The good news is that depression is very treatable. Even though you may feel hopeless right now, there is hope!! Often depression can be relieved through therapy alone. And when it is, you avoid all the potential side effects of medication. Taking medication for depression without also having therapy is like taking tylenol for a fever, but not treating the underlying infection. Stop the tylenol, and the fever roars back, worse than before. And in the meantime, the infection continues, doing serious damage.
Just like a fever, depression always has an underlying cause. Therapy addresses the underlying cause, and relieves the symptoms. So no further damage occurs, and you can also avoid future troubles because you now know how to recognize and deal with the underlying issues. In severe situations, medication can be helpful in addition to therapy, but I don't recommend medication unless it is necessary.
Symptoms of depression can include feeling "blah" or frequently getting "the blues," feeling hopeless and/or suicidal, having difficulty concentrating, disrupted or excessive sleep, unusually high or low appetite, and just not getting any pleasure out of life. In children, depression can be expressed by irritability. All these signs can run the gamut from mild to severe.
There are many types of anxiety, and therapy is a very powerful way to deal with it - it works!! Some people are just generally anxious much of the time. Others have panic attacks or phobias, or are excessively nervous in certain settings (like social situations). For still others, the symptoms involve obsessive thoughts or compulsive behaviors. What make anxiety different from fear is that when you have anxiety, you are not quite sure what it is you’re anxious about, or the worry is really irrational.
Usually there is something that you are not aware of that is driving your anxiety. The way that therapy works is to help you identify what is powering the anxiety so that you can deal with that directly, rather than by just avoiding anxious situations or feeling nervous all the time if you don't.
See this brief video on Therapy for Survivors of Childhood Trauma and Abuse.
Whether you have been sexually or physically abused, exposed to the abuse of others, or neglected as a child, these experiences have a profound impact on you. Even though the events may have happened years ago, they still live on in terms of their effect on your life. One of the reasons for this is, as neurological research has shown, that trauma literally changes your brain. The good news is that research has shown that therapy, even talk therapy, can also change your brain!
Common issues that survivors of abuse deal with include problems in relationships, trouble with sexual intimacy, low self-esteem, difficulty with assertiveness, avoiding conflict, poor anger management, and post-traumatic stress disorder (PTSD). In addition, many abuse survivors also experience dissociation, which can range from brief out-of-body experiences to multiple personalities (dissociative identity disorder). These experiences can be very troubling, scary and upsetting, and can also wreak havoc in your life.
While it may be important in therapy to talk about some of your experiences as a child, it is also critical that this be done at your pace and under your control. Perhaps the most damaging aspect of child abuse is that you lose control of what happens to you. Therefore, if you don't keep control of the pace and content of therapy, you can be re-traumatized. So I will work with you to move as slowly as you need to, always respecting your need to control the pace of the process.
Many people find that they keep repeating the same problems in relationships. You may not even notice this, but by examining the patterns of your relationships, you can stop repeating the same self-defeating mistakes. These can include pursuing people who are not really available, finding yourself attracted to abusive people, difficulty making a commitment, having too high or too low standards, or just finding that meeting new people is too hard or stressful.
Therapy can be particularly helpful with relationship problems. By talking about current and past relationships, you can identify the destructive patterns, and find out why you keep repeating them. Many times these issues are similar to relationships in your family, and examining the parallels can help both family relationships as well as romantic and friend relationships.
Group therapy is especially effective in dealing with relationship issues. In a therapy group, members do not have outside contact, so they can feel freer about being direct with one another, giving participants the unique opportunity to get honest, yet gentle feedback. This safe atmosphere allows you to try out new ways of relating to others before doing so in other areas of your life.
Human sexuality is one of the most important issues that I help people with. How you feel about your sexuality is often closely tied to how you feel about yourself generally. And sexuality can also be difficult to talk about because of messages you get from your family or from society that it is taboo or shameful. But if you have questions about your sexual functioning, sexual orientation, or sexual behavior, therapy can be extremely helpful.
The most frequent reaction expressed by people after they talk about sexual issues in therapy is relief. It feels so good to talk about something that, often, you have never talked about before with anyone. And it’s very important that the person you share these personal matters with is open-minded and non-judgmental. I believe that sexual feelings of all kinds are natural and important and need to be treated with understanding, not criticism or judgments.
