Both parents need to nurture children. Healthy parenting helps the grown child be his or her own best mother and father. A child must not only feel loved, but also that he or she is understood and valued by both parents as a separate, unique individual and that both parents want a relationship with him or her. Although we have many needs, I’m focusing on nurturing emotional needs.

Emotional Needs

In addition to physical nourishment, including gentle touch, care, and food, emotional nurturing consists of meeting a child’s emotional needs. These include:

• Love
• Play
• Respect
• Encouragement
• Understanding
• Acceptance
• Empathy
• Comfort
• Reliability
• Guidance
• The importance of empathy

A child’s thoughts and feelings need to be taken seriously and listened to with respect and understanding. One way of communicating this is by mirroring or reflecting back what he or she is saying. “You’re angry that it’s time to stop playing now.” Instead of judgment (“you shouldn’t be jealous of Cindy’s new friend”), a child needs acceptance and empathic understanding, such as: “I know you’re hurt and feel left out by Cindy and her friend.”

Empathy is deeper than intellectual understanding. It’s identification at an emotional level with what the child feels and needs. Of course, it’s equally important that a parent appropriately meets those needs, including giving comfort in moments of distress.

Accurate empathy is important for children to feel understood and accepted. Otherwise, they may feel alone, abandoned, and not loved for who they are, but only for what their parents want to see. Many parents unwittingly harm their children by denying, ignoring, or shaming their child’s needs, actions, and expressions of thoughts or feelings. Simply saying, “How could you do that?” may be felt as shaming or humiliating. Responding to a child’s tears with laughter, or “That’s nothing to cry about,” or “You shouldn’t be (or ‘Don’t be’) sad,” are forms of denying and shaming a child’s natural feelings.

Even parents who have sympathetic intentions may be preoccupied or misunderstand and misattuned to their child. With enough repetitions, a child learns to deny and dishonor natural feelings and needs and to believe that he or she is unloved or inadequate.

Good parents are also reliable and protective. They keep promises and commitments, provide nourishing food and medical and dental care. They protect their child from anyone who threatens or harms him or her.

Tips for Self-Love & Self-Nurturing

Once grown, you still have these emotional needs. Self-love means meeting them. If fact, it’s each person’s responsibility to be his or her own parent and meet these emotional needs, irrespective of whether you’re in a relationship. Of course, there are times you need support, touch, understanding, and encouragement from others. However, the more you practice self-nurturing, the better your relationships will be.

All of the things a good mother does, you have the superior capacity to do, for who knows your deepest feelings and needs better than you?

Here are some steps you can take:

• When you have uncomfortable feelings, put your hand on your chest, and say aloud, “You’re (or I’m) ____.” (e.g., angry, sad, afraid, lonely). This accepts and honors your feelings.
• If you have difficulty identifying your feelings, pay attention to your inner dialogue. Notice your thoughts. Do they express worry, judgment, despair, resentment, envy, hurt, or wishing? Notice your moods. Are you irritable, anxious, or blue? Try to name your specific feelings. (“Upset” isn’t a specific feeling.) Do this several times a day to increase your feeling recognition. You can find lists of hundreds of feelings online.
• Think or write about the cause or trigger for your feeling and what you need that will make you feel better. Meeting needs is good parenting.
• If you’re angry or anxious, practice yoga or martial arts, meditation, or simple breathing exercises. Slowing your breath slows your brain and calms your nervous system. Exhale 10 times making a hissing (“sss”) sound with your tongue behind your teeth. Doing something active is also ideal for releasing anger.
• Practice giving yourself comfort: Write a supportive letter to yourself, expressing what an ideal parent would say. Have a warm drink. Studies show this actually elevates your mood. Swaddle your body in a blanket or sheet like a baby. This is soothing and comforting to your body.
• Do something pleasurable, e.g., read or watch comedy, look at beauty, walk in nature, sing or dance, create something, or stroke your skin. Pleasure releases chemicals in the brain that counterbalance pain, stress, and negative emotions. Discover what pleasures you. (To read more about the neuroscience of pleasure, read my article, “The Healing Power of Pleasure”.)
• Adults also need to play. This means doing something purposeless that fully engages you and is enjoyable for its own sake. The more active the better, i.e., play with your dog vs. walking him, sing or collect seashells vs. watching television. Play brings you into the pleasure of the moment. Doing something creative is a great way to play, but be cautious not to judge yourself. Remember the goal is enjoyment – not the finished product.
• Practice complimenting and encouraging yourself – especially when you don’t think you’re doing enough. Notice this self-judgment for what it is, and be a positive coach. Remind yourself of what you have done and allow yourself time to rest and rejuvenate.
• Forgive yourself. Good parents don’t punish children for mistakes or constantly remind them, and they don’t punish willful wrongs repeatedly. Instead, learn from mistakes and make amends when necessary.
• Keep commitments to yourself as you would anyone else. When you don’t, you’re in effect abandoning yourself. How would you feel if your parent repeatedly broke promises to you? Love yourself by demonstrating that you’re important enough to keep commitments to yourself.

A Word of Caution

Beware of self-judgment. Remember that feelings aren’t rational. Whatever you feel is okay and it’s okay if you don’t know why you feel the way you do. What is important is acceptance of your feelings and the positive actions you take to nurture yourself. Many people think, “I shouldn’t be angry (sad, afraid, depressed, etc.). This may reflect judgment they received as a child. Often it’s this unconscious self-judgment that is the cause of irritability and depression. Learn how to combat self-criticism in my ebook, “10 Steps to Self-Esteem,” available in online bookstores.

1. Everyone has challenges.

Clinical psychologist Christina G. Hibbert, PsyD, wants readers to know that they’re not alone in their struggles. “We all have challenges. Even as I sit in my chair helping [a client], I have challenges too. It hurts me to see clients feeling like they’re the only ones on earth who ‘need therapy.’”

Therapist Joyce Marter, LCPC, agreed. She believes that our struggles are simply “part of the human condition…[E]verybody struggles with issues related to self-esteem, identity, navigating relationships, coping with various life traumas, managing stress or challenges in creating the life we want, personally and professionally.”

2. Everyone can benefit from therapy.

Therapy is a healthy and proactive approach to dealing with challenges, Marter said. “A therapist is like a personal trainer for your mind. I believe we can all benefit from therapy at various points in our lives and see it as a preventive and routine form of health care.”

3. Seeking therapy is courageous.

It’s a common myth that therapy is for weak people who can’t fix problems on their own. “I think of therapy as making use of all the tools at one’s disposal to manage negative emotional symptoms and maximize strengths and fulfillment,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. “People willing to delve into their own psyches are … actually quite courageous.”

4. Therapy helps you navigate life.

You can apply the skills you learn in therapy to any area of your life, according to Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression. “It really doesn’t matter if you go to therapy for anxiety, depression, to lessen obsessions, to quit smoking or to learn how to parent – whatever the reason – the techniques of self-reflection and thought-changing are involved in all.” In fact, she said, many people consider therapy to be the most meaningful and valuable experience of their lives.

