Radical acceptance take two

I've been thinking about my previous post on radical acceptance and what else I could add on the topic... 

I have encountered many clients that truly suffer because they just don't know when they will have certain things that they desire in life (love, money, house, job, etc etc) 

I feel it's part of the human condition and entirely unavoidable to experience uncertainty; there are the more "man-made" happenings such as a scheduled appointment, the first day of a job or school or wedding day that we may know with some certainty is coming on that day.... Most things, however, aren't in our control, so we live with not knowing whether we will get there or experience that or buy that, etc.

And in the meantime; while we wait; we encounter the choice whether to accept that this is where we stand or attribute lots of negative emotions followed by "should statements" ("I should get that raise", "I should be in a relationship", "I should own a house", etc) and just feel miserable. 

Of course, radical acceptance teaches us to accept our current situation and know that "all is as it should be", but many, many, many are very unhappy because of the waiting and the uncertainty of whether what they want will happen and fighting against reality. 

So, what is in our control?

 If you want a relationship, you can certainly date; blind dates, dating sites, going out, letting everyone know you are open to dating, etc. When you meet someone you like, you can work on assertive communication, fighting fair/not letting arguments escalate, being a pleasant person, respecting their feelings, making them happy, romance, etc etc. What I mentioned are things within our control but if with all that you still can't meet someone you like or a relationship ends; that is out of your control and where acceptance comes in; whether you leave burning fecal matter on your exes porch (and get arrested!) or gain twenty pounds from ice cream handling the break up or sware off dating because you can't meet someone; the fact is what it is and you can't change that (not to mention the consequences of your behaviors if you "act out" which will worsen how you feel!) so, you become mindful of your sadness, loneliness and accept those feelings as part of your life and than work on improvement (utilizing skills learned in therapy!!).

Another example is finding the job you love: you have the power to finish school in a chosen area, work on resume, send out resume, network, etc but when and if you land that job is beyond your knowing; you can't control the economy and job market! 

When overwhelmed with frustration, You can choose to pull your hair out, give up all together, lay in bed for days but it won't change the outcome but in fact, will negatively impact valuable problem solving ability thus prolonging and worsening the situation. OR! You can be mindful of your feelings of frustration and move on (using skills acquired in therapy,

Of course!)

It's all the "should statements" that we invent for ourselves when they really are self created, that make things worst!!  The outcome may be the same regardless of whether we go screaming in frustration or find joy in day to day life ..so isn't taking the path of least resistance (the later) so much more pleasant?? Isn't joy and fun so much better than depression and anger? 

How do you start cultivating inner balance? Acceptance! Accept that life is as it is and than take measures to change your situation. There is no real change without acceptance. 

To quote Dr. Marsha Linehan (creator of dialectic behavioral therapy and brilliant psychologist): "acceptance is the only way out of hell". 

Radical acceptance

Radical acceptance is a very powerful tool. Basically, radical acceptance suggests accepting what really is in our lives as it is. The skill is so powerful that without accepting reality as is; we can not begin to change. 

Acceptance doesn't imply forgiving truly horrific actions of others or never being angry or unhappy or loving an abuser-- but actually suggests understanding and truly feeling your emotions, coming to terms with reality (changing what can be changed) and moving on with our lives. For example, you may not be able to change an alcoholic parent or having been abused in your past or having a horrible boss that you hate- there are many things in our lives that are not possible to change.. So you work on acceptance.

Acceptance is the opposite of fighting against reality or making "should/shouldn't" statements ("my father shouldn't be like this", "my life should be like this"). And you can not have acceptance without being aware of your reality including thoughts and feelings which are coming up. You can not have acceptance with avoidance. 

It's in our nature to want to intellectualize things but I feel with this skill, it comes from a more feeling place. In other words, you need to feel what radical acceptance is to understand it's meaning. For example, you can curse the rain and scream at the clouds for causing rain and make lots of "why me" statements or stay in your house and avoid rain or you can accept that it's raining and use an umbrella and hope for a sunny day tomorrow. Another example is being stuck in traffic and basically fighting against the reality that traffic happens; beeping your horn, flashing your middle finger at drivers and swearing loudly or accept that it is frustrating being stuck in traffic and no matter how much you fight it in your mind, traffic will still be there so you may as well listen to music and sing or call Someone and make the most of it. 

Stuff happens in our lives whether we are fighting it or not and the fight just ruins the moment and our mood and relationships and causes lots of heartbreak. It's like rowing against the current and finally letting go and going with the current. 