- Chronic Pain | Physical Illness - TMS-Related Issues
Few things disrupt a person’s life more than being in constant pain. And dealing with a chronic illness can be so devastating to your plans and hopes and dreams – it changes everything. While medical treatment is your doctor’s job, there is always a psychological component to physical issues. If you have a chronic illness, you may feel depressed and demoralized, and it’s tough for your body to fight if your mind doesn’t have enough energy. It is now abundantly clear from research that mind/body interactions affect the course of illnesses.
Similarly, pain always has a mental side. If you focus on your pain, it’s going to hurt more. And some psychological issues can also increase pain, causing TMS (Tension Myositis Syndrome). It’s very important to understand that, even if there is a mental component to your pain, this doesn’t mean that the pain is not real. When I help people with chronic pain, I don’t minimize the experience of the pain or doubt that it hurts. Rather, I look for ways that your body may be expressing something on behalf of your mind. I am influenced by the work of John Sarno with back pain. My patients have had great success in overcoming back and neck pain, as well as other issues such as irritable bowel syndrome, chronic fatigue, fibromyalgia, and bursitis using his techniques and theories. For a summary of his theory and TMS see this two-part interview from Medscape (Part 1; Part 2) with Dr. Sarno, which explains it very clearly.
- Family Issues
Our families are where we get our start in life. The family environment becomes our baseline from which we learn about relationships and the way the world works. When your relationship with your family is not working well, it can be very troubling, upsetting and disruptive to your life. Therapy can be a good way to straighten things out.
Some common difficulties that people have with families involve the level of closeness and involvement with family members. Maybe you are having difficulty separating from them and having your own life apart from your family. Or perhaps your family feels too intrusive and controlling. Sometimes the opposite is the issue: you and your family are too separate, and you feel adrift and alone and without the anchor that a supportive family can provide. These and other family-related concerns are complicated and take care to untangle.
- Couples' Problems
Whether you are married or not, and whether you are heterosexual or gay, your relationship with your significant other or partner can be central to your life. If that relationship has turned sour, the impact often bleeds through to other areas. And even if breaking up seems like a good idea, just to end the agony, it is usually worth it to try couples therapy to see if it’s possible to make the relationship work. Not only is divorce VERY expensive and painful, but if you try couples therapy and you still end up ending the relationship, the ending will be less damaging as a result of the understanding you gain in therapy.
- Children | Parenting
Your children are precious. They are irreplaceable. But they are also quite a challenge, and sometimes you feel like…, well you know. And if your child is having some difficulties, it’s also very painful to watch them suffer, especially if you don’t know how to help them or if what you’ve tried hasn’t worked. The range of problems children can have is staggering. But the vast majority of them are very responsive to therapy.
The other end of the puzzle of children is parenting. Sometimes the best way to help you child is to help you. It is true that children do not come with an owner’s manual telling you how to raise them. It can be a relief to get some advice and pointers. And if those tips are customized to your own situation, and take into account your own personality and background, you are likely to find it very useful. And in the end, both you and your children will be happier and better able to handle life’s challenges.
- Addictions | Alcoholism | ACOA
No one intends to be an addict or alcoholic. And oftentimes people are not even aware of how much they are caught under the spell of addiction. Whether the addiction is to street drugs, prescriptions drugs, alcohol, gambling, pornography or sex, you are genuinely powerless to stop it on your own. This is because the addiction does indeed change your brain. And it takes a concerted effort to change it back.
Depending on how deep the addiction is (how much it has taken over your life), the treatment I recommend varies. Sometimes we can work with it by meeting regularly in my office. But many times it is first necessary to refer you to a residential or inpatient facility, or a hospital. After you finish such a program and are more stable, we can resume or start meeting for therapy in my office. I work closely with inpatient or outpatient addiction programs to be sure that we are pulling in the same direction.
Addictions are often a family affair. Your relationship to whatever you are addicted to interferes with your relationship with those around you. They may play a role in maintaining your addiction, as well as be profoundly affected by it. It may be important to include family members in your therapy. If you grew up in a home where one or both of your parents had an addiction, you have doubtless been scarred by the experience. Therapy can be very helpful for you to both heal those scars, and also to help you avoid playing out your ACOA issues in your current relationships, or with your own partner and family.