THE HOLIDAYS ARE WHAT YOU MAKE OF THEM


It’s “that time of year” here in the USA and many places in the world. Whether you celebrate Christmas, Hanukkah, Kwanza, Winter Solstice, Yule, something else or nothing at all, you are unlikely to escape events that occur during this time of year. For me, some years I have been totally engrossed in celebrations and other years, not so much.  In this short blog I'm going to offer a few tips from DBT (Dialectical Behavior Therapy) that might make the season more enjoyable for you no matter your feelings about it.  

A quick side note, DBT is an orientation we regularly operate from at Elephant Rock Counseling that emphasizes finding just the right balance and tension between the polarities we find in life, such as the simultaneous need for deep acceptance and much needed change in certain situations.  A certain phrase I have always liked that probably does a better job capturing what that really means and gets right to the heart of Holiday dilemmas, "If I only stand for myself what do I stand for, If I don't stand for myself who will?"  

Circling back, here are some tips to help make your Holiday more enjoyable:

• PLEASE is one of my primary go-to skills any time but especially important during times of potential stress.  It stands for:

PL – Physical – take care of yourself physically. Maintaining good physical health can ward off potential problems.  Make sure you follow good hygiene, get a flu shot, washing hands frequently, sneezing into a tissue or your elbow, avoiding crowds if you have immune concerns and taking medications as prescribed. 
E – Eat properly; not too much or too little. Enjoy the sweets but don’t go overboard. Balance is key.
A – Avoid non-prescribed drugs, excess alcohol. Limit caffeine and sugar.
S – Get enough sleep. 
E – Exercise! This is one people often miss. You don’t have to enter a marathon or iron man/woman contest. Getting outside and raking leaves, sweeping the porch or backyard, gardening (for me); walking the dog; taking a walk around the block. In addition to exercise, you get the benefit of being outdoors and maybe getting some sunshine.

• KNOW YOUR LIMITS – Consider when to say yes and when to decline. Over-commitment can lead to stress and even resentment. 

 

• PLAN AHEAD – Start with knowing your limits (above) – and be prepared for obstacles and changes. Having a Plan B and being flexible and gentle with yourself can help ward off unnecessary stress.

 

• SELF-CARE – Taking time for yourself in ways that nurture your body, mind and soul are not an option if you want to maintain your sanity. For me, following my daily sitting practice, reading something uplifting or humorous, yoga and movement, getting a walk and a workout, as well taking time to feed the birds in the morning and waiting for them to arrive and feed are ways I practice self care.

 

• GIFTS AND GRATITUDE – I am putting gifts and gratitude together because I think of them that way. We are given a gift each morning when we wake up and take that first conscious breath of the day. I try to begin and end my day with gratitude for those gifts. When you are considering gifting people you love and care about, remember it doesn’t have to cost a lot to mean a lot. Sure, I love gifting my kids and grandkids, and some years I spend more than others.  I often gift socks, and everyone loves them. Handmade gifts, including cookies and candy, imbued with our time, energy and love are well received. Gifts that promise time and efforts are other ways to show our love and appreciation. I like to give to places and organizations that I want to support, not only because of the good work they do but also because they feed my soul.

 

• REACH OUT  - Open up to family or friends about your feelings, and if despite all your best efforts, you (or someone you know) struggles with depression and they are unable to manage or at any time has any thoughts of suicide or self-harm please contact:

1-800-273-8255 (NATIONAL SUICIDE PREVENTION HOTLINE)
1-314-469-6644 (BHR – LOCAL HOTLINE)
CALL 911 or go to the nearest emergency room


These are just a few ways you might find helpful. I’m sure you can think of more. My wish for you is a peaceful, joyful and stress-free holiday.  If all else fails, just remember that December 21 is the shortest day of the year and the days start getting longer as the wheel of the year turns again.  And remember, if you need some help managing your stress and anxiety, please feel free to call us at Elephant Rock Counseling.


​
San Mueller, M.Ed., LPC, LBC-DBT Certified
Elephant Rock Counseling 
​Kirkwood, MO

San is a Licensed Professional Counselor with Elephant Rock Counseling, LLC.  San specializes in therapies that utilize mindfulness based principles such as Dialectical Behavior Therapy (DBT).  She enjoys teaching yoga, spending time with her family, and working with her clients.  

‘TIS THE SEASON 


“Here comes the sun.” “You are the sunshine of my life.” “You are my sunshine.” “Don’t let the sun catch you crying.” All these songs focus on the light and only the last one offers a hint of darkness. 


For many people (1.4% of Floridians and 9.9% of Alaskans) Seasonal Affective Disorder (SAD), and a less severe variety called “The Wintertime Blues” causes long-term and significant misery. While many people function better when the weather is bright and sunny, some enjoy at least the occasional rainy day to sit home and curl up with a book.  Most people are affected in the winter months, due to decreased sunlight, some people experience SAD in the summer months and a fewer number whenever there is a seasonal change.


Our bodies respond to sunlight and cycles of daylight and darkness. It affects our bodily functions, appetite, sleep cycles, energy and moods. Some are more affected than others and struggle with extreme or intense moods of depression with what we call SAD. SAD is a type or subtype of depression, and we will be primarily exploring one caused by a lack of natural light (sunlight).  


It is believed that the lack of sunlight affects a part of the brain in the area of the hypothalamus which is located toward the front of the brain in the limbic system. Blood levels of the pineal hormone melatonin are high at night and low during the day. Decreased sunlight may affect the ability of the hypothalamus to properly regulate melatonin levels which, in turn, affect sleep patterns.  Genetics may also be a factor, at least for some people who may be predisposed. Some behavior may also be learned or expected if children are exposed to adults dealing with SAD. It is sometimes seen in families.


Who gets SAD?  Women more frequently than men. People in the 20 to 40-year age group are most affected but also children and the elderly.  I recently saw an article suggesting people with lighter eye color (blue and grey) are more affected than those with darker color eyes due to how light enters the brain through the eyes.


What can you do about it? If you suspect you or a family member might be struggling with SAD, you can start by keeping a journal and tracking symptoms for a couple of weeks.  You can even use a large calendar and make notations of times, moods/emotions, events and weather.  This can help you discover if your reactions are in response to an event when you evaluate the intensity and duration over time.  If you see a pattern, are experiencing a number of symptoms, talk to a doctor bringing your journal or calendar with you.  If your symptoms are short term and not severe, you might try some techniques and strategies that others have found helpful before starting on medication. Of course, discuss this with your doctor as he/she may have a reason for wanting to start medication.  If  your depression is severe or you are experiencing any thoughts of suicide or self-harm, you need to seek attention immediately. 