Another example is being stuck in quicksand: the more you panic and try to swim out, the quicker you drawn. The only way to not drawn in quicksand is to lay flat on your back, perfectly still. Likewise, the only way to accept reality is to acknowledge it, feel it, understand it, and remain in the moment with it. Acceptance. 

Feeling anxious?

I often get asked the difference between feelings of anxiety or an anxiety disorder. The diagnostic statistical manual (DSM), aka the bible in the world of mental health, classifies symptoms into various disorders. The DSM is a large book which lists the different mental health disorders thus making it easier for mental health professionals to communicate with one another ("so and so has bipolar" or "A. has schizophrenia", etc).

Honestly, not all disorders are the same because we are working with unique individuals with characteristics, temperaments, personalities, unique histories, etc. Social workers take on a bio-psycho-social model which stands for biology, psychology and social, viewing all aspects of a clients life and not just the standard bio-psycho medical model that is our DSM.... BUT that is for another post so let's get back to anxiety. In my practice, I look more at the individual sitting in front of me and less on their labeled disorder.I love this quote:  'Ask not what disease the person has, but rather what person the disease has'-William Osler

What is anxiety?
We have all felt stress or anxiety at one point in our lives. Whether we are preparing for a big exam and feeling overwhelmed about how we will cram in all the information or feel our heart beating very fast, palm sweaty right before public speaking. Stress is a normal, biological response to an outside (external) challenge. Stress activates our "flight or fight" response by way of our sympathetic nervous system. Without feeling stress (or fear) we wouldn't know to run when a large grizzly bear is about to attack us or pay attention to serious problem that requires problem solving skills and a resolution.

I will get into the neurochemical mechanisms in a future blog post.

As I mentioned above, we have all felt stress. If anxiety is a normal function of our human existence, when does it become "a problem?" The answer is when the symptoms become excessive, debilitating and therefore prevent day to day functioning. While anticipating getting a root canal may bring some feelings of anxiety, having panic attacks when you sit in the car is excessive. Another example is feeling nervous for your first day of work vs having insomnia for months because you experience paralyzing fear when confronted with any social situation so you either avoid leaving your house or need to self medicate.

Anxiety disorders often are caused by dysfunctional thought pattern which influences maladaptive behavior. Often times, individuals with anxiety disorders begin avoiding situations, people, places which makes them anxious which in turn makes the anxiety worst.

Dysfunctional thoughts aka distorted thinking, commonly seen in individuals with anxiety are All or Nothing thinking ("if I don't do this perfectly, then I failed, have to be perfect"), Emotional reasoning ("my feelings are facts so therefore if I am feeling hurt then you have betrayed me" or "I am beginning to feel anxious sitting on this train therefore I must be in danger"), Should statements ("everyone should be nice to me", "I should be rich, married, loved by everyone around me").

.Click here for more information about cognitive behavioral therapy and here. More to come!

The outcome is excellent with cognitive behavioral therapy (CBT) treatment. In a nutshell, CBT teaches recognition of thought patterns and changes behaviors/thoughts which makes the anxiety worst. CBT also helps establish day to day tools and valuable problem solving skills to manage stress.

Interesting research in ADHD

I found this interesting and worthy to

Post! Some may believe meds are the only treatment for ADHD and this isn't true at all!! Some individuals benefit and need medication therapy, however, how we approach and address and mind and behavior is a critical part of treatment! 

"Now a growing stream of research suggests that strengthening this mental muscle, usually with exercises in so-called mindfulness, may help children and adults cope withattention deficit hyperactivity disorderand its adult equivalent, attention deficit disorder."

http://mobile.nytimes.com/blogs/well/2014/05/12/exercising-the-mind-to-treat-attention-deficits/?_php=true&_type=blogs&_r=0

What to do if you suspect child abuse or neglect?

April is child abuse awareness month!!! What to do if you suspect abuse or neglect? If you see actual marks on the child, a good place to start is a pediatrician. You can also speak to the childs teacher, social worker, or psychologist. Child care providers are MANDATED REPORTERS so legally have to take action if there are signs of neglect or abuse. It's always a good idea to create a paper trail (meaning, documented attempts at reporting to a child care provider). 

This is a very useful website. Please go here!!!!!!!!!There are places you can call. Please look on this website for resources where to call to ask questions, report cases, and get support:http://www.nationalchildrensalliance.org/index.php?s=100

Warning signs of child abuse

APRIL IS CHILD ABUSE AWARENESS MONTH. 

