Why be a counselor?

Often, during particularly intense counseling sessions, a client will look me square in the face and wonder out loud why I choose to spend my days listening to other peoples’ problems. They can’t imagine why anyone would choose to expose themselves to the pain, despair, anger, and even overt conflict that take up residence on my couch. What they have a hard time believing is that I more often than not see people at their very best.

 Their best is when:

  • they first dial my number despite their fears
  • they first walk through the door despite the unknown
  • they speak the unspeakable
  • they confront the immovable
  • they push themselves to be their most vulnerable

 It’s not about having it all figured out or living a life wrapped up in pretty packaging. I don’t get bored or sit down dreading the next 50 minutes. I have the best job ever.

Posted in Self Help, Work Place on 02/23/2011

Breaking up

Ending a significant relationship is hard. Even folks with the best intentions of trying to protect their partner can, and often do, muck up the process. Here are a few thoughts on initiating and/or recovering from the end of a relationship that can help.

#1 Take responsibility
If you’re the one initiating the break up, own your decision. Avoid playing games or putting your partner in a position where they feel compelled to break up with you. Talk it over with a trusted friend or family member if you need gain perspective or accountability before hand.

#2 Do it face to face
This should be a no-brainer but, if you are over the age of 18 don’t rely on technology to deliver the news. Find time in a private, neutral setting where you can both be comfortable talking and listening.

#3 Act with dignity
Breaking up sucks. Don’t make it uglier by taking one last opportunity to verbally smack your partner around through blame and shame.

#4 Be honest
Trying to protect your partner by avoiding the truth is not doing them any favors in the long run. Avoid leaving things open if future reconciliation is not really a possibility.

#5 Avoid clichés (it’s not you it’s me)
They get in the way of #1 and #4 – don’t do use them.

#6 Don’t over-explain
There’s no need to convince your partner to see your side and in most cases you will fail horribly. Over-explaining usually succeeds in escalating frustration and entrenching positions. There’s something to be said about keeping it simple.

#7 Acknowledge the good times
Few relationships are all bad and, while you might initially be tempted to only focus on the negative as a way of avoiding hurt and loss, doing so just feeds bitterness and prolongs unhappiness. Keeping a balanced perspective may not always feel good but it will help get you to a better place faster.

#8 Don’t demonize your ex
Living in resentment and contempt hurts you way more than it hurts them. Broadcasting it for all to see just makes you look like the crazy one. Practice #7 as a way of avoiding resentment.

#9 Don’t try to blot out the pain
Trying to avoid pain is a pretty normal response but be sure to set aside some time to be sad, angry, or lost. Avoiding what’s really going on inside only serves to invalidate your experience and keeps you stuck.

#10 Resist thinking you’ve lost your soul mate
Checkout the world population clock to put things in perspective. With 6.8+ billion people on the planet, odds are that you will find someone else if you want to.

Posted in Relationships, Self Help on 02/09/2011

Choosing a Counselor

January is upon us. The month in which gym memberships spike and therapists’ phones ring off the hook as people set about recovering from the holidays and look forward to embracing change in the New Year. Here are a few thoughts on choosing a counselor.

Ask someone you trust for a referral. Whether you ask a friend, family member, pastor, or physician, having a personal referral can help narrow the field of possibilities.

Do your research. Many counselors now have a presence on the web. Check out websites, blogs, and articles to help find prospects before hitting the phone.

Location isn’t everything but it can be important. Scrambling through rush hour traffic or frantically searching for parking to make an appointment probably isn’t the best way to lead up to a counseling session.

Check your benefits. Nothing is more frustrating than finding a counselor you like only to learn that they are not an approved provider for your plan. In some cases it may be worth using an out of network provider or simply paying out-of-pocket. If you have a health savings account, the cost of counseling can often be reimbursed. See my blog on affordable counseling for more cost saving ideas.

Make a list of questions to ask prior to making an initial phone call. Anxiety related to that first call can make it hard to remember everything you want to ask. Keep that paper and a pen close by for reference and note taking. Possible questions might include:
How long have you been in practice?
Do you have a specialty?
Do you have experience with ______?
What is your opinion about medication and mental health treatment?
Do you take insurance?
When is payment due?
What forms of payment are accepted?
How is contact handled between sessions?
What is your policy on cancellations or rescheduled appointments?

Be prepared for the initial appointment. Plan to arrive a few minutes early to fill out paperwork and be sure to take your insurance card and form of payment. If you’re anxious about the appointment, do a drive-by the day before to familiarize yourself with the route and location.