Behavioral activation is a tool that has proven helpful in managing depression in general.  You can start by making a list of as many things you can think of that you would be doing if you weren’t depressed.  Ask yourself  “What do I like doing or even have been interested in doing if I weren’t depressed.”  Select a couple that stand out and you think you would be willing to do.  Set up a date and time to do each of them and mark them on your calendar or in your journal. Consider what might get in the way and problem solve how to manage that obstacle.  Rate how difficult you think it will be to do each item on your list – 0 (not difficult at all) to 5 (extremely difficult).  If you decide any item will be more difficult than a 3, reconsider that particular item, or select another item, or problem solve how to overcome the obstacle. As you complete each item on your list, consider how difficult it was to do that thing (0 to 5) and compare to how difficult you thought it would be. Did you do it anyway? How did you feel after completing it?  In DBT (Dialectical Behavior Therapy) terminology, we might refer to this as acting opposite to the emotion and problem solving.  Validate yourself and celebrate your efforts. Keep going.


Other steps you can take to help lift your mood and increase your energy and motivation are:
    •    Brightening and lightening up your environment with colors and natural light. Spending more time in natural sunlight, windows and open spaces.
    •    Get outside, if it’s cold; dress warmly and take a walk even if it’s around the block or your back yard.
    •    Exercise regularly, daily if possible, start slowly if you are new to exercise and pick an exercise you think you would enjoy and are capable of performing. Commit to at least 3 times a week. Simple stretches and short walks can give you a boost.
    •    Watch your diet. Plan and eat healthy meals and snacks. Create a menu and shop for the week.
    •    Reduce alcohol and caffeine as well as sugar.
    •    Keep track of what works. Cross off things that you’ve done. Add, revise, delete and make a note of what is helpful.
    •    Consider starting a hobby, something you’ve done in the past and enjoyed or something you’ve wanted to do. 
    •    Take a class, join a book club or discussion group.
    •    Volunteer for a charitable or community cause.
    •    Talk to people. Use your support system or build one if you don’t have one. People need people.
    •    Play music. Dance. Sing along with the music.
    •    Light therapy works for some people. SAD light boxes are available but do your research and be careful about type and quality. You can use a light box for 20 to 30 minutes a day and it’s generally recommended to use it every day in the beginning at least. Pay attention and track your results. 
    •    Other options are vitamins and medication (talk to your doctor).
    •    Alternative treatments are massage therapy, aroma therapy, and acupuncture. 
    •    Talk therapy can be helpful especially if you are having trouble getting motivated. A therapist can help you challenge irrational beliefs and develop a treatment plan. Sometimes you just need a coach.


I encourage people to identify and name their chosen values and personal goals in life. What is important to you and are you living your values, you will be happier if you are. It makes a difference. For more information on values see my values blog from June 2018:

http://elephantrockcounseling.com/therapist-blog/living-your-values-finding-purpose
(clickable link at the bottom of this page)


Some other factors contributing to wintertime (or anytime) depression are:
    •    Financial worries
    •    Family problems (divorce, separation, relationship issues)
    •    Lack of exercise
    •    Loneliness/Nostalgia
    •    Holiday stressors
    •    Overindulgence eating, alcohol, etc.
    •    Grief, loss, or reminders of those events


Lastly, if you think you might need help in getting started or managing SAD or are struggling with depression or anxiety, give us a call at Elephant Rock Counseling. We would be glad to work with you to move toward a happier life.


San Mueller, M.Ed., LPC, LBC-DBT Certified
Elephant Rock Counseling 
​Kirkwood, MO

San is a Licensed Professional Counselor with Elephant Rock Counseling, LLC.  San specializes in therapies that utilize mindfulness based principles such as Dialectical Behavior Therapy (DBT).  She enjoys teaching yoga, spending time with her family, and working with her clients.  

Holiday Antidotes
DBT Top Ten Holiday Antidotes

10. The holidays can be rough going, so let’s begin by planning some small, doable, positive and pleasurable experiences. Do them. Mindfully notice the positives in your life. Each day note something for which you genuinely feel gratitude. Find one meaningful thing to do today.

9. All things in moderation. Use the PLEASE skills to lessen your emotional vulnerability—which only get more intense when negative Emotion Mind meets alcohol, non-mindful eating (under-control & over-control) and other old, unwise attempts to deal with stress.

8. The holidays are a great time to use the “contributing” skill to distract and interrupt increasing depression or anxiety by visiting or helping those in need, perhaps as close as a next-door neighbor.

7. Have access to music, a symbolic object, a photo, a pleasant smell, a comforting taste or touch. Also some quiet time with a hot bath, a good book, a loving animal, a kind human, or your compassionate, wise mind can provide some self-soothing when the holidays get tense.

6. Observe that emotions come and emotions go. The holidays often amplify the intensity of negative emotions. When you find your sadness, anger or fear rising and approaching the “red zone,” try taking a walk to get a working distance from the situation, remember your goals, and be sure to give yourself some validation. If possible, grab a trusted loved one to go with you.

5. Holidays are also prime viewing time to observe our negative thoughts, such as catastrophizing, all-or-nothing, and “should” thoughts. Getting hooked by our “twisted thinking” leads to unneeded suffering. Let’s use this time as an opportunity to practice “letting go” or “not buying” negative thinking or ruminating on past grievances. Instead, let’s participate in the present moment as it is.

4. Steer clear of holiday regrets by listening to wise mind and effectively responding to difficult family members. What does my wise mind say now? Listen. Cultivate a “mindful gap” in a tense, reactive situation. Walk away knowing you have successfully “surfed the urge” and sidestepped a potential round of conflict. Apply DEAR with GIVE or FAST when you can.

3. Communicate! Invite your curiosity to the conversation. Clarify your priorities in the interaction: making progress on an objective or task, maintaining a relationship, or standing up for yourself. Express or ask for what you need. Say “no” when you need to. Say “yes” when you choose.

2. Observe the judgmental thoughts. Re-describe in a non-judgmental way. What would you say to a close friend in the same situation? Help yourself to accept this moment as it is and to accept yourself as you are. Some wisdom with a good dose of compassion.

And the #1 Antidote… Mindfully Breathe 3x... mindfully… ahh… Repeat, as needed.


Guest Blogger this month,
John Mader, LMFT
Thank you John for allowing us to use your wonderful list!!!

DBT Holiday Antidotes John Mader, rev. 2018, contact: [email protected]
These top ten are based on Marsha Linehan’s DBT Skills

​Human beings are tribal by nature. We can’t avoid it. We have a place in the world and many of us spend our lives trying to find that place. Where do we fit? Who are our people? I’ve written in the past about finding our purpose, but I think finding our people is equally important and sometimes even more challenging.  Of course, we all belong to the human race. We are human beings first and foremost. When I talk about “finding our people,” I don’t mean this as a way of separation from our entire species, race or by  socio-economic status at all. What I mean is finding people who understand us, who “get us.” We might consider tribe as friends, family, clan, network, besties or something else. What we want  are people who can understand how we think, not necessarily that they think (or believe) exactly as we do, but they can find truth or value in our way of thinking. Maybe they just accept that we have value and something to add to the conversation even if they disagree with us.  They accept (or perhaps love) us for who we are.


