Saturday, December 13, 2008

Nutrition and Mental Health Part 2: Treating Anxiety

While treating anxiety can probably best approached with cognitive behavioral therapy and gaining an understanding of the environmental cause-effect relationships and behavior chains via SRT (see previous 3 part blog), herbal remedies are gaining popularity since their acceptance (note: short of an endorsement) by the FDA in 1994. As with herbal remedies for depression, many of these cures affect brain transmission and neurotransmitters directly, so an immediate benefit can be appreciated. Many of these cures have active ingredients that were isolated by pharmaceutical researchers and used in the production of anticonvulsants, anti anxiety, antidepressants and other branded medications that slow down brain activity. The herbal source, however, is often kinder to the kidney and liver as they are buffered and diluted in their natural state.

Let's consider a few anti anxiety remedies:

Kava Root: Perhaps the most popular and also the most maligned because of its potential to reach toxic levels in the body. Recent research has confirmed that this plant is effective in lower doses administered several times a day, reducing the likelihood that a toxic threshold will be reached. It is particularly found effective in the treatment of agoraphobic and social anxiety disorders.

Valerian: A recent up and comer in the treatment of anxiety, this plant originates in Europe and has been long known for treating insomnia. Valerian extracts interact with the GABA and benzodiazepine receptors in the brain. It is often used to help people wean off of Librium and similar pharmaceuticals that are cause for physical dependence. It is very successful in the treatment of anxiety disorders that coincide with gastrointestinal disorders, such as irritable bowel and acid reflux.

Passion Flower: This exists in many forms and varieties. It contains betacarboline harmala alkaloid, which was isolated to formulate Monoamine oxidase inhibitors (MAOIs), a once popular antidepressant. As is the case with its purified form, the use of passion flower has many undesirable drug and food interactions, so it must be used with caution. Their particular value is in treating anxiety secondary to mood disorders. particularly bipolar type 2.

Because anxiety and depression are so closely related, many of the recommended cures overlap and are effective in treating both. I have tried to isolate the 3 mood and affect herbal remedies that pertain the most to anxiety disorders. In the next section, we will target the treatment of depression through natural dietary supplements.

Sunday, November 30, 2008

Nutrition and Mental Health Part 1

I received a letter recently asking me if I take nutrition into account in treatment of common psychiatric disorders. Well the simple answer is yes and there are several facets here to consider. I will try sort this out and delineate the nuances of diet and supplements as it relates to a healthy mind.

The 1st consideration is that we as human organisms are defined as a biological and physiological system. In maintaining a healthy body through diet and exercise, we also keep our minds healthy. In keeping a healthy mind, we interact in our environment with good judgment, graceful movement and compensation with the world around us. We are less likely to be accident prone, put undue stress on our joints and spine, or take risks that are cause for injury. In past blogs I have continuously referred to this mind-body dualism, but it can not be understated. The health of one is innately tied to the other Therefore practices that promote the health of both body and mind are of the utmost importance.

A good example is the use of omega fats in the diet. Popular health nutrition has pointed recently to the importance of the use of unsaturated fats, with an emphasis put on omega 3's and 6's. Monounsaturated fats, such as olive oil, have long been touted in improving cardiac and vascular health. So why are these fats so important in promoting physical and mental health? While referencing several valid overall biochemical reasons, I will highlight their importance in mental health.

Omega 3's contain DHA (decosahexaenoic acid), which is vital in cell replication and structural integrity for the entire body. Brain cells are no exception. Not only are they important in maintaining healthy brain cells, but these fats are highly concentrated in the the synapses, where brain cells communicate with one another. The smooth and consistent firing of neuropathways are profound in their benefit to mood. Cultures that have a high intake of Omega 3's such as Japan have statistically lower rates of depression. A healthy brain is a happy brain. These fats directly effect the structural integrity and functioning of brain and nervous system.

Omega 6's benefits are more indirect. They are significant in maintaining vascular health. So this lowers the risk of stroke and allows for increased circulation. The blood-brain barrier becomes more unrestricted and allows for oxygen and nutrients to pass, nourishing the brain cells.

Another aspect to consider in terms of the viability of these fats is that polyunsaturated fats can not be reproduced in the body. Consumption of plant or animal is the only way to obtain these. As soon as they are processed or taken out of their natural state (e.g. the plant is cultivated, the salmon is killed), they begin to degrade and dissipate. This puts and emphasis on freshness and simplicity in menu planning. Along with fish these healthy fats are found in high concentration in nuts, seeds and legumes.

