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09 Oct 2020
Suicidal Ideation: A Fleeting Thought

Hopelessness can have a significant influence on daily life, as it may reflect an individual’s negative view of the future. Hopelessness can often lead to a person losing interest in important activities, events, or people. Someone who has become hopeless may no longer value things that were once important and may have no expectation of future improvement or success.


People experiencing hopelessness may make statements such as:


  • Things will never get better.
  • I am stuck.
  • No one can help me.
  • I feel like giving up.
  • It is too late now.
  • I am too tired to try.
  • I will never be happy again.


Many people who experience hopelessness may also be affected by mental health issues. Feelings of hopelessness that occur with a condition such as depression may lead an individual to have thoughts of suicide.


Suicidal ideation means having ideas about taking your own life or hoping to die. Suicidal ideation may occur in people with clinical depression or bipolar disorder or it may happen to someone with no mental health diagnosis at all. And during the COVID pandemic, it is estimated that hopelessness and suicidal thoughts have been increasing.


There Are Two Kinds Of Suicidal Ideation: Passive And Active.


Passive suicidal ideation occurs when you wish you were dead or that you could die, but you don’t actually have any plans to commit suicide.
Active suicidal ideation, on the other hand, is not only thinking about it but having the intent to commit suicide, including planning how to do it.


Be aware that passive suicidal ideation, wishing that you could die in your sleep or in an accident rather than by your own hand, is not necessarily any less serious than active suicidal ideation. It can quickly turn active. Therefore it is important to share these thoughts, even just fleeting thoughts, of suicide with your therapist and create a safety plan to help you develop coping skills, confirm support people in your own social network, and have an awareness of severity to know when to seek immediate medical attention.


Suicidal ideation in teens is often caused by untreated depression or drug misuse and always needs to be taken seriously.


Suicidal thoughts and depression often have many causes. Social difficulties, stress, academic pressures, and other concerns facing teens may contribute to suicidal ideation.


Other Risk Factors Include:


  • Poor social relationships
  • Lack of family support
  • Physical or sexual abuse
  • Substance and alcohol misuse
  • Health issues
  • Bullying


According to the CDC (Center for Disease Control), during June 2020, U.S. adults reported considerably elevated adverse mental health conditions associated with COVID-19. Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.


We can all help prevent suicide by learning the risk factors and warning signs, and by being alert to changes in our family, friends, and co-workers.


Trust your instincts if you notice differences in someone’s behavior. If they seem depressed, disengaged, or irritable, tell them you’ve noticed, and let them know what raises your concern. If someone isn’t sleeping or they seem agitated, are drinking more alcohol than usual, try to connect and be persistent.


Common Warning Signs


  • Isolating yourself from your loved ones
  • Feeling hopeless or trapped
  • Talking about death or suicide
  • Giving away possessions
  • An increase in substance use or misuse
  • Increased mood swings, anger, rage, and/or irritability
  • Engaging in risk-taking behavior like using drugs or having unprotected sex
  • Accessing the means to kill yourself, such as medication, drugs, or a firearm
  • Acting as if you’re saying goodbye to people
  • Feeling extremely anxious


Common Risk Factors


There are a variety of risk factors for suicidal ideation and suicide, including


  • Having attempted suicide in the past
  • Having a mental health disorder
  • Feeling hopeless, isolated, and/or lonely
  • Not being married
  • Being gay, lesbian, bisexual, or transgender
  • Having served in the military
  • Having a chronic physical illness like cancer, diabetes, or a terminal disease
  • Having chronic pain
  • Having a traumatic brain injury
  • Having a family history of suicide
  • Having a drug or alcohol use disorder
  • Having experienced childhood abuse or trauma
  • Living in a rural area


According to the NIMH (2019), suicide is the 10th leading cause of death in the United States and women attempt suicide more often than men, but men are successful about three to four times more often than women. Suicide is the second leading cause of death among 10- to 34-year-olds.




  • Psychotherapy, or talk therapy, during which you work with a therapist to explore why you are feeling suicidal and how to cope.
  • Teletherapy has become the most common way to conduct Psychotherapy during the COVID pandemic.
  • Family therapy and education. Involving loved ones in treatment can help them better understand what you are going through, learn the warning signs, and improve family dynamics.
  • Substance Abuse Counseling, if you are also experiencing an increase in alcohol or drug use.
  • Lifestyle changes, including managing stress, improving sleep, eating, and exercise habits, building a solid support network, and making time for hobbies and interests.
  • Medications to treat any underlying depression causing your suicidal ideation. This may include antidepressants, antipsychotic medications, or anti-anxiety medications.


If you start experiencing thoughts of suicide after taking an antidepressant, call your mental health care professional immediately. Some antidepressants have been linked to an increase in suicidal thoughts.


If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.


For non-crisis treatment, please contact our office to schedule a Teletherapy session, we do have available appointments and no waitlists.

15 Sep 2020
Teen Depression Is Different

The symptom profile for teenagers is different than that of adults. Parents sometimes do not recognize the symptoms because depression in teenagers is not what most people think of as signs of depression. As a result, many teens unnecessarily suffer in silence.

Depression has become increasingly common among American teenagers – especially teen girls, who are now almost three times as likely as teen boys to have had recent experiences with depression. Younger children have about equal rates of depression based on gender. After puberty, however, girls become much more inclined to be diagnosed with depression.

In 2017, 13% of U.S. teens ages 12 to 17 (or 3.2 million) said they had experienced at least one major depressive episode in the past year, up from 8% (or 2 million) in 2007, according to a Pew Research Center. And during COVID19 pandemic it is on the rise again.

Adults who have experienced depression are treated at higher rates than teens. Among adults who had recent depressive episodes, about two-thirds (67%) received treatment. Among teen girls who had recent depressive episodes, only 45% received treatment for depression over the past year. By comparison, 33% of teen boys with recent depressive episodes received treatment. From these statistics we can see that more teens go untreated than treated.


