Starting Therapy: What to Expect

Today we are going to talk about what it’s like to start therapy – how to find a therapist, and what to expect.

Most people feel a little nervous making the first call to a potential therapist, especially if they have never been in any type of counseling before. That’s to be expected, and you can tell a lot about the therapist by how they help you manage that first call.  For example, were they able to talk with you, or to return your call in a reasonable amount of time? Were they courteous and respectful? Did they allow you to ask any questions you may have? All of that can give you a sense of who you are talking to, before you even schedule an appointment. If you get an uncomfortable vibe, or it takes them a week to call you back, this may not be your therapist.

There are a variety of ways to find a therapist. One of the best is word of mouth. Quite often though, people don’t talk openly about seeing a therapist, so you may find yourself searching the internet, asking your physician, or visiting directories of therapists such as GoodTherapy.org or Psychology Today. Some things to keep in mind is the therapist’s office location, their hours of availability, their education and experience, and in general, their approach to therapy and the issues you want to work on. What matters most is your gut feeling when you meet the therapist. Is this someone who feels right to you? The relationship between therapist and client is of vital importance. A sense of trust, respect, and acceptance are all part of what make up a successful therapeutic relationship.

Price is likely to be a concern as well. There is generally an accepted range for services among licensed therapists, and you will want to know what your potential therapist charges. Some therapists offer a sliding scale to help make treatment affordable, or offer multiple session packages where you can save money as well. Not all therapists accept insurance, for a variety of reasons. Iwill put a link below to my site where I discuss the insurance issue in more detail.

So what happens at your first appointment? Every therapist has his or her own way of doing things, but there may be only a few differences. I’ll tell you a bit about how I get started with a new patient.In my office, new clients bring in their completed intake forms, and we use that as a starting point, going through the forms together to learn about you and your reasons for seeking therapy. I ask about things like physical health, diet, sleep habits, and any medications you may be taking. I will want to know about the relationships in your life, and what you would like to see happen by coming to therapy. New clients are sometimes nervous and I want to help them feel at ease and accepted. I start right away in encouraging clients to speak up when they have a need or a concern – most likely when they find they can do it with me, with good results, it will be easier to use that skill with others as well.

Your first visit is also a time for your questions. You may want to know if the therapist has treated issues like yours before,or how long treatment will take. There is no set answer for how long treatment lasts, but I can tell you there is no guaranteed “quick fix.” Therapists are not there to tell you what to do, unless there is an actual risk of real danger. We are there to examine your options and help you move toward the changes you want to see happen.

Therapists are trained to listen to you, and maybe sometimes we even hear what you don’t say, by your facial expression or tone of voice. We work to help you identify your goals and then move toward them.

That was a basic overview of starting therapy, and what you might expect. I welcome your comments below about therapy and how this whole process worked for you. 


My Least Favorite Word to Hear in Therapy ;-)

Words are powerful. Whether we are aware of it or not, the words we choose can actually shape your mood and even your behavior. For example, if you consistently use negative or catastrophic terms, pretty soon that colors your view of the world. If you say “I can’t take it” long enough, guess what – you will believe you can’t. It’s not always that simple, but becoming aware of the words you choose is a fairly reliable way to begin to strengthen your emotional state, your self esteem, and even disorders like depression and anxiety.

On my Facebook page, which I hope you are following and if not, here’s the link: http://facebook.com/sandiegotherapy , I asked people what word they thought I meant based on the title of this video. I got some great answers, and some really funny ones as well. I heard ones like “Doritos” and some that were pretty close, like always, can’t, and never. Those last three get my attention and will usually get me asking for more information.

 The one that I tend to notice a lot, though, is “should.” We all use it, maybe more than we realize. “I should earn more.” “I should not call him first.” “I should be happier.” On and on. When you really stop and hear it, this seemingly innocent word carries with it a degree of self judgment and maybe even shame. It’s like we are programmed to blame ourselves when things are not according to plan. We are all human beings with flaws and sometimes we make mistakes. “Should” is a flag we wave saying “Yeah, I’m not doing this well enough. I should do better.”

When I hear this word in session, especially if it comes along with depression, anxiety, and low self esteem, I ask about it. I want to know whose voice it is. “Who is telling you you should be thinner?” Often this gives the client a chance to stop and think. I have heard “Wow. I never thought of that. It sounds like my mom. She used to always tell me I should do better. It’s like I was never enough.”  So we notice that –that’s all. It’s a good start just to hear our own words. We increase awareness of language choices and how what we say affects our view of the world and ourselves in it. We don’t only apply “shoulds” to ourselves. It can be a way of indicating judgment of others, and is often met with resistance or defensiveness.

