How Do I refer someone for therapy?
Sometimes I am asked how people can recommend therapy to someone they care about who is in emotional pain. It may be uncomfortable to say, “I’m in therapy and finding great results”, or “You really ought to see a psychologist”. It may be easier to say, “I know of a therapist who specializes in treating _______” (anxiety, depression, relationship issues, addictions, etc.). Or, I have heard of a local therapist who has written about _______”. Just letting someone know where he or she can obtain more information about an emotional problem, can provide a step toward getting help.
You might also recommend looking at the increasing resources available on the Internet. On Dr. Nightingale’s website site there are anxiety and depression questionnaires for people wondering about their symptoms. This site also has free articles, including one on how to choose a therapist. Tell him or her that financial arrangements can be made by calling the therapist’s office. Often office staff will explain different payment methods, what the fees are for individual therapists, what if any discounts are available for paying at the time of visit, and may even check on insurance benefits for potential clients.
Therapy is about personal growth, exploration and finding coping skills to enjoy life again. Therapy is not a place of coercion, confrontation or where only seriously mentally ill people seek treatment. Therapy is more like having a coach for the most important sport you can play…your life.
Good results in therapy are best attained when a person has a good rapport with the therapist, is highly motivated to change painful aspects of life, and has specific treatment goals he or she wishes to attain.
© Lois V. Nightingale, Ph.D., 2018 Clinical Psychologist, (lic. #PSY9503), Marriage, Family and Child Therapist (lic # MA21027), director of the Nightingale Center, author, national speaker and mother 714-993-5343
Are You Experiencing Depression?
Everyone feels “down” sometimes. To feel discouraged or sad sometimes is perfectly normal. Having passing moods of dissatisfaction with life is a normal human condition. To feel grief or sadness during times of loss is expected and understandable. But for 9.4 million Americans feelings of hopelessness, helplessness, despondency, fatigue, isolation and futility have taken control of their lives. One in four women and one in ten men will experience a clinical level of depression at sometime during their lifetime. Even though Depression is a very treatable illness, many sufferers go untreated because they do not recognize the symptoms.
Do you have symptoms of depression?
Note the symptoms you have experiences persistently for two weeks or longer.
Feelings of sadness.
Feeling empty or purposeless.
Persistent feelings of helplessness and hopelessness.
Irritability.
Loss of interest in friends and family.
Difficulty concentrating or remembering things.
Missing work.
Changes in appetite (either significant weight loss, not from dieting, or weight gain).
Loss of interest and pleasure in activities you used to enjoy.
Loss of energy, fatigue.
Feelings of worthlessness.
Feelings of inappropriate guilt.
Inability to concentrate or think, indecisiveness.
Recurring thoughts of death or suicide, wishing to die, or attempting suicide (people suffering this symptom should receive treatment immediately!).
Melancholia (defined as overwhelming feelings of sadness and grief) accompanied by waking at least 2 hours earlier than normal in the morning and moving significantly more slowly.
Disturbed thinking, a symptom developed by some severely depressed persons. (For example, severely depressed people sometimes have beliefs not based in reality about physical disease, sinfulness, or poverty.)
Physical symptoms, such as headaches, stomach aches body pains and aches.
If you or someone you know has had four or more of these symptoms continually for more than two weeks, professional help should be sought.
Depression is highly treatable, between 80 and 90 percent of all depressed people respond to treatment and nearly all depressed people who receive treatment see at least some relief from their symptoms. Cognitive/behavioral therapy, which addresses the belief systems held by the depressed person is highly successful. As is Interpersonal Psychotherapy which focuses on how a person relates to others. Both of these types of therapy have been scientifically researched and shown to be effective in the treatment of depression.
If you know of someone who may be depressed it is important to help her or him learn more about this illness and look into treatment. Severe depression can lead to thoughts of hopelessness and despondency that may lead to thoughts of suicide. Suicide is the eighth leading cause of death in our country; it is the third leading cause of death in young people aged 15 to 24. Every day 15 young people in this age range kill themselves. One of the best strategies to prevent suicide is early recognition and treatment of depression.
Depression can occur at any age. Women who have just given birth are at higher risk (this form of depression is known as Postpartum Depression). Elderly people may be depressed but their symptoms go unnoticed because they are attributed to the slowing down of old age.
Depression is a successfully treated illness. Psychologists treat it with psychotherapies such as Cognitive/behavioral and Interpersonal Therapies. Psychiatrist treat people with highly effective medications that work in the brain to increase the nuerotransmitters which help the electro/chemical function of the brain and relieve depression. There are also many helpful books such as, Happiness Is a Choice: The Symptoms, Causes and Cures of Depression, by Frank Minirth and Paul Meier, and When Living Hurts: Directives for Treating Depression by Michael Yapko.