Warning Signs

While depressed adults often talk about emotional pain, depressed teens tend to report physical aches and pains. They may report headaches, stomach problems, or say they just do not feel well. In the case of depression, physical exams will not reveal any findings. Also teens present more irritability than sadness during an episode of significant depression. Here are some things to look for in your teen.



Adults usually describe feeling sad when they’re depressed, but teenagers often become increasingly irritable. They may behave disrespectfully or may have less patience than usual. They also may become defiant.

While mood swings can be normal during the teenage years, an unusually high amount of irritability should be considered a warning sign of possible depression.


Academic Changes

Teens may experience a sharp decline in their grades when depression strikes. But that’s not always the case. Some teens maintain a high grade point average (GPA) even in the midst of emotional turmoil.

In fact, sometimes the pressure to maintain good grades becomes a factor in depression. A teen who feels the need to get accepted into an Ivy League college, or one who insists a disappointing SAT score could ruin their life, may remain driven to achieve despite being depressed.


Sensitivity to Criticism

Depression can lead to an intense sensitivity to criticism. Sometimes teens deal with this increased sensitivity by avoiding activities where they fear failure. A teen may refuse to try out for the soccer team or may refuse to invite a date to a school dance in an attempt to avoid rejection.

At other times, teens may deal with this fear by becoming an overachiever. A depressed teen may become a perfectionist in an attempt to avoid the risk of being rejected. It is important to monitor how your teen responds to risk, criticism, and failure as changes in your teen’s behavior could signal your teen is depressed.


Social Withdrawal

Social isolation is a common problem for someone with depression, but teens don’t necessarily withdraw from everyone when they become depressed. Sometimes they simply change peer groups.

A teen may begin to hang out with the wrong crowd or may stop talking to certain friends or family members.

At other times, teens withdraw from real-life activities and focus their attention on the online world when they are feeling depressed. A depressed teen may create an online persona and may engage in online chats or play role-playing games for hours on end to escape the realities of life. There is also a tendency to sleep through the day to avoid a regular daily lifestyle.


Four Types of Teen Depression

The word depression is used to describe a variety of conditions. Recognizing the signs and symptoms can be key to getting a teen treatment. And early intervention can often be key to successful treatment.

There are four types of depression that commonly affect teenagers. Depression can affect all teens regardless of their gender, popularity, academic success, or athletic abilities. It is important to familiarize yourself with the common symptoms of depression in teens so you can provide support and seek help when necessary.


1. Adjustment Disorder with Depressed Mood

An Adjustment Disorder occurs in response to a life event. Moving to a new school, the death of a loved one, or dealing with a parents’ divorce are examples of changes that can spur an Adjustment Disorder in teens.

Adjustment Disorders begin within a few months of the event and may last up to six months. If symptoms persist beyond six months, another diagnosis would be more appropriate.

Adjustment disorders can interfere with sleep, school work, and social functioning.

Your teen may benefit from talk therapy to teach him new skills, increase emotional functioning, and get help to cope with the stressful situation.


2. Persistent Depressive Disorder (Dysthymia)

Persistent Depressive Disorder (dysthymia) is a low grade, chronic depression that lasts for more than a year. Teens with dysthymia are often irritable and they may have low energy, low self-esteem, and feelings of hopelessness.

Their eating habits and sleeping patterns may also be disturbed. Frequently, dysthymia interferes with concentration and decision making. It’s estimated that roughly 11 percent of teens, ages 13 to 18, experience dysthymia, according to the National Institute of Mental Health.

Although dysthymia is not as severe as major depression, the long duration can take a serious toll on a teen’s life. It can interfere with learning, socialization, and overall functioning. Cognitive Behavioral Therapy or Dialectical Behavior Therapy along with medication are often effective in treating dysthymia.


3. Bipolar Disorder

Bipolar Disorder is characterized by episodes of depression followed by periods of mania or hypomania (a less severe form of mania). Both the depressive and manic states will last anywhere from a couple of weeks to many months. Symptoms of mania include a reduced need for sleep, difficulty focusing, engaging in risky behaviors and a tendency for anger outbursts.

During a manic episode, a teen is likely to talk fast, feel animated or silly, and be willing to engage in risky behavior. Many teens engage in high-risk sexual behavior during a manic episode.

Teens with bipolar disorder will likely experience significant impairment in their daily functioning. Their severe mood changes interfere with their education and friendships. Bipolar is treatable but not curable. Bipolar is usually best treated with a combination of medication and therapy.


4. Major Depression

Major depression is the most serious form of depression. Symptoms of major depression include persistent sadness and irritability, talk about suicide, a lack of interest in enjoyable activities, and frequent reports of physical aches and pains. Teens will typically decline in their grooming and isolate socially.

Major depression can cause severe impairments at home and at school. Treatment usually involves weekly therapy and supervised medication treatment.


If you or your teen are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

05 Aug 2020
Radical Acceptance

Radical Acceptance is the acceptance of life, on life’s terms. While pain is part of life, radical acceptance allows us to keep that pain from becoming suffering. It is about accepting the facts of reality, no matter how painful, without avoidance, overthinking, or dangerous behaviors. When a person does not accept the realities of life issues, they often remain stuck in that pain and fail to move forward and lose the chance to heal. In other words, unresolved pain can continue to hurt you even when it is not happening anymore. If you simply do not accept the facts, it does not change the facts, and this can lead to unnecessary and prolonged suffering.

Resistance to reality may be a defense mechanism that helps to numb the pain in the short-run but in the long-run creates more problems. If you ignore a past due electric bill long enough, the lights will be turned off. Avoidance is not an effective problem-solving strategy.

During the course of your life, you can’t avoid pain and painful situations, but you can learn to cope with something you can’t change. When you practice Radical Acceptance, it does not mean that you approve of the issue or agree with it. It means that life happened, it was painful or hurtful, or unfair, and I can accept that it sucked. But now it is over, and I hope to learn from this, and hopefully not repeat it. I can accept that even though it was bad, I can live through it.

