The Psychological and Emotional Factors that make it difficult to succeed at Weight Loss - How a Therapist can help.

Many people struggle with being overweight. The Center for Disease Control (CDC) estimates that currently over 2/3 of adults in the US are overweight. There is a lot of information available to help people attain and maintain a healthy weight.

· Dietary plans and programs to lose excess weight and maintain a healthy weight.

· Exercise programs to safely increase metabolism.

· Techniques and strategies for controlling food intake, and managing cravings to overeat.

· Support group programs to help with information and motivation.

Yet many people have difficulty making use of these resources on a consistent basis so they can achieve success. The following are factors that often interfere with success and are not typically addressed by weight loss programs. A brief description of how a psychotherapist can help with each of these factors is also provided.

1. Demoralization, a sense of hopelessness about the problem, lack of faith they can succeed.

Many people have developed a reliance upon eating as a source of comfort that has become second nature to them, and they feel helpless to change it. People who view themselves negatively as weak or lacking in willpower can have a hard time feeling hopeful that they are capable of success. In addition, people who have experienced abusive treatment earlier in their lives may unconsciously use their weight as a protective shield to keep others distant, to avoid further hurt. People who have been sexually abused or exploited may use weight as a means of shielding themselves from unwanted sexual interest from others.

• A therapist can help people gain an understanding of the origins of their overeating - to soothe painful feelings, fill a void of unmet emotional needs, provide relief from hurtful experiences earlier in their lives. This makes it possible for people to see their overeating as an understandable coping response to difficult and painful circumstances, rather than something about which they should feel shame. It allows people to view their habits as behaviors they can begin to manage rather than something beyond their control.
• A therapist can help people understand how their low self-regard and lack of confidence is a consequence of prior experiences of people responding to their difficulties (including their weight) in harsh, punitive, coercive, or shaming ways, and not a reflection of their capabilities.
• A therapist understands that a big change in altering eating habits and improving health can involve anxiety and fear about letting go of established habits and the comfort they have depended on.  Having a therapist, interested in understanding their fears and self-doubts, accompanying them on this journey to health makes it possible for people to begin to face them with hope.  This is in itself a step towards releasing the grip on them of past traumatic and humiliating experiences.  With the therapist’s supportive presence, people can decide for themselves if their fears are valid in their current lives, and if they are ready to push themselves to make changes.

2. Procrastinating about getting started or jumping into action without enough preparation.

Making an important change like developing healthy eating habits and getting to a healthy weight can create anxiety that may lead to endless procrastination about starting or to jumping into action without sufficient planning.  In addition, past unsuccessful attempts to lose weight can make it difficult for people to want to try again.

• A therapist can help people see that their anxiety about a big change like altering eating habits is a normal part of the process and not a sign of weakness or that failure is inevitable. Therapy sessions can be a place where the fears are examined and understood - generally relating to challenges that will need to be addressed in order to succeed.  The therapist can assist people to commit to the changes and the challenges and sacrifices they will entail.
• A therapist can help people gain an awareness of how their habit of overeating will be triggered by the circumstances and experiences in their daily lives.  The therapist will help them adopt alternative coping responses to these high-risk times so they will be able to free themselves from their habit. This is an important step in people gaining confidence in taking control of their habit.
• A therapist can help people realize that past unsuccessful attempts at weight loss are learning experiences, not failures, from which important information will be gleaned that will help in being better prepared for the next attempt.  This will help in building confidence that success is possible.

3. Fears of being open to support from others.

Prior experiences of important people responding to them, and to their weight, in harsh, punitive, or humiliating ways can make it very difficult for people who want to lose weight to reach out to others (healthcare providers, family, friends, fitness experts) for needed support for fear of encountering further disappointment.  They may fear that important people in their lives will view them as selfish and resent or abandon them for their efforts to turn their lives around.  These fears can lead to what appears to be a stubborn refusal to acknowledge the serious implications of their weight and overeating and to resist any appeals by others to make changes.  It can also result in the approach some take of trying to do it alone, of hiding their efforts to lose weight.  This will be counterproductive, as they will be missing the benefits of concrete support from people who can really help.

• In therapy sessions, people have a direct experience of the therapist’s understanding and expertise in helping them overcome this daunting challenge.  This experience of their problem being dealt with skillfully, without judgment or disapproval, will give people hope that they can experience similar support from others in their lives.

4. Staying with it, dealing with setbacks.

An important factor in success is not giving up when the inevitable setback or lapses into overeating do occur.