This is information provided by helpguide.org.:  GO Here

It's VERY important to recognize the early signs of child abuse so you can DO SOMETHING ABOUT IT. 

Warning signs of physical abuse in children

• Frequent injuries or unexplained bruises, welts, or cuts.
• Is always watchful and “on alert,” as if waiting for something bad to happen.
• Injuries appear to have a pattern such as marks from a hand or belt.
• Shies away from touch, flinches at sudden movements, or seems afraid to go home.
• Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Warning signs of neglect in children

• Clothes are ill-fitting, filthy, or inappropriate for the weather.
• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).
• Untreated illnesses and physical injuries.
• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.
• Is frequently late or missing from school.

Warning signs of sexual abuse in children

• Trouble walking or sitting.
• Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior.
• Makes strong efforts to avoid a specific person, without an obvious reason.
• Doesn’t want to change clothes in front of others or participate in physical activities.
• An STD or pregnancy, especially under the age of 14.
• Runs away from home.

Here is another tragic story. Please recognize the early signs! Recognition could save a childs life! 

April is child abuse awareness month

April is child abuse awareness month. "Every year more than 3 million reports of child abuse are made in the United States involving more than 6 million children (a report can include multiple children). The United States has one of the worst records among industrialized nations – losing on average between four and seven children every day to child abuse and neglect. " -Child help USA

Here is one tragic story. Let's join together to put an end to child abuse and neglect. If your child has been abused, please please seak professional help and find a good therapist. The earlier the child begins treatment, the better the outcome. 


One tragic story worth watching.

Feeling angry?

1.       What consequence has anger had in your life? How does anger affect your life? When feeling angry, take a moment to walk away, count down from ten, deep breaths and then think: “if I respond or react now, what consequence will it have?”

We have different levels of consciousness (awareness).

A.      Lowest level is SHAME: “I am no good”, “I am worthless”, “I will never amount to anything”

B.      Second level is DEPRESSION: Depression is focusing on something which has already happened; something we can not change.

C.      Third level ANXIETY: racing thoughts, uneasy feeling overall, queasy feeling in your stomach. Anxiety is always the fear for the FUTURE that something will or may happen (with depression, that something has already happened)

D.      Above the three mentioned is ANGER: On a conscious level, we “would rather” be ANGRY then struggling with depression, anxiety or shame. It’s easier to LASH OUT then feel angry, depressed or shame. Anger is ALWAYS masking or hiding another emotion. When you LASH OUT or REACT to ANGER, you experience a temporary release which creates neuro-pathways in your brain to always respond to that external stimuli (experience) with anger: In other words, we teach our brain to always lash out when confronted with a similar situation. The temporary release (with long term consequences!) becomes addictive because it feels good in the moment. .. it feels better then shame, depression or anxiety.

E.       Long term goals for anger is to teach other strategies to handle anger such as defusing the situation before it escalates, taking time out to cool off, sitting with anxiety and counting down from ten, distracting your mind from ruminating thoughts, assertive communication, self awareness, meditating or other relaxation techniques, exercise, etc

What would you like to learn about mental health topics?

This is a question to the general public: What would YOU like to learn about the mental health field?



My idea for this blog is to create a resource. I am very interested in learning what questions YOU may have.



Please feel free to comment below or email me: Liza.Mordkovich@gmail.com



I hope everyone is having a great weekend!

What is the purpose of therapy?

The purpose of therapy depends on the individual. For example, one person may have the goal to quit smoking or overcome panic attacks when he gets into an elevator; another may want to improve her relationship with her mother while the third would like to feel better about going to work everyday. Goals created in therapy (whether short term or long term goals) are solely based on what the person would like changed.



Many times I have seen someone initially choosing therapy in order to improve one aspect of their life but realizing other STUFF in their lives that needs changing.



Basically, therapy is about "working on yourself".



The ultimate goal is to feel better, change maladaptive thoughts or behavior which prevents you from feeling good, improve relationships and an overall enjoyment of life.... Sounds good? Great!

Cognitive Behavioral Therapy, automatic thoughts and the million dollar question: is the point to be happy all the time?

Have been getting asked recently, whether the point of Cognitive Behavioral Therapy is to "think happy thoughts" all day long or be in a constant state of ecstasy. I WISH that we lived in a world/life/mindsets/existence where we knew no unhappiness OR this was easily attained through therapy... but we don't! In fact, everyday we may experience a whole rainbow of emotions!