5. Therapy is a process of self-discovery.

“To my thinking, therapy does not need to be an excruciating experience. Sometimes I think we do therapy itself a disservice when we call it ‘work.’ For my clients, I like to think of their therapy as a process of self-discovery, more joyous in the end than painful,” Duffy said.

6. Therapy isn’t about blaming others.

“Some people think therapy is about blaming their parents or their life histories for all of their woes,” said Marter, also owner of the counseling practice Urban Balance. Therapy is actually “about honoring those experiences and then taking full responsibility for your life from here forward.” She shared Wayne Dyer’s quote: “Everything you do is based on the choices you make. It’s not your parents, your past relationships, your job, the economy, the weather, an argument or your age that is to blame. You and only you are responsible for every decision and choice you make.”

7. Therapy is a place to say and ask anything.

“Therapy isn’t the place to put your best foot forward and try to convince the therapist that you have it all together,” according to Ryan Howes, Ph.D, a clinical psychologist and author of the blog “In Therapy.” Instead therapy is a space to be fully and authentically yourself. Bring everything from your daydreams and fantasies to your harsh opinions and random thoughts, he said. “A skilled therapist will work to understand these impulses and beliefs without judgment and help you make sense of them. Save the pleasantries for the outside world, and let your raw, real thoughts and feelings out here.”

The same is true for asking your therapist questions: If there’s a question you’d really like to ask about your treatment or therapy in general, ask away, Howes said. “If the therapist doesn’t want to answer, let them explain why and how not answering benefits you in the long run. If you’re not satisfied with the answer, let them know.” He noted that therapy is a relationship. “Therapists should be experts at setting boundaries and working through relational issues in a constructive way.”

8. Therapy doesn’t end as soon as you feel better.

Jeffrey Sumber, M.A., a psychotherapist, author and teacher, wishes that people knew that improvement doesn’t signal the end of therapy. “So often, folks begin to feel the shift within themselves, their patterns change, their mood improves, and they terminate treatment only to find themselves in a similar situation down the road.” That’s because those shifts are a mark of progress, not proof of a cure.

“The counseling process is multi-layered and the feelings of renewed purpose and lifeforce that accompany the internal shifts we make are actually there to help propel us forward so that we feel this way every day on our own. I wish people took the signs of improvement as a confirmation that treatment is helping, not over.”

9. Don’t compare your insides to others’ outsides.

“I often hear clients pathologize themselves and suggest that most other people are functioning at a higher level in various aspects of their lives,” Marter said. In reality, however, “we are all dealt a different hand of hardships and blessings. Therapy is a place to help you think through how you want to play your hand.” In fact, she’s seen “people overcome great adversity and others squander great blessings.”

10. Your thoughts dictate your feelings and behavior.

Marter cited Gandhi: “A man is but the product of his thoughts.” This is why it’s so helpful to pay attention to the things you say to yourself and shift your perspective to more realistic, empowering thoughts. “Through therapy, we can let go of negative or irrational thinking and promote positive thinking and a practice of gratitude that will attract more positivity into our lives,” Marter said.

11. Acceptance isn’t limiting; it’s liberating.

“Don’t get me wrong, there are times when we need to keep striving, pushing, and holding out hope for better health, better careers, or healthier relationships,” Howes said. However, many individuals end up wasting their time and energy wrestling limitations they can’t change, instead of focusing on the things they can alter. According to Howes:

We need to accept our age. We need to accept many physical and mental illnesses and addictions. We need to accept the past. We need to accept others as they are. This isn’t to say we need to like it, or that we can’t work to make the best of each of these entities, but we need to relinquish the idea that we have any power or responsibility to change them. Once people realize they can accept instead of fighting things beyond their control, they realize they have much more time and energy for things they can impact.

12. You are worthy. Whether her clients come in with depression, anxiety, relationship problems or parenting concerns, Hibbert believes that, at the core, they’re all struggling with the same thing: “an inability to comprehend and feel their worth.” She’s also seen this with friends and family and experienced it herself. “I’ve had to work very hard to discover my own self-worth.”

She wishes people truly understood that “they’re more than how they feel, what they do or say, and what they think. Deep down, we are each of infinite worth.” Connecting to our self-worth is “the key to living a life of meaning, abundance and joy,” said Hibbert, also a women’s mental health, postpartum and parenting expert. (She talks more about self-worth in this piece.)

13. Life requires balance.

Howes noted that while the idea of balance is cliché, he’s also seen the damage of living in extremes. “People who work too much, party too much, spend too much time online, exercise too much or let themselves become consumed by their relationships will face the consequences of a life out of balance.” The skills for achieving moderation are challenging yet critical to learn, he said.

14. Growth and progress are not linear.

“We all go through setbacks, relapses or regressions in life as a normal part of being human,” Marter said. Experiencing a setback doesn’t mean you’re back to square one. Instead, this is an “opportunity to learn, get back on the saddle, grow and move forward. Life is a process of ebbs and flows.”

15. Work on the inside.

According to Marter, “Some people are waiting for external factors such as a relationship, a job, a perfect body or a fat bank account to make them happy.” Instead, the key is to work from the inside out. She cited Eckhart Tolle: “If you get the inside right, the outside will fall into place.” Marter added: “Therapy is a place to explore your greatest gifts and align your life with those so that you will achieve all you desire personally and professionally.”

This is a fascinating book for those who want to think about and remember more useful information. It combines some common-sense advice with the author’s experience in the field of cognitive science. While I didn’t find every point helpful, there is much to like.

According to Markman, smart thinking is “the ability to solve problems using what you already know.” That sounds simple, but the book explains how we can put better information into our brains and then get better at recalling that information. As a result, we become better thinkers. That’s an appealing idea.

Markman’s formula goes something like this: We should develop a habit of acquiring high-quality knowledge which we then apply to problem solving. It doesn’t seem to be the author’s intent to present startling new methods, but rather to use his knowledge of how the mind works to give us basic ideas to improve our thinking. This can mean thinking outside the box, which is hardly a new approach. Or, applying what we know from one field to a totally different one to arrive at a solution.

Markman spends a chapter or more on the topic of habits. He suggests that if we develop good learning habits, we make it easier for our brain to think. This in turn relieves mental stress and preserves energy for more challenging tasks. We likely haven’t thought a lot about how much energy we use in thinking, but Markman wants us to understand that we use mental energy in much the way we consume physical energy. When we are in our comfort, or habitual, zones of working with familiar subjects, thinking seems to come easily and without much stress. So, he posits, our goal should be to make more subjects familiar ones.