 By changing the “shoulds” and choosing more empowering language – like I will or I can, you may see some positive changes in your life and your outlook. It may help you to see where any negativity comes from. For what it’s worth, it will help you expand your vocabulary and say more precisely what you mean.

Communication, Family of Origin, Family Ties, Marriage Counseling, Mental Health, Parenting, Relationships, San Diego Counseling, San Diego Therapist, Saying Goodbye, Solutions, Therapy

Parental Alienation Syndrome


When a couple with children makes the decision to end their relationship, the effect on their children can be profound.  How the parents manage this major life change can determine the difference between a positive outcome for the children, or years of prolonged struggle.

Parental Alienation Syndrome refers to an active campaign to turn a child against the other parent. I have heard it termed brainwashing – it is damaging to everyone involved. In my work with families, I have rarely seen behavior this extreme. But I have seen families struggle with negative feelings between the parents spilling over onto the children – even without meaning to.

In cases of divorce or breakup, there can be animosity between the ex-partners. Even when they start out committed to remaining friends or ensuring that the children are untouched by the breakdown of their relationship, this is not always easy to accomplish. Ideally, when a relationship ends, the children’s interests are put first. When the parents move on, even remarry, it is possible for this new, expanded family system to be a thriving and healthy environment for the children. I have seen it in my practice in working with families.  It takes effort and commitment on everyone’s part, and sadly, it doesn’t always work out this way, especially in the first years following a breakup.

Issues like custody, visitation, and child support can become very heated. The ages and maturity of the kids plays an important part, as well as the type of home each parent can offer. By home, I don’t mean luxury or extravagance, I mean that the child knows that he or she has a welcome spot in each parent’s home, and in their life, and that they are cherished, understood, and cared for. They need to know they matter, and that they can trust their parent to still be a parent.

Children were probably witnesses to the breakdown of the parents’ relationship, and they may have developed a sense of who was at fault. As parents, it is not our role to trash talk the other parent, or attempt to turn the child against them. What we can do is try our best to separate marital issues from parenting. If a “good guy/bad guy” scenario exists for the child,  both parents have to first become aware of their behavior, their words, and even their body language. Notice if there are any ways they are contributing to parental alienation. Even if your partner was a lousy wife or husband, they may still be a great parent to the kids, and again, this is what matters most.

So, what if a parent is not such a great mom or dad to the kids? When is it parental alienation and when is the child’s reluctance to be with a parent justified? In his extensive work on Parental Alienation, Dr. Richard Gardner states that if “true parental abuse and / or neglect is present” and the child’s animosity is justified, Parental Alienation Syndrome would not be an appropriate explanation for the children’s feelings. In other words, if the child has feelings of animosity toward a parent who is abusive or neglectful, those feelings may be justified.  Even then there is hope for repairing the parent-child relationship, if the parent who lacks parenting skills or has emotional issues is committed to getting help. If not, again, the child’s welfare is what matters.

Divorced parents need to understand that loving both parents is important whenever possible, even if they have ceased to love their ex-spouse or ex-partner. When one parent repeatedly belittles the other parent, or consistently brings the child into discussions of their faults or the reasons for the relationship breakdown, this can be called Parental Alienation Syndrome. Even if the faults are true, this is not appropriate for our children. Any behavior which is intended to disrupt the relationship between child and parent may be considered alienation. As I mentioned earlier, if there is neglect or abuse, this is an entirely different issue – if the child is frightened, unsafe, ignored, or subjected to harmful behavior, then custody and visitation may need to be adjusted for the child’s well-being. Being a parent is a privilege, and we owe our children our very best parenting regardless of how we feel about our ex-partner.

I hope this very brief overview of Parental Alienation gives you an idea of what it is, and what it isn’t. If this is an issue in your life, I encourage you to explore parental alienation and reach out for support for yourself and your children, if needed.

Video on Parental Alienation Syndrome is here: http://youtu.be/aGkJ5l0Z82s

Anxiety, Mental Health, Relationships, San Diego Counseling, San Diego Therapist, Solutions, Stress, Therapy, Toolkit

Five Steps to Cope With A Meltdown

A meltdown can be defined as a sort of emotional breakdown. It can last a few minutes or a few weeks or longer, depending on the circumstances and your state of mind.  You may say you “hit the wall,” “fell apart,” or “lost it.” Whatever you call it and however long it lasts, it’s an overwhelming feeling. This article will offer 5 quick tips to help you gain your equilibrium and manage stress.

