I believe I have some of the ones listed. I’ve never had hallucinations besides this one time where I was buzzed and thought I saw a woman in a parked car and freaked out but it turned out to be the head rest, and I’ve never heard anything crazy besides people calling my name time to time and me thinking my friend was talking to me when she actually wasn’t. I’ve also been told I’m overly sensitive, and there are times where I have irrational thoughts or make scenarios up in my head that get me angry but I know they aren’t real in the end. I worry all the time and have been looking up symptoms and stories everyday. I’ve also been told that my grandpa was crazy, not sure if he was schizo or not but it still worries me that this could give me a higher chance. I’m worried I’m developing Schizophrenia.

A. I cannot provide a diagnosis over the Internet but schizophrenia seems unlikely. Your symptoms are more consistent with an anxiety disorder.

Your fear that developing schizophrenia could have been triggered by your panic attack. The very nature of a panic attack is feeling out of control. It is not likely a coincidence that many of your fears are now focused on your losing control. The fear of losing control is a hallmark feature of anxiety disorders.

One of the more common questions that I receive, involves people who probably have an anxiety disorder but fear they have schizophrenia. It is common for people with anxiety to think that they have all sorts of ailments. They often believe that the worst things they can imagine are happening to them.

If you have not consulted a mental health professional in person, you should. They can evaluate your symptoms and determine what’s wrong. Most importantly, a treatment plan can be developed.

Treatment can remedy these issues. Untreated anxiety can worsen and significantly degrade your life. Medication and therapy are effective treatments for anxiety. Treatment works and you should try it. Please take care.

Dr. Kristina Randle

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Dr. Marie Hartwell-Walker <![CDATA[I’m Not Sure What to Do or Where to Go]]> http://psychcentral.com/ask-the-therapist/?p=41186 2016-06-14T22:57:54Z 2016-06-22T18:45:12Z

From the U.S.: I’m not sure what to do or where to go at this point. I wanted to try this out, see if I could get anywhere with this.

I’m a young woman with a past of self harm. I’m so confused about this. I would do it to relieve the pressure in my chest when I got upset at myself or a situation around me, or the nausea I felt. As I’ve had a problem with carrying guilt for a long time over things most people get over. When I told my parents a few years back while I was still doing it they showed little concern over it, thinking I was doing it for attention or to draw attention away from a failed test I had brought home earlier that day. And while I had cut because of the test, beating my self over not doing better, I had to agree as a child I loved the spot light.

I was told I had no reason to cut, having not been abused or neglected which I’ve been told is what causes self harm. This of course lead to a very lengthy conversation of them asking if I had been abused physically, sexually, or emotionally which I had not. So I refused to cut for a while, convinced it was all me.

Before, during, and up until now I had problems making deeper connections with people, especially of the romantic kind. I would feel physically sick, to the point of breaking off the interaction abruptly and damaging the relationship just to get away from the ill feeling, and this only increased after I stopped cutting.

I’m 20 now, a year and a half clean on cutting but not feeling any better. I get times where I don’t want to do anything. cutting myself off from my few friends and having almost no motivation to do anything but eat, sleep, and go to work. My anxiety is there, mostly a fear of upsetting others, and I don’t want to wake up sometimes. But I’m a generally happy person aside from everything, having the nickname ‘smiley’, and being considered the best in my position at work. I’m lost and I feel jumbled, as none of these pieces fit. Is this nothing? Or something? I don’t know what to do and can’t seek help. I’m scared to hear it is nothing.

A: Yes, it is something. Although I understand why your parents might think so, cutting isn’t only an outcome of abuse. There are a number of reasons that young people get into the habit of cutting. Often it is a way to relieve stress. Cutting does cause the body to release endorphins and that does help a person feel better — at least temporarily. There are much better ways to get that same relief, but sometimes people don’t know that.

It also gives the person the illusion of having control and it can be a way to distract from emotional pain. And, yes, sometimes it’s a way to get attention or to feel part of a group in which other young people are cutting. One size explanation does not fit all.

I’m reasonably certain that all your pieces “fit” if I knew what all the pieces are. I can’t help you beyond that statement on the basis of a letter. I can only assure you that there are good but mistaken reasons why you got into cutting and why it continues to have some allure.

You say that you can’t get help. I hope that isn’t true. A few sessions with a mental health counselor would probably do much to give you peace of mind and some new tools for handling anxiety.

