I pay my therapist $120 every other week. I should, theoretically, feel like I can tell her anything.

But I don’t.

Because I want her to like me. It’s part of being a stage-four people-pleaser.

I didn’t realize the extent to which I was holding back until, the other day, when I mentioned to my therapist something that I had told Dr. Smith–the psychiatrist that I see every four to six weeks–about positive thinking just not cutting it when you plummet to such a low depression.

My therapist asked me to back up and tell her more about that. Because either I hadn’t said anything about that to her in the last month or so or else she had missed it.

I stewed on that for a few days: Did I omit my frustration with self-help books and cognitive-behavioral techniques or maybe not express how depressed I have really been? And I realized that I divulge more to my psychiatrist about the status of my depression and anxiety than I do with my therapist.

Why? 

When I’m sitting on my doctor’s couch, I believe the most significant culprit to my bad mood is my illness. I’m somewhat like a diabetic going in to get her insulin levels checked.

However, when I perch myself across from my therapist, I feel more accountable for my moods … that I if I am unable to implement cognitive-behavioral adjustments, and thereby some find relief, that I am somehow to blame. Moreover, if I’m pulled

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I can’t help but mention this article in The New York Times about how to get mental health care when you have no insurance or for some reason your have minimal coverage for mental health concerns with your current health insurance (which should change come January 1, 2010 when the federal mental health parity law kicks in). In the article, Lesley Alderman “offer[s] advice for those without insurance, or with only minimal coverage, on how to find low-cost mental health care.”

The solutions should be familiar to our regular readers — self-help techniques (most of which you can find online; but you can also find them in self-help books, freely available at your local library); self-help support groups (such as the ones we host here at Psych Central); an employee assistance program, or EAP (if you still have some connection with a job); and a host of ways of seeing professionals at reduced costs out-of-pocket.

For instance, in some communities, there are community mental health centers that will see you for a mental health concern on a sliding scale fee — the fee is based upon how much money you make. If you’re making $0, they will still ask for a small amount (usually $10 to $20 per session). If your mental health concerns are affecting your ability to work or live your life, this is money well spent. Some private therapists also will see clients on a sliding scale, but their fees usually won’t go as low as a community mental health …

My brother’s childhood best friend committed suicide. I was 16 years old at the time, Mark (not his real name) was 21. Mark’s parents were close friends of my parents; we played together as little kids, he was my first crush. We drifted apart as we grew up. Mark was a Kennedy-esque figure to me, handsome and smart. Everyone expected great things when he went off to an Ivy League law school. Then he was dead.

I have a vivid memory of walking around the neighborhood with Mark’s brother at night. The adults were sitting shiva and he had to get away. Suddenly he grabbed a fallen branch and wailed it on the trunk of a tree. Raw anger.

This family did heal. Before support groups or national days of recognition they talked about the conflicting emotions pain, anger, guilt. The same tape kept playing in everyone’s head:
If only… If only… They used therapy, the love of family, friends and good works, to find their way through. They found a way to forgive. 

Today is National Survivors of Suicide Day. Around the country there will be gatherings, rallies for awareness and support.

If you suspect someone you care for is thinking of suicide tell them out loud that you are worried for them and ask if they have thought of harming themselves. Get over your fear of offending them and imagine if they are dead tomorrow, will you regret not asking? If the answer is yes, then follow the guidelines provided by

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Quebec woman Nathalie Blanchard poses on the beach in a Facebook photograph that convinced her insurance company that she was no longer depressed.

Nathalie Blanchard, a 29-year-old IBM employee from Quebec, took a long-term sick leave from her job after being diagnosed with major depression. Her doctor told her to try & have fun, and to take a sunny vacation to get away from her problems. She did just that while she received monthly sick-leave benefits from Manulife.

And she posted her vacation photos on her private Facebook profile.

But recently, the monthly payments stopped. So, Blanchard contacted her insurance company to see why she was no longer receiving her benefits:

When Blanchard called Manulife, the company said that “I’m available to work, because of Facebook,” she told CBC News this week.

She said her insurance agent described several pictures Blanchard posted on the popular social networking site, including ones showing her having a good time at a Chippendales bar show, at her birthday party and on a sun holiday — evidence that she is no longer depressed, Manulife said.

But can a series of photographs really demonstrate that someone is no longer depressed?

