All posts by James DelGenio

Individual, Family, and Couples Counselor with over forty years of experience as therapist, author, and continuing education provider.
Couples, Marital Family Issues, Relationships

How to maintain your relationship?

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By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

Maintain your relationship!

All couples argue. The key is to have rules for fighting so as not to create resentment over time. Resentment is very destructive to a relationship. Always be civil and respectful. There are no winners when couples lose control. The best-case scenario is that you both feel understood even if you don’t agree. Always be willing to compromise. When all is said and done, you should both feel understood even if the issue is unresolved. Agree to discuss the conflict in therapy if an issue remains unresolved.

• Always be civil and respectful. This is the foundation of your relationship. When civility and respect breaks down, the relationship is in trouble. Resentment is created and this has long term detrimental effects including lack of intimacy and bickering over little things.

• Relationships are like a car. They need maintenance to run well. Don’t take your relationship for granted. This is a very hectic world we live in. Sometimes couples get lost in the day-to-day grind of life, especially when there are children and all their after-school activities. Make time for one another; planning is key.  Plan a date night for just the two of you at least twice per month.  This fosters good communication and a feeling of connection.

• Good communication means everyone walks away feeling good about the interaction. Find a way to compromise or at least agree to disagree civilly.

• Offer greetings, a hug and a kiss when you leave in the morning and when you return. The duty of meet and greet, as I call it, is on both of you to find one another and give a hug and kiss. When you kiss remember you are not kissing your mother. It’s OK to laugh. I think you will find that this turns into a family hug once the children notice. Even the dog will want in.

• Look at one another when you talk. Make eye contact. It’s better to be nose to nose possibly with your arms around each other for difficult conversations. The intention is that this is about good communication and never about winning an argument.

• Be affectionate. Take walks together; hold hands.

• Make a love call during the day.

• Have a date night regularly for just the two of you. Don’t discuss issues; if you can’t think of anything to talk about, plan your next date or vacation.

• Take time to talk for a few minutes when you get home. Talk about your respective day. Share your feelings. Men typically try to offer solutions. Gentlemen, you need to listen, you don’t have to offer solutions. Men tend to try to fix it; just listen and acknowledge what you have heard by saying back what you heard with emphasis on the feeling you heard. This will help avoid, “you’re not listening.”

Now I can work via Zoom with anyone, anywhere in the country and it will still be covered by BCBS Insurance.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

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http://family-institute.org
http://takenotelessons.com   Effective online, one on one, SAT, ACT, GRE, test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Bipolar Mood Disorders

How to manage Bipolar Disorder and Denial?

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By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University


Denial is the biggest obstacle to management and recovery of Bipolar Mood Disorder.

People with bipolar disorders, in particular, seem to have the most issues with denial and are, therefore, the most difficult people to treat from a therapist stand point. Through self-deception, rationalization, justification, and excuse making, a person can deny that they have a problem when everyone around them sees that the problem is obvious. This seems to be most common with Bipolar Disorders.

Denial usual takes place around several key issues. They are: acceptance of the disorder, the use of medication in helping manage the disorder and the detrimental role of alcohol and substance use or abuse in achieving wellness.

When clinical depression is the disorder; it is biological. It is genetic in origin. One can usually trace it in family history. It may be a grandparent, parent, uncle or cousin, even if it was never formally diagnosed, the history is typically there. No matter how much one tries to pull themselves up by their bootstraps and try harder, they will not make a significant impact on managing their symptoms. Even a skilled CBT therapist, employing cognitive behavioral techniques will not make a significant difference in the management of the disorder.

This means that medication is indicated. Some women, generally more men will initially refuse medication. I often hear, “I won’t take medication.” I describe my view and experience in general terms. If that is not enough to convince them, I will agree to cognitive behavioral therapy for period of time. If there is still no impact on symptom management through clearly defined goals, I revisit the medication issue to encourage reconsideration. Ultimately, it’s your life; you can be a victim of your disorder or you can choose to manage it. It doesn’t happen often but I have discontinued treatment and offered some referrals to other therapists who are willing to treat the disorder without the help of medication. Personally, I just can’t do it at least not for very long.

This is also true around the use of alcohol and recreational drugs such a marijuana. Remember, alcohol is a depressant. When you are already depressed why make it worse. Initially it helps but then it slams you in the days that follow. That is why it is known as self-medicating.

