Trauma Answers

How can I overcome my trauma from an abusive relationship?

Dear Rain,   Thank you for your message and courageously sharing the traumas that you have been through, and what they meant to you and affecting your life at the moment.   This is indeed a painful process that can cause some emotions rising on your end, that is also because for a very long time we have been simply coping with these wounds through our defense mechanisms, rather than actually looking at them and process them.    As you have said, perhaps we have learned to deal and cope with these abuses and traumas by making explanations for them, validating them and even accepting them as a part of our lives. While we have learned to move on without processing these traumas, we could still the effects they bring especially in the form of anxiety and even panic when we are being reminded or triggered by events and people who have inflicted these wounds on us.   To truly move on and not let these traumas affect us, we need to learn to bring closures to these wounds and bind them up. I am glad that you are aware of the need to bring closures, I'll explain more here when it comes to closure.   A lack of closure frequently prevents people from moving forward with their lives and achieving all that they could. It makes it more difficult to reach goals, find self-happiness or make meaningful relationships. For this reason, it is important to find a sense of closure with any situation that you feel is holding you back.   Closure is any interaction, information, or practice that allows a person to feel that a traumatic, upsetting, or confusing life event has been resolved. The term has its origins in Gestalt psychology, but it is more commonly used to refer to the final resolution to a conflict or problem.   Closure means finality; a letting go of what once was. Finding closure implies a complete acceptance of what has happened and an honoring of the transition away from what's finished to something new. In other words, closure describes the ability to go beyond imposed limitations in order to find different possibilities.   People seek answers and explanations: They want to know why. However, finding answers does not necessarily end pain. Sometimes a person who seeks closure finds that an explanation makes no difference, or that it actually worsens their pain. Others find that closure may simply be a starting point for moving past a painful event. Though the trauma is not resolved, the person is better able to work through it. Seeking a definitive way to finalize grief and move on belies the importance of the grieving process. Simply putting an end to one's painful memories may be more harmful than helpful.   In some cases, though, closure is a profoundly transformative experience that does allow the person to move past the traumatic event. For example, a victim of abuse may need to confront the abuser and see them imprisoned before he or she can begin to feel safe again. In acknowledgment of this, the criminal justice system is increasingly recognizing the need for closure by instituting programs allowing victims and their families to meet with offenders in a controlled setting.   Unfortunately, there are times when closure is simply unattainable. This may be true in situations where someone moved locations or passed away before being able to resolve a problem. In some cases, the other involved person is simply unwilling to engage. In times like these, it can be easy to become bogged down by the lack of closure. It can be easy to cover up the underlying problem with meaningless coping mechanisms like substance abuse. With time and effort, there are many ways to move past unattainable closure to live happily once more.   The most important part of moving on from a lack of closure is taking care of yourself, both physically and mentally. This is also why we have began our therapy process with the focus on self-compassion. Self-compassion is the core of why we want to bring closures and bind up these wounds, because they make us feel better and they are the best decisions we can make for ourselves.   When we bring closures to our traumas, we need to keep in mind that we are doing this not because we have to, but we want to. When we practice forgiving those who have wounded us and let them go, we are not agreeing / accepting / acknowledging what they have done and not hold them accountable, we are simply letting go of the bitterness, resentment and hatred that we have hide with us all these years.   As for our physical health, engaging in adequate active exercises could be helpful. Improving your physical health through diet and exercise can help to improve self-esteem and emotional well-being, both of which are essential to moving on from unattainable closure.   Meditation, hobbies and social interaction are all great ways to nurture your mental health and find the inner happiness that makes a lack of closure bearable.   While self-care is essential to moving on from a lack of closure, it is often not enough to resolve the problem altogether. One great exercise to help you move forward is to write a letter to the individual that you have not received closure with. In this letter, you can describe all of your feelings about the situation and how you wish things had ended. Once the letter is complete, you can bury it, burn it, or simply throw it in the trash. Writing an unsent letter can help you get those feelings out that are hiding painfully inside and find a sense of self-resolution.   Forgiveness is another essential component to finding a sense of closure at times that closure cannot otherwise be achieved. Forgiving a person that caused you pain can sometimes seem like an impossible task. However, it is possible with daily efforts. We can go into details later regarding forgiveness, one step at a time.   To move past unattainable closure, you may also need to forgive yourself for anything you feel you did wrong in the situation. If you blame yourself for a broken relationship, death of a love one, or anything else, it will be impossible to move on and find inner happiness.   I'll pause here to learn from your thoughts, looking forward to talking with you more. Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022

How can change and adapt to society?