Cognitive behavioral therapy does not eliminate all negative thoughts and strive for constant joy: CBT helps individuals reframe negative thoughts to something more realistic that can improve our mood and change behavior.

Automatic thoughts suggest exactly what they sound like: thoughts which come on automatically, seemingly out of no where. Automatic thoughts may occur in response to our internal or external world (WILL WRITE ON ABC of CBT in a later post which will explain activiating events and relation to thoughts!). An example of an automatic thought could be "I will never graduate" as a response to failing an exam. A CBT therapist may suggest changing "I will never graduate" to "failing an exam is disappointing but it's only one exam and I will study harder next time". SEE THE DIFFERENCE?

In conclusion, examining our automatic thinking leads to learning how to monitor and substitute with something realistic (and yes, more positive but also realistic!). Modifying our thoughts has a direct impact on changing mood, emotions, perspective, and behavior. I've seen amazing transformations in clients JUST from understanding what they are thinking.

This is why as a therapist, I practice CBT-- it WORKS!

What do you think?

Shoot!

Just wrote a blog that seemed to have vanished into the internet vortex!

I used my mindfulness and acceptance skills to overcome this disappointment. Truth is, disappointments happen to all of us and how we handle and regulate our emotions after the fact, determines whether we will have a truly horrible day and miserable life OR experience disappointment, then move on.

In my case, I had spent nearly an hour writing and referencing and attaching a youtube video to a blog post. As I was about to press "publish", the post simply disappeared. Has this happened to anyone else? Has something similar happened to you?

After the fact, I could have allowed my mind to spin into victim-hood, catastrophic thinking, black or white thinking, all or nothing thinking ("poor me", "this ALWAYS happens to me", "all my hard work down the drain", "why did this happen to me"? etc). Instead, I shrugged, laughed, took a break and accepted that these things just happen. Mindfulness skill redirected my attention to how I feel at the present moment until I was ready to move on.

Reality is, life has hurdles and set backs. Reality is, how we perceive the glitches (our "self talk") will determine whether we are happy or just "eh" or truly unhappy in life.

What do you SAY to yourself after you experience disappointment? Please share!

All about Motivational Interviewing.

What is Motivational interviewing?

Motivational interviewing was created by Miller and Rollnick in the 1980’s. More than 80 randomized clinical trials have been published demonstrating its effectiveness in changing unwanted behaviors. The number of publication is doubling every two-three years in the past decade (Moyer, Miller 2006).

Motivational interviewing helps to change behaviors by exploring ambivalence to change (Parson, Rosof et al. 2005). Motivational interviewing is defined as “directive, client centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence (Rubak, sandboek et al., 2004)”. 

Motivational interviewing is a client centered approach, however, unlike Rogerian treatment (which is more open ended), MI is more goal directed. Motivational interviewing emphasizes the use of open ended questioning and a communication style to help foster changing results while respecting a clients autonomy and self determination (Resnicow, McMaster 2012).

Change

Motivational interviewing puts a focus on change as a normal human development and growth: change can move forward, fall back or stop periodically and then continue moving forward. There are three main components to motivational interviewing: 1. Collaboration, 2. Evocation and 3. Autonomy. Collaboration suggests teamwork between the therapist and client and working together to accomplish goals. Evocation refers to building on the clients intrinsic motivation for change. Autonomy suggests a clients right for self determination and direction (Kress, Hoffman 2008). 

Five stages of change

Motivational interviewing is composed of five stages of change: precontimplation, contemplation, preparation, action and maintenance. Precontimplation suggests an unwillingness or lack of recognition or denial that there is a problem. Contemplation involves a consideration to change using a pros and cons measure. Cons suggest consequences of the behavior. Preparation implies a determination in the form of a commitment in the future to change. Action suggests the change steps have begun to take place.  Maintenance occurs 3-6 months after the change. Maintenance involves lifestyle modification to avoid relapse (Shinitzky, Kub 2001). 

References

Rubak, sandboek et al., (2004), Motivational Interviewing, British Journal of General Practice, UK, P. 305-312

Miller, W. R., & Moyers, T. B. (2007). Eight stages in learning motivational interviewing. Journal of Teaching in the Addictions, 5(1), 3-17.

Ken Resnicow and Fiona McMaster. Motivational Interviewing: moving from why to how with autonomy support. International Journal of Behavioral Nutrition and Physical Activity 2012, 9:19 Available online: http://www.ijbnpa.org/content/9/1/19.