• A therapist is committed to being with clients on this journey, so when they slip or fall, the therapist is right there to help them get back up and continue on this journey towards improved health. A therapist views lapses into old habits as potential learning experiences and opportunities to improve or refine plans rather than failures or evidence of weakness.   This approach is an important factor in people not giving up, viewing themselves as failures and weak when lapses do occur.
• A therapist will keep in mind that achieving and maintaining a healthy weight is a life-long process, not a short-term goal.  This will be important in helping people set achievable goals about weight loss that they can sustain for their lifetime.
• A therapist can help prevent people from adopting a restrictive, self-depriving attitude towards food and eating that will undermine motivation over the long haul.  A therapist will assist people to not succumb to the idea that food is the enemy and help them make good food and healthy eating a part of a fully satisfying life.

To talk more about this challenging topic, you can contact me at either paulboscolcsw.com or (302) 832-1282 X204

Therapy with a Chronic Pain Patient

This article provides an account of how psychotherapy can make a real difference in the life of a person living with chronic pain. By describing the actual treatment of a chronic pain patient, the article shows how therapy can complement the efforts of medical providers in assisting people in living fuller, more meaningful lives. The description of the actual patient has been altered to protect the person’s privacy.

Introduction

Living with chronic pain is such a difficult challenge because so many factors can influence the person’s pain experience. Over the past several decades, researchers and medical providers who treat chronic pain have become more aware of the importance of psycho-social factors  - daily stress, family relationship difficulties, lifestyle issues, job dissatisfaction to name a few – in a person’s recovery from injury and leading a full life. In fact, studies of factors that lead to recovery vs. continued suffering and disability have consistently shown that factors such as maladaptive beliefs and coping styles, lack of emotional support, job dissatisfaction, and depression are stronger predictors of continued suffering and disability than the severity of the physical injury. These concerns cannot be fully addressed by medical providers however much they may try to take these into consideration. This article presents how psychotherapy can help with these factors and assist a person living with chronic pain in leading a fuller, more satisfying life.

Description of the Patient

Florence is a 59-year-old married, African-American female with three adult children. She presents as attractive, younger than stated age, lively, articulate, stylishly dressed, and with an engaging sense of humor. She is a college graduate, who had a career as an administrative assistant until she became disabled due to Lupus at age 41. Since then, Florence has been trying to establish her own mixed-media art business, has had volunteer and leadership positions in a community service organization, and has attempted to establish a connection with a church. However, she has felt unable to fully pursue these interests because of her strong sense of obligation feeling unfulfilled in life and living with a sense that life has been passing her by.

Florence reports that she was a relatively healthy and active working mother until she began to experience symptoms of lupus around age 40. Since that initial diagnosis, Florence has encountered other complications: Arthritis, Raynaud’s Syndrome, Fibromyalgia, Chronic Fatigue, Gastric Reflux and Sleep Apnea. She has twice undergone double knee replacement surgery and surgery on both her feet.

Florence has viewed her medical problems as evidence she is “broken”, “useless”, a “burden” or “liability”’ to her family and has lived with the fear that they will give up or abandon her. She has developed a pervasive pattern in important relationships – such as her marriage, her family of origin, her children, medical providers, and her artist colleagues and studio owners – of trying to “keep pace”. She would work her needs around what others wanted, trying to please and make it easier for others. When Florence began therapy, she would report how her efforts to help or please others would leave her exhausted, sore and unable to function for days after. She frequently talked about how she would try to “keep pace” with what others needed until her body “gave out”. Her focus on pleasing others left little time for her own interests: her art, participating in a church, singing in a choir. It was hard for Florence to feel entitled to measure that would help her chronic medical problems – pacing herself, getting regular safe exercise, getting sufficient rest, and limiting activities (like standing for long periods of time, lifting) that exacerbated her pain. She frequently reported feeling not understood by her medical providers, and not reassured by their responses to her questions and concerns. However, she continued to try not to “ruffle feathers” and would leave medical appointments with lingering doubts.

Her Sense of Self

Florence grew up the youngest of four children in a family environment where she felt deprived of security and love. Her mother was depressed and angry throughout Florence’s childhood, in large part due to difficulties in her marriage to Florence’s father. Her father was an absent figure in her life due to his work and alcoholism. Florence grew up feeling unwanted, at times hated by her mother, who would often tell her children she never wanted kids. She doubted that she mattered to her father. She came to think of herself as the “odd one” in the family, the least appealing, least capable, as inferior. From an early age, she developed the pattern of trying to please others to protect herself from feeling unloved and unimportant, and to gain some sense of acceptance from her family. Florence left home at age 16 and married her husband after becoming pregnant with her eldest child. She entered her marriage anticipating she would finally feel loved and wanted. But she soon found herself feeling undeserving and only important if she could please her husband. This intensified with her husband’s devotion to his work, his over involvement with his family of origin, and his emotionally reserved nature. Florence increasingly feared that her husband would abandon her if she did not please him or keep pace with his agenda. Her efforts to make things easier for others only intensified her her loneliness and lack of self-regard, and left her feeling increasingly hopeless about her future and the future of her marriage.