Trauma Redefined in the DSM-5: Rationale and Implications for Counseling Practice Laura K. Jones, Jenny L. Cureton Trauma survivors are a unique population of clients that represent nearly 80% of clients at mental health clinics and require specialized knowledge on behalf of counselors. Researchers and trauma theorists agree that, with the exception of dissociative identity disorder, no other diagnostic condition in the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has created more controversy with respect to the boundaries of the condition, diagnostic criteria, central assumptions and clinical utility than post-traumatic stress disorder. However, this mutable conceptualization of trauma and its aftermath have considerable implications for counseling practice. With the recently released fifth edition of the DSM (DSM-5), the definition of trauma and the diagnostic criteria for post-traumatic stress disorder have changed considerably. This article highlights the changing conceptualization of trauma and how the DSM-5 definition impacts effective practices for assessing, conceptualizing and treating traumatized clients. Keywords: trauma, post-traumatic stress disorder, PTSD, DSM-5, diagnostic, clinical utility   Nearly 80% of clients seen in community mental health clinics have experienced at least one incident of trauma during their lifetime, representing roughly five out of every six clients (Breslau & Kessler, 2001). Over the past 15 years, between increases in school and community violence in the United States and unrelenting wars overseas, overt exposure to traumatic events has become an epidemic. Such events affect individuals across the life span and precipitate numerous diagnoses within the Diagnostic and Statistical Manual of Mental Disorders (DSM), most notably post-traumatic stress disorder (PTSD; Breslau & Kessler, 2001). Survivors of trauma are a unique population of clients who require specialized knowledge and multifaceted considerations on behalf of counselors (Briere & Scott, 2006). The Council for Accreditation of Counseling and Related Educational Programs (CACREP) reiterates across both master’s and doctoral training levels the importance of understanding the implications of trauma theory, research and practice in counselor preparation and ultimately practice. CACREP (2009) standards incorporate trauma training within all eight core curricular areas of demonstrated knowledge and within each core counseling track. Section II, Professional Identity, says that counselors should understand the “effects of … trauma-causing events on persons of all ages” (CACREP, 2009, p. 10). However, even with the notable rates of trauma exposure, the deleterious outcomes faced by survivors and the call for counselor training in this area, counselors report feeling unprepared to work with survivors (Parker & Henfield, 2012). Over 60% of practicing therapists reported wanting additional support and education in their trauma work (Cook, Dinnen, Rehman, Bufka, & Courtois, 2011). Trauma theorists agree that, with the exception of dissociative identity disorder, no other diagnostic condition in the history of the DSM has created more controversy about boundaries of the condition, symptomatological profile, central assumptions, clinical utility and prevalence than PTSD (Brewin, Lanius, Novac, Schnyder, & Galea, 2009). Changing definitions and the rationale for such shifts have significant implications for counselors. The fifth edition of the DSM (DSM-5), released in May 2013 (American Psychiatric Association [APA], 2013a), contains substantial changes, including the reorganization of “Trauma- and Stressor-Related Disorders” (TSRDs) into a new category and chapter distinct from “Anxiety Disorders,” the restructuring of factors, the modification of symptoms and specifiers, and the addition of a new subtype of PTSD in children. The highly debated and variable definition of trauma and the diagnostic criteria for psychological responses to traumatic events may contribute to low counselor efficacy in trauma practice. Without a clear understanding of the latest views and requirements for trauma diagnosis using DSM-5, counselors may feel tentative about assessing for trauma and selecting efficacious interventions. This manuscript explores the changing definitions of trauma over time, implications of such changes on counseling practice and areas of needed growth and research. While this article’s core focus is on PTSD, we also briefly describe other TSRDs. By outlining DSM-5 changes, reviewing recent research substantiating such modifications and providing practical suggestions for practitioners, we hope to mitigate confusion and enhance efficacy in counselors working with trauma clients during this crucial diagnostic transition. History of Trauma Derived from the Greek word for “wound,” tales of trauma and the its profound consequences thereof date back to writings in antiquity. Only in the late 19th century did Pierre Janet and Sigmund Freud provide the first writings on the characterizations and clinical implications of traumatic events. In the mid-1890s, both practitioners developed similar theories of the etiology of hysteria, namely experiences of psychological trauma, particularly sexual trauma (Herman, 1992a). The theories presented in Freud’s The Aetiology of Hysteria (1962), however, were met with vehement contention, and such censuring stifled potential ramifications of his discoveries. Consequently, contemporary theories and definitions of trauma became largely fashioned from studies of male soldiers’ reactions to the horrors of war. Investigations of traumatic stress and apposite interventions for survivors emerged following World War I, purportedly as a means of rehabilitating soldiers for redeployment (van der Kolk, 2007). This attention waned during times of peace, but took command of the mental health research and literature during the Vietnam War. Concurrently, marked attention again became drawn to the consequences of sexual and domestic violence against women and children owing to the Women’s Movement (Herman, 1992a). The examination of traumatic responses on both fronts (i.e., combat and interpersonal violence) led to the inclusion of a distinct PTSD diagnosis in the third edition of the DSM (DSM-III; APA, 1980). Previous iterations of the DSM recognized reactions to stressful experiences as a “transient situational disturbance,” suggesting that without an underlying psychological condition, the individual’s psychological experiences would wane as the stressor subsided (Yehuda & Bierer, 2009). However, the DSM-III classified trauma as an event existing “outside the range of usual human experience” (APA, 1980, p. 236) and provided legitimization for the potential pervasive and deleterious effects of exposure. As research continues, however, both the definitions of what constitutes a traumatic experience and what characterizes the symptoms of PTSD have rapidly transformed. The publications of the DSM-IV and DSM-IV-TR brought a considerably more inclusive definition of trauma (APA, 1994, 2000).Varied events as a car accident, a natural disaster, learning about a death of a loved one, and even a particularly difficult divorce were considered variations of traumatic experience. This expanded definition engendered a 59% increase in trauma diagnoses (Breslau & Kessler, 2001). Modern trauma theory conceptualizes trauma and traumatic responses as occurring along a continuum (Breslau & Kessler, 2001), with researchers elucidating the importance of differentiating between traumatic experiences when investigating the etiology, physiological responses, course and efficacious therapeutic interventions for the range of potential traumatic responses (Breslau & Kessler, 2001; Kelley, Weathers, McDevitt-Murphy, Eakin, & Flood, 2009). The unique consequences of these diverse populations may be obscured if survivors of disparate populations are combined in research or excluded from trauma definitions altogether. Primary Challenges to the DSM-IV-TR The 13 years between the DSM-IV-TR (2000) and the DSM-5 (2013a) engendered considerable debate regarding how trauma was defined and the core criteria of PTSD. In the DSM-IV-TR, the presence of at least six symptoms (out of 17) distributed among three core symptom clusters served as a basis for diagnosing PTSD. This three-factor model stipulated that following a traumatic event, which induced fear, helplessness or horror, a survivor must experience at least one symptom of persistent re-experiencing (criterion B), three symptoms of avoidance or emotional numbing (criterion C), and two indicators of increased arousal (criterion D), all of which must persist for at least 1 month. Further, a clinician could specify whether the condition was acute, chronic and/or with delayed onset. An examination of the challenges surrounding this diagnosis follows. Is Trauma an Anxiety Disorder? PTSD was historically characterized as an anxiety disorder within the DSM. Authors supporting this view reference the pronounced fear and classical conditioning believed central among survivor experiences and treatment approaches that aim to extinguish such fear-based responses (i.e., exposure therapies; Zoellner, Rothbaum, & Feeny, 2011). Zoellner et al. (2011) branded PTSD a “quintessential anxiety disorder” (p. 853), arguing that the co-occurrence of PTSD with other anxiety disorders suggests common core constructs. These authors warned that reclassifying PTSD would suggest incorrectly to clinicians and researchers that “fear and anxiety are not critical in understanding PTSD” (p. 855). However, other researchers promoted making trauma-related disorders a new diagnostic category, suggesting that the traumatic event and not the symptoms demarcate such disorders (Nemeroff et al., 2013). Nemeroff et al. (2013) suggested that using the traumatic event as the foundation for the diagnosis respects the intensely heterogeneous nature and symptomatic presentation of the disorder. Precipitating Events and Subjective Response Also termed the stressor criterion, PTSD criterion A stipulated two requirements. An individual must first experience a traumatic episode (A1), defined as: A direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about an unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (APA, 2000, p. 463). The second prerequisite (A2) required that the survivor must have experienced “intense fear, helplessness, or horror” (p. 467) following the event. Clinicians and researchers have criticized both requirements (Breslau & Kessler, 2001; Friedman, Resick, Bryant, & Brewin, 2011). The debate over what constitutes a traumatic event emerged with the first inclusion of the diagnosis into the DSM-III, and has persisted. Some researchers argued that the DSM-IV’s broad definition of trauma led to “bracket creep” (McNally, 2009, p. 598) and overdiagnosis of PTSD resulting from less threatening events. McNally (2009) questioned the ramifications of having equivalent diagnoses for a traumatized individual who watched the World Trade Center collapse from thousands of miles away and a survivor who escaped the building directly. Some postulated that weakening the A1 criteria had detrimental outcomes in client care and in forensic and disability settings and supported a narrower definition of trauma (Rosen & Lilienfeld, 2008). Others starkly disagreed, suggesting that what may be traumatic for one individual may not be for another, and that an attempt to include all possible traumatic events within the context of a diagnosis was futile (Brewin et al., 2009). Numerous researchers and clinicians have remarked that for no other diagnosis in the DSM is a specific precursory event stipulated, and they have argued for the removal of the A1 event altogether (Brewin et al., 2009), questioning the compulsory relationship between a traumatic event and PTSD (i.e., other disorders may result from such an event) and asserting that minor events, repeated over time, can likewise lead to PTSD. More prominent was dispute over the latter stressor requirement (A2). Friedman et al. (2011) emphasized that the presence of a subjective response did not predict that an individual who would go on to develop PTSD. Although these subjective responses are characteristic trauma reactions, limiting the range of psychological responses may discount subpopulations, most notably survivors of sexual and partner violence, military and first responders (Friedman et al., 2011). The predominant post-traumatic reactions of interpersonal violence survivors include anger, guilt and shame; the military and first responders often report not having an immediate emotional reaction to traumatic exposure as a result of their training. In a sample of adult sexual assault survivors, over 75% endorsed shame as a leading psychological response (Vidal & Petrak, 2007). Over 20% of survivors were misdiagnosed due to not meeting the A2 criteria (Creamer, McFarlane, & Burgess, 2005). Three-factor Model: The Avoidance and Numbing Debate The third criterion for a PTSD diagnosis in DSM-IV-TR included experiencing at least three symptoms related to either behavioral avoidance or affective numbing (APA, 2000). Having a double-barreled criterion engendered considerable disagreement in trauma research and clinical practice. Although these two constructs were initially considered synonymous, with emotional numbing serving as a volitional form of emotional avoidance, research has elucidated differences in their bases, functions and neurophysiological underpinnings (Asmundson, Stapleton, & Taylor, 2004). Foa, Riggs, and Gershuny (1995) further determined that emotional numbing, over and above avoidance or another symptomatic feature of PTSD, best distinguishes PTSD from other diagnostic categories. Conceptually, authors (Foa, Zinbarg, & Rothbaum, 1992; Ullman & Long, 2008) frequently distinguished avoidance and numbing by examining the intentionality behind the event: whereas avoidance represents conscious attempts to escape trauma-related stimuli or responses, numbing is an unconscious and automatic physiological response to trauma exposure. Confirmatory factor analyses substantiated such claims and repeatedly demarcated a four-factor rather than a three-factor model of PTSD that differentiates avoidance and numbing (Friedman et al., 2011). The integrated conceptualization of numbing and avoidance had marked significance on clinical practice. It was often difficult to confirm three of the seven conditions (Schützwohl & Maercker, 1999), leading to subthreshold diagnoses or underdiagnosis. Further, the severity of numbing precipitated a category of trauma survivors marked by the most chronic and pervasive disturbances following trauma and most pronounced disruptions in daily life (Breslau, Reboussin, Anthony, & Storr, 2005). In addition, Asmundson et al. (2004) determined that symptoms of avoidance and numbing are differentially influenced by treatment approaches, reinforcing the notion that avoidance and numbing should be considered and clinically addressed as distinct symptomatic concerns. Further, using the DSM-IV, a clinician treating an unconscious response (i.e., numbing) as an intentional action (i.e., avoidance) could unintentionally lead to treatment that was ineffective, blaming, disempowering or even re-traumatizing to clients. Subthreshold Diagnoses Several of the aforementioned considerations denote concern around subthreshold or subsyndromal survivors, namely individuals whose trauma did not match the A1 or A2 events or whose symptoms did not fulfill the restrictive criterion C. These survivors, potentially facing grossly impaired functioning, did not fulfill PTSD criteria and thus may have been prohibited from receiving any services, appropriate services or related validation of their experiences (Cukor, Wyka, Jayasinghe, & Difede, 2010; Schützwohl & Maercker, 1999). Problems with subthreshold diagnoses and misdiagnoses under the DSM-IV guidelines were particularly notable among children (Pynoos et al., 2009; Scheeringa, Zeanah, & Cohen, 2011). Using DSM-IV criteria, over 30% of children with pervasive symptoms and severe functional impairment did not meet criteria (Scheeringa, Myers, Putnam, & Zeanah, 2012). Although notes regarding symptom presentation in children were presented, the DSM-IV did not identify a separate diagnosis for preschool post-traumatic reactions. Researchers argued that the DSM-IV criteria were not attentive to developmental considerations, owing largely to the linguistic and introspective differences of young children, and provided unrepresentative criteria for this population (Pynoos et al., 2009; Scheeringa et al., 2011). Consequently, researchers highlighted the need for child-specific PTSD criteria. Underdiagnosis in children and adults is particularly troubling given that these populations of survivors have long been misdiagnosed and stigmatized by the DSM (Fish, 2004; Rojas & Lee, 2004). Drawing on both behavioral and neurological research, these challenges to the DSM-IV PTSD diagnosis touched at the core of trauma theory and resulted in many shifting perspectives in the fifth edition. Given the historical complications in trauma theory and recent reformulations of trauma, it is important that counselors receive guidance on trauma-informed practice using the DSM-5 (APA, 2013a). Shifting Perspectives and New DSM-5 Diagnostic Criteria In the DSM-5, PTSD now serves as the cornerstone of a new category of diagnoses, TSRD. Within the new category, the definition of trauma is more explicit, and the symptomatic profile was expanded from a three- to four-factor structure. Subjective responses following a traumatic event are no longer required, and a separate preschool diagnosis for children 6 years old and younger is now available. The modifications to the PTSD diagnosis in the DSM-5 are delineated in Table 1. Exemption from Anxiety Disorders The foremost change in the DSM-5 diagnosis of PTSD is its assignment to an innovative diagnostic category, TSRDs. Throughout the review period, members of the Trauma and Stressor-Related and Dissociative Disorders (TSRDD) Sub-Work Group of the DSM-5 (Friedman, 2013) determined that PTSD did not “fit neatly into the anxiety disorder niche to which it had been assigned since DSM-III” (p. 549). This redefining of PTSD marks a significant shift from its former conceptualization and highlights the central importance of the predisposing stressor. Exposure to a traumatic or aversive event is now recognized as a vital cause of an entire class of conditions affecting mental well-being. Before the DSM-5, trauma exposure was an accepted catalyst of Acute Stress Disorder and PTSD, yet the explicit influence of such aversive events on numerous other disorders went largely unacknowledged. Restructuring the Stressor Criterion Emphasis on the precipitating traumatic event called for reconsideration of the definition of trauma. Despite the argument by Brewin et al. (2009) that what is or is not considered a traumatic event should be defined by the individual rather than a committee, the DSM-5 retained criterion A1, with modifications to the breadth of the definition. Trauma is now defined as exposure to actual or threatened death, serious injury or sexual violence in one or more of four ways: (a) directly experiencing the event; (b) witnessing, in person, the event occurring to others; (c) learning that such an event happened to a close family member or friend; and (d) experiencing repeated or extreme exposure to aversive details of such events, such as with first responders. Actual or threatened death must have occurred in a violent or accidental manner; and experiencing cannot include exposure through electronic media, television, movies or pictures, unless it is work-related.   Table 1 Key Modifications to PTSD in DSM-5 PTSD Modifications Location New category: “Trauma- and Stressor-Related Disorders”No longer a subcategory of “Anxiety Disorders” Criteria   A. Exposure Included sexual violence as a traumatic eventExposure refined to include:   Learning the event(s) occurred to close family or frienda, Repeated or extreme exposure to details of the event(s)b, i.e., vicarious trauma. Removed A2, subjective response (i.e., fear, helplessness, horror) B. Intrusion(1 of 5) No major changes C. Avoidance(1 of 2) New separate criterion (factor) for avoidance symptomsNo major changes to symptoms D. Negative Alterations in Mood/cognition(2 of 7) New criterion (factor) for numbing symptomsTwo new symptoms:   Persistent negative emotional states Persistent blame E. Arousal and Reactivity(2 of 6) One new symptom:   Reckless or self-destructive behavior F. Duration No change: Still 1 month since stressor G. Significance No change H. Not substance or medical Added criterion Specifiers Two types available:   With dissociative sx, i.e., depersonalization or derealization With delayed expression of 6 or more months Subtype For children 6 years or younger (Preschool subtype)Separate criteria Note. sx = symptoms. Adapted from  DSM-5 (APA, 2013a, p. 272). aActual or threatened death must have been violent or accidental. bSuch exposure through media, television, movies or pictures does not qualify unless for work.  Several changes in the DSM-5 definition stand out immediately, such as the inclusion of sexual violence within the core premise of trauma. Experiencing sexual violence may precipitate PTSD, as can witnessing it, learning about it and experiencing repeated exposure to stories of such acts. Furthermore, loss of a loved one to natural causes is no longer considered a causal factor. For example, now a client whose partner unexpectedly died of a heart attack no longer fits PTSD criteria. Lastly, a new subset of possible exposure has been established, namely vicarious trauma. This is the first time that DSM criteria have included deleterious effects of repeatedly witnessing or hearing stories regarding the aftermath of trauma. This inclusion may not be surprising to trauma counselors, as nearly 15–20 % develop PTSD symptoms from hearing and sharing in the stories of survivors; this inclusion may help to legitimize the gravity of counselors’ reactions (Arvay & Uhlemann, 1996; Meldrum, King, & Spooner, 2002). The inclusion also may serve to de-stigmatize the reactions of first responders and reinforce the need for wellness training and post-exposure care (Royle, Keenan, & Farrell, 2009). However, the DSM-5 clearly states that vicarious trauma cannot be the result of repeated exposure via electronic or print media. This precludes, for example, McNally’s (2009) case example of an individual with trauma symptoms who repeatedly witnessed the attacks on the World Trade Center by way of television monitors.  Removal of Subjective Response Along with changes to the definition of trauma, the DSM-5 now excludes the A2 subjective response. The PTSD diagnosis now represents survivors who experience reactions other than fear, helplessness or horror, or who exhibit no pronounced emotional response. For example, a client who witnessed a fatal car accident and predominantly feels pervasive guilt for not offering support could be diagnosable. This change has great significance for numerous populations and may lead to more survivors gaining access to efficacious mental health care.  A Four-Factor Approach In accordance with evidence supporting a four-factor model of PTSD, the APA (2013a) split the previous criterion C into two distinct categories within the DSM-5: (a) avoidance and (b) negative reactivity and related numbing. The new criterion C (i.e., persistent avoidance) requires only one of the two original avoidance symptoms. The new criterion D in DSM-5, “negative alterations in cognitions and mood” (p. 271, APA, 2013a), underscores the notion that trauma leads to unconscious numbing of positive emotions and increased negative affect overall (Frewen et al., 2010). Persistent negative emotionality and persistent blame are additions to the original symptom profile, the latter of which predicts PTSD severity and chronicity (Moser, Hajcak, Simons, & Foa, 2007). Two of seven symptoms must be endorsed in the new criterion D.  Criterion B (i.e., presence of intrusive symptoms) remains unchanged from the DSM-IV, and requires only one of five symptoms. The new criterion E, persistent alterations in arousal, reflects the previous criterion D and includes one additional symptom, reckless or self-destructive behaviors. Self-destructive behaviors comprise anything from hazardous driving to suicidal behavior (Friedman, 2013). Two of the now six symptoms of altered arousal are required. Despite refinements to criteria, considerable overlap remains across and within PTSD symptoms, such as between intrusion and the dissociative-depersonalization specifier.  Dissociative Specifier In addition to delayed expression, the DSM-5 includes specifiers for dissociative symptoms in PTSD, with either depersonalization or derealization constituting the primary presentation. Dissociation often predicts significantly greater severity, chronicity and impairment in survivors, as well as decreased responsiveness to common treatment approaches (Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012). The inclusion of this subtype acknowledges differences in neurological and physiological functioning among this population (Felmingham et al., 2008) and relevant needs and clinical considerations (Lanius et al., 2012). Post-traumatic Stress Disorder in Children In recognizing the gross oversights in previous iterations of the DSM regarding developmental considerations in PTSD, the DSM-5 explicitly provides a preschool subtype for children 6 years and younger. This new diagnosis honors the unique trauma experiences and responses of children, with symptoms that are behaviorally based and thus not reliant upon the cognitive or linguistic complexity absent in young survivors. For example, symptoms include restless sleep, temper tantrums or decreased participation in play. Children may express symptoms through behavior or play reenactment, which may or may not appear related to the traumatic event. The preschool subtype retains the three-factor model that combines avoidance and negative alterations of mood and cognition. To circumvent concerns related to children not meeting criterion C requirements, only one of six symptoms is necessary. These changes have pronounced implications for counseling adult and child survivors of trauma. Implications for Counseling Practice Understanding these changes and the rationale behind them is essential to thorough client conceptualization and efficacious counseling. Otherwise, counselors may feel tentative about key areas of care, such as assessing for trauma exposure, making accurate diagnoses, selecting efficacious interventions and filing reimbursement claims. A consideration of specific ways the new that the DSM-5 PTSD diagnosis impacts counselors, clients and clinical practice follows.  Multifarious Symptom Structure and Trauma Prevalence The expanded PTSD symptom set in the DSM-5 set leads to extensive variations in possible trauma responses. The increase in symptoms from 17 in the DSM-IV-TR to 20 in the DSM-5 now yields over 600,000 possible symptom combinations (Galatzer-Levy & Bryant, 2013). Consider this number in comparison to the potential 70,000 combinations possible in the DSM-IV-TR (2000), a number already criticized for its expansiveness, and the meager 256 possible for depression (Zoellner et al., 2011). This marked increase in symptom patterns calls into question prevalence rates for trauma under the new DSM. A recent study established similar prevalence rates using DSM-5 and DSM-IV-TR criteria, 39.8% and 37.5%, respectively, and an overall 87% consistency between the two versions (Carmassi et al., 2013). Carmassi et al. (2013) determined that the discrepancy was due primarily to individuals not fulfilling criterion C within the DSM-IV-TR. This finding illustrates the impact of modifications related to the bifurcation of avoidance and numbing. Kilpatrick et al. (2013), however, found marginally decreased prevalence with the DSM-5, citing constraints on the A1 definition of trauma. However, both studies found significantly increased prevalence among females than males using DSM-5 (Carmassi et al., 2013; Kilpatrick et al., 2013).  Although heterogeneity may provide a more thorough scope and representation of traumatic responses, the considerable variation in behavioral presentation may lead to confusion among both counselors and clients (Friedman, 2013). Two clients may present in drastically different manners, but receive the same diagnosis. One client with PTSD may be distrustful, experience violent nightmares and behave aggressively, while another with a PTSD diagnosis is more withdrawn and self-blaming, with internally directed negative emotionality. Conversely, a counselor could have two clients who present analogously; and yet, due to the nature of the traumatic event, one could be diagnosable and the other not. This may cause complications for counselors in providing psychoeducation or in determining appropriate clinical interventions.  Counselors will encounter many questions with the changing and heterogeneous face of PTSD. For instance, would a counselor work differently with the client with a PTSD diagnosis than with a client having an analogous presentation, but no PTSD diagnosis? Do neurological ramifications differ dramatically now given the shifting labels, and thus call for varied interventions? How does a counselor explain to a client who had PTSD under the DSM-IV that she or he no longer meets criteria nor qualifies for reimbursement with the new diagnosis of adjustment disorder? Or will adjustment disorder, re-categorized as a TSRD in DSM-5, now be recognized by third-party payment systems as a reimbursable disorder? Although some answers are beginning to unfold, an increased awareness and adaption of trauma assessment, treatment and administration can help counselors navigate such questions and effectively work with clients.  Client Assessment Changes precipitated by the DSM-5 require counselors be acutely aware of the modified PTSD diagnostic criteria for careful assessment of survivors. Thorough assessment includes applying both informal and formal approaches, using multiple sources of information, and conducting initial and ongoing screenings. During the present transition, informal assessment becomes especially important as efforts to revise and validate formal assessment tools continue.  Informal assessment. Given the central importance of trauma exposure in client care, counselors may continue to struggle to sensitively solicit needed information early in the counseling process. Honed skills for developing and continually fostering the therapeutic alliance are essential to client disclosure and in conscientiously deciphering such information. Some clients may be more reticent to share information, while others may reveal very detailed accounts of their story. In either case, counselors need to remain cognizant of the risk for re-traumatization during this process and pace sessions accordingly. Friedman (2013) also recognized that the current conceptualization of trauma in the DSM-5 insinuates the trauma has already happened, and that the individual is now “in a context of relative safety” (p. 763). This assumption may complicate assessment of individuals in enduring traumatic environments (e.g., partner violence).  During informal assessment with adults, counselors should practice acute observation skills for nonverbal clues that may signal present intrusive, numbing, arousal and dissociative symptomatology. Reported experiences of feeling detached from body or mind and reports of the world seeming dreamlike or unreal are primary indicators of dissociative experiences. Objective cues of dissociative responses also may be present, such as the client appearing to space out (Briere & Scott, 2013). Further, behavioral responses such as reckless and self-destructive behavior must also be recognized as potential trauma responses. The two new criterion D symptoms related to client cognitions, however, require counselors to determine a survivor’s cognitive perception of the event, self and world, and how perceptions of the latter two may have shifted post-trauma. Moreover, given the current distinction between numbing and avoidance symptoms, counselors may need to discern conscious from unconscious motivations behind client behaviors.  In children, informal assessment of traumatic responses, although now facilitated by developmentally appropriate criteria, may be particularly challenging. This requires keen observation of behavior, interpersonal interactions, sleep patterns and play. Cohen et al. (2010) suggested that child assessments must account for the onset of symptoms and changing patterns therein to avoid potential misdiagnoses. Recognizing how trauma responses manifest in children will help counselors correctly identify child survivors and help children get the mental health care needed to avert potentially protracted concerns across the life span.  Formal assessment. Formal assessment methods consistent with the revised diagnostic criteria are an essential adjunct to a counselor’s informal assessment. A notable addition to the DSM-5 is the provision of diagnostic assessments. Many are still considered “emerging,” as the APA continues to gather feedback from clinicians (APA, 2014). Counselors can familiarize themselves with these measures and stay updated on their availability and validation through the DSM-5 website (www.psych.org/practice/dsm/dsm5).  Relevant formal measures of PTSD for the DSM-5 include the following: Level 1 Cross-Cutting Symptom Measures for brief assessment, Level 2 measures for in-depth domain-specific assessment, disorder-specific Severity Measures, and potentially Early Development and Home Background Forms (APA, 2014). Level 1 surveys include questions related to avoidance, sleep quality, repetitive unpleasant thoughts and other symptoms found in DSM-5 PTSD criteria. This level provides a measure for adults, a self-rated measure for children ages 11 to 17, and a guardian-rated measure for children ages 6 to 17. Level 2 Cross-Cutting Symptom Measures allow for more in-depth explorations of symptoms. Disorder-Specific Severity Measures contain the National Stressful Events Survey PTSD Short Scales for adults and for children ages 11-17. Although guardian measures are available, the applicable age range is limited from 6 to 17 years. Thus these measures are not appropriate for assessing symptoms in preschool children, despite the addition of distinct diagnostic criteria for this population.  In addition to the DSM-5 measures provided by the APA, the National Center for PTSD updated three measures to include DSM-5 criteria: the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the Life Events Checklist for DSM-5 (LEC-5). Counselors wanting to access these measures can submit requests on the National Center for PTSD’s website (www.ptsd.va.gov/).  Differential diagnosis: A resource with limitations. Another component of assessment is differential diagnosis. The use of updated measures for formal assessment may not always resolve confusion engendered by facets of DSM-5 diagnosis such as overlapping criteria. Selecting among the Level 2 cross-cutting measures may be challenging, as many currently focus on anxiety, anger and inattention, which may not be applicable or adequate in assessing PTSD. Differential diagnosis may help counselors gain needed clarity and is often considered integral to every initial clinical encounter and the basis for treatment planning (First, 2014).  Decision trees allow for diagnostic determination based on the entirety of a client’s presenting symptoms and assist in identifying diagnostic options by using lists of symptoms relevant to PTSD, including distractibility, mood concerns, suicidal behavior, anxiety, avoidance and insomnia. Out of the 29 available decision trees in the DSM-5 Handbook of Differential Diagnosis (First, 2014), nine include decisions that may result in an accurate diagnosis of PTSD or another TSRD, not including lists with adjustment disorder as the sole TSRD.  However, some decision trees, which include symptoms reflective of PTSD criteria, do not include the disorder as a possible conclusion. For instance, criterion D covers “negative alterations in cognitions and mood,” though none of the three decision trees associated with mood include PTSD. The new symptom in criterion E is “self-destructive or reckless behavior,” yet the Decision Tree for Suicidal Ideation or Behavior does not include PTSD as a possible diagnosis, nor does its counterpart for self-injury or self-mutilation. Thus, in the initial absence of information about a precipitating event, well-developed informal assessment skills for PTSD may be the best tool a counselor can use to form initial hypotheses for client conceptualization and associated treatment planning.  Treatment New changes to the DSM also engender implications for PTSD treatment. As noted, the four-factor model of PTSD discriminates between avoidance and negative emotionality/numbing. This transition emphasizes the need to address these two constructs as unique symptom sets in survivors and highlights the influence of neuroscience research on best practices in trauma care. For instance, positive emotional numbing is considered a neurologically based symptom outside the conscious control of survivors, as opposed to the conscious or conditioned behavioral-based responses of effortful avoidance used to decrease arousal (Asmundson et al., 2004). The degree of emotional numbing versus avoidance in clients (or vice versa) suggests differential subpopulations of survivors and thus treatment approaches. For example, exposure therapy has proven particularly beneficial for avoidance symptoms (Asmundson et al., 2004). However, given the longstanding conceptual overlap in avoidance and numbing symptoms, optimal measures to assess treatment responses to emotional numbing have been limited (Orsillo, Theodore-Oklota, Luterek, & Plumb, 2007). Such findings suggest that effective treatment for trauma clients may become increasingly multidimensional and multidisciplinary.  The addition of new symptoms within criterion E and subtypes of PTSD calls for modified treatment approaches and goals for survivors who fulfill such criteria. For example, the inclusion of reckless or self-destructive behaviors as a feature of hyperarousal in criterion E now encompasses suicidal behavior (Friedman, 2013). Researchers have long denoted strong correlations between PTSD and suicide risk (Krysinka & Lester, 2010). The inclusion of self-destructive behavior as a symptom finally gives credence to this relationship. Counselors should practice vigilance and responsiveness to warning signs of suicidality. Regarding treatment, distress tolerance was shown to moderate PTSD and suicidal behavior (Anestis, Tull, Bagge, & Gratz, 2012), although perceived social support may buffer the impact of trauma symptoms on such behavior (Panagioti, Gooding, Taylor, & Tarrier, 2014). Similarly, the addition of dissociative subtypes highlights the severity and uniqueness of this subpopulation and the need for appropriate treatment considerations. Cloitre et al. (2012) endorsed a staged treatment emphasizing affective and interpersonal regulation as one option for treating dissociation in PTSD.  The addition of a preschool PTSD diagnosis increases the discernible importance of trauma-informed counseling with children and families. Research on best practices with children 6 years old and younger supports the use of cognitive-behavioral therapy (CBT), individually or in groups, most notably Trauma-Focused CBT; as well as child-parent relational psychotherapy; EMDR; and play therapy (Scheeringa, 2014). Scheeringa stressed that the key to working with this age group is engaging the child in developmentally appropriate methods that respect linguistic and introspective abilites (2014). Although some treatment implications stemming from the DSM-5 are presently discernible, additional research on best practices for addressing novel symptoms and symptom patterns of PTSD in children and adults will further inform practice.  Reimbursement and Legal Ramifications Additional implications of DSM-5 modifications, such as healthcare consequences, remain largely unknown. General healthcare implications are explored in a file provided on the DSM-5 website (APA, 2013b), with the major foci including International Classification of Diseases (ICD) coding and assessment of disability and functioning. The APA (2013b) assured “periodic updates of agreements with federal agencies, private insurance companies, and medical examination boards as they become available” (p. 4). It can be expected that insurance companies will continue to reimburse for PTSD. However, a parallel expectation or hope is for companies to begin reimbursing more consistently for subthreshold PTSD, adjustment disorder and related diagnoses. Conclusion  Although the changes to PTSD in the DSM-5 were empirically based and arose after considerable analysis and debate, several areas of concern and oversight still stand. Research remains mixed about overall prevalence rates of vicarious trauma (VT) in mental health practitioners (Kadambi & Ennis, 2004). Given the inclusion of VT in trauma definitions, the expected increase of PTSD diagnoses in clients, and the related potential for reimbursement and access to care for a broader range of traumatized clients, the prevalence of VT in clinicians may increase as well. Further research is needed on prevalence, risk and protective factors, and effective help for counselors experiencing VT. The addition of VT in the DSM-5 provides a diagnostic construct, yet future research will yield notable contributions to conceptualization and inform counseling practices for individuals experiencing VT. Furthermore, a growing body of evidence suggests that a traditional diagnosis of PTSD is not sufficient to describe the range and intensity of symptomatology experienced in survivors of unremitting and recurrent abuse, notably abuse during early stages of development. Research has determined that such iterative and early trauma engenders symptomatic sequelae divergent from adult onset or isolated acts of violence (Herman, 1992b; van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005). Herman (1992b) and van der Kolk et al. (2005) proposed a diagnostic formulation distinct from PTSD: complex PTSD or disorders of extreme stress not otherwise specified (DESNOS). The profoundly disruptive nature of DESNOS led researchers to characterize complex PTSD as an experience of “mental death” (p. 617; Ebert & Dyck, 2004). In field trials on the addition of complex PTSD in forthcoming editions of DSM, 68% of children who experienced sexual abuse were found to have complex PTSD over and above an expression of PTSD alone (Roth, Newman, Pelcovitz, van der Kolk, & Mandel, 1997). In a follow-up to earlier field trial studies, van der Kolk et al. (2005) found early interpersonal trauma gives rise to more complex pathology than later interpersonal victimization, and that the younger the age of onset of the trauma, the more likely the individual is to suffer from C-PTSD. However, at the time of the DSM-5’s publication, the TSRDD Sub-Work Group of the DSM-5 determined that there was not currently enough information on the distinctiveness and pervasiveness of the disorder to warrant a formal diagnosis (Friedman, 2013). However, the group incorporated certain proposed DESNOS symptoms (e.g., self-destructive behavior, dissociative subtype) into the reformulated diagnosis (Friedman et al., 2011). Given evidence of uniquely deleterious consequences of early and repeated trauma, ongoing conceptualization and validation of DESNOS will be essential.  Although the DSM-5 provides improvements to PTSD diagnoses, it also presents notable challenges and engenders numerous unanswered questions for counselors and other mental health professionals. Counselor experiences in the field will inform practice, and continued research will provide more coherent understanding of criteria such as negative emotionality and numbing, accurate assessment of TSRDs, and ramifications in legal, health care and forensic settings. To continue to work ethically within their scope of practice (American Counseling Association, 2014), counselors must ensure that they are trained in the area of trauma and continue to seek professional education and guidance on the ongoing developments in this topic.   Conflict of Interest and Funding Disclosure The author reported no conflict of interest or funding contributions for the development of this manuscript.   References American Counseling Association. (2014). 2014 ACA code of ethics. Alexandria, VA: Author. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. American Psychiatric Association. 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H. (2012). Diagnosing PTSD in early childhood: An empirical assessment of four approaches. Journal of Traumatic Stress, 25, 359–367. doi:10.1002/jts.21723 Scheeringa, M. S., Zeanah, C. H., & Cohen, J. A. (2011). PTSD in children and adolescents: Toward an empirically based algorithma. Depression and Anxiety, 28, 770–782. doi:10.1002/da.20736 Schützwohl, M., & Maercker, A. (1999). Effects of varying diagnostic criteria for posttraumatic stress disorder are endorsing the concept of partial PTSD. Journal of Traumatic Stress, 12, 155–165. doi:10.1023/a:1024706702133 Ullman, S. E., & Long, S. M. (2008). Factor structure of PTSD in a community sample of sexual assault survivors. Journal of Trauma & Dissociation, 9, 507–524. doi:10.1080/15299730802223370 van der Kolk, B. A. (2007). The history of trauma in psychiatry. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 19–36). New York, NY: The Guilford Press. van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389–399. doi:10.1002/jts.20047 Vidal, M. E., & Petrak, J. (2007). Shame and adult sexual assault: A study with a group of female survivors recruited from an East London population. Sexual and Relationship Therapy, 22, 159–171. doi:10.1080/14681990600784143 Yehuda, R., & Bierer, L. M. (2009). The relevance of epigenetics to PTSD: Implications for the DSM-V. Journal of Traumatic Stress, 22, 427–434. doi:10.1002/jts.20448 Zoellner, L. A., Rothbaum, B. O., & Feeny, N. C. (2011). PTSD not an anxiety disorder? DSM committee proposal turns back the hands of time. Depression and Anxiety, 28, 853–856. doi:10.1002/da.20899   Laura K. Jones, NCC, is an Assistant Professor at the University of Northern Colorado. Jenny L. Cureton, NCC, is a doctoral student at the University of Northern Colorado. Correspondence can be addressed to Laura K. Jones, University of Northern Colorado, Department of Applied Psychology and Counselor Education, Box 131, Greeley, CO 80639, laura.jones@unco.edu.
(LPC, NCC, CEDS-S)
Answered on 01/21/2022

