The term “cognitive psychology” was coined by Ulric Neisser in 1967. “Cognition” is defined as “all processes by which the sensory input is transformed, reduced, elaborated, stored, recovered, and used. It is concerned with these processes even when they operate in the absence of relevant stimulation, as in images and hallucinations … cognition is involved in everything a human being might possibly do” (1). Some of the most notable cognitive psychologists include Aaron Beck, Eric Lenneberg and Charles Sanders Peirce.

The most common areas in which cognitive psychologists practice are abnormal psychology (such as the study of depression, anxiety and other mental illnesses), social psychology (studying the way in which humans interact), developmental psychology, educational psychology and personality psychology.

Most cognitive psychologists have a specialty, such as attention, memory, problem-solving, language processing or information processing. They can work with patients with any variety of mental illness, those who may have suffered trauma, or any number of brain disorders. They also can work with patients on a long-term basis, such as those dealing with dementia, or on a short-term basis, such as helping a child with a learning disability learn how to cope with their schoolwork and process the information they receive in school.

Cognitive psychologists work in schools and universities, research facilities, prisons, treatment or rehabilitation centers, government agencies, hospitals or in a private practice setting.

Treating patients is not the cognitive psychologist’s only job. Most cognitive psychologists also teach at the graduate and undergraduate level. They may be professors or academic advisors or they may work with groups of students who are doing research projects.

In addition to teaching, many cognitive psychologists also focus on research. Research is important in the field of cognitive psychology. Many cognitive psychologists are required to participate in research projects and publish their findings in peer-reviewed journals. It is important for cognitive psychologists to pursue their own research in areas that interest them, as well as to research specific projects dictated by employers and universities.

Becoming a cognitive psychologist takes time, dedication and a desire to explore the human brain in all its glory. The education begins with getting a Bachelor of Arts (BA) in psychology. Although a Master of Arts (MA) in psychology can lead to work, many cognitive psychologists are required to have a Ph.D (a doctor of philosophy) in psychology or a Psy.D (a doctor of psychology). They must also be trained in the areas of neuroscience, cognitive learning and conducting.

Following a Ph.D or Psy.D program, cognitive psychologists generally work at internships and at entry-level jobs in order to gain experience and get the hours needed to qualify for the examination for professional practice in psychology that will provide them with their license. Any psychologist wishing to practice in a private setting must pass this test after completing 3,000 hours (approximately two years) of supervised practice. Once certified to practice in a clinical setting, cognitive psychologists are required to take continuing education credits to maintain their license.

If you are interested in a career in cognitive psychology, please be sure to check out the resources for more information.

Resources

http://en.wikipedia.org/wiki/Cognitive_psychology

http://work.chron.com/cognitive-psychologist-job-description-17172.html

Before reaching a tipping point, people often are able to balance known or unknown ADHD challenges with strategies they may not have even realized they were using. They had been able to adapt and cope well with their symptoms. Their symptoms may not have interfered with their functioning, so that they avoided an official ADHD diagnosis.

But for some reason a life change — a job promotion, relationship change, school change, or myriad other things — renders the current strategies ineffective. Over time there is a sense that things are no longer going well and in fact, life seems to be falling apart in a big way.

Here are some life situations that could be possible tipping points::

1. New problems at school.

Often, when higher elementary or middle school hits, students begin unraveling. They experience more responsibility in juggling multiple classrooms, more homework and larger classes. Suddenly it seems like nothing is working anymore. They can’t get things done that they want to get done, everything becomes chaotic, things start to come undone. Their schoolwork starts to suffer; they may have trouble concentrating in class, forget to hand in homework or start to experience difficulties with old friendships.

Often, no one recognizes these warning signs as being ADHD-related because the students previously had managed or were able to compensate for their challenges. Parents and educators start to feel helpless when a previously successful student seems to become unmotivated. Students are told they just need to try harder. Everyone is unsure how to get the child back on track and the students begin to feel stupid, lazy and incapable.

2. Inability to cope after significant life changes.

Some people with ADHD experience their first tipping point after a significant life change, even a positive one such as getting married or moving into a new home. These major life celebrations are anticipated with great joy, but often may be a change that tips the balance. Perhaps you’ve been able to balance your own life and your own schedule and where you put things up until now. But then you get married and now your spouse has a different way of doing things or expectations of the way things should be organized that differ from your views. That’s not to mention having to deal with the extra stuff in your space.

Slowly you notice that things are not working as well as they had before, and because this is supposed to be the happiest time of your life, you think there must be something wrong with you — right? Wrong! Significant life changes such as getting married, having another child or moving homes often can upset an unknown balance.

3. Unable to transition successfully into a new role at work.

Up until your “tipping point” you have been performing really well in your job — so well, in fact, that you are promoted. Slowly you may start to notice that you are not doing this new job as well as everyone expected, and you begin to isolate yourself, dread going to work and may eventually get fired.

What happened? You reached your tipping point. Not because you didn’t deserve the job, but because changes in work often come with changes of staff, support, work space, etc. that throw you off.

4. Change in family dynamics.

If you find yourself with new responsibilities and changes in your family, such as taking in an elderly parent, adding members to your family, or getting a new roommate, the additional responsibilities, change in routine and stress can gradually sink in and leave you overwhelmed and unable to cope as you have previously. It is so easy to begin to think you are a terrible mom, unfit for the responsibilities of a family or that you may be destined to live alone.

It’s not you. You were thrown off-balance, and your ability to compensate for your ADHD with your old routine, structures or systems is no longer working. But instead of seeing the truth, that it isn’t anything you’ve done wrong, or knowing that you can fix this, you’re filled with undeserved guilt and shame.

5. Physical injury.

People often experience their tipping point when an ADHD-management strategy such as exercise decreases or activity level changes. Unbeknownst to many people with ADHD, participation in sports or daily exercise provides some additional dopamine to our brain and helps to create structure and routine in our lives that help to better manage ADHD symptoms.

Tipping points are common for high school athletes who have earned success not only in their sports but academically, only to go off to college and experience failure for the first time. Without the rigorous physical training and structure of high school, they begin slowly to fall apart. Another common tipping point for people with ADHD is when they have experienced an injury and have to decrease their activity or exercise level. This change in routine and absence of daily dopamine boosts can challenge previous steadiness, energy levels and ability to focus. Life begins to wobble.

As you can see, there are many reasons, often beyond your control, that might lead you to your tipping point. A tipping point means that you are at a crossroads. You have a choice which way you will react. You can continue down that path to chaos and overwhelm, or you can get restructured and relearn ways to to cope and get back on track.

“With 6 kids, ages 16 to 5, a husband and home to care for, a private practice, and my many ‘side jobs,’ including running a non-profit, speaking, writing for my website, blog, and other people, doing some legal consultation, and writing a book, I like to say my life is ‘full,’” said Christina G. Hibbert, PsyD, a clinical psychologist and expert in postpartum mental health. She’s also active in her church and has commitments on Sundays and Wednesday evenings every week.

Joyce Marter, LCPC, a therapist and owner of the counseling practice Urban Balance, also has a lot on her plate. “I am a wife, a mother, a psychotherapist and owner of a group practice with nearly 50 therapists and five locations, a writer with a book in development, a public speaker, the Vice President of the Board of the Illinois Mental Health Counselors Association, and frequently serve as a psychological expert in the media.”

That’s enough to make anyone’s head spin. In addition, Marter takes her kids to and from school, eats dinner with her family, has an active social life, vacations for at least six weeks every year and gets eight hours of sleep per night.

So what’s their secret? Below, Marter, Hibbert and other therapists spill the details on living a fulfilling life and getting things done.