Some people hold on to unresolved issues with pain and anger. It’s exhausting to fight reality, and it doesn’t work. Refusing to accept that you were blamed for something you didn’t do, that your friend lied to you, or that you weren’t called back for a second interview for a job you wanted, doesn’t change the situation, and it adds to the pain you may experience. Until that pain is accepted and realized, the wound stays active.

This can also happen with false hope. Making excuses and minimizing toxic situations, pursuing abusive and toxic people in the face of negative evidence. Repeating patterns of violence and abuse; over and over again. Radical Acceptance is giving up the notion that you can control other people’s thoughts or behaviors. It is acknowledging that it is what it is, nothing more and nothing less. By holding on to a false hope, you may simply be fooling yourself and staying in a pain producing situation. The false hope that things will get better, that someone else will change, maybe this time, is keeping you and perhaps your other family members and children, in the grip of abuse and pain.

Working with trauma cases, one of the main things we do as therapists is to get to the acceptance of the trauma. We help a client look at negative thinking patterns that may be reinforcing an inaccurate self-story about a trauma event. And it is always a part of our treatment to confront the trauma and get away from denial and avoidance patterns. Again, you really can’t move forward if you are stuck in your past and in your pain.

DBT or Dialectical Behavior Therapy has offered the following ways that you can begin the process of Radical Acceptance. This is a part of strengthening your coping skills and ability to increase Distress Tolerance:

  • Observe that you are questioning or fighting reality (“it shouldn’t be this way”)
  • Remind yourself that the unpleasant reality is just as it is and cannot be changed (“this is what happened”)
  • Remind yourself that there are causes for the reality (“this is how things happened”)
  • Practice accepting with your whole self (mind, body, spirit) – Use accepting self-talk, relaxation techniques, mindfulness and/or imagery
  • List all of the behaviors you would engage in if you did accept the facts and then engage in those behaviors as if you have already accepted the facts
  • Imagine, in your mind’s eye, believing what you do not want to accept and rehearse in your mind what you would do if you accepted what seems unacceptable
  • Attend to body sensations as you think about what you need to accept
  • Allow disappointment, sadness, or grief to arise within you
  • Acknowledge that life can be worth living even when there is pain
  • Do pros and cons if you find yourself resisting practicing acceptance



15 Jul 2020
Benefits Of Gratitude Journaling

Modern psychologists suggest that our overall personality is relatively fixed and stable throughout life. But the brain possesses the remarkable capacity to reorganize pathways and create new connections. This is called neuroplasticity, or brain plasticity.


Modern research has demonstrated that the brain continues to create new neural pathways and can alter existing ones in order to adapt to new experiences, learn new information, and create new memories. So, we may not change our core personality but researchers do believe that there are things you can do to change certain parts of your personality that can result in real changes to the way you act, think, and function in your day-to-day life. Our beliefs shape so much of our lives, from how we view ourselves and others, how we function in daily life, how we react to life’s challenges, and how we connect and relate to others. If we can create real change in our beliefs, it is something that might have a resounding effect on our behaviors and possibly on certain aspects of our personality.


So how does therapy help to create change? You only spend 1 hour a week with a counselor but have 168 hours between sessions to reinforce the changes you define in your session. This kind of directed therapeutic work outside the therapy office is vital to making the new neural pathways of sustainable change. Turning knee-jerk negativity into increased positivity, both in thought and action.


One of the most basic and reliable concepts towards positivity is gratitude. Gratitude is defined as the quality of being thankful; a readiness to show an appreciation for and to return kindness.


  • When we express gratitude and receive the same, our brain releases dopamine and serotonin, the two crucial neurotransmitters responsible for our emotions, and they make us feel ‘good’. They enhance our mood immediately, making us feel happy from the inside.
  • By consciously practicing gratitude daily, we can help these neural pathways to strengthen themselves and ultimately create a permanent grateful and positive nature within ourselves.


Gratitude Improves Health


  • Gratitude impacts on mental and physical well-being. Positive psychology and mental health researchers in the past few decades have established an overwhelming connection between gratitude and good health. Keeping a gratitude journal causes less stress, improves the quality of sleep, and builds emotional awareness.
  • Gratitude is positively correlated to more vitality, energy, and enthusiasm to work harder.


Gratitude Improves Relationships


Simple practices like:


  • maintaining a Gratitude Journal
  • complimenting the self, daily affirmations
  • sending small tokens and thank you notes


Can make us feel a lot better and enhance our mood immediately. Couple studies have also indicated that partners who expressed their thankfulness to each other often, could sustain their relationships with mutual trust, loyalty, and had long-lasting happy relationships.



What is a Gratitude Journal


  • A tool to keep track of the good things in life. No matter how difficult and defeating life can sometimes feel, there is always something to feel grateful for.
  • Regularly journaling about the good things in your life can help prepare and strengthen you to deal with the rough patches when they pop up.
  • Regular use over time can encourage positive neural pathways.


Getting Started

Writing can sometimes flow very easily and sometimes not. If you get blocked and are finding it difficult to get the creativity flowing here are some prompts to get things going:


  • List five small ways that you can share your gratitude today.
  • Write about a person in your life that you are especially grateful for and why.
  • What skills or abilities are you thankful to have?
  • What foods or meals are you most thankful for?
  • What elements of nature are you grateful for and why?
  • What part of your daily routine are you most thankful for?
  • Write a letter to someone who has positively impacted your life, however big or small.
  • What is something you are grateful to have learned this week?
  • List five parts of your body that you are grateful for and why.


Gratitude Journaling Formats

People can get pretty creative with how they format their journal. Here are some examples:


  • Write an essay
  • Use a Gratitude Worksheet
  • Use an APP
  • Do a photo journal
  • Use Bullet Point journaling technique



A gratitude essay is a more detailed account of your life and requires more involved writing. It is a declaration, a reflection, and an acknowledgment of what you have to be grateful for and, indirectly, who you are. As you choose your gratitude memory, you really put it through some reflective filters and eventually learn a lot about yourself in the process.

If you reflect back on a moment where someone went above and beyond for you, you may come to realize that you value people that are unselfish, kind and generous. And may be inspired to do the same for others.

