CHALLENGES TREATED

Listed below are the most common issues that clients seek help with — along with some information that may help you decide whether to seek help. Please note that it isn't really possible to diagnose a serious problem simply from reading a list of symptoms. But if you find your experiences described well below, you might consider seeking a professional consultation. If you're interested in more information — or to schedule your free initial consultation — please contact me.

Depression
Depression — also known as clinical depression or major depressive episode — is diagnosed when an individual experiences at least five of the following symptoms for more than 2 weeks: a depressed mood most of the day nearly every day; a marked diminishment of interest or pleasure in daily activities; significant weight loss or gain; insomnia or oversleeping; physical agitation or moving slowly; fatigue or loss of energy; feeling worthless or guilty; difficulty concentrating or making decisions; recurrent thoughts of death or suicide.

Depression does not always include a sad mood. Some people experience a loss of interest or pleasure. In children and teens, depression may show up as an increased irritability. Also many people discover they are depressed when they report odd aches and pains in their bodies.

Depression also comes in other forms. Dysthymia is a low-grade depression that lasts for more than 2 years. Postpartum depression is a serious form of depression that occurs within 2 years of childbirth. Premenstrual dysphoria is associated with hormonal changes around the time of menstruation.

I've found that nearly all clients recover from major depression with a mixture of medication (prescribed by a medical doctor) and cognitive therapy.

If you are concerned that you may be depressed, take this online questionnaire.

Grief
Grief therapy helps you identify and solve problems you may have in separating from the person who died. Difficulties can show up as physical or behavior problems, delayed or extreme mourning, conflicted or extended grief, or unexpected mourning.

Grief therapy may help you see that you can have positive feelings about the person who died mixed with anger, guilt, or other negative or uncomfortable feelings.

A person must accomplish certain tasks to complete the process of grief before mourning can end:

1. develop the ability to experience, express, and adjust to painful grief- related changes
2. find effective ways to cope with painful changes
3. establish a continuing relationship with the person who died
4. stay healthy and keep functioning
5. reestablish relationships and understand that others may have difficulty empathizing with the grief they experience
6. develop a healthy image of oneself and the world

If you have uncompleted grief from earlier losses, grief may be complicated. Before you can handle your current grief, you must managed the grief from the earlier losses. Grief therapy will help you with blockages to the mourning process, identifying unfinished business with the deceased, and identifying other losses that result from the death. The bereaved is helped to see that the loss is final and to picture life after the grief period.

Anxiety/Stress

Everyone feels anxious and under stress from time-to-time. Fears are not normal, however, when they become overwhelming and interfere with daily living. They are symptoms of an anxiety disorder, the most common and most successfully treated problem in therapy.

"Anxiety" is a word so commonly used that many people don't understand what it means in mental health care. "Anxiety" refers to an unpleasant and overriding mental tension that has no apparent identifiable cause. Fear, on the other hand, causes mental tension due to a specific, external reason, such as when your car skids out of control on ice.

"Anxiety disorders" refers to a group of illnesses: generalized anxiety disorder, phobias, panic disorders, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorders (OCD). When people suffering from anxiety disorders talk about their condition, they often include some or all of these descriptions:

• unrealistic or excessive worry
• unrealistic fears concerning objects or situations
• exaggerated startle reactions
• "flashbacks" of past trauma
• sleep disturbances
• ritualistic behaviors as a way of with dealing with anxieties
• shakiness
• trembling
• muscle aches
• sweating
• cold/clammy hands
• dizziness
• jitteriness
• tension
• fatigue
• racing or pounding heart
• dry mouth
• numbness/tingling of hands, feet or other body part
• upset stomach
• diarrhea
• lump in throat
• high pulse and/or breathing rate

I treat anxiety disorders with a combination of cognitive therapy and behavior therapy, which gradually exposes you to whatever causes you stress in small, manageable doses.

If you are concerned that you are experiencing anxiety, take this online questionnaire. If you believe you are dealing with overwhelming stress, try this questionnaire. You may also be interested in this test for life-event stress levels.

Panic
Panic disorder, in which you experience "panic attacks," is an anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms. Your heart may pound and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have nausea, chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control.

I have found that cognitive therapy, sometimes supported with medication, can help most people with panic disorder and other anxiety disorders lead productive, fulfilling lives.

Phobias
A phobia is an excessive or unreasonable fear of an object or situation of something harmless. You probably realize your fear is unreasonable, but you still can't control it. You become overwhelmed with extreme feelings of anxiety, fear, and even panic. This experience is so unpleasant that you will go to great lengths to avoid the object or situation you fear. Fears become a reason for concern when they are persistent and interfere with your daily functioning.

The most common phobias are of animals, storms, heights, illness, injury, and death. Animal phobias and blood-injection-injury phobias are most common in children. Situational phobias usually begin in the mid-twenties and are most common in adults. Although there are many possible causes of a specific phobia, some phobias are the result of a traumatic experience.

Social Phobia (also called Social Anxiety Disorder) is an overwhelming and disabling fear of social situations where you may be scrutinized or evaluated negatively. Fear of public speaking is the most common type of specific social phobia.

Agoraphobia was traditionally thought to be a fear of public places and open spaces. Now we believe agoraphobia develops as a complication of panic attacks. Afraid that they may have another panic attack, people avoid crowded places such as shopping malls, movie theaters, or standing in line. You may also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.