1. They know their priorities.

Hibbert knows what matters most to her, and she focuses on those things first and foremost. “[This] allows me to prioritize my time and helps me know when to pull back from other things. If any of my top priorities are out of shape, I push off the others until things are in order again.”

Her top priorities are: “My relationship with God, my relationship with my husband, and my role as a mother and relationship with my kids.” Her work comes next. But this also has to match her mission: “to learn all I can and teach what I learn.”

Marter takes a similar approach. She starts off with a vision for her personal and professional lives. (For instance, you can create a vision board, she said.) “Then we need to align our priorities and intentions to support that vision. We need to focus our energy on the things that provide meaning, value and life energy and let go of the things that don’t.” She then sets clear goals and firm boundaries around her time, such as her work hours.

2. They have a formula for their days.

“It has taken me many years and several iterations to find a formula that worked for me,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens.

He sees clients either three or four days a week from late morning into the evening to accommodate his clients, many of whom are teens. “I work fairly long hours those days, but I enjoy the work.” The other days he works on his next book or with the media. For instance, he’s been on the Steve Harvey Show multiple times.

3. They protect family time.

Clinical psychologist Ryan Howes, Ph.D, wakes up early to make breakfast for his sons and drop them off at school. He comes home around 6 p.m. to have dinner with his family and eventually put his boys to bed.

“After the boys’ bedtime I enjoy the evening with my wife, which includes checking in with each other, talking about our future plans, and watching some reality TV cooking shows.”

Duffy also “[protect[s] nights and weekends for my wife, son and friends.”

4. They delegate.

When Hibbert needs more time to accomplish projects after school, she asks her older kids to watch the younger ones. She asks her husband to help with grocery shopping and dinner several nights a week. She also has a housekeeper come once a week. “[This] is one of the best things I’ve ever done for myself!”

Marter outsources anything that doesn’t “provide personal meaning or value to me. In my business, I delegate the responsibilities that are not my strengths or passion.” At home, she outsources house cleaning and grocery shopping. This way she has time for what’s most important, such as hosting her kids’ play dates.

5. They have pets.

Having a dog actually makes my life more productive,” said Jeffrey Sumber, M.A., a psychotherapist, author and teacher. “I’m responsible to make sure he is well fed, walked and properly taken care of but this also helps punctuate activities in my day and organize tasks around set breaks in my process.”

6. They use activities to ground them.

Sumber uses the walks with his dog to map out his days and intentions.

It is often during my morning walk with Tashi that I run through my day in my mind, determining priorities and goals and create a visual for how the day will ideally play out. This walking meditation is functional as well as intentional and sets me off on a conscious trajectory into my day.

He also finds focus while making his morning coffee.

I also enjoy the process of my morning coffee. I grind the beans, pull the espresso shots and mix the Americano to my personal perfection. This takes me 10 minutes every morning and I might as well be repairing the space station tethered in deep space…I am very focused.

As I sip the coffee, I ease into my morning by sifting through emails (mostly deleting) and then send personal birthday messages to Facebook friends. I typically take time to prepare meals for the day and then set off to work.

Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, uses her senses to switch gears and get things done.

My typical day has me in the role of clinician, homemaker, professor, writer and woman. I know the metaphor of wearing “different hats” gets tossed around in shifting roles, but for me, it’s more of what’s in my hands that helps me get things done.

It’s as if my sense of touch transforms me into who I next need to be. My appointment book helps me shift into clinician mode. As soon as I touch it, I can feel myself move into a professional posture.

I have a home office, so in between patients, when I walk back into my home and I touch the doorknob, I’m into homemaker mode – cooking, doing laundry or tidying up the place.

When I pick up my lecture notebook, I’m into professor mode and readily head off to the local university to teach. And if I’m sitting at the keyboard, I easily shift into writer mode.

When I return home and settle into comfy clothes, I become just a woman again -connecting with my family and myself. I’ve always been a very sense-oriented person, and have found using touch as both a cue for change and a grounding way to cement my identity.

7. They stay fully present.

Howes focuses on being present in all his activities:

Freud said “love and work are the cornerstones of our humanness.” I agree with that and try to make the most of both. I do my best to be fully present when I’m wearing either hat. I want to engage with my family, regardless of what is happening at work, and be fully present with my clients, regardless of what is going on at home. On my best days, I’m able to do both.

8. They practice self-care.

Marter always makes time for self-care, which helps her be more productive in other areas of her life.

I prioritize self-care (like rest, meditation, exercise and fun) so that I have the energy to manage all my responsibilities. I practice gratitude and positive thinking to facilitate the energy and confidence I need to achieve my dreams. I tap into my support network (friends, family, therapist, coach, colleagues, mentor, etc.) for feedback, wisdom and support in helping make my life vision a reality.

Hibbert practices her self-care routine first thing in the morning.

On a day-to-day basis, one of the best things I do is wake up before my kids so I can enjoy an hour just for me. I exercise, meditate, and study scriptures to start my day right. When I miss this time, life just doesn’t seem to run as smoothly.

The morning also designates self-care for Duffy. “I work out, meditate when I can, and get to the office early. I eat breakfast there, page through the paper, and clear my mind for a while before the chaos begins!”

Hibbert prioritizes sleep, which is crucial to her productivity and well-being.

For me, the other big key to getting anything done is sleep. If I’m not sleeping well (and I’m not a great sleeper in general), I can’t function well. I get grumpy and overwhelmed too easily. So, I focus on getting to bed as early as I can so I can get up early, and I try to “sleep in” on weekends, when I am given the chance.

When he has the time, Howes strums his guitar, plays hoops, or works on “creating the world’s next great pasta sauce.”

9. They pay attention to their energy levels.

Sometimes Marter lets her energy guide the projects she works on. “When I occasionally experience an ebb of energy, I let myself rest or do the tasks that are easy for me. When my energy is high, I make a concerted effort to carve out time to tackle tasks that are high priority but low urgency like writing my book.”

All of these clinicians lead fulfilling professional and personal lives. They know their priorities and do their best to protect them. They manage their time effectively, know when to delegate and make sure to be completely present at every point.

A few months ago, he was under scrutiny for standing up to the Rockets’ lawyers and officials. He requested that his anxiety issues be treated the way other players’ physical illnesses and injuries are treated. For instance, NBA players are expected to fly frequently to cities where their games are played. White’s anxiety disorders makes it so that sometimes he is unable to do so. He requested to be able to travel by bus, and if he is delayed he doesn’t want to be fined the same amount as players who miss practice because they overslept.

Both parties struggled to reach a resolution, but after many discussions and meetings, the Rockets and White were able to reach a compromise in some areas. He was reassigned to the Houston Rockets’ D-league team, the Rio Grande Valley Vipers.

White’s story is of interest to many who are afflicted by mental illness. He is not in denial of his challenges, but he is not being quiet about it either. He has taken on the cause to help decrease the stigma society continues to place on mental health issues.

The Anxiety and Depression Association of America reports that there are “40 million American adults who suffer from anxiety disorders and only one-third of those suffering from an anxiety disorder receive treatment.” Anxiety itself has found its way into everyday language by many who experience stress. Yet, there are still many people who have no idea that anxiety disorders can be paralyzing and should not be trivialized.

Many individuals are embarrassed about their illness because they fear discrimination or that it’ll be a stumbling block in their careers or jobs. White has taken the risk and has decided that his basketball career is important, but becoming a “poster child” to decrease the stigma is more significant.

If you personally are struggling with mental illness or have a loved one who is, how are you handling it?

• Acknowledge it.