I wrote this blog several weeks ago. Since then, I have had second thoughts about using the words tribe and tribal due to a concern that it might reinforce the idea of separation and add to the divisiveness that has become so rampant in our world today.  Like most Americans, I am deeply saddened by the recent killings of innocent people, apparently based on intolerance and hate.  I think we need to be judicious about judging our group of friends as better or superior to others.  Ultimately, I would love to see circles of friendship spreading out across the world, finding common ground and embracing differences. A core concept of DBT (Dialectical Behavior Therapy) is finding the kernel of truth in seeming opposing viewpoints.


As a therapist, I’ve worked with many lonely people who feel they have no one in their lives who understands them.  Often, these same people struggle with the pain and shame of trauma or hurt that keeps them shut off, unable to let anyone into their lives. They believe that if people knew them, could see into their hearts and souls, that they would be utterly and completely rejected.  From ancient times, being ostracized from the tribe meant almost certain death. So, it becomes a self-fulfilling prophecy. We either shut ourselves off completely, hiding behind a mask, or we project our worst selves and are rejected. It often seems a tough sell to find people who accept and love us if we see ourselves as essentially unlovable and without value or worth.  Another key concept in DBT is that we are connected to the universe, that we have validity. I understand that to mean we have worth, are part of and related to a greater whole and have a right to exist.


One of the most important, perhaps the most important thing I do (or try to do) as a therapist, is to help people find the essential goodness within themselves.  No matter what we’ve done or think we have done, we all have an essential goodness.  That, to my way of thinking, is the way back to finding our tribe.  The next step is to figure out what is important to us (referring back to my blog on purpose, finding your values).  This can help clarify what gives meaning to your life.  Once we figure out what we value and begin to live in accord with our chosen values, we can actively watch for and seek out others who share those values.


I don’t think it’s necessary to have lots of friends to feel connected.  Recent research says we only need one good friend but 3 to 5 is better. After all, it’s a good idea not to feel we are burdening one person with all of our problems too frequently.  Share the wealth! According to British anthropologist, Dr. Robin Dunbar, humans can only maintain social relationships with up to an average of 148 people – say 150 for simplicity. This is due to the size of our brain as  maintaining and processing information requires quite a bit of cognitive resources. Dunbar broke this down into layers with 150 as the top layer. The closest layer at the bottom is 3 to 5 people; the next layer around 15 people and so on up to the 150 at the top.  Consequently, for those vital, life affirming, validating relationships, we want to shoot for 3 to 5 people.  So your social circle  could be up to 150 if you are a very social, extroverted sort of person (where your energy and life force is fed by being with others) but your “tribe” or closest and most intimate circle, you ideally want to include 3 to 5 people that both validate your essential goodness and that you can trust enough to tell you the truth in a way you can hear and accept it. They may or may not hold your values as close to their hearts as you do, but they should respect you and your values.  If you are more of an introvert (drawing your energy from time spent alone to recharge yourself), your tribe might be a smaller pool, but you still want a few close and trustworthy individuals.


A few tips for finding your tribe: join a book club, or other club or group, church, take a class, volunteer, connect with neighbors, call a friend for coffee or just to keep In touch.  Consider the quality of your current relationships. Are you giving more than you receive? Do you take more than you give? Do you enjoy the time you are spending together or is it an effort? Sometimes we need to make space for new relationships. Are you willing to put in the time and effort to build new and/or maintain current relationships?  After all, we are tribal by nature, that is depending on one another helped us survive and thrive as a species. We need each other.


As the holidays approach, many tend to gather and reconnect with others. We are moving into the holiday season. It can bring both a sense of connection, nostalgia and, for some, longing and loneliness. It can be an opportunity to explore and strengthen your connections.


If you are struggling with loneliness or relationships, and it’s causing you pain in your life and are unable to move forward, you might want to consider talking with a therapist to help you sort things out.  At Elephant Rock Counseling, we are available to listen and provide support and guidance.  We would be happy to talk with you.



San Mueller, M.Ed., LPC, LBC-DBT Certified
Elephant Rock Counseling 
​Kirkwood, MO

​
San is a Licensed Professional Counselor with Elephant Rock Counseling, LLC.  San specializes in therapies that utilize mindfulness based principles such as Dialectical Behavior Therapy (DBT).  She enjoys teaching yoga, spending time with her family, and working with her clients.  

I have a very special place in my heart for those who are trying to overcome an addiction.  I have helped numerous people in therapy overcome their addictions in the last ten plus years, one of them being myself almost twenty years ago.  Overcoming nicotine in my late twenty's was one of the most painful, humbling, and eventually one of the more rewarding accomplishments of my life.  Yes, it was that hard.  Nicotine won't immediately turn your life upside down like Heroin or Severe Alcohol usage can, however numerous studies have rated its addictive qualities equivalent to Heroin.  Overcoming an addiction takes a lot of heart, but it also takes a lot of brain.  In this short blog, I'm going to share 3 tips that can help get you started if you're ready to give up your addiction.

​

Tip 1:  Don't Judge Your Addiction, Be Curious  


I discussed this so many times with one of my counseling clients she brought in a framed quote by Walt Whitman to hang on my wall which stated, "Be Curious, Not Judgmental."  Entering a mindset that is free of judgment clears the mind allowing us to see a lot more clearly how the pattern continues to repeat.  This is an important step as often patterns are extremely subtle and elusive in terms of what we say to ourselves, people and places we associate with, and how we interact with painful emotions and stressful events.  It makes sense that we naturally judge ourselves when we're doing something that is harmful to us or other people.  However, if the judgment has been going on for quite some time without progress, it's likely guilt thats morphed into toxic shame making it even harder to get free from the addiction.  Shame becomes a powerful self-fulfilling force that can make one believe it's hopeless, we deserve it, we're weak; and believing there's no way out is a few short steps away from, "I give up."  


It can be helpful to remind yourself that of course I'm doing the best I can, maybe I need to do better, but I haven't figured that out yet so I'm still doing the best I can for now.  I've never known anyone who truly wants to be miserably addicted to substances or behaviors that are controlling their lives, but often judgments from ourselves and family would imply that I must want to be miserable.  Not judging and being curious is a lot more helpful.  Even if what we notice is - "I'm not that willing to give up my addictive behaviors," we can notice that without judgment.  This strategy is partly how I was able to give up nicotine. 


After years of failing to give up nicotine I started to notice how shameful I was about my continued failing over and over, and equally shameful that I continued to notice a secret part of me that didn't want to give it up.  I started to wonder if something must be wrong with me for not being able to overcome the addiction.  I wondered if I must be very weak because another part of me really did want to quit.  Fortunately, out of curiosity I decided that I was going to try something different.  I wasn't going to judge myself any longer.  I was at least going to enjoy the nicotine, and then see what happened.   And something really interesting happened about 4-6 months later.  I woke up one day having a strong motivation to quit and it wasn't motivated by shame.  I was just ready to make another effort to quit and that was the beginning of me successfully overcoming my addiction.  I will never forget how getting free from my shame was an integral part of getting free from the substance.  Some would rationally argue that certain drugs or addictive behaviors would be very risky to simply enjoy for another 4-6 months.  This is true, especially if the person is a legitimate harm to themself or others.  Nonetheless, after addressing those realities, it's still going to be very hard to make any progress if you're stuck in shame and judgment.  Research indicates that it takes the average person years to overcome substance abuse or addictive behaviors such as eating disorders.  I would argue that in many situations if individuals and families would STOP, take a step back, be curious and non-judgmental about the addiction, trust the therapy process through ups and downs, they would likely work through it much faster.  After failing for several years, it was a few months of non-judgmental spirit that finally helped me get the upper hand.  I haven't used nicotine for almost 20 years and going.  