For instance, are you able to move about a room in the dark? If so, that’s because you have made it a habit to maneuver around furniture and other objects by making a connection between an action (your movement) and an environment (the room). When we make that connection in other learning situations such as a classroom or meeting room, it helps our brain to retain the information.

That example works well. But much of Markman’s discussion of other types of habits, such as smoking or overeating, is belabored. They aren’t bad suggestions; it’s just that we have read these ideas in many places before. Still, a helpful tip from the book is that if we want to change or drop a negative habit it works better if we replace that habit with a good habit. Markman adds that keeping a diary can be effective for some people.

I felt the most helpful and interesting discussion was on the subject of memory. Markman suggests that because our memory has capacity limits, it is important to take in information in a smarter way in order to retain more valuable knowledge. He uses a concept called the “Role of 3” to make his point. Even though there may be a lot going on around us, we are capable of absorbing only about three aspects at a time. Further, what we retain in long-term memory is even less detailed. For example, can you remember an early childhood birthday? Being honest, you may recall that there was a party that likely was in a home you recall and likely included certain friends. But you can’t recall much detail with certainty, including how you felt about it. Markman’s bottom line is that if you are having trouble remembering something, you did something wrong on the intake end.

Being aware of the Role of 3 can also be used to our advantage when we are delivering information, as we might in making a presentation or while teaching. We may want to tell our audience or colleagues everything we know, but this could result in their retaining the less important information. It’s better to stick to three main points. In fact, the author repeats common speakers’ advice: Tell them what you are going to say; say it; then tell them what you said.

Markman also says that we miss much of what is right in front of us. He calls it “change blindness,” explaining that although our eyes may be constantly scanning our surroundings, we only notice a small part of what we are scanning. We see examples of this when witnesses to a crime have difficulty describing the perpetrator with much detail, or describing accurately.

The book also claims that it is easier for us to learn new information that is related to something we already know than when it is a totally new topic for us. We can accept this as likely and use this to make us work harder when we are in new learning territory.

Why do we even want to become smart thinkers in the first place? Why not! It can help us in school at any level; in work and careers; and in social interaction. In showing us why we think the way we do, Markman’s book is a useful one, even if not every point is fresh. And if some of his suggestions seem to take too much effort or seem too challenging, we can still learn how to be more alert to what we absorb—and hopefully become more interesting people as a result.

Smart Thinking: Three Essential Keys to Solve Problems, Innovate, and Get Things Done
Perigee, Penguin Group, December, 2012
Paperback, 272 pages
$15

Have you ever gone to an online news source to suddenly, surprisingly encounter a gut-wrenching headline or photo? Did it make you feel sucker-punched in the stomach?

Now, don’t get me wrong: I think as citizens we have an obligation to know about certain events that may be tragic, hurtful, sad, distressful or disturbing. I’m not saying that horrible events shouldn’t be reported. However, as a psychologist, I would argue that as a society we should have somewhat ‘safe spaces’ in which we can receive news without the proverbial punch in the stomach, if we know, at least in that moment, that we just simply can’t handle it.

As a psychologist, I work with veterans, many with PTSD. Sometimes, they, like many of us, log onto online content to feel more socially connected. Like a self-therapeutic gesture, we do this to sometimes feel more soothed, or distracted from dark or lonely feelings as we delve into novel online content.

Typically, when looking for that sense of connection, or delight, or enrichment, one may turn to news of recent politics, world news, sports scores, entertainment news, comedy sites, book reviews, health & science news, pictures of natural wonders, and so on. However, for many seeking engagement with the news in such a way, they may instead find that their initial encounter will be overshadowed by abrupt headlines detailing deaths, deaths of children, or tortured children on the front page of a particular news site. Even if one is Internet-savvy enough to skip to the front page of these news sites and go straight to their section of interest, horrific headlines and pictures of death and torture will await them on the sidebars. These are non-sequiturs popping up on the same page as articles devoted to meditation, real estate, sports, comedy, and parenting.

Not being able to control encounters with this type of devastating news can be psychologically problematic. It’s not just a problem with combat veterans, or those with PTSD. In fact, I repeatedly hear about this problem from people from many walks of life. Combat veterans and parents of young children are particularly vocal about it. I believe this phenomena causes something that I’ve coined as “news blues.” News blues causes distress when one is not expecting it or prepared for it. It often causes the reader to disengage in that moment from reading the news altogether.

As an avid online news reader, I too have personally felt the news blues. There has been the sting of an unexpected photo, the headline of atrocities to children when I am expecting to read something more benign at night, such as sustainable architecture awards.

Yes, I listen to horrible stories of atrocities for a living. I am able to listen fully, in the right context. For me, there is a large difference between learning about tragedy and atrocities when one feels empowered to help in some way, as a psychologist helps a patient, and then reading about it passively from a new source, with no way to help. The other piece of this is the element of surprise. It is easier to cope with news of such events when it is expected. This allows people to then prepare for such news and work to be emotionally ready for it.

We are rapidly losing control over when and how we are exposed to devastatingly detailed headlines and their accompanying graphic photos.

Some news sites are better able to provide content of all types without the surprise gut-wrenching punch from the headline itself. Although they don’t have a perfect track record, the New York Times often is able to report on crimes important to the nation and world without giving the reader panic attacks or news blues from the headline.

In contrast, the Huffington Post and the Daily Beast -– ironically, two of my favorite news aggregator sites — do so less well. Recently, both sites had headlines on their front page announcing the murder of children in Afghanistan, accompanied by an actual photo of the corpses of these dead children. There was no warning label obscuring the view. There was no “click here” for those who were willing to see. In other words, the visitor on the front page/home page of these sites had no choice but to see this.

What can happen from not being able to control what one sees? For those adults with anxiety and mood disorders, this can set off a whole slew of anxious and harmful sequelae. For those adults without mental health issues, I contend that this can cause news blues. A common emotional response is difficulty in processing the surprise graphic encounter with a horrible atrocity and tragic image, followed by a decision to shut off the news site all together, and ending, at least for the time being, seeking out news.

My concern, apart from the emotional health of readers, is that news blues has the potential to contribute to a civic crisis. When adults stop reading the news, our responsibility as a populace to be informed is eroded. Everyone may not be experiencing news blues. Yet, many report they are becoming desensitized, and this is also problematic. We need to be informed and maintain compassion for other humans.

The social norms of what can be shared in the U.S media have shifted. Where are the honest-but-gently-worded headlines that beckon readers to read more about an important tragedy within the content of the article, instead of disclosing the most disturbing aspects within the headline? Where are the online hyperlinks that can protectively place graphic and upsetting photos behind further ‘clicks’ for the intrepid, willing, and prepared adult readers? Where are the warnings that inform and caution the reader that “some of the following photos may contain graphic content” ?