Another consideration is a balancing the intake of the 3's and 6's in your diet. I believe this is a little overblown by nutritionist because both of these fats are good for you and what the body doesn't need it will metabolize. However, 3's are more difficult to obtain in modern diets, so reading labels or researching content may be beneficial, Additionally, these fats are also found in caloric foods and if you are trying to restrict your intake of all fats for this reason, composing a diet that has a 1:1 ratio of 3's and 6's is what is recommended by most nutritional researchers.

We have often heard to fish referred to as "brain food." This points to the high concentration of omega 3's in these foods. Fish has many other health benefits of course, as it is an excellent lean source of protein. In terms of nutritional supplements, however, please consider flax or hemp seed over fish oil. These supplements contain up to 7 times per weight more of the omega 3 and 6's than salmon oil does.

I will be writing more about specific nutritional treatment of mental disorders in part 2 of this blog module, but i wanted to kick it off by highlighting the importance of healthy fats in our diet, because they probably have the single most impact on the way we think, feel and adapt to the world around us.

Sunday, November 9, 2008

Treating Anxiety Part 3: reactive elements and body awareness

In parts 1 and 2 of this series, I examined the nature and course of anxiety as it occurs and techniques to break the escalation of anxiety in the comfort of your home or in a clinical setting. Because anxiety is cumulative, there is some benefit to seeking a reduction at anytime we feel overwhelmed with stress, even after a long day. It gives us an opportunity to "reset" and reverse the mounting pressure that our rigorous activity brought forth and put us in the proper state of mind to truly enjoy our recreational and leisure portion of the day. But addressing stress as it occurs, in the social milieu, presents an even greater challenge. When suddenly confronted with a profound external stressor, we often lose that part of us that is the most grounded and pragmatic. So the question becomes, how can I maintain control when I am at my absolute worse?

In part one, I mentioned taking "stress breaks" throughout the active part of your day, utilizing the lunch or personal time appropriated to you. You have developed some stress reduction techniques at home, but because you lack the privacy and resources to fully implement these techniques in a work, school or community setting, it is beneficial to bring SRT into play by creating "portable" versions of these techniques to implement when you have a few moments or even seconds to yourself in these settings.

Meditation and positive visualization are possible anywhere. The most important element here is being well practiced enough at home to jump quickly into the technique in more formal settings, if even for just a brief period of time. Someone who is well-practiced at home can quickly let their mind "empty out," if for just briefly before regaining focus. And break time is an opportunity to take stress on for an even more extended period of time.

Recently a client with and anxiety disorder had some moderate success with deep breathing and meditation in the clinic setting and home. The panic attacks continued at school, however. These attacks included increased heartbeat and profuse sweating. I told him he needed to take time out during the school day and deep breathe and relax. He stated he thought this impossible because he would become self-conscious, aware that others were observing him taking deep breaths. My rational response was what did he find more embarrassing, him taking deep breaths or his shirt becoming soaking wet from perspiration? In fact, there is nothing embarrassing or impractical about breathing in this manner when sedentary or involved a moderately paced activity. And there is absolutely no benefit to displaying tension to others by taking short breaths and speaking in a pressured tone. People respond positively to those that exude calmness and confidence in any formal setting.

In order to claim this calm and confident persona, we need to examine our everyday physical orientation and movement in the workplace. How you sit at your desk chair and get up from it, for example can set the tone for the way you react to stressful situations. Are the muscles of your neck and spine overly tensed? Or do you sit slouched with your shoulders slumped in a submissive manner? Either one will contribute to anxiety when exposed to a stressful situation. Extreme muscle tension causes bodily discomfort, which in turn makes our mind even more confused and less adept to deal with adversity. Slouching passively is cause for unpreparedness and ambush when we our suddenly challenged. The happy medium is a healthy orientation of your head, neck and spine. Sitting upright, shoulders pronounced but not locked square as if at attention, is the correct stress reducing posture. Your neck should allow your head to be slightly forward, but not tilted downward or fixed upright. You should feel a widening in your lower back, as the orientation of head and neck allow the muscles along your spine to relax.

