5 Truths to Tell Your Therapist

Certain topics can be tough—but they're crucial to explore.

Jean Kim, M.D.

Certain topics can be tough—but they're crucial to explore.

Posted Oct 29, 2019

The relationship between a patient and a therapist is a delicate one, one that requires careful nurturance and the gradual building of trust, as there are deeply personal, fundamental issues being explored and revealed to someone who is otherwise a stranger. It is more than understandable why many people are afraid to even seek out a therapist initially, given this huge leap of faith involved.

But a therapist’s creed is to provide a truly safe space, to become a private and confidential listener and adviser. They have dedicated their lives to directly addressing and guiding people through the struggles of life, oftentimes the darkest and most painful ones, such as trauma, abuse, and illness. They are crucial outside support, a neutral party, and sounding board for difficult family, relationship, and workplace stressors.

There are some common themes in therapy that can be sensitive to broach or discuss, but not unlike tension points in one’s muscles, those are often the areas that require the most help and targeted intervention. But because of their sensitivity, it may sometimes take a longer period of time, even months or years, for someone to open up or acknowledge some of these crucial concerns.

I am hoping to highlight these important topics so that readers can consider more direct attention and focus on them, whether they are in therapy and still haven’t discussed them, or whether they are considering beginning therapy.

1. Traumas and Tragedies

Tragic and painful life events are often the underlying basis or trigger for other presenting symptoms that initially manifest to a therapist’s office. For example, it’s not uncommon for someone to come in saying they are having trouble sleeping and have a lot on their mind, that they are feeling sad or irritable or stressed out. But shortly after, they will then note that their loved one recently passed away, or that they were raped when younger and never told anyone, and other serious, devastating events.

Even when openly admitted to, the process of uncovering the ripples and layers that radiate from a traumatic event often defines the process of therapy itself moving forward. Trauma becomes the elephant in the room that must never be ignored, although the process of addressing it must be individualized and occur at a safe, agreed-upon pace for the patient.

2. Obsessive Thoughts and Anxiety

Anxiety spans a wide range of causes and themes, everything from seemingly unprovoked panic attacks to obsessive-compulsive disorder to isolated phobias (like flying). It is another one of the most common reasons for people to visit therapists. Anxiety is a complex condition that is linked to both neurobiological loading, where people have physiological and/or genetic priming to develop hyperreactive responses to fear-provoking phenomena and complex emotional and psychological defense mechanisms from past life memories or relationship dynamics that can manifest as anxiety.

What is important for patients to open up about is the thought content linked to any anxiety, even anything that seems incredibly trivial, absurd, irrational, or frightening and disturbing. All of these “automatic thoughts” (as cognitive-behavioral therapy calls them) cropping up with anxiety are important data pointing towards an underlying cause that needs to be addressed.

3. Sexual Concerns

One of the most embarrassing and difficult topics for people to open up about is sexual problems. Given our still relatively conservative societal taboos about sexuality, and also past histories of people who have abused appropriate boundaries, many people don’t feel comfortable talking about these issues with strangers.

However, although many of Sigmund Freud’s overtly specific theories about sexuality are considered outlandish today, he wasn’t wrong necessarily about the importance of sexuality itself on human development and how it manifests in relationships and anxiety. A therapist is a professional who understands this context and maintains a non-judgmental, open-minded space to address this crucial part of human existence; their goal is to be pragmatic and supportive of sexual concerns.

4. Emotions Underlying Physical Pain

Due to ongoing stigmas, particularly in certain cultures or gender norms, about emotional vulnerability, and worries about having emotional concerns dismissed, sometimes serious mental conditions like depression and anxiety manifest initially as physical or somatic issues, in order to get more direct attention.

Any true medical issue should absolutely be fully worked up to its full extent first and taken at face value, but if there is ample evidence that the underlying cause may be psychological, it is important to create an atmosphere of safety and acceptance, so these patients can express those underlying emotional concerns and not feel dismissed or ignored (which may have led to those initial presentations).

