Blog

By: Eric Kruse

Legalization
Right now, 33 states have legalized medical marijuana, while 10 have legalized recreational marijuana. Advocates for legalization believe that legalizing the drug may reduce use and make its use safer. Critics argue that legalization will make marijuana more easily accessible, which will result in increased use, misuse, and abuse.

It’s too early to say whether legalization has resulted in increased marijuana use and research on the topic is inconsistent. The RAND corporation found a correlation between legalization, increased marijuana use, and increased dependence. However, Columbia University’s Mailman School of Public Health found increased use of marijuana, but lower rates of marijuana dependence.

Marijuana vs Alcohol
              Alcohol has been legal in all 50 states since the end of prohibition in 1933. Effects of alcohol on public health and safety are arguably more dangerous than marijuana. For example, liver damage, fatal care crashes, and anger outbursts that could lead to violent behaviors. Marijuana use is not harmless though. Daily marijuana abuse can increase depression and anxiety.

Marijuana and Depression
              Although marijuana is legal for medicinal purposes in 33 states, this system tends to get abused. Patients are prescribed marijuana for medical conditions that marijuana is not meant to treat, such as depression. Many patients claim that medical marijuana alleviates their depression and those who use it recreationally often use it for mood enhancement.

However, daily abuse of marijuana over time can increase depression. This is because your body builds a tolerance to any substance that you use daily. The stronger your tolerance gets, the less mood enhancement effect you will receive from the drug.

Furthermore, marijuana affects the processing of emotions. Researchers at Colorado State University conducted a 2-year study and found that marijuana users may have a reduced ability to implicitly identify emotions and to empathize on a deeper emotional level. Emotional connection and empathy play a vital role in cultivating meaningful relationships. Marijuana can impair these processes, which could result in increased social isolation. Furthermore, social isolation maintains depression and is a catalyst to increased depression.

Marijuana is a “Manageable” Addiction
              From a harm reduction standpoint, Marijuana is one of, if not the least harmful mind-altering substance one can be addicted to. Due to its less overtly harmful nature, it tends to be more “manageable” when compared to other addictions. For example, alcohol abusers will “blackout” and hurt themselves or others. Marijuana users eat too much food and go to bed. Unfortunately, it is still harmful in its own way. It distorts how we view ourselves, others, and the world around us. It can make us withdraw socially. It can make us feel apathetic, unmotivated, and depressed. Days turn into months, months turn into years, and we end up watching our life pass us by as we sit in a cloud of smoke.

Getting Help
              Marijuana addiction can be different to other substance addictions since it is lower on the totem pole for risky behaviors. Finding a recovery meeting tailored specifically to marijuana, such as Marijuana Anonymous can be beneficial for those who struggle with relating to harder drug addictions (meeting directory: https://www.marijuana-anonymous.org/find-a-meeting/).

             If one-to-one support is your method of preference, counseling is a good approach. A therapist can help guide you through the early stages of sobriety.  

By: Katrin Steinert

Dialectical Behavior Therapy or DBT is an evidence-based treatment that was created by Marsha Linehan in the 1980s. DBT was originally created to treat highly acute borderline personality disorder. Linehan based DBT after having worked as a CBT therapist but realized that CBT was missing one key component; acceptance.

Dialect
The D in DBT stands for dialectical. The definition of a dialect is two seemingly opposite truths that exist at the same time. A good example of a dialect is I love you and I hate you. The world is full of dialects and DBT encourages the acceptance of living in the dialectic. 

Mindfulness
The cornerstone of DBT is mindfulness. According to Linehan, without the practice of mindfulness it would be nearly impossible to recognize and describe emotions that are coming up when high stress situations occur. Being mindful can be done in many ways including mindful walking, mindful driving or mindful eating. These are daily activities that most people engage in and by practicing them mindfully will create more insight into feelings and experiences that are coming up in the body.

If your family dinners are anything like mine, then you are probably used to individuals speaking over one another. You must fight to have your voice heard and there is no space to reflect before responding or else your voice will be lost. The result is that conversation is watered down and less meaningful than it could be if people slowed down, reflected, and took time to process how to respond. The following are different approaches you can use to respond in your next conversation. Make it meaningful, there is nothing wrong with a long pause as you process how to respond. As Buddha said, “If you propose to speak always ask yourself, is it true, is it necessary, is it kind.”  

Ways to Respond in Conversation
Advice (fix it)
Advice is when you give guidance on how someone should proceed in a situation or how you may proceed if you were in the same situation. You offer solutions to a problem by going into fix it mode. This is the probably the most common type of response that individuals offer in Western society. There is a time and place for advice, but often it is not the best way to build connection. There are more effective ways to show someone that you care about what they are saying.

Challenge (new perspective) –
When we listen to others speak, we often consider different perspectives that the speaker has not considered. This is when we challenge them to consider an alternative view. Challenging someone or being challenged by someone is how we grow and change. However, it is also not the most effective tool to build connection. Sometimes people want to be listened to and heard, and not challenged.  

