Take Good Care of Yourself


5 Tips to peaceful sleepI have had a couple of things I have been working on, don’t have anything I feel ready to publish just yet, but ran across this from Center for Greater Good on how getting enough sleep is good for your relationships.

There are so many places where therapists talk about taking care of your mental health and end up talking about taking care of your physical health. Eating right, getting some exercise, and sleeping are all helpful. We know that the brain, the organ of thought and emotion, depends on proper care to work properly. In addition to the physical and obvious benefits of good nutrition, exercise, and sleep, there’s also the benefits in terms of a sense of self-efficacy– the sense that “I can do something that works.” In the case of self-care, this also dovetails nicely with self-soothing or self-nurturing, take your pick for what you want to call it.

There are times of extreme emergency when we can’t take a time out to self-nurture or self-soothe, but these are relatively rare. Even if I’m freaking out about taxes on April 14, I can still file an extension. I just need to get over my freakout before the extension expires. If I have a lifestyle that depends on the creation of crisis after crisis, that’s another conversation for a different time.

Many years ago, when AIDS was still a death sentence, I learned about some research that found that one group of women who were diagnosed with AIDS lived about six weeks after diagnosis. Given the nature of the disease, this was a shockingly short time, even before there were any medications. What further investigation showed was that these women were so busy taking care of others that they wouldn’t go to the doctor to get any help for themselves until they were nearly dead. The point here is that adequate self-care is also helpful to other people in your life. Taking care of yourself adequately means there’s less strain on others who might otherwise have to care for you, and you also have a greater capacity to help others in your life who you may wish to nurture.

For now, just recognize that when you take good care of yourself, you are also improving your ability to have good relationships and over all health. Self-care is not selfish.

image from https://www.sleepingfactor.com/deep-sleep-techniques/5-tips-to-peaceful-sleep/

The site from which the image was taken has some good tips on healthy sleep as well.

Posted in behavioral health, physical health | Tagged , , | 2 Comments

The Parable of the Shopping Cart

Have you ever gone to a supermarket, gotten a shopping cart, started to push it up the aisle, and realized that it tended to pull to the right (or left)? It’s like a car that needs the alignment done. At first you don’t think much about it. You just compensate by pushing it a little more to the left (or right) to make it go straight. But if you speed up to get down an aisle where you don’t need anything, you have to push more forcefully to keep it going straight. If you load the cart with a lot of groceries, as it starts to get heavier, you have to push harder to keep it going straight. If you try to go fast while it’s heavily loaded, then you have to push really hard to keep it going straight. It’s easier to just slow down. Of course with a car, you have motivation to get the alignment done– you don’t want to wear out your tires. That’s where the metaphor turns a psychotherapist into the equivalent of your mechanic, but I’m sticking with the shopping cart for now.

Can you relate the shopping cart image to other areas of your life? I’ll bet you can. My clinical experience is that we all have certain tendencies as to how we react to various stressors in life. Specifically, some people will become more anxious when stressed, and some will become more depressed. Some of us may experience both, depending on the stressor. When the shopping cart of my life is too heavily loaded, or going to fast– or both– I have to push harder all the time to keep it going straight.

If we go back 200+ years, the idea that people had basic personality types was well established. There were supposedly four humors, the predominance of one or the other leading to the four temperaments. In more recent times, theories of personality have been reworked in various ways, but most people would agree that we all have characteristic ways of being in the world. So, in shopping cart language, some of us are more likely to pull to the left, some of us to the right when we get overloaded or in a hurry.