If, while reading online, we want to know what the “7 Foods We Shouldn’t Live Without Are” or where the “Happiest Cities in the World” are, we have to get there by a dozen clicks and endure slow-loading slide shows. Yes, I know that’s how these sites gauge our engagement which they then use to earn money from advertisers. But why hide this benign information behind a multitude of clicks and slow-loads and then put images of the corpses of dead children openly on the front page and openly on the side-bars of every news page?

Of course, feeling trapped is a state of mind. No one needs consent to leave a relationship. Millions of people remain in unhappy relationships that range from empty to abusive for many reasons; however, the feeling of suffocation or of having no choices stems from fear that’s often unconscious.

People give many explanations for staying in bad relationships, ranging from caring for young children to caring for a sick mate. One man was too afraid and guilt-ridden to leave his ill wife (11 years his senior). His ambivalence made him so distressed, he died before she did! Money binds couples, too, especially in a bad economy. Yet, more affluent couples may cling to a comfortable lifestyle, while their marriage dissolves into a business arrangement.

Homemakers fear being self-supporting or single moms, and breadwinners dread paying support and seeing their assets divided. Often spouses fear feeling shamed for leaving a “failed” marriage. Some even worry their spouse may harm him- or herself. Battered women may stay out of fear of retaliation. Most people tell themselves “The grass isn’t any greener,” believe they’re too old to find love again and imagine nightmarish online dating scenarios. Also, some cultures still stigmatize divorce.

Unconscious Fears

Despite the abundance of reasons, many of which are realistic, there are deeper, unconscious ones that keep people trapped – usually fears of separation and loneliness. In longer relationships, spouses often don’t develop individual activities or support networks. In the past, an extended family served that function.

Whereas women tend to have girlfriends in whom they confide and are usually closer with their parents, traditionally, men focus on work, but disregard their emotional needs and rely exclusively on their wife for support. Yet, both men and women often neglect developing individual interests. Some codependent women give up their friends, hobbies, and activities and adopt those of their male companions. The combined effect of this adds to fears of loneliness and isolation people envisage from being on their own.

For spouses married a number of years, their identity may be as a “husband” or “wife” – a “provider” or “homemaker.” The loneliness experienced upon divorce is tinged with feeling lost. It’s an identity crisis. This also may be significant for a noncustodial parent, for whom parenting is a major source of self-esteem.

Some people have never lived alone. They left home or their college roommate for a marriage or romantic partner. The relationship helped them leave home – physically. Yet, they’ve never completed the developmental milestone of “leaving home” psychologically, meaning becoming an autonomous adult. They are as tied to their mate as they once were to their parents.

Going through divorce or separation brings with it all of the unfinished work of becoming an independent “adult.” Fears about leaving their spouse and children may be reiterations of the fears and guilt that they would have had upon separating from their parents, which were avoided by quickly getting into a relationship or marriage.

Guilt about leaving a spouse may be due to the fact that their parents didn’t appropriately encourage emotional separation. Although the negative impact of divorce upon children is real, parents’ worries may also be projections of fears for themselves. This is compounded if they suffered from their parents’ divorce.

Lack of Autonomy

Autonomy implies being an emotionally secure, separate, and independent person. The lack of autonomy not only makes separation difficult, it naturally also makes people more dependent upon their partner. The consequence is that people feel trapped or “on the fence” and wracked with ambivalence. On one hand, they crave freedom and independence; on the other hand, they want the security of a relationship – even a bad one. Autonomy doesn’t mean you don’t need others. In fact, it allows you to experience healthy dependence on others without the fear of suffocation. Examples of psychological autonomy include:

1. You don’t feel lost and empty when you’re alone.
2. You don’t feel responsible for others’ feelings and actions.
3. You don’t take things personally.
4. You can make decisions on your own.
5. You have your own opinions and values and aren’t easily suggestible.
6. You can initiate and do things on your own.
7. You can say “no” and ask for space.
8. You have your own friends.

Often, it’s this lack of autonomy that makes people unhappy in relationships or unable to commit. Because they can’t leave, they fear getting close. They’re afraid of even more dependence – of losing themselves completely. They may people-please or sacrifice their needs, interests, and friends, and then build resentments toward their partner.

A Way Out of Your Unhappiness

The way out may not require leaving the relationship. Freedom is an inside job. Develop a support system and become more independent and assertive. Take responsibility for your happiness by developing your passions instead of focusing on the relationship. Find out more about becoming assertive in my e-book, How to Speak Your Mind — Become Assertive and Set Limits.

Have you seen that bit of dastardly magic happen in your life? You start the week with three priority-related tasks; by Monday night, you haven’t completed any of the original tasks and, somehow, your to-do list has more than quadrupled. You didn’t sleep the day away. You were actually working. So why isn’t the list shorter?

Enter Elizabeth Grace Saunders.

The 3 Secrets to Effective Time Investment may be the answers to your time-/work-related prayers. As a time management coach, Saunders is the founder and CEO of Real Life E, a time-coaching company that strives to empower their clients through a “schedule makeover” coaching process and various training programs. With a list of clients to back up her claims, Saunders’s method is straightforward and seemingly very helpful.

Throughout her book, Saunders provides “mental shifts” to help readers adjust their thoughts in a direction that will foster productivity, confidence, and positivity. She also includes action steps to move progress forward and journal exercises at the end of each chapter to give the reader the opportunity to meditate on the various crucial points.

Saunders addresses the importance of time investment, goes over the kinds of crippling emotions that stall productivity, and provides a series of mental exercises meant to empower and build confidence in the reader. She provides both “key mental shifts” and “essential actions steps” to combat and overcome emotions that can hold us back. For example, regarding the emotion “overwhelm,” one of the action steps is “allocate time carefully.” In this step, Saunders explains that the reader should not just determine what they need to do but also determine how much time to allot for each to-do item. One of the key mental shifts for “overwhelm” is:

Harmful thought: “I must do whatever it takes to keep up with my environment.”
Helpful thought: “I can choose to modify my environment and my response to my environment so that I feel comfortable with the pace and quantity of what is asked of me.”

This breakdown is helpful, but the so-called secrets alluded to in the title are the real meat of the book. Simply put, the three secrets are:

1) Clarify action-based priorities
2) Set realistic expectations
3) Strengthen simple routines.

These may seem rather straightforward, and there may be a few people who believe that those three lines are enough to give them the tools to implement effective time management. Do not be fooled. Saunders delivers these simple statements and then elaborates on their importance and how to successfully implement them. She also addresses potential roadblocks to the implementation of each step.

Saunders does a great job of looking at routines. She provides a step-by-step guide to developing your own set of simple routines. This section also includes references and notes to available templates on her blog, such as her “Simple Project Plan Template.” She also recommends other sites that can help, such as Harvest (www.getharvest.com), iDoneThis (www.idonethis.com), and Basecamp (www.basecamp.com).