  Mental illness does not discriminate against race, gender, age, religion, or economic status. However, many sufferers may be in denial because they believe that asking for help, taking medication, or seeking therapy is a sign of weakness and irresponsibility. They don’t want to admit they have a problem and will only accept help when their normal functioning has deteriorated significantly, and they can no longer afford to suffer alone.People in prominent positions may be embarrassed to admit they have a mental illness. I’m not necessarily talking about movie stars or other celebrities. I am referring to individuals who have been able to succeed in life despite their mental adversities. They need to speak up to help normalize the disrespect many still receive due to their mental ailments.

• Speak up.

  When people share their struggles, others will become aware and even be surprised that their friend, boss, best friend’s daughter or spouse also is experiencing emotional and mental pain. Successful men and women with a mental illness can be an example to society and can contribute to the idea that a mental disorder does not define the person. The media seem to highlight the negative situations and many sufferers feel embarrassed and despondent. Thus, they choose to continue their silence.

• Connect with others.

  A dear friend has found that when he shares the challenge of having a son with mental health struggles, others connect emotionally with him. They trust him and are able to share their own journey with him. Your story of having been there may make a difference to someone who is feeling hopeless.

Society needs to understand that a person can be “normal” and still have mental health challenges.

Royce White is a hero. We need more heroes to stand up and speak up for mental health. Depression and ADHD are becoming more accepted as those in the limelight continue to talk about their experiences. Even people not in the public eye can tell our stories and help someone.

Will you be a hero for someone else? Take a stand. It will be worth it!

This month we have the pleasure of interviewing Gerti Schoen, a psychoanalyst and couples counselor in private practice in New York City and Hoboken, New Jersey. Before she immigrated to the U.S., Schoen worked as a professional print and radio journalist in her native country of Germany.

Schoen is the author of The Gentle Self, a self-help book about depression and anxiety, and a blog of the same name here at Psych Central. Her new book Buddha Betrayed is about spiritual abuse and the pitfalls of working with a spiritual teacher.

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

Just how similar we all are. Everyone struggles with periods of sadness or anxiety, couples bicker about similar things as my husband and I do. The ‘human condition’ that life isn’t perfect applies to everybody.

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

The one I frequently recommend is Tara Brach’s Radical Acceptance, a much-needed book about how to foster self-compassion. I very much like Susan Cain’s Quiet, which will reassure all the introverts out there that there is nothing wrong with being an introvert. Right now I am reading You Can Go Home Again by Monica McGoldrick. It’s a stunning account of how our family histories make us into who we are.

3. What’s the biggest myth about therapy?

That you can bring about change within a few weeks and it lasts forever. It’s possible to change quickly, but it often doesn’t last very long without putting in all the hard work that is required to change the brain.

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

Accepting that life is painful and that confronting one’s issues is painful.

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

Confrontation. It gives me anxiety when people get very aggressive with me. But it doesn’t happen very often and, when it does, I try to deal with it constructively and honestly.

6. What do you love about being a therapist?

It’s a field that never gets boring. The human mind is a vast source of ideas and feeling. You can never dive too deep; you will always find new treasures to be discovered.

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

To accept that life isn’t perfect and pain is a part of being alive. If you can deal with that, you can deal with everything.

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?

It would have been interesting to learn about psychoanalysis in my native country, Germany, first before studying it here in the U.S. to see how it is utilized and interpreted in different countries.

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

[I wish clients knew] that you can’t just pop a pill and all your worries will go away.

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

[I practice] yoga, go out in nature, plant flowers, take a nap, have a cup of coffee and slow down.

Stop! Before you reserve the moving truck or buy the ring, take the time to discuss the issues that can make or break your relationship. Love really isn’t enough. Once the pheromones calm down, once you get over the intoxicating time of new love, how you handle these topics will decide whether you will have lasting love. It’s essential that you are on the same page, or at least in the same chapter, when it comes to your feelings or convictions about each one.

Fidelity. Do you have a common understanding of what being faithful means? What would each of you consider to be “cheating”? Is it okay with you if your partner has friends of the other gender? Where is the line between being a friend to others and doing things that will jeopardize your relationship?

Sex. Few couples keep up the frequency and intensity of new-love sex. What is a comfortable rhythm for each of you? When and how and how often do you like to have sex? If you like it in the evening and your partner only wants it in the morning, it can be trouble. How adventuresome or athletic are you each willing to be? How generous are you in satisfying each other?

Money. This is even harder for many couples to talk about than fidelity and sex. What are your attitudes about who should provide for the family? Who should pay the bills? Do you have similar ideas about what should be mine, yours, and ours? Have you been honest about any debts that you are bringing into the relationship? Are you on the same page about how money is spent and how much should be saved? Who is going to take responsibility for such things as insurance, taxes, and retirement accounts?

Work. What is the role of work in each of your lives? Are you in agreement about how hard each of you should work and the choices you should each make about bringing in the money? If one or both of you is in a high-powered career, what are you each willing to sacrifice to make it possible? If one of you out-earns the other, does it matter in terms of decision-making? Will the agreement change if you have children?

Leisure time. What are your ideas about how much of your leisure time you spend together and how much you spend with your individual friends? Is it okay with each of you for the other to go out for a guys’ or girls’ night out? Do you have strong feelings about what can happen then? What do you like to do together that will ensure that you will continue to have some fun as a couple?

Health and fitness. Related to the use of leisure time is how you each regard the importance of the basics: getting enough sleep, eating well, getting in some exercise as part of your routine. Are you in agreement about bedtime and about nutritional choices? Are you supportive of each other in building activity into your lives? Do you have similar views about getting to the dentist and routine doctor visits?

Social media and gaming. What is the place of video gaming, texting, and computer surfing and chatting in your lives? Do either of you have strong feelings that some sites or games aren’t appropriate? How much time can be devoted to gaming and screen time before it becomes a threat to your relationship?

Church, charity and volunteering. Do you share religious or spiritual beliefs? If not, do you respect each other’s? If you have children, will there be issues about which religion they will be raised in? Do you agree about how much time and money should go to charitable work and volunteering to better your community?

Kids. Are you on the same page about having children? If you are going to have kids, do you have similar ideas about when and how many? How about discipline? Do you share an approach to child-rearing? And how will you each distribute time for childcare, carpools, kid activities, and family time?

Relationships with in-laws. How much time do you think you should spend with relatives? What occasions are non-negotiable events for each family? Where do you set your boundaries? Are relatives welcome to drop in any time they please or do they need to have an engraved invitation three months in advance to visit you?

Chores. Arguments about who cleans what have pulled many couples apart. Do you have similar ideas about who should do the laundry, the food shopping, the cooking, the cleanup after dinner, and the general straightening up of the house? Who is supposed to take care of the trash, the yard, the snow shoveling? It’s easy to fall into stereotypical roles that neither person likes. Do you have shared standards for how clean is clean enough?

Partying. Are you in agreement about the use of alcohol and recreational drugs? Gambling may also fit into this category. How much, if any, is okay? When do you think someone has crossed the line and it is a problem? What will you do if that happens?

Conflict. How do you each handle conflict? Do you have the tools you need to negotiate differences? Do you avoid conflict? Blow up? Stomp off? How should your partner handle it when you are upset or angry?

Planning for the future. As heady as the present may be, if your relationship is to last, the two of you also need to be on the same page about where you think you are headed. Do you have similar goals? Are you mutually committed to those goals? Of course, goals may evolve and change but it’s important to have some idea of what you both hope for the future.

Don’t assume that of course you and your true love are in agreement just because you are in love. Once the wonderful haze of new love settles into daily loving, these are the issues that can become deal breakers. Better to talk about them before making a commitment than to find yourselves astonished, angry, and saddened by huge differences that can’t be resolved. Serious discussion now can prevent a painful breakup later. Even more important, conversations about these issues can help you get to know each other better and to lay down a united and strong foundation for your relationship.