For people in therapy, it’s a reminder to take care of ourselves without becoming self-victimizing through “should” statements about how we wish we could perform. To give a physical example, if my doctor has told me that I have a back problem & will aggravate it if I lift more than a certain amount of weight, I’d best follow the advice and not try any heavy lifting. Unfortunately, psychological conditions are not always as clear-cut, and family, friends, and employers are not always understanding.  I’ve heard from so many clients whose friends and family have told them to “Just snap out of it” or “Pull yourself up by your bootstraps” or equivalent, unable or unwilling to accept that a mental disorder can impose limitations on what a person can do. Psychological problems can be disabling, and not taking care of ourselves because the problem is invisible can only make things worse. That’s why it’s good to have some kind of self-care plan already in mind, before things start to go sideways. That’s why we want to take time to think about what can make us feel good, what can get us through a hard time, and have a self-care plan in advance. It’s good to be able to have someone to talk to, but it has to be someone who understands. Otherwise, I may be better off binge watching stand-up comedy on Netflix. I also have to be able to say “no” to people,  especially during the holidays. I may not be able– emotionally– to attend one more holiday gathering, pick up one more kid in the car pool, or bring an additional dish to the potluck. When I feel the cart start to pull, I slow down– before I crash into the shelves. And I don’t overload it, either.

image from: https://wwl.radio.com/articles/study-shopping-cart-handles-are-full-bacteria

Posted in behavioral health, choices, Distress tolerance, mental health | Tagged , , | 2 Comments

Did You Plant Cotton?

Image result for field of cottonSooner or later,  people come to some issue where they may want to go it alone, but they need help. I sometimes confront people, but in a way I hope is gentle. I take hold of my shirt sleeve and ask rhetorically, “When I wanted a shirt, did I go out and plant cotton?”

Depending on how it goes from there, I may go on to point out that when I bought the shirt, I relied on someone to plant the cotton, someone to harvest it, someone else to take the cotton to a place to be spun into thread, someone else to put the thread on a loom to weave cloth, someone else to make the cloth into a garment, and a veritable fleet of truck drivers to transport the intermediate and the final products. Everyday life requires us to be dependent on others for many things. In fact, the division of labor makes life better for us. There are many examples: even the most talented musician is unlikely to be able to play violin, viola, clarinet, oboe, french horn, trumpet, tympani– everything in a symphony orchestra– and even if they could, they couldn’t do all of them at once. It’s the collaboration of the group that makes for the beauty and power of the orchestra.

Why, then, is it so hard to allow ourselves to be helped when it comes to mental/emotional issues? Well, of course, sometimes we are more open to it than others. We may get help from family, friends, a spiritual director or pastor, or see a therapist.  But it is complicated, no question. Perhaps a family member is too involved to be a disinterested helper. Sometimes a friend is too quick to jump to problem solving and has a hard time listening. But the barriers to getting help can be inside us, as well. Maybe we have a hard time talking about it, or don’t trust anyone, or are inhibited for any one of a number of reasons. Perhaps a pastor of spiritual director will direct us to a therapist because the issues are outside of what is considered the scope of a spiritual director.

By the same token, we can get advice from others who have been through similar experiences. We can ask other parents, what did you do when your kid just couldn’t seem to get their homework turned in? Who did you find who was a reliable handyman to fix the front steps? What was it like caring for your elderly relative with Alzheimer’s? And there are, of course the 200+ twelve step programs,  all based on the idea of one sufferer, who has been through a similar experience, helping another. Being networked in to a community, being part of an interdependent group, is likely to help. If you already are a cotton farmer,  go ahead and plant cotton. But I’ll bet that even cotton farmers go to the store to buy their cotton clothing. It’s OK to depend on others.

Posted in behavioral health, mental health, Uncategorized | Tagged | 2 Comments

The Boy Who Wanted to Be Happy

man beach sea coast sand person people boy vacation male model spring africa child black fish season muscle beauty african network south africa africans photo shoot barechestednessI have found myself recounting this story many times in the course of my professional work, most recently in the week just past. I read it many years ago in a collection of children’s stories, and I associate it with my being in what was then called junior high school, now middle school. In my vague memory, the story was attributed to a West African folk tradition. I have looked for it in various ways a number of times over the years and have never found a version that seemed like the one I remember. Memory is a fallible thing, as we know. If anyone recognizes it & can direct me to a reasonable facsimile, please feel welcome to contact me. I am not going to try to represent the story in its original form; just the bare bones plot details as I remember them.

A boy was fishing at the river, and he caught a magic fish, which promised to grant him a wish– a single wish– in exchange for being released back into the river. The boy wished, “I want to always be happy.” The fish, being a wise as well as magical fish, encouraged him to think about his wish carefully, but the boy persisted. What could be wrong with always being happy? So, poof! the wish was granted and the boy immediately felt very happy, and released the fish back into the river.