Perhaps it was timing or perhaps it is because I love resources that help me get my life more organized and productive — but regardless of what it was, I absolutely loved The 3 Secrets to Effective Time Investment.  Although I have not yet taken the time to completely implement the book, I did actively participate in the exercises and journaling throughout my read. I am already planning on rereading the book more slowly and starting to implement the steps. I have recommended it to almost everyone I know who could potentially benefit from it — and that is basically everyone I know.

The 3 Secrets to Effective Time Investment
McGraw-Hill, December, 2012
Hardcover, 256 pages
$22.00

Types of Boundaries

There are several areas where boundaries apply:

• Material boundaries determine whether you give or lend things, such as your money, car, clothes, books, food, or toothbrush.
• Physical boundaries pertain to your personal space, privacy, and body. Do you give a handshake or a hug – to whom and when? How do you feel about loud music, nudity, and locked doors?
• Mental boundaries apply to your thoughts, values, and opinions. Are you easily suggestible? Do you know what you believe, and can you hold onto your opinions? Can you listen with an open mind to someone else’s opinion without becoming rigid? If you become highly emotional, argumentative, or defensive, you may have weak emotional boundaries.
• Emotional boundaries distinguish separating your emotions and responsibility for them from someone else’s. It’s like an imaginary line or force field that separates you and others. Healthy boundaries prevent you from giving advice, blaming or accepting blame. They protect you from feeling guilty for someone else’s negative feelings or problems and taking others’ comments personally. High reactivity suggests weak emotional boundaries. Healthy emotional boundaries require clear internal boundaries – knowing your feelings and your responsibilities to yourself and others.
• Sexual boundaries protect your comfort level with sexual touch and activity – what, where, when, and with whom.
• Spiritual boundaries relate to your beliefs and experiences in connection with God or a higher power.

Why It’s Hard

It’s hard for codependents to set boundaries because:

1. They put others’ needs and feelings first;
2. They don’t know themselves;
3. They don’t feel they have rights;
4. They believe setting boundaries jeopardizes the relationship; and
5. They never learned to have healthy boundaries.

Boundaries are learned. If yours weren’t valued as a child, you didn’t learn you had them. Any kind of abuse violates personal boundaries, including teasing. For example, my brother ignored my pleas for him to stop tickling me until I could barely breathe. This made me feel powerless and that I didn’t have a right to say “stop” when I was uncomfortable. In recovery, I gained the capacity to tell a masseuse to stop and use less pressure. In some cases, boundary violations affect a child’s ability to mature into an independent, responsible adult.

You Have Rights

You may not believe you have any rights if yours weren’t respected growing up. For example, you have a right to privacy, to say “no,” to be addressed with courtesy and respect, to change your mind or cancel commitments, to ask people you hire to work the way you want, to ask for help, to be left alone, to conserve your energy, and not to answer a question, the phone, or an email.

Think about all the situations where these rights apply. Write how you feel and how you currently handle them. How often do you say “yes” when you’d like to say “no?”

Write want you want to happen. List your personal bill of rights. What prevents you from asserting them? Write statements expressing your bottom line. Be kind. For example, “Please don’t criticize (or call) me (or borrow my . . .),” and “Thank you for thinking of me, but I regret I won’t be joining (or able to help) you . . .”

Internal Boundaries

Internal boundaries involve regulating your relationship with yourself. Think of them as self-discipline and healthy management of time, thoughts, emotions, behavior and impulses. If you’re procrastinating, doing things you neither have to nor want to do, or overdoing and not getting enough rest, recreation, or balanced meals, you may be neglecting internal physical boundaries. Learning to manage negative thoughts and feelings empowers you, as does the ability to follow through on goals and commitments to yourself.

Healthy emotional and mental internal boundaries help you not to assume responsibility for, or obsess about, other people’s feelings and problems – something codependents commonly do. Strong internal boundaries curb suggestibility. You think about yourself, rather than automatically agreeing with others’ criticism or advice. You’re then empowered to set external emotional boundaries if you choose. Similarly, since you’re accountable for your feelings and actions, you don’t blame others. When you’re blamed, if you don’t feel responsible, instead of defending yourself or apologizing, you can say, “I don’t take responsibility for that.”

Guilt and Resentment

Anger often is a signal that action is required. If you feel resentful or victimized and are blaming someone or something, it might mean that you haven’t been setting boundaries. If you feel anxious or guilty about setting boundaries, remember, your relationship suffers when you’re unhappy. Once you get practice setting boundaries, you feel empowered and suffer less anxiety, resentment, and guilt. Generally, you receive more respect from others and your relationships improve.

Setting Effective Boundaries

People often say they set a boundary, but it didn’t help. There’s an art to setting boundaries. If it’s done in anger or by nagging, you won’t be heard. Boundaries are not meant to punish, but are for your well-being and protection. They’re more effective when you’re assertive, calm, firm, and courteous. If that doesn’t work, you may need to communicate consequences to encourage compliance. It’s essential, however, that you never threaten a consequence you’re not fully prepared to carry out.

It takes time, support, and relearning to be able to set effective boundaries. Self-awareness and learning to be assertive are the first steps. Setting boundaries isn’t selfish. It’s self-love – you say “yes” to yourself each time you say “no.” It builds self-esteem. But it usually takes encouragement to make yourself a priority and to persist, especially when you receive pushback. Read more on setting boundaries in Codependency for Dummies and my e-book, How to Speak Your Mind and Set Limits.

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

During a recent discussion with some friends this became a topic. Surprisingly, as a group of pretty successful, educated women, none of us gave numbers others expected. We discussed what we thought others’ numbers should have been, but began questioning why our numbers were not so great. We realized our numbers were not so great because we were feeling not so hot.

We discussed how sometimes in the hustle and bustle of getting things done, we forget how much we actually accomplish. We examined how sometimes being successful breeds the desire to be more successful, but is sometimes followed by disappointment when we don’t reach those goals. It was a very interesting conversation, to say the least. This branched off into several directions, one of which included what factors determine how we rate our self-esteem. As educated as we all appear to be, we were rating ourselves by using some pretty dumb factors.

Some were setting unrealistic expectations for themselves, while some were comparing themselves to others. This is crazy. If we are always looking at the person we believe is better than we are, has more than we do, or is capable of more than we are, how much time are we spending honestly and truly looking at ourselves? Some of us were looking at personal achievements and external circumstances. This discussion led to the conclusion that all of these things are stupid. We questioned how we got to this way of thinking, when we all knew the truth was that self-esteem comes from within.

Regardless of whether we like to admit it, we all sometimes measure ourselves by others’ expectations or our own unrealistic expectations. We all seem to have this idea of success and failure. What is “failure”? We are taught so many meanings of failure as we grow and this definition varies among cultures, statuses and individuals.

I personally do not like to view anything as a failure. If I don’t succeed at something, but I’ve walked away with a lesson learned, it’s not a failure. If I don’t complete something the correct way, but I learn how to do it correctly in the future, it’s not a failure. Our view of “failure” kills our self-esteem. As a matter of fact, most of the thinking that I’ve mentioned here could be enough to kill our self-esteem. So how do we avoid these killers? We avoid them by using these boosters!