I need to forgive my mother and I don’t know how to get over childhood traum

I need to forgive my mother and I do not know how to get over childhood trauma I read where you shared that your mother mentally and emotionally scarred you as a child and now as an adult you also shared that you cannot tolerate her for more than 15 mins which has pushed you away from dealing with her. You also shared that you avoid her at all costs and fight with her every chance you get. You shared that you two do not see eye to eye and you shared that you cannot seem to agree on anything. You shared that there is animosity and resentment that you have not been able to let go of. You shared that you need to forgive your mother and you questioned how to get over childhood trauma. Based on your question, I would highly suggest that you first start with seeking mental health therapy from a licensed professional counselor and or licensed professional mental health therapist to discuss your thoughts and feeling in regards to what you need to forgive your mother and how you can effectively start working on how to get over childhood trauma. With emotional trauma, there is no right or wrong answer on how to forgive someone and or how to recover from emotional trauma. It specifically depends on the individual and what specifically happened in your childhood that continues to cause you emotional distress as an adult. A licensed professional counselor and or licensed professional mental health therapist can be very beneficial in supporting you with discussing and processing what happened when you were a child. Traumatic experiences can cause psychological trauma which can cause damage to an individual's mind as a result of one or more distressing event. The distressing event can cause overwhelming amounts of stress that can surpass the individual's ability to cope or understand their emotions which can lead to serious long term negative consequences. With the help of a licensed professional counselor and or licensed professional mental health therapist, you can receive adequate help in regards to your licensed professional counselor and or licensed professional mental health therapist providing you with effective and or appropriate skills and techniques to learn how to develop and implement effective skills and strategies for you to effectively deal with the traumatic experience that you experienced as a child that continues to cause problems and or concerns for you as an adult. Behavior interventions, Psychotherapy, and Cognitive Behavioral Therapy (CBT) have all been beneficial in helping people to express their thoughts, feelings and emotions in regards to a traumatic experience that you experienced as a child that continues to affect your relationships as an adult. A licensed professional counselor and or licensed professional mental health therapist can introduce you to deep breathing techniques, stress relaxation techniques, calming techniques, grounding techniques, social skills, positive interpersonal relationships techniques, progressive muscle relaxation, and imagery as a means of decreasing your emotional distress at this time. In an effort to feel less emotional distress that manifests from your traumatic experiences with your mother you can try to commit to changing the way you think. It will take a lot of practice, dedication and determination to work on decreasing triggers of your past childhood trauma. However, trying to do this will help you feel better and it can lead to your feeling much better and becoming more productive. You can recognize when it is happening and when you find it happening you can choose to think about something more productive. You can also look for solutions by committing to learning from your mistakes and solving your problems so you can productively move forward, set aside time to think when you notice that you are beginning to feel triggered by your past childhood trauma, distract yourself with a self-care activity and you can practice Mindfulness. Mindfulness is the key to living in the "here and now." When you become mindful, you will be completely present in the moment. It can be like a form of meditation that takes a lot of practice, but over time and with consistency, it can be very beneficial in decreasing your thoughts and feelings regarding your past traumatic experience. Overall, I highly recommend that you seek help from a licensed professional counselor and or licensed professional mental health therapist to properly discuss your thoughts, feelings and emotions in regards to your past traumatic experience as a child that continues to interfere with your relationships as an adult due to you experiencing some triggers about your past traumatic experiences. Mental health is not a one size fits all, so it is important to get personalized treatment for your specific and current mental and emotional needs. I highly recommend that you contact the Betterhelp team to discuss what specific payment options and payment plans are available for you to access counseling services at this time. Betterhelp does offer financial aid and various other options for individuals who are seeking counseling for their personal and or emotional well-being through the use of affordable therapy sessions. The Betterhelp Platform is designed to be able to assist you better if you contact them directly. Contacting Betterhelp directly is the best way for them to verify your identity and securely help you with your specific account information and needs. When it comes to questions, issues or concerns in regards to the cost of using the Betterhelp platform please contact the Betterhelp team. You can reach out to the Betterhelp team for issues including but not limited to the following: billing issues, account questions and or concerns, and or subscription questions and or concerns. The Betterhelp members are there to help answer your questions, concerns and or issues, so if you have a question in regards to what the cost would be to begin using the Bettehelp platform you can contact the Beterhelp team members directly to gain accurate information in regards to what payment options are available for you if you decide to join the Betterhelp platform in regards to possibly talking to a licensed professional counselor and or licensed professional mental health therapist. Please feel free to reach out to the Member Success Team directly by emailing contact@betterhelp.com to discuss what payment options are available for you to use the Betterhelp platform for you counseling needs and or therapy needs at this time. Best regards to you!
(EdS, LPC-S, NCC, BC-TMH)
Answered on 01/21/2022

How do I feel worthy of myself and that I am good enough?