The point is that writing a gratitude essay is not just a great way to acknowledge and reflect on some of the most important or defining moments of gratitude in your life, it is also a way to learn about yourself.



There are many templates online for us to download on this topic. (Google Gratitude Worksheets). It is worth your time to check out some of the formats and try a few out to see which ones work best for you.

Some that I have found are basic calendar-type worksheets that list each day of the week, with 3-5 spots to list what I am grateful for. If that sounds too plain for you, there are some that have designs and more prompts within the worksheet.


There is a fun worksheet that is has 3 areas:


  1. What I learned today.
  2. My favorite part of the day.
  3. Three things I am grateful for.


Gratitude Apps

This has a variety of options in the APP STORE. Just type in the search: Gratitude Journal and many APPS will pop us. The good news is that many are free, and some are at least offering a free trial. Try a few out and use the one that works best for you. Here are some common features:


  • Able to take this journal everywhere you go with your smartphone in your pocket.
  • You can set notifications for reminders to journal on the app.
  • You can track your progress and gain insight on your feelings.
  • Motivational quotes.
  • Click up to ten emoji images of topics you are grateful for or can type it in. You can also click emojis about how you feel about the things you are grateful for.
  • Write about your day up to 100 words.
  • Add pictures from your phone onto your daily journal entries.
  • Send gratitude messages to others.


Bullet Journal

If you aren’t keen on writing or find yourself short on time, you can still get the benefits of journaling by using the gratitude bullet journal format where you basically list at least one thing you are grateful for each day, which may make it easier to start if you are struggling to come up with five items each day. The whole idea is to still scan your day and pop into the positive zone on a regular basis.


Abalance Counseling_CBT-Anxiety 03 Jun 2020
Cognitive Behavioral Therapy (CBT)

(CBT) Cognitive Behavioral Therapy


We have all been through a certain rough patch in our life that has had a severe impact on our mental health. Most of the time we get over such incidents on our own but sometimes we need professional help. An evidence-based technique that has proven to be very helpful with treating mental health issues is Cognitive Behavioral Therapy, also known as CBT.


Cognitive Behavioral Therapy or CBT is a communication approach that will help you improve your functioning by improving the way you feel and react to stress. It is more widely used to relieve anxiety and depression, but can be effective for many emotional and physical health conditions.


CBT can help you cope with your issues in a more constructive manner. It is based on the idea that your emotions, beliefs, thoughts and actions are interlinked, and that negative emotions can cage you in a destructive spiral.


The objective of CBT is to help you interrupt this loop by disintegrating daunting issues into smaller bits, analyzing your emotions and bad habits more closely, and teaching you how to alter such emotional trends and make you feel better.


By participating in CBT counseling you will focus on your emotions, thoughts and behaviors, and challenge your own dysfunctional patterns to create newer and more healthier ways of living. To further familiarize you about this effective treatment, we have gathered important details that should give you a good sense of how CBT works and what you may expect during your sessions.


What is (CBT) Cognitive Behavioral Therapy?


Cognitive behavioral therapy (CBT) is a type of behavioral counseling that has been proven to be successful with a number of issues including stress, personality disorders, concerns with alcohol and drug usage, relationship issues, anorexia, binge eating and serious mental issues.


Multiple study results suggest the CBT contributes to major changes in working and quality of life. In several trials, CBT has been found to be equally successful or more efficient than other types of clinical treatment or behavioral medication.


This is worth noting that CBT advancements have been achieved on the basis of both study and clinical experience. In reality, CBT is a technique for which there is sufficient evidence that it has significant and sustainable positive results.


What does Cognitive Behavioral Therapy Involve?


CBT incorporates a variety of strategies and methods that tackle feelings, attitudes and behaviors. This can vary from formal psychotherapy to self-help resources.


CBT usually involves these steps:


  • Recognize the troublesome scenarios or circumstances of your life. These can involve problems such as a breakup, sadness, rage, or signs of a mental health illness. You and your therapist can spend some time discussing what concerns and priorities you want to work on.
  • Be mindful of your feelings, sentiments and opinions on these things. When you have established the things, you intend to focus through, the therapist may allow you to express your feelings on them. This could include witnessing what you tell yourself about an observation, your understanding of a scenario, and your faith in yourself, others, and events.
  • Identify misleading or imprecise thought. In order to help you understand trends of thought and behavior that can lead to your question, your therapist can ask you to pay attention to your physical, mental and behavioral reactions in various circumstances.
  • Reshape pessimistic or wrong thoughts. Your therapist is likely to allow you to question yourself if your interpretation of the scenario is founded on reality or an erroneous understanding of what is going on. This move may be difficult. You may have a long-standing mindset about your experience and yourself. Through practice, constructive thoughts and action habits can become a routine, so they won’t require too much of an effort.


Examples of Cognitive Behavioral Therapy


In cognitive therapy we learn to assess negative thoughts when they arise, rather than taking them for granted as being true, and considering if there might be other ways of looking at a situation. Asking yourself some of the following questions, grouped below into three categories, can help you to reframe a distressing situation and see it in a different light.

By taking the time to ask these questions, you can disrupt the thinking-in-circles pattern that typically occurs when we allow negative thinking to go unchallenged. Asking these questions gives you the opportunity to step back from your thoughts a little, slow down your mind, and consider things from a fresher and calmer perspective.


What are the facts?


  • How do I know that my thought is true? What is the evidence (or proof) that my thought is true?
  •  Is there any evidence that disproves my thought? What’s the evidence that this thought might not be true, or not completely true?
  •  Are there facts that I’m ignoring or I’ve overlooked?
  •  Am I using any words or phrases that are extreme or exaggerated such as always, never, forever, should, must, can’t, etc.?
  • Are there any small things that contradict my thought that I might be discounting as unimportant?


Are there any other possible explanations?