A final note on Tip #1.  Not judging doesn't mean I'm warm and fuzzy with the person who's addictive behaviors are causing serious problems or worry for others.  Enforcing appropriate consequences, allowing natural consequences, and utilizing reinforcement principles can also be very effective.   I often coach families not to show up to the hospital after an overdose or suicide attempt with stuffed animals and a lot of warm sympathy.  This can reinforce the behavior and the natural tendency to repeat something that elicits a lot of positive attention.  Providing any necessary support and counseling to get back on the track of curiosity and learning from the incident without judgment is all that is needed.  



Tip 2:  Admit You're Powerless to Your Addiction


Many of you are probably aware this is the first step in AA (Alcoholics Anonymous) 12 step support groups.  It's also another important piece related to my own path in overcoming that addiction.  Sometime during those 4-6 months, I clearly remember a silent prayer acknowledging just those words, "I'm powerless to this," and asking for help with the addiction.  I will never forget the transformative power in those words, it was very subtle and yet so powerful.  For the first time I deeply admitted that I had no ability to manage or control the addiction.  I was no match for the addiction and I made this fully conscious.  Up until this point I was always holding onto hope that I could be one of those people who could use nicotine in moderation and that somehow I could manage the addiction which is a common distortion for individuals stuck in addiction.  I always find it interesting when talking with clients about the first step, as it was such a turning point for me even when I had no clue what the 12 steps were.  Therefore, it's probably important to note that 12 step groups are just one of many tools and strategies to overcome an addiction.  Many people have overcome addictions without them including myself as many of the steps are universal archetypal strategies that have been given names with a structure and format.  


Once taking the fist step, powerlessness becomes not a weakness but a mighty sword when taking on addiction.  Once we have a healthy dose of respect for the addiction complex one usually starts to naturally move away from trying to overpower the addiction to outmaneuvering the addiction.  Be smart not strong is a common treatment phrase.  Similarly, during a session when working with an adolescent we processed how powerful his gaming addiction was comparing it to the sirens in "The Odyessy" or the ring in "The Lord of The Rings."  Shortly after, he was trying to complete homework that he desperately wanted to do and yet he observed over and over the pull of his X-box was so powerful he was defenseless to its stunning graphics and dopamine hits to the brain.  He then experienced a moment of clarity and envisioned his only way out was to quickly and decisively smash his X-box to the point of no return.   He processed some natural and expected remorse, but he also indicated experiencing a tremendous relief no longer trying to manage or be stronger than the addiction.  He also couldn't remember the last time he was caught up on all his assignments since his mom stopped monitoring his school work.  



Tip 3:  Develop The Right Outlook With Relapse


The last tip is an important mindset for the addicted person and equally helpful for supporting family.  Many times the client and his supports see relapse as failure and view treatment as an "event" versus a "process."  It's not uncommon to hear these supports comment about the treatment after a set back, "Well that didn't work."  A lot of times there has been significant progress and improvements that go unnoticed.  Seeing treatment as an event can be demoralizing when the person knows how hard they have been trying.   It's very important to validate those efforts and keep things in perspective. 


It can be a lot more helpful to see recovery as a process, and relapse as part of recovery especially since we know on average addictions can take years to recover from.  Usually about this time the thought comes to mind, "Well isn't that the perfect excuse to not change."  It's helpful to remember something I mentioned earlier, I've never known anyone who truly wants to be miserably addicted to substances or behaviors that are controlling their lives and making them unmanageable. 


Ironically, it's often the supports who are providing the most cover for the addicted person who fall into the insincerity trap, "they don't want to get better."   It's definitely more likely someone will continue an unhealthy behavior when there are no natural consequences to their behavior and they have someone else handling financial obligations.  I have witnessed many parents allowing their adult children to live in their basement using drugs, having little expectations, and instead relying on relentless lectures and shame to change the behavior.  It's likely the person still does want to change but its become too easy to not address the problem.  Often someone in addiction will change because the pain of not changing is starting to become even more painful.  Natural consequences usually take care of this but when family members unwittingly get in the way despite their best intentions, it slows down the process.   


After making sure we aren't reinforcing the behavior in some way, it's extremely important to develop a relationship with relapse that emphasizes what can be learned from the setback without judgment (tip #1).  This emphasizes the process of practicing like playing a sport or instrument and getting better over time.  If your addiction becomes manageable right away, consider yourself one of the lucky ones.  


I hope you learned something valuable from this short blog and don’t hesitate to reach out for any further information or assistance.  Comments are always welcome below.


Best, 

Chad Randall, M.Ed., LPC, CCDP-D
Elephant Rock Counseling
Kirkwood, Missouri


​   

Cutting is a form of self-harming behavior or non-suicidal self-injury (NSSI), and, unfortunately, not uncommon, particularly in the adolescent population. If you are a parent discovering that your child is engaging in this behavior, it can be terrifying. Older studies estimate that 4 per cent of young adults in the US have engaged in some form of self-harm at some time, although the actual number is uncertain.  (Gratz, Conrad, and Roemer 2002, Paivio and MCulloch 2004; and Zoroglu et al. 2003).  More recent studies indicate up to 20 percent of high school and 40 percent of college students have engaged in self-harming behavior. Other studies indicate 1/3 to 1/2 of adolescents in US have engaged at some time.  (Petersen, Freedenthal, Sheldon & Andersen, 2008) . Until recently, it was believed that girls were more likely to self-harm, but we now believe that boys are equally engaging in self-harm. However, girls are more likely to be in treatment, so those numbers are higher.  I’ll be using the terms self-harm and non-suicidal self-injury (NSSI) interchangeably in this article.  Children younger than adolescence and adults also engage in self-harm. However, this article will focus on adolescence.



What is self-harm?  Deliberate self-harm is causing intentional damage to one’s own body WITHOUT an intent to die.  This doesn’t include smoking, drug use, bingeing, purging or behaviors that may be harmful but are not a suicide attempt.  Self-harming behavior besides cutting can be burning, skin picking, biting, head-banging, interfering with wound healing, ingesting toxic substances, breaking bones, punching or hitting oneself with the intent to injure or wound but not die. I’ve worked with individuals who have engaged in all these types of behavior but cutting is the most common in my experience. Individuals who self-harm tend to be impulsive, engaging in self-harm with less than an hour of planning, highly reactive, sensitive to real or perceived criticism, may be victims of bullying or intense peer pressure and frequently exhibit and engage in highly dramatic behaviors.  While intentional self-harm is deliberate without an intent to die, it can become addictive in some individuals. This can increase the likelihood of suicidal behavior.