The movement from office chair to copying machine or from classroom to classroom should be scrutinized also. Anxious people tend to move about in a twisting, herky-jerky fashion. They think in terms of function, quickness and utility as opposed to their physical well being and comfort. Do you pop up out of a chair suddenly and automatically with a focus on your destination or the next task at hand? If so, you are reinforcing stress. You are placing unneeded tension on your joints and spine, and once again experiencing that discomfort that is cause for even more confusion and anxiety.

Take on the task of improving the most fundamental physical ergonomics in your day to day activities. Concede that these debilitating repetitious movements are taken for granted and never scrutinized. Resolve to partake in a deliberate and fluid physical motion. Unlearn the repetitious motor movements of your body that are cause for physical and mental tension. Reinvent your physical orientation and increase your awareness in those places were you experience the most stress. Both mind and body will be that much better for it.

This concludes my clinical insight on the practical treatment of the infliction of stress and the experience of anxiety. Hopefully you have achieved an awareness and knowledge of how anxiety manifests itself, the tools and techniques to keep it at bay and the means to take it on where it is most likely to have it most profound effect, in the places where you struggle everyday for achievement, income and recognition.

Sunday, October 26, 2008

Treating Anxiety Part 2: stress reduction techniques

Empowerment is the key to a stress reduced life. I say reduced as opposed to free because we all experience stress on some level. Deadlines from work, difficulties with significant relationships and financial dealings to name a few. It's more the way we react to these situations than the content or magnitude of the challenge that makes it debilitating. A former friend of mine's favorite saying was "it is only a big deal if you make a big deal out of it." And although I wanted to slap him upside the head when he evoked this after my pet died, there is some truth to it.

We need to control and quantify our reactions to challenges and setbacks as they occur. So developing a repertoire of stress reducing and controlling techniques is a valuable weapon in the battle against anxiety disorders. Being comfortable and well practiced with them is probably the most difficult facet in being successful with them. When we feel overwhelmed with problems our narrow focus becomes the problem itself, not our disposition as we take them on. So appreciate the importance of your mind-set in dealing with your anxiety related problems.

Listed below are a few SR techniques I have had success with clinically. It is important to experiment around and find the one or many that work for you. You must gain some mastery of the technique in a comfortable setting, and then be able to implement it when you first feel the anxiety coming on, anywhere, anytime anyplace.

Deep Breathing Technique: This is the most basic and widespread of SR techniques. It is frequently ridiculed in the media and movies as a desperate measure when someone is overwhelmed. I don't know how many movies or comedy sketches I have seen wherein someone is breathing into a paper bag in the most inappropriate of settings (you don't really need the paper bag).

The most important element of DBT is control. You chose a slow deliberate pace to breathe. When you inhale, you do not let your abdominal muscles expand, as if you are filling up with air. Instead, you tighten your abdominal and diaphragm muscles. When you exhale you can slowly relax the abdominal and diaphragm and control the stream of air. Performers, particularly singers, woodwind and brass players use this technique to enhance execution when reciting.

Although the easiest to master, DBT is highly effective. It is also the most feasible to combine with other techniques. The increase in oxygen to the brain and vital organs gives one a sense of well-being. One of the main symptoms of anxiety disorders is a feeling of loss of control, in particular body functions. An increased pulse, or sweating, for instance, makes us feel even more anxious. In taking complete control of our breathing, we resume command over our bodies. We gain a calmness that lets us address these uncomfortable sensations.

Positive Visualization: When overwhelmed with disturbing thoughts, simply imagine a time and place when you were completely relaxed. A vacation at the beach, the warm breeze and the sound of the surf. Even a romantic encounter, one you truly enjoyed and does not invoke other insecurities. We all have memories that when vividly recalled will elicit the same calming sensations when the experience occurred. They can serve as a distraction when we feel on the brink of an anxiety episode.

Meditation: This technique really utilizes the power of the mind. Mediation, in a transcendental sense, is the "art of think of nothing." You position yourself seated in a quiet, non-stimulating setting. You can start with a mantra, a 2 or 3 syllable nonsense phrase or word. Keep repeating it in your mind till all meaning is lost. Eventually you can drop the mantra and jump to thoughts of nothing. When you loose the internal dialogue associated with a conscious state, all of the physical symptoms associated with stress vanish. Muscle tension in the neck, a rapid pulse, acid stomach, will slowly melt away.

