Problems and challenges treated by Dr. Allison Kahner

DEPRESSION is a common response to a wide range of life’s difficulties. It is also very variable in duration, frequency and severity. Some depressive disorders are long-standing or characteristic in nature, whereas others are a clear reaction to an event. The latter are usually relatively brief, but sometimes more intense than the more chronic, “low grade” variety. The experience of depression often, but not always, involves a mood of sadness, and can also involve subjective feelings of heaviness, slowness, and lack of motivation to engage in activities. Sleeping and eating patterns may be disrupted. Social withdrawal, and sometimes a quickness to become irritable or easily hurt, can accompany an episode. Along with feelings of hopelessness and pessimism, thoughts of suicide may occur.

Why do so many people experience depression, in one form or another? One way to view a depressive response is as one of the mind’s alarm systems. Problems that ultimately manifest in depression may be long neglected, avoided, or not managed effectively. When depression rises, it may mean that your mind’s wisdom is letting you know that something is wrong. What exactly is wrong may not be so clear, and that is where professional help can assist a person in getting a handle on the problem. Understanding the current problem and its origins, and finding viable solutions are commonly the ultimate goals of therapy for depression. Therapy is also useful in helping people learn how to identify problems early on, and to address them before the difficulties accumulate. Oftentimes, changes in the way a problem is viewed in the process of therapy can be very successful in helping people to cope better and to make the external changes they seek to accomplish.

ANXIETY is a reaction that most, if not all, people experience on occasion. It is a normal response to stressful thoughts or situations, and the subjective feelings of emotional tension, stress, or fear vary widely in duration, frequency and severity. At intense levels, the emotional response is often accompanied by physical sensations, such as muscle tension, headache, stomach upset, heart racing, or localized pain. Over time, prolonged anxiety reactions can take a toll on one’s physical health, not to mention one’s peace of mind. An anxiety disorder can manifest in what is commonly known as a “panic attack,” or similar type of panicky reaction. Sometimes anxiety becomes very intense in relation to specific types of situations or to objects, and is commonly referred to as a phobia. Others experience anxiety in a wide range of situations, and in severe cases can cause people to avoid leaving their homes.

When anxiety is disproportionate to the event or life circumstances, it is likely that the response is more reflective of a problem in coping or ways of viewing the situation rather than the actual threat posed by the external factors involved. Main objectives for individuals in therapy for anxiety are to learn and practice calming techniques, and to gradually become more accustomed to, and at ease when faced with, the triggers to anxiety. Helping people to adjust their perspectives of anxiety-provoking situations and their abilities to cope with them often contributes to the success in therapeutic outcomes. If the problem is long-standing, identifying and coming to terms with the origins of their fears may further promote the individual’s ability to reduce and effectively handle stress reactions.

ASSERTIVENESS is essential in adult communication. The ability to differentiate between appropriately direct and tactful statements or requests and less desirable forms of communication (aggressive, passive, and passive-aggressive) is a skill that can be developed and enhanced with awareness and practice. Assertiveness is what many of us strive for, though sometimes experience difficulty in exercising. Sometimes, even when we can identify the appropriate response to a problematic situation when given a set of choices to select from, we can have trouble when responding spontaneously to an actual event as it occurs. The complexity of human interactions can readily be appreciated when they are examined more closely and viewed in light of all the choices we have in responding to others. When we practice handling matters with an assertive response and attitude, we can make our lives more manageable and rewarding, for both ourselves and those close to us.

Why is assertiveness in communication difficult for so many people? It often appears that a combination of fears and lack of experience has much to do with inhibiting this appropriate and mature way of dealing with the world. To be sure, no one is perfect, and we all occasionally flub our interactions with others. However, a persistent struggle in one or many social contexts can indicate a need for more attention to developing assertiveness skills. In therapy for assertiveness training, the therapist can serve as a coach, helping the individual to examine the particular situations in which problems are experienced, and to find ways in which that person can better respond to such situations. The reasons for that person’s difficulty in communicating assertively are also identified, so that these blocks can be recognized and overcome. A therapist can provide alternative perspectives on the situation that might not have been considered, and can function as a sounding board. Role-playing, evaluating alternative responses, and receiving feedback are often the most effective ways a person can strengthen communication skills.