Information on depression and its treatment are available through the Nightingale Center. To make an appointment please call 714-993-5343.
This site contains general information and is not intended as a substitute for therapeutic intervention, professional diagnosis by a licensed mental health professional or for consulting your physician. If you are experiencing an emergency situation please call 911 or go to your local emergency room for intervention and treatment.
For further reading on this topic you can find Mind Over Mood, by Geenberger and Padesky and The Depression Workbook, a Guide for Living with Depression and Manic Depression, by Copeland and London.
Tips for Attaining Success
Balance in one’s life is essential to functioning at peak performance and accomplishing goals. Anyone who has studied business strategies, martial arts, skiing, golf, or serious sorts of any kind, knows the essential importance of balance to experience power and flexibility. Balance may be the most important thing we can achieve in life, giving us the ability to attain all our other dreams and goals.
The following is a quick summery of simple exercises to help attain balance in your life. It is not necessary to implement all of them. In areas, however, where you would like to achieve more balance, putting a few of these straightforward ideas into practice can bring a sense of control and of being centered to your life.
Surround yourself with other well-balanced people.
Many people do not know what a busy, successful, yet balanced life even looks like. Few of us had great role models for this growing up. Take the time and effort to search out people who are spending time bettering themselves and going for their dreams. Limit your time with people who primarily see themselves as victims, even if it is tempting to be the hero and rescue them.
It is hard to retain balance in your own life if you are spending a great deal of time with people who live in extremes or who have addictions to substances, spending, gambling, sex, work, fear, anger, etc. Find healthy friends and associates who are also working on themselves and heading toward balance in their own lives. Find friends whom you can support and encourage as they head for their own dreams of being of service to humanity.
Practice meditation.
So much has been written and researched about meditation that it is almost common knowledge what benefits can be attained through practice. A meditative practice is any activity that helps a person shut down the “chatter” that goes on in one’s head. Exercise, listening to music, sitting quietly in nature, contemplative meditation, yoga, breathing and relaxation techniques, mindful gardening or just quietly watching clouds change shape, are all examples of training the mind to focus or slow down.
Set aside time for meditation in your written schedule. As you continue to practice meditation as part of your daily routine, it will become hard to imagine how you did life without these “mini-vacations” and times of rejuvenation. Great insights and “genius” creative problem solving can be attained from regular meditative practice.
Feed your primary relationship.
Spending time and energy building closeness and a sense of trust can bring you a feeling of balance, flexibility, support and connectedness. Remember the things that brought you together in the first place. Celebrate anniversaries of significant events.
If you are holding grudges or resentments, put them down. Let go of past betrayals and find a way to forgive and release your loved one from indebtedness.
Even if you do not have a specific significant other, finding friendship is important. Human connection and feeling “seen” can bring a sense of balance and security. Write down the name of one person with whom you would like to feel closer. What interests or hobbies do they have? How do you contribute to his/her life? Have you let him/her know they are special to you? Push yourself to be available to those who care about you.
If you have children be sure to spend time together as a family, but also make special time to spend individually creating memories with each child. Often children will not be as open and self-revealing with siblings around.
Participate in Secret Giving.
Do something nice for someone without them finding out who did it. Leave an anonymous flower or treat. Give the gift of yourself; offer your time or talent to help someone else. Do it without expecting anything in return. Send a special wish, a smile or silent prayer even when you walk past someone. Only in giving do we feel a sense of purpose. When we feel down one of the quickest ways to feel better is to be of service to someone else.
Recognize there are always “two sides to every coin”.
Remember that “the glass is always half full as well as half empty,” and “there are two sides to every coin.” For every positive side to a situation, event, job or relationship, there are also difficult ones. We sometimes tend to think of situations in terms of all good or all bad. There is no such thing as an all positive or all negative situation.
Make a list of things that are now challenges in your life and beside each one write the benefit or potential benefit each one gives you or may bring you in the future. Now write a list of things you are very grateful for, beside each one write the price you were willing to pay or sacrifice for it. Give yourself a compliment for acknowledging both sides
of the important things in your life. If this is difficult for you spend some time practicing this exercise. The rewards are many and you will end up feeling much less trapped by life.
Reconnect with your spiritual side.
Spirituality means something different to each person. It is a sense that there is a higher order to things and that life is not just random events. Connecting to this deeper side of life is essential to obtain a sense of balance.
Some people want to affiliate with others who hold similar beliefs. Others wish to be alone in nature or read inspirational material. It is important that each person find the activities and practices that bring a sense of reconnection with their own spirituality.
Financial balance is not a matter of luck.
Keep a current cash flow chart that is updated daily or at least weekly. Keep a net worth file that is updated monthly or at least biannually. Financial balance comes from being aware of in-flows and out-flows of money, being able to predict and make purchase and investment decisions based on current facts.