Thought Stopping: This is effective for anxiety related disorders related to repetitive disturbing thoughts. It is a procedure used to stop thoughts that are cues to thinking obsessively or acting compulsively. The key is to hear “stop” literally or figuratively whenever a negative or unhealthy thought arises. You can yell it to yourself when you are at home or alone, then replace it with the imagined audible in your head when in a more formal setting. Another method entails making a tape recording of your voice by repeating the unhealthy thought, i.e, "I think my hands are dirty," over and over again for 2 minutes, then yelling "stop" loudly and repeating the cycle over and over. Then lie down in a semi-conscious state and listen to the looped tape.

The idea is to "jar" the negative thoughts and feelings out. Once you are redirected you can shift your thinking and activities to more healthy ones. Hopefully, over time, the repetitive thoughts will vanish.

Biofeedback: Biofeedback is not a SRT per se. It is a method of measuring physical responses associated with stress. A SRT is implemented and then the effectiveness of that technique is measured by the biofeedback instrument, as it looks for a decrease in a stress related physical response. It gives the client the ability to confirm the effectiveness of the technique. The client no longer will have to say "I think I am relaxing," because there is measurable confirmation to the relaxation. Once the sensation is confirmed and quantified, the client has learned to relax.

There are several biofeedback instruments available to measure stress. Some are quite inexpensive. I have found a Galvanic Skin Response instrument quite effective in practice. I paid $25 for it on ebay. Here are some definitions:

Pulse and Variable Heart Rate: When stressed, the heartbeat not only increases, but becomes more arrhythmic or uneven. Breathing does too. The "Stress Eraser, " measures both of these and keeps a diary to monitor improvement. It will even tell you when to breathe in a healthy cadence. It is portable and made of i pod style polished metal. It measures from your index fingertip. Might be an overkill on price but very stylish and effective.

Galvanic Skin Response: As mentioned above, very effective and inexpensive. Measures moisture at your fingertips, the minute "perspiration response." It emits a theramin-like tone that lowers as you relax. PC software is also cheap and attainable. These will create graphs to illustrate response over time and offer games that encourage you to relax. Time proven and effective biofeedback instrument.

Muscle Tension Instruments: Not highly commercialized, these measure tightening muscles, particularly in the neck. Highly effective in treating migraines and muscle tension-related headaches. Not very practical in terms of comfort (hard to cope with electric diodes placed on the neck).

Brain-Wave Machines: These are also used mostly in clinical settings, but are gaining popularity via the portability of the microchip. These directly measure the beta waves that are associated with a relaxed, conscious state. They are potentially the most effective way of measuring anxiety, but are also the most expensive, with the alpha-beta-wave machines of any real value topping $1k.

External Skin Temp- As we become stressed, blood rushes out of our extremities to our vital organs. These instruments measure body temp at your finger tips and scrutinize temps slightly below the normal 98.6. These are the most inexpensive in the biofeedback realm, but as you might have guessed, the least effective because there is a delay between the anxious response and the change in skin temperature, analogous to the delay in change in room temperature after you turn the thermostat down. It is therefore hard to get a feel for the cause and effect relationship of anxiety and this physical response. A mood ring is a simple example of an external skin temperature biofeedback instrument.

Stress reduction techniques do work. This is supported by research. It is difficult to find the time to implement them and find the right one that works for you. Biofeedback gives you an opportunity to confirm your progress and accomplishments and makes the dedication to anxiety reduction that much easier.

This blog has covered valuable information regarding controlling anxiety. In part one, we gained an understanding of how anxiety manifests itself and relates to our daily living and cycles. Part two has given us background on tools and techniques we can use to combat this illness. In part three, we will examine how to use stress reduction in the most practical settings, when and where it occurs in our work, travels and at home.

Monday, October 20, 2008

Treating Anxiety Part 1: cycles and patterns

Anxiety is by far the most addressed issue in clinical therapy. It is the big kahuna of psychiatric treatment. The 3 largest selling prescription drugs in the U.S. for all ailments of body and mind are approved to treat anxiety. These drugs usually produce moderate to excellent initial success, but are known for profound side-effects and increased tolerance. That's why learning to manage it on your own is so important.