The good news is people who self-harm usually don’t want to die, although self-harming behavior is a risk factor for suicide.  They self-harm for various reasons and while it’s important to understand why they do it, in my opinion, and according to experts on the topic, it’s even more important to know what they gain from it. The why and the what usually aren’t the same thing. Knowing what is gained helps us understand why they continue to engage in the behavior. All behavior has a cause and some sort of reward.  Another bit of good news is that understanding what is gained provides an opportunity to help the individual obtain the result by learning healthier, more adaptive coping strategies. 



Even though finding out your child is self-harming will naturally cause extreme distress, maintaining a calm and supportive attitude can help you help them.  I’ll be providing some information, guidance and tips. Recognizing and seeking treatment for your adolescent as well as support for yourself will provide the best outcome.  


Sometimes the why and what are congruent. So we consider why and what is gained (the reward) which reinforces the behavior. Some of the reasons kids say they self-harm are:  1) To stop suicidal ideation or suicide attempts; 2) It is calming; 3) It helps manage distressing thoughts by distraction due to focus on pain; 4) It helps regulate emotions as a coping strategy, decreases arousal and heart rate; 5) It is numbing (Some say they don’t feel pain.) likely due to release of endorphins which react with the opiate receptors in the brain to reduce perception of pain and act similar to drugs like morphine and codeine; 6) It causes them to “feel real,” for those who feel numb; and 7) It provides positive attention from adults who may decrease pressure to do chores, homework and other responsibilities for fear of upsetting the adolescent and contributing to NSSI.


Associated with NSSI are borderline personality disorder (BPD), depression, post-traumatic stress disorder (PTSD), generalized anxiety disorder, oppositional defiant disorder, eating disorders, and substance use disorders. There is no diagnosis for NSSI. However, it may be a symptom as part of another emotional disorder and often associated with BPD.



While not the only treatment available, dialectical behavior therapy (DBT) is considered the gold standard treatment for managing impulsive self-harming behavior.  Developed by Marsha Linehan in 1980 as a treatment for suicidal women who also self-harmed without an intent to die. It has been rigorously researched in scope and depth. The scope DBT treatment has expanded and is successfully being used to help individuals with a variety of issues, including depression, anxiety and impulse control disorders. While the original population was adults with suicidal ideation or NSSI, the treatment was adapted and thoroughly researched to work with adolescents with these problems. It is still the first choice and continues to offer help and successful results for adolescents and families.



DBT focuses on dialectics which is finding the value in two seemingly opposite or opposing points of view - or creating a balance between validating thoughts, emotions, urges and behavior and teaching healthier more adaptive ways to cope with those thoughts, emotions and urges. We look for the synthesis, the kernel of truth to create pathways to change.  We validate the reason for engaging in the behavior without validating the behavior. Other types of therapies may focus primarily on validation while others emphasize change. In working with individuals with high sensitivity and emotional reactivity, Marsha Linehan discovered they respond more successfully when both validation and change are balanced; when the therapist can be aware of what is needed and adjust the approach. 



DBT provides comprehensive treatment for the adolescent and family members. While there are variations in the way it is implemented, comprehensive DBT for adolescents and families will provide the following components:  1) Weekly individual therapy for the adolescent with optional family therapy as needed; 2) Weekly skills group sessions for the adolescent and at least one caregiver (parent); 3) Coaching calls for the adolescent to help reinforce use of skills and coaching for the participating caregiver; 4) Weekly consultation team meetings for the DBT therapists providing DBT.  Adolescent and family DBT skills group teach Core Mindfulness skills to help recognize and manage thoughts, Distress Tolerance Skills to learn to recognize, manage and survive crisis situations without resorting to NSSI, SI or other extreme or maladaptive behavior, Emotion Regulation Skills to learn ways to practice self-care and healthy life patterns, Interpersonal Effectiveness Skills to teach individuals to manage and keep current relationships, end unhealthy relationships, learn & practice asking for what they want and saying no in a way that allows them to maintain their self-respect. Lastly, The Middle Path, which is unique to Adolescent & Family DBT, helps adolescents and parents examine the dialectical dilemmas they face, specifically between Making light of problem behavior vs. Making too much of typical adolescent behavior; Forcing independence too soon vs. Holding on too tightly; Being too loose vs. Being too rigid.


Adolescents are expected to keep a daily diary card tracking and logging emotions, urges, behaviors and skills used each week. This will be reviewed with the DBT individual therapist to help the adolescent recognize helpful and unhelpful behavior and to learn and practice skills.



What can you do as a parent/caregiver to help your child? Here are a few guidelines and suggestions.  

• First, don’t panic!  You’ve probably already done that as most of us would if we found out our child was hurting him/herself. After you panic, take a breath and a mental step back. If you are reading this blog, you’ve likely gained some new and hopefully helpful information. 

 

• Don’t try to remove all the sharp objects from the house. Of course, if your child has a knife or weapon in their room, remove it, but they must learn to live with and be around knives, razors, scissors and the like. It’s important that they gain skills and find other ways to manage their distress.

 

• Don’t do body checks. It will increase the adolescent’s sense of shame and humiliation which is likely already high. It may seem like a punishment and may trigger more maladaptive behavior.

 

• Keep communication open with your adolescent  by using validation to let them know you recognize they are in emotional distress, and you want to help and support them.  Last month’s blog went into detail about the importance of validation and how to do it.  It’s worth reading or re-reading again:

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validation-the-secret-to-better-communication.html

•  To recap here, validate only what is valid. Don’t validate what is invalid. For instance, you discover your child has been cutting.  She tells you she had a fight with her best friend who told other kids about her recent suicide attempt and hospitalization. You saying, “That’s ridiculous to get so upset about something silly that you would intentionally hurt yourself.” That invalidates the depth and intensity of her feelings. Alternately saying, “Of course, you cut yourself. What else could you do?” That’s validating the invalid. You don’t approve of her cutting, but you want her to know you understand her emotional distress. Instead say, “Of course, you were upset and were hurting. I suspect you felt hurt, embarrassed and betrayed. Who wouldn’t? I want to keep you safe and learn other ways to manage your distress. I’m here for you.” This opens the door to communication and shows understanding, attention and puts words on the experience. It may also offer comfort and a sense of support. You would, of course, assess the severity and attend to the wounds. 

 

• Find a therapist who understands and works with adolescents and families and have your child evaluated.  Finding a DBT therapist would be my recommendation, preferably someone who has trained with Behavioral Tech (Founded by Marsha Linehan) or more locally here in Missouri with Ronda Reitz who is a trainer with Behavioral Tech and has trained with Marsha Linehan.  You can search behavioraltech.org, dbt-lbc.org or http://www.dbtmo.org (Missouri) for names of therapists and programs.

 

• Patience, persistence and perseverance are required. Most parents don’t find out about cutting when it first starts. It will take time to help your child learn skills needed to change this behavior, particularly if it has become habitual. When our children are hurting, we want to fix it immediately.  That’s natural but, unfortunately, not realistic.  However, behaviors are learned and can be unlearned, or rather healthier and more skillful behaviors can replace unhealthy ones.