Some clients, again mostly men will refuse to consider stopping the use of marijuana. Yet the reason they have initiated treatment is panic and anxiety. Duh! Though not addictive per se, marijuana is habit forming psychologically. Prolonged daily use may cause anxiety and panic for those with a mood disorder. Take medication or stop using. I encourage both.

Though denial can be an issue for both men and women, I have found that men especially do not want to admit that they have a problem. They are generally more resistant to seeking help, taking medication or facing dependence.

In my practice, I recognize that this is a trust issue. If I feel that this will be an issue, I will put the referral for a medication evaluation off for a time while building a therapeutic relationship. I also address this resistance as most therapists do by comparing mood disorders with other physical disabilities such as diabetes or epilepsy. All are physical issues with a genetic origin which affects thinking and behavior. If your doctor told you, “I’m sorry to inform you that you are diabetic like your father was”, you would not like it but would likely be willing to take insulin injections.

The same thought process regarding antidepressants or mood stabilizing medication should apply with a diagnosis of mood disorder. There really is very little difference! Until you can accept your issues and play the hand you were dealt by genetics, environment and personality traits, you will be unlikely to manage your life well.

This will affect your marriage, relationships, employment and your ability to cope with day to day life. There is no soft way to peddle this. A psychiatric evaluation will determine if medication is appropriate. Medication does the first 50% and is considered the foundation. Once on the right medication at the right dose, symptom management with a skilled therapist will likely be more successful. Once this is addressed, we are more likely to resolve relationship issues through individual, family or couples counseling.

Case Scenario
Case Scenario: Denial or Acceptance – Beth
Beth is a twenty something year old female who enjoys partying with friends. Her friends can drink, smoke pot and stay out until 4am without major negative impact on their life. Beth cannot. Her partying has made her medication ineffective.

She initially presented with severe anger issues. She reported that she would lose control, even become violent. She was already on an antidepressant but it wasn’t helping. The symptoms of clinical depression including her lack of motivation, poor sleep, poor concentration and tendency to withdraw and isolate have come to a head. She reported that her anger was out of control. In addition, she had no motivation and had difficulty getting out of bed. She was experiencing panic and anxiety and had thoughts of suicide.

Beth can’t do what her friends did almost every weekend. I encourage someone like this to track their alcohol and pot use in the days after to see if this can help her connect the dots. It’s tough when your friends can do it but you can’t. I always remind my clients that they do have a disability that they need to manage. This makes them different, not bad, just different. However, if she makes the connection then it becomes a choice. A choice to be a victim of her disorder or a choice to be well. You’re only to blame if you ignore it. Then you need to be held accountable.

Payment and Insurance:
Blue Cross and Blue Shield PPO insurance welcome. Cash, check, Visa, Master Card or American Express accepted.

Zoom

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance.  Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy.  Always share this material and your questions about this material with your doctor and therapist.

Alcohol Dependence, Couples, Premarital Issues, Relationships

What are the Benefits of Premarital Counseling?

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By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

The Benefits of Premarital Counseling.

Premarital counseling can help ensure that you and your partner have a strong, healthy relationship. This will give you a better chance for a stable and satisfying marriage. Premarital counseling can also help you identify weaknesses that may become larger problems during marriage. Good marriages don’t happen by accident. Many issues can be resolved prior to marriage with the help of a therapist. Common issues addressed may include: mental health issues, work, finances, drug and alcohol use, lifestyle, spending habits, credit card balances, student loans, savings, retirement planning, roles and responsibilities, children, parenting, in-laws, and leisure and fun. Marriage requires an understanding of yourself, your future spouse, and the tools and skills you need to make it work.

Does your significant other have a Mood Disorder?
Some moodiness is a part of everyone’s life; sometimes we feel happy, other times we are sad; some days we have lots of energy, while at other times we may be fatigued and unmotivated. When mood changes interfere with your ability to function, work or go to school, when they harm your relationships significantly, when they cause you to miss sleep, abuse drugs, or behave in ways you later regret, or when they lead to risky behaviors, thoughts of suicide, or losing touch with reality, your mood requires professional attention.

