Blog

By: Ranjita Rao

Do the holidays stress you out?  Do you feel like you have too many obligations?  Are you anxious and overwhelmed this time of year? You are not alone. 
The holidays can be an overwhelming time for many people, especially those who suffer from symptoms of anxiety and depression. While it’s true that the holidays are a time for joy and happiness, for many, they are chalked full of stressors-- financial, personal, relationship, and family issues are often exacerbated during the holidays. Though the holidays are a great time to do for others, it is important to be aware of your own needs and to take care of yourself as well. The best gift you can give to yourself this holiday season is to learn how to manage your stress and anxiety before it strikes. 
Below are some helpful tips to set yourself up for success.
 

1. Learn to be realistic.Be realistic about expectations of others, but most importantly, for yourself.  Take the pressure off of yourself by not taking on too much.  If you have a problematic relationship with your parents, don’t expect to solve it all over a weekend – instead, just aim to make progress, and celebrate the small wins. 
2. Learn to say no.It is perfectly fine to say no. No one expects you to be able to do everything, and if you already feel that you are committing too much of yourself, there is nothing wrong with saying no. 
3. Make a budget. Take away that post-holiday stress by creating a budget early on and sticking to it. Remember that you cannot buy happiness, and that the thought behind a gift goes much further than the gift itself.  You’ll definitely thank yourself for doing so in the new year!
4. Don’t abandon self-care practices. Even if you are extremely busy, there is always time to practice self-care. Remember that if you let yourself become depleted, you will have far less to give others. Make sure that you stick to a routine-- practice your meditation, go to a yoga class, draw a bath for yourself every night, or do something else that you love to assure that you are creating and maintaining a healthy mindset.
5. Reach out. Be kind to yourself and know when you need some extra help. Reach out to family or friends if you’ve got too much going on and need some support. It’s also important to recognize when you may need to reach out to a mental health professional. Sometimes, despite our best efforts, we cannot do it all. Reaching out to a doctor or mental health professional is a great way to get extra support, learn coping strategies, and expand your support network. 

By: Katrin Steinert 

​Group therapy may be a great adjunctive resource if you would like more support outside of individual therapy or seeking a like-minded community. Group therapy is a small group of people that meet to discuss their problems together under the supervision of a therapist or co-therapists. There are a variety type of groups including grief groups, recovery groups and support groups. In his book The Theory and Practice of Group Psychotherapy, Irvin D. Yalom discusses key principles that create a successful group therapy experience. Here are a few: 
 

1. The instillation of hope: Seeing others process and recover during their treatment gives hope to group members who are in different stages of their treatment. 
2. Universality: Connecting with others who have a shared experience helps group members realize they are not alone in their struggle. 
3. Imparting Information: Helping other group members by sharing and reflecting on their own experiences. 
4. Altruism: Helping group members recognize their own confidence by helping others realize their strengths. 
5. Catharsis: By sharing pain, experiences and feelings with the group will help relieve guilt or stress. 

 
Group therapy has many benefits including creating a community, gaining coping skills, finding and becoming a role model, having a safe haven and is cost effective. Group therapy can be the right choice for you if you feel alone in your struggle and want to connect with others. 

By Rachel Thomasian
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For over a decade, I have been helping children overcome worry, anxiety and fears. When my son developed his own fear of “a green guy in his room at night” I knew I had to arm him with the arsenal I had created over the years.
 
The first thing I want parents to know about bedtime anxiety in preschool-aged children is that some degree of it is completely normal and, in fact, developmentally appropriate. At this age, children’s imaginations are running wild. We encourage this behavior by asking them to play pretend and reading them fairytales because we’re working to foster their creative, cognitive, problem-solving and social skills. When we couple that with the development of an increased sense of danger around this age, children naturally start thinking about the possibility of bad guys and monsters. Additionally, at this age, children are taking greater leaps away from their parents. As they enter preschool or naturally engage in more independent activities, they may start to realize how big and scary the world might be and how vulnerable the world is. All of this can combine into the perfect storm of bedtime worry.
 
As a mom, I can understand the need to protect our children and the discomfort we feel when our children experience any kind of discomfort or pain. As a therapist, I know the importance of adversity and the growth and strength that come from working through a problem. So this issue of bedtime worry often becomes one of the first encounters of a problem a child has that their parents cannot simply solve for them, but instead can help the child learn ways to cope with the problem.  We can’t make the monsters go away, we have to teach our children ways to protect themselves from the monsters.
 
I’m going to start with what not to do: Don’t tell your child that they’re big brave kid who shouldn’t be worried. All this does is give them another thing to worry about, the fact that they are not as brave as you think they are.
 