Step 1 – slow down and breathe. Give yourself a little time to calm down and take stock of what is going on around you. A meltdown can make you feel you are being swept away by emotion. Slow down, breathe, relax your muscles, and become aware of the present moment.

Step 2 – Ask yourself what you need right now. It may be anything from some company or a friend to listen to you, to medical care, or anything in between. Identifying what it is that you need will help you focus on taking the next three steps.

Step 3 – Reach out. Whether it is talking to a family member, a friend, or a therapist or doctor, sometimes we all need support in getting through a challenge. We may sometimes need time alone to recharge, that can be true. At the same time, you do not want to isolate – if you get to the point where you have little meaningful connection with people, you can change that.

Step 4 – Accept help that is offered.  If someone reaches out to you, if there is a community resource that might help, or if your doctor says “Call me if you have any questions or complications” – allow that connection to happen and accept support.

Step 5 – Don’t give up. When we are on overload, we lose perspective sometimes. We can feel hopeless to change, and pessimistic about our present and future. You may not be able to see the big picture right now, but I promise you, there is an optimistic side to every situation, and there is help available. You will have to do your part – but it is worth it.

Thank you so much for reading! A video version of this article is available here: http://www.youtube.com/watch?v=kICTDK3AzZM

Medical Issues, Mental Health, Therapy, Toolkit

Sleep Deprivation

I was planning to make this video two weeks ago, but no joke, I was so tired that I took a weekend off to catch up. How’s that for ironic? The good news is I did catch up, and here I am to talk about this topic that affects nearly everyone from time to time – not getting enough sleep.

We have a new puppy in our house who is still in the crazy puppy stage, and our other dog had routine surgery. I think we had about 3 nights where neither of us got more than a couple hours sleep. I felt exhausted, sore, couldn’t think as clearly as usual, had no appetite, and finally caught a cold.  Maybe when I was 20 this would not have been much of a problem. Even at 30 when my daughter was born, sleepless nights were not a big deal. Nowadays, I need to catch it and get my sleep cycle back on track to function my best. I find that to be true for my therapy clients as well.

People who come to see me for counseling sometimes must think I am a broken record, but I do ask about sleep patterns during most sessions.  I want to know how they are sleeping, if they have trouble falling asleep, staying asleep, or they are sleeping too much – especially if they wake up unrefreshed. More often than not, there IS a sleep problem – most often not enough.

How much sleep is enough?

The standard answer to this is eight hours of sleep for adults. This can vary from person to person. What seems to be most important, according to the Centers for Disease Control, is Rapid Eye Movement, or REM, sleep. REM sleep starts about 90 minutes into a sleep cycle and generates the most active dream states. This period helps the brain sort through experiences of the day and neurologists have identified this stage as a period of reorganization of your brain cells.

One reason this matters to us is that being deprived of this necessary period of rest and repair can lead to psychological and physiological problems. A study conducted by the University of Berkeley showed that a severely sleep-deprived brain shows deficits in decision making, appropriate thought patterns, and can even result in psychosis. Not getting enough sleep has also been linked by the CDC to obesity and depression.

There are some mental health conditions that seem to always include disturbed sleep. I have rarely seen someone for Post Traumatic Stress Disorder, for example, who did not have problems sleeping. People experiencing anxiety also will usually report problems either falling or staying asleep. It’s surprising to me how many of us report regular bouts of insomnia, or feel they are always running on a sleep deficit.

Here are some common sense ideas for getting a good night’s sleep:

Substances like alcohol, caffeine, or sugar can make it much harder to sleep. If you can’t cut these out of your diet entirely, try not to ingest them after dinnertime. The half life of caffeine is seven and a half hours. That’s plenty of time to keep you awake long after you drink it.

Speaking of dinner, going to bed on a full stomach can interfere with sleep. The same is true for intense exercise. Allow your body to wind down as you approach bedtime, and see if this improves your sleep patterns.

Make your environment as conducive to sleep as possible. Keep your room cool, dark, and ventilated. If you find yourself tossing and turning, don’t lie in bed and fight it – get up and find a calming, quiet activity until you are ready to fall asleep.

If you are a female over the age of 35, symptoms of perimenopause can begin to interrupt your sleep. Both sexes can experience things like restless leg syndrome or sleep apnea, which can prevent the needed amount of REM sleep. For all of the above, I strongly recommend you see your health care practitioner to talk about your symptoms and see what might help. There are a number of non-prescription methods to improve sleep, so if you are worried you will just be given a bottle of sleeping pills, chances are your practitioner has a number of alternatives to try first.

Many people report difficulty sleeping. I hope these ideas were helpful in getting you closer to a good night’s sleep. I welcome your comments below on anything that has worked well for you. Thank you for reading!