Physical symptoms include:

• Shortness of breath or smothering sensation
• Palpitations, pounding heart, or accelerated heart rate
• Chest pain or discomfort
• Trembling or shaking
• Feeling of choking
• Sweating
• Nausea or stomach distress
• Feeling unsteady, dizzy, lightheaded, or faint
• Feelings of unreality or of being detached from yourself
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations
• Hot or cold flashes
• Fear of fainting

If you have blood-injection-injury phobia, your symptoms are slightly different. When faced with blood or a needle, you experience not only fear but disgust. Like other phobias, you show an initial increase in heart rate and blood pressure. However, unlike other phobias, this acceleration is followed by a quick drop which causes nausea, dizziness, and fainting. Blood-injection-injury phobia is the only phobia where actual fainting occurs.

The most frequently used form of therapy for the treatment of specific phobias is a type of cognitive behavioral therapy (CBT) called systematic desensitization or exposure therapy.

Phobias in children are common. According to The Child Anxiety Network, 90% of children between the ages of 2-14 have at least one specific fear. The following fears are shared by many children and are considered normal:

• 0-2 years — Loud noises, strangers, separation from parents, large objects.
• 3-6 years — Imaginary things such as ghosts, monsters, the dark, sleeping alone, strange noises.
• 7-16 years — More realistic fears such as injury, illness, school performance, death, natural disasters.

If your child's fear is not interfering with his or her daily life, then it is unlikely that treatment is needed. However, if the fear is interfering with your child's social activities, school performance, or sleep patterns, you should seek professional help from a qualified therapist.

If you believe you experience panic attacks, try this online questionnaire. If you believe you have a phobia, try this questionnaire.

Post-Traumatic Stress
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

Such events can include:

• Combat or military exposure
• Child sexual or physical abuse
• Terrorist attacks
• Sexual or physical assault
• Serious accidents, such as a car wreck.
• Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake.

After the event, you may feel scared, confused, and angry. If these feelings don't go away or they get worse and interfere with your daily life, you may have PTSD. Strong emotions caused by the event create changes in the brain that may result in PTSD.

PTSD symptoms usually start soon after the traumatic event, but may not happen until years later. They also may come and go. About half of people who develop PTSD get better at some time. But about 1 out of 3 people who develop PTSD always will have some symptoms.

Symptoms of PTSD can be terrifying. There are four types of symptoms: re-living symptoms, avoidance symptoms, numbing symptoms, and feeling keyed up. Reliving the event: You may feel the same fear and horror you did when the event took place. You may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger: a sound or sight that causes you to relive the event.

Avoiding situations that remind you of the event: You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.

Feeling numb: You may find it hard to express your feelings. This is another way to avoid memories. You may not have positive or loving feelings toward other people and may stay away from relationships. You may forget about parts of the traumatic event or not be able to talk about them.

Feeling keyed up (also called arousal or hyper-arousal symptoms): You always may be alert and on the lookout for danger. This can cause you to become suddenly angry or irritable, have a hard time sleeping, have trouble concentrating , fear for your safety and always feel on guard, be very startled when someone surprises you.

PTSD in children and teens: Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom. Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event.

People with PTSD may also have other problems: drinking or drug problems; feelings of hopelessness, shame, or despair; employment problems; relationships problems including divorce and violence, and physical symptoms.

Today, there are good treatments available for PTSD. When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better. I use both cognitive therapy and supportive therapy to treat PTSD. Some medications have also been shown to be effective.

If you believe you experience post-traumatic stress disorder, try this online questionnaire.

Perfectionism
Perfectionists believe that only perfection counts — and that perfection can and should be attained. When the individual comes to believe that anything less than perfect is unacceptable, perfectionism can be crippling, leading to many self-defeating behaviors.

While seeking to excel can be admirable and lead an individual to achieve the best that they are able, the perfectionist takes this desire to unhealthy levels. Some perfectionists procrastinate or are even unable to complete simple tasks: "I can't clean my house to my standards, so why even try?" It can lead to unattractive self-deprecation when used as an excuse for poor performance or to seek sympathy: "I don't believe I couldn't get this done right; I must be stupid."

The perfectionist in the work place may be subject to low productivity, being lost in small, irrelevant details. The result is frequently depression and poor relations with co-workers. Adderholt-Elliot describes five characteristics of perfectionist students that contribute to underachievement: procrastination, fear of failure, the all-or-nothing mindset, paralysed perfectionism, and workaholism.

In relationships with others, the perfectionist may expect more than their partner can deliver, meaning both partners end up dissatisfied.

Perfectionists can suffer anxiety and low self-esteem. Perfectionism is a risk factor for obsessive-compulsive disorder, eating disorders, and clinical depression.

I work with people suffering from perfectionism by attacking the distorted thinking that surrounds perfectionism and with cognitive therapy. We also work on setting realistic goals and facing hidden fears of failure.

If you are concerned you may be a perfectionist, try this online questionnaire.

Self-Defeating Behaviors
Self-defeating behaviors are habitual choices that keep you from experiencing life-supporting feelings, values, attitudes, beliefs, and actions. We chose self-defeating behaviors at first because they seem to "work" by masking the pain of an experience. But in the long term, they don't solve the problem or heal the pain at all. They make problems worse.

Some common self-defeating behaviors include:

• Criticalness
• Victimhood
• Procrastination
• Defensiveness
• Substance abuse/ over eating/ under eating
• Alienation and isolation
• Perfectionism
• Projection
• Worrying
• Exaggeration
• Hostility
• Suspiciousness
• Comparing self to others
• Unrealistic expectations
• Distorting feedback and selective memory
• Blaming others
• Imposing guilt
• Hanging on to past hurts
• Intellectualizing
• Hiding feelings

Self-defeating behaviors are usually based on distorted thinking and beliefs. I work with people who defeat themselves by identifying the "fairy tales" they tell themselves, reality testing these beliefs, and providing a safe environment in which you can create new positive, rational beliefs to replace them through affirmations, journaling, and cognitive therapy.