  • Can I see any other way of viewing this?
  •  If my best friend or someone I loved had this thought, what would I tell them?
  •  If my best friend or someone who loves me knew I was thinking this thought, what would they say to me?
  •  What evidence would my friend point out to me that would suggest that my thought is not 100% true?
  •  When I am not feeling this way, do I think about this type of situation any differently? How?
  •  Five years from now, if I look back at this situation, might I look at it any differently?
  •  Am I blaming myself for something over which I do not have complete control?
  •  Have I had experiences that show that this thought is not true all the time?
  •  Are there any strengths in me that I’m ignoring?
  •  Are there any positives to the situation that I’m ignoring?


What can I do to help me deal with the situation?


  • Have I been in this type of situation before? What have I learned from prior experiences that could help me now?
  •  When I have felt this way in the past, what did I think about that helped me feel better?
  •  What is the worst that could happen?
  •  What is the most likely thing that will happen?
  •  If the worst did happen, what would I be able to do to cope?
  •  What is the effect of thinking this way?
  •  Will this view help me to deal with the problem? Would another view be more helpful?


Once you’re able to gain a broader perspective, things tend not to be as overwhelming, your mind quiets down, and you can start to see things more clearly. Once you have some clarity, then you can find concrete ways to deal with whatever is troubling you.

Often it helps to actually write out your answers to these questions, as writing thoughts down helps get them out of your head and slow down your mind. And seeing the answers written out in front of you can make them sink in and seem more real than if they are just more thoughts added to whatever is going on in your mind already.



Journaling about your feelings with the intent of identifying the irrational, negative or distorted thoughts and perceptions that accompany them is called cognitive journaling. Cognitive journaling helps you identify and revise your distorted perceptions and irrational thoughts.


  1. You open up to a broader perspective. When you sit down and write about your experiences and feelings, you choose to dedicate a special time window to reflecting on your own life. By putting your emotions and thoughts on paper, you gain some momentum in the process of working through them. They stop being absolute, and you feel less overwhelmed. You imply that they do not reflect the whole of reality, as it may often feel when you’re deep into them. You become, in a sense, an observer of your own thinking.
  2. You can change your views. You get more perspective on your thinking because you force yourself to slow it down. By acting as an observer of yourself, you have a chance to reorganize your thinking, spot patterns in it, and choose to change your mind with the fresh information you discover.
  3. You begin to externalize. Part of the process of healing is to identify your feelings and to externalize bottled-up or repressed emotions.  Unresolved issues can be stuck points to your growth as a person.


Who is a Good Candidate for (CBT) Cognitive Behavioral Therapy?


Cognitive behavioral treatment has been used to combat depression, and there is strong support that it performs as effective as psychiatric drugs for mild to severe depression.

Mental illnesses that respond well to CBT include:


  • Posttraumatic stress disorder (PTSD)
  • Disorders of Depression
  • Anxiety
  • Phobias
  • Obsessive Compulsive Disorder (OCD)


Cognitive behavioral treatment can also be used to combat issues such as binge-eating and other food habits, hypertension, alcohol, sleep disturbances, physical discomfort, attention deficit disorder (ADD), panic attacks, and attitude. If a person is dealing with any of the above mentioned complications then they are suitable enough to opt for CBT.


CBT Strategies

Individuals also have ideas or emotions that perpetuate or exacerbate flawed views. Such beliefs can lead to disruptive behavior that can impact many areas of life, which include relatives, intimate relationships, work, and educational experience.


  • Address Negative Thinking 

It is necessary to learn how thoughts, feelings, and circumstances can make contributions to pessimistic behaviors. The process can be complicated, particularly for people struggling with self-reflection, but it can inevitably result in self-discovery and perspectives that are a vital part of the healing process.


  • Practicing New Techniques 

It is vital to begin pursuing valuable skills that can then be used in real-life situations. For example, a person with drug abuse disorder may begin to practice healthy coping strategies and rehearsals to prevent or response to social situations that could likely cause a recurrence.


  • Progressive Improvement 

In most instances, CBT is a steady method that enables a person to take gradual steps towards behavior interventions. For example, somebody with social anxiety could begin by simply imagining anxiety-provoking social situations. After that, they may start talking to colleagues, relatives, and associates. By steadily working towards a greater goal, the procedure seems to be less difficult.


Bottom Line 

Mental issues are a serious concern and they should be dealt with a hands-on approach. Unlike several other talking therapies, CBT involves coping with your present concerns, instead of dwelling on things from the experience. It assists you to particularly analyze and challenge thoughts and feelings to enable you to achieve a healthier mind. One of the greatest benefits of cognitive behavioral therapy is that it helps clients develop coping skills that can be useful both now and in the future.

26 May 2020
Top 25 Ways To Deal With Depression

Many people think depression is an emotion, often confusing it with just being unhappy. However, depression is a clinical condition and is the leading cause of disability among U.S. individuals aged 15 to 44 years. Depression is fairly common, affecting more than 15 million adults in the United States.

Depression is when you feel sadness, hopelessness, and helplessness and just can’t snap out of it. It may be hard to socialize, meet the demands of school and work, and may even lead to thoughts of self-harm. With depression, the activities you once found enjoyable are no longer bringing any pleasure and the feeling of slipping into a dark place looms over you every day for weeks at a time.

Some people have reported to me that when they are feeling depleted from depression, they just can’t seem to get the laundry done, and the ever-looming pile keeps growing and growing. And yet, they will look at it, and just walk by it due to feelings of overwhelm and being totally unmotivated to take care of it. Other clients have reported to me that they just stopped caring about daily grooming. Finding it hard to shower, brush their teeth and put any make-up on. Weight gain and weight loss can both happen during a depression episode.

The persistent feeling of sadness or loss of interest that characterizes depression can lead to a range of behavioral and physical symptoms. These may include changes in sleep, appetite, energy level, concentration, daily behavior, or self-esteem.

Recognizing an on-going pattern is very important as it can become a very dangerous game for some if the confusion about depression continues unchecked. If you feel that you shy away from what you love or what usually gives you energy then it’s time to examine deeper as to why you are feeling that way. Many people can reach out to find some relief by talking to a supportive family member or friend, but when your own support system is not enough, it is probably time to see a professional counselor. The good news is that treatments are available. But many people who have depression do not seek treatment.