I wish you well.
Dr. Marie

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Daniel J. Tomasulo, PhD, TEP, MFA, MAPP http://www.FormerChild.com <![CDATA[I Want Someone to Hurt Me]]> http://psychcentral.com/ask-the-therapist/?p=41749 2016-06-14T22:52:56Z 2016-06-22T11:35:33Z

From Australia: I am 17 and recently I have felt urges to do things that make me feel this weird kind of satisfaction. For example, holding objects so that they touch the center of my palm and breathing in deeper than usual (I’ve described this to others as breathing in until it ‘clicks’, almost like yawning but intentionally). These things make me feel good/ satisfied but only for a second or so which makes me want to repeat them or distract myself.

I haven’t got any mental illnesses that I know of but I have been self-harming occasionally for a couple of years. However, lately I’ve been wanting to be beaten up, stabbed, injured in a car crash, become unconscious, break bones or slit my wrists in order to feel that weird feeling of satisfaction. I get excited when I think about being injured like this and I often make up scenarios in my head and I’ve started saving photos of bruised knuckles, blood and black eyes, etc. on my computer. However, after thinking about these things for a while, I start feeling really sad and empty and disappointed because I realize how unlikely it is for these things to happen to me.

Why do I feel like this? Is this common? Is it bad for me to feel this way?

A: I am very glad you took the time to ask your question. You probably already realize that it is not common and this is likely the reason behind why you have written us. The discomfort you feel that prompted you to write this email is important to pay attention to.

Self-harming, wanting to be punished, and feeling satisfaction from these desires can be brought on by a variety of reasons. However, the fact that this has been going on for a while means that an evaluation by a clinical psychologist or psychiatrist is warranted. You’ve taken the first step writing us here. Because of your age I suggest you talk to your parents and ask them to arrange an appointment with one of these professionals. I would do this sooner rather than later.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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Holly Counts, Psy.D. <![CDATA[Teen with Alienating Behavior]]> http://psychcentral.com/ask-the-therapist/?p=41728 2016-06-14T22:41:56Z 2016-06-21T18:45:01Z

I have a 15 year old daughter who is lovely in many ways. She is talented and generally self-confident, but seems to be oblivious to social constraints about what is or isn’t appropriate to say. She speaks her mind with brutal honesty — think of a petite Dr. Gregory House. Most people who have known her for a long time are accustomed to her acerbic nature and take it with a grain of salt.  Some people find it amusing/entertaining, but her inability to filter her comments is starting to cause problems in some of her peer groups. How can I steer her toward more socially appropriate behavior? (age 48, from US)

A: Your daughter is at an age when her peer group will have more influence over her behavior than you do — so as difficult as it is to watch, you may need to sit back and let her experience some natural consequences. Of course you can speak to her about the virtues of being kind to others and that there is a time and a place for everything, including speaking up or holding your tongue, and so forth. Keeping in mind that positive reinforcement is the best way to influence someone else’s behavior. Meaning, complimenting her or finding a way to reward or encourage the behaviors you want to see more of is more powerful than punishment or drawing attention to her negative behaviors. However, you still may have little influence over how she speaks to others.

As I stated, her peer relationships may be the best vehicle for change. Once she loses a close friend or gets embarrassed after being confronted by someone, perhaps she will change her approach.

On the flip side, her course in life may involve less pitfalls due to her strength and directness. At least it doesn’t sound like she suffers from low self-esteem, which for girls in our current culture, is a great thing. If you want to seek outside help you might consider looking for a social skills group for kids her age or an empathy training program.

All the best,

Dr. Holly Counts

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Dr. Marie Hartwell-Walker <![CDATA[I Think I Might Have Had Some Sort of Seizure]]> http://psychcentral.com/ask-the-therapist/?p=41180 2016-06-14T22:37:27Z 2016-06-21T11:35:22Z

From the U.S.: I was laying flat on my back, eyes closed, and all of a sudden as I’m trying to fall asleep, I start feeling heavier and heavier, like my body is suddenly gaining mass and pressing me into the mattress. I start shaking, and my heartbeat is going crazy. The next thing I know, I’m seeing things. Like, dreaming, but not. I can still feel my body, and I’m not all the way asleep, and I can kind of see shapes and impressions of things but it’s all made up of black. There’s no color to it. It all feels very real, and all of a sudden, as I’m trying to pick up a box in this not-dream, I can’t lift it. It isn’t that the box is heavy, it’s that my arms just won’t lift! I can just feel my heart going faster and faster, and my entire body is almost buzzing. I open my eyes, shaking, and my arms feel like they’ve been straining at something for hours. I have to roll over and curl up against the wall because my body is still freaking out. The entire thing lasted about half an hour. What the heck just happened to me?? All I know is that my arms and shoulders are still tensed an hour later (not like constantly, but I definitely feel like they’re still trying to tense all the time), and my heart is still not back to normal yet.