Validate
Validation is when you demonstrate support for someone’s view or feeling. You say, “I understand what you are saying” or “It’s understandable that you feel that way.” It normalizes their experience and demonstrates that you are listening.

Empathize
Empathy is the strongest tool for emotional connection. Empathy is about putting yourself into someone else’s shoes and feeling the emotions they are feeling in that moment. Examples of empathic statements are “that sounds like it must have been very difficult for you” or “I don’t know what to say right now, but I am glad that you told me, and I am glad that we are talking about it.” Empathy is an advanced form of emotional connection and if you are not accustomed to using it, it will take some practice. A great prompt for empathizing is: “The part of your story that felt like it was happening to me was [Fill in a part of their story that was impactful to you, using their words, don’t talk about yourself].”

Ask the Speaker what they Need
Next time you have a conversation with someone, I encourage you to take a moment to slow down. Ask the speaker what type of response they need from you. Ask them if they are looking for advice, validation, empathy, or if they are looking for a new perspective (challenge). Many misunderstandings stem from the listener responding in way that the speaker was not looking for when they decided to share part of themselves with you. Ask them what they need and take a moment to reflect before you respond.   

By: Eric Kruse

“Deciding whether or not to trust a person is like deciding whether or not to climb a tree, because you might get a wonderful view from the highest branch, or you might simply get covered in sap, and for this reason many people choose to spend their time alone and indoors, where it is harder to get a splinter.”        
Lemony Snicket

Lately I have heard many people talk about betrayal and how they are making the choice to never trust again. I understand where they are coming from. They have been hurt in the past and they are choosing self-preservation at the cost of cultivating deeper relationships. As the age old saying goes, fool me once… However, this is sad to me because I believe that those who choose not to trust are missing out on the opportunity to have something beautiful in their lives. The following are my thoughts about how to build trust.

Trust People to be Themselves
If you have been hurt in a relationship before, you probably are wary about opening yourself up again. You may be one of those individuals who says, “I tired building trust with others and then I got cheated on so…” or “trust isn’t worth giving to anyone honestly.” I would challenge these people to consider the ways they trust others in small ways in their life every day. For example, you trust your doctor/hair stylist/dentist/ will be in when you show up for your appointment. You trust that your parents will be annoying at thanksgiving. You trust that your teacher will administer an exam when its scheduled. You trust that your friend who forgets to shower may smell when you hang out. If you are starting to see a theme in the examples here, then you may begin to understand my point. People do as they do. There are patterns in their behavior that are consistent so you place faith in the probability that it will continue (with exceptions of course). Sometimes people try to change bad behaviors and if they fail at it, don’t take it personally. You can trust that quitting bad habits is a hard thing to do and that people falter at it along thee way.  

Surround Yourself with People who have Similar Values
Since people do as they do and you can trust them to do as they do, then pick someone with similar values to your own. For example, if you value honesty, integrity, and monogamy, then find someone who also values it. Talk about your values with this person and see if they also feel strongly about it. You may start to get a sense of whether you can place trust in this individual. If they live by their principals in the same way that you do, then you are less likely to get hurt. Unfortunately, there are deceptive people out there (The Betrayers) who can fool you. If you place your trust in someone and they betray you, then you have been “covered in sap” on your way up the tree in pursuit of the “wonderful view,” but that does not mean you should “spend your time alone and indoors, where it is harder to get a splinter” (see quote at the top). Furthermore, sometimes people who are trust worthy make a terrible mistake and it’s worth trying to rebuild that trust with them. This is where therapy can help.  

By: Katrin Steinert

Freud’s personality theory saw the psyche in three parts; the id, ego and superego, which develop during different stages of the life cycle. According to Freud, the id is the primitive and instinctual part of the mind. The id contains the sexual and aggressive drives and hidden memories. The superego operates as the moral conscience and the ego is the realistic part that mediates between the desires of the id and the superego. The three parts work together to create human behavior. Freud believed that in order to become a healthy person, the ego should be the strongest element. When the ego is the strongest out of the three, it can satisfy the need of the id, not upset the superego and still take into consideration the reality of every situation. 
 
3 ways to strengthen your ego:
 

• Acceptance: Start by accepting something small. It can either be accepting the rain, that person who cut you off in traffic or forgetting to take the trash out.
  
• Adjusting expectations: Every unrealistic expectation we create sets us up for disappointment. By adjusting what the expectations are regarding us and other people in our lives it lower our frustrations when expectations aren’t met.
  
• Consciously raising our frustrations and stress tolerance level: The strength of your self develops by framing things in empowering meanings. Positive framing and reframing allows us to take a new view of things, which then effects how we actually feel about things. In this way, framing and reframing things can enhance our ego-strength to face, cope with, and even master the challenges of life.
  

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: 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.