Blanchard confirmed that she’s happy “in the moment” that the …

Earlier this month, I was honored to attend the 25th Annual Rosalynn Carter Symposium on Mental Health Policy in Atlanta, Georgia. The focus of this symposium every year is to tackle a particular issue in mental health policy, population or care. This year focused, fittingly enough, on health care reform and how mental health and substance abuse programs need to be an integrated part of that effort:

Currently health care in this country is focused on illness rather than health, on procedures and face-to-face interventions rather than on coordination and prevention, and on fragmented, specialty-driven care rather than on a primary care-driven delivery system. There is a solid evidence base that shows that a health system centered on primary care costs less and has better outcomes on a population basis than one dominated by specialty-driven care.

For behavioral healthcare, this kind of system reform poses significant opportunities and challenges, specifically in the scaling up of the evidence-based integration of mental health and substance use treatment and prevention into primary care. Thus, it is through system reform—replacing a fragmented, specialty-dominated system with a more effective and efficient primary care-driven one—that national health care reform may have its greatest impact upon the behavioral healthcare field.

In other words, in order for mental health to be more accepted, primary care physicians — those docs who already see most people with mental health concerns initially anyway — really should be at the forefront of coordinating all of a patient’s care, including their mental health care. I’m not sure I …

It’s that time of the year again, when we pull together our top picks for mental health and psychology stories in the news in the past year. There’s no magic to our choices, we’re just looking for stories that you believe had the biggest positive or negative impact in this area. For instance, last year the passage of the mental health parity law here in the U.S. was the biggest mental health news story of 2008. One example for this year might’ve been the debate we had surrounding what I thought was a pretty sensible law about postpartum depression. You can take a look at last year’s Year in Review to get a feel for what we’re looking for here.

Note your top picks in the comments and we’ll review those and the ones on our own list to come up with our big list for the year. If you had a favorite blog entry from the past year, we’d love to hear about that too in the comments!

The Year in Review will be published in December.

I’m pleased to announce the introduction of two new blogs here in the Psych Central family.

The first is from Leigh Pretnar Cousins, MS called Always Learning. Leigh is a private tutor and is studying in educational psychology. Although her blog will focus on the topic of educational psychology and learning, she believes these lessons are of value to all of us throughout life:

Every day my work teaches me some lesson that holds, not only for kids, but for all of us. I can hardly wait to share these things with you.

I’m excited to have this place to talk about learning and all its facets… Learning and school, learning and work, learning and emotions, learning and relationships, Learning and Life.

I agree. Learning doesn’t stop just because we don’t go to school any longer, and I look forward to reading her blog in the days and weeks to come.

Our second blog is called The Y Factor, which will talk about men, dating and the single life (from a woman’s perspective). Kate Nickerson (and others) will share her insights with us as she learns from her life experiences and psychotherapy:

I had no conscious realization how my life had been seriously screwed up by the way I related to men. So now I’m going to face the truth — deal with men in my life. Take the lessons and leave the negative memories in the past.

These lessons are what the “The Y Factor” will explore. From my father and grandfathers, to ex-boyfriends and

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To get us in the mood for the Thanksgiving Holiday!

Cicero said that “gratitude is not only the greatest of virtues, but the parent of all the others.” The English preacher John Henry Jowett wrote that “every virtue divorced from thankfulness is maimed and limps along the spiritual road.” And according to Aseop Fables, “gratitude is the sign of noble souls.” A dear professor of mine just acknowledged a thank-you note I sent him and told me that “gratitude is the sign of maturity and wisdom.”

I don’t feel like I’m very good at gratitude. This virtue comes hard to a depressive whose first thoughts are seldom positive. It has only been with much work and lots of practice that I have been able to cultivate gratitude and be genuinely thankful. Here are 12 techniques I use to help me get to the parent of all virtues.

1. See with the heart.

One of my very favorite quotes is from Antoine de Saint-Exupery’s “The Little Prince”: “It is only with the heart that one can see rightly, what is essential is invisible to the eye.” Every time I throw myself into a tizzy because things aren’t going as expected, or as I projected on my Excel spreadsheet for the year 2020, I have to remind myself that I’m looking with the wrong instruments: I need to go back and tell my heart to get some guts and speak up to my head because it’s starting to listen to …

Meagan really wanted this Christmas to be “extra special” — not like last year, when the family dinner turned nasty and Uncle Fred left in a huff. But as Christmas approached, the shopping chores multiplied, and the savings account dwindled, Meagan became increasingly anxious and dejected. Paul, her husband, wasn’t of much help — he was preoccupied with his job search, after having been laid off two months ago. Meagan was left to deal with three school-age kids and a part-time “temp” job as a secretary. And all this, at a time Meagan strongly associated with her late mother, who always used to help with the holiday cooking — and who had passed away at about this time last year.