If you have long-term financial goals write out the steps you will need to take to attain them. Give yourself credit and acknowledgement for attainment of short-term goals leading to long-term objectives. If you need a professional to look over your finances and give advice, don’t delay in setting up an appointment.
Bring balance to your habits.
Think of one excessive habit that you would like to bring into balance, such as, overeating, overspending, gambling, drinking, criticizing, watching TV, or computer time. Then write out three steps you would like to take toward getting that habit back to a place of balance in your life (such as; spending more time with friends, writing a budget, joining AA, GA or Weight Watchers, finding an exercise partner, giving more compliments, making a commitment to someone you trust, etc.) Now circle the first step you would like to take toward your goal. Write a time in your planner by which you will take that first step.
Don’t think in terms of all or none.
In our fast-paced, addictive society many of us are tempted to think of situations, goals and activities in terms of all or none. Retrain your mind to think in terms of, “on a scale of 1 to 10” or in percentages. For instance, I would like to cut my sugar intake by 50% or I would like to arrive home earlier from the office 25% more of the time. This is a much kinder and more practical way of speaking to yourself and you increase the likelihood of real behavioral change taking place.
If you incorporate these ways of speaking in your communications with others, you will also find much less defensiveness on the listener’s part. For instance, rather than saying “You are always late,” say, “I notice you are late about 50% of the time. That is too much.” Rather than saying, “You always make me angry,” say, “On a scale of 1 to 10 my frustration level is up to a 7. I really don’t want it to go higher”. Speaking without absolutes in limit setting will increase how often your message is actually heard.
Create A “Pie Chart” of Your Life.
Draw a circle that symbolizes your life. Divide it into 7 wedge sections representing the physical, mental, emotional, spiritual, financial, relationship and the professional aspects of your life. Allot space to sections according to how fulfilled and comfortable you feel about the time and energy you spend on each section of your life.
Now look at your pie. Where would you like to devote more attention? Where could you expend less energy? What would balance look like to you? Does any one part look neglected?
Redraw your circle to match your ideal situation, not necessarily in equal portions. Now write the first specific step you would need to impact each area you do wish to change.
Whatever area of your “pie chart” you wish to work on, set up small easily attainable steps toward more balance in that area. For instance, if you wish to work on the physical “slice” of the “pie”, don’t start out with a goal of loosing 20 pounds and working out 7 days a week. Set up incrementally attainable goals. Weekly or daily reevaluate them at a scheduled time. Don’t drop your idea all together if you fall short of your ideal goal, just modify your goals to something more realistic for your current life style and work up from there.
Address procrastination in your life now.
Procrastination can rob otherwise very productive brilliant people from feeling a sense of success and balance. Set aside time each day to write a prioritized to-do list for the next day. Take a time-management class or listen to a tape series on overcoming procrastination. Buy yourself a complete daily calendar program and follow it. Ask organized friends what methods they recommend.
Set up small rewards for yourself when you complete tasks. Congratulate yourself when you accomplish intermediate goals along the way to the large tasks. Observe what you say to yourself. Make sure you are complimenting yourself and not “beating yourself up”.
Always keep your word.
One of the fastest ways to feel off balance is to be trying to make up excuses to “cover your tracks” when you have not kept your word. If you only commit to things you are quite certain you can fulfill and you keep these promises, you will walk through life with more confidence, a faster, clearer mind and radiate trustworthiness to all those with whom you come into contact. The word gets around fast about those people who can be counted on to finish projects, show up on time or go the extra mile if they have committed to it.
The converse is also true. When a person has not made a habit out of keeping his or her word there is an instant tenseness that fills the air when a promise is made. An uneasiness and a sense of defensiveness follows them into whatever new project they undertake. Create an air of confidence by always following through on what you say you will do.
A quick way to center your body.
Sit up straight in a chair. Close your eyes, take a deep breath in and completely exhale. Focus your attention on your body and how it feels. Sit up as straight and upright as possible. Now, leaning with your left shoulder, lean as far as you can to the left and then as far as you can to the right.
Then return to center, with your eyes still closed. Imagine what leaning half the distance to your left would be. Now lean only that far to the left, followed by leaning the same halfway reduced distance to the right.
Continue leaning left and then right, cutting the distances in half each time in both directions. Continue, with your eyes closed, even past the point where you feel any perceptible body movement. Stop when you feel at complete center both physically and mentally. Relax and enjoy this centered feeling. Remember how this relaxation feels at times when you are stressed and anxious.
Many of these concepts may seem strange, uncomfortable, time-consuming or even a bit foreign at first. But these are strategies that have been used successfully by thousands of people who have put them into practice. If you choose just one and implement it in your life on a regular basis you will be sure to see a difference. Having balance in your life gives you a competitive edge in our fast paced society. Flexibility self-confidence and high energy all come from finding balance in life’s most important areas.