How do I feel worthy of myself and that I am good enough? I read where you shared that all of your life you were quite chubby and you shared that you thought that once you loss the weight you would finally love yourself and feel worthy in general. However, you shared that you have lost all the weight but these feelings of unworthiness are still there. You also shared that you do not feel confident in your own body even though other people say you look good. All your life you shared that your mother used to tell you to eat less and stop being fat. You shared that you do not know how to get rid of this voice in your head and forgive your mother and love myself. You questioned how do you feel worthy of yourself and you questioned if you are good enough. Based on your question, I would highly suggest that you first start with seeking mental health therapy from a licensed professional counselor and or licensed professional mental health therapist to discuss what your feelings of low self worth and past traumatic experiences  look like at this time. You can also meet with a licensed professional counselor and or licensed professional mental health therapist to openly discuss how often you experience overthinking about your feelings of low self worth and past traumatic experiences that continue to cause you emotional distress at this time. When you meet with a licensed professional counselor and or licensed mental health therapist you can discuss how often it occurs and how it affects you at this time. A licensed professional counselor and or licensed professional mental health therapist can help you fully share your personal thoughts and feelings in a safe and confidential setting of your choice to alleviate your about needing specific information about possibly dealing with experiencing feelings of low self worth and past traumatic experiences. You can also discuss your thoughts and feeling in regards to your personal thoughts and feelings about your experience with a licensed professional counselor and or licensed professional mental health therapist. A professional counselor and or licensed professional mental health therapist can help you fully share your personal thoughts and feelings in a safe and confidential setting to of your choice to discuss your emotional distresses and past traumatic experiences at this time. Experiencing feelings of low self worth and past traumatic experiences can absolutely affect your overall mental well being. Therefore, Behavior interventions, Psychotherapy, and Cognitive Behavioral Therapy (CBT) have all been beneficial in treating individuals who have struggled with feelings of low self worth and past traumatic experiences.  A licensed professional counselor and or licensed professional mental health therapist can assist you in learning how to effectively implement coping skills to decease your thoughts and feelings of low self worth and past traumatic experiences. A licensed professional counselor and or licensed professional mental health therapist can also introduce you to deep breathing techniques, calming techniques, grounding techniques, stress management techniques, progressive muscle relaxation, and imagery as a means of decreasing your thoughts and feelings of low self worth and past traumatic experiences. In an effort to decrease your emotional distress you can also try to commit to changing the way you think. It will take a lot of practice, dedication and determination to alleviate your thoughts and feelings of low self worth and past traumatic experiences. However, trying to do this will help you feel better and it can lead to your feeling much better and becoming more productive. You can recognize when it is happening and when you find it happening you can choose to think about something more productive. You can also look for solutions by committing to learning from your mistakes and solving your problems, so you can productively move forward, set aside time to think when you notice you are experiencing emotional distress due to past traumatic experiences outside of that scheduled time, remind yourself that you will think about it later, distract yourself with a self-care activity and you can practice mindfulness. Mindfulness is the key to living in the "here and now." When you become mindful, you will be completely present in the moment. It can be like a form of meditation that takes a lot of practice, but over time and with consistency, it can be very beneficial in decreasing your emotional distress that to help you experience an overall healthier mental well-being. Overall, I highly recommend that you seek help from a licensed professional counselor and or licensed professional mental health therapist to properly assess your thoughts and feelings of low self worth and past traumatic experiences. It would also be a great idea to talk to a licensed professional counselor and or licensed professional mental health therapist openly in regards to your personal thoughts and feelings about experiencing feelings of low self worth and past traumatic experiences. Please remember that mental health is not a one size fits all, so it is very important to get personalized treatment for your specific and current mental and emotional needs at this time. Best regards to you! I highly recommend that you contact the Betterhelp team to discuss what specific payment options and payment plans are available for you to access counseling services because you are wanting to know how to get help for yourself at this time. Betterhelp does offer financial aid and various other options for individuals who are seeking counseling for their personal and or emotional well-being through the use of affordable therapy sessions. The Betterhelp Platform is designed to be able to assist you better if you contact them directly. Contacting Betterhelp directly is the best way for them to verify your identity and securely help you with your specific account information and needs. When it comes to questions, issues or concerns in regards to the cost of using the Betterhelp platform please contact the Betterhelp team. You can reach out to the Betterhelp team for issues including but not limited to the following: billing issues, account questions and or concerns, and or subscription questions and or concerns. The Betterhelp members are there to help answer your questions, concerns and or issues, so if you have a question in regards to what the cost would be to begin using the Bettehelp platform you can contact the Beterhelp team members directly to gain accurate information in regards to what payment options are available for you if you decide to join the Betterhelp platform in regards to possibly talking to a licensed professional counselor and or licensed professional mental health therapist. Please feel free to reach out to the Member Success Team directly by emailing contact@betterhelp.com to discuss what payment options are available for you to use the Betterhelp platform for you counseling needs and or therapy needs at this time. 
(EdS, LPC-S, NCC, BC-TMH)
Answered on 01/21/2022

How do I stop fixating on my own thoughts and feelings?

Dear Bella Claire,   Thank you very much for your message.   I understand that we are going through some fluctuations with our emotions and often it can feel like we are going backwards. However the reality is that the night is always darkest before the dawn. The reason you are feeling discouraged is because you are trying to move forward in this healing process, therefore when you do experience any kind of anxiety or depression you begin to doubt yourself in this process.   Meanwhile, as a human being we will always have times when we feel anxious or depressed. That is normal and natural. Just like there are days that it rains, there are also days that the sun shines. This isn't a problem to be fixed.    We will only feel more depressed if we constantly compare ourselves with our old selves in the past that seemed to be happier, while we forget that back then we did not have this much on our plate to worry and we did not experience what we have experienced recently that gave us hurts and pain. Therefore it isn't fair to our current self if we always think about how to go back in time, that isn't possible anyways.   To further recover from feelings of depression and anxiety, we must constantly be thinking about how to develop a healthy, positive interaction with ourselves.   Happy relationships all depend on how happy we are with ourselves. So how happy are we?   If you feel like you're on a constant quest for inner bliss, you might be asking yourself: If there was one secret on how to be happy in your relationship or marriage, workplace, home life and family wouldn't you have learned it by now?   Are you constantly searching, asking people who seem happy, reading articles and watching videos on how to be happy? If so, you're certainly not alone. Online search engines get millions of people asking this question, and the internet is full of promises that this strategy or that formula will deliver you to a place of lasting happiness. Yet, many miss the main point: they never even touch on the fact that the real key to happiness with others is happiness with yourself.   If you haven't noticed or been here yourself (most of us have), an insecure person's need for constant approval is exhausting. Those who are happy and love themselves don't hang around with that kind of negative energy. Since we can't change other people, lead by example and others will follow in your footsteps, becoming good role models themselves. Here are 5 lessons that I learned (still learning) to find peace within ourselves and enjoy true happiness that does not depend on others.   1. Forgive Yourself   Forgive yourself for anything and everything you think you caused that was bad in your or someone else's life. You can't go back for a do-over, so learn the lesson and move forward, promising to better handle any similar situation that may arise. Now you're freed up to relax more and have greater peace of mind without beating yourself up over guilt and resentment.   2. Understand That You Are Complete   And understand that, "You complete me," was just a cheesy line in a Tom Cruise movie. (I loved that line at first too... for a few seconds, until I realized how inaccurate it was. Keep reading to learn why!) The reason most of us don't feel complete, and latched onto that line like it was the end-all be-all relationship concept is because we're waiting for someone else to be or do something that makes us feel whole.   First of all, as mentioned, we are already complete. But even if we weren't, no one else would be able to complete us anyway - it's impossible. When we put our happiness in someone else's hands we set them up for failure. Why would we do that to someone we care about? Because we don't realize we are the only ones who control our happiness.   Does this mean if you're unhappy it's your fault? Yes. Does this also put you in a position of power in your life? Absolutely. You want your relationships to be the joining of two complete individuals to create a third, larger entity so that you're a part of something, not just half of something. The whole "my other half" thing just breeds insecurity, which leads to the most painful relationship challenges like jealousy, abuse and infidelity. Why on earth would you want your happiness to be determined by someone or something outside of yourself?   3. Get To Know Yourself   When do you feel you're at your best when you're alone? Are you reading your favorite book overlooking a beautiful view? Enjoying your favorite tea, watching a movie? Shopping outside at the farmers market? Listening to your favorite music? How does your body feel? Healthy? Need some work? No one will be happier than you when your body looks good and functions well. This is a good confidence builder and when you have more confidence, you look better and healthier, and carry yourself in a completely different way that attracts confident people to you.   Here's a personal example: I had a spider vein on my lower leg and didn't feel comfortable in shorts for years. I finally had it removed and couldn't believe how much better I felt. My posture and confidence in shorts was much improved. Some things are easily fixable and for the others we may need to adjust our perspective a bit.   What are your favorite parts of yourself - your appearance, your character traits, your values or your personality? Do you get a kick out of your great sense of humor? I get a kick out of mine. I laugh to myself quite often! Are you really excited that you value honesty, which has attracted honest, genuine people to you? Are your eyes or hands or knees your favorite part of your body? Get to know your favorite parts and love them all.   4. Take A Good Look At Yourself   Take a look and notice how amazing you are. Keep your self-talk positive. There are things supermodels hate about themselves, so don't go thinking you're the only one who has dislikes. You can be happy with yourself even if there are things you'd like to change. I've always been shorter than most other people and would have given anything to be "normal" height. It took me 27 years of hating my height when many other people always wanted to be taller and would have traded me in an instant. Look how many years I experienced self-induced suffering. (This describes all suffering by the way. Pain is inevitable; suffering is optional.)   What are you good at, best at and want to improve at? What are your talents and what skills have you developed? What would you like to do in your life that you haven't done yet? What is the best thing you've ever done? Are you noticing that you might ask some of these questions on a date to get to know someone and determine if you like them or not? We get to know people by asking questions although we rarely ask them of ourselves. And when someone else asks, we sometimes answer differently than when we're asking ourselves.   5. Ask Yourself Questions   To find out more about yourself, ask yourself the questions you would ask on a date. The quality of your relationships is determined by the quality of the questions you ask. Ask good questions and lots of them (more than you would ask on a date; it's OK to be a chatterbox with yourself) to build that strong, healthy relationship with yourself.   Take time away from other people and be happily alone. At first, it might feel weird choosing to be alone but being alone and being lonely are two very different things. Dr. Wayne Dyer says, "You cannot be lonely if you like the person you're alone with." I went from being scared to sit alone in Starbucks for fear some stranger would think I didn't have any friends to loving going places alone. I have attracted wonderful friends by learning how to like myself and since like attracts like (energy), they happily do things on their own too. Yes, we do enjoy each other's company as well; we don't just talk about all the things we did by ourselves (although that would be funny).   Welcome to your inner power. You are qualified, capable and worthy of being happy with yourself regardless of anyone else on the planet so lead by example and show others how it's done. You will see that you can have much more fulfilling relationships without putting the responsibility of your happiness on someone else.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022

Can I have PTSD after 2.5 years of an accident?