What the Therapist Did That Helped

· Therapy provided a consistent and sustained relationship where the exclusive purpose has been to assist Florence in leading a fuller, more satisfying life, and fulfilling her aspirations in life. Florence experienced someone – in this case her therapist – as genuinely wanting to understand her experience rather than encouraging or criticizing her inclination to seek the favor of others. This allowed Florence to let go of her need to prove her goodness and worth in session by talking about her endless efforts to please others. This, in turn, opened the door for Florence to share, in a more authentic manner, her own lack of self-regard, distrust of others, and her lack of real fulfillment in her life.

· Therapy has helped Florence gain insight into the origins of her automatic people pleasing: to protect herself from hurt and rejection, earlier in her life, by attending to the needs of others. This allowed Florence to see her habit as an understandable reaction to difficult circumstances and as a coping response over which she could gain some control.

· Florence’s therapist helped her understand that her sense of inferiority and unimportance was a consequence of her experiences with family members earlier in her life. The therapist provided the space for Florence to begin to question the validity of her low self-regard. This helped Florence be more open to the idea that being herself was valuable in its own right, and that her unique perspective, talents, and interests were elements to be nurtured, not dismissed as defects or liabilities.

· The therapist helped raise Florence’s awareness of how much she had been oriented to gaining the favor of others in her daily life. This made it possible for Florence to begin to judge for herself if her automatic people pleasing was counterproductive to her desire to improve her life.

· The therapist helped Florence look for opportunities to let go of her protective habits of pleasing others, keeping peace in order to more directly confront difficulties in important relationships in her life – family member, medical providers, colleagues. Florence began to experience herself as standing up for herself. This bolstered her faith in her inner strength and resilience, increased her self-respect, and diminished her feelings of failure.

As therapy progressed, Florence has been able to accomplish the following:

· Florence has been able to impress upon her husband and adult children how committed she is to her art, the importance of church involvement to her emotional and spiritual well-being, and the necessity of taking better care of herself physically. Her husband’s positive response, in particular, has helped F. feel more secure in his commitment to her.

· Florence has joined a church where she has become an active participant in religious studies and a member of the choir. Having a spiritual home and contributing to the spiritual growth of others has strengthened her sense of goodness as a person.

· Florence resigned from the studio/gallery where the policies, expectations, and the physical layout of the building were hindering her creative process, creating increased physical pain, and providing little benefit in terms of sales. Working at her home and developing her own business website has been a more satisfying arrangement for her.

· Florence was able to attend to her physical warning signs that something was not right following her earlier knee replacement surgeries. She persisted in sharing these concerns with her medical providers, did not allow herself to be placated by responses she found neither reassuring nor convincing, and she sought other opinions until her concerns were satisfied. It was ultimately determined corrective surgeries were needed and these subsequent procedures were successful.

· Florence has been more comfortable letting go of her urge to be at her family’s beck and call. She has gained confidence in her ability to decide for herself her obligations to her family and has been more at peace with the limits she sets with her family.

When Loving Support Encounters Discouragement and Frustration

One of the more noble aspects of being human is the capacity to be compassionate and supportive to others. It is human nature to want to help a spouse, partner, adult child, relative, or friend who is experiencing a setback in life, is facing a health or financial crisis, is having difficulty starting a career or achieving independence. But what if your efforts to be supportive to a loved one start to take a toll on you? What if all your efforts leave you increasingly uncertain about your loved one’s true intentions, more doubtful that the other will make good decisions, do the right thing. What if, in spite of your best intentions, you start to wonder if you are not part of the problem? 

How do you maintain a supportive relationship with someone experiencing difficulties in life without becoming discouraged and getting dragged down by that person’s problems?  A first step can be to identify signs that your support efforts have crossed over to enabling.  Here are some of the more common signs that I’ve encountered in my work with clients struggling with this challenge:

· Discouragement and a sense of hopelessness continues to grow in spite of all your efforts and love.

· The person is not progressing in terms of bettering him/herself, improving his/her life, and you find yourself bailing them out of one bad situation after another.

· Your relationship with the person you are helping seems one-sided; the other is giving nothing back.

· You are neglecting your own needs (e.g. health, exercise, healthy eating, financial, or social-recreational) in your efforts to help.

· Your feelings of guilt or shame about the loved one’s problems, or behavior causes you to isolate yourself, withdraw from people who know and care about you.