By: Eric Kruse

​It has been estimated that humans have anywhere from 30,000 to 70,000 thoughts per day and that up to 80% of these thoughts can be negative. It should be no wonder why so many members of the population struggle with anxiety and depression. It’s impossible to stop ourselves from having negative thoughts, which is why we call them “automatic thoughts,” but we do have control over the thoughts that follow our “automatic thoughts.” 
An effective tool for doing this is to treat our automatic thoughts as guesses. For example, you see people in your office whispering and looking at you and your automatic thought is, “they must be making fun of me.” Instead, try framing that thought as question by altering it to, “Are they making fun of me?” Then follow it with another question, “Are they saying nice things about me? Are they talking about someone or something else and just looking in my general direction?” There are so many conclusions that are positive or neutral that we often miss the chance to consider.
The next step is to write down all the guesses and arrange them into a pie chart. Consider the evidence that supports each guess (i.e., hypothesis) and then assign probability percentage to each guess. For example, the fact that you cannot hear what your colleagues are saying about you and the fact that you don’t know if they are actually looking at you is evidence to support the guess that “they are talking about something or someone else and looking in your general direction” so you can assign I high percentage of the pie chart to that guess. Furthermore, the fact that up to 80% of our daily thoughts can be negative is evidence against the possibility that your colleagues are making fun of you because you now know that statistically there is a high chance that your first automatic thought will be negative. 
Your pie chart can be drawn out by hand our done as a mental image if writing things down is not your thing. The purpose of this exercise is to slow down and consider that your thoughts may not always been accurate, especially when they are tainted by a smoke-colored lens. Treat your thoughts as guesses and make an active effort to follow your negative guesses with neutral and positive guesses. 

By: Eric Kruse

"Great stories happen to those who can tell them." --Ira Glass

“Storytelling is the most powerful way to put ideas into the world today” – Robert McKee
​
What is Narrative Therapy?
Narrative therapy is a medium for self-reflection and growth through stories or narratives (hence the name). The general idea is to change your perspective on your life by the way you tell your story. Every event that happens can be told from a positive, negative, or neutral lens. For example, let’s say you are suffering from depression. What is the story you are telling yourself about your depression? Are you telling yourself that there is something wrong with you and that you will feel depressed for the rest of your life? How does that story make you feel? Typing that out made me feel hopeless and sad. This is how the stories we tell ourselves about our life impact how we feel. 
Externalizing our Problem
What if I told myself a different story about my depression? What if my depression was not a part of me, but instead an evil entity that dwells inside me. I can even give it a name, such as The Dark Voyager. Sometimes The Dark Voyageris not inside me. Those are my good days. Whether The Dark Voyageris with me today or not, there is definitely nothing wrong with me. If anything, I am strong person for endearing The Dark Voyager’s poison. This is strength-based narrative that allows me to feel proud of my level of resilience to the depression I am facing. 
Life Stories
The story that you tell about your life does not have to be clever. You are not trying to win a creative writing contest. You don’t need characters, such as The Dark Voyager. You can start with a very simple template, such as “my past, my present, my future.” Here is a link to a free template online:
https://www.therapistaid.com/worksheets/life-story.pdf
Everyone has a story so don’t tell yourself that you don’t. If you tell yourself that your story is dull and boring, then you are formulating a negative narrative, which once again, will make you feel sad about your life. Regardless of how much you believe your life is mediocre and not worth telling a story about, the truth is, it’s not! We have all had formative experiences that have shaped us into the people we are today and those experiences are worth sharing and talking about from a strength-based perspective. 

​What does it mean to be mindful? This is a question I come back to a lot on my own, and also one that my clients ask me often. There are so many ways to be mindful and to meditate, and there is not a one size fits all for any person. The key to living in the moment and learning to be more present can come from starting with the little things. Enjoying your coffee in the morning, taking a ten-minute walk after work, combing your hair and washing your face before bed. It is easy to go through the motions- it is harder to do these things with intention. Taking five extra minutes to sit down when drinking your coffee and not sipping it as you rush out the door. Taking a walk without your phone and paying attention to the beauty and nature around you, instead of making an internal list of what you need to do when you are back. Combing your hair and washing your face and recognizing that this is a way you care for yourself, instead of rushing through it because you feel its another thing that needs to be done. 
 
We can so easily live out of habit instead of out of intent. Being able to stay in the present and make changes requires this intention, and being able to live in the present (or be more mindful!) is what leads us to feeling happier and more content with our life. It can feel overwhelming to feel like we have to be mindful all of the time. When clients come to me and want to start being more present, I always remind them to start small. Form habits and create the time in your day to enjoy what is and just be. Being able to implement this will lead to more lasting change and present moment awareness. Even as a therapist, being mindful is something I am always trying to work at and implement into my life more. Paying attention to what I need and what feels right is important as well and has helped me to take more time for myself and think about what I want for my life in a more intentional way. “The Mindfulness Journal” by S.J. Scott and Barrie Davenport is a great way to help with the process of becoming more mindful and can help with beginning to create that habit into your daily life and practice. I highly recommend this to anyone who is wanting to be more present, aware, grateful and intentional.