Let’s Talk About Sex!

Of all the topics that are difficult to bring up, even in the therapy room, sex has to be near the top of the list. If sexuality is an important part of who we are and our relationships, but it’s uncomfortable to talk about, we’ve got a bit of a Catch-22.  I think we can find a middle ground, and this video will give you some ideas for addressing issues around sexuality in your relationships in a way that increases your comfort and increase your sense of freedom.

 First, when we are uncomfortable with being sexual with someone else, and the relationship is basically sound, sometimes what is underlying is a feeling of not feeling comfortable with yourself.  Worrying about things like your body or your performance get right in the way of your ability to relax and enjoy the connection of sex. So first and foremost, feeling good about yourself, the way you are, is the first step in healthy sexuality.

Second, your connection with your partner in non-sexual ways is extremely important. Things like holding hands, hugging, or other ways of showing physical connection create a couples connection even out of the bedroom. If the only time you are touching is as a prelude to sex, you are missing out on all the ways you can use touch to show that you care for your partner.

 Third, communication is key.  Yes, it can be difficult to talk about, but telling your partner how you feel and what you like are ways to strengthen your sexual bond. Worries can feel much lighter when shared, as well.

 Finally, those of you who do seek therapy to work through issues of sexuality may be in for a surprise at how helpful it can be.  We are not there to judge you, and chances are we have heard stories similar to yours before. We can work with you to help turn sexuality from a source of confusion or worry to a renewed connection with yourself and your loved one.

Thank you for reading! I welcome your comments below.

Mental Health, Relationships, Self Esteem, Therapy

The Highly Sensitive Person

You may or may not have heard the term “Highly Sensitive Person,” or “HSP.” If you have, maybe you wondered what it meant, or if it applied to you. This blog will talk about this personality type, which according to Dr. Elaine Aron, occurs in up to 20% of the population. Research estimates it affects as many as half of the clients who seek therapy.

20%? That’s quite a bit. But for people who fit the description of the traits attributed to a Highly Sensitive Person, or HSP, it can sometimes feel like being alone and misunderstood in a crowd of people who don’t feel things as acutely as you do, or perhaps even criticize you for your tendency to heightened awareness of your environment and those in it.

Let’s back up for a minute and talk about some common traits of Highly Sensitive People.

As I mentioned, HSPs tend to have a heightened awareness of subtleties in their environment, whether it’s sight, sound, touch, taste, or smell. Bright lights, loud noises, strong smells, rough fabrics, and things like that feel amplified and intrusive.  If you are an HSP, you can become stressed out when overwhelmed and may find it necessary to step away in order to regroup and recharge.

HSPs can be creative, conscientious, hard working, and meticulous. They are often their own worst critics, and may lean toward perfectionism.  They may have been considered quiet, introverted, or shy as a child.

Highly Sensitive People feel more comfortable when things are in organized and orderly, and they may become overwhelmed by change or chaos. Now, everyone can be overwhelmed by chaos – true. However, for the HSP, the threshold where overwhelm occurs can be lower than for others. Loud parties and crowds can range from annoying to almost painful.

Highly Sensitive People can also be affected by other people’s moods, emotions and problems. They are often described as intuitive and empathetic – it’s almost as if they feel the emotions of others. If something is wrong with a friend, or someone is not being truthful, the HSP may tune into it quicker than other people.

HSPs think or worry about many things, and may have been told “you take things too personally” or “don’t be so sensitive.” Believe me, if the HSP could help it, they probably would.

Highly Sensitive People may avoid extremes in the media, such as violence or even movies that are too sad. As far as interpersonal relationships go, they have a low tolerance for toxic people and may have had to step back from friends or family members – as far as cutting people out of their lives when they feel they have no choice.

An HSP typically has an appreciation of nature, music and art, and these may move them to deep emotional reactions. He or she may tend more toward cooperation than competition, even to the point of underperforming in competitive environments.

HSPs are not necessarily introverts. Highly Sensitive People may be extroverted, but with their love of people and lack of shyness, they still tend to be introspective, have rich inner lives, and need a lot of time alone.

Having heard all of this, do you think you might be a Highly Sensitive Person? I highly recommend getting Elaine Aron’s book as a next step. I have also included a link to a free test on her website for those of you who are curious to see where you fit. If you identify as an HSP, it’s actually a relief to know that you are not neurotic or socially hopeless. If up to 20% of the population is wired this way, you are most definitely not alone. Take the time to learn more about the Highly Sensitive personality type, and set a goal to love and accept yourself for exactly who you are.

Free Test from Dr. Aron’s website: