​Alcohol is the most commonly used mind-altering substance in the United States. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that over half of all-American adults were current drinkers of alcohol at the time of the 2015 national survey. Having a beer or a glass of wine with dinner is common, and millions of adults regularly enjoy alcohol responsibly.

Even though alcohol is a depressant substance, it is often used to get the party going. Many of us have tales of doing stupid things when we drink, and they don’t often involve mellowing out and going to sleep. So, alcohol is not just a depressant then; it also acts on moods, emotions, actions, and reactions.

It changes the way you think and feel, and therefore influences how you act. Of course, the more you drink, the more impact alcohol will have. With a few drinks, you are probably more social and outgoing, happy, full of energy, talkative, and fun to be around. A few more and you may start slurring your speech, falling down, and becoming more aggressive. Even more drinks and you may blackout and not remember what you did or said the next day.

Drinking alcohol can make it hard for you to think clearly and make good decisions. It can make it more likely that you will get into potentially harmful or dangerous situations that you will regret the next day. Alcohol changes brain chemistry, which in turn impacts moods, behaviors, thinking, memory, and physical movement and bodily functions, which may have costly side effects.

How Alcohol Affects Behavior
When you drink alcohol, it is thought to raise levels of GABA in the brain. GABA is one of the brain’s chemical messengers, or neurotransmitters, that helps you to feel relaxed, and it aids in lowering anxiety and stress. GABA is considered to be an “inhibitory” neurotransmitter. High levels of GABA cause your body temperature to drop, and your heart rate and blood pressure to come down.
Alcohol also increases levels of dopamine in the brain. Dopamine is one of the chemical messengers responsible for sending signals of pleasure. When levels of dopamine are elevated, it can create the “high” or “buzz” that makes alcohol pleasurable to drink.

Alcohol also jacks up the amount of norepinephrine present in the brain; this neurotransmitter acts as a stimulant. Elevated levels of norepinephrine increase arousal and excitement, and it can lower your inhibitions and increase impulsivity, making it hard for you to consider potential consequences of your actions.

Alcohol also decreases some of the activity of the prefrontal cortex. This part of the brain is what helps you to think clearly and rationally, and it is involved in your decision-making abilities. When you drink, alcohol makes it harder for the prefrontal cortex to work as it should, disrupting decision-making and rational thought. In this way, alcohol prompts you to act without thinking about your actions.

Alcohol reduces the functions of the behavioral inhibitory centers in the brain, Forbes reports. It also slows down how information is processed in the brain. When you see, hear, taste, or smell something, your brain processes this information and then tells you how to think or feel. Alcohol interferes with this process, making it harder for you to work out what you are feeling and also making you less likely to be able to really think through potential consequences.

The prefrontal cortex part of the brain is partly responsible for your sense of control over your emotions and behaviors, impacting willpower and even aggressive thoughts and actions. It can enhance emotions you are already feeling and make it harder for you to gauge when enough is enough. When you drink, you may be less able to control your emotions; you may speak and act without thinking; and situations may get out of hand faster than they would if you weren’t drinking.

Risks of Lowered Inhibitions and Alcohol
When your ability to think, make rational decisions, and control your impulses is impaired by alcohol, there are numerous potential consequences. You may be willing to do or try anything that you think will make you happy in the moment, without any thought to what may come next. Lowered inhibitions and bad decision-making abilities are side effects of alcohol use that may have the following possible ramifications:

• Getting into an accident and/or getting injured
• Engaging in possible criminal behaviors
• Being more open to trying other drugs
• Having violent outbursts and getting into fights
• Taking part in unwanted or unsafe sexual encounters
• Becoming the victim of a crime

The National Council on Alcoholism and Drug Dependence (NCADD) warns that alcohol is a factor in 40 percent of all violent crimes that are committed in the United States. Lowered inhibitions can make you more prone to fall victim to crimes, such as sexual assault and date rape. You may be more approachable when you are drinking, and you may be more open to trying things and talking to people than when you are sober. Alcohol dispels anxiety, making it easier to feel more social, less afraid, and less aware of your surroundings. You may then find yourself in a situation that goes downhill fast and can become dangerous.

Physically, alcohol impairs coordination, balance, reflexes, and your ability to fight back. It can make you more open to engage in sexual behaviors that may be questionable or even downright unwanted. Alcohol can leave a person completely incapacitated and unable to consent to sex, and it is the number one drug involved in date rapes, USA Today reports. Even if you do consent to sex while under the influence of alcohol, you may not be safe about it. Therefore, you put yourself at risk for an unwanted and unplanned pregnancy or for contracting a sexually transmitted (STD) or infectious disease.

Alcohol can also make you more open to trying other drugs. While you may typically not take illicit drugs, when you are drinking, you may be more willing to take bigger risks and not be as worried about what might happen when you do. Mixing drugs and alcohol can be very dangerous, however, as they can interact together and potentially lead to an overdose or other hazardous side effects. Opioid drugs like heroin and prescription painkillers can further suppress your central nervous system, for instance, and when mixed with alcohol, they can cause a toxic overdose that can cause you to stop breathing and even die.

Drugs can also further impair your thinking, memory, and physical abilities. You may get drunk faster and get more intoxicated than normal when combining substances. Drug and alcohol combinations can be unpredictable, and you can never know exactly how the mixture of the two is going to affect you.

We are often embarrassed about our actions the night before, and we may have to repair relationships with people who we upset while drinking.  Don’t be too hard on yourself, but do make an effort to make things right. Remember that you are not alone; most people who drink alcohol have probably done something they regretted while under its influence at some point. In the future, make some boundaries for yourself; set limits to decrease the odds of being in a similar situation again.

It can also be a good idea to make pacts with friends to watch out for each other and hold each other accountable. It’s even better if one friend stays sober. Usually, if you stick to drinking only a few drinks on a full stomach and spread them out over a period of time, you can drink responsibly and not suffer many negative consequences. The less you drink, the better your brain will function, and the more able you will be to make sound decisions that you will not regret the next day.

If you are unable to moderate your drinking, it’s a sign that professional help is needed. I can help  by providing harm reduction therapy as well as the abstinence model.  I am a licensed clinician and a Registered Addiction Therapist in private practice in Marin County. 

Thom Kessler, LMFT, RAS
Licensed Psychotherapist 
Registered Addiction Specialist
415-454-8931
marintherapist@gmail.com
www.thomkesslertherapist.com

From hoarding to handwashing to forever checking the stove, obsessive-compulsive disorder (OCD) takes many forms. It is an anxiety disorder that traps people in repetitive thoughts and behavioral rituals that can be completely disabling.

Surveys conducted by the National Institute of Mental Health show that 2 percent of the population suffers from OCD—that's more than those who experience other mental illnesses like schizophrenia, bipolar disorder, and panic disorder. OCD might begin in childhood, but it most often manifests during adolescence or early adulthood. Scientists believe that both a neurobiological predisposition and environmental factors jointly cause the unwanted, intrusive thoughts and the compulsive behavior patterns that appease the unwanted thoughts.

Unless treated, the disorder tends to be chronic—lasting for years, even decades—although the severity of the symptoms may wax and wane over the years. Both pharmacological and behavioral approaches have proven effective as treatments; often a combination of both is most helpful. For more on causes, symptoms and treatments, see our Diagnosis Dictionary.

The Varieties and Symptoms of Obsessions
These uncontrollable thoughts or behaviors can interfere with a person's work, school, and relationships. Though the behaviors may give the person momentary relief from his overall anxiety, he doesn’t derive pleasure from the obsessiveness. People suffering from obsessive-compulsive habits may also contend with motor tics or repetitive movements, such as grimacing and jerking. Research into OCD is ongoing. For example, defects called micro-structural abnormalities have been found in the brain’s white matter of those who suffer OCD, and frontline treatment for this disorder includes exposure and response prevention, as well as plain old empathy and compassion in delivering therapy.

The first symptoms are the obsessions—the unwanted ideas or impulses that occur over and over again and are meant to drive out fears, often of harm or contamination. "This bowl is not clean enough. I must keep washing it." "I may have left the door unlocked." Or "I know I forgot to put a stamp on that letter." The compulsions appear after that—repetitive behaviors such as handwashing, lock-checking, and hoarding. Such behaviors are intended to mitigate fear and reduce the threat of harm. But the effect does not last and the unwanted thoughts soon intrude all over again.

Sufferers may understand the uselessness of their obsessions and compulsions, but that is no protection against them. OCD can become so severe that it keeps people from leaving their homes. The condition strikes males and females in equal proportions.

What Causes OCD?
Current scientific thinking holds that OCD results from a confluence of factors—a biological predisposition, environmental factors including experiences and attitudes acquired in childhood, and faulty thought patterns.

The fact that many OCD patients respond to SSRI antidepressants suggests the involvement of dysfunction in the serotonin neurotransmitter system. Ongoing research suggests there may be a defect in other chemical messenger systems in the brain.
OCD may coexist with depression, eating disorders, or attention-deficit/hyperactivity disorder, and it may be related to disorders such as Tourette's syndrome, and hypochondria, though the nature of the overlap is the subject of scientific debate.

How to Treat Obsessions and Compulsions
Either psychotherapy or medication, or both, may be prescribed for OCD, and patients may respond better to one form of treatment than to the other. Studies conducted by the NIMH, however, show that combination drug-psychotherapy is best for young people. The drugs given are typically one of the so-called SSRIs, or selective serotonin reuptake inhibitors. The SSRIs fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil) have been specifically approved for the treatment of OCD. These drugs have been shown to reduce the frequency and severity of obsessions and compulsions in more than half of patients, although discontinuation of drugs often leads to relapse. Behavioral therapy for OCD tends to produce long-lasting effects. Psychotherapy generally focuses on two aspects of the disorder: unraveling the irrational thoughts involved in the condition and gradually exposing sufferers to the feared object or idea until they are desensitized to it and can tolerate anxiety without engaging in compulsive rituals.

Is OCD on the Rise? 
Rates of OCD have not gone up, but public interest in the disease (and its various forms) has. Hoarders and those compelled to engage in rituals to ward off disturbing thoughts have lately appeared as characters on the big and small screens. A slew of real-life sufferers of OCD have written memoirs and sought help in the public eye. There is also evidence that subclinical obsessiveness about cleaning and germs could be on the rise.

About a third of adults with OCD developed the disorder as children. The repeated rituals those with OCD engage in, such as constant handwashing or hair-pulling, are meant to allay anxiety, but the relief does not last for long. As with many other mental health conditions in children, the best and most durable treatment is psychotherapy.

A critically important clinical feature of obsessive-compulsive disorder (OCD) is the pervasive secrecy of patients suffering from the condition. OCD involves recurrent, disturbing thoughts and recurrent and excessive behaviors, including rituals and constant checking. Secrecy about OCD symptoms has been responsible for a long-standing, marked underestimation of the true incidence of the illness. Although clinical recognition has increased, patients' secrecy, shame and denial continue to have an impact on assessment, treatment, and the validity of research results.

More than with many other many psychiatric disorders, OCD patients do not spontaneously or voluntarily report their symptoms to health providers or even intimate family members. OCD patients fear that revealing their symptoms will lead to severe censure and disapproval because the symptoms are often ego-dystonic and seemingly antisocial or bizarre in nature: repetitive obscene or blasphemous phrases, for example, or thoughts of attacking children or loved ones or removing one's clothes in public. Also, there is reason to believe that secrecy has its own function in both the formation and perpetuation of OCD symptoms, which serve to protect against painful anxiety.

The feelings of shame and desire for secrecy strongly influence patients' open acknowledgment of the senselessness of symptoms. OCD patients are characteristically highly concerned with approval from other people, and their acknowledgment or denial of symptom senselessness is often determined by assumptions about the expectations of interviewers, raters or administrators of self-report measures, rather than provisions of truthful accounts. There is very likely somewhat more acknowledgment of senselessness in those indulging in checking or else cleanliness behaviors, the latter being more congruent with the values of middle-class culture and therefore more individually and socially acceptable.

Attempts at diagnostic measurement, including studies of accompanying personality disorder symptoms, have been extensively confounded by the problem of shame and secrecy. These studies have shown markedly variable results. Such wide variation in itself suggests unreliability of diagnostic instruments, but less shameful-feeling obsessive-compulsive personality disorder (OCPD) patients are also secretive about reporting certain behaviors and characteristics—in this case, irrational control, hoarding, rigidity, miserliness, and meticulous perfectionism.

Sensitive extended clinical evaluations, because of trust and familiarity developed, reveal a full range of OCD patterns. Patients will readily supply answers when asked simple questions in an unthreatening manner. The questions must rely on voluntary report and in each case, the patient should be asked to evaluate the excessiveness and inappropriateness of behaviors stipulated.

How much is "excessive"? It is up to the trained clinician together with the patient to determine the answer. This orientation is also necessary for ongoing treatment and the following of specific features of the illness. In order to determine whether the patient engages in excessive checking behavior, information is gathered about job histories, including whether one repeats tasks. If so, how often?

