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.

Have you ever wondered if, or been told that, you drink too much? Contrary to popular opinion, there are standards by which professional therapists measure and diagnose whether or not your use falls into troublesome levels. These standards are based on research produced by the National Institute on Alcohol Abuse and Alcoholism.

 It’s not just drinking daily– if it’s no more than 1 daily drink a week for a woman and two for a man, it’s generally not considered problematic—but also HOW MUCH at one time. So, even if you only drink once a month, IF you drink in excess of more than 4 drinks for a man or 3 for a woman in one day, you can be considered alcohol-dependent, have alcohol related problems, or be at risk. Medical, behavioral, and family history will all be taken into consideration. Further testing, such as the SASSI (Substance Abuse Subtle Screening Inventory) may be done by your therapist.

Fill out this form below and submit to your therapist for further evaluation. Take that first step toward your best YOU!

On average, how many days a week do you drink alcohol? ____________

On a typical day when you drink, how many do you have? ____________

On any given day, what is the maximum number of drinks you had in the past month? _________

Have you ever felt you should CUT DOWN on your drinking?  Yes    No ____

Have people ANNOYED you by criticizing your drinking? Yes    No   _______

Have you ever felt bad or GUIILTY about your drinking? Yes   No _______

Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

 Yes  No _______

If YES to any of these: has this occurred in the past YEAR?  Yes   No ______

Peggy Drexler, PhD

As social media has mutated into a ravenous, many tentacled time-eater, news from our friends about their families’ triumphs and trials has become omnipresent, and unrelenting. It can be a never-ending vacation slide show from hell. As a result, every day there’s a new complaint from those who follow: too much self-promotion in my feed. Too many photos of other people’s posh vacations. Too many selfies! No one wants to see what you had for lunch/what your baby had for lunch/how cute your cats are. And yet the posts keep coming.

“For the love of God, stop posting 9,000 pictures of your baby on Facebook,” pleads an author on Chicago Now. “You know the type I’m talking about. That mom who genuinely thinks her baby is cuter than all the others. Yo, jackass, we all think our own kid is the cutest.”

Indeed, social media and babies are a particularly dangerous combination. A 2010 study by the Internet security firm AVG Technologies found that 92 percent of American children under the age of two have some kind of digital profile, with images of them posted online. But posts chronicling every adorable move of our friends’ babies and kids certainly aren’t the whole of the online offensiveness: Elite Daily lists the 50 most annoying people you encounter on Instagram, including the Internet Model, the Fashionista and the Rich Kid—and I can certainly list a few more—while others offer endless advice on how to politely ask your connections to be less boastful, less prolific and less, well, annoying.

Part of the problem is that social media just makes sharing—oversharing—way too easy. A click of the button on a digital camera, a quick download, and the picture or video clip is flying to your Facebook feed. But there are also plenty of studies supporting the addictive nature of social media, and how obsessive posting works directly on the pleasure centers of the brain.

And yet the real problem here is not that we’re an addiction-addled culture of oversharers, though that may indeed be true. Instead, it’s that we’re a culture of complainers. We use complaints as icebreakers or to bond with others: What’s with this weather? What’s with our boss? We use complaints to establish rapport. Studies have suggested that complaining adds years to your life by helping us release tension. But we also complain because it’s in our nature, and we’re more apt to complain than to do something about it. Complaining about the social media habits makes this ever more clear, and has become a favorite topic of conversation: Who’s most annoying in your feed? Because of course, the solution to dealing with the oversharers clogging our feed is painfully obvious: Unfollow them. Stop engaging. Delete.

But can we? Or have the followers become as obsessed and addicted as the oversharers, the ones who do it for the “Likes”? We tend to issue blame on the people who post, but we’re hooked, too. Obsessive posting, after all, is a result of obsessive following—if there were no audience at the ready, there would be no need or reason to post. Consider as an example the end of relationships that take place over social media, from that of your college friends to that of Representative Mark Sanford, who ended his engagement to María Belén Chapur via public Facebook post. We’re not talking about the change in Relationship Status from “Married” to something else, but long, drawn out, intimate details that we’re shocked and horrified to read—and yet read we do. I followed along as two old friends ended their long-term relationship by posting all the last details of each other’s transgressions. I knew that this was not information I wanted to have. And yet I read it. All of it.

This, of course, is what keeps people over posting. It’s not their inherent flaw, or simply their desire to be heard. It’s our willingness to listen. The only way people will stop oversharing, or badly sharing, is to refuse to be their audience. That’s not something we’re willing to do. So instead we complain, and pretend to wonder what it is we can do about all these selfies filling our feeds. But if you really want your friends, colleagues and the strangers who appear in your feed to stop being so obnoxious, inappropriate and self-promotional, you know what to do. It’s as simple as hitting Unfollow.

By: D. Harrison, PhD

1. Save your major worries until about midnight, then start heavy thinking. Suggested topics include your age, losing your job, the mistake you made at work last week that they haven’t discovered yet, that suspicious wart you’ve had for five years, or radon in your basement. You can work up a good panic by 1 AM.

2. Keep an inventory of your faults. Ignore strengths. Focus only on your bad points. Try to select friends who will remind you of how awful you are. If you don’t have friends like this, you probably have some relative who can be counted on to point out your weaknesses.

3. Set unreasonable goals. No matter how much money you earn, remember there are others doing better. Try to name three of them, preferably younger and better looking than you. Think how others could do a better job.

4. When your children make mistakes, don’t accept it as part of growing up. View each situation as the first sign of impending moral decay, delinquency and a wasted life.

5. Put off everything until the last minute. In this way, you can create a sense of frenzy and chronic stress no matter how much time you had in the first place.

6. Aid and abet the creation of stress. Sleep as little as possible. Eat junk. Drink a lot of coffee. Never exercise if you can help it.

7. Never let others know how you feel or what you want. You shouldn’t have to tell them: they should be able to read your mind. If you assume this, you stand a good chance of feeling deprived.

8. Never trust anyone, particularly a counselor. Struggle with problems alone. If you feel the urge to confide in someone who seems to care, remind yourself that people are basically no good and are out only for themselves. Convince yourself that asking for help is a sign of weakness and that you can tough it out alone.

9. Never take a vacation. It’s a luxury you can’t afford, especially if you’re working up to a really good state of exhaustion.

If you follow this program, you have a good chance of feeling really rotten in no time at all!

“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.

Always begin with a visit to your doctor or health care provider to ensure that there is not an underlying medical cause to your symptoms. Don’t self-diagnose.

Panic attack symptoms include:

• Shortness of breath
• Tightness in the chest
• Rapid heartbeat
• Inability to relax
  • NOTE: since these can be symptoms of other medical emergencies, DON’T self-diagnose. Seek emergency medical care if this is the first time you’ve experienced this

What Can I Do To Cope?

• RATE the panic on a scale of 1 to 10, 1 meaning not bad at all, up to 10 meaning, call an ambulance! Anything we can MEASURE we can start to control.
• ACCEPT, don’t fight. Fighting increases the bodily symptoms.
• ASK yourself: what’s the worst that could happen here? How would I handle it?
• BREATHE normally and naturally. Pay attention to your breath.
• FOCUS on an object in the room. See it, describe it to yourself. This helps orient you in the present moment reality.
• TIME the attack (measuring again). Note how little time it actually lasts.
• NOTICE if the attacks are happening in a certain location or at a certain time (“cued” attacks.) When it passes, get out a piece of paper and write about that place or time. BE A SCIENTIST about your panic—objective, measuring, curious.
• TAKE your writings to your counselor to further explore the causes of the panic.
• REMEMBER that overcoming panic is not a matter of willpower. It is a malfunction of brain chemistry which can be helped by cognitive-behavioral therapy and/or medication. Medication takes away the SYMPTOM but not the CAUSE. Therapy helps get to the root of the problem.

Remember that a panic attack won’t hurt your physically. Although it’s very uncomfortable, your body will continue to breathe and function through it. Relaxing even a small amount and observing what’s happening will give you a much-needed distance and perspective.

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.