This month we’re pleased to present an interview with psychologist and psychoanalyst Suzanne B. Phillips, Psy.D, ABPP. Phillips writes the excellent blog “Healing Together for Couples” on Psych Central.

She also is an adjunct full professor of clinical psychology at the CW Post Campus of Long Island University, N.Y. and on the faculty of both the Derner Institute of Adelphi University and the Suffolk Institute for Psychoanalysis and Psychotherapy in New York.

Phillips is the author of three books, including Healing Together: A Couple’s Guide to Coping with Trauma & Post-Traumatic Stress. Plus, you can hear her Wednesday nights on “Psych Up” on CoSozo Radio with host Tom Matt of Boomer Rock.

Phillips has a private practice in Northport, N.Y., where she lives with her husband. She has two grown sons.

Learn more about her work at her website.

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

What surprised me most was how much I would receive from those who trust me with their care. There are the books and then there are the people. Working closely with people continues to invite me to think beyond what I know and feel beyond where I have been.

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

I just read Narrating Our Healing: Perspectives on Working Through Trauma by Chris N. van der Merwe and Pumla Gobodo-Madikizela. It is a beautiful book. Inspired by the horrific trauma suffered in South Africa and the impetus toward healing by the Truth and Reconciliation Commission, the authors underscore the capacity, regardless of history, for reclaiming self and others through the narrating of trauma.

Given the individual, couple, group and trauma work that I do, I resonate with the thesis that when we share our trauma, when we hear the sound of pain in each other’s hearts, we “make public spaces intimate.” We make it possible for someone else to hear, identify with our pain, and step beyond old wounds to connect.

3. What’s the biggest myth about therapy?

The biggest myth about therapy is that the therapist has the answers. The curative factor in therapy is not the therapist, it is the mutuality between the patient and therapist and the journey they share.

I have been teaching doctoral students in clinical psychology for over 25 years and I always remind these wonderful and passionate young professionals that they will never know more about the patient, than the patient.

What they offer is their clinical training to see and hear what the patient knows but cannot yet access because of history, pain, fear, addiction, trauma, etc. No matter what type of therapy, it is the collaboration between therapist and patient that makes change and healing possible.

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

The biggest obstacle is the conflict between the wish to change and the wish to hold on to the familiar. Most people are trying to regulate their anxiety and although they are in tremendous pain, the familiar can actually feel less frightening than the unknown.

Often people hold on to the most successful childhood survival strategies they know. The problem is that they are no longer needed and they impair adult functioning.

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

The most challenging part about being a therapist is seeing how therapists and their work are portrayed in the media. My family has told me that I have ruined most films and shows that depict therapists. Once my children were old enough, they would simply say, “Mom, you can’t stay if you keep commenting about what they are doing wrong!”

6. What do you love about being a therapist?

I love seeing the best of people emerge. I love the resilience and the hope that I have seen even in the darkest moments. I love passing on in my clinical work, my books, my lectures, and my blogs—anything that will give people the tools to become experts in their own lives.

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

Take the lessons learned from your past, set up some personal goals for your future and then live each day you are given.

In the course of that day, find a small way to include some generosity, some gratitude, some connection and some laughter. A meaningful life is in the details of how we live each day.

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 started in literature, headed into psychology and never turned back. I can’t imagine doing anything else. It is a way of thinking and being. There is always something more to learn, more to write, more to teach and what a gift to be able to share and care with people.

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

That mental illness is not something they caused. It is not something about which to feel blame or shame. It is suffering that is as painful as any physical illness. Anyone suffering from mental illness is entitled to compassion and help. The damage comes when help is avoided or unavailable. With help, mental illness need not define your life.

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

Actually I use a number of things to cope with stress. I have been running to music for 30 years and treasure it as a stress-reducing gift. I have always loved books and can become so engrossed that it is not unusual for the conductor on a train to come over to say, “ Ma’am, this is the last stop, the train is headed into the yard – you have to get off!”

I have a rule that on the weekends, I put down the work to enjoy time with my husband and I am always amazed at the revitalizing power of being together and off task.

That said, I try to be aware of the signs that I am on overload. When I start burning pots left on the stove, I know I have to drop down the stress by dropping something out. Big or small, when I open up space by rescheduling, by saying “No,” or by deciding to let something go – it always helps.

In today’s economy, more and more unemployed people are finding it increasingly difficult to find work. As a result, many people are taking whatever jobs they can find — even undesirable jobs such as shift work.

Shift work jobs can leave both partners with very different feelings. For example, the partner working the job may experience feelings of guilt regarding being away from the home. They may feel frustrated and “left out” due to being unable to participate in particular events or family time. This worker also may experience increased stress, feelings of overwhelm, and even irritability due to inconsistent sleep patterns combined with other emotions.

On the other hand, the other partner with more regular hours may experience feelings of loneliness. If there are children or others to be cared for in the home, this partner may feel a greater sense of responsibility and accountability. These feelings may lead to resentment and frustration.

Shift work may not be the ideal way of working or living, but it may be necessary to make ends meet or to keep employment. However, even with all of the negative things stated, there is hope.
If you and your partner work different shifts, there are ways to ensure you still maintain a happy and healthy relationship. Consider the following tips:

1. Call or text during breaks.

   This simple gesture will keep communication open throughout the day. If possible, try to keep the conversations light. Avoid talking about things that require more time than you have or that could create negative feelings.

2. Remember, quality is better than quantity.

   You and your partner may not have tons of time to spend together, but you can make the most of the time you have. Set a date or plan a fun activity during your next available time together and make the most out of whatever you do.

3. Leave little reminders of your love.

   Little reminders can come in the form of a note or a simple gift. Leave your partner items in surprising places such as the car, the bathroom, or even the fridge. This will let your partner know that you are thinking of them and leave them thinking of you as well. If you’re not really into notes or don’t have time or money for small gifts, consider completing a chore for your partner. This will show that you are considerate of his or her feelings and willing to pitch in to help in any way you can.

4. Set aside time for “business talk.”

   When partners have different, hectic schedules there is little time for anything. You don’t want the majority of your time spent talking about serious matters such as finances, household issues, etc. Set aside a specific time to address these issues so the remaining time can be enjoyed to the fullest.

5. Check in emotionally.

   In the chaos of hectic days we can remember to say “hi” or ask “how are you?” in passing. We may also get to squeeze in an “I love you” and “can you pick up some milk?” We want to make sure that we are checking in with our partners on a deeper level. Take the time to know how your partner is really feeling. As mentioned earlier, each spouse can experience various emotions as a result of their roles. Talk about these feelings and discuss what can be done to help both partners fell more comfortable.

Shift work doesn’t have to be miserable for partners, nor does it have to be a death sentence to your relationship. Relationships take hard work. For partners who have very different schedules, hectic lifestyles, or minimal time to spend together, these relationships may require a little extra work. You may choose to use some or all of the tips in this article or you may choose to use none. Evaluate your relationship, look at your partner’s needs, and do whatever is necessary to keep your relationship healthy. Don’t let shift work get the best of you.

This month we’re pleased to present an interview with clinical social worker Carla Naumburg, Ph.D. Naumburg authors the informative, inspiring and super-popular blog Mindful Parenting on Psych Central. She’s also a contributing editor for Kveller.com and mom of two young girls.

Below, Naumburg reveals the trials, triumphs and surprises of being a therapist; the books that have inspired her; the biggest obstacle for clients in therapy; her advice for leading a meaningful life; and much more!

Follow Naumburg on Twitter at @SWMama. Check out her writing at carlanaumburg.com.

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

Early in my training, I thought that being a therapist was about having the right tools and the right words to say that would make someone feel better. What I learned is that being a good therapist is about being able to stay truly present and accepting of someone else’s pain or fear, and that staying connected in hard moments is healing. Therapists don’t ever “fix” anyone, but if we’re doing our job well, our clients will feel less alone, suffer less, and feel stronger as they face life’s challenges.