If this sounds like you’re intended. All is not lost. The key factor in this decision is Denial. If your partner tends to deny issues now, do you really think it is going to get better later?

I find that most premarital couples are well aware of their intended’s mood and alcohol/substance issues. My main questions are as follows:
Is he/she:
• Willing to seek help?
• In need of psycho-education?
• Willing to take medication, if prescribed?
• Willing to honestly address alcohol and substance abuse issues?
• Willing to see a therapist for relationship issues and support?

Rules of Engagement
All couples need rules for fighting. The most important rule is civility and respect. This, of course, means no hitting or throwing ever. If there is physical violence, you must call the police. Beyond that essential rules are no screaming, swearing, or name calling ever. This is destructive and may lead to your undoing as a couple. Couples need to work on resolving conflicts in their relationship with civility and respect so that bitterness and resentments can not build. It is possible to argue, resolve conflicts, and agree to disagree. In order to do this, all couples need rules of engagement for conflict. Establish your rules!

Finances and Spending
One of the biggest causes of problems in relationships is differences in values and goals and habits when it comes to money, and especially communication about money issues. That old saying is true …. money can’t buy you love, but it sure can tear it apart.

This makes a discussion of finances necessary before marriage. Learn how to talk about money, and align your financial goals such as retirement, savings, spending, debt, and disposable income. If you can do those two things, you’ve done more than most couples, and you’ve done a lot to start your relationship off on solid ground.

I therefore, recommend meeting with a financial planner to discuss issues such as spending, use of credit cards and financial goals. Goals should include the following: savings, pension contributions, retirement planning, debt, discretionary spending, school loans and the use of credit cards. How will you handle school loans and debt brought into the marriage? How much money can be spent without consulting the other. I usually recommend $100 to $300.

Family Ties and In-laws
A family is made up of many unique individuals, each with a range of thoughts and opinions on almost every subject and situation. Add to the mix extended family with their countless beliefs and personal opinions and there is no wonder there are disagreements from time to time. Conflict is simply the natural and healthy progression of any relationship

Some questions to explore – What sort of relationship do you have with your extended family? Are they local? Do they like your fiancée? Are they affectionate? Are they over-involved or critical? Have there been any major conflictual issues?

I suggest that couples begin to see themselves as their own family unit. When addressing family of origin, always say that “we” will have to discuss the event or holiday and that he or she should respond to their own family unit. This is especially true once children enter the picture. Now consider, if you want to see us come over………  This way the kids don’t have to get up open presents and get in the car! Now your doing what is best for family.

Religious Beliefs
This potentially contentious issue should always be discussed in premarital counseling. The first step is to seek a better understanding of your future spouse’s religious and spiritual background.
Topics to look into are:
• How to reconcile differing ideologies and practices
• How to observe and celebrate each other’s holidays
• How to raise children so that they are exposed to both partners’ traditions without being overwhelmed and/or confused
• How to integrate both extended families, especially during the wedding/holidays

Case Study:

Mark is not religious; Eileen is and expects to go to Church every week. What if they did marry and had children; would Mark go to Church then?
What if Mark is Catholic and Eileen is Jewish? Will one of you convert? Does it matter at all? What will the respective families say? That is a big question especially in regard to child rearing.

“What do you mean; you are not going to raise the baby Catholic? Jewish?” For some, the consequences of that decision may be long lasting or a deal breaker. It is clearly better to decide before marriage and tell both families about your decision. In discussions with the extended families, always use the phrase “we” have decided.

Children and Parenting
Do you want children? How many and when? Are there already children from previous relationships? Have you discussed blended family issues? What do you expect from your spouse regarding parenting/step parenting roles? When a problem arises, how does my partner communicate? What are the responsibilities of each parent in raising a child?

I strongly recommend that you have two to four years together as a couple before you have children. This time is critical, it gives you the opportunity to get to know one another as a married couple.

Children don’t bring you closer together; they create stress and sometimes distance especially if you and your intended are not on the same page regarding roles and responsibilities. And even more stress when ex’s and step in-laws are in the picture.

Blended families have a lot to discuss: the ex, custody issues, the in-laws, parenting, finances, loans, debt, child support, etc.. They especially need premarital counseling. I am surprised at how often these have not been fully addressed.