The medical community does not fully understand the causes of depression. There are many possible causes, and sometimes, various factors combine to trigger symptoms.

Factors that are likely to play a role include:

  • Genetic Features
  • Changes In The Brain’s Neurotransmitter Levels
  • Changes In Hormonal Levels
  • Environmental Factors
  • Psychological And Social Factors
  • Adverse Childhood Experiences
  • Lack Of A Positive Support System


Types Of Depression

There are several forms of depression. Below are some of the most common types.


Major Depression

A person with major depression experiences a constant state of sadness. They may lose interest in activities that they used to enjoy.
Treatment usually involves medication and psychotherapy.


Persistent Depressive Disorder

Also known as dysthymia, persistent depressive disorder causes symptoms that last for at least 2 years.
A person with this disorder may have episodes of major depression as well as milder symptoms.


Postpartum Depression

After giving birth, many women experience what some people call the “baby blues.” When hormone levels readjust after childbirth, changes in mood can result.
Postpartum depression, or postnatal depression, is more severe.
There is no single cause for this type of depression, and it can persist for months or years. Anyone who experiences ongoing depression after delivery should seek medical attention.


Major Depressive Disorder With Seasonal Pattern

Previously called seasonal affective disorder, or SAD, this type of depression is related to the reduction in daylight during the fall and winter.
It lifts during the rest of the year and in response to light therapy.
People who live in countries with long or severe winters seem to be affected more by this condition.


Depression Treatment

For mild-moderate forms of depression, psychotherapy is usually the first-line treatment. When the symptoms are more severe or chronic, some people respond better to a combination of psychotherapy and medications.

CBT and DBT psychotherapy are two types of psychotherapy successful in treating depression. It is a way to challenge the negative recurring thoughts that bring you down and to reintroduce affirmations and self-care behaviors. It can also uncover old unresolved trauma issues, even as far back as childhood, that may be contributing to the depression cycles in adulthood.

CBT is the best-proven form of psychotherapy. It sometimes works as well as antidepressant drugs for some types of depression. Some research suggests that people who get CBT may be half as likely as those on medication alone to have depression again within a year.

Medication works well to treat depression. If you also get CBT, your treatment might work even better and the benefits might last longer. Most people who get CBT for depression or anxiety continue to keep using the skills they learned in therapy a year later.

Dialectical Behavior Therapy is a very structured form of therapy based on a synthesis of self-acceptance and change. It incorporates techniques geared toward validation and tolerance, as well as techniques that will improve certain behaviors.

A 2002 study published in the American Journal of Geriatric Psychiatry found that 71 percent of study participants who received Dialectical Behavior Therapy for depression reported to be free of their depression symptoms by the end of the study.

Researchers taught the participants new skills to help manage their negative emotions and life problems, especially in times of crisis. These skills can be especially useful when dealing with the negative emotions you typically experience when depressed.



25 Things You Can Do To Fight Depression

  1. Exercise – This has been my sharpest sword. Try to get at least 20 minutes of exercise everyday, even if it’s just a quick walk.
  2. Eating Well – Depression can lead to overeating or under-eating. Eating better makes your body feel better. Consider eating less sugar and processed foods and eating plenty of protein, fruits and vegetables.
  3. Find a Counselor – Find someone to talk to about the way you are feeling and who can help you navigate the hardest parts of your story. Having a confidential person who is on the outside of your life looking in can often see things friends and family cannot.
  4. Journal – Writing down how you are feeling can bring relief and provide a feeling of “control” that depression can often take from us. You may find it helpful to write a Gratitude Journal: jotting down five things or people you are thankful for each day to keep my mind focused on the good.
  5. 7-8 Hours of Sleep – Another symptom of depression is over-sleeping or under-sleeping. If you’re struggling to fall asleep, try moving all of the screens and distractions out of your room. Give yourself an hour to wind down in the quiet with soft music, a journal or a book. Set an alarm and get up at 8 hours.
  6. Stick to a Schedule — – If you’re struggling, make a few appointments throughout the day and stick to them. Could be a workout time at the gym, going to something at church or a park, even just alone time at a coffee shop. Make a plan to get out of the house and around other people.
  7. Don’t Over-Schedule – Make sure you are not hyper-busy and over-extended. Make sure you have time to relax and recharge.
  8. Go for a Walk or Hike – Not only will the exercise improve your mood, being in nature has shown to ease stress.
  9. Medication – There are many medications out there that have been proven to really help. Talk to your doctor and consider giving it a try.
  10. Avoid Drugs and Alcohol – When at your lowest state, alcohol often seems like a quick-fix and a crutch to numb the depths of your sadness. However, chemicals not only numb the low, they numb the good feelings as well. And can lead to addictions and major health problems.
  11. Set New Goals –Goals give life focus and direction. They help remind people what they are working towards and provide satisfaction when they accomplish them. Set small goals to get instant successes. These will build over time.
  12. Get a Massage – Touch therapies have been shown to ease the symptoms of depression by lowering stress and increasing the feel-good oxytocin.
  13. Meditate and Pray – Daily time in meditation encourages a relaxation response that is very beneficial to your mental health. As prayer can be a great way to ground yourself and connect to your spiritual senses.
  14. Watch Something Funny – Medical research has shown that laughing actually provides relief and gets your mind off your struggles.
  15. Get Around People – In the worst moments sometimes it helps to just get around people. Either strangers at a store or loved ones.
  16. Challenge Negative Thoughts –When a negative thought starts swarming, such as, nobody cares about me, immediately challenge that thought and write down a counterargument. Don’t let those thoughts take hold.
  17. List Your Accomplishments – When you are having negative thoughts and life may feel like it isn’t going anywhere and that you haven’t really done much. Writing a list of those things that you have accomplished, no matter how small, helps to get us unstuck.
  18. Try Something New – New experiences can provide a quick jolt of fun and happiness, a reminder that life is meant to be lived to the fullest. Make time to take that class you’ve always wanted to take. Go visit a new park or ice cream shop.
  19. Take More Pictures –Do one thing every single day that makes your life better or makes the world a better place and photographs it. Then anytime you are really struggling, you can look at the photo album and see that life is in fact worth living.
  20. Write Your Life Story – There are some really cool studies out there that show writing your life story is one of the most therapeutic things you can do because it allows you to document what you have lived through and shape it using your own narrative. You definitely don’t have to share it with anyone either.
  21. Forgive Someone –Release yourself from those angry feelings that may be part of what is weighing you down like a sack of rocks and move on. Just because you forgive doesn’t mean that you approve of what they did.
  22. Listen to Upbeat and Positive Music – We have known for thousands of years that music can change our moods. Create a playlist to use when you are having a negative moment or day.
  23. Make a Bucket List (and check something off) – Similar to setting goals. Print off a list of the things you’ve always wanted to do and hang it up somewhere you will look at it regularly.
  24. Do Something You Don’t Feel Like Doing –By getting unstuck from a pattern of neglecting things you are empowering yourself to see that you can handle things, perhaps one at a time.
  25. Never Give Up – If you’re having suicidal thoughts, please ask for help. Talk to someone you love. Call the suicide prevention hotline at 1-800–273-TALK (8255).