Choosing a counselor can be an intimidating task. Research suggests that selecting a counselor who is a good fit has a more significant impact on success than the counselor’s degree, licensure, or theoretical orientation. What constitutes a good fit is a difficult thing to measure and often comes down to initially trusting your instincts. If it’s not a good fit explain why and ask for a referral. A competent counselor will be happy to provide one.

Posted in Self Help on 01/10/2011

Suicide Rates and the Holidays

Over the past few weeks I’ve heard time and time again about the supposed increase in suicides around the holidays. After a bit of research, I learned that the increase is only partially true. A 10 year study by the National Center for Health Statistics suggests that national suicide rates actually decrease on all major holidays with the exception of New Year’s Day. One theory to explain that increase is that New Year’s Day actually symbolizes the end of the holiday season for many and the return to work and “everyday” life.

If you become concerned about a friend or family member and suspect that they may be considering harming themselves, ask them about it. Better to risk a few awkward moments than a lifetime of regret. After asking, make it a point to listen without judgment. Offer reassurance that you are there and that you care. If you continue to be concerned, stay with them and contact a professional. Most communities offer some type of crisis hotline that will connect you trained personnel who can assess risk and coordinate resources. The same resources can be accessed by calling 911.

Posted in Self Help on 12/22/2010

Great video on the importance of vulnerability by U of H researcher Brene Brown:

Making Resolutions that Stick

Research shows that failure rates for New Year’s resolutions fall between 60% and 85% depending on the study with around 30% failing within the first 30 days. January sees gym memberships spike and therapists’ offices fill up with well-intentioned individuals and couples desperate to do things differently in the coming year. It’s a great time of year to reflect, assess, and plan. Increase your chances for success by: 

  • Keeping it simple. Don’t try to reinvent yourself all at once. Pick one or two changes, not 20.
  • Putting pen to paper. Write it down. Say it out loud. Imagine yourself doing it. Use as many senses as possible during the planning stages.
  • Keeping resolutions attainable. Change is hard enough without setting yourself up for failure from the start. Make sure you have the resources available to succeed by keeping things realistic.
  • Being specific. If you only have ambiguous goals, it makes it all the more difficult to measure progress and success.
  • Asking for help. Share your goals with family or friends. You may need their support, encouragement, and accountability along the way. It is a lot easier to give up if you only have yourself to answer to.
  • Keeping it visible. Notes on the mirror, refrigerator, or dashboard help keep your focus. Symbolic reminders like a picture or quote may be easier to display in more public areas like an office or shared space.
  • Anticipating failure. If you suffer a setback, having a recovery plan already in place makes it easier to get back on track.

If you have a history of failed resolutions or have difficulty even knowing how to get to where you want to be, enlisting the help of a counselor may be a good way getting and staying on track. Asking a friend, pastor, or family physician is a good way to find a counselor who might be a good fit.

Posted in Relationships, Self Help on 12/09/2010

Depression in the Legal Community

Depression in the Legal Community

By Michael Hilgers, M.A., Licensed Professional Counselor

Much has been written about mental health and the legal profession over the past decade. During that time, awareness programs have been launched at the national, state, and local levels. Law schools have hired mental health professionals to assist at-risk students and to manage campaigns aimed at education and prevention of mental health issues. While the United States currently boasts the highest rate of diagnosable mental illness in the world, studies suggest that practicing lawyers experience rates of depression eight to 15 percent higher than the general population. According to one OSHA study, lawyers rank highest for rates of depression and fifth for rates of suicide out of 104 studied occupations.

Numerous studies have sought to identify personality traits that distinguish lawyers from the general population. Not surprisingly, high levels of autonomy, skepticism, perfectionism, and competitiveness are generally found along with low levels of sociability (difficulty initiating intimate relationships) and a tendency to utilize self protective, defensive thinking. The very traits that likely contribute to a successful legal career often make it difficult for many lawyers to acknowledge interpersonal struggles and to reach out for help. High demand positions that have limited control over outcome tend to exacerbate depressive symptoms, as do long, sedentary work hours, working in isolation, and exposure to negative people or events.

Depression in the workplace comes with a hefty price tag. The U.S. Surgeon General reports that lost productivity and absenteeism due to untreated mental health disorders cost American businesses $70 billion annually. In the legal arena, billable hours suffer; quality or thoroughness of work suffers; and interactions with coworkers become strained. According to the National Alliance on Mental Illness, depression is associated with more annual sick days and higher rates of short-term disability than any other chronic disease. Despite this, mental illness in the workplace remains largely ignored.