In the past few days, Meagan had found it increasingly hard to fall asleep, and noticed that her appetite was poor. From time to time, she found herself weeping or sighing, but not knowing what to do. She wondered if “maybe having a few drinks” might do her some good.

Meagan (a composite character) has a number of risk factors for feeling down or depressed. First, women have rates of serious depression about twice those of men, and are also at higher risk for a particular type of major depression called Seasonal Affective Disorder (SAD). In addition, the combined stresses of holiday chores, child care, and financial woes put Megan at …

While most of us will be spending Thanksgiving with our loved ones next week, there are already 140 Army families who will not be spending this year celebrating their time together. Instead, those families will be mourning the loss of one of their own, due to suicide. With 140 suicides already on the books amongst Army families, 2009 is going to the be a record-breaking year for the Army, but not in a way they would like anyone to notice. 2009 will mark the year that the Army has suffered the highest suicide rate ever.

So what does the Army do? Does it recognize the significance of this number with a solemn, sincere statement? No, instead it turns on the full denial PR machine:

“We are almost certainly going to end the year higher than last year,” General Peter Chiarelli, the Army’s vice chief of staff, told a Pentagon briefing.

“This is horrible, and I do not want to downplay the significance of these numbers in any way.” [...]

Chiarelli cautioned against generalizing about the causes of the suicides, or assuming links to combat stress on forces stretched thin by the wars in Iraq and Afghanistan.

So in one breath, General Chiarelli says he doesn’t want to downplay the significance of these numbers. In the next, he says we can’t generalize these numbers to any actual military combat missions that soldiers may be actively involved in. Huh?

With all due respect, perhaps General Chiarelli needs to take a course in logic or read more of the prior reports released about this …

Terrorism is not a particularly new problem — it’s been a part of the world since civilization first organized. Despite how old it is, what we know about terrorist motivations and psychology is fairly limited. There isn’t a whole lot of empirical, scientific research on this topic (although there is an abundance of theory and anecdotal reports). But luckily, psychologists are slowly changing that, according to an article in the American Psychological Association’s monthly magazine, Monitor on Psychology.

One researcher, John Horgan PhD at Pennsylvania State University, found that people who are more open to terrorist recruitment and radicalization tend to:

• Feel angry, alienated or disenfranchised.
• Believe that their current political involvement does not give them the power to effect real change.
• Identify with perceived victims of the social injustice they are fighting.
• Feel the need to take action rather than just talking about the problem.
• Believe that engaging in violence against the state is not immoral.
• Have friends or family sympathetic to the cause.
• Believe that joining a movement offers social and psychological rewards such as adventure, camaraderie and a heightened sense of identity.

A lot of this is not particularly surprising, as we learn time and time again from the profiles constructed in the media of famous terrorists after-the-fact. But the insights gained from talking to ex-terrorists helps us better understand individual terrorists’ motivations:

For instance, based on what he’s gleaned about why people leave organizations, a particularly promising strategy may be highlighting how the promised glamorous lifestyle never comes to

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One heavily researched area within psychology is couples’ and marital communication. How a couple chooses to communicate — especially during a conflict — affects all sorts of things in the relationship: stress, relationship health, intimacy, even each person’s health. As Gouin et al. (2009) note in a summary of our existing research on this issue:

Individuals reporting lower marital satisfaction experienced more non-specific physical illness symptoms over a 4-year period than individuals with higher marital satisfaction. Among healthy women, lower marital satisfaction was also associated with a more rapid progression of carotid atherosclerosis. Furthermore, women who were initially dissatisfied in their marital relationship were more likely to develop metabolic syndrome over an 11-year period.

Among women hospitalized for an acute coronary event, those who reported moderate to severe marital strain at baseline were 3 times more likely to experience a recurrent coronary event during a 5-year follow-up, compared to women reporting less marital stress. Poor marital quality was also associated with a lower 3-year survival rate among end-stage renal disease patients, and a lower 8-year survival rate among congestive heart failure patients.

Collectively, these results from prospective observational studies provide evidence of an association between marital stress and negative health outcomes.

The latest research from Graham et al. (2009) shows that couples who are more considerate and rational during a fight release lower amounts of stress-related proteins. This suggests that rational communication between partners can ease the impact of marital conflict …