06 May 2020
What Is Self-Esteem and Why Is It Important?

What Is Self-Esteem?


The term self-esteem is used to describe a person’s overall sense of self-worth or personal value. In other words, how much you appreciate and like yourself.

  • Self-esteem is often seen as a personality trait, which means that it tends to be stable and enduring over the lifespan.
  • Self-esteem can involve a variety of beliefs about yourself, such as the appraisal of your own appearance, beliefs, emotions, and behaviors.
  • Self-esteem refers to a person’s beliefs about their own worth and value. It also has to do with the feelings people experience that follow from their sense of worthiness or unworthiness. 


Self-esteem is based on who you are and the relationships and experiences you have had at home, in school, with friends, and in the community. You form an image of yourself based on these experiences and relationships, starting with your parent or primary caregiver. Positive experiences and relationships contribute to healthy self-esteem, and negative experiences and relationships contribute to poor self-esteem.


Self-Esteem Is Important


Self-esteem is important because it heavily influences people’s choices and decisions. For instance, some people really like cars. Because cars are important to them, these people take really good care of their cars. They make good decisions about where to park the car, how often to get it serviced, and how they will drive it. They may decorate the car and then show it off to other people with pride. Self-esteem is like that, except it is yourself that you love, care for and feel proud of. When children believe they are valuable and important, they take good care of themselves. They make good decisions about themselves which enhance their value rather than break it down.


Self-esteem is important because it heavily influences people’s choices and decisions. In other words, self-esteem serves a motivational function by making it more or less likely that people will take care of themselves and explore their full potential.


Healthy self-esteem can help you achieve your goals and can contribute to good relationships with others. It can give you self-confidence. Poor self-esteem can make it difficult to get things done, make you question your abilities, and can even contribute to depression.

Signs of Healthy Self-Esteem


You probably have a good sense of who you are if you exhibit the following signs: 


  • Confidence
  • Ability to say no
  • Positive outlook
  • Ability to see overall strengths and weaknesses and accept them
  • Negative experiences don’t impact overall perspective
  • Ability to express your needs

Signs of Poor Self-Esteem


You may need to work on how you perceive yourself if you exhibit any of these signs of poor self-esteem: 

  • Negative outlook
  • Lack of confidence
  • Inability to express your needs
  • Focus on your weaknesses
  • Excessive feelings of shame, depression, or anxiety
  • Belief that others are better than you
  • Trouble accepting positive feedback
  • Intense fear of failure

Rebuilding Self-Esteem


Rebuilding self-esteem takes time, self-compassion, self-acceptance, patience and mindful action. Here are 4 things you can do to rebuild your self-esteem:

  • Be Mindful of Self-Talk

Negative self-talk can really alter our perspective on the world and our role in it. The problem with negative self-talk is that over time, it can become something which happens automatically – we don’t even realize we’re doing it. In order to change that, we need to start being mindful of our thoughts. We need to consider whether the expectations we place on ourselves are realistic and fair. Whether we allow ourselves to make mistakes and learn from them or make mistakes and erode ourselves with belittling and self-loathing. Try reading daily affirmations.

  • Make An Effort To Practice Self-Care

Self-Care really matters and it doesn’t have to be expensive. The negative self-talk we may be indulging in can become dominating, overbearing and destructive. When we take small actions of self-care, we’re taking back some of the power. We’re showing our negative thoughts that we ARE worthy of care and kindness.  It can be very empowering.

  • Spend Time With People That Give You Good Energy

Sometimes we spend time with people we don’t really enjoy, it doesn’t feel like a choice but an obligation or duty. Sometimes we don’t know how to say ‘no’and so we bend backwards to accommodate the needs of others. Try to spend time with those you actually enjoy spending time with. Those who you would absolutely choose to see. Practice saying ‘no’ to those that bring you down. It’s not easy, but it does get easier over time.

  • Compartmentalize

To avoid feeling overwhelmed or not good enough, try breaking things down into smaller chunks. Each time you complete a micro action, your faith in your abilities will grow incrementally over time. Smaller actions tend to be achievable, maintainable and not at all overwhelming. Learn to create small successes.


27 Apr 2020
Creating Structure With Your Children At Home

During the current pandemic most children are at home and will not be returning to school or daycare for many weeks to come.  This can create chaos in the house and make parenting a difficult and sometimes overwhelming experience.  This article is about creating a structure in your home so that its not becoming a never ending free-for-all.  Let’s look at some common behavioral challenges and how structure can help you, as a parent, to reduce some of these problems.


Consistent routines and rules help create order and structure your day. Things go more smoothly when you and your child know what to expect. When things are reliable and predictable it can relieve anxiety and apprehension.