While diagnosing depression or other mental illnesses should be left to those licensed and trained to do so, having a basic understanding of the most common visible symptoms can help increase the potential for early intervention. It is important to remember that depression can manifest in many different ways, which may add to confusion when determining whether to seek help or not. Some individuals may exhibit overwhelming sadness, while others appear emotionally vacant. Anxiety and or physical complaints often accompany depression, which can make diagnosis even more difficult.

The most common symptoms of depression include:

  • Disturbance of sleep
  • Disturbance of appetite
  • Difficulty concentrating or increased indecisiveness
  • Diminished interest or pleasure
  • Increased irritability
  • Increased tendency to withdraw from others or isolate
  • Loss of productivity
  • Feelings of hopelessness
  • Low energy or fatigue

Despite sometimes being difficult to identify, depression is one of the most successfully treated forms of mental illness. One of the most common and effective forms of treatment is talk therapy. Through perspective building, exploring new ways of thinking, and adjustments to lifestyle, talk therapy helps increase both insight and skills that help diminish the impact of depressive symptoms and increase functionality.

Low grade, situational depression can often be effectively self managed and will generally dissipate on its own over time. Self management techniques include:

  • Engaging in some type of physical activity each day. Take the stairs if you can’t take a walk.
  • Practicing good sleep hygiene. Get a routine and stick with it.
  • Avoiding excessive use of alcohol.
  • Eating healthy or at least healthier.
  • Practicing relaxation exercises. A quick online search will yield many suggestions.
  • Telling at least one person in your life that you’re struggling. Ask them to check in on you periodically.
  • Reaching out to others. Practice social connectedness.
  • Interrupting unproductive ruminating thoughts by starting an activity or engaging someone in conversation.

Moderate to more severe grades of depression may present challenges that are beyond what one can effectively self manage. Significant relationship difficulties or work performance issues are often the impetus for someone reaching out for professional help. A trusted referral is the best way to identify options for outside help, however insurance companies, employee assistance programs, and your local bar association are also resources that can help to identify professionals in your area who may specialize in helping to manage depression. Untreated, depression can derail otherwise successful relationships and careers and in general makes life pretty miserable. With treatment, symptoms can be effectively managed until they abate, and life can resume unhindered by defeating thoughts and behaviors.

If you or someone you know is suffering from depression, you are not alone. Please call the Texas Lawyers Assistance Program, at 1-800-343-8527. TLAP is a 24-hour confidential crisis counseling and referral program to help lawyers. TLAP can screen you for financial assistance with therapy and medication through the Austin Bar Foundation’s Justice Mack Kidd Fund.

Posted in Self Help, Work Place on 11/29/2010

Surviving the holidays

The holidays are usually defined as a time of family get-togethers, good food and drink, and relaxation. But for a lot of us, the holidays are difficult in a number of ways. Going into debt, dealing with family conflict, high stress, travel and marital discord, depression, and anxiety characterize the experience of many these days. You maximize your chances for a fulfilling holiday season if you’re willing to consider these things:

  1. Know your limits: Whether money, time, food, or alcohol, it is important know your limits. If you’re not doing things in moderation, you are more likely to over extend yourself physically, mentally, or emotionally. Practice graciously declining, learning to say “no” when it is the best thing for you will ultimately help you and those closest to you enjoy the holidays to their fullest potential.
  2. Watch for holiday mental health hazards: This is a memorable season, and for some, those memories are more haunting than festive. This is a time that we can reflect back on our year, for better or for worse. If you’ve experienced a difficult year, the holidays have a way of amplifying struggles and loss. If you anticipate that the holidays will be challenging for you, reach out to friends or family and let them you need some extra support during this time of year. If support is not easily found, contact a counselor for help with coping strategies.
  3. Practice effective communication skills: Clear communication is essential during the holiday season. There’s so much going on, the opportunities to communicate poorly are endless. Making the extra effort to state your needs while realizing that your priorities may not be the priorities of others.
  4. Don’t avoid conflict: If you’re having an issue with someone, be direct with them and don’t beat around the bush. Holding in frustration or anger is only going to make things worse, whether you’re having an argument with a family member during Thanksgiving or squabbling in that pre-Christmas spat with your loved one, don’t avoid conflict.
  5. Developing a holiday stress management plan: whatever you do to cope with stress, keep doing it! Diet, exercise, and sleep tend to be easy to let go of while keeping up with holiday demands but they are also the very things that help keep us steady in times of stress. Know and pay attention to your stress symptoms. Practice being present by focusing on all your senses in a given moment. Take time to notice the scents and sounds of the holidays, the air temperature against your skin, the taste of a holiday goody, and the decorations that surround you.   
  6. Plan: Good planning helps avoid last minute crises. Whether that means budgeting for gifts, scheduling shopping, or getting your clothes ready before the morning of your flight out, you’ll be glad you set forth to take care of business before hand. Good planning will help prevent stress and conflict which will make the holidays more enjoyable for all.
  7. Create exit strategy: holiday gatherings can be overwhelming. Especially extended stays. Even the most harmonious family will start to feel the effects when routines are interrupted and privacy is limited for an extended amount of time. Make a point to take some time away for yourself. Go for a walk, a drive, or offer to run errands. If you exercise regularly, locate a nearby gym or walking trail and continue your routine. Taking time out to breath, collect your thoughts, or just to enjoy some quiet will ultimately help you better engage with others during the holidays.
Posted in Parenting, Relationships, Self Help on 11/17/2010