I have been working with individuals who struggle with emotional intensity including suicidal ideation and self-harm for over 20 years.  For the past 10 years, my primary orientation has been using DBT as I have found it the most effective and beneficial treatment for this population. At Elephant Rock Counseling, we offer a comprehensive DBT program for adolescents and families.  We teach, guide and support providing adolescents with the ability to learn healthy, adaptive coping skills vs. maladaptive skills that may provide them with short-term relief, i.e., self-harming behaviors, but lead to long-term suffering.  It’s not a “quick fix” and won’t solve the problem overnight. We include and require one parent/caregiver to attend group sessions with the individual to learn along with the adolescent and provide support to help them as well. In my experience, the individuals who enter and complete a DBT program stop engaging in self-harming behavior and begin to move toward the goal of DBT which is “a life worth living”.  



I hope this blog has provided you with helpful information. If you have a child who you suspect is engaging in self-harming behavior, please seek help.  We would be happy to provide an assessment and further information about our program.



San Mueller, M.Ed., LPC, LBC-DBT Certified
Elephant Rock Counseling 
​Kirkwood, MO

​
San is a Licensed Professional Counselor with Elephant Rock Counseling, LLC.  San specializes in therapies that utilize mindfulness based principles such as Dialectical Behavior Therapy (DBT).  She enjoys teaching yoga, spending time with her family, and working with her clients.  

Healthy communication can be a lot of work and very elusive.  It can require some trust and creates some vulnerability that feels like a losing strategy to some.  Additionally, sometimes it means temporarily tolerating our own discomfort.  These aspects and the communication strategies I’m going to be advocating in this blog are certainly not visible when watching cable news guests who model harsh retorts, winning at all cost, deeply invalidating each others point a view even when there seems to be at least some truth in both positions.  I think many of us have been in those situations ourselves with family, friends, colleagues and wonder if there has to be a better way to interact while trying to work through a conflict, or even when trying to help someone we think isn’t making the best choices.  Fortunately, there is one tool that can be very helpful, and in this short blog I’ll be introducing the concept of validation which can be very powerful in creating healthier communication, especially if the relationship is important to you.  It should be noted validation is not the same as agreement and I will repeat this theme many times throughout in different contexts.    


It’s been my observation that a lot of unhealthy communication in typical conversation stems from the position that one of us is right and one of us is wrong.  In truth, this is rarely true.  To illustrate this we often use the on/off light switch versus dimmer light switch analogy to teach less black and white thinking.  If we can interact with opposing positions/views on a dimmer switch versus an on/off switch we can often begin to see at least a “small kernel of truth" from the others perspective.  It’s quite remarkable but acknowledging a small kernel of truth can go a long way in building a bridge towards meaningful and positive outcomes.  As therapists we often elicit this type of approach.  For instance, I remember an interaction from a while back going something like this, “She called me a jerk for the last time, I’m not a jerk, I’m done.”  “Were you maybe acting a little bit like a jerk.”  “Well - maybe a little bit.”


When I work with couples or parent-child relationships sometimes I get an image of an old Atari game called Pong while initially watching their strained communication.  Pong was one the first video games ever produced where a little ball would go back and forth with each player raising or lowering an object on their side of the TV screen so as not to let the ball hit the wall behind them, and thus sending the ball back towards the other side after successfully positioning the object directly in the path of the ball.  Imagine two goalies protecting their nets but with no pause in the game between saving a goal and shooting back at the other goal, as it's all happening in one continuous motion.  As the game went on the ball kept going faster and faster until someone couldn’t keep up with the movements and the ball would eventually hit the wall behind one player making the other side a victor.  The ball for me took the shape of communication itself (a point of view) being transmitted from one person to another.  I say something, you say something, I say something, you say something, etc.  As neither one slows down enough to acknowledge an understanding of the others point of view and only asserts their own point of view the ball starts going faster and faster which is what I call competitive “escalation.”  You can easily observe the intensity pick up in conversations where there is no validation with each other.  


Validation on the other hand slows everything down.  I’ve imagined this same game from a validation perspective with the objects used to bounce the ball back to other side having baseball gloves where they catch the ball first before sending it back, taking some time to look into the glove curiously observing the ball (other point of view), and then sending the ball back with an acknowledgment of the others perspective before adding their own perspective.  As I mentioned earlier, validation doesn’t mean agreement.  It means I can understand how you might think that, and I hear what you are saying.  With this rhythm it’s hard to imagine the ball moving into a state of escalation where it just goes faster and faster. 


Here are a few vignettes to demonstrate both styles:


No Validation (faster and faster):


I think we should get a cleaning service.
We don’t have the money for that.
I think we do.
Not really.
Maybe you should clean more around here then.
I don’t think so.  This is your idea.    
Then we are getting a cleaning service.
No we aren’t and you have the time to do that anyway.
How dare you - you don’t appreciate what I do around here.
You don’t appreciate what I do around here, and you’re not being realistic.
You need to give up a few hobbies and then we can afford a cleaning service.
You spend more money than me, forget it, we aren’t getting a cleaning service.
Yes we are.
No we’re not.


Validation (slower):


I think we should get a cleaning service.
Sounds like you think the house is dirty.  
Yes, it really gets me down.
I could maybe see that, I know you like things to be really clean.  I have some concerns how we can pay for that.
That’s a valid concern, this is really important to me though and I think it's feasible.  
If this is really important to you I think we’d have to look at our budget.
Sounds like you are worried about the finances if we do this.
Yes, it stresses me out when we get overstretched.
I know that’s important to you, maybe we can find some middle ground.
I like that.  For instance, cleaning services are usually every couple of weeks, maybe it could be monthly?
That could work, and if I wanted the service more often maybe I could give something else up.
Sounds good.  Let’s talk more this weekend.
That works.



I think most people reading over the two vignettes would easily prefer the second style of communication and yet the first is all to common.  I think this is largely because people believe that validation weakens their position.  They think - If I acknowledge your viewpoint, it means I wholly agree with what you are saying and forfeit my position.  And this is just not true!  Again, validation is not agreement to your position.  It's an understanding how what you did or think could make sense.  Usually, the more someone acknowledges at least our point of view, the more likely we are to acknowledge their point of view.  It makes us feel better about the other person, the interaction, and increases the likelihood we can find an agreement that works for both of us.  I used the qualifier “usually” because there are relationships where it’s very clear the other person doesn't care about your wants, needs, and is extremely harsh going about getting what they want.  Using a lot of validation in these circumstances can lead to the other person taking you for granted, making it harder to find a healthy resolution.  In general though, even in strained relationships, I find that most people underuse validation and see progress in their relationships when they start slowing down the conversation and taking some time to acknowledge and validate what the other person is saying before asserting.  I had a very difficult personal relationship for many years and after both of us were introduced to validation via career paths and speciality training - our relationship has dramatically improved.  Interacting has went from challenging to pleasurable and rewarding.  