I believe that the children don’t come first; your relationship comes first. Now I know that is not true but if you divorce, it will be children that suffer most. Of course, my point is don’t forget to make time for your relationship after you have children. Planning for alone time or date night is a key component in addressing this issue. Take turns planning so the wife isn’t doing it all. But above all – Parent as a team! Be consistent with consequences. Discuss issues prior to discussing them with the children. What to say and how to say it.

Work, Lifestyle, Leisure and Fun
What sort of lifestyle do you want? Will you both continue to work when children are born? Do you have the same idea of what is fun? Where will you want to live?

Today most couples are comprised of two working parents. Couples want to maintain or improve the lifestyle they had going into the marriage. This is difficult in today’s economy and job market. For the first time in history, couples may not meet or exceed their parents’ lifestyle. The common expectations of employment today are long hours and work from home in the evening and on the weekend. This reduces quality time together. These forces necessitate compromise and making the most of the time you have together. Planning mutually enjoyable activities and social events and balanced with appropriate alone time is a key component in maintaining a strong relationship.

Final Thought
You may not feel you NEED premarital counseling, but it is still wise choice to consider. You may be on cloud nine with the impending marriage but counseling may help bring up and resolve some difficult topics. Better to discuss issues before marriage then with a divorce attorney later.

Zoom!

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material with your doctor and therapist.

Bipolar Mood Disorders, Substance Dependence

Denial  is the biggest obstacle to being well when you have a mood disorder.

3 Comments

By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

What is the biggest obstacle to managing depression?

Denial is the biggest obstacle to management and recovery of a mood disorder or alcohol and substance dependence.  Through self-deception, rationalization, justification, and excuse making, a person can deny that they have a problem when everyone around them sees that the problem is obvious.

Denial usual takes place around several key issues. They are: acceptance of the disorder, the use of medication in helping manage the disorder and the detrimental role of alcohol and substances on achieving wellness.

When clinical depression is the disorder; it is biological. It is genetic in origin. One can usually trace it in family history. It may be a grandparent, parent, uncle or cousin, even if it was never formally diagnosed, the history is typically there. No matter how much one tries to pull themselves up by their bootstraps and try harder, they will not make a significant impact on managing their symptoms. Even a skilled Cognitive Behavioral Therapy (CBT) therapist, employing cognitive behavioral techniques will not make a significant difference in the management of the disorder.

This means that medication is indicated. Some women, generally more men will initially refuse medication. I often hear, “I won’t take medication.” I describe my view and experience in general terms. If that is not enough to convince them, I will agree to cognitive behavioral therapy for period of time. If there is still no impact on symptom management through clearly defined goals, I revisit the medication issue to encourage an appointment with a psychiatrist.

Ultimately, it’s your life!  You can be a victim of your disorder or you can choose to manage it. Lets not make life more difficult then it already is. Try the medication for six months and see if it helps.   At least go hear what the doctor has to say.

This is also true around the use of alcohol and recreational drugs such a marijuana. Remember, alcohol is a depressant. When you are already depressed why make it worse. Initially it helps but then it slams you in the days that follow. That is why it is known as self medicating.

Some clients, again mostly men will refuse to consider stopping the use of marijuana. Yet the reason they have initiated treatment is panic and anxiety. Duh! Though not addictive per se, marijuana is habit forming psychologically. Prolonged daily use may cause anxiety and panic for those with a mood disorder. Take medication or stop using. I encourage both.

Though denial can be an issue for both men and women, I have found that men especially do not want to admit that they have a problem. They are generally more resistant to seeking help, taking medication or facing dependence.

In my practice, I recognize that this is a trust issue. If I feel that this will be an issue, I will put the referral for a medication evaluation off for a time while building a therapeutic relationship. I also address this resistance as most therapists do by comparing mood disorders with other physical disabilities such as diabetes or epilepsy. All are physical issues with a genetic origin which affects thinking and behavior. If your doctor told you, “I’m sorry to inform you that you are diabetic like your father was”, you would not like it but would likely be willing to take insulin injections.

The same thought process regarding antidepressants or mood stabilizing medication should apply with a diagnosis of mood disorder. There really is very little difference! Until you can accept your issues and play the hand you were dealt by genetics, environment and personality traits, you will be unlikely to manage your life well.