5. How Bad Things Really Get

The hardest thing to discuss for some is the feeling or frank intent of ending one’s life. While some patients manage to open up about these thoughts (a crucial point for intervention, since they are clearly a cry for help), many suicides still occur without warning.

Most therapists will directly ask you about these suicidal thoughts as part of a screening interview; unfortunately, many people will not reveal the full extent of those thoughts due to fear that they will be hospitalized or misunderstood, or because they do not trust a new person. (Of course, others are determined to go through with it and won’t tell anyone.) If you are unsure, and your thoughts are imminent or severe, it may be your best chance to receive the full extent of help available and learn what options are out there; you deserve that chance.

Ultimately the goal in partnering with a therapist is to confront the troubles in your life in a safe and professional manner. It may be the one space and setting where you can discuss difficult and taboo topics with an expectation of privacy and with the goal of understanding and growth. In a future blog post, we will discuss certain defense-related untruths that one should avoid telling one's therapist.

Proving "Extreme Hardship" to a U.S. Relative for Immigration Purposes

If you are attempting to get a visa or green card in the U.S., but are blocked by being inadmissible, you may be eligible to file for a waiver of certain grounds of inadmissibility based on the extreme hardship your qualified relative will experience if you are not admitted to the United States.

Building Trust

As much as parents may care for their children, developing a healthy level of trust helps to strengthen relationships in a family. Trust is easily broken, yet difficult to build, but it is never too late for parents to place effort into establishing trust with their children. In fact, the lasting impacts of having a strong trust or mistrust can deeply affect children well into their adult life. As a leading American educator and mother, Esther Wojcicki provides incredible insight on how to build trust in a family from her article on Psychology Today.

Anxiety !!!!

5 Ways Anxiety Can Cause Social Problems and Rudeness

Alice Boyes Ph.D.

 What loved ones and colleagues need to know.

Anxious people are frequently hyper-concerned with being perceived positively by others. However, a Catch-22 is that anxiety can sometimes lead to behaving in ways that make a poor impression. The purpose of this article is to help loved ones, coworkers, and the anxious person themselves better understand these patterns.  I'll also give some suggested solutions that anxious individuals can use to mitigate these problems. 

1. Getting caught up in thoughts about social evaluation can result in lost opportunities for connection.

A few nights ago my neighbor was putting up his Christmas decorations*, and they looked great.  I wanted to call out and say that but something stopped me.....  I was caught up in my head thinking "They probably think we're lazy or stingy for not putting up decorations when everyone else does." 

A reality check on that thought was that I had no evidence my neighbor was thinking that, and it's only about half of our street that decorates, not everybody. And, even if he was thinking that, I still should've called out and complimented the decorations. In the moment, my anxiety got in the way of an opportunity to reinforce a positive social connection with our neighbor.

Solution:  The next day, after I'd had a chance to correct my thinking, I did compliment the decorations. As in this scenario, it's often possible to go back and recover from lost opportunities for social connection, after you've had a chance to challenge your anxious thinking.

2. Perfectionism that leads to procrastinating and avoiding can make you seem unreliable.

Imagine this scenario. You get a work-related email from someone you want to impress. You're not immediately sure how to respond and want to get it "just right" so you hold off. The next day you're still feeling anxious about how best to respond, so you put it off again. As the days go by, the harder it gets and the more embarrassed you feel about not having responded. Now you're worried the other person is thinking you're unprofessional, disorganized, or disinterested, which they very well might be (or not).

Solution:  Focus on your values as the driver of your behavior. This can sometimes make it easier to promptly decide how to respond in interpersonal situations in which you feel perfectionism-pressure. In general, pick 1-3 relevant core values and let your behavior reflect those. For instance, your relevant core values might be authenticity, conscientiousness, and creativity. How would those values help you decide how to respond to the email? This can help take the focus off social-evaluative concerns. When you act in line with your own values, it's easier to let the chips fall where they may. No one can completely control others' reactions but whatever those reactions are, you'll feel better and more at peace if you've acted consistently with your own values.