Depression and Suicide are great examples where concerned family members are reluctant to validate deep sadness or suicidal thoughts because they erroneously think it will increase those things, that somehow they are agreeing they should stay depressed or kill themselves by validating their experience.  So instead of communicating something helpful like, “I can’t imagine how hard it must be if you're thinking about killing yourself,” (validation of their experience) family members often send well intended but unhelpful messages such as, “don’t be depressed, you shouldn’t be thinking about killing yourself, it’s killing everyone to see you like this.”  If they were depressed before imagine how depressed and shameful they are now.  On the other hand, the first statement is usually therapeutic for individuals as it’s validating their internal experience and that feels very good to people in pain.  Someone really understands.  Once people feel safe and validated they are often more willing to explore ways they could be less depressed and suicidal.


Distorted cognitions of what helps or beliefs that one is undermining their own position aren’t the only reasons people struggle to validate.  Tolerating our own discomfort is another challenge with validation.  When someone is upset, often we don’t want to be around that emotion so we try to change the emotion by cheering them up or expressing anger or disappointment with them for being upset.  This is very invalidating because it communicates that your feelings are wrong, and paradoxically it makes it even harder for the person to let go of that emotion when you invalidate the emotion.  Has anyone said to you, “I don’t want you to fix it, I just want you to listen.”  They sense you are trying to push away their emotion, they don’t want to be calmed down, they want you to listen and understand.  Pushing away their emotion doesn’t calm them down, it can even make it harder to calm down.  However, it’s understandable people try to do this as the effective response is somewhat counterintuitive.  Nonetheless, validation is extremely important here and the other person will likely be more in the mood to problem solve if you slow down and validate first, letting the emotion come down naturally before you try and offer some helpful feedback.  However, that might involve you experiencing some temporary uncomfortable emotions until the other person is more regulated and has fully processed what they wanted to share with you.  This is one of the highest levels of validation as you are communicating - I’m here with you, I can tell this is really painful, you matter enough for more to endure this with you.


In closing, there is nothing I find more important in working with clients than to first make sure I understand where they are coming from, why they are doing what they are doing, how it makes sense, even if it’s obvious they need to make some big changes.  This has taken me very far on many occasions when helping people work through their problems and it’s an often underused skill that many of us could give more attention in improving our relationships.


I do hope you gained something from this short blog and don’t hesitate to reach out for any further information or assistance.  Comments are always welcome below.


Best,


Chad Randall M.Ed, LPC, CCDP-D
Elephant Rock Counseling
Kirkwood, Missouri

LIVING A PURPOSEFUL LIFE (Why Values Matter)


What is your purpose in life?  Do you know?  Are you living your purpose?  Has it changed?  Have you changed?  As a counselor, after many years and meeting with people of all ages, I believe that everyone has values or characteristics and qualities that guide their thinking and behavior.  They may not have ever considered what those values are or whether they are helpful, but nonetheless, they are guided by them.


Let’s start with some definitions.


Values, as defined by the dictionary, are:

• The regard that something is held to deserve; the importance, worth, or usefulness; and
• A person’s principles or standards of behavior, one’s judgment of what is important in life.

Morals are defined as:

• A lesson, especially one concerning what is right or prudent, that can be derived from a story, a piece of information, or an experience and
• A person’s standards of behavior or beliefs concerning what is and is not acceptable for them to do.

Ethics are defined as:

• Moral principles that govern a person’s behavior or the conducting of an activity; and
• The branch of knowledge that deals with moral principles.

The first three are frequently confused.  I’ve not included laws and rules, which are often the attempt to codify and enforce a set of values.  They may be helpful in keeping societal order, but as they consider the whole, they are not always fair or just, and over time, particularly as we become more global, values can vary or conflict.


What I’d like to present here is an introduction as to some ideas about how we might find more purpose in our lives by examining what we truly value, what is important to us in the following way: how we as individuals develop our value systems; why it’s helpful to know what we value, and lastly, how we are living up to or in harmony with our values.  If not, we might question if the values we live by are truly our own or inherited, or learned from our family system or environment, and then to make a conscious decision to accept, question and possibly reject or change our values.


This is not necessarily an easy process as our values become part of who we are.  Very simply, I believe people are happier and more content when they are living in harmony with their “chosen” values.  I put “chosen” in parentheses, because if we are unhappy with ourselves and our lives, we may be either unsuccessfully attempting to live with values we haven’t chosen freely, or we are living in conflict with our chosen values.  Many of us, perhaps most, go about our lives without consciously considering what guides us.  If you are able to meet your basic survival needs, have satisfying work or living arrangements, are healthy and, for the most part, feel content and satisfied, it’s likely you are living in harmony with what is important to you (your values).  However, if you are frustrated, angry, depressed and struggle with guilt, there’s a good chance you may be living in opposition to your values.


In my opinion, it’s helpful to be able to identify and clarify what we value.  There are universal values that most of us believe are important – justice, equality, compassion, loyalty, honesty – come to mind.  Other values that are frequently identified are – family, friendship, success, respect, challenge, excitement, cohesion, safety/security, structure, independence, power, truth, integrity, freedom, beauty, wisdom, God, religion/spirituality, creativity, intelligence, health, and money (more a symbol of success, achievement, etc.).  There are more, but these often surface.  Which of these seem relevant to you? Consider your current situation or career. If your job duties conflict with your values, you will struggle mentally and emotionally.  What if your partner’s values are different from yours?  Do opposites really attract?  Maybe and maybe not.


Once we start down this road to identify our chosen values, it’s important to consider if you have truly chosen your values or if they were passed on to you from your family or environment.  Are you a square peg trying to fit into a round hole?  That’s a tough fit and generally unpleasant.  Many people attempt to live with (or against) values that were passed down to them but don’t always agree with or truly accept them.  These folks tend to live conflicted and frustrated lives.  Additionally, our values can change over time.  We leave home, go away to college, get a job, meet people with different views and lifestyles, and develop new interests.  Our values can shift and evolve as we grow and change.  Yet if we don’t recognize and acknowledge this, we may constantly struggle with feelings of discontent and disharmony in our lives.  Once we become aware, we can explore, consider and make a conscious choice to accept or reject old values, change, shift or develop new values and move toward a path that is aligned with what is important and valuable to us.  We can move toward a happier, more fulfilled life, free from inner turmoil and conflict (or at least decrease it).


I recently read an article on different personality concepts.  It described two basic beliefs we may hold about our capabilities.  We are either “fixed” or “growth” oriented.  People who have a fixed personality believe that we are born with only a set amount of intelligence, skill set, ability, etc., to function in the world.  People with this belief tend to “stay in their own lane” and aren’t likely to be risk takers but move toward safety.  They would value safety, structure, conformity and be averse to risk and change.  Growth-oriented people are more likely to be willing to try new things and take risks.  They recognize that they may have to work harder to develop new skills and abilities, but they are willing to do the work, because they believe it will pay off.  These people tend to value challenge and see it as an opportunity.  They are willing to risk failure to grow.