A: What you are reporting may be sleep paralysis. This happens when the normal atonia that happens in REM stage sets in sooner than usual. Those who experience it report feeling as though they are being held down or that they have become solid and heavy. Often other sensory phenomena occur at the same time. Do a little research and see if the information validates your experience.

However — If you believe you may have had a seizure, you should be contacting your doctor immediately, especially if this has happened before. The Internet can be a useful source of information, but it is not a substitute for medical help when something is a serious concern.

I wish you well.
Dr. Marie

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Daniel J. Tomasulo, PhD, TEP, MFA, MAPP http://www.FormerChild.com <![CDATA[Fear of Getting Pregnant]]> http://psychcentral.com/ask-the-therapist/?p=41650 2016-06-14T22:35:13Z 2016-06-20T18:45:43Z

I have had this fear for a long time. I’m afraid that if the water in the toilet splashes and my dad has recently went to the bathroom I will get his sperm in me. Or if I sit in the shower, what if my dad’s stuff is in there and will get up my hole. Can this happen? Thank you.

A: Tokophobia, the fear of getting pregnant, is a somewhat common fear woman may have. Here is some information from an article on some of the most common issues surrounding this fear.

However, the means through which you are concerned about getting pregnant are not feasible, which means the first order of business is for you to learn from your health and science teacher the mechanics of how pregnancy occurs — and the viability of sperm. This information alone should be helpful in dispelling your fears.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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Kristina Randle, Ph.D., LCSW <![CDATA[Irrational Irritability]]> http://psychcentral.com/ask-the-therapist/?p=41560 2016-06-07T18:46:05Z 2016-06-20T11:35:36Z

I am usually a very happy individual and throughout most of the day I am quite upbeat and friendly. However, I find that sometimes I will become irritable for little reason. If my shoes feel weird, if I can’t find something, just setting up my computer, or for no reason at all, can cause me to become irritated. It is not to the point where I am yelling and screaming, but I feel a strong urge to break something or to exert force of some kind.

I find this occurs approximately once every day or two days. I have gotten better at recognizing when I am in one of these moods and try to calm myself down by telling myself it is irrational, but it can be difficult. Sometimes the feeling subsides only after I have broken something, afterwards I feel regret and usually slightly depressed.

The problem is that I am not sure what is causing it. I lead a pretty healthy lifestyle. I get lots of exercise, I socialize with people regularly, I eat very healthy and I am generally content with my life. Any advice is appreciated. Thanks!

A. It’s important to gain a better understanding of what’s happening when your irritability occurs. To do that, document these experiences. Keep track of how you’re feeling when they occur. Do this for at least several weeks. Consider things such as:

  • whether you are tired
  • whether you are interacting with certain people
  • whether you are hungry
  • whether they coincide with certain medications you might be taking

Tiredness increases irritability; that’s true for everyone. It’s difficult to maintain emotional stability when you lack energy.

The same is true with hunger. Some people joke about being “hangry,” a phenomenon where people are hungry and it makes them angry and frustrated. A recent Snickers advertising campaign “You’re not you when you’re hungry” highlights this kernel of truth. When people are hungry they can be irritable.

Certain people can make you irritated after interacting with them and you might not be aware of it. It’s good to explore this possibility.

Do you take any medicine and if so, does it coincide with your moodiness? For instance, certain acne medications cause extreme mood changes.

Hormonal changes are also worthy of exploration. Other things that may seem trivial can make you irritated including your apparel. Uncomfortable clothing can be distracting and annoying.

If this continues to be a problem, consider seeing a therapist. Objectivity could help you to uncover triggers that you might be overlooking. Moodiness can also be a sign of depression and therapy could help. Don’t hesitate to consult a mental health professional. They specialize in solving these kinds of problems. Please take care.