Does DBT work?

The short answer is YES, the long answer can be found below...

Effectiveness of Dialectic Behavioral Therapy

Dialectic behavioral therapy is recognized as the top treatment choice for symptoms associated with the borderline personality disorder including suicidal ideations, self harm, emotional dysregulation, impulsivity and interpersonal conflicts. Often associated with the treatment of choice for borderline personality disorder (BPD), DBT has been proven useful in the treatment of other disorders. 

Now for the research:

Cochrane review is a database of systematic peer reviews and meta-analysis which summarizes medical research. The Cochrane library contains resources for evidence based practices in medicine including areas in mental health. Cochrane review has declared DBT the most effective treatment for symptoms often classified as BPD (Source: http://summaries.cochrane.org/CD005652/psychological-therapies-for-borderline-personality-disorder), however, the symptoms listed above are universal and can meet requirements for other diagnostic criteria.

To date, Dialectic Behavioral Therapy is the only treatment for the symptoms of BPD that has enough outcome data and improvement rates to enable a Meta analysis. A meta-analysis uses statistical data from individual studies, looking at research as a whole (Source: http://www.cochrane-net.org/openlearning/html/mod12-2.htm).

Eighteen randomized controlled trials have been published demonstrating the effectiveness of DBT in populations with complex problems and disorders. Some examples of past research include: In 1991, Linehan, Arm-strong, Suarez, Allmon, and Heard conducted research using 18-45 year olds in an outpatient setting. Subjects participated in 150 minute skills group including homework for 12 months. The 1991 research study showed that parasuicidal behaviors were more likely to start treatment, 83% completed treatment, and 60% maintained lower parasuicidal behaviors (self harm) a year after treatment. (Source: http://behavioraltech.org/downloads/Research-on-DBT_Summary-of-Data-to-Date.pdf)

In 2011, Hirvikoski, Waaler, Alfredsson, Pihlgren, Johnson, Ruck,and Nordstrom used 51 year olds diagnosed with ADHD in a Swedish outpatient psychiatric unit. Two hours of DBT skills groups were the only course of treatment (without individual or phone coaching) for 24 sessions and still participants showed less symptoms of ADHD. (Source: http://behavioraltech.org/downloads/Research-on-DBT_Summary-of-Data-to-Date.pdf)

In 2010, Kroger, Schweiger, Sipos, Kliem, Arnold, Schunert and Reinecker used 24 to 31 year old with Anorexia and Bulimia in addition to Borderline Personality Disorder. Participants competed three months of inpatient DBT program including Weekly 1 hr individual therapy, 100

Minutes of skills group 3 times per week, and weekly consultation. At the 15 month follow up, participants showed reduction in anorexia and bulimia symptoms (Source: http://behavioraltech.org/downloads/Research-on-DBT_Summary-of-Data-to-Date.pdf).

The National Registry of Evidence-Based Programs and Practices published a summary of all evidence based practices and outcomes since 2006. In 2009, the American Recovery and Reinvestment Act (ARRA) created the Federal Coordinating Council for Comparative  Effectiveness research to provide the most recent health care information by comparing different approaches to managing health issues (including mental health). The purpose of National registry of evidence based programs is to inform and educate and bring evidence based awareness. DBT was mentioned as evidence for treatment of symptoms associated with borderline personality disorder (Stoffers, Völlm at al. 2013).

References

Stoffers, Völlm at al.(2013), Psychological therapies for borderline personality disorder, Cochrane Summary, Retrieved: http://summaries.cochrane.org/CD005652/psychological-therapies-for-borderline-personality-disorder),

Dialectic Behavioral Therapy Skills

Dialectic Behavioral Therapy Skills

There are four main therapy modules which compose the skeleton of the dialectic behavioral theory.  The four main therapy modules are:

Core Mindfulness

Being present in the moment and not ruminating on the past or worrying about the future. Mindfulness suggests awareness of what is. “Observe, discribe and participate” encourages being an active participants in the present moment. “Non judgmentally, one mindfully” suggest engaging in one activity or thought at a time.

Emotion Regulation

Learning how to balance your emotions by separating yourself from the emotional experience.

Interpersonal Effectiveness Skills

Learning skills to effectively communicate and relate to others as well as getting your needs met. This skill is frequently used in any assertive communication problem solving lessons: the lessons include saying no/boundary setting, assertively asking for what one needs and conflict resolving.