3.  Being caught up in your anxiety can sometimes make you insensitive to others' emotional needs.

Anxiety is a powerful emotion. The evolutionary basis of it is that it has developed so that it grabs our attention and it's hard to distract yourself from it. One way this plays out is that when you're consumed by anxiety and ruminative thoughts it can feel like dealing with your own stress is all you can manage. This can sometimes lead to imbalances in relationships. For instance, when your spouse or partner gets home from work, you might desperately need to debrief about something that is making you anxious, but this can crowd out when your spouse needs some attention paid to what type of day they've had, or whatever is on their mind. Your emotional needs might seem more intense than their's and therefore more of a priority, but it becomes a problem if this is always the case. If your ruminative mind is running on hyperdrive about an unrelated topic, you might seem to not be concentrating when others are talking. 

Solution:  If you have a trusting relationship with your partner, try letting them call you on it when you're not paying as much attention to their thoughts, priorities, and emotions as they need. Instead of viewing getting self-absorbed as a personality flaw, treat it more as a symptom of anxiety and see it less judgmentally.

4. Relying too heavily on a few people can create stress in those relationships.

Anxious people sometimes only have a small circle of people they trust. If it's hard for you to develop trust or to approach people you're not already close to, this is understandable. However, this can sometimes result in relying too heavily on just one or a few individuals in a way that strains those relationships. Sometimes anxious people rely heavily on their romantic partner, parent, or sibling to run interference for them.  It's common for anxious people to avoid asking for help in general, but have a few people they excessively ask for reassurance, help with decision making, or assistance in a particular area in which they feel unconfident (for instance, with technology).  At work, a person may only have functional relationships with a few trusted colleagues and anxiously avoid other teammates. This can limit opportunities and strain relationships e.g., if you're always asking the same people for help, while at the same time avoiding asking for input from a wider circle of people.  

Solution:  The main fix for this pattern is to recognize it and, as much as you can, develop collaborative working relationships with all your teammates. If you think a particular person is likely to be unfriendly towards you, check whether you have any evidence for this or if your thinking is fear-based.

5.  Being caught up in your anxiety can sometimes make you demanding or indirect.

Anxiety can sometimes cause people to overcompensate by being excessive. For instance, you worry about being late for a flight so much you demand that your family go to the airport excessively early. Or, something is stressing you out so much you want it resolved right now, even if the other people involved want to deal with it later or wait to see how the situation plays out.

On the other hand, anxious people can sometimes be less inclined to ask directly for what they want.  They might fear that being told no would harm their relationship with the person they've asked. They might hint or beat around the bush instead and this can get frustrating for everyone.  

Solution: Allow other people to put in place reasonable boundaries when you're being truly excessive, and again don't personalize this pattern but recognize when your urgency is being driven by anxiety. Take opportunities to practice asking directly for what you want when this seems appropriate.

Wrapping Up

Anxiety manifests in a wide variety of ways. Any particular anxious individual may display none of these patterns or all of them to various degrees.  For loved ones and coworkers, recognize that these anxiety-driven patterns can be extremely difficult for the anxious person to adjust, especially if they're in the midst of a clinical anxiety problem that needs treatment.

*If you're wondering why there is an example about Christmas decorations in March, I've had this article sitting half-finished in draft since last December!

Life isn't unfair. By Terry A Gordon DO, FACC

Life isn't unfair, life is always fair.

Now, I can imagine the tremendous leap of faith embracing such a premise might require. We have all posed the question: “Why me? Why do bad things keep happening to me? How can a good God allow such injustices to occur?”

Crap happens. None of us is immune to the seemingly negative occurrences life can present. At some point, we will all experience pain and turmoil, but we must remain mindful that life's events become tragedies only if we make the conscious decision to frame them as being calamitous. We might just as easily choose to view them as being in perfect order, offering up to us at just the right time, opportunities for personal growth. These so-called catastrophes can actually become the driving force of change.