Although anxiety manifests itself in many ways, there are some common elements we can identify that help us gain an understand of the cause-effect relationship and behavior chains that make it an obstacle to enjoy and function in our daily lives. Here are a few commonalities:

The Tension Mounts: Anxiety accumulates through stress. Most people report anxiety heightening by the end of the day. Panic attacks occur far more often in the PM then AM. It is therefore very important for sufferers to take stress breaks during the day. If you have an anxiety problem and you are spending your lunch or coffee break surfing the net, calling family or friends or some other activity that requires significant attention and concentration, then you are making poor use of your time. Take a few minutes periodically during the day implement a stress reduction technique (much more on them later). This will at least slow the accumulation of stress during the day and make it more manageable as it peaks.

Domino Effect: When we are under stress, we often make hasty and impulsive decisions. The consequences of these decisions are often cause for more stress and anxiety. Like a bad lie made from a politician, things start to unravel and we experience chaos and a loss of control. The saying or song "one thing leads to another," probably alludes to this phenomena. This dynamic once again points to the need to keep stress at a minimum and reset periodically during the day.

The Mind-Body Relationship: There are several measurable physical response directly associated with anxiety: increased and variable heart rate, adrenalin being dumped in the blood stream, increased muscle tension to name a few. These will be further addressed in the discussion of biofeedback in part 2. When we experience uncomfortable physical sensations the result is generally, you guessed it, more anxiety. Someone's heartbeat increases and palpitates and they wonder if they need to go to ER. Or someone begins to perspire in a social setting and they become more self-conscious and less confident.

The common theme between these 3 elements of anxiety disorders is one of mounting and accumulating stress. We see a chain of events and behaviors that help feed the anxiety. The preventive or proactive element of treating this disorder is vital. The onus is on you to identify these maladaptive trends as they happen and try to subvert them. Then the therapist or other resource can give you a repertoire of techniques to help you tame this debilitating beast.

up next: Treating Anxiety Part 2: relaxation techniques

Friday, October 17, 2008

My 1st Letter!

After patiently waiting for 3 weeks now I finally got a request for advice from an anonymous source. As I clicked the link to view the correspondence I was anxiously anticipating the content, The snail mail equivalent would be having trembling hands as I opened the unsealed envelope.

This inquiry is excellent because of it's focus on equity, respect and control in significant relationships, an issue so many of us can identify with:

Hi Jeff, How are you doing? I clicked on your blog page. I also bookmarked it. I need all the advice I can get in I still have an insecure feeling inside when it comes to men. Is this normal? Like one thing about Trent that irritates me is that like he said he would call me last night and he didn't. This is about the 3rd time he has done this. Should I not be so petty or realize now he is not always a man of his word? I honestly would just like to learn to be happy without a man. lol Have a good day. Anonymous

Ty for the wonderful thoughts and your letter. I guess we all wish we could be content by ourselves. But having a romantic relationship that meets our needs is an important part of anyone's life. And having someone you can rely on and is consistent is very important too. So I can see why you are disappointed in Trent's recent behavior.

As adults seeking relationships we all fight this constant battle of 2 mutually strong desires: between being alone an accountable to no one and having our romantic and companionship needs met by someone significant in our lives. Both seem like strong and persuasive needs. Unfortunately it is difficult to satisfy both: in sharing your time and space with someone else, we are forced to surrender some of the freedom and autonomy we can enjoy when we focus on our own interests and self-care.

Developmental psychologist and psychoanalyst Erik Erikson makes reference to this quandary in his eight stages of human development:

Intimacy vs. isolation (young adult stage) refers to the 6th stage of Erik Erikson's theory of Psychosocial development where the social task of the young adult is to create strong, long-lasting bonds of friendship and love. Those that fail in this task risk remaining isolated for the rest of their lives.

He identifies this as a conflict that begins at young adulthood. I would contend that in this era of transient and more temporary romantic bonds this conflict carries on into middle adulthood, given the slowing of the aging process and our youthful and neotenous values and outlook in modern society.

I would also argue that the "risk of remaining isolated for the rest of their lives," is a gloomy exaggeration of the isolation outcome, as some people are quite content with a solitary existence.

Ok, I need to get some advice in here at some point and get away from the academic digression.

So how can we try to live our lives in a way where both needs are satisfied? What are some of the common misconceptions or cognitive errors that we bring into the relationship? Here are a few "bullets" that contend with my writer's difficulty with her boyfriend.