Dear Ash,   Thank you for your message and sharing with me how you've been interacting with yourself, especially on how you've been handling unpleasant feelings and emotions. As you said this has also affected your life significantly. Perhaps by addressing how to handle unpleasant emotions in a healthier manner, we can dive into addressing the issues in your life as well?   Often the experience we've had about anxiety (or any strong emotion such as stress / depression) was so terrible (even physically) that our body sort of become traumatized to it. We naturally become nervous about these unpleasant feelings because we don't like these sensations and experiences. As a result we would do everything we can to avoid / fight these anxious feelings, often using numbing techniques such as using substances or distracting ourselves. Yet only to find that the anxiety gets stronger over time because we have never been able to make peace with it.   Therefore rather than trying to "change" / "fight" / "get rid of" these unpleasant sensations, perhaps the best thing that we can do is to make room for these feelings and even sensations, while staying on track to do what brings us meaning and fulfillment. Floating without judging / blaming ourselves through the anxiety experience, while focusing on making room for anxiety can be helpful.   Here is a short video put up by the author of the book "The Happiness Trap" which does a good job explaining this concept:   Please take some time to watch this and share your thoughts later :) I also highly recommend picking that book as well to supplement this therapy process.   https://www.youtube.com/watch?v=rCp1l16GCXI    We as human beings do not like sufferings, therefore often times we would be doing our best to fight it. However just like the analogy of swimming vs floating that we have talked about before, the more we fight it, the faster we sink. While if we can learn to float with these waves, we will realize that we won't sink.   Radical acceptance / Expansion is about accepting of life on life's terms and not resisting what you cannot or choose not to change. Radical Acceptance is about saying yes to life and all that life brings (including all sorts of emotions such as joy, sadness, peace and pain), just as it is without forcing our ways into our lives.   Why do we want to accept life as it is? Because with anything that we do in life that brings us meaning and fulfillment, it always accompany a wide range of emotions, we can't possibly just choose the ones that we like and fight / avoid those that we don't like. Learning to experience all emotions as they are, is a sign that we are living our lives to the fullest.   To do so we must learn to accept (and make room for) any unpleasant sensations, feelings or thoughts that we experience.   We don't want to fight it because the more we fight, the stronger they will come back.   We don't want to avoid it either because the more we avoid, the more we'll be afraid of it.   So the key here is to make room for these sensations, feelings and thoughts, while continue to do what brings us meaning and fulfillment in life.    Learning to "co-exist" with these feelings will naturally reduce the intensity of them.   Floating, is a form of learning to accept these feelings and make room for it.   Let me give you some practical guidelines on what I mean by accepting these feelings and make room for it.   You can look up "expansion technique" under Acceptance and Commitment Therapy (ACT) for more information as well.   How to accept our emotions (and make room for them):   1. OBSERVE. Bring awareness to the feelings in your body.   2. BREATHE. Take a few deep breaths. Breathe into and around them.   3. EXPAND. Make room for these feelings. Create some space for them.   4. ALLOW. Allow them to be there. Make peace with them   Some people find it helpful to silently say to themselves, 'I don't like this feeling, but I have room for it,' or 'It's unpleasant, but I can accept it.'   • When you're feeling an unpleasant emotion, the first step is to take a few slow, deep breaths, and quickly scan your body from head to toe.   • You will probably notice several uncomfortable sensations. Look for the strongest sensation - the one that bothers you the most. For example, it may be a lump in your throat, or a knot in your stomach, or an ache in your chest.   • Focus your attention on that sensation. Observe it curiously, as if you are a friendly scientist, discovering some interesting new phenomenon.   • Observe the sensation carefully. Notice where it starts and where it ends. Learn as much about it as you can. If you had to draw a line around the sensation, what would the outline look like? Is it on the surface of the body, or inside you, or both? How far inside you does it go? Where is the sensation most intense? Where is it weakest? How is it different in the center than around the edges? Is there any pulsation, or vibration within it? Is it light or heavy? Moving or still? What is its temperature?   • Take a few more deep breaths, and let go of the struggle with that sensation. Breathe into it. Imagine your breath flowing in and around it.   • Make room for it. Loosen up around it. Allow it to be there. You don't have to like it or want it. Simply let it be.   • The idea is to observe the sensation - not to think about it. So when your mind starts commenting on what's happening, just say 'Thanks, mind!' and come back to observing.   • You may find this difficult. You may feel a strong urge to fight with it or push it away. If so, just acknowledge this urge, without giving in to it. (Acknowledging is rather like nodding your head in recognition, as if to say 'There you are. I see you.') Once you've acknowledged that urge, bring your attention back to the sensation itself.   • Don't try to get rid of the sensation or alter it. If it changes by itself, that's okay. If it doesn't change, that's okay too. Changing or getting rid of it is not the goal.   • You may need to focus on this sensation for anything from a few seconds to a few minutes, until you completely give up the struggle with it. Be patient. Take as long as you need. You're learning a valuable skill.   • Once you've done this, scan your body again, and see if there's another strong sensation that's bothering you. If so, repeat the procedure with that one.   • You can do this with as many different sensations as you want to. Keep going until you have a sense of no longer struggling with your feelings.   • As you do this exercise one of two things will happen: either your feelings will change - or they won't. It doesn't matter either way. This exercise is not about changing your feelings. It's about accepting them.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022

How can I regulate my past traumas. They keep on coming back to my mind. I keep thinking about death

Dear Boy,   Thank you for your message and courageously sharing the traumas that you have been through, and what they meant to you and affecting your life at the moment.   This is indeed a painful process that can cause some emotions rising on your end, that is also because for a very long time we have been simply coping with these wounds through our defense mechanisms, rather than actually looking at them and process them.    As you have said, perhaps we have learned to deal and cope with these abuses and traumas by making explanations for them, validating them and even accepting them as a part of our lives. While we have learned to move on without processing these traumas, we could still the effects they bring especially in the form of anxiety and even panic when we are being reminded or triggered by events and people who have inflicted these wounds on us.   To truly move on and not let these traumas affect us, we need to learn to bring closures to these wounds and bind them up. I am glad that you are aware of the need to bring closures, I'll explain more here when it comes to closure.   A lack of closure frequently prevents people from moving forward with their lives and achieving all that they could. It makes it more difficult to reach goals, find self-happiness or make meaningful relationships. For this reason, it is important to find a sense of closure with any situation that you feel is holding you back.   Closure is any interaction, information, or practice that allows a person to feel that a traumatic, upsetting, or confusing life event has been resolved. The term has its origins in Gestalt psychology, but it is more commonly used to refer to the final resolution to a conflict or problem.   Closure means finality; a letting go of what once was. Finding closure implies a complete acceptance of what has happened and an honoring of the transition away from what's finished to something new. In other words, closure describes the ability to go beyond imposed limitations in order to find different possibilities.   People seek answers and explanations: They want to know why. However, finding answers does not necessarily end pain. Sometimes a person who seeks closure finds that an explanation makes no difference, or that it actually worsens their pain. Others find that closure may simply be a starting point for moving past a painful event. Though the trauma is not resolved, the person is better able to work through it. Seeking a definitive way to finalize grief and move on belies the importance of the grieving process. Simply putting an end to one's painful memories may be more harmful than helpful.   In some cases, though, closure is a profoundly transformative experience that does allow the person to move past the traumatic event. For example, a victim of abuse may need to confront the abuser and see them imprisoned before he or she can begin to feel safe again. In acknowledgment of this, the criminal justice system is increasingly recognizing the need for closure by instituting programs allowing victims and their families to meet with offenders in a controlled setting.   Unfortunately, there are times when closure is simply unattainable. This may be true in situations where someone moved locations or passed away before being able to resolve a problem. In some cases, the other involved person is simply unwilling to engage. In times like these, it can be easy to become bogged down by the lack of closure. It can be easy to cover up the underlying problem with meaningless coping mechanisms like substance abuse. With time and effort, there are many ways to move past unattainable closure to live happily once more.   The most important part of moving on from a lack of closure is taking care of yourself, both physically and mentally. This is also why we have began our therapy process with the focus on self-compassion. Self-compassion is the core of why we want to bring closures and bind up these wounds, because they make us feel better and they are the best decisions we can make for ourselves.   When we bring closures to our traumas, we need to keep in mind that we are doing this not because we have to, but we want to. When we practice forgiving those who have wounded us and let them go, we are not agreeing / accepting / acknowledging what they have done and not hold them accountable, we are simply letting go of the bitterness, resentment and hatred that we have hide with us all these years.   As for our physical health, engaging in adequate active exercises could be helpful. Improving your physical health through diet and exercise can help to improve self-esteem and emotional well-being, both of which are essential to moving on from unattainable closure.   Meditation, hobbies and social interaction are all great ways to nurture your mental health and find the inner happiness that makes a lack of closure bearable.   While self-care is essential to moving on from a lack of closure, it is often not enough to resolve the problem altogether. One great exercise to help you move forward is to write a letter to the individual that you have not received closure with. In this letter, you can describe all of your feelings about the situation and how you wish things had ended. Once the letter is complete, you can bury it, burn it, or simply throw it in the trash. Writing an unsent letter can help you get those feelings out that are hiding painfully inside and find a sense of self-resolution.   Forgiveness is another essential component to finding a sense of closure at times that closure cannot otherwise be achieved. Forgiving a person that caused you pain can sometimes seem like an impossible task. However, it is possible with daily efforts. We can go into details later regarding forgiveness, one step at a time.   To move past unattainable closure, you may also need to forgive yourself for anything you feel you did wrong in the situation. If you blame yourself for a broken relationship, death of a love one, or anything else, it will be impossible to move on and find inner happiness.   I'll pause here to learn from your thoughts, looking forward to talking with you more. Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022

Hi! Do any of your therapists offer EMDR or biofeedback?

Dear Mariko,   Thank you for your message.   I am sorry to learn that you are suffering from this chronic pain. I definitely would recommend that you follow up with a therapist who offers EMDR, unfortunately it is not something I can offer here online.   Physical pain can be treated and although it takes time and effort, you will feel so much better after receiving proper treatment. I would definitely encourage you to do so.   Meanwhile to prepare for any chronic pain coping technique, it is important to learn how to use focus and deep breathing to relax the body. Learning to relax takes practice, especially when you are in pain, but it is definitely worth it to be able to release muscle tension throughout the body and start to remove attention from the pain.   Coping techniques for chronic pain begin with controlled deep breathing, as follows:   - Try putting yourself in a relaxed, reclining position in a dark room. Either shut your eyes or focus on a point.   - Then begin to slow down your breathing. Breathe deeply, using your chest. If you find your mind wandering or you are distracted, then think of a word, such as the word "Relax," and think it in time with your breathing...the syllable "re" as you breathe in and "lax" as you breathe out.   - Continue with about 2 to 3 minutes of controlled breathing.   - Once you feel yourself slowing down, you can begin to use imagery techniques.   These are also some specific imagery and chronic pain control techniques that are effective for pain control include:   Altered focus    This is a favorite technique for demonstrating how powerfully the mind can alter sensations in the body. Focus your attention on any specific non-painful part of the body (hand, foot, etc.) and alter sensation in that part of the body. For example, imagine your hand warming up. This will take the mind away from focusing on the source of your pain, such as your back pain.   Dissociation   As the name implies, this chronic pain technique involves mentally separating the painful body part from the rest of the body, or imagining the body and mind as separate, with the chronic pain distant from one’s mind. For example, imagine your painful lower back sitting on a chair across the room and tell it to stay sitting there, far away from your mind.   Sensory splitting   This technique involves dividing the sensation (pain, burning, pins and needles) into separate parts. For example, if the leg pain or back pain feels hot to you, focus just on the sensation of the heat and not on the hurting.   Mental anesthesia   This involves imagining an injection of numbing anesthetic (like Novocain) into the painful area, such as imagining a numbing solution being injected into your low back. Similarly, you may then wish to imagine a soothing and cooling ice pack being placed onto the area of pain.   Mental analgesia   Building on the mental anesthesia concept, this technique involves imagining an injection of a strong pain killer, such as morphine, into the painful area. Alternatively, you can imagine your brain producing massive amount of endorphins, the natural pain relieving substance of the body, and having them flow to the painful parts of your body.   Transfer   Use your mind to produce altered sensations, such as heat, cold, anesthetic, in a non-painful hand, and then place the hand on the painful area. Envision transferring this pleasant, altered sensation into the painful area.   Age progression/regression   Use your mind’s eye to project yourself forward or backward in time to when you are pain-free or experiencing much less pain. Then instruct yourself to act "as if" this image were true.   Symbolic imagery   Envision a symbol that represents your chronic pain, such as a loud, irritating noise or a painfully bright light bulb. Gradually reduce the irritating qualities of this symbol, for example dim the light or reduce the volume of the noise, thereby reducing the pain.   Positive imagery   Focus your attention on a pleasant place that you could imagine going - the beach, mountains, etc. - where you feel carefree, safe and relaxed.   Counting   Silent counting is a good way to deal with painful episodes. You might count breaths, count holes in an acoustic ceiling, count floor tiles, or simply conjure up mental images and count them.   Pain movement   Move chronic back pain from one area of your body to another, where the pain is easier to cope with. For example, mentally move your chronic back pain slowly into your hand, or even out of your hand into the air.   Some of these techniques are probably best learned with the help of a professional, and it usually takes practice for these techniques to become effective in helping alleviate chronic pain. I would recommend that you go on youtube and look up some demonstration / guided imagery meditation when learning to apply these techniques. It is often advisable to work on pain coping strategies for about 30 minutes 3 times a week. With practice, you will find that the relaxation and chronic pain control become stronger and last longer after you are done.   Sometimes, after you are good at using the techniques, you can produce chronic pain relief and relaxation with just a few deep breaths. You can then start to use these techniques while you are engaged in any activity, working, talking, etc. With enough experience you will begin to feel a greater sense of control over the chronic pain and its effects on your life.   Please let me know what you have found to be helpful after giving them some practice, it takes time and patience to learn, so let's not beat ourselves up during the process. This is when self-compassion is important, our body and mind will learn if we allow them to and not push ourselves too hard. :)   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022

How can I learn to love myself?

Dear Ron,   Thank you very much for your message.   I understand that we are going through some fluctuations with our emotions and often it can feel like we are going backwards. However the reality is that the night is always darkest before the dawn. The reason you are feeling discouraged is because you are trying to move forward in this healing process, therefore when you do experience any kind of anxiety or depression you begin to doubt yourself in this process.   Meanwhile, as a human being we will always have times when we feel anxious or depressed. That is normal and natural. Just like there are days that it rains, there are also days that the sun shines. This isn't a problem to be fixed.    We will only feel more depressed if we constantly compare ourselves with our old selves in the past that seemed to be happier, while we forget that back then we did not have this much on our plate to worry and we did not experience what we have experienced recently that gave us hurts and pain. Therefore it isn't fair to our current self if we always think about how to go back in time, that isn't possible anyways.   To further recover from feelings of depression and anxiety, we must constantly be thinking about how to develop a healthy, positive interaction with ourselves.   Happy relationships all depend on how happy we are with ourselves. So how happy are we?   If you feel like you're on a constant quest for inner bliss, you might be asking yourself: If there was one secret on how to be happy in your relationship or marriage, workplace, home life and family wouldn't you have learned it by now?   Are you constantly searching, asking people who seem happy, reading articles and watching videos on how to be happy? If so, you're certainly not alone. Online search engines get millions of people asking this question, and the internet is full of promises that this strategy or that formula will deliver you to a place of lasting happiness. Yet, many miss the main point: they never even touch on the fact that the real key to happiness with others is happiness with yourself.   If you haven't noticed or been here yourself (most of us have), an insecure person's need for constant approval is exhausting. Those who are happy and love themselves don't hang around with that kind of negative energy. Since we can't change other people, lead by example and others will follow in your footsteps, becoming good role models themselves. Here are 5 lessons that I learned (still learning) to find peace within ourselves and enjoy true happiness that does not depend on others.   1. Forgive Yourself   Forgive yourself for anything and everything you think you caused that was bad in your or someone else's life. You can't go back for a do-over, so learn the lesson and move forward, promising to better handle any similar situation that may arise. Now you're freed up to relax more and have greater peace of mind without beating yourself up over guilt and resentment.   2. Understand That You Are Complete   And understand that, "You complete me," was just a cheesy line in a Tom Cruise movie. (I loved that line at first too... for a few seconds, until I realized how inaccurate it was. Keep reading to learn why!) The reason most of us don't feel complete, and latched onto that line like it was the end-all be-all relationship concept is because we're waiting for someone else to be or do something that makes us feel whole.   First of all, as mentioned, we are already complete. But even if we weren't, no one else would be able to complete us anyway - it's impossible. When we put our happiness in someone else's hands we set them up for failure. Why would we do that to someone we care about? Because we don't realize we are the only ones who control our happiness.   Does this mean if you're unhappy it's your fault? Yes. Does this also put you in a position of power in your life? Absolutely. You want your relationships to be the joining of two complete individuals to create a third, larger entity so that you're a part of something, not just half of something. The whole "my other half" thing just breeds insecurity, which leads to the most painful relationship challenges like jealousy, abuse and infidelity. Why on earth would you want your happiness to be determined by someone or something outside of yourself?   3. Get To Know Yourself   When do you feel you're at your best when you're alone? Are you reading your favorite book overlooking a beautiful view? Enjoying your favorite tea, watching a movie? Shopping outside at the farmers market? Listening to your favorite music? How does your body feel? Healthy? Need some work? No one will be happier than you when your body looks good and functions well. This is a good confidence builder and when you have more confidence, you look better and healthier, and carry yourself in a completely different way that attracts confident people to you.   Here's a personal example: I had a spider vein on my lower leg and didn't feel comfortable in shorts for years. I finally had it removed and couldn't believe how much better I felt. My posture and confidence in shorts was much improved. Some things are easily fixable and for the others we may need to adjust our perspective a bit.   What are your favorite parts of yourself - your appearance, your character traits, your values or your personality? Do you get a kick out of your great sense of humor? I get a kick out of mine. I laugh to myself quite often! Are you really excited that you value honesty, which has attracted honest, genuine people to you? Are your eyes or hands or knees your favorite part of your body? Get to know your favorite parts and love them all.   4. Take A Good Look At Yourself   Take a look and notice how amazing you are. Keep your self-talk positive. There are things supermodels hate about themselves, so don't go thinking you're the only one who has dislikes. You can be happy with yourself even if there are things you'd like to change. I've always been shorter than most other people and would have given anything to be "normal" height. It took me 27 years of hating my height when many other people always wanted to be taller and would have traded me in an instant. Look how many years I experienced self-induced suffering. (This describes all suffering by the way. Pain is inevitable; suffering is optional.)   What are you good at, best at and want to improve at? What are your talents and what skills have you developed? What would you like to do in your life that you haven't done yet? What is the best thing you've ever done? Are you noticing that you might ask some of these questions on a date to get to know someone and determine if you like them or not? We get to know people by asking questions although we rarely ask them of ourselves. And when someone else asks, we sometimes answer differently than when we're asking ourselves.   5. Ask Yourself Questions   To find out more about yourself, ask yourself the questions you would ask on a date. The quality of your relationships is determined by the quality of the questions you ask. Ask good questions and lots of them (more than you would ask on a date; it's OK to be a chatterbox with yourself) to build that strong, healthy relationship with yourself.   Take time away from other people and be happily alone. At first, it might feel weird choosing to be alone but being alone and being lonely are two very different things. Dr. Wayne Dyer says, "You cannot be lonely if you like the person you're alone with." I went from being scared to sit alone in Starbucks for fear some stranger would think I didn't have any friends to loving going places alone. I have attracted wonderful friends by learning how to like myself and since like attracts like (energy), they happily do things on their own too. Yes, we do enjoy each other's company as well; we don't just talk about all the things we did by ourselves (although that would be funny).   Welcome to your inner power. You are qualified, capable and worthy of being happy with yourself regardless of anyone else on the planet so lead by example and show others how it's done. You will see that you can have much more fulfilling relationships without putting the responsibility of your happiness on someone else.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022

How to I cope?

How to I cope? I read where you shared that you were raped by your boyfriend from high school which you shared was almost 13-14 years ago. You also shared that you have just started getting flashbacks and nightmares about it. You shared that you recently have not been sleeping well either. You also shared that you are currently on anti depressants at this time. You questioned how do you cope. Based on your question, I would highly suggest that you first start with seeking mental health therapy with from a licensed professional counselor and or a licensed professional mental health therapist to discuss your thoughts and feeling in regards to what specifically had happened and what is currently happening in your life that continues to cause you problems currently as you experience emotional distress with your mental health at this time due to a past sexual assault. Your shared that you are currently experiencing flashbacks, nightmares, and trouble sleeping which can discussed with a licensed professional counselor and or licensed professional mental health therapist.   A licensed professional counselor and or a licensed professional mental health therapist can be very beneficial in supporting you with discussing and processing what you are currently experiencing at this time. Not dealing with your mental health can lead to you experiencing emotional distress. Traumatic experiences can cause psychological trauma which can cause damage to an individual's mind as a result of one or more distressing event. The distressing event can cause overwhelming amounts of stress that can surpass the individual's ability to cope or understand their emotions which can lead to serious long term negative consequences. With the help of a licensed professional counselor and or a licensed professional mental health therapist, you can receive adequate help in regards to your licensed professional counselor and or a licensed professional mental health therapist providing you with effective and or appropriate skills and techniques to learn how to develop and implement effective skills and strategies for you to effectively deal with the traumatic experience that you experienced currently that continues to cause problems and or concerns for you as an adult. I would highly suggest that you try to seek help for your specific mental health needs. A licensed professional counselor and or licensed professional mental health therapist can assess your current mental health concerns with you. Once you have been properly assessed and diagnosed by a licensed professional counselor and or licensed professional mental health therapist you can both then discuss and process what your mental health symptoms look like. Therapy and medication together can help minimize the severity of your mental health issues if needed. Individuals who receive therapy and medication often see quicker improvements and overall better outcomes than those who only receive therapy or those individuals who only take medication in regards to dealing with their mental health. Therefore, continuing to take antidepressants is a great idea to help you minimize your emotional distress along with counseling and or therapy from a licensed professional counselor and or a licensed mental health therapist. Behavior interventions, Psychotherapy, and Cognitive Behavioral Therapy (CBT) have all been beneficial in helping people to express their thoughts, feelings and emotions in regards to a traumatic experience that you experienced that continues to affect your relationships and current emotional distress with your mental health at this time. In an effort to feel improve your mental health, you can try to commit to changing the way you think. It will take a lot of practice, dedication and determination to feel more emotionally stable at this time. However, trying to do this will help you feel better and it can lead to your feeling much better and becoming more productive. You can recognize when it is happening and when you find it happening you can choose to think about something more productive. You can also look for solutions by committing to learning from your mistakes and solving your problems so you can productively move forward, set aside time to think when you notice that you are beginning to feel less appreciated, distract yourself with a self care activity and you can practice mindfulness. Mindfulness is the key to living in the "here and now." When you become mindful, you will be completely present in the moment. It can be like a form of meditation that takes a lot of practice, but over time and with consistency, it can be very beneficial in decreasing your thoughts and feeling regarding your past traumatic experience and mental health at this time. Overall, I highly recommend that you seek help from licensed professional counselor and or a licensed professional mental health therapist to properly discuss your thoughts, feelings and emotions in regards to your traumatic experience that continues to interfere with your relationships as an adult. Mental health is not a one size fits all, so it is important to get personalized treatment for your specific and current mental and emotional needs where you shared that you experience flashbacks, nightmares, and trouble sleeping at this time. I highly recommend that you contact the Betterhelp team to discuss what specific payment options and payment plans are available for you to access counseling services because you are wanting to know how to get help for yourself at this time but you are currently unemployed. Betterhelp does offer financial aid and various other options for individuals who are seeking counseling for their personal and or emotional well-being through the use of affordable therapy sessions. The Betterhelp Platform is designed to be able to assist you better if you contact them directly. Contacting Betterhelp directly is the best way for them to verify your identity and securely help you with your specific account information and needs. When it comes to questions, issues or concerns in regards to the cost of using the Betterhelp platform please contact the Betterhelp team. You can reach out to the Betterhelp team for issues including but not limited to the following: billing issues, account questions and or concerns, and or subscription questions and or concerns. The Betterhelp members are there to help answer your questions, concerns and or issues, so if you have a question in regards to what the cost would be to begin using the Bettehelp platform you can contact the Beterhelp team members directly to gain accurate information in regards to what payment options are available for you if you decide to join the Betterhelp platform in regards to possibly talking to a licensed professional counselor and or licensed professional mental health therapist. Please feel free to reach out to the Member Success Team directly by emailing contact@betterhelp.com to discuss what payment options are available for you to use the Betterhelp platform for you counseling needs and or therapy needs at this time. Best regards to you! Best regards to you!
(EdS, LPC-S, NCC, BC-TMH)
Answered on 01/21/2022

What is wrong with me?

I am so sorry to hear that you are struggling with loneliness and sadness as a result of trauma you have experienced.   It will be important to recognize when your feelings have a purpose versus when they do not.  We of course want positive feelings in our lives, but sometimes negative feelings are there for a reason and we need to live out that purpose in order for it to get better.  If we do not live out the purpose of our feelings, it likely leads us to feel worse.  For example, something as simple as having anxiety about needing to get the chores done has the purpose of getting us motivated to get the chores done.  Therefore, if we do not live out that purpose and the chores remain undone, that can lead to more bad feelings, such as, “I am lazy” or “I am worthless.”  This is a simple example of how if we do not pay attention to our feelings and live out the purpose, they can become much, much worse.  So, I would encourage you to try and separate out the thoughts that have a purpose from the thoughts that do not have a purpose and are more intrusive.    For the ones that do have a purpose, it can be helpful to allow yourself to think through the anxious thoughts because anxiety has a nasty way of going to the worst possible scenario.  If you can wrap your head around that scenario, it can make it less scary.  For example, I had a client that was very anxious daily about being single for the rest of his life.  Thinking to that extreme is clearly anxiety and it just lingers there.  So, then he was able to think through that scenario and come up with a plan to make it less scary.  He then came up with that if he really is going to be single the rest of his life, which is highly unlikely, he is going to work towards being able to live close to the ocean since that is a dream of his.  Thinking about it now does not make him as scared because he recognizes he could be happy with that. So, try to think through specific things you are anxious about that have a purpose and make sure you have a specific plan on how to improve those things. For example, having a specific plan for how to address specific triggers that lead you to think about your trauma.   Intrusive thoughts tend to not have a purpose and it can be really helpful to try and overpower those before they are accepted as truths.   We can have power over our thoughts and I want to help you not engage in these thoughts that make you so upset.  The easiest example of this that I can think of is if I went skydiving.  If I went skydiving I would have some obvious, rational, anxious thoughts.  If I really have a desire to skydive though I will need to not engage in those thoughts.  I might have thoughts such as, "My parachute could fail, I will hit the ground, I am going to pass out, etc."  However, since I really want to follow through with skydiving, I would want to stop those thoughts in their tracks with, "I know this is going to be really fun, they inspect the parachutes ahead of time, people hardly ever get hurt doing this, etc."  By focusing on those thoughts and not engaging in the others, I would be able to follow through with skydiving. Try to sort through any thoughts that get you down about yourself and that you can’t handle all of this and try to overpower those.  These types of thoughts are very common when dealing with this kind of loneliness and sadness.    As you do those processes it can be helpful to validate yourself as someone of worth and that has been able to get through challenges in your past.  Something that could be helpful for you is what I like to call centering thoughts.  These are thoughts that are predetermined and unique to you for you to turn to in low moments.  They need to be powerful enough to bring you back to your center.  It is important that these thoughts are accessible for you to look at when you need to.  Some clients prefer to read and re-read them and some prefer to write and re-write them until they feel better.  I have clients that write these somewhere they will see daily such as their bathroom mirror or phone background, while others simply have them in their phone to pull out when they need to.  An example of a centering thought would be from a client I had that related to nautical themed things and her thought was, "I will not let this sink me."  Another example is from an Olympic skier that actually had difficulties with negative thinking getting in the way of her performance so she went to therapy.  She mentioned that she learned about centering thoughts to battle all of the people telling her she “should be” or “should do.”  To battle those thoughts, she uses the simple centering thought of, “I am.”  She can then remind herself that she is good enough, that she is confident, and that she does want to still compete, which really affirms her own feelings and not others.  Hopefully you can come up with something that helps validate your worth and abilities to move forward.       I hope that some of this is helpful and that you can apply it to your circumstances.  I hope that you can lean on some family and/or friends through this.  Doing so can help take weight off of your shoulders as well as hopefully get some valuable advice from them. Try to take the healing one day at a time and adding one positive thing back into your life each day. I wish you all the best and I hope that you are staying safe.
(MA, LPC, NCC)
Answered on 01/21/2022

How to try and figure out who I am through constant anxiety, random bursts of depression and DPDR

Dear Jempleking,   Thank you very much for your message.   I understand that we are going through some fluctuations with our emotions and often it can feel like we are going backwards. However the reality is that the night is always darkest before the dawn. The reason you are feeling discouraged is because you are trying to move forward in this healing process, therefore when you do experience any kind of anxiety or depression you begin to doubt yourself in this process.   Meanwhile, as a human being we will always have times when we feel anxious or depressed. That is normal and natural. Just like there are days that it rains, there are also days that the sun shines. This isn't a problem to be fixed.    We will only feel more depressed if we constantly compare ourselves with our old selves in the past that seemed to be happier, while we forget that back then we did not have this much on our plate to worry and we did not experience what we have experienced recently that gave us hurts and pain. Therefore it isn't fair to our current self if we always think about how to go back in time, that isn't possible anyways.   To further recover from feelings of depression and anxiety, we must constantly be thinking about how to develop a healthy, positive interaction with ourselves.   Happy relationships all depend on how happy we are with ourselves. So how happy are we?   If you feel like you're on a constant quest for inner bliss, you might be asking yourself: If there was one secret on how to be happy in your relationship or marriage, workplace, home life and family wouldn't you have learned it by now?   Are you constantly searching, asking people who seem happy, reading articles and watching videos on how to be happy? If so, you're certainly not alone. Online search engines get millions of people asking this question, and the internet is full of promises that this strategy or that formula will deliver you to a place of lasting happiness. Yet, many miss the main point: they never even touch on the fact that the real key to happiness with others is happiness with yourself.   If you haven't noticed or been here yourself (most of us have), an insecure person's need for constant approval is exhausting. Those who are happy and love themselves don't hang around with that kind of negative energy. Since we can't change other people, lead by example and others will follow in your footsteps, becoming good role models themselves. Here are 5 lessons that I learned (still learning) to find peace within ourselves and enjoy true happiness that does not depend on others.   1. Forgive Yourself   Forgive yourself for anything and everything you think you caused that was bad in your or someone else's life. You can't go back for a do-over, so learn the lesson and move forward, promising to better handle any similar situation that may arise. Now you're freed up to relax more and have greater peace of mind without beating yourself up over guilt and resentment.   2. Understand That You Are Complete   And understand that, "You complete me," was just a cheesy line in a Tom Cruise movie. (I loved that line at first too... for a few seconds, until I realized how inaccurate it was. Keep reading to learn why!) The reason most of us don't feel complete, and latched onto that line like it was the end-all be-all relationship concept is because we're waiting for someone else to be or do something that makes us feel whole.   First of all, as mentioned, we are already complete. But even if we weren't, no one else would be able to complete us anyway - it's impossible. When we put our happiness in someone else's hands we set them up for failure. Why would we do that to someone we care about? Because we don't realize we are the only ones who control our happiness.   Does this mean if you're unhappy it's your fault? Yes. Does this also put you in a position of power in your life? Absolutely. You want your relationships to be the joining of two complete individuals to create a third, larger entity so that you're a part of something, not just half of something. The whole "my other half" thing just breeds insecurity, which leads to the most painful relationship challenges like jealousy, abuse and infidelity. Why on earth would you want your happiness to be determined by someone or something outside of yourself?   3. Get To Know Yourself   When do you feel you're at your best when you're alone? Are you reading your favorite book overlooking a beautiful view? Enjoying your favorite tea, watching a movie? Shopping outside at the farmers market? Listening to your favorite music? How does your body feel? Healthy? Need some work? No one will be happier than you when your body looks good and functions well. This is a good confidence builder and when you have more confidence, you look better and healthier, and carry yourself in a completely different way that attracts confident people to you.   Here's a personal example: I had a spider vein on my lower leg and didn't feel comfortable in shorts for years. I finally had it removed and couldn't believe how much better I felt. My posture and confidence in shorts was much improved. Some things are easily fixable and for the others we may need to adjust our perspective a bit.   What are your favorite parts of yourself - your appearance, your character traits, your values or your personality? Do you get a kick out of your great sense of humor? I get a kick out of mine. I laugh to myself quite often! Are you really excited that you value honesty, which has attracted honest, genuine people to you? Are your eyes or hands or knees your favorite part of your body? Get to know your favorite parts and love them all.   4. Take A Good Look At Yourself   Take a look and notice how amazing you are. Keep your self-talk positive. There are things supermodels hate about themselves, so don't go thinking you're the only one who has dislikes. You can be happy with yourself even if there are things you'd like to change. I've always been shorter than most other people and would have given anything to be "normal" height. It took me 27 years of hating my height when many other people always wanted to be taller and would have traded me in an instant. Look how many years I experienced self-induced suffering. (This describes all suffering by the way. Pain is inevitable; suffering is optional.)   What are you good at, best at and want to improve at? What are your talents and what skills have you developed? What would you like to do in your life that you haven't done yet? What is the best thing you've ever done? Are you noticing that you might ask some of these questions on a date to get to know someone and determine if you like them or not? We get to know people by asking questions although we rarely ask them of ourselves. And when someone else asks, we sometimes answer differently than when we're asking ourselves.   5. Ask Yourself Questions   To find out more about yourself, ask yourself the questions you would ask on a date. The quality of your relationships is determined by the quality of the questions you ask. Ask good questions and lots of them (more than you would ask on a date; it's OK to be a chatterbox with yourself) to build that strong, healthy relationship with yourself.   Take time away from other people and be happily alone. At first, it might feel weird choosing to be alone but being alone and being lonely are two very different things. Dr. Wayne Dyer says, "You cannot be lonely if you like the person you're alone with." I went from being scared to sit alone in Starbucks for fear some stranger would think I didn't have any friends to loving going places alone. I have attracted wonderful friends by learning how to like myself and since like attracts like (energy), they happily do things on their own too. Yes, we do enjoy each other's company as well; we don't just talk about all the things we did by ourselves (although that would be funny).   Welcome to your inner power. You are qualified, capable and worthy of being happy with yourself regardless of anyone else on the planet so lead by example and show others how it's done. You will see that you can have much more fulfilling relationships without putting the responsibility of your happiness on someone else.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022

