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By Andrea Slagle-Abrams, LSCSW

1.  Get close to them and use their name to get their attention first.  It is not helpful to call from across the room.  For example, go up to your child and say, “Sally, I have something I need you to do.” 

2.  Once you have their attention and eye contact, give them the direction in an age-appropriate manner.  A three year-old may not be able to do more than one step at a time.  You will likely be able to give your twelve-year-old 3 directions at a time.  For example, “Get dressed, eat breakfast, and go wait for the bus.” 

3.  Give directions with a calm, but serious voice.  Yelling will likely escalate your child, and this will not help them to be cooperative.  But you also want them to know that you are not joking around.

4.  Give directions in a positive manner.  Tell them what TO DO, instead of what NOT to do.  For example, say, “Walk, please,” instead of “Don’t run.”  Also, be descriptive so that they know exactly what you expect.  Instead of saying, “Be good,” which is very vague, say something like, “Put your hands on your lap and sit on your bottom.” 

5.  DO NOT ask a question when giving a direction.  Do NOT say, “Do you want to clean your room?” if this is not something that they can say no to.  Also, do NOT say, “It’s time to do your homework, okay?”  The okay and question at the end implies that it is up to them to decide. 

6. Provide two acceptable choices, such as, “You can eat breakfast or get dressed.  Which would you like to do first?”  You can even start by saying, “You have a choice!” 

7. Empathize with them if your child complains about what you asked them to do.  “I know you are having fun playing and don’t want to stop.”  “I understand that you don’t like cleaning your room.” 

8.  Give them something to look forward to after completing the task.  “As soon as you are finished putting away the dishes, you can go outside and play.” 

9.  Help them if the task is difficult, while still making sure they are doing their part.  “I will help you clean your room.  Would you like to put away your clothes or your toys?”  Then you can put away what they do not choose.        

10.  If nothing is working, tell them about the consequence if they do not complete the task.  Try to make it a natural consequence.  A natural consequence is something that would happen naturally as a result.  It also helps to give them a time frame.  For example, “If you do not get dressed before we leave for school, you will go to school in your pajamas.”  “If you do not put on your coat, you will be cold.”  Or if there is no natural consequence, try to make it related to the task.  “If you do not clean your room before bed time, I will take away those toys that are not cleaned up.”

11.  Enforce the time limit and the consequence.  It is important that your child knows that you mean business when you tell them something.  If you give in or do not follow through, they will learn that they can test you because they do not always have to do what you tell them.

12.  Children behave best when they are feeling loved.  Make sure that you spend plenty of positive, fun time with them. 

No matter if you are coming in for depression help, anxiety help, marriage counseling, or other issues, many factors determine the depth of relief and satisfaction a client experiences from their counseling. Here are some suggestions for making your therapeutic experience the best possible:

1) Be totally honest. Believe me, I've heard every story. The human condition contains basic elements that exist in all problems presented, and you're not going to shock me, nor am I going to disapprove of you!

2) Be open to new ways of thinking. Although you are free to examine, use, or discard any suggestions I make, remember that behavior change is required for growth. "If you always do what you've always done, you'll always get what you've always gotten."

3) Understand the difference in professional therapy and "talking to a friend." A minimum of six years of college, two of them in human behavior, is required to legally practice as a counselor. We are also required to get several thousand hours of internship experience and supervision before being licensed.

4) Expect some resistance from family or friends. Change, even good change, can be threatening, and comes with a price. Your relationships will change because your world changes when YOU change. There will be people in your life who resist this, who want you to "stay in your box." It is indeed necessary to rock the boat for things to ultimately improve.

5) Do your homework. The true change of the therapy experience only takes place outside of the office, as you test the new ideas I give you and report the results back to me.

6) Journal, journal, and journal some more. The research is compelling: journaling continues the therapeutic progress outside of the session, releases tension, and moves you forward faster.

7) Attend as regularly and as often as possible. It's also smart to come in occasionally after therapy has ended if you sense a downturn in mood or thinking.

8) Be patient with yourself. It took you a lifetime to develop these thinking patterns; it will take more than a session or two to change them!

9) Make notes after the session. Ideally, schedule enough free time after your therapy to go somewhere and process what came up.