  • Never Again: it is unreasonable to expect the same intense feelings and bonds in a later adult relationship as you had as a young adult. Both parties are more protective of their hearts and set in their ways and you will never get that feeling of "oneness,' that you did with earlier love interests. It is a sad fact, but a realistic expectation. Even young couples that do stay together for years and beyond to a golden anniversary drift apart in terms of insatiable attachment and time spent together. But their appreciation for each other and love grows in many other ways; their shared time together, the mutual pride of raising a family. That mutual love can also be gleaned in a relationship that starts in later adulthood. It is a matter of duplicating that appreciation by finding mutual pride in shared and productive activities (including the combining of two families) and sharing time in activities that are spontaneous, fun and unique enough to be chronicled as an enduring and sustained memory.
  • Be Confrontational: If your partner does something that you believe falls short of your mutual agreement, don't just sit back and keep taking it in a patterned way. Take a stand, but frame it in a way that is constructive and encourages further growth and so he/she does not feel put on the spot. "I want to ask you about something because I really care about our mutual satisfaction in this relationship," for example. Keep your emotions in check, moderately positive and upbeat. You will in most cases get some honest dialogue and know where you stand in the relationship. Maybe you won't like the answer, but it beats the uncertainty and painful lingering effect of feeling like you are being taken advantage of and not knowing where your partner stands.
  • Keep Yourself Centered: Aware of what you have control over and do not. Remember your self-worth and that it is reasonable, desirable and you are deserving of having a healthy relationship. When you start to say you must have this relationship and you must have it right now, that's when you cross over to irrational thoughts that lead to unrealistic expectations and a deteriorating mood.
We all have to find a balance between our own personal content and the satisfaction of having someone special in our lives. Once we have found our place in that continuum and find a person that shares our dreams and values, the conflict between autonomy and belonging will be resolved.

Saturday, October 11, 2008

Small Craft Warning: Politics and Emotion in 2008

Still waiting for that 1st advice letter/inquiry. Having a friend, former client (one sent an amusing prank email) or even myself send me one would be easy, but I want the letters to be real and genuine. I know quite a few of you are giving me my share of impressions, so please help me get this thing rolling.

Ah, but there is plenty of treatment fodder out there anyways. I was thinking about the current economic "crisis" and the upcoming election and how this cultural climate might impact treatment. What are some attitudes and feelings I am picking up on in these turbulent times? I may see this exaggerated in my practice because I live in a Detroit suburb and this area is being impacted by the economic downturn more than any other area in the US. I have a few listed below and the how and why as it relates to a mounting tension in American culture. As the third wave feminists would say "the person is political" and I have been observing how the political seas of change are effecting my clientele, many who are finding how these hard times are compounding the stress associated with their already unsettled lives.

wait and see

people's dreams and aspirations are being put on hold. Fearful of making large purchases. Reluctant to take on new challenges, such as school or a new business venture. Hopeless thinking about their future endeavors panning out. A pessimistic paralysis as they tread water and wait for the cultural environment to change in a way that makes personal growth more feasible.

bargaining with themselves

A lost job, a foreclosed home, will lead to self-reflection. Having explored all reasonable options, they endeavor in magical thinking: perusing luck, ritual behaviors and excessive use of faith.

slash and burn

A sense of abandonment. People feel they may as well run up the credit cards and enjoy life because "I am loosing my home and going bankrupt anyways." Hedonistic tendencies follow.

sour grapes

As the election nears, and the outcome becomes more evident, those who see that their ideas for change are not going to take place. They begin to express anger and hatred towards those that do not see things their way.

these are all irrational responses to an albeit overwhelming challenge. We need to contain and moderate these feeling as a starting point to our own personal adaptation to these changes in our political and economic environment. We need to have a grip on how much influence these socio-economic factors have on our lives and how much control we can exert over this phenomena and how much support we can glean from those around us. And lastly, in terms of exerting our own control, DON'T FORGET TO VOTE.

Jeff aka “Dr. Memory.”

Saturday, September 27, 2008

Press Release for Webpage

Launch of New Personal Advice Blog

At some point in our life we encounter an obstacle or challenge that seems insurmountable or unsolvable. Getting true objective advice from friends or loved ones can be difficult for a number of reasons. They may be to close to the problem to have the needed perspective and clarity to address the Issue. They may be reluctant to be confrontive in fear that they might hurt your feelings or damage their rapport and alliance with you. We can find the objective help we need in a number of ways, be it through the church, employee assistance, self-help fellowship or psychotherapy.