The storms we encounter, while they have the potential of creating incapacitating turbulence in our minds, don't have to. Fortunately, life is balanced, not only with those things that cause us to suffer, but it is beautifully coupled with those things that bring us pleasure as well. Thus we are not overly burdened with the negative aspects of such experiences. 

The question becomes: is there really such a thing as a negative experience? I don’t think so. Such a so-called negative encounter can actually be a blessing in disguise, providing fodder for growth, becoming a catalyst for change. If we can learn just one small thing from such a negative ordeal, the encounter loses its negativity and becomes a positive experience. The tragedy arises from experiencing something of this nature and not learning from the encounter.

The gift of each of these apparently negative events is a tool from the Divine that can help nurture our spiritual evolution and progress. The more daunting the obstacle, the greater potential there is for personal growth. From the Kabbalah, an ancient mystical text of Judaism, it is written: "It’s the falls of our life that provide the energy to propel us to a much higher level."

No storm that lasts forever. And despite the darkness of the most foreboding storm clouds, somewhere the sun is shining. The challenge becomes adjusting our perception of events enough to recognize the presence of higher powers within the experience.

In doing so, we must look beyond what the mind wants to judge as good or bad. Rather than lamenting so-called adversities and becoming victimized by them, it is far better to choose instead to be grateful for them, embracing them as gifts, knowing that within them lie important nuggets of knowledge that can promote our spiritual development.

The difficulties we face can be a source of strength, enabling us to rise above perceived adversity. Accepting that premise, I have come to the realization that I deserve the heartache. I am worthy of the difficult lessons I have been given. The question for me has become not “Why me?” but “Why not me?” It's all in changing the thought, changing our perspective—changing our outlook. The choice is simple, become the victim, licking our wounds while resisting. This will result in perpetual turmoil, pain and immense suffering. It is far better to transcend above the quagmire, choosing instead to accept the magnanimous gift and grow from it.

The key is to exalt in the falls of our lives. Embrace them. For they offer us the milieu to transform, giving us the springboard to rise above the turmoil, disappointment and suffering, transcending to the place where understanding, enlightenment and complete healing occur.

Depression

Depression

Depression is the most prevalent of all the emotional disorders. This may vary from feelings of slight sadness to utter misery and dejection. It brings together a variety of physical and psychological symptoms which together constitute a syndrome.

Depression is the most unpleasant experience a person can endure. It is far more difficult to cope with than a physical ailment. The growing complexities of modern life and the resultant crisis, as well as mental stress and strain in day to day living, usually leads to this disorder. It also arises out of the monotony and drudgery of a daily routine, without any meaningful variation in urban life. Suicide is the major risk in extreme cases of depression.

Symptoms

It is not always easy to diagnose depression clinically. The most striking symptoms of depression are feelings of acute sense of loss and inexplicable sadness, loss of energy and loss of interest. The patient usually feels tired and lacks interest in the world around him. Sleep disturbance is frequent. Usually the patient wakes up depressed at 4 or in the morning and is unable to return to sleep. Other disturbed sleep patterns are difficulty in getting off to sleep on going to bed at night, nightmares and repeated waking from midnight onwards.

The patient often suffers from guilty, oppressive feelings and self-absorption. Other symptoms of depression are: loss of appetite, giddiness, itching, nausea, agitation, irritability, impotence or frigidity, constipation, aches and pains all over the body, lack of concentration and lack of power of decision. Some persons may lose interest in eating and suffer from rapid loss of weight while others may resort to frequent eating and as a result gain in weight.

Cases of severe depression may be characterized by low body temperature, low blood pressure, hot flushes and shivering. The external manifestations represent a cry for help form the tormented mind of the depressed persons. The severely depressed patient feels worthless and is finally conceived that he himself is responsible for his undoing and his present state of helpless despair.

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