At home, how many times is the lock on the door tested when the patient goes out, how often are the stove burners checked, how long does it take to dress in the morning? In order to assess cleanliness, the patient is asked about patterns of housekeeping, showering and handwashing. Are particular places avoided because of possible contamination or dirt? For symmetry and order, questions are directed toward preferred placement of objects in the home, pictures on the wall, and preferences about physical work environments.

For assessment of obsessional thinking, information is effectively evoked by identifying everyday difficulties in living and performing. Commonly reported problems in sleeping are followed by questions about the possibility of bothersome or repetitive thoughts that keep the patient awake. Similarly, if a patient reports distractions and inability to concentrate at work or at school, questions are asked about mental preoccupations

Obsessive disorder has long been hidden and difficult for both sufferers and therapists. Currently, various treatments are available with varying degrees of promise. A number of SSRI medications have shown beneficial effects, including clomipramine, fluoxetine, paroxetine, sertraline, and fluvoxamine—and psychotherapy is an absolute must.

Thom Kessler, LMFT, RAS
Thom@thomkesslertherapist.com
415-454-8931

The New York Times recently published an article called, "Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?" The author chronicled several teens' battle with anxiety over the course of a few years. The article questioned why we're seeing such a rise in anxiety among today's youth. Some young people are overachieving perfectionists with a crippling fear of failure. Others worry so much about what their peers think of them that they're unable to function. Some have endured rough circumstances throughout their young lives. But others have stable families, supportive parents, and plenty of resources. I suspect the rise in anxiety reflects several societal changes and cultural shifts we've seen over the past couple of decades. Here are the top 10 reasons:

1. Electronics offer an unhealthy escape.
Constant access to digital devices lets kids escape uncomfortable emotions like boredom, loneliness, or sadness by immersing themselves in games when they are in the car or by chatting on social media when they are sent to their rooms. And now we're seeing what happens when an entire generation has spent their childhoods avoiding discomfort. Their electronics replaced opportunities to develop mental strength, and they didn't gain the coping skills they need to handle everyday challenges.

2. Happiness is all the rage.
Happiness is emphasized so much in our culture that some parents think it's their job to make their kids happy all the time. When a child is sad, his parents cheer him up. Or when she's angry, they calm her down. Kids grow up believing that if they don't feel happy around the clock, something must be wrong. That creates a lot of inner turmoil. They don't understand that it's normal and healthy to feel sad, frustrated, guilty, disappointed, and angry sometimes, too.

3. Parents are giving unrealistic praise.
Saying things like, "You're the fastest runner on the team," or "You're the smartest kid in your grade," doesn't build self-esteem. Instead, it puts pressure on kids to live up to those labels. That can lead to crippling fear of failure or rejection.

4. Parents are getting caught up in the rat race.
Many parents have become like personal assistants to their teenagers. They work hard to ensure their teens can compete: They hire tutors and private sports coaches and pay for expensive SAT prep courses. They make it their job to help their teens build transcripts that will impress a top school. And they send the message that their teen must excel at everything in order to land a coveted spot at such a college.  

5. Kids aren't learning emotional skills.
We emphasize academic preparation and put little effort into teaching kids the emotional skills they need to succeed. In fact, a national survey of first-year college students revealed that 60 percent feel emotionally unprepared for college life. Knowing how to manage your time, combat stress, and take care of your feelings are key components to living a good life. Without healthy coping skills, it's no wonder teens are feeling anxious over every day hassles.

6. Parents view themselves as protectors rather than guides.
Somewhere along the line, many parents began believing their role is to help kids grow up with as few emotional and physical scars as possible. They became so overprotective that their kids never practiced dealing with challenges on their own. Consequently, these kids have grown up to believe they're too fragile to cope with the realities of life.

7. Adults don't know to help kids face their fears the right way.
At one end of the spectrum, you'll find parents who push their kids too hard. They force their children to do things that terrify them. On the other end, you'll find parents who don't push kids at all. They let their kids opt out of anything that sounds anxiety-provoking. Exposure is the best way to conquer fear but only when it's done incrementally. Without practice, gentle nudging, and guidance, kids never gain confidence that they can face their fears head-on.