Terminal Language

Always and Never. Two simple words that often get used to paint broad strokes of blame and justification. They leave no room for exception. Always and Never epitomize black and white thinking in a world that is mostly gray. When I hear these words I can’t help but confront the thinking behind them and I inwardly cringe when I get called-out for using them. Acknowledging exceptions encourages perspective which in turn leads to a more balanced approach to dealing with issues or conflict. Challenge yourself to use non terminal language. Words matter. Choose carefully.

Interesting Twist on Job Related Stress

Job killing you? Stressed mob bosses seek help

By FRANCES D’EMILIO 

The Associated Press

REGGIO CALABRIA, Italy — The mafia boss was having a dreadful time dealing with loss. But he wasn’t struggling with the loss of lives, or even the loss of his freedom.

“Doc, it’s my hair,” the mobster from the ‘ndrangheta crime syndicate confessed to his psychiatrist in jail. “I’m afraid of losing my hair.

“And look at these spots on my arm. See them?” he half-pleaded as he rolled up a sleeve and thrust out his arm.

“But your hair is fine. Absolutely fine. And there aren’t any spots,” Dr. Gabriele Quattrone tried to reassure his patient — who had tied himself into a knot of anxiety over the hair he believed to be falling from his head and the imaginary blotches popping up all over his arms.

Quattrone is one of a tiny corps of psychotherapists who have treated Italian organized crime bosses or their family members. Patients include dons haunted by nightmares, turncoats tormented after ratting, wives left frigid by rigid codes of loyalty. In exclusive interviews with The Associated Press, granted on condition that the identities of the mobsters not be revealed in line with doctor-patient confidentiality, the doctors offered rare insights into the secretive, increasingly strung-out world of Italy’s centuries-old criminal organizations.

Quattrone, a neuropsychiatrist, treated his jailed ‘ndrangheta patient with tranquilizers — and made some attempts at nurturing introspection.

“It’s the stress of 20 years of being a fugitive, of going on trial,” he told the man, a top boss in Reggio Calabria, the toe of Italy’s boot.

“Yeah, I’m stressed, all right. I’m stressed because I’m innocent,’” the boss retorted.

These are indeed tense times for Italy’s mobsters.

A growing police crackdown and a rebellion among businessmen expected to pay protection money have left some sons of organized crime families wrestling with self-doubt, unsure they are cut out to take their fathers’ and grandfathers’ place in the bloody, vengeful world of the mob.

But seeking help is risky business: among mobsters, visiting a psychologist is a weakness you can pay for with your life. Palermo psychologist Girolamo Lo Verso recalled the case of a mobster’s son who told another therapist at a public mental health facility: “‘If my father knows I come here, he’ll kill us.”

“If you’re a mafioso, and you’re anxious, you’re not trustworthy and you have to be eliminated,” said Lo Verso. “A mafioso is paranoid about everything” — trusting the mafia code of silence (“omerta”) more than the medical code of patient confidentiality.

The state’s war on organized crime has put hundreds of bosses behind bars, sometimes for decades, sorely testing the mental health of spouses, children and sometimes the mobsters themselves.

Quattrone, the head of neuropsychiatry at a Reggio Calabria hospital, was once summoned to an apartment building in an upscale neighborhood. An elevator, with no buttons and an armored door, led from the garage straight to an apartment with windows shuttered tight.

In the sprawling master bedroom, complete with inlaid swimming pool, lay the mafia boss’ severely depressed wife. Doctor and patient looked into each other’s eyes. The husband’s presence made communication hard but the woman’s gaze told Quattrone everything he needed to know.

“We understood each other,” Quattrone said. “She was oppressed in her role as a mafioso’s wife.”

Diagnosis? Existential loneliness.

The wife was depressed because she could hardly ever get out of the house — and had a driver and a car with tinted windows on the rare times she did. The psychiatrist prescribed anti-depressants and checked up on her for the next few months.