Distress Tolerance

Specific tools to help cope during a distressing moment or personal crisis. An appropriate alternative to self harming behaviors such as substance use, cutting, etc.

What is Art Therapy?

Art Therapy is a mental health modality which integrates elements of psychotherapy with the creative process of art making to facilitate dialogue, relieve stress, explore emotions, modify behavior, reconcile emotional and interpersonal conflict, increase self esteem and bring overall well-being. Art therapy is very effective in expressing elements of our lives and ourselves which are not easily formulated with words (i.e. falling in love, emotional pain, loneliness, sadness, feeling empty, trauma, etc.) An art therapist has knowledge of visual arts including drawing, painting, sculpting, etc and comprehension of human behavior, psychology and counseling techniques. An art therapy session is an integration of psychotherapy (“talk therapy”) with art making, therefore, utilizes Cognitive Behavioral Therapy and Dialectic Behavioral Therapy. I myself am an artist so have had training in art making.  For more information on Art Therapy, please visit the American Art Therapy Association: http://www.arttherapy.org/

What is Dialectic Behavioral Therapy?

I will write a lot more about Dialect Behavioral Therapy skills in greater detail but wanted to begin by explaining DBT. Dialectic Behavioral Therapy (DBT) had originated in the 1980’s by Dr. Marsha Linehan. Dialectic Behavioral Therapy is a cognitive behavioral based treatment which incorporates elements from Zen practices of mindfulness, with skills training (coping skills).  Dialectic Behavioral Therapy is constructed of weekly individual sessions and weekly group sessions with an emphasis on a psychoeducational (teaching) framework. The desired outcome and goals include distress tolerance, emotional regulation, and overall pleasure and enjoyment in life (Hayes, Linehan, et al. 2004).  Dialectic Behavioral Therapy Skills There are four main therapy modules which compose the skeleton of the dialectic behavioral theory.  These skills are taught to clients. The four main therapy modules are: Core Mindfulness Being present in the moment and not ruminating on the past or worrying about the future. Mindfulness suggests awareness of what is. “Observe, discribe and participate” encourages being an active participants in the present moment. “Non judgmentally, one mindfully” suggest engaging in one activity or thought at a time. Emotion Regulation Learning how to balance your emotions by separating yourself from the emotional experience. Interpersonal Effectiveness Skills Learning skills to effectively communicate and relate to others as well as getting your needs met. This skill is frequently used in any assertive communication problem solving lessons: the lessons include saying no/boundary setting, assertively asking for what one needs and conflict resolving. Distress Tolerance Specific tools to help cope during a distressing moment or personal crisis. An appropriate alternative to self harming behaviors such as substance use, cutting, etc.  The Dialectic Behavioral Program Individual DBT: Individual DBT is a crucial factor in a comprehensive DBT program. Trained DBT therapists work collaboratively with clients, tailoring treatment to specific individual needs. Therapy will address issues that interfere with an individual’s quality of life, and help individuals take steps toward building a better life while encouraging self-acceptance. Sessions are generally once a week. Clients are required to be in individual therapy in order to participate in the DBT group. DBT Groups: Groups are generally from 2-2.5 hours and on a weekly basis. Group focuses on skills from the four modules: Mindfulness, emotional regulation, interpersonal, and distress tolerance. A trained DBT therapist runs groups. Phone consultation: In the event of acute distress, DBT therapists have to be available to their clients over the phone 24 hours. Phone conversations are brief; therapists assess risk factors and review appropriate DBT skills that would help improve the moment.

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy was first introduced by Aaron Beck in the early 1960’s. Cognitive Behavioral Therapy (CBT) is an evidence based, short term, goal oriented, approach.  Homework assignments are often given at the end of most sessions in order to practice the skills between sessions. Change is dependent on behavioral modification, cognitive formulation, and psychoeducation. Disorders are viewed as a result of dysfunctional thinking, which in turn affects mood and behavior. Improvement is conditional upon changing or modifying distorted thinking to achieve more realistic and adaptive thought patterns. (Beck 2011). The Cognitive behavioral approach attempts to interpret an individual’s processing of information and assumptions i.e. cognition (your thoughts!). In other words, what an individual thinks and perception influence behavior and emotions. The idiosyncratic rules and assumptions become cognitive distortions or automatic thoughts which appear spontaneously but are mood dependent. What does all of this mean? Our thoughts are what drives behavior and influences how we feel. Therefore, examining thought patterns with a skilled CBT therapist, can change behavior and improve mood. Cognitive Behavioral Therapy is a very effective treatment and supported by research.  Please feel free to contact me with any questions about Cognitive Behavioral Therapy! I will write more later on CBT!