I am offering one more resource for anyone seeking objective advice. I have worked in the area of counseling for over 30 years with a wide array of populations, regardless of race, sexual orientation or socioeconomic background. I really enjoy my work and pride myself in individualizing treatment for every client.

This same meticulous approach will be taken in my free advice blog. Interested readers can send me confidential emails regarding some disturbing, disruptive or debilitating personal or relationship issue. I pledge to respond to every email, either by posting the advice on the blog or personally responding by replied email. This becomes a viable resource to anyone who needs objective advice and lacks or has exhausted other avenues. If interested, please visit my blog site at or simply write me with your presenting problem via

Thank you for your consideration.

Jeff aka “Dr. Memory.”

Monday, September 22, 2008

Treatment Considerations and a Case Study

This is my first day "on the blog," so I am giving treatment considerations and a case study in lieu of advice. This will not be my usual format, but an opportunity to see how I approach one on one therapy.

Life in this modern world zips by. We are in a fast-paced society that is fueled by impulsively and the need for immediate gratification. To compliment this facet of society, professional and self-help must be geared for a quick solution to a presenting problem.

In the realm of psychotherapy, long gone are the days of an elaborate clinical course utilizing psychoanalytic techniques. The recline on the couch and the reciting of childhood memories have been outmoded due to the restrictions of managed health care, the time constraints and personal demands of the client.

Solution-focused therapy holds the belief that the client has already done allot of deliberate internalizing regarding "the problem." When they present to a therapist, assuming they are fairly high functioning, the process of solving the problem is already well underway. It is the therapist's job to identify the stumbling blocks, obstacles or where the client got stuck in trying to resolve their issues along the way. The therapist may present some ideas to overcome these obstacles that were not previously considered by the client. He/she may propose ways to alter or "tweak" approaches that have already been attempted.

It would be easy but ineffective to mechanize therapy and categorize presenting problems and create pat answers and solutions for those in need. This is where adept and advanced listening skills come into play. The active listener will absorb the details and nuances of the situation and be able to hypothetically place themselves in the clients’s realm while having an appreciation of their background, personality, demeanor and deficits and attributes. I call this ability "Individualizing," the ability to immerse one's self into the present day challenges of the client with an appreciation of their past experience, present dilemma and future aspirations and dreams. I suppose a frivolous analogy could be made with the sci-fi "mind melding" fantasy. This treatment approach is selfless, time consuming and requires a tremendous amount of energy. But I would argue that is the only way to be an effective behavioral counselor. The complicated problem solving process can not take place without these devote approaches to therapy.

A case study:

Korrina was a 35 year old divorced female. She had 2 children and was in skilled trades. She presented as anxious and depressed. She stated she was in a "committed" relationship of almost 2 years. She complained that the relationship was not going anywhere. The commitment she spoke of was very arbitrary and ill defined. Her partner often referred to his own personal freedom as a means to avoid any obligation or emotional support to her. When she would make the subtlest of demands from him, he would castigate and demean her. He felt that she was always trying to pin him down and their weekend plans were often not settled until a day or 2 before they got together.

She realized that they wanted 2 completely different things in this relationship. She had tried to leave him a couple times, but a physical attachment had been formed and the idea of "starting all over again," seemed difficult. The idea of finding someone accepting of her and her preadolescent children, her past failed relationships and her busy work schedule made dumping her self-absorbed friend and finding the "right one" seem like an impossible task. She knew the current relationship was unhealthy to the point of fueling her anxiety and depression, but the physical attachment to her current partner and the belief that she was not "good enough," based on her past failed relationships kept her from moving on.

Korrina was at that immobilized or "stuck" point I referred to earlier. She was an intelligent, emotionally mature woman and had tried to change her life for the better in the past. As her therapist I had to identify the hurdles she had to overcome to solve her problem. It was also my task to identify what assets she had to overcome these obstacles and give her the confidence to operationalize the agents of change.

She had got as far as realizing the poor quality of her relationship and attempting to break things off. The obstacles were her perceived physical and emotional attachment and the belief that she wasn't capable or didn't "deserve" a healthy relationship.