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

Brené Brown’s books, including Daring Greatly and The Gifts of Imperfection, have truly inspired me. She is a social worker who studies shame and vulnerability, and her TED Talks are wonderful.

Viktor Frankl’s book, Man’s Search for Meaning, is a classic, and it’s one of my favorites. Dr. Frankl’s ability to find meaning in his experience in a concentration camp truly puts things in perspective.

3. What’s the biggest myth about therapy?

The biggest myth is that going to therapy means that there is something wrong with you. I have heard this over and over again, and it’s just not true. Attending therapy means that, like every other human on the planet, you have come up against challenges in life, and you could use some support from a safe, supportive, impartial person. That’s all it means.

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

One of the biggest challenges clients face is something that many of us struggle with, even when we’re not in therapy. I’m talking about the ways we beat ourselves up because we think we’re not smart enough, not productive enough, not good enough. In addition to the pain we feel from whatever is going on in our lives, we inflict additional harm on ourselves each time we judge ourselves so harshly.

For example, I might have a client who is struggling with depression, and in addition to how sad, lonely, and hopeless she feels, she is also angry at herself for not getting out of bed in the morning or accomplishing enough each day.

Our pain is lessened greatly when we can have self-compassion, when we can love and forgive ourselves, even when life is hard, when it is painful, when we are really struggling.

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

The hardest part of being a therapist is truly sitting with, and staying with, difficult emotions and trying not to offer solutions. When someone you care about (and yes, therapists do care about their clients!) is in pain, your first response is to fix it, to make the pain go away.

The problem with this response is that a) it implies that there is something wrong with experiencing difficult feelings (which is not true), and b) sticking a Band-Aid on a problem may help our clients feel better temporarily, but it doesn’t give them the insight, support, and perspective that will serve them well over the long run.

6. What do you love about being a therapist?

There is a proverb that describes what I love about my work: “I ask not for a lighter burden, but for broader shoulders.” Being a part of someone’s journey as they broaden their shoulders is incredibly meaningful to me.

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

I believe a meaningful life is authentic, compassionate, and not always easy. Figuring out who you are and what you love can be hard work, because it requires listening to your inner voice, silencing your inner critic, and taking risks. Most of us can’t do this on our own; we need supportive family and friends, and at times, a good therapist. (I would recommend Brene Brown’s writing, which I mentioned above.)

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 would choose the same professional path. My training in clinical social work has shaped how I see the world and understand people and social interactions and I value that tremendously. I am focusing on my writing right now, but in terms of my training and my professional identity, I am proud to be a social worker.

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

Lots of folks seem to be under the impression that there is a fundamental difference between people who are mentally healthy and people who are mentally ill. The reality is that we are all on a spectrum; we all have better days and worse days, and you never know what might happen in life that can change things—either for better or for worse. Remembering this fundamental truth can help us find compassion for ourselves and each other in difficult times.

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

I try to get exercise (walking, jogging, or yoga) every day, and I generally have a healthy diet (although sometimes a nice big piece of chocolate is just what I need). I find that journaling helps me find perspective, as does spending time with my friends and family. I have begun a mindfulness practice, and when I’m really stressed in the moment, taking a few mindful breaths and trying to stay present helps a lot.

All are good ideas if the problem merely is that you need a jumpstart to the work week. But such suggestions are beside the point if there is a real and important underlying issue that needs to be addressed. Sometimes the resistance to Monday is an inner emotional alarm going off. If that’s the case, taking a cold shower or drinking a cup of coffee won’t solve your Monday Blues any more than taking the battery out of a smoke detector will stop a fire.

Hate Mondays? Maybe you aren’t paying attention to one of these signals:

1. Your job isn’t really “workable.”

Let’s face it: For many, work has become much more demanding in the last 10 years. As companies cut personnel to cut costs, those left are expected to do more and more. Those who have been in their jobs for a long time often have high personal standards for quality that are almost impossible to meet with the increased workload. It’s exhausting and discouraging to feel like “the hurrieder you go, the behinder you get.” It may be appropriate to talk with your supervisor about adjusting your own or the company’s standards. If that’s impossible, it may be time to consider whether you can find a different job.

2. Your job isn’t satisfying.

Only a lucky few have jobs that are thrilling, satisfying, enjoyable, and enriching every minute of every day. Most of us have a whole lot of routine mixed in with occasional periods of excitement, or at least satisfaction. If those moments are few and far between, get busy. You may be able to up the portion of the time that you are happy in your work. Is there a project you could take on that would renew your interest? Is there a way to change your job within the company, either by going for a promotion or through a lateral move that would give you new opportunities? Does the human resources department offer workshops you could take to develop new skills?

3. Your life is out of balance.

“All work and no play makes Jack a dull boy” (or Jane a cranky girl.) It’s an old saying that is never irrelevant. If your life is work, work, work, of course you feel out of sorts. No matter how important our work is, we need to remember to refuel through self-care. That includes developing a hobby or interest, taking time for some fun and vacations (or stay-cations), and doing the usual daily regimen of eating right, sleeping enough, and getting some exercise. If you only take care of yourself on weekends, Monday morning is the beginning of five days of deprivation. Not good. Take the time to reassess how you are managing the balance of your life during the week.

4. Your job is hostile to your relationships.

Jobs that require long hours, or that require you to take work home or put in time on the weekends, are killers to family life and friendship maintenance. It’s sad to see parents at kids’ events who couldn’t leave their laptops at home. Friends get impatient with friends who interrupt a social evening to take a business phone call. Yes, these folks are in attendance, but they aren’t really there. Your discontent with your job may be a signal that you are missing out on too much of the warmth and intimacy you need from your relationships. Take a careful look at how you can manage the demands of your job in such a way that it doesn’t cost you love.

5. Your attitude toward work needs adjustment.

We do get what we expect. For some people, work is a four-letter word. Work is, well, “work.” It’s seen as the opposite of fun, the nasty dinner you have to eat before you get to have dessert. When a person has developed an attitude that any work or chore or required activity is a major distraction from enjoyment, Monday morning is, by definition, a downer. If that’s the case, it’s time for an attitude transplant. Unless you are one of the fortunate few to win the lottery or to inherit a trust fund, you’ll be working a great many hours of your life. Better to find a way to embrace it, and, yes, even enjoy it.

6. You are struggling with depression.

Depression can sneak up on a person. It may not be the job that is pulling you down. It may be that you are becoming clinically depressed. Is your appetite off? Are you having trouble getting to sleep or staying asleep? Has your interest in sex plummeted? Does doing things that used to be pleasurable for you seem like just too much effort? These could be the signs of depression. Consider going to see a mental health counselor for an evaluation. If you are depressed, the counselor will discuss possible treatment options. This may include some medication and some talk therapy to help you get back to your old self.

Before you buy into the notion that Mondays are awful and simply can’t be changed, take another look. It’s important not to ignore the possibility that the awfulness resides in your choices, not in a day of the week. If that’s the case, you do have the option to make it better. Confront the issue, make some changes (and maybe give yourself that splash of cold water and a cup of coffee), and you can make Monday the start of a productive and satisfying week.

Fortunately, clinicians have various effective ways of navigating stuck scenarios. In our monthly series therapists spill the specifics on helping clients move forward.

John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, talks candidly with his clients about being stuck. Just having such conversations, he said, ignites change.

Over the course of 15 years in practice, I’ve tried a lot of different techniques when I get stuck with a client. Now, I have found a device that seems to shift the dynamic almost immediately. I make the issue overt, and meta-communicate with my client around the stagnation of the therapy.