RELATIONSHIPS are very central to our personal sense of satisfaction, and we may even find that they at least partially define who we are. When our relationships are healthy and strong, we can derive much happiness and feel better about ourselves. Positive relationships can also provide us support in our efforts to pursue interests or achieve success. Each relationship has its problems, at least from time to time. However, when they are significantly problematic, we can wind up feeling undermined, depleted, trapped, deprived, insecure, resentful, and/or overwhelmed. This is especially true in relationships that are destructive or abusive. Harmful relationships can damage one’s self-esteem, and can foster the view of oneself as a victim.

Seeking solutions and ways of repairing damage done within a long-term or very significant relationship is often a primary focus in MARITAL/COUPLES COUNSELING. In therapy, a couple can find the opportunity to work on the issues which threaten the integrity of the relationship and cause suffering to one or both parties. This is particularly the case when the couple recognizes that the same issues seem to arise repeatedly, or that they need to learn more effective ways of resolving conflicts. Improving communication and understanding can often lead to improved health of the relationship. In therapy, couples can learn better ways of speaking and listening to each other, and can observe the patterns that affect the relationship in positive and negative ways. In this manner, a couple can make intelligent choices regarding the relationship together rather than taking on adversarial roles. A mutual commitment to the improved health and stability of the relationship is the key to success.

SUBSTANCE ABUSE and other ADDICTIVE BEHAVIORS (eating disorders, sexual compulsions, gambling) are particularly challenging difficulties to overcome. There is no one right way that all people absolutely must adopt in the effort to successfully manage the tendencies to engage in certain problem behaviors. Some people benefit substantially and sufficiently by involvement in a 12-step program, such as AA or NA, whereas others do best with a combination of methods, such as a 12-step program along with individual therapy, and/or a therapy group. As is true with other problems, different people achieve success in different ways. Whatever works for that individual is the practical way to determine the value and success of any given therapeutic endeavor.

The most essential factor for success in abstaining is the individual’s genuine desire to be free of the addictive behavior. Also important are the particular benefits of ceasing the behavior, and the negative consequences that may result if it continues. There are many additional factors, however, which can powerfully counter a person’s desire and reasons to stop, such as the immediate gratification or relief gained through the behavior and the loss of adequate control over the impulse to engage in the behavior. Strengthening adaptive coping skills is a very necessary part of affecting behavioral change. In therapy, the individual is assisted in identifying and developing alternative coping strategies, and is also afforded the opportunity to understand why and how the problem started and progressed. Without a good understanding of the problem, a person is at a significant disadvantage in being able to resist the tendency to fall back into old habits and patterns. Also, increasing self-awareness is very important for the purpose of self-monitoring and spotting trouble situations early on. Typically, the earlier a developing problem is interrupted, the easier it is to avert. Learning effective ways of preventing relapse, and managing any temporary lapses, is a major goal for those in therapy for substance abuse or other forms of addictive behavior.

WORK can be, and often is, a major priority in our lives. The ways we perform and the satisfaction we derive are influenced by a number of factors over which we have varying degrees of control. Creative strategies in addressing and handling these issues can make a significant difference in our daily work experience. Some common WORK/CAREER ISSUES encountered in therapy include the following:

-Problems with the boss
-Coworkers who give you a hard time
-Trouble in concentrating or finding the motivation to perform the job
-Burnout and workaholism
-Lack of satisfaction or sense of meaning about what you do
-Difficulty in deciding about a career change or in adjusting to a work-related transition

Productively coping with or altogether resolving problem issues related to work or career can also help us be more available to those who are closest and most important to us, including ourselves.

SELF-ESTEEM… so many people these days emphasize the importance of having good SELF-ESTEEM. When things go wrong, and we have to face difficult situations, it helps to have a lot of this thing that everyone keeps talking about. But what exactly is self-esteem? This seemingly simple question is not so easily answered. Basically, one may consider self-esteem to be the regard with which one has for oneself. It has to do with the level of respect for oneself, and is also often referred to as self-worth.

This feeling about oneself is related to but different from one’s self-image, which is essentially the internal view of oneself, and is often, but not always, based on and measured against external norms and standards. Self-esteem is located on a deeper level, and may be thought of as part of the foundation for an individual’s personality. As a central aspect of the self, it can exert a powerful influence on our overall functioning and well-being. Positive change at this level can lead to significant improvements in a person’s life.

In therapy, a person can receive help in examining the reasons for impairments in self-esteem, and working toward resolving those issues that diminish it. One can also gain assistance in identifying and striving toward ways of increasing it, thereby promoting healing and repair. The ultimate goal in therapy for problems relating to self-esteem is for the individual to achieve greater internal satisfaction and strength.

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