How to stop a controlling mother and other things?

How to stop a controlling mother and other things? I read where you questioned how to make things better with your partner. You also shared how to stop a mother being controlling over you. You shared that you are interested in how to find a way out of your house. You also questioned how to better your life. Along with that you questioned how to make things better than worse for yourself at this time. You questioned how to stop a controlling mother and other things. Based on your question, I would highly suggest that you try to seek help from a licensed professional counselor and or licensed professional mental health therapist to begin sharing and opening up about the relationship with your mother to then discuss how to stop seeking validation from a toxic source find ways out of your home and better your life. A licensed professional counselor and or licensed professional mental health therapist can help you fully share in a safe and confidential setting. Along with that, a licensed professional counselor and or licensed professional mental health therapist can also work with you on discussing appropriate ways to deal with effective communicating and building a positive interpersonal relationship with your mother.  A licensed professional counselor and or licensed professional mental health therapist can also provide you with effective coping skills and techniques to decrease your current thoughts and feelings in regards to your relationship with your mother. A licensed professional counselor and or licensed professional mental health therapist can assess your current mental health concerns with you to see what triggers your need to develop a better relationship with your mother. Once you have been properly assessed and diagnosed by a licensed professional counselor and or licensed professional mental health therapist you can work on developing a better relationship with your mother. A licensed professional counselor and or licensed professional mental health therapist and you can both then discuss and process what is best for you and your mother’s relationship at this time. Behavior interventions, Psychotherapy, and Cognitive Behavioral Therapy (CBT) have all been beneficial in treating individuals who have struggled with a need to have a better life and mend the relationship with your controlling  mother.  A licensed professional counselor and or licensed professional mental health therapist can assist you in learning how to effectively implement coping skills to decease need to seek validation from your mother’s controlling behaviors as a means of having a better life. A licensed professional counselor and or licensed professional mental health therapist can introduce you to deep breathing techniques, calming techniques, grounding techniques, stress management techniques, positive interpersonal relationships, progressive muscle relaxation, and imagery as a means of decreasing your need to have a better life and forming a better relationship with your mother. In an effort to decrease your need to have a better life and improve the relationship with your controlling mother you can also try to commit to changing the way you think. It will take a lot of practice, dedication and determination to alleviate your need to have better life and improve the relationship with your controlling mother. However, trying to do this will help you feel better and it can lead to your feeling much better and becoming more productive. You can recognize when it is happening and when you find it happening you can choose to think about something more productive. You can also look for solutions by committing to learning from your mistakes and solving your problems so you can productively move forward, set aside time to think when you notice you are feeling your obsessive and or overthinking about it outside of that scheduled time, remind yourself that you will think about it later, distract yourself with a self care activity and you can practice mindfulness. Mindfulness is the key to living in the "here and now." When you become mindful, you will be completely present in the moment. It can be like a form of meditation that takes a lot of practice, but over time and with consistency, it can be very beneficial in decreasing your need to seek validation from your controlling mother in an effort to help you experience an overall healthier mental well being and better life. Overall, I highly recommend that you seek help from a licensed professional counselor and or licensed professional mental health therapist. The help of a licensed professional counselor and or licensed professional mental health therapist can be quite beneficial in helping you to properly get a better understanding of your current need to seek validation from your controlling mother, as it can look different for everyone. Please remember that mental health is not a one size fits all, so it is very important to get personalized counseling and or therapy for your specific and current mental and emotional needs in reference to your need to seeking a better life and validation of a better relationship from your controlling mother at this time. Best regards! I highly recommend that you contact the Betterhelp team to discuss what specific payment options and payment plans are available for you to access counseling services because you are wanting to know how to get help for yourself at this time but you are currently unemployed. Betterhelp does offer financial aid and various other options for individuals who are seeking counseling for their personal and or emotional well-being through the use of affordable therapy sessions. The Betterhelp Platform is designed to be able to assist you better if you contact them directly. Contacting Betterhelp directly is the best way for them to verify your identity and securely help you with your specific account information and needs. When it comes to questions, issues or concerns in regards to the cost of using the Betterhelp platform please contact the Betterhelp team. You can reach out to the Betterhelp team for issues including but not limited to the following: billing issues, account questions and or concerns, and or subscription questions and or concerns. The Betterhelp members are there to help answer your questions, concerns and or issues, so if you have a question in regards to what the cost would be to begin using the Bettehelp platform you can contact the Beterhelp team members directly to gain accurate information in regards to what payment options are available for you if you decide to join the Betterhelp platform in regards to possibly talking to a licensed professional counselor and or licensed professional mental health therapist. Please feel free to reach out to the Member Success Team directly by emailing contact@betterhelp.com to discuss what payment options are available for you to use the Betterhelp platform for you counseling needs and or therapy needs at this time. Best regards to you!
(EdS, LPC-S, NCC, BC-TMH)
Answered on 01/21/2022

Thanks for sharing your feelings about this difficult time, Becham. First, let me say that I'm so sorry you're going through this. As a person, before I became a therapist, I had an extended period of time when I felt a lot like what you're describing. It was awful. I feel a lot of empathy. You probably realize that what you're experiencing is depression. It's always good, by the way, to get a thorough checkup from your primary care physician when you get feeling this way to be sure there isn't a medical issue. Medical science has learned relatively recently that depression can be closely related to inflammation. Inflammation can be caused by a lot of health issues, some of them that may not show a lot of symptoms. So I'd advise you to get checked up if you have the means and the time. But in the meantime, I have some thoughts about this. Depression can be a symptom of unresolved trauma, or untenable life circumstances. If you and I were to work together, I'd want you to take a good, honest look at your life and if bad things happened to you as a child, or teen (and maybe even later) it could be helpful to sort through those. There are some effective techniques to "let it go." Regarding difficult current life circumstances, I've been surprised to find that some clients have issues that they were "putting up with" which they thought were normal and "just something you have to endure." But when my client and I looked closer, we found that they were actually triggering feelings of helplessness. And there are always things we can do about that. Another important thing to take a look at is the drinking. "Prime for Life" is a group who has done extensive studies of people who drink alcohol. They found that 70% of people who drink, do so responsibly. In fact, alcohol in moderation shows signs of healthy effects in people, so I never condemn it right off the bat. However, Prime for Life also noted that the other 30% of people were having significant difficulty with their drinking. It worries me a little that you stay in your bedroom alone with the curtains closed at times. Alcohol is a depressant. If it gets out of control, people often begin to want to be alone. I know a lot about this, and although anyone with a dependence on a substance usually resists looking closely at the substance as a problem, I think it would be a good thing to do if you're willing. If you don't want to do that, there are other things we can look at. There is a lot more we can talk about as we try to ferret out what is causing this painful time for you. Some important information regards the "two brains" each of us has, the prefrontal cortex and the limbic system. The limbic is sometimes called the "primitive" brain, because it's been with us since we were animals, from within the perspective of evolution. It is all about survival, procreation, finding pleasure and being sure the body is sated with what it needs. However, it is reactive and impulsive. Sometimes it can think it's protecting you from danger while paradoxically causing you to sort of shut down. It is where strong emotion comes from. I hope I'll have a chance to work with you. I think I can help. Lanny Monson, MS, PMC, LMFT
Answered on 01/21/2022

If life only gets more difficult over time, what is the point is living in the first place?

Thank-you for reaching out to better help for assistance. I look forward to assisting you.  Sounds like you would like to know if life only gets more difficult over time what is the point in living in the first place?  Sounds like you are a college student and you feel worn out from previous trauma in your life and social anxiety.  Sounds like you are not feeling very hopeful that things will get better in your life. I understand things seem very frustrating now.  Sounds like you do not feel like the good times will come and life will only get more difficult from here.  You do not say what kind of trauma you experienced but trauma can create grief and triggers and you do not want to get stuck in the grief stage of depression, anger or guilt. Anytime you have change you have stress. Change= stress. You want to build up your tool kit of coping skills so you can develope more positive ways to cope and deal with your trauma and issues in your life. I understand this is frustrating and difficult but it takes time. The stages of grief are:  shock, denial, anger, depression, guilt and finally acceptance. Grief takes time but you do not want to turn to negative coping skills. Negative thinking, will just make you depressed. Turning to too much drinking or other negative coping skills will not helped either. I would suggest you apply some cognitive behavioral therapy/ CBT.  You can google this therapy.  This therapy challenges your thoughts and beliefs to get the best possible outcome for yourself. I would have you apply the ABC Model. A= the activating event, B= your thoughts and beliefs, C= the outcome or conequence. The key is to challenge your B or thoughts and beliefs to get the best possible  C or outcome for yourself. You need to ask yourself is thinking negative or do this helping me or hurting me?  You want to do things that will help you. You want to think about your goals and work towards your goals. Grief and change take time but by applying positive coping skills you can make the outcome better. By applying negative coping skills the outcome will be worse and take longer. Life is like school. You have lessons to learn. You need to learn ways to do things. If you do not learn, you will keep repeating those lessons in life. I hope this helped you some?  I wish you the best and look forward to hearing from you. 
(LPC, NCC, MS)
Answered on 01/21/2022

Is it normal to forget serious events, or to be unsure if memories about serious events are real?

Dear Hound'sBoy,   Thank you for your message and courageously sharing the traumas that you have been through, and what they meant to you and affecting your life at the moment.   This is indeed a painful process that can cause some emotions rising on your end, that is also because for a very long time we have been simply coping with these wounds through our defense mechanisms, rather than actually looking at them and process them.    As you have said, perhaps we have learned to deal and cope with these abuses and traumas by making explanations for them, validating them and even accepting them as a part of our lives. While we have learned to move on without processing these traumas, we could still the effects they bring especially in the form of anxiety and even panic when we are being reminded or triggered by events and people who have inflicted these wounds on us.   To truly move on and not let these traumas affect us, we need to learn to bring closures to these wounds and bind them up. I am glad that you are aware of the need to bring closures, I'll explain more here when it comes to closure.   A lack of closure frequently prevents people from moving forward with their lives and achieving all that they could. It makes it more difficult to reach goals, find self-happiness or make meaningful relationships. For this reason, it is important to find a sense of closure with any situation that you feel is holding you back.   Closure is any interaction, information, or practice that allows a person to feel that a traumatic, upsetting, or confusing life event has been resolved. The term has its origins in Gestalt psychology, but it is more commonly used to refer to the final resolution to a conflict or problem.   Closure means finality; a letting go of what once was. Finding closure implies a complete acceptance of what has happened and an honoring of the transition away from what's finished to something new. In other words, closure describes the ability to go beyond imposed limitations in order to find different possibilities.   People seek answers and explanations: They want to know why. However, finding answers does not necessarily end pain. Sometimes a person who seeks closure finds that an explanation makes no difference, or that it actually worsens their pain. Others find that closure may simply be a starting point for moving past a painful event. Though the trauma is not resolved, the person is better able to work through it. Seeking a definitive way to finalize grief and move on belies the importance of the grieving process. Simply putting an end to one's painful memories may be more harmful than helpful.   In some cases, though, closure is a profoundly transformative experience that does allow the person to move past the traumatic event. For example, a victim of abuse may need to confront the abuser and see them imprisoned before he or she can begin to feel safe again. In acknowledgment of this, the criminal justice system is increasingly recognizing the need for closure by instituting programs allowing victims and their families to meet with offenders in a controlled setting.   Unfortunately, there are times when closure is simply unattainable. This may be true in situations where someone moved locations or passed away before being able to resolve a problem. In some cases, the other involved person is simply unwilling to engage. In times like these, it can be easy to become bogged down by the lack of closure. It can be easy to cover up the underlying problem with meaningless coping mechanisms like substance abuse. With time and effort, there are many ways to move past unattainable closure to live happily once more.   The most important part of moving on from a lack of closure is taking care of yourself, both physically and mentally. This is also why we have began our therapy process with the focus on self-compassion. Self-compassion is the core of why we want to bring closures and bind up these wounds, because they make us feel better and they are the best decisions we can make for ourselves.   When we bring closures to our traumas, we need to keep in mind that we are doing this not because we have to, but we want to. When we practice forgiving those who have wounded us and let them go, we are not agreeing / accepting / acknowledging what they have done and not hold them accountable, we are simply letting go of the bitterness, resentment and hatred that we have hide with us all these years.   As for our physical health, engaging in adequate active exercises could be helpful. Improving your physical health through diet and exercise can help to improve self-esteem and emotional well-being, both of which are essential to moving on from unattainable closure.   Meditation, hobbies and social interaction are all great ways to nurture your mental health and find the inner happiness that makes a lack of closure bearable.   While self-care is essential to moving on from a lack of closure, it is often not enough to resolve the problem altogether. One great exercise to help you move forward is to write a letter to the individual that you have not received closure with. In this letter, you can describe all of your feelings about the situation and how you wish things had ended. Once the letter is complete, you can bury it, burn it, or simply throw it in the trash. Writing an unsent letter can help you get those feelings out that are hiding painfully inside and find a sense of self-resolution.   Forgiveness is another essential component to finding a sense of closure at times that closure cannot otherwise be achieved. Forgiving a person that caused you pain can sometimes seem like an impossible task. However, it is possible with daily efforts. We can go into details later regarding forgiveness, one step at a time.   To move past unattainable closure, you may also need to forgive yourself for anything you feel you did wrong in the situation. If you blame yourself for a broken relationship, death of a love one, or anything else, it will be impossible to move on and find inner happiness.   I'll pause here to learn from your thoughts, looking forward to talking with you more. Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022

How do you prevent depression and what can you do to get out of it once it has set in?