Website is up! Would you like a free newsletter?

Hello readers,

My website is finally up!

If you would like to get in touch or/and sign up for a free newsletter, feel free to go to my website and fill in your information on the first page!.

I look forward to connecting and hearing from you!
http://www.lizamordkovich.com/

All about perspective

For many, happiness (or a state of happiness) is a desirable goal. We seek out and build relationships, purchase glittery, extravagant jewelry, go on vacation, eat out at restaurants, shopping therapy, food therapy, movie therapy, (hopefiully, eventually psychotherapy!)... all with the ultimate hope that we may just find our happiness in the stuff or the place or the people.

External items create a sense of instant reward which feels gratifying in the moment, however, fleeting. In some ways (for some people), making something or someone else responsible for our happiness generates blame when rewards are scarce or non existent. After all, it's "easier" to finger-point at someone/something  than taking ownership of our lives. An excuse for a dysfunctional relationships may be the OTHER persons anger issues or being broke because of our irresponsible government, sick because of horrible healthcare (although illness can be out of our control), overweight because it's winter--- does any of this ring a bell??

So, where are the origins of happiness? What is the secret to complete state of joy and appreciation for our lives? How do we make all our problems go away?

Let me answer the last question first: our problems will NEVER all go away.

Let's divide our population into two categories A. Happy people B. Not happy people. The difference between group A and group B isn't that group A has no problems in life; Group A has realized that happiness is a mindset. Certainly, certain concerns are more severe and sitautional grief, depression, stress is a normal human reaction. Even in circumstances which are beyond our control such as loss of a loved one or illness, perspective (and acceptance!) is key. We can hate and feel anger at our chronic pain or we can incorporate mindfulness based approaches and work with a pain specialist. We can curse the universe for taking our loved one and ask "why me?" OR establish and utilize skills to endure grief. Even though emotions can be warranted; emotions can still prevent us from moving forward. Asking "why me?" will not bring the person back. Blame, excuses, dysfunctional, unrealistic perspective is what MAKES misery.

In other words, happiness is found internally not externally.

Cognitive behavioral therapy examines our thought pattern and its influence on emotions and behavior. Dysfunctional thoughts influence maladaptive behavior which influences how we feel. An example: if an individual believes "I am worthless and unloved" than even the most unconditional of relational love will never seem enough. If the underlining belief is "I will fail at everything I try" than any measurable success or achievement will be minimal and internally scrutinized. It's all about perspective. By replacing dysfunctional or unrealistic thoughts with something else (with the help of a skilled CBT Therapist!) , our mood will improve.

Our "self talk" (internal dialogue) is what determines how we experience life. The good news is Cognitive behavioral therapy can help reexamine what thoughts just aren't working for you and help change them! Imagine that!

 In my own practice, I have found how successful CBT really, and truly is! After all, we all deserve a life worth living!

Artists and ADD/ADHD: What came first the chicken or the egg?

Artists and ADD/ADHD: What came first the chicken or the egg?

I’ve known many creative folks in my lifetime. Having attended an art high school (where about 2/3 of the students were popping Ritalin like vitamins!), later double majoring in art and psychology in my undergraduate studies, having artists friends and personally being interested in the arts. I can safely say, I have been around enough artists and aspiring artist to observe certain “trends”: Artists have similar symptoms to ADD/ ADHD.

I’ve known artists who easily can transform a thrown out, broken stereo into a sophisticated and truly beautiful creation, belonging in a museum, however, won’t remember to pay rent on time or get too distracted when paying cable online. A certain artist friend of mine, has a difficult time reading and following directions and therefore “can’t” put Ikea furniture together or follow complex cooking recipes (though she cooks well!). My friend is a brilliant painter and photographer but has a hard time concentrating on things that are “boring”, mundane, the everydays.. She can be tangential in conversation and overly impulsive but impulsive (bold!) decisions has contributed to her mindblowing art!

I always wonder, what came first the chicken or the egg. In other words, does a creative, artistic mind contribute to ADD/ADHD symptoms OR are some (DISCLAIMER: CERTAINLY NOT ALL) individuals with ADD/ADHD just creative, artistic, different thinkers? Is what the psychology community labels as ADD/ADHD really just an “artist brain” which is imaginative, innovative, explorative, emotional, passionate, talented (*inserts many other positive adjectives*)? Do artists process information and manage their lives differently? Is it talent and perhaps the idiot savants of our society that just don’t have the room in their brain for the commonplace, inconsequential, one-at-a-time slow paced activities, because they are unique and gifted? Are we mental health providers (pointing my finger here!) more obsessed with stamping the ADD/ADHD diagnosis rather than truly understanding the interworking of an artist mind?