8. Parents are parenting out of guilt and fear.
Parenting stirs up uncomfortable emotions, like guilt and fear. But rather than let themselves feel those emotions, many parents are changing their parenting habits. So they don't let their kids out of their sight because it stirs up their anxiety, or they feel so guilty saying no to their kids that they back down and give in. Consequently, they teach their kids that uncomfortable emotions are intolerable.

9. Kids aren't being given enough free time to play.
While organized sports and clubs play an important role in kids' lives, adults make and enforce the rules. Unstructured play teaches kids vital skills, like how to manage disagreements without an adult refereeing. And solitary play teaches kids how to be alone with their thoughts and comfortable in their own skin.

10. Family hierarchies 
Although kids give the impression that they'd like to be in charge, deep down they know they aren't capable of making good decisions. They want their parents to be leaders—even when there is dissension in the ranks. And when the hierarchy gets muddled—or even flipped upside down—their anxiety skyrockets.

EMDR is the treatment of choice for PTSD and other trauma-related conditions. EMDR stimulates the psyche’s natural healing process and changes the way traumatic memories are stored in the brain. When a trauma occurs, it becomes stored in the nervous system in its original disturbing form. EMDR shifts how trauma is stored in the brain and speeds-up the processing of traumatic events and reduces the disturbing emotions, symptoms, and negative beliefs associated with those experiences. Clients are often amazed at how issues they’ve worked on for years in talk therapy are no longer problematic.

Traumatic memories are stored in the brain differently than other kinds of memories.
Research has shown that traumatic memories are primarily stored in the right hemisphere of the brain, where they do not have access to networks in the left hemisphere. The left hemisphere, however, contains important thoughts and awareness that could relieve the distress if a connection can be made between the hemispheres. EMDR therapy creates this connection by stimulating both hemispheres simultaneously — restoring the brain’s natural healing processes. EMDR helps people become unstuck and renders traumatic memories manageable.

Unresolved trauma is often retriggered by environmental cues and reminders that lead a person to re-experience the emotional, physical, psychological effects of the past in the present. Through the use of eye movements, tapping, or sounds, EMDR stimulates memory processing and fundamentally changes the way the memory is stored. With EMDR therapy, your past experiences may no longer intrude on your ability to fully engage with the present.

EMDR can aid people in experiencing less fear, panic, stress, anger and shame and access more curiosity, joy, love, gratitude, and other life-enhancing affects. In addition to the effects of trauma, EMDR is used to treat anxiety, panic attacks, phobias, addiction triggers, and performance enhancement for artists, athletes, and performers.

Treatment for Anxiety
Everyone feels anxious at times. Anxiety is an inherent part of the human condition and a natural response to everyday stress such as: relationship conflicts, financial problems, work demands, receiving a medical diagnosis, and making an important decision. However, if you suffer from panic attacks, persistent fears, worry, or phobias, are on “edge,” irritable, have difficulty sleeping and concentrating, experience frequent muscle tension, or have intense dread, you may benefit from therapy in order to get relief from the debilitating effects of anxiety and improve the quality of your life. 

Do you:

• Experience anxiety or worry most of the time?
• Have feelings of fear, uneasiness, or experience sudden, unexpected panic attacks?
• Feel constantly tense, keyed up, or on “edge”?
• Feel irritable or restless?
• Have difficulty concentrating and making decisions?
• Have difficulty falling or staying asleep?
• Suffer from fears that you know are irrational, but can’t shake?
• Avoid everyday situations or activities because they cause you anxiety?
• Have a sense of impending doom?
• Have an excessive fear of dying?
• Suffer from feelings of unreality or of being detached from yourself?
• Feel out of control or like you are going crazy?
• Have frequent intrusive thoughts or ruminations?
• Experience frequent muscle tension?
• Have difficulty breathing or feel like you are choking?
• Fatigue easily?
• Excessively sweat, tremble, or shake?
• Have frequent headaches?
• Feel dizzy, lightheaded, or faint?
• Have abdominal distress, stomach cramps, urinate frequently or have diarrhea?
• Have chills or hot flashes or have cold or sweaty hands or feet?
• Have numbness or tingling sensations?
• Have nausea or dry mouth?

If you answered yes to four or more of the above then you might benefit from psychotherapy. The good news is that anxiety is a treatable condition.