The second thing you should not say is: “Monsters aren’t real”. The same strong imagination that allows your kid to believe in Santa or Mickey Mouse as a real entity is the same mechanism in play that makes monsters very real to your child. You have to get on their level if you’re going to start to help. By validating their fears “I know that must feel so scary” you can make a connection that will help your child feel less alone and more able to trust that you can help.
 
So now we start with what is helpful to a child in this developmental stage, and that is the same thing that created the problem in the first place: their imagination. I like to help kids imagine a superhero that will protect them from the green guy, we’ll draw it and talk about their super powers, and now the superhero becomes just as powerful as the monster in their world view. Another protective tactic is to line up stuffed animals as a line of defense. I always arm these children with “no monster spray” (a spray bottle with some magic water). We talk about how spraying this magic potion while we say “go away monster” makes it impossible for a monster to enter our room.
 
I like to share some of my favorite books about the topic with kids experiencing night time worry. These are a combination of stories to help a child feel not alone in their experience as well as books that teach simple yet effective coping skills. Links to some of my favorites are below. 
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Typically, it takes a few nights to a few weeks of practicing these rituals to create such a sense of safety that a child will no longer be bothered by their bedtime fears, so much so that not only do they no longer need the ritual but they forget about the fear altogether. When this anxiety persists or consumes a lot of your child’s day, a great child therapist can be really helpful in working through this problem in a safe and efficient way through play therapy, usually on a short term basis.  

Please note these are affiliate links and PVC will receive a small commission from your purchase at no additional cost to you. 

By: Eric Kruse 

A Thanksgiving Exercise to do with Family and Friends

We all take things for granted. It’s easy for us to forget about the things in our life that we are lucky to have. For example, if you are able-bodied, you probably forget to be grateful for you ability to walk. Often, we take our relationships for granted. We forget to tell our family, friends, and loved ones how much we appreciate them. Thanksgiving is the perfect opportunity to tell your loved ones how much you appreciate them, and you can do it with the following exercise that I call The Gratitude Hot Seat.
Setup
Add an empty chair to the thanksgiving dinner table. This will be the Gratitude Hot Seat.
Exercise
Each person at thanksgiving table will take turns sitting in the gratitude hotseat. The person sitting in the gratitude hot seat will listen to the others express what they appreciate about them. Going around the table, every person takes a turn saying what they appreciate about the person in the hot seat. 
Conclusion
I came up with this exercise for a thanksgiving dinner with my family a few years ago. I learned things about my family that I had not considered before. It’s amazing what happens at a family dinner when only one person speaks at a time and the focus of the dinner is about expressing what you appreciate about one another. 

by Rachel Thomasian

What makes you unique and special?
One of the ways I help clients gain confidence and self esteem while decreasing symptoms of anxiety and depression is by identifying, tapping into and expressing gratitude for the best parts of themselves. We all have traits that make us uniquely special. By identifying and nurturing these qualities, we can feel a bigger sense of belonging, purpose and exceptionalism all at the same time.
If you're having trouble identifying your strengths, I recommend the VIA Character Strengths and Virtues Classification, which measures 24 strengths across 6 virtues. Learning yours helps you gain a better understanding of your assets. ​Find your signature strength by taking the free survey at ​VIA. 

Talking about money seems to be a topic so often avoided in our intimate relationships. Culturally we have often been taught more often than not that it is taboo to ask about money. We have learned to never ask someone how much rent they pay, or what they make at their job, or what they are saving for. Money is seen as private, so we don’t ask about it and we don’t talk about it. However, money cannot be avoided. We make money at our jobs, we need money to pay rent and bills, and we need money to do the things we want to do. In many ways, our lives revolve around money, making it even more imperative that we learn how to talk about it openly- especially with our partners. 
 
In couples therapy, part of my job is to help couples learn how to be more comfortable when speaking on the topic of finances. Below are some important steps that can help in making the topic of money one that can be talked about more openly and freely. 

1. Identifying your “Money Operating System”

Financial Wealth Manager and ‘Profit Boss’ radio host Hilary Hendershott has spoken a lot about our ‘money operating system’ or “MOS”. These MOS are the beliefs that we have come to have surrounding money. Some common “MOS” include the belief that ‘there is never enough money’, ‘there is always enough money’, ‘money is bad’, ‘money gives me value’, ‘spend now, worry later’ etc. We have all grown up differently and been taught different things about money. This greatly impacts how we view and spend money as we get older, as well as how comfortable (or not comfortable) we may be when talking about money. It is important to begin to learn and have a deeper understanding of you own money operating system. Not uncommonly, we often pair up with someone who has different beliefs about money, spending, and saving than we do. Being able to first learn to identify and talk openly about our own MOS and then learn to listen to our partner’s experience with money is an important step for being able to then get on the same page about finances. 