© 2004 Dr. Lois V. Nightingale, Clinical Psychologist (psy9503) professional speaker, author and director of the Nightingale Center in Yorba Linda, California 714-993-5343
Seven 5 Minute Tips to Help New Mothers Relax and Rejuvenate
Parenting by Dr. Lois Nightingale on December 9, 2017
Seven 5 Minute Tips to Help New Mothers Relax and Rejuvenate
Sometimes 5 minutes at a time is all new mothers can find in their busy days. When the baby is sleepy or older kids are briefly entertained. These can be thought of as “mini vacations” that you can return from more relaxed and ready to take care of the tasks you have committed to.
Focus on you breath. Breathe in and feel how cool and dry the air is as compared to warmer moister air as you exhale. Breathe deeply filling your lungs from the bottom up. Let your abdomen move as you breathe. As you breathe in, say silently “re” and as you exhale “lax”. Say silently to yourself “re-lax” as you breathe deeply.
Sit quietly and comfortably and close your eyes. After taking 5 deep cleansing breaths, bring your attention to noises, smells and feelings around you. What can you hear, smell and feel? Pay attention to detail, subtle sensory stimuli and what you might not usually notice, when your mind wonders, gently bring it back to something you hear, smell or feel.
Spend 5 minutes, just noticing without judgement. If you notice undone housework, clothes on the floor, your fatigue, just notice that it is so. Do not use “should”, “would”, “could”, “ought” or any other derogatory statements about yourself or others. Detach yourself from the emotional judgement about your environment and those around you. Begin bringing this perspective into the rest of your day.
Walk outdoors. Notice how nature works effortlessly, without worry or anxiety. Notice the colors, movement, and temperature, breathe in the fresh air. Exhale completely. Be fully present. Watering, gardening, watching clouds, playing with pets or just watching leaves blow in the breeze creates tranquility.
Spend 5 minutes each night writing down things that you accomplished, giving yourself credit. These may be “small” in comparison to “life before the baby”, but now take effort, focus and forethought. Give yourself credit for healthy food you’ve eaten, quality time you spent with your baby and other family members, and relaxation time you have taken out during your day.
Have a lovely fragrant lotion (the more “decadent” the better) to give yourself a 5 minute hand or foot massage, feel the softness, smell the fragrance, bring your attention to the muscles relaxing as you massage the lotion into your skin.
When driving, listen to positive self-confidence building tapes or CD’s. Feed yourself emotionally by what you listen to. Avoid angry and hostile talk shows or personal acquaintances. Notice if what you are listening to builds you up or tears you or someone else down. Surround yourself with positive growing people who encourage you.
Free relaxation techniques for new mothers can be heard on Sound Cloud
Dr. Lois Nightingale, author of “A Quiet Time for New Mothers, Ways To Relax and Rejuvenate” 1999 ISBN #1-889755-28-1 and “Overcoming Postpartum Depression, A Doctor’s Own Story” 1998 ISBN # 1-889755-25-7
What is Cognitive Behavior Therapy?
Anxiety by Dr. Lois Nightingale on April 8, 2016
What is Cognitive Behavior Therapy?
Cognitive Behavior Therapy is an action-focused psychotherapy that focuses on addressing thought patterns (cognitions) that lead to disruptive behaviors and uncomfortable emotions. It is a relatively short-term form of therapy based on the concept that the way we think about things affects how we feel emotionally. CBT focuses on changing current mal-adaptive thought patterns, behaviors and communication rather than on past experiences. It is oriented toward current problem solving.
CBT is based on extensive empirical research. It is the primary psychological treatment being studied in research today. CBT has been shown to be as useful as antidepressant medication for individuals with depression and is superior in preventing relapse. Studies indicate that patients who receive CBT in addition to medication have better outcomes than patients who do not receive CBT as an added treatment.
While CBT acknowledges many of the core beliefs contributing to “automatic thoughts” in response to life situations, may have been developed in childhood or during times of crisis, the predominant focus is on helping clients feel better and behave better their current lives.
CBT clients need to be motivated, as CBT can be hard work. Clients may feel uncomfortable at times as they practice new behavioral habits. Clients are expected to do work outside of therapy. Homework assignments, journaling, role-playing, cognitive rehearsal, relaxation techniques, systematic desensitization, deep breathing exercises, reinforcement strategies, and validity testing, are all techniques used in CBT. Clients who seek CBT can expect their therapist to be active, problem-solving and goal-directed.
The harder clients work, the better their chances of recovery.
Cognitive therapy is not about “positive thinking” in the sense that you must always think happy thoughts. Rather, it is a way to gain control over racing, repetitive thoughts which often feed or trigger anxiety or depression. In CBT people learn how to change their behavior and their feelings to live more fulfilled lives.
Dr. Lois Nightingale, Psychologist PSY9503 714-993-5343