Think positive and you will be positive.

I am a firm believer that what we think and what we believe plays a part in all of the outcomes in life. Think positive and positive things will come. Step out of your comfort zone and say “I can do this.” We tend to talk ourselves out of things before we ever begin to try them. If you don’t believe you can think positive, then as my mother and father would say, “fake it ‘til you make it.” It may seem silly, but pretend to be the confident person you wish you were. Eventually you will begin to make that role more of a reality, and you may be surprised by the results.

Begin embracing your positive qualities.

Make a mental or actual list of all the skills, experiences, talents and resources you have that make you great. Being mindful of how wonderful you actually are will surely increase your self-esteem.

Remember, you are in control of how you feel about you. Let go of unrealistic expectations and stop making comparisons. You are you, and you are the only person who can be you. Be the best you that you can be and feel great about 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.

The statistics regarding obesity in America are alarming. Currently, 35 percent of American adults are obese (CDC, 2012), and that number is projected to rise to over 50 percent in most states by 2030 (Henry, 2011). We’ve been fighting the so-called “war against obesity” since the 1980s, and yet despite all of our efforts, the problem has only gotten worse. Clearly, what we’ve been doing to try to solve this problem isn’t working and is possibly making it even worse. In my opinion, the reason for this is that the psychological piece hasn’t been addressed yet and until it is, we will have an increasing problem on our hands.

Years ago I was seeing a client who we’ll call Sarah. Sarah was very obese and desperate to lose weight. Her doctor had recently told her that if she didn’t lose a significant amount of weight she would lose her mobility as well as have a host of other medical consequences. Sarah tried numerous diets and exercise programs but nothing worked. She even enrolled in a weight loss clinic but had no success. She actually ended up gaining even more weight during this time. Not knowing what else to do, Sarah’s doctor told her that she needed to talk to a therapist.

When I met Sarah she was quite desperate to lose the weight and very depressed. Much to her surprise, I told her that I didn’t want us to work on her losing weight, but rather I wanted to work on her depression and teach her to accept and love herself unconditionally. This seemed the opposite of what she needed in order to lose weight, but Sarah decided to trust me anyway. You see, like a lot of people, Sarah thought that if she could just hate herself enough, that would motivate her to do whatever it took to lose the weight. As a therapist, I know that that is simply not going to work. We therapists follow something called the “Rogerian hypothesis,” which states that people tend to move in a positive direction only when given unconditional love and acceptance. Well, I’m happy to say that after we had alleviated Sarah’s depression and she had learned to love and accept herself, the weight came right off.

The current methods for helping people lose weight seem to be the opposite of love and acceptance. Much of the efforts seem to involve trying to shame and scare people into losing weight. This simply doesn’t work. The worst thing you can do is give someone more anxiety and depression regarding their weight, and I’m going to explain why that is later on. Also, the ways we go about teaching people to lose weight are much more complicated than they need to be. One should not have to read a book, go to a clinic, or take a class to learn how to lose weight. There is a very successful diet that has been around for thousands of years and all of the big celebrities do it. Can you guess what it is? It’s called “Moving more and eating less.” How you go about accomplishing this is up to you. I believe that losing weight is not complicated and that people intuitively know how best to do it when it comes to themselves. They simply need to stop feeling so anxious and depressed about it.

Obesity and Genetics

Before I talk more about how obesity is linked to depression and anxiety, I first want to briefly address the popular belief that obesity is purely a problem of bad genes. This is the popular belief and I can see why it is so popular. In a society where people are constantly trying to shame you about your weight, it can feel good to be able to say “Hey, you have no right to shame me about my weight! It’s not something I can control! It’s because of these bad genes I have!” But in order for this to be true, it means that our genes would have had to somehow change since the 1960s. Scientists agree that genetics is not responsible for the obesity epidemic, although they do agree it is a factor. Depending on which study you look at, genes only account for between 1 percent and 5 percent of a person’s body mass index (Li et al., 2010). I think that most people would agree that 5 percent of bad genes doesn’t excuse the 95 percent of it that scientists claim is due to bad habits.

When confronted with these facts, people often cite that most of the people in their family are also obese, so it must be genetics. However, the more likely possibility is that families tend to eat the same foods and have similar habits. Genetics also doesn’t explain why obese people also tend to have obese pets (Bounds, 2011). Obviously the dog doesn’t share the same genes as the owner, but they do share the same environment. Of course, we can’t mention genetics without looking at twin studies. Since identical twins have identical genes, researchers often compare twins to examine the effects of genetics and the environment on a person.

Obesity and Depression

Researchers aren’t quite sure if obesity causes depression or if depression causes obesity, but the two are definitely linked. In fact, the two conditions are so intertwined that some are calling obesity and depression a double epidemic. Studies have found that 66 percent of those seeking bariatric, (weight loss) surgery have had a history of at least one mental health disorder. And of course, it doesn’t help that the medications people take for depression and other mental health issues can cause dramatic weight gain.

Consider this: According to the CDC, half of Americans will suffer from some sort of mental illness, and most of them will not receive any treatment for it. 63 percent of Americans are also overweight or obese. There are almost as many Americans taking diet pills as there are taking antidepressants (8 percent and 10 percent). People with mental health issues are twice as likely as those without them to be obese, and that’s even before they start taking psychiatric medication (McElroy, 2009).

So why are people with mental health issues so much more likely than those without them to be obese? We know that depression and bipolar depression slows down your metabolism (Lutter & Elmquist, 2009). Depression also depletes our willpower, making us less likely to avoid eating unhealthy foods. Depression also causes us to crave high-fat foods and sugar. This is where emotional eating comes in. When we’re feeling down, fatty and sugary foods make us feel better, at least temporarily. Of course, you don’t need to have depression or a mental illness in order to engage in emotional eating. It’s something we learn at a very young age. Eating something unhealthy is much easier than fixing the problem or dealing with what’s causing us to feel unhappy. Teaching people how to deal with unpleasant moods other than by eating would certainly cut down on emotional eating and would certainly lead to significant weight loss.

So if depression causes weight gain and antidepressants cause weight gain, then what is the solution? Well, research has shown that talk therapy is just as effective at relieving depression as antidepressant medication (Doheny, 2010), and talk therapy doesn’t have the negative side effects that medication does. Another option is exercise. In a 2005 study on the effects of exercise vs. Zoloft (anti-depressant medication) on the treatment of depression, participants were randomly placed into two groups. On group received 150 mg of Zoloft while the other group engaged in 20 minutes of cardiovascular exercise three to four times a week. After eight weeks, they found that the exercise was just as effective at reducing depression as the Zoloft! Another thing to consider is that Zoloft has negative side effects such as weight gain, sleep problems, and sexual dysfunction. As you can imagine, the side effects of exercising are the opposite of that.