Quattrone scoffed at the notion her husband would ever consider psychotherapy himself. As Tony Soprano put it to his therapist in the TV show: “I understand therapy as a concept. But in my world it does not go down.”

Lo Verso teaches at Palermo’s University of Studies, which will soon offer a masters course in Mafia psychology, the first of its kind. The therapists draw psychological profiles from treatment of mobsters and their relatives, turncoat testimony in courtrooms, lawyers’ dealings with Mafia clients, and countless pages of intercepted conversations between bosses that wind up in indictments.

Group therapy sessions conducted in prison also provide fodder for Lo Verso’s research.

At group talk in Reggio Calabria’s maximum-security San Pietro Prison, inmates turned up perfectly groomed — doused in cologne, hair neatly combed, nattily dressed — and sat in armchairs arranged in a circle, recalled Paolo Pratico, a Calabrian psychologist who organized three sessions.

The prisoners showed eagerness to earn “good conduct” points toward early release. But to the man, they refused to admit the ‘ndrangheta even existed. Rather, they insisted they were victims of a miscarriage of justice. If the mafia doesn’t exist, they argued, how could they be convicted of mafia association?

Many mobsters stay silent when Quattrone visits them in prison. A few complain of nightmares. They see “terrifying” images, but not of the people they’ve killed. One jailed mobster’s sleep was haunted by thoughts of his terminally ill 12-year-old daughter.

“I can’t sleep because I hear the voice of my daughter,” the mobster lamented. “It’s not fair that I can’t see her. I can’t accept that.”

Sociologist Alessandra Dino, who has interviewed wives of Cosa Nostra turncoats and pored over transcripts of turncoat testimony to prosecutors, believes few mobsters have “crises of conscience.”

“They have a mechanism of neutrality, where deviance equals normality,” said Dino, who teaches at Palermo’s university. “Murder becomes philanthropic because it is somehow related to helping the group they belong to.”

Lo Verso said he has concluded that “the mafioso identifies himself totally with Cosa Nostra, which is his family. He has no individuality.”

The therapist recalled a woman who was leaving her Cosa Nostra husband. She came to him for a psychiatric evaluation in a bid to gain custody of the couple’s children. The woman, in her 40s, was beautiful, elegantly dressed and accompanied by her lover.

The pair would go away to romantic hotels for the weekend and sleep in the same bed. The man would undress and get sexually aroused, but the woman kept her clothes on and never showed any sign of sexual excitement.

She had the Mafia hardwired inside her, Lo Verso concluded — noting that, like many Mafia wives, she was the daughter of a mob boss, well familiar with Cosa Nostra’s code that the wife never betrays the husband. In short, she remained married to the mob — all the more striking because she suspected her husband of having a hand in her father’s slaying.

Quattrone said over the last decade or two, he has seen a slight shift, from mobsters who wouldn’t have anything to do with psychologists to those who will consult them if they think the problem can somehow be “masked” as a physical illness.

A ‘ndrangheta family from the Calabrian countryside came to Quattrone after their young daughter started having panic attacks. “She can’t have a mental illness, she has to have a physical problem,” the girl’s mother and brother told him.

Quattrone ran a battery of tests, and did find an unrelated physical ailment.

“The family was very happy to hear she had something. … Because if it’s a mental illness, the family risks being seen as untrustworthy.”

Alberto Cisterna, a prosecutor in the national anti-Mafia office in Rome, is a Calabrian whose schoolmates included future ‘ndrangheta bosses. He is fascinated by the growing body of psychological studies of mobsters, since “psychology figures a lot” in persuading a boss to turn over evidence.

In the rugged Aspromonte mountains of Calabria, Cisterna said, paramilitary police go out every night looking for fugitive mobsters, often in their families’ farmhouses.

“You don’t go looking for them at high noon, you go at 4 a.m.,” Cisterna said in an interview. “The kids are bundled up in blankets and put in the street … Everything in the house gets turned upside down.”

After repeated raids, Cisterna said, “the wife will either begin to hate the state, or they’ll hate their husband who subjects them to this.”

In Taurianova, a ‘ndrangheta stronghold, students at a vocational high school discussed how the crime syndicate affects their lives. Daniela, a soft-spoken 16-year-old from the nearby town of Rizziconi, talked about a childhood friend, the son of lawyer now in prison on charges of murder and of belonging to the ‘ndrangheta.

The boy often asks her to go to his house and keep him and his mother company.

“Sometimes he cries and cries and says, ‘I don’t want to end up like my father,’” Daniela said.

Posted in Work Place on 11/08/2010