· You’re covering up, lying for the person you’re trying to help, protecting that person from the consequences of his/her actions-decisions. 

· Even though you do not want this, resentment towards the person you are helping continues to grow; you are finding it increasingly difficult to maintain patience-compassion towards the other; or you are walking on eggshells around the person trying to keep peace. 

· People who know and care about you are expressing concern that the help you’re providing is too much for you; they worry about the toll they see it taking on you.

If you find you are experiencing some of these signs, it may be time for you to step back and re-examine your role with your loved one. It can be a time to ask yourself questions such as:

· How do I step back without abandoning the person I care about?

· What help can I offer that doesn’t just depend on me?

· What changes can I make that might motivate the person I care about to do more for him/herself?

· What are the limits to what I can offer so I am not dragged down by the other’s problems?

· How can I take better care of myself?

· Where can I look for support in my efforts to find a healthy balance in my efforts to help and take care of myself?

These are not easy questions to answer when it involves someone you love and care deeply about and that person is jeopardizing his/her future. It is often helpful to confide in trusted family or friends about your struggles. In many cases, it is helpful to have a support group or a therapist as resources for developing a more balanced approach to this challenge. A support group or therapist can help you decide how to be available to help within reason, to resolve uncertainty about your limits to the help you are willing to provide, and to gain peace of mind that you are doing the best you can.

Infidelity in Relationships

The revelation of a partner’s affair is a serious crisis in a relationship.  It undermines trust, causes great pain to the hurt partner, and often brings the relationship as a whole into question.  While it is difficult to know precisely how many relationships experience infidelity, studies as a whole suggest that between 18-20% of married couples, and 30-40% of unmarried couples have experienced infidelity.  There are societal factors that make it increasingly challenging for couples to maintain fidelity in a committed relationship.  Among these are: more permissive sexual attitudes, population shifts to larger communities with greater anonymity, the increased availability of internet pornography and cybersex, changes in the status and roles of women towards increasing financial independence and higher positions of power, and the fact that the traditional in-tact family is less and less the norm.  While these risk factors do exist and while infidelity can occur even in a good relationship, there are ways that personal recovery and healing of the relationship can occur.  In this article I will share the key factors to recovery that I’ve learned in working with couples struggling with infidelity.

 

Infidelity in a relationship can happen for different reasons; there is not just one kind of affair.  The range of affairs include:

·        one night stands

·        emotional affair

·        sexual addiction - a series of affairs

·        a single long-term affair

·        as a reflection of the unfaithful partner’s insecurities, unmet needs, internal conflicts

·        as a means of exiting the relationship

·        as a response to difficulties in the relationship

 

These different scenarios will have different implications for each partner and for the couple.  A therapist can help the couple make sense of this crisis in the relationship - an important first step.

 

Affairs are traumatic/painful for the hurt partner and can affect each person differently.

 

·        Some will view the discovery of a partner’s affair as a negative reflection on their worthiness, acceptability.

·        Some will begin to question the validity of their judgement, feelings, intuition, and begin doubting themselves more.

·        Some, in response to feelings of shame/humiliation, will withdraw from supports, and will isolate themselves.

·        Others may experience the understandable urge to retaliate, seek revenge as a way of releasing intense anger or to protect from further hurt.

·        Others may try to escape these painful emotions by burying their feelings, moving quickly to forgiveness, putting the experience behind them or ending the relationship.

·        Most will experience increased doubts - questions about their partner and about the future of the relationship itself.

 

A therapist can create a safe environment that allows hurt partners to face the shock and pain of the betrayal, to resist the urge to make quick decisions about the relationship or to retaliate destructively at the unfaithful partner.  The therapists non-judgmental, non-pressuring presence can assist hurt partners to not bury or hide from their feelings, to learn to trust their intuition that warns them that ‘something isn’t right’, and to carefully understand their own feelings and needs.

 

If unfaithful partners have any intentions of saving their relationships, it is their responsibility to acknowledge the pain they have caused, to resolve any doubts or misgivings about commitment to their partner, to stop the affair in order to create any hope of rebuilding the relationship, and to do the hard work of regaining the hurt partner’s trust.

 

A therapist needs to be aware that often the individuals in a couple do not have the same agenda for the relationship.  Although one partner may want to continue the relationship, the other partner may have real reservations.  A therapist needs to be sensitive to this possibility and be available to meet individually with each partner to assess each partner’s interest in continuing the relationship.  The therapist’s ability to understand each partner’s state of mind and to help the partners confront doubts, conflicted feelings about committing to the relationship will help the couple be clear where they stand with each other.