    2. Getting on the same page- asking the hard questions
This next step is important! Often couples get engaged and married and have never talked about what their financial future will look like together. Will we combine finances? Who will pay for what? If I make more, do I pay for more? Will we have a joint credit card? Joint savings? Is my debt now our debt? Do you get access to my trust? What if I want a prenup? These are extremely important questions to address when approaching marriage or combining finances. Often these questions around money can be charged, and often carry with them a lot of emotions. This is normal! Money is a complicated topic and can have many feelings attached, including shame, stress, anxiety and worry. Being able to acknowledge these and navigate them when talking about money is where therapy can be super helpful. Ask the important questions that need to be asked in order to get on the same page with your partner. 
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    3. Budgeting- setting goals and expectations
 As individuals, we often have our own thoughts about spending, saving and budgeting. These are important topics to talk about with your partner, especially if you are going to be combining finances in any way. Is saving a priority? Do we want to buy a house or rent? Do we want to have kids? Do we want to take vacations? Sitting down and talking about what goals you have financially and what those goals will cost is important. This also involves being able to budget together and look at how much money is coming in and going out each month. Having mutual goals surrounding what you want life to look like together can be helpful when carving out where money will be going. 
 
As mentioned- talking about money is hard and something we often have not learned to do well. Couples therapy is a wonderful place to start to explore and talk about this crucial and inevitable topic between partners. When you learn to more openly talk about and navigate the topic of money together, you will be setting yourself up for less stress and better communication in the future. 

By: Eric Kruse

​The fight or flight response is a physiological response that occurs when danger is present. It was essential to our survival in the Paleolithic period.  If the Paleolithic man saw a tiger, the fight or flight response would increase adrenaline and anxiety and cause us to run away from or fight against the source of danger (i.e., the tiger). 
Modern society is much different. Generally, there are no tigers running around that are threatening our survival.  However, our fight or flight response is still intact, and it gets triggered when we get into arguments with our loved ones. For example, have you ever felt severely emotionally dysregulated when a loved one makes a comment that you perceive as emotionally hurtful? Does this increase your anxiety? Do you get angry? Perhaps you feel like running away or lashing out with hurtful comments. That is your fight or flight response. You feel emotionally dysregulated because your body is perceiving the hurtful comment as a tiger that is threatening your life. However, your life is not threatened. Your loved one is not trying to kill you.
When our adrenaline and anxiety increase, we become impulsive and are at risk of saying things or doing things that we may regret. It is important that we slow down our thoughts and calm down before we react to the present situation. It can be helpful to name what is happening by saying to yourself, “this is my fight or flight response perceiving a threat, but there is no physical threat.” Take a break and step away from the situation if you need to. Just let your loved one know you will come back after you calm down.
Often, having the awareness of what is happening in our body can be the first step to regulating our emotions. It can be comforting to understand why we feel anxious and wound up. Once we feel calmer, we can utilize our “observing mind” to analyze the situation free of judgements, heightened emotions, and adrenaline. 
For example, perhaps you get a new job and your partner says, “I never thought you would be able to get that job.” You feel nervous that you will not be able to handle the new job and your partner’s comment triggers your insecurities. Your negative thoughts start to spiral and you feel emotionally dysregulated. You feel the impulse to lash out and make a hurtful comment in return. This is the time to remind yourself that your fight or flight response is perceiving a threat and that you need to calm your thoughts before your react. Consider the possibility that perhaps your partner is proud that you got the job because they thought it was a hard position to get hired for. 
The more you pay attention to your body and raise your awareness of when you are feeling emotionally dysregulated and why, the easier it will be for you to center yourself and observe the situation free of judgments and heightened emotional sensitivity. You can look at your interactions from a objective perspective rather than an emotionally reactive perspective. This will increase the quality of your relationships and help reduce the anxiety that you experience in life.