10) Take responsibility for the session. Notice during the week what bothers you, excites you, what insights come up in your journaling that need to be explored further. Bring this information to session.

WHAT Did You Just Say?
Communication Differences of Men and Women

“He should just KNOW what I want if he loves me,” she exclaims.

“I TRY to solve her problems, but she gets mad when she’s upset and I give her advice,” he declares.

And both of them think they are right. And both of them have a right to see it that way.

And both of them would be wise to learn to see it from another point of view.

Individuality notwithstanding, the stereotypes are somewhat borne out by research: men are generally problem solvers and women generally want intuitive, compassionate responses. To put it another way, when we approach our partner with a problem, we expect them to react the way our best (same sex) friends do. Or to put it another way: Men “fix” and women “feel.”

“And here’s what you SHOULD do, wife…”

Men most often communicate in order to solve a problem, and they feel a sense of responsibility and love when their partner is upset. What he doesn’t realize is that she is not generally asking for advice, unless she comes out and says so. Instead, she would like to be listened to and valued while she processes her problem verbally. It tends to go something like this:

She: “I got so mad at my boss today.”

He: “Well, you should just quit that job and look for another. Here’s the employment listings.”

When he jumps directly to his solution for her life, she feels belittled, as if he feels she is not capable of adult decisions. She really just wanted him to listen, not solve!

So let’s look at a better way:

She: “I got so mad at my boss today.”

He: “You seem really upset. Tell me more.”

“If you LOVED me you would just KNOW, husband…”

A mistake that women often make when communicating with the opposite sex is called “mind reading:” that is, expecting to just hint, sigh, glare, or otherwise get him to pick up on what she wants. This conversation might go:

She:  (sarcastically) “That trash really smells, doesn’t it?”

He: “Sure does.”

 Of course, she wanted him to take the trash out, not agree with her! She winds up frustrated and furious that he didn’t bow to the control, hint, guilt and manipulation barely hidden in that remark.

A better way would be:

She: “Would you please take the trash out sometime in the next hour?”

He: “Sure, it’s my turn anyway.”

Women are socialized to be tactful, accommodating, and indirect, but this does not serve them well in the real world. Instead, women (and indeed, men as well) should be DIRECT, BRIEF, and SPECIFIC when asking for what they need. This could save a lot of resentment; we all appreciate honest, courteous, and upfront communication.

So it goes like this: men, you get in a lot of trouble when you offer solutions instead of focused, eye-to-eye, undivided attention and a listening ear when she is sharing her problems with you.

And women, you shut down any hope of getting what you need when you hint, sigh, use sarcasm, or otherwise expect him to read your mind. Instead, be direct (“the trash”), specific (“within the next hour”) and courteous (“please”).

Communication is a skill that must be learned, but the basic principles listed here can go a long way toward each person getting what they want- a “win-win” for all parties.

Marilisa Sachteleben

Remember that healing is a process; one day at a time. Your self-esteem wasn't trashed overnight and true recovery takes a long time. But you will be energized as you begin to feel better.

Pause and listen to the negative messages you send yourself and talk back. Learn to catch yourself and delete negative messages. Generate some new positive images, memories and messages. If you are hearing negative messages about yourself, answer back. Speak up for yourself to others and to yourself. Be your own best friend.

Remove yourself from 'dangerous' situations and people. Detach from cruel, selfish, hurtful people. No one can make you feel badly without your permission. Get away from painful people. This may only need to be temporary, but it will help to salvage your self-esteem.

Don't put a red flasher on your car for everyone else's crises. Many of us have learned to 'give without counting the cost'… It is important to count the cost to yourself and your needs. There are people who thrive on chaos and crisis. You aren't obligated to bail everyone else out. You don't have to be the designated emotional ambulance driver.

Stop volunteering to be a victim. Many of us who have chronic low self -esteem, cannot bear for anyone around us to be angry. We are afraid we've failed. Low self-esteemers go out of their way to be ultra- nice, patient, forgiving, etc. Let them be angry, if you know you have done nothing hurtful. You don't have to join everyone in their misery

And let people own their feelings. Let people feel their feelings, but don't stress out over what is essentially their problem. You can say, 'I'm sorry that happened' or something like that but don't apologize for yourself if you have done nothing wrong. If they can't move on, you can. And pat yourself on the back for being a good friend.