 

An important complicating factor occurs when unfaithful partners have difficulty letting go of the affair and committing to the relationship. It can happen that unfaithful partners may have difficulty letting go of someone with whom they experienced something needed at a certain time in their lives. In addition, the unfaithful partner may experience guilt over ending the affair, abandoning or deserting someone who provided something positive to them. Since it is probably expecting too much for the hurt partner to be patient and understanding of these conflicts, this is where a therapist may be helpful.  A therapist’s non-judgmental presence can provide the space for unfaithful partners to resolve their reluctance or guilt about ending the affair, or to mourn the loss of the positive aspects of the affair in ways that don’t create more distrust and damage to the relationship.

 

Finally, once trust had been broken, it can only be regained through concrete action, behavioral changes that reassure the other “you’re safe with me, I’m committed to you”. Verbal reassurance alone won’t accomplish this. The hard work for the unfaithful partners involves pushing themselves beyond their normal comfort zone, taking initiative, making sacrifices that communicate to their partners “I’m not trying to sweep this under the carpet”, i.e., that they are diligently working to understand the reasons for the affair(s). A therapist can help the unfaithful partners manage feelings of guilt, shame, or a desire to spare the hurt partners further pain. This can lead to defensiveness, or impatience with or avoidance of the hurt partners’ questions about the affair, or to pressuring the partner to prematurely trust or forgive, or to put the affair in the past. This will only leave hurt partners with lingering uncertainty about “when the axe will fall again”.

 

Once the hurt partner has been convinced that the affair has ended, that partner faces the difficult decision of giving the relationship another chance.

 

The hard work for hurt partners involves their willingness to give the other the opportunity to regain trust, and to work with that partner to build a better relationship. This isn’t easy when one has been deeply hurt, and involves the risk of further disappointment and pain if things don’t work out. There is the factor of the couple’s lifestyle and social relationships, which will be severely impacted by a separation or divorce.  It becomes even more difficult when children are involved.  Hurt partners need to consider all these factors in deciding what is right for themselves and their families, what they can live with, their personal limits.  A relationship with a therapist can provide the space for hurt partners to consider all these factors without external pressure or advice (which can come from well-meaning family and friends) to make a premature decision about the relationship. Hurt partners may need the aid of a therapist to overcome fears of rejection or of disappointing others in order to voice their doubts, needs at the time, to assert what is required from the unfaithful partner to feel safer and emotionally secure, and to hold their partners accountable when they are not doing enough.

 

If the affair has ended, and the couple chooses to give the relationship another chance, therapy can provide an opportunity to identify and understand pre-existing problems in the relationship and help the couple make careful decisions about their future.

 

Affairs are often symptomatic of longer-standing problems in the relationship that have been difficult for the couple to confront in their own. This can be due to the lingering effects that important, but difficult, relationships earlier in life (parents, siblings, and extended family) have on each partner’s sense of self and what they can expect from or are entitled to from others in relationships. These lingering effects - on self-worth, sense of entitlement, willingness to be close, fears off trust - can inadvertently undermine a couple’s efforts to build a foundation of understanding, trust and love. Although discovery of an affair is an extremely painful and damaging crisis in a relationship, it provides an opportunity for the couple to understand problematic patterns of relating to each other, and deeper personal insecurities or conflicts that interfere with developing closeness, trust, and confidence in their ability to manage normal conflicts and the ups and downs of a relationship. A therapist can provide a safe environment where strong emotions are acknowledged and dealt with in ways that help the couple engage in constructive dialogue about the affair, what it means to their relationship and work together to make careful decisions about their future.

Living With Chronic Pain - How a Therapist Can Help

Chronic Pain is one of the most difficult and troubling health problems confronting our society. It has been conservatively estimated that one in 10 people in the U.S. suffers from some form of chronic pain - defined here as pain that persists for 6 months or longer. If you are someone living with chronic pain, it is important to know that chronic pain does not have to shut down your life, stop you from living a meaningful life. A therapist, knowledgeable of the challenges of living with chronic pain, can help you to prevent this from happening. This article addresses how a therapist can be helpful to you.

 

Assisting you in leading as active a life as possible, reversing the tendency of chronic pain sufferers to become sedentary, physically inactive. 

Reduced physical activity and a sedentary life style is a common consequence of chronic pain and can actually increase your physical distress. Reduced physical activity leads to muscle inflexibility, loss of strength and physical stamina, weight gain due to inactivity. It can increase sleep difficulties, contribute to a sense of uselessness, and intensify feelings of depression and hopelessness. A therapist, with an understanding of how chronic pain differs from acute pain (which yells STOP as we are causing damage to our bodies) can help you:

·   To manage understandable fears of injury that will prevent you from resuming safe physical activities

·   To learn how to avoid exacerbating pain symptoms by pacing physical activities, learning safe exercises, and managing the urge to overdo activities on days you’re feeling better.