Dr. Kristina Randle

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Dr. Marie Hartwell-Walker <![CDATA[Is My Encounter with the Psychiatrist a Red Flag?]]> http://psychcentral.com/ask-the-therapist/?p=41157 2016-06-07T18:41:06Z 2016-06-19T18:45:37Z

From the U.S.: I recently started seeing a psychiatrist for ADHD. She also offers psychotherapy and comes from an ISTDP and CBT approach. I am now on medication for that and requested therapy to help me understand and manage some of the issues my ADHD has caused. During my first 30m med management appointment yesterday, it became clear I was more depressed than I had considered myself during intake.

We ended up sort of arguing about me going on a more rigid schedule – set bedtimes, work periods, meals. I agreed multiple times that it could help and that I’d at least try, she kept trying to get me to buy into the idea with much more enthusiasm than I can honestly muster (strictly scheduled periods of my life have been some of the worst due to a non-24 sleep cycle, and I have a lot of baggage and resistance resulting from it). She kept repeating that it needs to be for me and not for her, but was more like her demanding I feel something I don’t. It had a combative feel to it, me doing nothing other than agreeing to at least try and agreeing it might help, her trying to get me to say things like yes it will help (she insisted I say yes or no, because not being sure “gives me an out” or something.) There was little effort to persuade me to see it her way, just the refusal to accept my response as acceptable.

She then said she doesn’t think psychotherapy can help me unless I’m on a schedule. It came off very much like an ultimatum, and she repeated this in reply to an email where I sent the schedule I put together. Accordingly, she has not agreed to treat me yet even though that’s one thing that appointment was supposed to address.

Unfortunately, sticking to a schedule feels like an overwhelming goal at this point, something that will take willpower I seriously don’t feel like I have available right now (e.g. forcing myself to stop what I’m doing and sleep when I’m totally wired at night due to the non-24, and having one of my main drivers for going to therapy be that it’s nearly impossible for me to begin and stay focused on my work). If I did have that willpower I might not be seeing her at all, because I could just pull myself up by bootstraps and so forth. So it just feels like she said “stop having the problems of a depressed person and I’ll treat your depression.”

Again, I’m not totally opposed to this, but I’m a bit angry about feeling browbeat into it if I want help. I have so many other things I want to work through besides depression – remember I requested help specifically for ADHD, not depression, but I also have a serious physical illness that has just worsened and am also dealing with some loss. My intake and first regular appointment have not really been long enough or open-ended enough to address any of this, and my next appt will only be a 30m med mgmt as well.

So, I don’t want to undermine this if it’s a reasonable but poorly received intervention, but now I am very hesitant to continue with her. I wonder if everything I don’t agree to immediately and with enthusiasm will result in an ultimatum, I wonder how skilled and empathetic she actually is if I come away from my second meeting with her feeling angry and doubting her skill and not wanting therapy with her anymore, I wonder if any hesitation will have her perceive me as not committed enough to work with, and I wonder if everything I’ll be asked to change is going to be something that feels like a monumental life change rather than being given the space to chip away at things in smaller, less intimidating chunks.

Does this not bode well for the therapeutic relationship? Should I look for someone else before getting too invested in this relationship? Was it reasonable to argue with me and basically turn it into an ultimatum for refusing therapy when she encountered ambivalence? It took me a long time to work up the energy to seek therapy, and the last thing I need is to spend months finding out for sure that we’re not compatible.

Thanks in advance for any thoughts or perspective you can offer.

A: Thank you for writing. I’m impressed that you are thinking so carefully about how to get the best treatment possible.

Without hearing from the therapist, I can’t fairly evaluate what went on between you. But what I can do is validate your experience. The most important factor in determining the success of treatment is the connection of trust between the patient and the therapist. Therapy is difficult. You need to feel that the person who is caring for you is in your corner if you are to take the personal risks that come with self-disclosure and efforts to make fundamental changes.

You don’t feel that connection with this provider. The help she is offering doesn’t feel helpful to you at this point. That doesn’t necessarily mean that either of you did anything wrong. It does mean that it may not be a “match.”

I therefore encourage you to interview another therapist or two or three until you find someone who inspires your trust and who offers a plan that you feel you can manage.

If, after seeing several therapists, you still feel that you haven’t found the right “fit”, it may be that you are expecting too much or expecting the wrong things. That then becomes something to honestly explore. But people usually find a professional they feel is right for them within the first few interviews.

I wish you well.
Dr. Marie

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