Effectively, I express my feelings. I might say, “Lately, it feels to me like we’re stuck, and things are not changing, either for you, or in sessions.”

This type of statement alone tends to change the dynamic immediately. You are no longer ignoring the issue, but you moved directly toward it.

I find that stagnation in therapy matches stagnation in life outside the therapy room. So, starting a shift in the room effectively becomes the therapy. In my opinion, few interventions are more effective, and it’s a model a client can use when stuck in most any area of her life.

Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression, focuses on understanding why her clients are stuck. She views these stalemates as stepping stones on the path toward growth and progress.

I’m a psychoanalyst by training, so for me, analyzing why a client is stuck is a meaningful treatment tool.

In the field, this is known as resistance — and the experience becomes a stepping stone that enables us to delve into historical reasons why the client may be blocked, stuck or looping in an emotional holding pattern.

Understanding why resistance is happening leads to newfound insight, which always “unsticks” therapy!

It’s important for readers to know that analyzing resistance is a positive thing, so being stuck shouldn’t always be a red flag. I often tell my clients that being stuck allows us to roll up our sleeves and dig deeper to discover great things.

When he’s stuck with a client, Ryan Howes, Ph.D, a clinical psychologist in Pasadena, California, explores what’s going on between him and his client. Again, just bringing up the issue in session has tremendous benefits, as Howes noted.

The first line of defense against feeling stuck is a strong grasp on theory. Most theories present a way to understand and address the common obstacles that arise all the time. In fact some would say that’s why theories exist – to help therapists know “what should I do next?”

For example, a CBT therapist may return to the list of goals and treatment protocols when they feel stuck, while a dynamic therapist may start looking for the client’s unconscious defenses or their own countertransferrence as obstacles. Comprehensive theories almost always provide someplace else to go with the client.

As a relational psychodynamic therapist, I highly value authenticity, equality, and collaboration in the therapy office. When I feel stuck, I look at it as a relational issue and ask myself what’s happening between us that is bringing our progress to a halt.

Is there a misunderstanding that needs to be addressed? Are both of us here in the room, or are our thoughts elsewhere? On some occasions I’ve simply told the client I feel stuck and invite them to solve the problem with me.

If I’m stuck, we’re probably both stuck, and this gives us an opportunity to tackle the stuckness together. I’ve actually found this strengthens the working alliance, helps the client feel more empowered and invested in the work, and demystifies the therapeutic process.

Jeffrey Sumber, MA, a therapist, author and professor, also considers how he might be stalling progress and creatively examines the effectiveness of his treatment.

When I feel stuck with a client, I rely on C.G. Jung’s premise that a client can only move beyond the places in therapy that their therapist has moved themselves, in their personal work.

First and foremost, I ask myself if there is something I am doing to hold the process back … Am I afraid of any emotion in the room? Am I excited about the client’s journey as I used to be? Am I feeling any underlying resentment toward the client?

Then I begin to look at the treatment from new angles, asking new questions to myself and to the client. I often ask the client how they feel our process is going and what is working and what might not be moving as smoothly as they would like. Sometimes I will ask the client to switch seats with me and role-play client and therapist from our new vantages.

Similarly, Christina G. Hibbert, Psy.D, a clinical psychologist and expert in postpartum mental health, carefully analyzes how both she and the client might be contributing to the stagnation in session.

I always try to pay close attention to how I feel when I’m working with a client. What I’ve learned over the years is that when therapy’s working well it’s a smooth, give-and-take process between client and psychologist. It’s when I start to feel like I’m working harder than my client that I know we have a problem. That’s how I know we’re “stuck.”

Of course, each client is unique and therefore each situation requires a unique approach, but in general, when I feel stuck with a client I first take a “step back” to give myself some perspective.

I try to imagine what might be going on with the client and I question myself to make sure there’s nothing going on with me that is getting in the way of the treatment.

Then, I bring it up to the client. I tell her, “Lately things haven’t been working as smoothly as before. Do you feel it too? I thought we should spend some time today discussing why this might be.”

Discussing it directly allows the client to share insights about her emotions, her experience in therapy, and her experience with me. This helps me understand what the client thinks about being “stuck,” gives me insight into any part I might play in the “stuck-ness,” and almost always helps clear things up one way or another. By confronting the “elephant in the room,” we’re able to get “unstuck” and keep the therapeutic process moving forward.

Joyce Marter, a psychotherapist and owner of Urban Balance, considers how her own concerns are affecting therapy with all her clients. Then, like the other clinicians, she talks directly with her client and raises specific key questions.

First, I will consider my countertransference responses to my client by reflecting on my feelings about the client, on other times I have felt similarly, and recognizing if any of my own issues are getting triggered.

I also consider if other clients of mine are also stuck, in which case I am the common denominator and becoming “unstuck” may need to start with me. I bring any discoveries to my clinical consultant and/or personal therapist to address so that I am best able to help my client.

If I am simply frustrated by the client’s “stuckness” and no other issues of mine are being triggered, I will refer to the teachings of Al-Anon to practice detachment with love, or the ability to stay present with my client without taking on any feelings of powerlessness.

Secondly, I will ask my client how he or she is feeling about therapy, our relationship, the process and his or her progress. I also ask if he or she has ever felt this way or had this experience before, as a way of identifying if this is [a] pattern being unconsciously recreated.

Marter shared how these kinds of conversations in session can spark great insights for clients.

I often find that this process sheds new light on the situation and provides an opportunity to take the therapy to a deeper level by exploring dynamics in the therapeutic relationship. Frequently, this increases the client’s consciousness and he or she is able to experience the therapeutic relationship as a corrective experience.

This was the case with a 45-year-old adult male client who, despite being extremely intelligent and educated at the graduate level, had never established a satisfying career. After we worked through issues related to depression and self-esteem, he seemed to be stuck in therapy.

As we explored this impasse in our relationship, he realized that his family (thinking they were being loving) enabled him to not work by making him a trust fund baby and never pushing him to be independent, which he took to mean he was incapable.

The therapeutic relationship proved to be a corrective experience for him, because we pushed beyond where others had stopped and he was made accountable and responded extremely well to that experience. His confidence soared and his career became more defined, vital and prosperous.

Sometimes, it’s the client’s defense mechanisms that trigger the paralysis, according to Marter. When that’s the case, she uses several techniques.

If the lack of progress in therapy seems related to the client’s defense mechanisms, I will consider using a different therapeutic technique as appropriate. For example, I may use a body-centered approach such as EMDR or a technique that is very collaborative and non-threatening, such as the Internal Family Systems Model.

Alternately, I find the use of CBT to address thoughts that are keeping the client stuck to be extremely helpful in moving through them and establishing new belief systems that encourage positive growth and change.

When a client stops making progress or takes a few steps back, clinicians contemplate their role in the stagnation. They have an honest conversation with their clients to pinpoint the problem. And they work on getting unstuck together.

** Thanks so much to KC, a substance abuse counselor, for suggesting this topic. If you’d like to see a specific topic in this series, email me at mtartakovsky at gmail dot com with your suggestion.

This month we’re thrilled to feature Elisha Goldstein, Ph.D, a clinical psychologist who writes one of the most popular blogs on Psych Central: Mindfulness and Psychotherapy. Goldstein sees clients at his private practice in West Los Angeles. He is the author of The Now Effect: How This Moment Can Change the Rest of Your Life and co-author of A Mindfulness-Based Stress Reduction Workbook.

He’s also created other valuable resources on mindfulness, including the Mindful Solutions audio series, Mindfulness Meditations for the Troubled Sleeper and Mindfulness Meditations for the Frantic Parent.

Learn more about Elisha Goldstein at his website.