On returning to his village, he found that his family’s house had burned down. People were lamenting this unfortunate event, especially the rest of his family, but he was very happy. Everyone thought this was at least odd, if not downright disrespectful, or worse. Then he went into the jungle, where he soon found himself being chased by a lion. As he ran for his life, he noted that he was very happy, and even realized that if he were scared, he might be able to run faster. He then had several other adventures in which happiness was not called for. He finally went back to the river, was able to recapture the fish, and wished to always have the right emotion for whatever befell.

So many times, I have been with someone who bemoaned feeling anxiety, or depression, or another negative emotion. Yet, negative emotions are appropriate to negative events. Depression is not a mental disorder. Anxiety is not a mental disorder. If I have just lost my home to a hurricane, it is a time for depression and sadness. It is also a time for action. If I have anxiety about being able to retire, my worry about the future can lead me to save money today. If I am depressed and anxious about my health, it may lead me to start exercising and to stop having seconds on chocolate cake. A depressive disorder is when my depression impairs my ability to have a life, or is so severe that it immobilizes me, making it impossible to work toward having the life I want. An anxiety disorder is when my anxiety prevents me from living my life, or makes it incredibly distressing.

This also means that when I recover from a mood disorder, I cannot expect to be free from negative emotions. I will still be depressed or sad when bad things happen. I will still be anxious when I worry about the risks and uncertainties of life. What recovery means is that I can still work toward having the life I want, whether it means climbing up out of setbacks to get on level ground again, or setting out to climb the mountains of my goals and aspirations.

image source: https://pxhere.com/en/photo/1332002


Posted in anxiety, behavioral health, Depression, Emotions, happiness, mental health, Uncategorized | Tagged , , , , | 2 Comments

Resources on Youth, Vaping & Cannabis

https://cdn.schoolloop.com/uimgcdn/aHR0cHM6Ly9jdW5oYS5zY2hvb2xsb29wLmNvbS91aW1nL2ZpbGUvMTUwMDE3ODk3MzczNS8xNTIyNzQxMDk1MzEwLzY3NTkwNzc0NTM0MjcyMzQ0MTQuanBnI want to thank all the parents and youth who came to the cannabis forum informational event last Wednesday, October 17 at Manuel F. Cunha Intermediate School.You were very kind to me and to the other presenters. I was told that a link to this post was going to be made available to school parents and I see some people have already visited.

There are a great many sources of information about these sometimes controversial topics, and I have tried to limit myself to sources which I believe to be factual and to the extent possible, not controversial.

One of the things that we talked about at the forum is the fact that there are multi-billion dollar industries which want people to use nicotine and either the whole cannabis or its extract, THC. The purveyors of nicotine drug delivery systems are quick to point out that vaping is safer than smoking (still a somewhat controversial claim), but neglect to point out that breathing pure air is safer than vaping. The purveyors of THC will point out that you won’t suffer respiratory failure from THC overdose the way you do from alcohol overdose, but they won’t go out of the way to say  you are  at still more likely to crash your car if you drive high. Soda manufacturers won’t tell you that sugar rots your teeth, either. That’s life in America.

I have always strongly believed that knowledge is power, and I hope this will empower parents in talking to their kids. As I said at the forum, it’s never too soon to talk to talk to your kids about these risks, but you want to be armed with honest facts, not vague claims of, “it’s bad for you.” As Dr. O said so eloquently at the forum, you want to have the kind of open, loving relationship with your kids where these kinds of conversations can happen honestly.

Here are some web sites that give information on youth & substance use and substance use disorders:

The TEDS Report:  Age of first use of substances among people age 18-30 when admitted to substance abuse treatment programs.

FAQ’s from young people on alcohol/drug use from NCADD, 

Tobacco Prevention Tool Kit from Stanford.

SAMHSA free store of publications on a wide variety of topics.