Answer: “Only one, but it has to want to change.”

Of course, changing ourselves is usually a lot harder than changing a light bulb. As a mental health professional, I have come across many different self-help books that were supposed to be life-altering. Clients and colleagues alike have often come to me saying, “you have to read this,” or “this book changed my life.”

Much of the time, however, the books they talk up offer a few helpful pieces of advice or interesting bits of personal philosophies, but not much more. I have rarely read one that I truly felt could bring real, meaningful change into a person’s life. But despite my wariness of the self-help genre, I found John C. Norcross’s Changeology: 5 Steps to Realizing Your Goals and Resolutions to be one such book.

One of the differences between this and other self-help texts is that it not merely based on theory or some feel-good ideology. Norcross, a clinical psychologist and professor of psychology and psychiatry, based Changeology on years of research that looked at what makes people change their behavior, as well as his own clinical experience. As a practitioner myself, I can actually get behind his findings.

The research, he tells us, shows that there are five distinct stages of change: precontemplation, contemplation, preparation, action, and maintenance. But as the author notes, most people are not overly concerned about which stage they might be in. Rather, he states, “people dedicated to change want to know what to do.” Norcross therefore uses these stages of change to determine the five steps a person should take to reach their goal. For each stage, he identifies corresponding types of actions.

The book gives encouragement to the reader, telling us that change is possible by reminding us that the author’s formula is based on more than 30 years of studies including thousands of individuals. It weaves in true-life stories, with examples of how others have used this five-step process to create their own changes. One feature I found helpful is the “Check Yourself” boxes that are interspersed within chapters. These mini-assessments help the reader determine their understanding of each topic and assist with measuring progress toward a goal.

While the first part of the book focuses on the science behind Changeology, it is the second part, “Becoming a Changeologist in 90 Days,” that contains the meat of the text. Here, Norcross explains the specific actions he recommends in order to enact change.

The author uses some examples of common ambitions, such as losing weight, to illustrate his process. Some readers might think, “I want to improve my life, but I am who I am.” But, Norcross show us, changes in our behavior are possible, if not inevitable. Who hasn’t looked back a few years and thought to him- or herself, “I can’t believe I actually did that?”

Norcross makes a point of addressing the questions and doubts that might arise during his process, and provides satisfying answers to those naysayers who think that change might not be possible. He also does an excellent job explaining each part of his technique. Every step is broken down so that the reader understands not only exactly what they need to do, but also the reason behind doing it. Norcross avoids psychological jargon, making the book easy to read. By the end, a reader can develop a well-defined goal, take deliberate action towards this goal, and also have a plan in place so that whatever change they have made will be long-lasting.

For those looking to make significant changes in their lives, Changeology provides a terrific outline. Of course, no self-help book, not even a good one, can be a substitute for professional therapy, and certain types of change may require more help (the author does provide resources for this in an appendix).

In addition, the book skips over the precontemplation stage of change, in which a person has no desire to alter a behavior. Norcross means instead to address those who already know they want to take action (quit cigarettes, for example) but may have difficulty doing so. So if you’re looking to convince a friend or family member that they need to change, but they don’t think they do, this isn’t the book for you.

However, for most of the kinds of change that people are already trying to make, Changeology will prove to be a wonderful source of assistance. It has an easy-to-follow formula based on credible research — and even this wary mental health practitioner found it helpful.

Changeology: 5 Steps to Realizing Your Goals and Resolutions
Simon & Schuster, December, 2012
Hardcover, 272 pages
$25.00

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

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

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

Tips on Ending Therapy

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

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

2. Don’t stop therapy abruptly. Again, it’s important for clients to talk with their therapists, because they may realize that their desire to part ways is premature. Even if you decide to leave therapy, processing this is helpful. “A session or two to discuss how you feel and what kinds of post-treatment experiences you may go through will help ease guilt, regret or sadness that often arises when wanting to stop therapy,” Serani said.

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

But there are exceptions. Howes suggested leaving abruptly if there are ethical violations. He reminded readers that you’re “the boss” in therapy:

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

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

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

When offering feedback to your therapist, do so “without bitterness or judgment,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. “After all, this person will be working with others in the future, and your thoughts may change his or her style, and help them to better serve their clients in the future.”

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

5. Communicate clearly. “Your best bet is to be as direct, open, and clear as possible,” Hibbert said. Articulate your exact reasons for wanting to end therapy. Hibbert gave the following examples: “’I didn’t agree with what you said last session and it makes me feel like this isn’t going to work,’ or ‘I’ve tried several sessions, but I just don’t feel like we’re a good match.’”

(“’Not being a “good match’ is a perfectly good reason to terminate therapy, since so much of it has to do with a good personality fit and a trusting relationship,” she added.)

6. Be ready for your therapist to disagree. According to Serani, “It is not unusual for a therapist to agree with ending therapy, especially if you’ve reached your goals and are doing well.” But they also might disagree with you, she said. Still, remember that this is “your therapy.” “Don’t agree to continue if you truly want to stop, or feel persuaded to keep coming for sessions because your therapist pressures you to stay.”

7. Plan for the end in the beginning. “Every therapy ends, there’s no reason to deny this fact,” Howes said. He suggested discussing termination at the start of treatment. “Early in therapy when you’re covering your treatment goals, why not talk about how and when you’d like therapy to end? Will you stop when you’ve achieved all your goals? When the insurance runs out? When and if you get bored in therapy?”

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

How Therapists React to Termination

So how do clinicians take it when clients end therapy? All the therapists noted that having their clients share feedback on their experiences is incredibly valuable. In short, it helps them improve and grow as clinicians.

But, when there’s no official end to therapy, therapists are left with many unanswered questions. According to Howes:

When a client terminates via voicemail, fades away with a vague “I’ll call you for my next session,” or abruptly announces the end and leaves, I feel loss and am left with many questions.

What fell short in this therapy? What would have worked better? How could I have been a better therapist for you? What made you feel like you couldn’t discuss this with me? I’m left with no answers for these questions, and that’s difficult. I spend a lot of time reflecting on our work together, but I have no definite answers.

Serani and Marter echoed this sentiment. “Sometimes clients just ‘fizzle out’ without explanation, which has been one of the harder pieces of being a therapist for me because I am very invested in my work with my clients. It causes me to wonder if I did something that bothered them and wished that I knew,” Marter said.

Serani also talked about attempting to understand the client’s decision. “I always want to explore the reasons why. Was it something I said? Was it something I didn’t say? What has happened to make this decision so urgent? I often feel confused, and work hard to make sense of why this has happened.”

Hibbert tries not to take it personally. “Usually clients simply ‘stop coming,’ so it’s not easy to know if they’re just ‘done’ with therapy or if I’ve done something to make them want to leave. When this is the case, I just let it go. It’s their issue, not mine, and I don’t need to stress over it when I don’t know the reasons behind it.”