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

How big the gift of being of service can be. I have the privilege of knowing people intimately and supporting them in being happy. When I sit with that, it gives me an immense sense of purpose. I’m also lucky enough to be a teacher for other therapists as I often train many in the field of Mindfulness and Psychotherapy. The ripple effects give me immense joy.

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

Well, besides The Now Effect (wink) – I’m a big fan of books that keep it simple. Thich Nhat Hanh is a Vietnamese Buddhist monk who writes simply and elegantly and I am a fan of many of his works. Taming the Tiger Within and The Miracle of Mindfulness are some of my favorites.

3. What’s the biggest myth about therapy?

That there’s an end goal. I don’t mean that people need to be in therapy for an indefinite time, but there’s a faulty notion of achieving some end state. This focus makes therapy more difficult as the mind is cluttered with an expectation instead of focusing on learning.

Even if insurance only covers 10 sessions and wants to hear the end goal, we have to always keep in mind that therapy is a vehicle for learning, and while we can begin to master certain ways of being, growing and learning about ourselves in life never ends.

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

Translating what happens in session into their daily life. There are magical moments of insight that can happen in a therapy session. A feeling that something has really shifted mentally, physically at times and even spiritually.

But when we get back in our daily environments we slip back into old patterns and the insights are mere whispers that we often can’t hear. A big part of the work in psychotherapy is about bringing intention to reconnect with the insights and practices from therapy into the other 167 hours of the week.

Finding ways to create reminders that work and stick is an invaluable tool. The best reminders come in the form of relationships.

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

A couple things come to mind. The first is that at times I care so much about my clients that I take them home with me and that may affect my life outside of the office. But I’ve gotten better over time of not doing that as much and when it does [happen], there’s still a lot of meaning in it. I’m lucky enough to have a wife who’s also a psychologist and can relate.

The second is challenging myself to stay present in the face of uncertainty within a session. There are times when I’m not sure where things are going or what “to do.” It’s important to remember that there’s richness in uncertainty; to be able to “be with” it cultivates courage, self-trust and creative potential.

When you bring it into the relationship between therapist and client, it builds trust between the two. This trust is the foundation for change.

6. What do you love about being a therapist?

Living what I feel my purpose is. Being of service, there’s no greater gift.

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

Find what is meaningful to you in life and take steps to make those actionable. Look at the activities in your day and see where the spaces are that are either neutral or depleting. See if you can replace some of these with more meaningful activities and see what happens. Ultimately as therapists we want our clients’ experience to be their guide, not our advice. This builds self-trust, which is a fundamental factor in resiliency and happiness.

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?

Absolutely. I took a risk a while back leaving a profession that provided me some golden handcuffs (making good money, but wasn’t aligned with a sense of purpose for me.) I re-entered into a rickety financial position pouring everything I had and taken loans to go back to school.

It was a great risk to take. Now, I’m very happy working with people individually, running Mindfulness-Based groups, speaking, training therapists, creating the Mindfulness at Work™ with eMindful.com, a program that is currently in Aetna, Blue Cross Blue Shield and many other multi-national corporations and writing meaningful and practical books like The Now Effect, Mindfulness Meditations for the Anxious Traveler and co-authoring A Mindfulness-Based Stress Reduction Workbook.

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

The best way to enter therapy is to see it as a learning process, not something to achieve. This drops our anxieties over imperfections and frees up energy to open up to the wonders in life we’re not seeing.

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

I have a daily mindfulness practice, play with my kids, [take] rigorous walks, eat healthy, try and get good sleep when my kids allow it, [have] a weekly gratitude roundtable with family and practice, practice, practice self-compassion.

Occupational therapy often is misunderstood in this process. According to the American Occupational Therapy Association, the primary goal of occupational therapy is to support and enable each person’s “health and participation in life through engagement in occupation.”

“Occupation” does not solely mean work. Some examples of occupations include time spent on personal hygiene, preparing a meal, managing finances, painting a picture, attending a community leisure course, and socializing with others. Occupational therapists enhance people’s ability to live meaningful and satisfying lives.

The purpose of occupational therapy can best be described by the profession’s motto, “Occupational therapy: living life to its fullest.” All individuals have a right to live life to its fullest. An occupational therapist can help people consider not only their needs, strengths, abilities, and interests, but also their physical, social, and cultural environment.

Origins of Occupational Therapy

While many commonly think of occupational therapy as physical rehabilitation after injury or illness, it actually has roots in mental health.

Occupational therapy’s emergence can be found as far back as eighteenth-century Europe. At a time when mentally ill people were treated like prisoners, a “moral treatment movement” began to evolve. While the previous treatment model was associated with punishment, brutality and idleness, the moral treatment movement sought to encourage kindness and the therapeutic value of engagement in purposeful activities.

The first occupational therapy treatment model, called Habit Training, began at Johns Hopkins in the early twentieth century. This approach proposed that in mentally ill people, occupational activities such as work, rest and play had become unbalanced. Early occupational therapists introduced therapeutic occupations such as weaving, art, and bookbinding. These goal-directed activities were used to help individuals learn new skills to be productive, and derive therapeutic benefits of a balanced daily schedule.

The occupational therapy profession grew as wounded soldiers returned from World War II, and then surged again in the 1970s with the medical field’s increase in specialized skills and knowledge.

Occupational therapists always have believed in treating the whole person, whether the primary problem relates to physical or mental health. They practice in diverse settings, including hospitals, outpatient clinics, skilled nursing facilities, intermediate care facilities, home health, neonatal intensive care units, community programs and the workplace. Those who work in mental health can do so in residential hospitals, community-based mental health settings and outpatient private practice clinics.

Assessments and Treatments

When working with someone with a mental health condition, occupational therapists employ a variety of assessments. Once the necessary information has been obtained, the therapist creates a personalized occupational profile. This profile is used for goal-setting and treatment planning.

Common areas of assessment include:

• Activities of daily living (e.g., bathing, dressing, eating)
• Instrumental activities of daily living (e.g., driving, money management, shopping)
• Education
• Work (paid and volunteer)
• Play
• Leisure
• Social participation
• Motor processing skills
• Mental and cognitive processing skills
• Communication and interaction skills
• Habits, roles and routines
• Performance contexts (e.g., cultural, physical, spiritual)
• Activity demands
• Client factors (e.g., difficulties due to body structures or functions)
• Occupational self-assessment

For example, an occupational therapist may assess a client with schizophrenia who is living in a residential hospital in order to help to determine the best placement in the community. The assessment may include standardized evaluation tools, individual interview, and observation to determine ability to function and live alone safely, and identify important roles and occupations. This information is then used to determine the skills, supports, and environmental modifications the person may need to live as independently as possible.

Occupational therapy can be vitally important in the overall mental health treatment process. Following are some common interventions:

• Life skills training
• Cognitive rehabilitation
• Supported employment
• Supported education
• Social and interpersonal skills training
• Life balance intervention
• Modalities such as biofeedback and mindfulness-enhanced therapy

Part of Collaborative Process

As noted in the beginning of this article, occupational therapists collaborate with many other professionals to help individuals on their road to recovery. While the role of the occupational therapist may overlap with other team members, the occupational therapist provides a unique theoretical and clinical contribution to the recovery and treatment team; thus, occupational therapy should be considered a vital part of a comprehensive and integrated treatment program.

And, most important, books are life-changers. The kind that change your career, how you interact with loved ones or how you see the world.

Below, in our monthly series, therapists spill about the books that have changed their lives for the better.

The Prophet by Kahlil Gibran

This book had a powerful effect on psychotherapist Jeffrey Sumber’s perspective on life and love.

Kahlil Gibran’s The Prophet had a huge impact on me as a young man because he was able to address the major elements of life, love and relationship through a poetic angle. There is such beauty and truth to Gibran’s book that I often considered it to be a beautiful version of the Bible without all the names and killing.