In my own words, list of diagnostic criteria for substance use disorders:

  1. Had times when you used more, or for longer than you intended?
  2. More than once, wanted to cut down or quit, but you could not?
  3. Spent a lot of time getting it, using, it getting over the effects?
  4. Experienced craving?
  5. Using interfered with fulfilling job, family, or school obligations?
  6. Continued to do it even though it was causing problems with family & friends?
  7. Reduced or quit other activities that were important or interesting?
  8. Got into risky or dangerous situations due to use (for example, driving intoxicated)?
  9. Continued to use even if it made other problems, like depression or anxiety, worse?
  10. Experienced tolerance– having to use more than previously for the same effect?
  11. Experienced withdrawal– got sick from not getting it, or had to use a replacement?

mild= 2 or three symptoms

moderate = 4-5 symptoms

severe = 6+ symptoms

example: I want to vape, and if I don’t get to, I get cranky, irritable, and won’t feel right until I do. This would be criterion # 4, craving, along with #11, withdrawal, so right there I have a mild nicotine use disorder. If I get in trouble with my parents because they don’t want me doing it, and I risk getting busted because I’m using under age, one could say I meet #6 and #8, so that’s a moderate nicotine use disorder. The whole thing is not as clear-cut as this necessarily, but this gives a rough idea of how it works.

For a different view, here is the ASAM addiction definition  from the American Society for Addiction Medicine.

Statistics and studies on youth substance use:

NIDA (National Institute on Drug Abuse) pamphlet on vaping

NIDA teens & e-cigarettes

New Yorker article on JUUL

Centers for Disease Control and Prevention fact sheet on tobacco


Monitoring the future 2017

This is a national survey on youth and a wide variety of drug issues.

With introductory remarks & some additional links to vaping/cannabis info:


National Survey on Drug Use and Health (NSDUH) 2017 This is a summary. The full NSDUH runs hundreds of pages and is a treasure trove for statistics nerds.

California Healthy Kids Survey is a statewide survey on a variety of issues including drugs, alcohol, tobacco, mental health, school safety.

CANNABIS HEALTH EFFECTS SUMMARY  This is the conclusions summary of a committee  from the National Academies of Sciences, Engineering, and Medicine after an extensive review of the literature on the effects of cannabis. Highlights include that the committee found that there is substantial or conclusive evidence that cannabis is effective for chemotherapy-induced nausea and for treatment of chronic pain in adults and other potential benefits of medical use.

On the other hand, the committee also found out that there is substantial evidence for a statistical association between cannabis use and increased risk of motor vehicle crashes, substantial evidence of a statistical association between use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users, and moderate evidence of a statistical association between use increased incidence of suicidal ideation and suicide attempts with a higher incidence among heavier users.

The committee also found substantial evidence that initiating cannabis use at an earlier age is a risk factor for the development of problem cannabis use.

October 30, 2018 update: article on adolescent cannabis cessation from NPR

Please feel welcome to contact me.




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Pay Attention When I’m Talking to Me!

little girl talking to herself in the mirror

Just want to follow up on the last post, because I met with a client earlier a couple of weeks ago who specifically wanted to start working in a cognitive way. The hardest part of doing cognitive therapy, I’ve found, is to start. This makes doing cognitive therapy a lot like everything else, of course, but I’ll forego a juicy opportunity for digression.

The thing is, when we think, we are talking to ourselves. Thinking is not an automatic pronouncement of absolute truth, a description of absolute reality, or anything else. It might be a pronouncement of absolute truth, a description of absolute reality– but most likely not. What it usually is, is an inner monologue. Sometimes, it’s true, we may think in music, or think in images, but mostly we are talking to ourselves, either consciously and deliberately or not.

Cognitive therapy involves looking at this inner monologue and challenging the cognitive distortions. So if I’m feeling depressed over a failed relationship I might tell myself, “All my relationships fail. I’ll never have a successful relationship.” One cognitive distortion there is fortune telling. Another one is all/nothing thinking. In this case, the two overlap. Even the assertion that “All my relationships fail” may be suspect– perhaps if I review my relationship history I’ll realize I have sometimes dumped other people, or we called it off mutually. Even if I determine that I was dumped every time, I will likely have to admit that the relationships worked for a while. In short, the statement was not a statement of absolute truth, it was a judgment call– and I may have slanted the judgment against myself!