Discover what you need and get it for yourself. Stop taking such good care of others that you don't care for yourself. Nourish and comfort your mind, soul, body and spirit.

Vent your frustrations. Don't just smile and say I'm fine. If someone asks, you can say, no I'm not doing too well just now.' Be honest most of all with yourself. Don't cover it. Process it. Listen to yourself. Go to therapy.

Encourage yourself. Progress seems slow sometimes. Give yourself a pat on the back for your hard work.

By Amie Koehn, LCSW

“I just don’t know if I can do it anymore,” my client said as she cried. “He just needs so much, you know? I don’t think I can do it all.”

Are you taking care of an elderly parent, spouse, sibling or an adult child? Taking care of an adult presents unique challenges. It’s hard enough providing 24 hour care for children, but what happens when the person we’re caring for is someone who has been or “should” be able to take care of themselves but now can’t?

Caregivers are uniquely prone to depression and anxiety. Most often women, caregivers devote their physical energy- meal preparation, being present with the person, perhaps helping that someone walk or feed or even bathe and toilet themselves. They expend mental energy- arranging appointments, arranging services, keeping track of medication, and even providing stimulation and direction when needed, and emotional energy- feelings of sadness, grief, frustration, futility, anger, resentment and guilt are common in caregivers.

The devotion of all this energy often results in depression and anxiety, with the effects of caregiving lasting well beyond their loved one’s death or placement of their loved one in a more structured environment. Virtually all of the caregivers I’ve worked with over the last fourteen years felt guilt. A LOT of it. Guilt about not providing enough care or the right kind of care, guilt about feeling angry or resentful toward their loved one at times, even guilt about wishing sometimes that their loved one’s life would end so that they could both be better off. Caregivers often believe they could have/should have done something more or different to help their loved one- even though they logically can’t put their finger on what that something is.

Caregivers often take increasingly less time for themselves, usually out of concern that something bad will happen to their loved one if/when they leave them to run errands or just get away for a couple of hours; or they feel awkward asking someone else to help. They stop spending time with friends or doing hobbies or fun activities because taking care of their loved one seems to take all of their time. For this reason, many develop tunnel vision about themselves and what needs to be done, and feel isolated. With all of this going on, is it any wonder that caregivers are more prone to depression and anxiety?

There are ways to make caregiving less stressful:

• Ask for help. Adult siblings, friends, neighbors you trust can help with everything from chores and cooking to sitting with your loved one so that you can get a break. Professional respite care is also available.
• Accept help. When someone offers to help, accept it! If they offer to help, but don’t know how to help, be prepared to name a few things that you could use help with- respite care, meal prep, errand running, etc. It doesn’t have to be a major task; even getting help with the little tasks can make life easier for you.
• Stay in touch with community. To the extent possible it is vitally important to keep up your social activities- spending time with friends, faith practices and clubs are examples. These activities “re-charge your batteries” and help you keep perspective on life. Support groups are also quite helpful.
• Know your limits. You are human. Humans are not built for staying up all hours of the night without a break to take care of someone, or physically managing someone who weighs as much or more than we do, or to devote all physical, mental and emotional energy toward another human being on an ongoing basis. We simply are not designed for it. With some disease processes, such as dementia, there comes a time when one person cannot do it all. It’s okay to recruit professional help or consider placement in a structured environment where they can get the 24 hour structure and care they need by a team of people who are specifically trained to deal with your loved one’s condition.
• Keep in mind your feelings are valid.  It’s normal and okay to feel angry, frustrated, or resentful at times. These are just feelings and we have them for a reason. Taking care of someone else is very hard work; and it would be surprising if you didn’t feel this way at times. If you’re experiencing these feelings more often than not, it’s long past time to get some help.

How to know when you need professional help:

• Feeling down, depressed, sad or hopeless more often than not
• Loss of interest in fun activities
• Unable to “turn off your mind”- constantly worrying about what needs to be done or what you’ve already done; intrusive random thoughts
• Feeling resentful, angry, frustrated more often than not
• Increased tearfulness
• Increased feelings of guilt or thoughts that you’ve let your family or others down

If you’re having trouble dealing with the aftermath of caring for someone you love, call me! With my solution-focused approach, you can learn tools that will aid in caring both for your loved one AND YOU.