One quick revelation I gave to her was how intertwined these 2 obstacles were. She had been programmed by her current partner to believe that she was inadequate to obtain the closeness she longed for in a relationship. In convincing her of these inadequacies she felt more and more dependent on him. Her physical dependence was not formed from admiration and genuine affection but the irrational belief that she was destined to be in a relationship where her partner was aloof and uncaring. She may have loved him, but for all of the wrong reasons.

The disappointment of her divorce and subsequent failed relationships had made her lose sight of what a healthy relationship was and discard the belief they could exist. I gave her examples of healthy relationship and encouraged her to describe some couples she personally knew who had been happy a long time. We kicked around what made them successful relationships. She began to appreciate that although there may be no prince charming or perfect man for her as she may have expected from a developmental, adolescent schema she had developed, there were healthy relationships out there.

The next task was getting her to refute the demeaning observations that her partner had made to her. He was trying to program her in such a way to keep her under his thumb. Without being flattering or flirtatious I contested his observations about her personality and appearance and help invigorate her self-esteem. I pointed to many of her outstanding personal qualities.

The identification of these personal strengths signaled the next phase of therapy. She was professionally employed in trades, committed to family life and of strong Christian faith. Her ability to love her children and God made an easy transition to self-love and a renewed confidence.

She had tried dating sites in the past, ones geared towards the general population and Christian oriented ones. She had always give them a half-hearted try because the thought of returning to the unhealthy relationship was always there and seemed like an easy way out. And the notion that she was truly in love. This obstacle was now removed due to the recent appreciation of how badly she had been treated, the realization that there was something better out there for her and her more positive self-concept. She began a more vigorous approach to Internet dating. More important she realized the value of her beliefs and children and gleaned the support of church and family. She had become more content, happy for who she was and not beholden to anyone.

After sometime dating several men she found someone who fit her values and beliefs and is fortunate enough to feel the genuine benefits of having someone whom is loving, considerate and caring and appreciates that she gives him all of these things in return. A happy ending.

To review the course of treatment and to try to step-by-step a very personalized process: 1) An identification of "the problem (in the context of the client's personal experience)," and where the client was at in terms of already solving that problem. 2) Specifically pinpointing the obstacles that were cause for the client to fall short of bettering her life. 3) The refuting of irrational beliefs, cognitive errors and long-held schema that were cause for emotional and mental paralysis and 4) The operalization of the client's strengths and assets in overcoming the pinpointed obstacles.

This is an example my approach to therapy. I am eclectic enough to use any modern treatment approach for the betterment of the client. In this case study, short-term, solution focused, cognitive-behavioral and strengths/asset based therapy were the recipe for my client’s betterment. May I leave you with a poem by Bessie Stanley:


To laugh often and much;
To win the respect of intelligent people and the affection of children;
To earn the appreciation of honest critics and endure the betrayal of false friends;
To appreciate beauty, to find the best in others;
To leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition;
To know even one life has breathed easier because you have lived.
This is to have succeeded.

Sunday, September 21, 2008

Ask Dr. Memory

To the Humble Masses:

I am venturing into the advice column realm. I am doing this at the encouragement of friends and as a bit of fun. I am a trained psychotherapist and I wonder how well being an adept one on one therapist translates into general advice.

The format for the blog will consist of taking emails from interested readers regarding some disturbing, disruptive or debilitating personal or relationship issues. I will then post select answers to help the person cope and problem solve these issues. If enough emails are generated, I am going to pledge to answers ALL emails personally if their questions do not get on the site. I want to emphasize ANONYMITY and CONFIDENTIALITY for all inquirers.

You can send your personal questions/dilemmas to

To enhance the bit of fun aspect, I will occasionally post a "spoof reply," One that contains ridiculous and absurd advice. These will be laden with cynicism and satire and will be a "how not to" primer for advice bloggers. They will be labeled as such for the easily confused or mislead.

OK lets get this thing rolling, throw caution into the wind while I check my liability coverage.


Creative Commons License
Ask Dr. Memory Advice Blog by Jeffrey Deneau is licensed under a Creative Commons Attribution-No Derivative Works 3.0 United States License.

disclaimer: I am not a real doctor, but I do have a Master of Social Work degree and several certifications, including those for the treatment of anxiety, depressive and bipolar disorders, substance abuse and couples counseling. I have over 30 years experience in this field.
The advice given here is not intended to be a substitute for psychotherapy or psychiatric intervention; rather it is intended as a means of basic asessment and possible referral to a professional source.