What is Anxiety
Anxiety and fears are the body’s natural alarm system and occur in response to danger. The emotion of fear is experienced when we are faced with a dangerous situation and has an evolutionary role in providing safety by preparing us for fight or flight. In contrast, anxiety can occur when we anticipate or perceive an imagined danger or threat, even if unreal. Anxiety can be mild, moderate, or severe. In moderation, anxiety can be adaptive in that it helps us to stay alert and focused, spurs us to action, motivates us to solve problems, and can be used as a signal that something is important to us. However, when anxiety is constant, overwhelming, and interferes with relationships, work, and other aspects of life, it stops being productive and becomes debilitating. At the severe end of the spectrum, anxiety, worry, fear, and panic cause extreme distress that interferes with one’s ability to cope with life.

A combination of factors contribute to anxiety such as: ongoing external pressures and stress, a genetic predisposition or a family history of anxiety, adverse or traumatic childhood experiences, certain medical conditions, the effects of certain medications, foods, or substances like caffeine, and negative beliefs about oneself. Anxiety manifests in a variety of ways such as: excessive worry, panic attacks, social anxiety, and physical symptoms.

My Approach to Treatment for Anxiety
Anxiety is so much a part of our modern life that it is one of the most common reasons people seek therapy. Since anxiety manifests differently in different people, my approach integrates many different modalities and approaches such as: psychodynamic psychotherapy, CBT, DBT, EMDR, and mindfulness. Psychotherapy can help you to better understand and manage the physical and psychological effects of anxiety and panic.

If we worked together we might:

• Explore the history of your anxiety and identify any patterns or triggers of it.
• Explore any life stressors or circumstances that are contributing to your anxiety and identify any changes that you would like to make in your life.
• Explore any negative thoughts about yourself that are worsening your anxiety or panic and work to change those thoughts.
• Look at how your current lifestyle might be contributing to your anxiety by exploring your eating habits, medication and substance use, and environmental influences.
• Explore some practical tools for calming and managing your anxiety such as breathing techniques and mindfulness practices.
• Utilize EMDR or other trauma focused methods, if you have experienced any trauma that causes you to feel anxiety or panic in order to help you gain relief and move forward in your life.
• Rule out any medical contributors of your anxiety by a referral to your primary care physician.

You do not need to be a prisoner of your anxiety. Therapy for anxiety can help you gain relief from the debilitating symptoms and effects of anxiety, which can improve self-esteem and self-confidence and help you experience more enjoyment and fulfillment in your life.

The quality of our lives depends upon the quality of our relationships. Life is all about relationships. We are in relationships at all times. We are in a relationship with ourselves, with others, and with our world. As social animals, humans cannot survive without other people. We effect and are effected positively and negatively by our relationships on a daily, even hourly basis.

Attachment
Attachment is the emotional bond between people. Our earliest bonds with our caretakers have a tremendous impact throughout our lives. Psychology, interpersonal neurobiology, and neuroscience have demonstrated that attachment bonds stimulate brain growth, effect personality development, social and emotional development, the ability to form stable relationships, and to effectively regulate our feelings. For better or worse, our early life experiences lay the foundation for our relationships throughout life.

Repetitive Relational Patterns
Throughout life we repeat our relationship patterns. Freud discovered what he called “the repetition compulsion,” which he described as the tendency for humans to be drawn to situations reminiscent of unresolved traumas from earlier in life. These repetitions can be seen as an unconscious attempt to belatedly master or heal our original relational dynamics with the intent of changing the outcome. Inevitably each of us brings all of our past experiences including our feelings, expectations, defenses, coping mechanisms, and beliefs to our current relationships with the unconscious hope that they will turn out better this time. The child in us thinks, “This time will be different. I will get him or her to love me. I can change him or her if only I try hard enough.”

Trauma, abuse, neglect, and other adverse childhood experiences negatively impact the quality of relationships. A child who grew up with an abusive parent may repeatedly be drawn to abusive partners. Someone who was abandoned as a child, may be drawn to people who will leave him, and a child who grew up with an alcoholic parent, may partner with people with substance abuse problems. Unfortunately, these repetitions can cause additional suffering for ourselves and others and further entrench the distressing patterns.

Our relationships provide the potential for both our most meaningful and our most painful experiences. In addition to love, bonding, and attachment, our relationships inevitably bring up our fears, needs, desires, dependency, ambivalence, sadness, anger, jealousy, hate, resentment, and guilt. The more difficult, distressing, and traumatic our earlier relationships, the more potentially hurtful and damaging our current relationships can become. If you find yourself repeating the same painful relationship patterns over and over again, you might benefit from psychotherapy.