“It just never works to be in contact with my mother,” said my client as she started our session, wiping away tears. “I don’t want to cut her out of my life completely, but I can’t keep going back to be sniped at again and again.”

This client and I had already strategized ways to talk to mother assertively, addressing the hurtful comments, to no avail. Her mother flatly refused to admit fault or change her behavior.

Our next step was to set strong boundaries of self- protection in specific ways. Here’s a list of ways to do just that. If you have a difficult person in YOUR family, ask yourself:

• Do I want to limit phone calls? Yes/no
  
• If yes, how many per week/month/year? _________per _________________________
• Do I want to limit time of day I answer the phone?  Yes/no
• If so, what are my limits? __________________________________________________
• Do I want to limit the amount of time we talk? Yes/no
• If so, what’s the limit? _____________________________________________________
• Do I want to limit time we spend face to face?  Yes/no
• If so, what’s that going to look like? __________________________________________
• Do I want to remove myself when they are inebriated or otherwise inappropriate? Yes/no
• Do I want to acknowledge birthdays and holidays?  Yes/no
• If so, how?       Card          phone call               visit with others present                 visit alone
• Other ways to protect myself: ______________________________________________________________________________

Let’s discuss your answers in our next session. Together we CAN find ways to protect YOU.

1. Push for quick involvement: comes on very strong, pressures for an exclusive commitment almost immediately

2. Jealousy: Excessively possessive: calls constantly, visits unexpectedly; prevents you from going to work because “you might meet someone:” checks your mileage

3. Controlling: Interrogates you intensely, especially if you’re late, about whom you talked to and where you were. Keeps all the money; insists you ask permission to go anywhere or do anything.

4. Unrealistic expectations: Expects you to be the perfect woman and meet his every need.

5. Isolation: Tries to cut you off from family and friends; accuses your supporters of “causing trouble;” deprives you of a phone or car.

6. Blames others: for his problems and mistakes: The boss, you—it’s always someone else’s’ fault.

7. Makes everyone else responsible for his feelings: says, you make me angry” instead of “I AM angry,” or, “you’re hurting me by not doing what I tell you.

8. Hypersensitivity: Easily insulted, claiming his feelings are hurt when he is really mad; rants about things that are just part of life.

9. Cruel to animals or children: kills or punishes animals brutally; expects children to do things that are beyond their ability, i.e. whips a two year old for wetting a diaper; teases children until they cry. SIXTY FIVE PERCENT OF ABUSERS WHO HIT THEIR PARTNER WILL ALSO HIT CHILDREN.

10. “Playful” use of force during sex: enjoys throwing you down, holding you down against your will; says he finds the idea of rape exciting.

11. Verbal abuse: constant criticism, says cruel or hurtful things; degrades, curses you, calls you ugly names. This may also involve sleep deprivation, waking you with relentless verbal abuse.

12. Rigid gender roles: expects you to serve, obey and remain at home.

13. Sudden mood swings: switches from sweetly loving to explosive in a matter of minutes.

14. Past battering: admits hitting women in the past, but says they made him do it or the situation was to blame.

15. Threats of violence: makes statements like “I’ll break your neck” or “I’ll kill you,” then dismisses it with “everybody talks that way, you’re too sensitive” or “I didn’t mean it.”

IF IT HAS COME THIS FAR, GET HELP OR GET OUT.

From the Project for Victims of Family Violence, Lafayette, ARK

If you’ve never talked to a counselor, social worker, or psychologist—and you should ONLY put your life in the hands of a licensed professional– it may seem like a mysterious process. What actually happens in there? Why can’t I just talk to my buddy instead?

Let’s take those questions one at a time.

Should I go to therapy?

If you think you might need to, that’s a good indicator that you should give it a try. There’s no commitment made in the first session; it’s a time to tell your story, get some feedback and a sense of your therapist’s personality, ask questions about how they work, then go home and make your decision.

There’s a saying that those who don’t study history are condemned to repeat it. Therapy is a place to recount your history and hear about new ideas: new ways to think about your life, new responses to replace your old ones that aren’t working. I am extensively educated to help you with that.

What actually happens in there?