I remember sitting on a huge sand dune in the Sinai Desert when I was 21 years old, reading this book and meditating on its meaning in my life. I wish more people read this.

Siddhartha by Herman Hesse

Siddhartha is another pivotal book for Sumber, a teacher and author. He also recommends the book to clients who are stuck in life’s “shoulds:” My life should look like this. I should be doing that.

Siddhartha follows the story of a young man who seeks his own illumination but everything he accomplishes never seems to be enough.

At first many people feel that this fictional book about an Indian man in the Far East has little to do with them until they start to see themselves in his journey. The ups and downs, achievements and challenges all seem to resonate at our core because the overall message of the book is so simple in the end.

Sometimes we get more mileage by just stopping, breathing and contemplating life as it passes by.

A Prayer for Owen Meany by John Irving

John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, loves the redemptive endings and hope inherent in Irving’s writing, particularly in A Prayer for Owen Meany.

Irving is brilliant with language, his wild descriptions of family and relationship dysfunction that, in the end, ring fairly true and lie just beyond the norm. There are no clearly delineated villains or angels. Instead, Irving characters are painfully, blessedly human, flawed and terrified and perfectly drawn.

On the whole, though, as bizarre as his stories are, this one in particular, the plot always sits atop an undercurrent of hope and love. It’s a joy to read.

The Giving Tree by Shel Silverstein

This book is a favorite of Deborah Serani, Psy.D, a clinical psychologist and author of Living with Depression. She still finds it stirring today.

As a young girl, Shel Silverstein’s The Giving Tree was a book that I read over and over again. Of course, at first I didn’t really understand its message, but as time passed I realized that it was a story of unconditional love. It still moves me whenever I pick it up to read.

Freud and Beyond by Stephen Mitchell and Margaret Black

Serani’s other favorite is Freud and Beyond, which she also uses as a teaching tool with her graduate students.

As an adult, I have to say that Freud and Beyond by Stephen Mitchell and Margaret Black is one of my favorites books because it beautifully details the origins of psychodynamic psychotherapy from Freud ‘til present time. Chapters cover many schools of thought and give the reader a great taste of theories, technique and practice.

Pig Will and Pig Won’t by Richard Scarry

This childhood book was one of two that led to a significant decision for Joyce Marter, a psychotherapist and owner of Urban Balance.

The two books that have impacted me the most are vastly different from one another, yet the combination of messages I received from each of them sheds tremendous light on why I became a therapist.

The first book was from my childhood, Richard Scarry’s Pig Will and Pig Won’t, which inspired me to choose and develop one of my primary modes of operation. In the story, Pig Will and Pig Won’t are brothers who respond differently when asked to help with chores and other acts of service.

Pig Won’t declines opportunities to help and misses out on the sometimes surprising rewards that come to Pig Will for choosing to be of service to others, such as feeling connected to his community, taking pride in shared accomplishments, or simply being taken out for chocolate ice cream.

At a young age, this story helped me consciously choose to take the path of engaging in life opportunities to be of service to others, and I am grateful that this decision has resulted in countless rewards and blessings both personally and professionally.

Imagine you’ve just been fired. Many of us would react to this situation in at least some of the following ways:

“I’m terrified.”

“I should have seen this coming.”

“I’ll never find another job in this economy.”

“Am I going to be homeless?”

“I’m a failure.”

Reactions like these reflect a fear-based survival framework for viewing the situation: We filter the external facts through the internal lens of thoughts, feelings, beliefs and body sensations. In this way, our fear creates our reality, locking us in anger, powerlessness, and blame.

Recontextualizing and Reframing

People are not afraid of things, but of how they view them. — Epictetus

It’s understandable why we might react from fear when facing challenging situations. Mindfulness, however, is a powerful tool that offers the opportunity to make a radical shift in orientation.

Mindfulness is the practice of bringing our awareness to what we are experiencing in the present, both internally and externally, without judgment (Kornfield, 2009). It is a wakeup call to become conscious of the ways we perceive and respond to life’s situations.

Here’s a traditional, easy-to-follow mindfulness exercise (Klau, 2009). Mindfulness takes time to develop. It is an ongoing process. Be kind and compassionate to yourself as you follow these instructions.

• Sit in a quiet room where you won’t be disturbed.
• Close your eyes and focus your attention on your breath.
• It’s natural for your attention to become distracted. When that happens, simply return to your breath.
• While focusing on your breath, allow your thoughts, feelings, beliefs, and body sensations to enter your awareness as you perceive the external situation.
• Now ask yourself: What are the facts of the situation? What are my thoughts, feelings, beliefs and body sensations? How am I responding?

With practice, this exercise can bring us to our calm, reflective center. This safe haven, in which we can rest and see more clearly, holds and contains everything arising for us in the present. From here, it is possible to deconstruct, recontextualize and reframe our original fear-based feelings and reactions, honoring and embracing them without being their victims. (This discussion shares much in common with neuroscientist and clinician Dan Siegel’s work on the concepts of “differentiation” and “integration,” which he views as the key to well-being.)

For example, let’s return to the original situation, where you’ve just lost your job. Rather than automatically reacting with fear, mindfulness helps you realize and accept: “The only fact about this situation is that I don’t have my job right now. Everything else— my self-judgment, my fear, my blame, my anger, and the tightness in my body— is my feelings.”

We don’t have to meditate to practice being mindful. There are many ways to incorporate mindfulness into our daily lives. As we become increasingly mindful, we can begin to respond from a place of freedom and choice.

In other words, we can act with resilience.

Mindfulness and Resilience

As we become more mindful, we broaden and build several inner resources that help us strengthen our resilience (Fredrickson, 2001). These include:

• Compassion. You hold the intention not to judge yourself or others. You are mindful of your self-talk. However, if you do judge yourself, you don’t judge yourself for judging. You are kinder and more supportive. If mindfulness brings the wisdom to see clearly, then compassion brings a loving heart (Neff, 2011).
• Acceptance. You increasingly accept the facts, which you can distinguish from feelings. Acceptance isn’t about giving up. It is having the strength to let go of control and stop fighting reality.
• Openness. You’re progressively open to viewing even the most difficult situations as opportunities for growth. You trust that they have something to teach you, and you expect to learn.
• Creativity. You draw on your power to visualize and create the results you desire. At the same time, in the spirit of acceptance, you are not attached or fixated upon your own expectations.

Living resiliently is more than just “bouncing back.” It is about shifting our perceptions, changing our responses, and learning something new. For example, a resilient response to losing our job might recontextualize and reframe the situation in any of the following ways:

“I’m going to breathe deeply and take things one step at a time.”

“I may not like it, but this is the way it is. My first step will be to file for unemployment.”

“I’m not going to play ‘the blame game.’ It’s not my boss’s fault or mine.”

“I’m sure that there’s a lesson or two for me to learn from all this.”

“It would be easy to get ‘just another job.’ I’m going to find one that I’m truly passionate about.”

Living resiliently represents a whole new way of being and doing. It isn’t just for the hard times — it’s for all times. Empowering us to live, love, and work adventurously in the face of change, it builds a well from which we can draw for the rest of our lives.

References

Fredrickson, B.L (2009). Positivity: Groundbreaking Research Reveals How to Embrace the Hidden Strength of Positive Emotions, Overcome Negativity and Thrive. Random House: New York.

Klau, L (2009). Mindfulness: The New Zen of Time Management. GAINS Quarterly, Summer.

Kornfield, J. (2009). The Wise Heart. Random House: New York.

Neff, K. (2011). Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind.

Siegel, D.J. (2010). Mindsight: The New Science of Personal Transformation. Random House: New York.