ADD/ADHD has several classifications/symptoms:

• ADD (Also may be known as ADHD inattentive subtype): Attention Deficit disorder is categorized as poor concentration (zoning out in the middle of reading a sentence or conversation, for example.
• Extreme distractibility
• Difficulty completing tasks
• Poor listening skills
• Tendency to overlook important details, being late with deadlines, difficulty starting and finishing projects, etc WITHOUT the hyperactive component
• Other symptoms may include poor self esteem, anxiety/depression

ADHD: Attention deficit hyperactivity disorder

• Same as ADD BUT with added hyperactivity/ impulsivity which creates a higher than normal activity level making it difficult to sit still and very fidgety.

There is another subtype that is the OVERFOCUED subtype which gives artist the ability to obsess and obsess and obsess and over-concentrate in their art. Hyperactivity is just the energy necessary to work hard in art making. The creative process is gratifying; full of instant rewards, cathartic releases and perhaps praise.

Many artists I know, may work throughout the night claiming to be more inspired at night and therefore lethargic and in a brain fog during daytime hours, perhaps exacerbating or contributing to the commonplace-related boredom (art process IS more stimulating!).

So, what really IS the artist brain composed of?

And if you are one of those brilliant visual expressers who I lost after the first paragraph, perhaps this entry was written about you!!! But I have to say, THANK YOU for making the world more colorful  :)

#ADHD #Mentalhealth #Artist #Creativity #Iloveartists #Artmakestheworldgoround #Iamatherapist

Anxiety disorders and Exposure Therapy

Exposure therapy is the most effective form of treatment for anxiety disorders. Exposure therapy is exactly what it sounds like: gradually EXPOSING the individual to the feared stimulus resulting in desensitization. And what happens next? No more panic!

I have worked with anxiety disorders of different types ranging from OCD, Social phobias, Agoraphobia, Panic Disorder. Treatment usually begins in my office where we discuss thought pattern and behaviors associated with the disorder. Together, we practice relaxation techniques and other coping strategies proven very effective. Homework often follows sessions. When ready, exposure work consists of myself accompanying the individual to the location that triggers anxiety. I go to clients homes, accompany an individual to a restaurant, subway, car ride… in vivo exposure suggests in real life exposure to the feared stimulus.

#ExposureTherapy #AnxietyDisorders #AnxietydisordertreatmentNYC

What is mental health and why is it important?

We hear terms like “taking a mental health day” or having a “nervous breakdown” and may wonder what it means to have or not have our mental health. In our yoga addicted, acupuncture going, green tea drinking , namaste society, being “unbalanced” is something serious which requires immediate attention…. but what is being unbalanced, really? The answer lies in an explanation of mental health. 

So, what is mental health anyways?

Mental Health Gov defines mental health as a system involving our emotional, psychological and social well being, affecting thinking, behavior and overall feelings across the lifespan. Mental illness is a medical condition which happens when our thinking, behavior and/or how we feel becomes disrupted. The National Alliance of Mental Illness (NAMI) discusses how the disruption can affect quality of life, ability to relate to others and ability to cope with day to day functions.

The DIagnostic Statistical Manual (DSM) currently in fifth edition, is a manual of disorders and their symptoms. The DSM discusses the criteria for disorders, duration of symptoms, and distinction between disorders. Basically, the DSM makes it possible to label the symptoms.

Disorders include anxiety disorders, mood disorders, autistic spectrum disorders, ADHD/ADD, schizophrenia, schizoaffective disorder, etc. Conditions resulting from disorders include insomnia, racing thoughts, hallucinations, general uneasiness, isolation, suicidal thoughts or ideations, substance use, difficulty sustaining healthy relationships and/or employment, etc…. 

In a nutshell, mental health ensures that other systems or components in our lives run smoothly and our ability to handle hurdles is strong. When faced with a mental health illness, situations may seem overwhelming and intolerable: our ability to handle stressful situations at a job, on the subway, waiting in line at a grocery store, in marriage, at Thanksgiving dinner becomes negatively affected leading to horrible, debilitating thoughts and just feeling very, very bad.  

Our mental health IS important.