But the hardest part for so many people is to recognize that what I’m looking at here is my own inner monologue, not a statement of objective truth or reality.  The best statement I ever heard about this process came, as so many pearls of wisdom have, from a client. She said, “When I’m talking to myself, paying attention is a form of self-respect.” Listening carefully to the inner monologue and recognizing it as my own voice, talking to me, is a sometimes difficult but invaluable step in being able to change.

Image source: https://www.mnn.com/health/fitness-well-being/stories/go-ahead-talk-yourself-its-good-you

Note: the image source also includes a post about the practice of deliberately talking to oneself and why it helps. Here I’m writing about something significantly different, the process of being mindful of one’s own inner monologue, which seems (and may be) spontaneous and unguided, and the recognition that it comes from me.


Posted in behavioral health, change, cognitive therapy, mental health | Tagged , | 1 Comment

Power Tool Safety

Hardware Power Tool, Vector Files

A theme that I come back to again and again in my work with clients is that one’s mind is powerful. My joke about that is that you need to use such a powerful tool safely. Another thing to keep in mind– and we learn this from mindfulness practice–is that you are always thinking. You may be thinking about what you want for lunch, or you may be thinking about the kid that bullied you in second grade, or you may be thinking about a revolutionary way to deliver behavioral health care. It’s all thinking. Additionally, you may be flooded with emotions of various kinds, be hearing mental music, or other kinds of mental processes may be going on, but whatever is happening, the mind is always on.

One of the most salient examples of how we think– again, one that comes up repeatedly– is how “should” statements work. When I first started studying cognitive therapy, this one baffled me, I’ll admit. Isn’t it true that people sometimes should behave in certain ways? Isn’t it true that we should be polite, be considerate of others, be responsible for ourselves, and a long list of other shoulds?

Albert Ellis, who famously originated REBT, used to tell people, “You’re shoulding all over yourself!” When I first began to understand the problem with should statements, I realized that they are comparisons.  The world is one way, and we want it to be another. I used to tell people that when they used should statements, they were at war with reality, and reality would always win. That seemed harsh to me, and I looked for a different way of putting it. One day I came up with an alternate frame. I told my client, “Every time you say ‘should’ you just created a parallel universe where things went differently.” This is in keeping with my view that each of us has a very powerful creative mind. Our minds are so powerful that we can, with a single word, create a parallel universe where things went differently. It also takes the harsh, judgmental edge off of spotting our shoulds. It’s OK to wish for something different; we just want to recognize that we don’t have it.

From whatever trick of language, however, the should always comes out as a kind of accusation: you should be better– but you’re not. You are, in fact, bad, and in addition to being bad, you’re shoulding all over yourself.  Dang, Dr. Ellis! I already feel bad– that’s why I’m in therapy! Can’t you be a little nicer? Well, any therapist will tell you that sometimes you have to give people bad news, and sometimes you have to be blunt.  But the flip side of that is the well known saying that diplomacy consists of telling someone where to go so nicely that they look forward to the trip.

To me, that’s the whole thing about having the  power to create a parallel universe where things turned out differently– with a single word. So to come back to my original puzzlement with the problem with should, there’s absolutely nothing wrong with visualizing a world where people are polite, are considerate of others, are responsible for themselves, and so on. It’s just that it’s a goal statement. Of course people want a world where people are polite, considerate of others., and so on. To crib yet another trite and true statement, for your dreams to come true, you must first dream. But the problem arises when you forget that it’s a goal, not a reality. “I should be more assertive.” “I shouldn’t be so depressed, anxious, obsessive…” Language is such a weird tool, isn’t it? Try saying it this way: “I want to be more assertive.”  “I want to feel more relaxed, more positive…” Now it’s a goal statement, not an accusation.  Now I’m using that power tool– my mind– in a safer, dare I say it– saner– way. I’m trying to get to a better place, not condemning myself for not already being there. And taking credit, as well as responsibility, for being a powerful, creative person.

Image source: http://clipart-library.com/clipart/76963.htm

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