Both fixed and growth personality types can struggle with conflicted values.  A “fixed” type might have been part of a “growth-oriented” family or environment and struggle to conform.  A “growth” type would likewise find him/herself unhappy and frustrated living in a “fixed” environment.  It is important for us to recognize that there are certain things that are "fixed" and trying to move beyond what is physically possible isn’t going to work.  If people are content and happy in their lives, there isn’t a problem.  I think it’s helpful to consider developing more openness towards the potential for growth and change since we will be faced with changes at some time in our lives.  Growth-oriented folks are more likely to be unhappy where their ability to grow and learn is stifled.  They can feel guilty, frustrated and depressed trying to conform to values that are not their own. If they can recognize and accept what they truly value; i.e., freedom, change, challenge and risk taking, they will be able to move more easily toward doing those things that bring them happiness and contentment.


So how do we begin the journey toward living our values?  Here are a few suggestions.

• Take a sheet of paper and divide it into 3 columns.  At the top of the page, write “MY VALUES”.
• Write the words VERY IMPORTANT at the top of one column, IMPORTANT at the top of the second column and NOT IMPORTANT at the top of the third column.
• Consider those things that are very important to you and jot them down under that column. Do the same with things that are important but less so than the first column.  Repeat with things that are not important to you.  Try to come up with as many items under each column as you can – at least 10 under each heading if possible. You can brainstorm and make changes or adjustments. Just start writing.
• Now circle the top 3 values in each of the 3 columns.
• Take a 3 x 5 card and write down the top 3 you have chosen from your VERY IMPORTANT column
• Think about how you are living your life, your job, your family and friends, and your free time activities and hobbies (I hope you have some); and consider if these are moving you toward or away from your chosen values.  For example, if you value health but don’t eat a healthy diet, don’t exercise, don’t get enough sleep, don’t take care of the stress in your life, then you probably are feeling guilty about it.  If the guilt can motivate you to begin to change your lifestyle to move toward your chosen value, health, then it’s doing its job (to motivate you to change).
• Make a plan to identify steps you can take to move toward your goals.  Set a timeline.  Don’t make them too big or too little.  They should be reasonable and doable.
• Start now.  Don’t wait.  Tell someone and get support.  Once you put it out there, you are more likely to act.  This is important!!!!
• Don’t judge yourself if you aren’t successful right away.  Stop and evaluate your plan.  Maybe you set initial goals too high and set yourself up for failure.  Take it down a notch.  If it was too easy, then step it up.  This is a form of deliberate practice and a lesson we can learn from the “growth” mindset folks.  Don’t see it as a failure but as an opportunity to learn and grow.
• Celebrate your successes!  Share them with your support system.
• Notice how you are feeling about the changes you’ve made.  Your life will not be perfect, but when we recognize, acknowledge and live in accord with our stated values, we tend experience less stress (from struggling toward values which we haven’t chosen and don’t truly value), are happier and more confident in our lives.

While recognizing and living in harmony with our values won’t solve all our problems, in my experience, finding a purpose and meaning in our lives gives us more control and direction.  For most people, if we feel we have a purpose and are able to act in ways that fulfill our purpose, we are happier.  At Elephant Rock Counseling, we help people on the path toward living a meaningful, purpose-driven life.  We hope this information is useful to you in that endeavor.  Let us know if you would like our help.


San Mueller, M.Ed., LPC, DBT
Elephant Rock Counseling 
​Kirkwood, MO

​
San is a Licensed Professional Counselor with Elephant Rock Counseling, LLC.  San specializes in therapies that utilize mindfulness based principles such as Dialectical Behavior Therapy (DBT).  She enjoys teaching yoga, spending time with her family, and working with her clients.  ​

In our first blog last year, “Our Phones & Mindfulness” we talked about the tremendous power technology has had on our culture in positive and negative ways.  In that blog we encouraged mindful consumption of smartphone usage and even taking intentional breaks from electronics.  However, from the perspective of not fighting the trend and being a “realist” related to just how much PC’s and Smartphones dominate the lives of many people we are going to highlight some ways technology can help assist depression treatment.


Behavioral Activation is considered one of the most effective treatments for depression and a new product “Willow” has incorporated your PC front and center into this treatment.  Behavioral Activation is not a complicated treatment, it’s basically utilizing daily activities to reverse a downward spiral of mood and sedentariness (doing nothing), and move into an upward spiral of improved mood as people often become less depressed when they get moving with healthy activities that are pleasurable and important to them.  Motivational strategies are important in achieving this but for the purpose of this short blog I’m going to focus on the Willow technology which utilizes the increased presence of electronics to manage depression.


Willow is still in the development stage but I’ve had the pleasure of being in their research study and given full access to use the product.  It’s eventually going to be marketed to large hospital organizations and likely will have very little exposure in small private practices like ours.  So far Willow has been a very helpful tool in working with clients.  Clients are sent an email and have access to the Willow site in seconds.  The therapist and client accounts are now synced and the therapist can assign videos to watch, homework assignments, weekly tracking measures, etc.  Therapist and client then review this material at each weekly session.  Well designed plot graphs show your weekly tracking measures related to anxiety, depression, stress, etc.  All of the content is very simple, common sense, and that's probably what makes it work because most of us prefer things to not be too complicated.  A lot of us are on our computers all too often and it takes advantage of that.  

There is something about seeing things in black and white which can be highly motivating, and related to this Willow had a dramatic affect with a recent client who was experiencing unabating depression for quite some time.   After several weeks of data this client observed clearly on the plotted graph that as stress and activity continued to decrease, depression continued to increase.  The next week they made a commitment to follow through with the hierarchy of activities we brainstormed and the depression lifted rather dramatically after a few weeks.  I’ve had other clients who have enjoyed watching the videos and found the activity monitoring to be helpful.  However, my overall experience has been the tracking measures to be the most helpful for client and therapist. I believe this is related to how well those weeks of data on various metrics are beautifully presented to the client.  It can be insightful and motivating.


There is another product on the market “Therachat,” that is considerably more common which we are currently researching and considering using with our client base.  Therachat utilizes the commonly known “App” which can be downloaded in the Apple or Android App Stores.  Similar to Willow, you can assign your clients homework with customized activities, track emotions and symptoms, spot patterns over time, and practice journaling.  Importantly, it provides reminders to do these things along with reminders to practice skills learned in session.  The content is available for your therapist to review making it easier to stay connected with your week.  Changing behaviors and patterns often involves first remembering to practice new behaviors, and these products can be helpful in assisting those efforts as most of us usually have a device nearby throughout the day.  If you have any experience using this product with a past therapist we’d love to hear your opinion in the comments.


In summary, we have found technology to be helpful in assisting with our mental health treatment.  We will likely see more of this in the future.  We have chosen to embrace some of these trends and look forward to offering these tools to our clients in managing depression and other mental health struggles.  Please feel free to inquire with any questions about these tools and treatments and comments are always welcome below.


Best Regards,

Chad Randall, M.Ed., LPC, CCDP-D
Elephant Rock Counseling
Kirkwood, MO