Book Review by Eric Kruse

​Recently I was fortunate enough to receive a complimentary copy of Addicted to the Monkey Mindby J.F. Benoist. It was sent to our office, so I decided to start reading it since someone was kind enough to take the time to send me a copy. I must admit that although I use cognitive behavioral therapy techniques in my practice, and I am very familiar with the inner critic that we all have, I have never heard it referred to as the monkey mind.  I did some research and discovered that “monkey mind” is a Buddhist term that refers to being unsettled, restless, or confused. Perhaps the content of this book could help me, or my clients battle their inner critic.
The book highlights two different states of mind: the “monkey mind” and the “observing mind.”  The monkey mind is the inner critic that spirals your emotions out of control, invokes erratic thoughts, and creates anxiety. The “observing mind” offers an objective perspective free of judgments. 
The book uses characters and stories to illustrate how the “monkey mind” and the “observing mind” play out in our lives. Early on, the book tells the story of Elizabeth, a woman with a drinking problem who is dissatisfied in her marriage because her husband is consumed by his work.  She consults with two of her friends for support. One friend, Paula, embodies the essence of the “monkey mind” and the other, Sarah, embodies the essence of the “observing mind.”
Paula (monkey mind) tells Elizabeth that her husband is probably cheating on her with his secretary at the office, which is a judgmental conclusion based on anxious doubts. On the other hand, Sarah (observing mind) asks Elizabeth for more details, such as who, what, why, where, and when. Sarah points out that it is a huge leap to go from “he works too much” to “he is having an affair.” As can be expected, Elizabeth feels more anxious and emotional after speaking with Paula (monkey mind) and calmer and more relaxed after speaking with Sarah (observing mind). 
This is just one example of the many stories that are captured in this book.  J.F. Benoist does a great job of showing how we develop our monkey mind from not just our families, but from growing up in a “shame-based society.”  Benoist claims that the more we use our “observing mind” the less anxious we will feel in our day-to-day lives.  I don’t know about you, but the thought of having less anxiety in my life sounds like a welcomed outcome. I found the characters and stories in this book to be relatable and I was able to see how I can make more use of the “observing mind” in my own life. 

By Katrin Steinert

 ​Death is apart of life. It is also one of the most painful, agonizing and difficult experiences that a person can go through. Most of us are familiar with the five stages of grief, which are: 

1. Denial and Isolation
2. Anger
3. Bargaining 
4. Depression
5. Acceptance 

 
The stages are meant to be gone through one after the other with little flexibility in revisiting stages. J William Worden disagreed with the fives stages and created his own idea of how grief is experienced. He proposed the Four Tasks of Grief model. The model is meant to flexible and allows mourners to tailor each stage to their own experience versus having to fit their grief into pre-determined stages. The tasks are as followed: 
 
Task 1: To Accept the Reality of a Loss
            During task one the mourner is faced with the death to the point where it almost might not feel real. It may not hit the mourner how deep the death can affect their lives. What will holidays look like? Who will I call when I need support? During this task some ways to help accept the death are by completing rituals including funeral planning or creating a way to honor the life of the loved one. 
 
Task 2: Process Grief and Pain
            The second task is all about feeling whatever comes up for the mourner. That can include anger, sadness, relief, and exhaustion to name a few. The spectrum of feelings will be large and vast. The most important part of task two is to remember that the mourner must express these feelings and not avoid them. To acknowledge how grief is felt and be open about the feelings will help to work through the complex feelings. 
 
Task 3: Adjust to the World Without Your Loved One
            With the death of a loved one many holes will be left. Some of the holes are internal and others are external. If a parent has died, it will require adjustments to parental support and roles in families. The adjustment to the new reality is emotional and can require a lot of time. To help work through this task, it will require awareness of the impact of that the death had and how to create a new life without that person in it. 
 
Task 4: To Find a Connection with the Deceased While embarking on a New Journey
            Task 4 is about creating a way to remain emotionally connected to the person who has died. There are many ways to achieve the connection by remembering the person who died, finding a physical memorial connection or rituals such as visiting their gravesite. 
 
Death is permanent and painful. It is important to practice self-care in the time of grief and maintain relationships that bring you joy. 

By: Eric Kruse

​Dialectical Behavioral Therapy uses a concept called “The Wise Mind.” The Wise Mind is where your emotions and your intellect come together to create a balanced perspective.
The Emotional Mind
Emotions are beneficial because they help us feel things. We cry when we are sad. We smile when se are happy. It provides opportunities for us to cultivate relationships with others because others can relate to our emotional responses. Emotions are the catalyst for empathy and empathy is greatest tool in developing deep emotional bonds with others. 
The Reasonable Mind
Intellect helps us solve problems and think about the world around using knowledge and information. We use it to cook or meals, fix our cars, drive technological advancements, study medicine, and to write blog articles such as this one.
Knowing when to use each state of mind
Being overly emotional or overly intellectual at the wrong time can cause problems. For example, sometimes people in your life want you to empathize with their situation when they are struggling rather than trying to “fix it” with intellectual problem solving. Sometimes, it’s better to keep your emotions under control, such as when you make a mistake at work and you start to feel defensive. You don’t want to act impulsively. 
The Wise Mind – Finding balance
The Wise Mind strikes a healthy balance between intellect and emotions. It allows you to understand others by reading their emotional cues and allows you to process what you want to say and how you want to proceed without impulsively acting on your emotions.
 
The following website link shows a Venn Diagram of The Wise Mind, The Emotional Mind, and The Reasonable (intellectual) Mind:
https://www.therapistaid.com/worksheets/wise-mind.pdf
The bottom of the sheet asks you to list an example of an experience that you have had with each of the three states of mind. I encourage you to apply the knowledge from this by describing your own experience with each state of mind so that you can be more aware of when you are using each state of mind.