·   To overcome reluctance, feelings of intimidation to communicating to medical and health providers important lifestyle activities ( work, hobbies, recreational activities, travel) you hope to be able to resume, to getting advice on safe ways to resume these, and to keep providers informed of symptom changes that may need further attention.

 

By promoting a healthier state of mind, fostering hope  for a better future.

A therapist who works with chronic pain patients needs to be knowledgeable of the mind-body connection. This means knowing how physical pain can affect emotions and thinking patterns, and how emotional distress and negative-pessimistic thinking can intensify already existing pain.  An experienced therapist can help with:

·   Self-calming strategies and techniques to reduce the physical tension that stress creates that can increase pain, interfere with restful sleep, and wear you down. These strategies and techniques can also reduce the need to rely on medications that have troubling side effects.

·   Managing overly pessimistic and unrealistic thinking that can intensify feeling of depression and hopelessness, and make it harder to cope.

·   Assistance in facing and resolving conflicts or stress in important relationships that can intensify pain.

·   Gaining acceptance of the loss of hope for a cure, and facing the reality of a future life with some degree of pain.  This is a difficult pill for anyone to swallow, but it is particularly hard if you’ve experienced significant painful losses earlier in life.  However it is necessary for constructive coping to replace the desperate and unrealistic searching for a cure.

 

A therapist can help prevent the social withdrawal and isolation that can occur with chronic pain.

When living with chronic pain, there can be an understandable tendency to withdraw from family and friends as part of a desire to not burden or distress them, or to avoid having to deal with misunderstanding, skepticism or negative judgment from others.  This can be particularly strong when you don’t have any obvious handicap or physical abnormality.  This tendency to withdraw in anticipation that people will disappoint or let you down can be very strong if you’ve had repeated experience of disappointment, hurt, or rejection from important people earlier in life.  This withdrawal from people and loss of emotional support, understanding, and comfort can intensify feelings of isolation, loneliness, and depression. A therapist can help you:

·   To manage fears of disappointment and rejection so you’re more willing to lean on others for support, understanding, encouragement, comfort.

·   To overcome fears of assertiveness or a tendency to be submissive so you can advocate for your needs for understanding and information in order to take good care or yourself, make informed decisions about your medical care.

·   To be able to voice understandable fears of burdening loved ones or of them “getting fed up” with your pain, so that important emotional connections are not lost.

·   To resume and strengthen sexual relationships that have been curtailed by chronic pain.

 

A therapist can work with you to find ways to live as full and constructive a life as possible.

This is extremely important as we all need to feel a sense of purpose in life, to experience ourselves as making a valuable contribution, as being needed by and helpful to others. A therapist can be helpful to you:

·   By supporting your efforts to face the loss of previously gratifying and valued activities, roles, jobs and either redefine these, or create new ways to contribute that are equally satisfying for you.

 

·   By helping you manage the frustration, uncertainty, self-doubts, and fears you may encounter so you don’t give up on the difficult but important work of fashioning new ways for you to lead a full and meaningful life.

Myths About Changing Bad Habits (e.g. smoking, overeating, excessive drinking, substance use, pornography)

When people are hoping to live healthier, balanced lives, and let go of unhealthy habits, they will often encounter popular opinions-beliefs that may sound convincing but are actually counter-productive.  Here are some of the more popular myths about changing bad habits, why they’re not helpful, and more realistic beliefs that will increase the likelihood of successful change.

Changing bad habits is just a matter of willpower, and can be accomplished quickly if one had sufficient willpower.

A related belief is: for some people habit change is easy, for others its impossible because of lack of willpower. While there are people who seem to have an easier time breaking bad habits, they are in fact the rare exception. For most of  us, bad habits have been with us for a significant part of our lives, and we've learned to rely upon them to meet certain emotional and psychological need. The urge to engage in the habit at certain times has been conditioned in us over years or even decades. Willpower, while important, is not sufficient to manage these urges-cravings over the long-haul.  Long-term success, is more  likely to occur by understanding what needs are being met by the habit, and planning alternative ways of meeting these needs.

Relying solely on willpower sets one up for failure in another way. If you believe willpower is all it takes to succeed, when you encounter any of the inevitable difficulties or setbacks that can occur in your efforts to change, you could easily come to the conclusion that you don’t have what it takes and give up trying to change.