Becky, I'm so sorry to hear about your loss. I can't imagine what it is like to have to suffer the loss of both a best friend and a mother. Grief is a process and happens in stages over time as moving through it. Depression is one of those stages that often comes after denial, shock, and anger. After anger comes bargaining and then acceptance. That does not mean we wake up every day going through them one by one though. The sudden feelings of overwhelming depression show the difficulty in managing the emotional responses that come with grief. Building awareness around triggers and reminders of the grief is the first step to be aware which of these reminders are more debilitating than others. Sometimes actually blocking a number or deleting a social media app is necesssry to have space from the triggers. When going through depression there are clear factors including a lack of interest in activities once interested, socially isolating yourself, withdrawing from family gatherings/supports, lack of exercise, disturbance in sleep, and others that affect self. There are often several different thoughts that happen for the human brain throughout a normal week, when grieving it overall affects our brain even more when fight the effects from the cloud of emotional grief experienced on the daily. It is always wise to get some type of professional support when going through a significant loss. I've had some signicsnt losses in my life as well that have affected my emotional reactions too. I was thankful and appreciative to go to a therapist to not let my build up suppressed thoights add up too much. If open to connecting with a professional through Better Help that would be an excellent option to get this type of support. Staying busy and utilizing distractions is definitely effective to keep the mind busy in switching tasks to not have to sit in the depression or negative thoughts. Planning to utilize community supports, family, friends, professional help, and sometimes medication management to best assist depending on the severity of the depression. It could get emotionally exhausted to feel this way and feel so alone. Sometimes even picking up an activity or hobby that is new is a major contributing factor to working through grief. When we ar grieving or serotonin and sense of feeling content with our life is very low. Trying to find interests and utilizing your own strengths to consider using née tools is beneficial to not only distract the mind, but to feel productive with how your spending time. Some cultures are not accepting to the ideas of depression and mental health. If our family and culture are not as for these ideas it could be harder to take in fully to adapt. There are several different tools and interventions to utilize when working on grief in therapy. One that has been particularly helpful for myself both as a therapist and a client is writing the person who has passed a letter, poem, or dedicate a type of passage such as a song to them. Doing this is helpful to assist the heart in feeling closure to the loss and express your true feelings around the loss. There are also different types of ways to connect spiritually if believing in a Higher Power or if practicing religion could always take time to pray. It isn't always easy to work through grief and you should not have to do it alone. You deserve to have a safe space where you can openly talk about and work through this grief while knowing there is at least one person that will always be there to listen. I'd be open to working with you in the future in this area and I wish you the best in next steps of your journey. 
Answered on 01/21/2022

How long does it take to recover from an emotional trauma?

How long does it take to recover from an emotional trauma? I read where you shared that you want to work on self love and you are not sure how to start. You shared that you did not exactly grow up in a loving environment and you shared that you feel like your relationships keep failing because of your childhood issues. You questioned how long does it take to recover from an emotional trauma. Based on your question, I would highly suggest that you first start with seeking mental health therapy from a licensed professional counselor and or licensed professional mental health therapist to discuss your thoughts and feeling in regards to how long it takes to recover from emotional trauma as there is no right or wrong answer on how long it takes us to recover from emotional trauma. It specifcally depends on the individual and what specifically happened in your childhood that continues to cause you problems as your thoughts trigger your current thoughts and feeling related to self love and relationships as an adult. A licensed professional counselor and or licensed professional mental health therapist can be very beneficial in supporting you with discussing and processing what happened when you were a child. Traumatic experiences can cause psychological trauma which can cause damage to an individual's mind as a result of one or more distressing event. The distressing event can cause overwhelming amounts of stress that can surpass the individual's ability to cope or understand their emotions which can lead to serious long term negative consequences. With the help of a p licensed professional counselor and or licensed professional mental health therapist t, you can receive adequate help in regards to your licensed professional counselor and or licensed professional mental health therapist providing you with effective and or appropriate skills and techniques to learn how to develop and implement effective skills and strategies for you to effectively deal with the traumatic experience that you experienced as a child that continues to cause problems and or concerns for you as an adult. Behavior interventions, Psychotherapy, and Cognitive Behavioral Therapy (CBT) have all been beneficial in helping people to express their thoughts, feelings and emotions in regards to a traumatic experience that you experienced as a child that continues to affect your relationships as an adult. A licensed professional counselor and or licensed professional mental health therapist can introduce you to deep breathing techniques, stress relaxation techniques, calming techniques, grounding techniques, social skills, positive interpersonal relationships techniques, progressive muscle relaxation, and imagery as a means of decreasing your feelings of loneliness and self-worth and self-confidence issues.   In an effort to feel more appreciated at work, you can try to commit to changing the way you think. It will take a lot of practice, dedication and determination to work on decreasing triggers of your past childhood trauma. However, trying to do this will help you feel better and it can lead to your feeling much better and becoming more productive. You can recognize when it is happening and when you find it happening you can choose to think about something more productive. You can also look for solutions by committing to learning from your mistakes and solving your problems so you can productively move forward, set aside time to think when you notice that you are beginning to feel triggered by your past childhood trauma, distract yourself with a self-care activity and you can practice Mindfulness. Mindfulness is the key to living in the "here and now." When you become mindful, you will be completely present in the moment. It can be like a form of meditation that takes a lot of practice, but over time and with consistency, it can be very beneficial in decreasing your thoughts and feelings regarding your past traumatic experience. Overall, I highly recommend that you seek help from a licensed professional counselor and or licensed professional mental health therapist to properly discuss your thoughts, feelings and emotions in regards to your past traumatic experience as a child that continues to interfere with your relationships as an adult due to you experiencing some triggers about your past traumatic experiences. Mental health is not a one size fits all, so it is important to get personalized treatment for your specific and current mental and emotional needs.  I highly recommend that you contact the Betterhelp team to discuss what specific payment options and payment plans are available for you to access counseling services because you are wanting to know how to get help for yourself at this time but you are currently unemployed. Betterhelp does offer financial aid and various other options for individuals who are seeking counseling for their personal and or emotional well-being through the use of affordable therapy sessions. The Betterhelp Platform is designed to be able to assist you better if you contact them directly. Contacting Betterhelp directly is the best way for them to verify your identity and securely help you with your specific account information and needs. When it comes to questions, issues or concerns in regards to the cost of using the Betterhelp platform please contact the Betterhelp team. You can reach out to the Betterhelp team for issues including but not limited to the following: billing issues, account questions and or concerns, and or subscription questions and or concerns. The Betterhelp members are there to help answer your questions, concerns and or issues, so if you have a question in regards to what the cost would be to begin using the Bettehelp platform you can contact the Beterhelp team members directly to gain accurate information in regards to what payment options are available for you if you decide to join the Betterhelp platform in regards to possibly talking to a licensed professional counselor and or licensed professional mental health therapist. Please feel free to reach out to the Member Success Team directly by emailing contact@betterhelp.com to discuss what payment options are available for you to use the Betterhelp platform for you counseling needs and or therapy needs at this time. Best regards to you!
(EdS, LPC-S, NCC, BC-TMH)
Answered on 01/21/2022

How do you heal from childhood trauma?

Cici, This is a great question to explore, and it's not necessarily something that can be answered in one giant response, but I'll gladly offer what I can for your consideration. The fact that you have begun some recent reflecting on your past is a great exercise in terms of resolving what has been, and it may lead you toward a sense of closure. Some of the most challenging aspects of our lives occurred during a season when we are too young to properly understand them and the impact those things will have on our future. Based on your question, it sounds as though you have been through some things that have undeniably shaped your past as well as your view of yourself and those around you.  It seems like you have also reached a moment of reckoning, for lack of a better phrase. It may be a moment, or perhaps a season, where you acknowledge the things that happened to you and how to accept what has been. At the same time, it's a moment that could serve as a great springboard for you to work toward healing and wholeness, for you to become the person you've always dreamt you could be! This can be done in a number of tangible ways. I would encourage you to consider creating a window of time and space to write down the things that happened, what they meant to you at the time they occurred, how you see yourself now as a result of those things, and how you want your relationships to be as you move forward.  Healing from childhood trauma takes patience, too, mostly for yourself as you process everything in your own way. It's complicated and oftentimes messy, and it will also require some forgiveness along the way. However, it's one of the best moves you can ever make, first for yourself and then for those around you who truly love you, care about you and want to have you in their lives. If you want to explore this together, at a pace that feels comfortable to you, I'd be happy to help.
(MS, NCC, LPC)
Answered on 01/21/2022

How can someone who lost everything and has nothing to look forward to get out of his depression????

Dear Frida,   Thank you very much for your message.   I understand that we are going through some fluctuations with our emotions and often it can feel like we are going backwards. However the reality is that the night is always darkest before the dawn. The reason you are feeling discouraged is because you are trying to move forward in this healing process, therefore when you do experience any kind of anxiety or depression you begin to doubt yourself in this process.   Meanwhile, as a human being we will always have times when we feel anxious or depressed. That is normal and natural. Just like there are days that it rains, there are also days that the sun shines. This isn't a problem to be fixed.    We will only feel more depressed if we constantly compare ourselves with our old selves in the past that seemed to be happier, while we forget that back then we did not have this much on our plate to worry and we did not experience what we have experienced recently that gave us hurts and pain. Therefore it isn't fair to our current self if we always think about how to go back in time, that isn't possible anyways.   To further recover from feelings of depression and anxiety, we must constantly be thinking about how to develop a healthy, positive interaction with ourselves.   Happy relationships all depend on how happy we are with ourselves. So how happy are we?   If you feel like you're on a constant quest for inner bliss, you might be asking yourself: If there was one secret on how to be happy in your relationship or marriage, workplace, home life and family wouldn't you have learned it by now?   Are you constantly searching, asking people who seem happy, reading articles and watching videos on how to be happy? If so, you're certainly not alone. Online search engines get millions of people asking this question, and the internet is full of promises that this strategy or that formula will deliver you to a place of lasting happiness. Yet, many miss the main point: they never even touch on the fact that the real key to happiness with others is happiness with yourself.   If you haven't noticed or been here yourself (most of us have), an insecure person's need for constant approval is exhausting. Those who are happy and love themselves don't hang around with that kind of negative energy. Since we can't change other people, lead by example and others will follow in your footsteps, becoming good role models themselves. Here are 5 lessons that I learned (still learning) to find peace within ourselves and enjoy true happiness that does not depend on others.   1. Forgive Yourself   Forgive yourself for anything and everything you think you caused that was bad in your or someone else's life. You can't go back for a do-over, so learn the lesson and move forward, promising to better handle any similar situation that may arise. Now you're freed up to relax more and have greater peace of mind without beating yourself up over guilt and resentment.   2. Understand That You Are Complete   And understand that, "You complete me," was just a cheesy line in a Tom Cruise movie. (I loved that line at first too... for a few seconds, until I realized how inaccurate it was. Keep reading to learn why!) The reason most of us don't feel complete, and latched onto that line like it was the end-all be-all relationship concept is because we're waiting for someone else to be or do something that makes us feel whole.   First of all, as mentioned, we are already complete. But even if we weren't, no one else would be able to complete us anyway - it's impossible. When we put our happiness in someone else's hands we set them up for failure. Why would we do that to someone we care about? Because we don't realize we are the only ones who control our happiness.   Does this mean if you're unhappy it's your fault? Yes. Does this also put you in a position of power in your life? Absolutely. You want your relationships to be the joining of two complete individuals to create a third, larger entity so that you're a part of something, not just half of something. The whole "my other half" thing just breeds insecurity, which leads to the most painful relationship challenges like jealousy, abuse and infidelity. Why on earth would you want your happiness to be determined by someone or something outside of yourself?   3. Get To Know Yourself   When do you feel you're at your best when you're alone? Are you reading your favorite book overlooking a beautiful view? Enjoying your favorite tea, watching a movie? Shopping outside at the farmers market? Listening to your favorite music? How does your body feel? Healthy? Need some work? No one will be happier than you when your body looks good and functions well. This is a good confidence builder and when you have more confidence, you look better and healthier, and carry yourself in a completely different way that attracts confident people to you.   Here's a personal example: I had a spider vein on my lower leg and didn't feel comfortable in shorts for years. I finally had it removed and couldn't believe how much better I felt. My posture and confidence in shorts was much improved. Some things are easily fixable and for the others we may need to adjust our perspective a bit.   What are your favorite parts of yourself - your appearance, your character traits, your values or your personality? Do you get a kick out of your great sense of humor? I get a kick out of mine. I laugh to myself quite often! Are you really excited that you value honesty, which has attracted honest, genuine people to you? Are your eyes or hands or knees your favorite part of your body? Get to know your favorite parts and love them all.   4. Take A Good Look At Yourself   Take a look and notice how amazing you are. Keep your self-talk positive. There are things supermodels hate about themselves, so don't go thinking you're the only one who has dislikes. You can be happy with yourself even if there are things you'd like to change. I've always been shorter than most other people and would have given anything to be "normal" height. It took me 27 years of hating my height when many other people always wanted to be taller and would have traded me in an instant. Look how many years I experienced self-induced suffering. (This describes all suffering by the way. Pain is inevitable; suffering is optional.)   What are you good at, best at and want to improve at? What are your talents and what skills have you developed? What would you like to do in your life that you haven't done yet? What is the best thing you've ever done? Are you noticing that you might ask some of these questions on a date to get to know someone and determine if you like them or not? We get to know people by asking questions although we rarely ask them of ourselves. And when someone else asks, we sometimes answer differently than when we're asking ourselves.   5. Ask Yourself Questions   To find out more about yourself, ask yourself the questions you would ask on a date. The quality of your relationships is determined by the quality of the questions you ask. Ask good questions and lots of them (more than you would ask on a date; it's OK to be a chatterbox with yourself) to build that strong, healthy relationship with yourself.   Take time away from other people and be happily alone. At first, it might feel weird choosing to be alone but being alone and being lonely are two very different things. Dr. Wayne Dyer says, "You cannot be lonely if you like the person you're alone with." I went from being scared to sit alone in Starbucks for fear some stranger would think I didn't have any friends to loving going places alone. I have attracted wonderful friends by learning how to like myself and since like attracts like (energy), they happily do things on their own too. Yes, we do enjoy each other's company as well; we don't just talk about all the things we did by ourselves (although that would be funny).   Welcome to your inner power. You are qualified, capable and worthy of being happy with yourself regardless of anyone else on the planet so lead by example and show others how it's done. You will see that you can have much more fulfilling relationships without putting the responsibility of your happiness on someone else.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 01/21/2022