She takes a similar approach when a client wants to stop therapy because of personality differences. “Only a couple of times has a client verbalized a desire to leave because of ‘personality’ or ‘style’ differences. I can’t say it never stings, but I try not to take it personally. Like I said before, therapy, in large part, is a personality fit, and I can’t fit with every personality.”

When client and clinician are able to have a session (or two) for proper closure, it becomes a great opportunity to reflect on their work together. In fact, for Howes, these are often his most enjoyable sessions.

My goal is to help a client confront life head-on. If they have clear reasons to end therapy and we’ve had the time to talk about it and tie up the loose ends, ending therapy is a great time to reflect on our work, talk about the client’s future, and discuss what has been accomplished and what hasn’t. We can leave with a sense of closure, without lingering questions.

Some of my best sessions have been final appointments where we reminisce about our time together, talk about the client’s future, and I learn how to be a better clinician for others.

Serani described final sessions with mixed emotions. “This is usually an exciting but bittersweet time, where we both feel a loss about the goodbye, but know that leaving is part of the healing process. I’m always sad for me, but happy for my patient.”

Unless there are ethical violations, it’s important to discuss your desire to end therapy with your therapist, in person. As Duffy said, doing so with “respect and integrity will set the tone for other relationship issues you will encounter in life.” It also helps you process your emotions and figure out if you’re leaving too soon. And it gives your therapist valuable feedback that improves their work. In other words, with proper closure, everybody wins.

I’m just getting to know Michelle. She had her first baby 3 weeks ago and has been sad and irritable ever since. Her pediatrician was worried about her at the well-baby visit this week and sent her to me. She’d had a tough pregnancy (morning sickness that wouldn’t quit for what felt to her like forever), made tougher by the financial stress that came from her husband being out of work for several months. The doctor is worried that she and her baby aren’t getting off to a good start.

Sadly, moms like Michelle often feel alone and guilty. Not feeling what they think they are supposed to feel, they are embarrassed to admit to themselves and others that things aren’t going well. Just when they need help the most, many don’t reach out. Some start to resent their babies and begrudge them time and attention. They force themselves to do what needs to be done but don’t provide their newborns with the nurturing they need.

Still others give up on nursing, or holding their babies when bottle feeding, depriving themselves and their babies with the closeness that comes with the quiet feeding times. Propping a bottle is the best they can do. Overtired, irritable, and sinking into depression, life after birth isn’t at all what they expected.

As hormones shift and settle, it’s absolutely normal to feel what is commonly known as the baby blues in the weeks following birth. One of my clients described the first couple of weeks after her first child was born as PMS times ten. Others feel more emotionally fragile than usual and maybe a little weepy. Still others are surprised that they are on an emotional roller coaster, feeling great one minute and set off into tears by something that normally wouldn’t bother them the next. It’s all because the endorphins from delivery are leaving the new mother’s system and the body is resetting itself.

Different women react differently but normal baby blues are usually accompanied by moments of joy and wonder and happiness about the baby and motherhood. The emotions settle down after a couple of weeks and the routines and rhythms of new parenting get established.

But when those up and downs last more than a few weeks, and especially if they get worse, it may indicate that the new mom is developing postpartum depression (PPD). This happens to between 11 and 18 percent of new mothers, according to a 2010 survey by the Centers for Disease Control (CDC). Surprisingly, it can last anywhere from a couple of months to a couple of years.

Symptoms of Postpartum Depression

Postpartum depression looks like any major depression. Things that once gave the mother pleasure are no longer fun or interesting. She has trouble concentrating and making decisions. There are disturbances in sleep, appetite, and sexual interest. In some cases, there are thoughts of suicide. Many report feeling disconnected from their baby and some worry that they will hurt their baby. Feelings of hopelessness, helplessness and worthlessness immobilize them. Many feel guilty that they can’t love their child, which makes them feel even more inadequate.

In some cases, women develop psychotic delusions, thinking their baby is possessed or has special and frightening powers. Sadly, in some cases, the psychosis includes command hallucinations to kill the child.

Who Develops Postpartum Depression?

There are a number of issues that contribute to a woman’s risk of developing PPD:

• A prior diagnosis of major depression. Up to 30 percent of women who have had an episode of major depression also develop PPD.
• Having a relative who has ever had major depression or PDD seems to be a contributing factor.
• Lack of education about what to realistically expect of herself or the baby. Teen mothers who idealized what it would mean to have a baby to love with little appreciation for the work involved are especially vulnerable.
• Lack of an adequate support system. Unable to turn to someone for practical help or emotional support, a vulnerable new mom can become easily overwhelmed.
• A pregnancy or birth that had complications, especially if mother and baby had to be separated after the birth in order for one or the other to recover. This can get in the way of normal mother-child bonding.
• Being under unusual stress already. New mothers who are also dealing with financial stress, a shaky relationship with the baby’s dad, family problems, or isolation are more vulnerable.
• Multiple births. The demands of multiple babies are overwhelming even with substantial support.
• Having a miscarriage or stillbirth. The normal grieving of loss is made worse by the shifting hormones.

What to Do

In cases of the normal “baby blues,” often all a new mom needs is reassurance and some more practical help. Engaging the dad to be more helpful, joining a support group for new parents, or finding other sources of support so the mom can get some rest and develop more confidence in her mothering instincts and skills can put things back on track. As with any other stressful or demanding situation, new parenthood goes better when the parents are eating right, getting enough sleep, and getting some exercise. Friends and family can help by bringing some dinners, offering to take over with the baby for an hour or so so that the parents can get a nap, or by babysitting siblings to give the parents time to focus on the infant without feeling guilty or pulled in multiple directions.

Postpartum depression, however, is a serious condition that requires more than naps and caring attention. If the problem has persisted beyond a few weeks and has been unresponsive to support and help, the mother should first be evaluated for a medical condition. Sometimes a vitamin deficiency or another undiagnosed problem is a contributing factor.

If she is medically okay, those who care about her and her baby need to encourage her to get some counseling, both for the emotional support counseling offers and for some practical advice. Cognitive-behavioral treatment seems to be especially helpful. Since women who have experienced postpartum depression are vulnerable to having another episode of depression in their lives, it is wise to establish a relationship with a mental health counselor to make it easier to seek help if it is needed in the future. If the mom has had thoughts of suicide or infanticide, the therapist can help the family learn how to protect them both. If the birthing center or hospital offers a PPD support group, the new mom and dad should be encouraged to try it. Finally, sometimes psychotropic medications are indicated to alleviate the depression.

The baby blues are uncomfortable. Postpartum depression is serious. In either case, a new mom deserves to get practical help from family and friends. When that alone doesn’t help a new mom adjust, it’s time to seek out professional help as well.

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.