A more realistic belief is that success in changing bad habits is really a life-long process of understanding the important emotional-psychological needs being satisfied by the habit, learning what situations will trigger urges-cravings for the habit, and planning healthier, esteem-building alternatives that one can rely upon for the rest of one’s life.

Its best to “just do it, don’t delay”.

Because of  lack of confidence in being able to change long-standing habits, or fears of failing, sometimes people will get into the rut of procrastinating or putting off change efforts until “just the right time”, which never comes.  Others, becoming increasingly worried about the damaging effects of their habits, or perhaps feeling pressured by loved ones to change, will leap into change without sufficient preparation.  While understandable responses,  chronic procrastination and “just leaping in” ignore a crucial process in successful change efforts - the need to understand the benefits or needs the habit has provided, and be prepared for those high-risk situations when strong urges to engage in the habit will occur.  It is through careful preparation - paying close attention to, charting the habit, identifying high-risk times, planning alternative strategies, educating oneself about the long-term effects of the habit, planning a quit date, and  of particular importance, seeking support for change - that confidence is built and a realistic plan for sustained success is achieved.

In changing bad habits, no one can do it for you, you have to rely on yourself, support isn't necessary.

It’s understandable that people want to be self-reliant, and yes, no one can successfully make changes for you. But keeping change efforts to yourself continues one of the patterns that fuels the habit - hiding the extent of the problem to avoid feelings of shame or embarrassment, and to avoid the disappointment of others.  By keeping change goals a secret, you lose the positive peer pressure that occurs by going public with your goal.  You also lose opportunities to confide in trusted others about your struggles with your habit, and to get specific help or encouragement for your efforts to change.  I think a more helpful metaphor is to view changing bad habits like a boxing match with your bad habit;  no one can do the fighting for you, but it is really helpful to have trainers, coaches, first-aide people in your corner.

Lapses, setbacks in changing bad habits are signs that failure is inevitable.

This assumption seems to be associated with the belief that all it takes is willpower, and  lapses-setbacks reflect internal deficiencies weakness on the part of the person trying to change.  This belief ignore the fact that long-standing bad habits (smoking, overeating, pornography, substance abuse) have served some important emotional and psychological need , and that over time,  anyone will experience strong urges to engage in the habit in certain situations.  It is more helpful to realize that  external events or circumstances can and often do trigger the urge to use or engage in the habit.  Encountering strong urges to use or having a lapse indicate that one has encountered a situation he/she has not adequately prepared for or expected,  and further preparation or support is needed.

Spouses, family and loved ones of  the person with the bad habit have to be patient and understanding, and may have to get used to living with uncertainty, waiting for the shoe to drop - for the habit to create bigger problems.

Of course, family and friends want to be understanding, supportive of, and caring towards someone with a difficult habit, and don’t want to approach the person in a nagging, judgmental, or threatening manner. However, the view that loved ones should be unfailingly patient and tolerant  of the bad habit and of its effects on others is not always helpful.  For one thing, it neglects the fact that loved ones are frequently more aware, than the person with the habit, of certain aspects of the bad habit and the effect of the habit on the person and others. It is often the case that the person with the bad habit - living in denial of the seriousness of the problem - is unaware of the hurtful emotional, social, or  financial effects on those around him/her.  Being too patient and tolerant may protect the one with the habit from experiencing and taking responsibility for the damaging consequences of his/her habit.  That experience can be an important step in the process of moving from a person with a bad habit to a habit changer.

Another problem with just being patient and tolerant is that it can convey the message that the person with the habit is not capable of  changing or of taking responsibility for the habit.  This can inadvertently reinforce the sense of shame and helplessness the person already feels about himself and his habit.  An extreme example of this process is when family members hide or cover up the extent of the bad habit to protect the person with the habit (and themselves) from embarrassment or disapproval from others.

A final and more serious problem with the patient-tolerant approach is, especially in out-of-control or dangerous habits (for example, substance abuse, high-stakes gambling, sexual addictions), the safety and stability of the family or relationships can be jeopardized unless someone can take action and set limits to ensure safety.

A more helpful approach for family and friends would include:

• To be direct and honest with the person about the harmful impact of the bad habit on the person himself and loved ones.
• To be clear in communicating the hope the person will decide to work on changing the habit and the belief that he/she is capable.
• To communicate a willingness to understand the struggles the person has with the habit.
• To be willing to offer advice help, or information if the person with the habit is receptive.
• To be prepared to set limits, take action if the habit jeopardizes the safety or health of loved ones.