Psychotherapy Provides a Choice
Psychotherapy can facilitate a movement from unconscious reenactment of distressing experiences to consciousness of our patterns. Understanding of our patterns provides a choice about how we want to act in the future. Awareness is the first step toward positive change. Acceptance and compassion for ourselves is the foundation of being able to love and have compassion for the people in our lives. It is possible to heal our original relational wounds and learn how to better handle repetitive situations in order to put an end to a destructive cycle.

Most of the people I work with are concerned about the quality of their relationships. Some are individuals who seek to improve the relationship with their partner, child, family members, and work colleagues. Others come for Couples Counseling to heal and change the repetitive and conflictual patterns that threaten to destroy their bond.

If you are suffering by repetitively re-experiencing some old relational patterns, I’d like to help.

Depression
Everyone feels sad sometimes. Feelings of sadness and grief are natural and adaptive responses to loss. However, if you feel sad, irritable, or “empty” most of the time, have lost interest in activities or relationships that you once enjoyed, have difficulty concentrating, and find your appetite, sleep, or activity level has changed, you may be experiencing depression. For some people feelings of sadness and grief become overwhelming and debilitating while others find that they feel numb and have difficulty feeling anything at all. Depression occurs when these symptoms interfere with daily functioning.

Are you…

• Feeling sad or “empty” most of the day, nearly every day?
• Feeling irritable or restless?
• Losing interest and pleasure in activities and relationships that you once enjoyed?
• Having difficulty concentrating or making decisions?
• Having difficulty sleeping or waking?
• Losing your appetite or overeating?
• Experiencing more aches or pains, digestive problems, or headaches?
  Feeling hopeless and pessimistic?
• Experiencing a sense of worthlessness or excessive guilt?
• Feeling tired, unmotivated, or helpless?
• Having thoughts of suicide?

If you answered yes to five or more of the above then you are probably experiencing depression and you are not alone. The good news is that depression is a treatable condition. Depression is fairly common and is one of the most common reasons people seek therapy. About 9 percent of American adults suffer from some form of depression and its rates worldwide are increasing. Major Depression, a severe form of depression, is the leading cause of disability worldwide.

Whether your depression is a reaction to a recent event or events in your life, something that you have felt off and on for years, or something you have struggled with throughout your life, there is help. Depression slows us down and provides an opportunity for self-understanding.

My Approach to Treatment for Depression
Depression is a highly treatable condition. It is complex, manifests differently in different people, and can be mild, moderate, or severe. Depression is usually caused by a combination of genetic, biological, environmental, interpersonal, psychological, and situational factors. My approach to working with depression integrates many different modalities and approaches. I would want to become as informed as possible about your particular depression so that our work can best meet your needs.

There may be a reason for what you are experiencing. If we worked together we might: Explore the history of your depression and any history of depression in your family. We might identify any patterns or triggers of your depression and explore if there are any early losses or childhood events that are contributing to it.

We can explore any life circumstances, stressors, or any repetitive relational patterns that are worsening your depression and identify any changes that you would like to make in your life. We can explore the possible “wisdom” in your depression and that it might be indicating that there is something important that is missing in your life. We might explore a possible discrepancy between where you want to be in your life and where you are currently. Perhaps you are seeking more meaning and a sense of purpose in your life. We can explore any negative thoughts about yourself and use cognitive techniques to identify any negative thought process that are fueling your depression and work to change those thoughts.

We would want to rule out any medical and biochemical causes of your depression, which is usually done by your primary care physician.

We could look at how your current lifestyle might be contributing to your depression by exploring your eating habits, exercise, and alcohol and substance use and explore any environmental influences that might be worsening your mood.

I could teach you some practical tools for shifting your mood in the moment and we could engage in dreamwork, sandplay, active imagination, or other creative methods in order facilitate the natural wisdom and healing of your imagination for integration and wholeness.

If you have experienced trauma or feel stuck in your life due to unresolved emotional hurts or injuries, we could utilize EMDR or other trauma focused methods in order to aid you in moving forward. Recent scientific research has suggested that there may be an evolutionary reason for depression.

Research has shown that depression promotes introspection and increased mental acuity. Numerous studies have demonstrated that when someone is depressed their increased blood flow to certain areas of the brain. Studies have also shown that people who are depressed are better able to solve complex problems those who are not. By taking your depression seriously, you may be able to gain insight into yourself and make important changes so that you can more fully engage in and enjoy your life.