It’s normal for young children to test the limits. That’s how they learn what is right and wrong. But, it can be frustrating and really test our patience as parents! One way to keep control and help children learn is to create structure. Structure is created by consistent routines and rules. Rules teach children what behaviors are okay and not okay. Routines teach children what to expect throughout the day.


Structure helps parents and their kids. Kids feel safe and secure because they know what to expect. Parents feel confident because they know how to respond, and they respond the same way each time. Routines and rules help structure the home and make life more predictable.


Three key ingredients to building structure in the home:

  1. Consistency
  2. Predictability 
  3. Follow-through




Consistency means that you respond to your child’s behavior the same way every time no matter what is going on or how you’re feeling. Misbehaviors are less likely to occur again if you always use the same consequence, like ignoring or time-out. Good behaviors are likely to be repeated if you let your child know you like them. This doesn’t mean that you need to give consistent attention to ALL of your child’s behaviors. Think about something you want your child to do more often. This could be sharing, cleaning up, or following directions. To increase those behaviors, praise them each time you see them occur. Your consistent response will help those behaviors happen more often.




Predictability means your child knows what will happen and how you will respond. When your daily routines are predictable, your child knows what to expect for the day. When your rules are predictable, your child knows how you will react to her behavior.


Follow Through


Following through means that you do what you say you will do in response to your child’s behaviors. This is often called the “say what you mean and mean what you say.” If you tell your child a behavior will be punished, you punish it every time it happens. If you tell your child he will be rewarded for a behavior, you give him the reward after he has done what you asked. To be consistent and predictable, we need to follow through. Follow-through is important for ALL behaviors. This includes behaviors we like and don’t like. Use the Reward Menu and Consequence Chart (below)


Reward Menu


The concept of a reward menu is to have incentives that you can easily use to promote desired behaviors.  Poll the child/children to see what kinds of things they would like and create a list with a variety of their choices that you agree to provide. Some items may be food rewards, video game time, staying up late, getting out of a chore, reading a book with mom, etc.  The menu can offer the five to ten most popular choices. 


Consequence Chart


The concept of a consequence chart is to get your child/children to participate in their own punishment choices for 3 levels of infractions.  This process creates a kind of contract with the kids.  For each level, negotiate up to 4 consequences. By doing this at a time of calmness and cooperation, executing it during a battle becomes a much easier way to enforce the consequences.  Also, you as a parent have a ready made list of choices that are appropriate for the right level of infraction.  It is probably not fair to be on restriction for 3 months for leaving the lights on.


  1. Level 1:  YELLOW ZONE – minor infraction
  2. Level 2:  ORANGE ZONE – moderate infraction
  3. Level 3:  RED ZONE – major infraction


Bedtime Routines


Establishing a bedtime routine is very important. This routine includes what your child does before bed and where your child sleeps at night. It may be helpful for the routine to include things that help your child relax, such as reading a story. Once you decide on the activities for the routine, talk about it with your child. Some parents like to make the routine into a song and sing it with the child. For example, you can sing, “After you take a bath, we’re going to put your PJs on, brush your teeth, get you in your bed, read a story, and then it’s time for sleep!” Your child may try to push the limits and get a “few more minutes” of awake time before sleeping, but do not allow this. At the end of the routine, leave your child to sleep. By creating a bedtime routine and sticking with it consistently, your child knows exactly when and where she should be sleeping.


Troubles With Transitions


Having trouble getting your child to go from one activity to another during the day? Daily schedules can help because they take the surprise out of what will happen next.


A structure that helps your child learn to behave has routines and rules that are consistent, predictable, and have follow through. There is a basic routine you follow and rules you live by on most days of the week. You set appropriate expectations and limits for your child’s behaviors. Your child learns how you are going to respond to behaviors that are okay or not okay.


Daily schedule


  • Wake up at 9:00 a.m. 
  • Cartoons until breakfast at 9:30 a.m.
  • Get dressed for the day
  • Snack at 11:00 a.m.
  • Art or Science activity until lunch
  • Lunch at 1:00 followed by nap/quiet time at 1:30 p.m.
  • Outdoor play following nap or quiet time around 2:00 pm
  • 3:00 pm Snack and Video games/TV/reading
  • 4:00 pm chores (older kids)
  • Prepare dinner around 5:00 p.m., eat around 6:00 p.m.
  • Bath time around 7:30 p.m.
  • Read or do something together, like a game or art project, around 8:00 p.m.
  • Pajamas, brush teeth and then to bed by 8:00 p.m. (younger kids)
  • Read story and quiet/asleep by 9:30 p.m. (older kids)




  • Instead of looking at large time blocks, make the day into short, manageable chunks (think 30-minute blocks).
  • Be flexible! Don’t stick to the time listed in the schedule, it’s more about flow. If the kids are playing nice – don’t stop them because the schedule says it’s snack time. Let it be.
  • Adjust this to fit your child – you know your kid(s) and what they need. You know how long they can tolerate certain activities. Adjust for them.
  • Don’t rely on screen time to save the day: use screens as your tool and reserve it for when it’s crucial.
  • It’s important to give some of your time to engage in activities with the kids, but also encourage some independent play for kids so you can get some time to yourself also.


26 Feb 2020
New Things In Counseling: NEUROPLASTICITY

This is a new day for psychotherapy and the understanding of how counseling works. It is much more than just talking to vent our frustrations, or get validation from a professional person. The challenge is to create new neuropathways to establish and sustain positive change.

I really love YouTube as it often has short videos on key concepts so that we can all understand some of these complex issues. I will be posting links to some of my favorite things so that you can benefit from these little gems.


05 Jan 2020
Understanding Play Therapy

I have met many therapists that see play therapy as a way to build a rapport with children but can not articulate beyond that. Play Therapy is a very special kind of treatment, if done properly, to create a verbal and non-verbal expressive clinical environment to work with children that are suffering from a variety of mental health issues. The play therapy rooms at my offices are set up with 5 standard kinds of toys found in a well-designed setting. All of our therapists get the play therapy training needed to ensure a relevant and effective treatment experience for you and your child. Good treatment is far more than just playing board games with a counselor.