Failure To Launch

As young people learn about adult roles and responsibilities, and prepare for independence, there is certainly a place for parental support and guidance.  Sometimes the help takes the form of the young person living at home while preparing for independence.  Yet all too often this becomes a burden on the parents and an experience of stagnation for the young person.  In this article, I will share some of what I’ve learned working with families where capable young adults seem stuck at home.  Hopefully this will provide both parents and young adults with ideas for getting along better at home while helping young adults towards independence.

When young adults living at home become a problem:

Parents experience:

• Conflicts over responsibilities at home
• Parents feeling responsible for fixing or solving the young adult’s problems for them, cleaning up their messes
• Feeling frustrated, resentful
• Feeling between a rock and a hard place - tired of nagging, arguing, yet worried their kid will fail or suffer it they stop
• Making threats they can’t follow thru with                       

Young adults experience: 

• Feeling their parents don’t listen or understand
• Tired of hearing parents lectures, threats
• Troubled by feelings of failure, of not living up to their potential
• Living with a sense of falling behind their peers
• Not feeling confident in his/her ability to succeed, be independent
• Feeling nagged, mistrusted, misunderstood by parents

Common obstacles to progress, getting along at home: 

Parents:

• Parental anxieties making it difficult to realistically see their adult kid’s capabilities and readiness.  It is understandable that parents’ anxieties, worries will get triggered when adult kids have difficulty taking on responsibilities for themselves.  Some parents may start to doubt their young adult’s capabilities and become protective, wanting to shelter them from failure.  For other parents the opposite may occur; normal anxieties may cause them to push the young adult towards success, e.g. pushing for college before the young person is ready to push himself.
• Parents being fearful to allow their young adults to experience frustration, sacrifice.  Parents doing for their kids what the kids can do for themselves.
• The difficulties parents face over how much to trust, help, guide, or set limits with adult kids.  With more self-motivated young adults, the parents’ role can be that of a consultant  or adviser, and they can trust their kids to make good decisions.  However, with young adults who are struggling, lacking confidence, or having more serious problems (e.g. substance abuse, extreme social difficulties), parents will need to be more proactive in establishing guidelines, setting rules at home, or setting clear limits about what behaviors they are willing to tolerate at home.  In these situations, parental trust is something the young adult needs to earn. 
• Discomfort with conflict, disagreements - Parents viewing young adult’s push back, anger as a sign they’re bad parents.
• Parents unconscious needs to rectify their experiences of parental failure-disappointment with their kids. E.g. parents who don’t want to be restrictive or harsh in the way they experienced their parents to be, and are reluctant to set any limits on the help they give or to expect their kids to do more for themselves.

Young Adult:

• Difficulty acknowledging their own weaknesses- academic, social - that need improvement; a tendency to view these as evidence of inferiority.
• Confusion about trust- it’s not parents job to trust their young adult’s decisions, it’s the young person’s job to gain parents trust.
• Intolerance of frustration- the young adult may view frustration-sacrifice as something to avoid, not work thru.
• Taking parental expectations for improvement too personally, as a bad thing- That’s what good parents do. 

Positive steps towards growth, getting along better:

• Acknowledging resentments as warning signs that some changes are needed .  Resentments generally are signs that parents are doing too much, being too helpful.  That the young  adult is not using the opportunity of residing at home to make progress, prepare to stand on his/her own feet, but is stagnating
• Parents focusing more on motivating the young person to do more for themselves, rather than trying to solve the young person‘s problems for him. e.g. parents restraining their urge to be so generous with financial help that the young person has no reason to seek work for himself;  parent asking  the young person about his/her interest in college, why he’d want  to go to college, rather than pushing the young person to fill out college applications or doing it for him.
• Parents and young adults negotiating current, day-to-day issues first, e.g. chores, considerate behaviors, financial obligations, work or school obligations.  This will help create a foundation of mutual trust and understanding.  It will also prevent both from falling into the trap of making bargains with the young adult before the young adult has earned the parents trust that he’ll hold up his end of the bargain, e.g., lending money or buying an expensive item (like a car)  before the young person has demonstrated a willingness to work consistently, save $ - things required to pay back a loan, keep a car.
• Viewing the young person’s  frustrations - social, academic, work -  as  a necessary part of  growth rather than a bad thing to be avoided. A young person’s experience of working thru frustrations, solving problems for themselves, making sacrifices to achieve a goal are a part of  the growth experience; this is how self-confidence is built.
• Creating  a family atmosphere that encourages openness about problems, difficulties, mistakes and encourages problem solving. It is more constructive to work towards a family environment where problems, mistakes can be tolerated, talked about as opportunities for learning, areas to be improved upon  rather than sources of shame, something to hide.
• An openness to recognizing when, in spite of everyone’s genuine efforts to get along at home,  antagonism within the family is building, family members don’t know what else to do, and outside help is needed.