There will be paperwork, of course, including a written explanation of the privacy laws that govern licensed therapists. For example, you can tell me anything and keep it private, with these exceptions:

If you use insurance, your company has the right to your chart.

If you say you’re going to hurt yourself or someone else, I have to contact authorities.

If you say a child or elder has been or is being abused, I have to report this information as well.

I will take a history of the important events in your life, hear about your current challenges, and possibly have you fill out some tests to get a better diagnosis of your problem. In future sessions, I will give you a Plan of Care that outlines our work together.

Why can’t I just talk to my buddy instead?

Friends are not unbiased, trained, objective, or equipped to help challenge and change your thinking. Talking to a friend without professional feedback just keeps the problem going in circles. We are governed by strict codes so that we can’t be your friend, business associate, or anything else that would complicate your care.

If you would like to explore therapy with me, I welcome your questions! Call today for an appointment.

“What is it?”

Although the specific diagnosis is complicated, these symptoms may indicate signs of Seasonal Affective Disorder: craving for carbohydrates, excessive sleeping, lack of energy, weight gain, and all of the symptoms of depression that go along with it: excessive guilt, irritability and others.

“Who’s at risk?”

People who live at higher latitudes have a higher risk, as do people already diagnosed with Bipolar II disorder. Younger people are more at risk than older ones. Regardless of these factors, anyone can suffer with symptoms of Seasonal Affective Disorder. ONLY A LICENSED HEALTH PROFESSIONAL can make this diagnosis!

“What makes it worse?”

Having the short days of winter upon us right after the overspending, overeating, and family time of the holidays can contribute to the exhaustion we feel. Less daytime light to feed our vitamin D needs is also a factor, as is less stimulation of the glands that provide serotonin production. Making New Years’ Resolutions can make you feel ineffective and hopeless if you are depressed; postpone until spring.

“What makes it better?”

Getting outside, even 20 minutes a day, without sunglasses. This exposes you to unfiltered light.

Leaving lights on inside the house, and drapes open to outside light.

Light boxes (available online) specifically designed for Seasonal Affective Disorder.

Therapy to offer support and new ways of viewing your world, and to prevent worsening of depression.

Exercise, exercise, exercise: again, 20 minutes a day helps. Exercise can be a ‘magic bullet’ for depression and anxiety relief! If it’s bad weather, walk at a mall or a gym.

“How can a therapist help me?”

A therapist can hold you accountable for putting these helps into place in your life, as well as help you examine how you think when depressed and challenge that faulty thinking. There’s no need to go at life alone, and untreated depression is indeed dangerous. There IS help!

When the Holidays Aren’t So Merry—Making it Through the Season

“What’s wrong with me?” my patient (fictional) asked, shredding the tissue in her hands as she wept on my couch. “Shouldn’t this be a happy time of year? Why can’t I feel Christmassy and jolly?”

And she is not alone. When you think of all of the people who are grieving and/or going through their first holiday season after divorce, widowhood, or the loss of a loved one, you realize that the memories can make the holidays more painful than happy at this time of year. Add to that the additional stress the season brings in the form of activities, shopping, and school events—well, you can see the problem. It’s like adding that last too-much drop of water to an already overflowing bucket.

What to do? If you are experiencing loss this time of year, your goal is this: to make it through. This is not the time to fill your chore list with handmade gifts (or gifts at all—who’s going to blame you this year?) or high stress dinners. If ever there was a time in your life to put you (and your children, if any) first, this is it. Exercise your “say-no” muscle with a firm and assertive smile and pass on committees, obligations, and entertaining. The people who might judge you—and believe me, there are fewer than you imagine—are simply not worth a second thought.

When the memories and tears come, allow them. What we resist, grows stronger, so don’t fight the feelings that arise. Tears actually expel cortisol, a stress hormone that is damaging to the body and needs to come out in order for you to be healthy.

Ask your friends and family for what you need this year, specifically. Do you need help making decisions on the children’s Christmas list? You probably have at least one friend who would love to help you. Do you need people to just listen to your grief without advising you? Tell them that you really just need an ear, not a response, from them.

These are just a few ideas; you know best what helps you stay strong. Just remember that you WILL make it through. Rest, heal, and wait for better days.