This will affect your marriage, relationships, employment and your ability to cope with day to day life. There is no soft way to peddle this. A psychiatric evaluation will determine if medication is appropriate. Medication does the first 50% and is considered the foundation. Once on the right medication at the right dose, symptom management with a skilled therapist will likely be more successful. Once this is addressed, we are more likely to resolve relationship issues through individual, family or couples counseling.

Case Scenario
 Case Scenario: Denial or Acceptance – Mary
Mary is a twenty something year old female who enjoys partying with friends. Her friends can drink, smoke pot and stay out until 4 am without major negative impact on their life. Mary cannot. Her partying has also made her medication ineffective.

She initially presented with anger issues.  In addition, she had no motivation and had difficulty getting out of bed. She was experiencing panic and anxiety and had thoughts of suicide. The symptoms of clinical depression including her lack of motivation, poor sleep, poor concentration and tendency to withdraw and isolate have come to a head.

Mary can’t do what her friends did almost every weekend. I encourage someone like this to track their mood in the 3 days after to see if this can help her connect the dots. It’s tough when your friends can do it but you can’t. I always remind my clients that they do have a disability that they need to manage. This makes them different, not bad, just different. However, if she makes the connection then it becomes a choice, a choice to be a victim of her disorder or a choice to be well. You’re only to blame if you ignore it. Then you need to be held accountable.

Zoom!
Now for the first time, I can work zoom time with anyone, anywhere in the country and it may be covered by BCBS Insurance. Check with your BCBS carrier for details.  Call Jim at 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://psychologytoday.com
http://takenotelessons.com  Effective on line, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Anxiety Panic Grief Depression, Bipolar Mood Disorders, Glossary of terms

Mood Disorder Terms

3 Comments

By: James E. DelGenio MS, LCPC
Senior Staff Therapist                                                                                            The Family Institute at Northwestern University

Glossary of Terms for mood disorders.

The purpose of this glossary is to begin to familiarize and educate you with psychiatric language. There are many web sites such as WebMD, National Institute of Mental Health (NIMH) and Substance Abuse and Mental Health Services Administration (SAMHSA) that offer more detailed information. There are also many support groups and web sites available via the internet.

Addiction is the preoccupation with acquiring alcohol and drugs, compulsive use of alcohol and drugs despite adverse consequences, and a pattern of relapse to alcohol and drug use despite the recurrence of adverse consequences (Miller, 1991). In other words, alcohol and drug abuse cause problems in your life and you continue to abuse them anyway.

Bipolar Mood Disorders include two types. They are Bipolar I and II. Bipolar I is the more severe of the two with more pronounced mood swings from depression to mania. Bipolar II has milder mood swings with manic phases known as hypomania. This, of course, means less extreme manic behavior.

Both are characterized by:

  • Thoughts or plans of self-harm or suicide.
  • Inflated self-esteem or grandiosity
  • Hostile and aggressive behavior
  • Decreased need for sleep or no sleep.
  • Unusually talkative, may be difficult or impossible to interrupt.
  • Racing thoughts, skidding from subject to subject
  • Easily distracted.
  • Agitation, inability to sit still.
  • Poor judgment, lack of insight into one’s own behavior.
  • Buying sprees, reckless spending
  • Marked increased sexual activity or risky behavior.

These symptoms, if severe, may result in hospitalization to prevent self-harm or harm to others. If you note 2-or more symptoms consult a psychiatrist and therapist and/or go to the Emergency Room at your local hospital.

Client versus Patient Psychiatrists, Psychologists and some Clinical Therapists refer to the people with whom they work as patients. As a Licensed Clinical Professional Counselor, I am very much aware of the negative stigma attached to people with mental health issues. Therefore, my preference has always been to refer to the people with whom I work as my clients.

Clinical Depression is a biopsychosocial disorder that requires psychiatric intervention (medication) along with therapy that includes education, the use of coping skills and supportive treatment. Depression is not simply a matter of “just pull yourself up by your bootstraps and keep on going.” Associated factors may include both genetic and environmental issues (your experiences growing up) and what was likely inherited by a parent or grandparent. There is usually a family history of depression, mood disorder or alcoholism even if it was never formally diagnosed. Though there may be periods of remission, clinical depression requires ongoing psychiatric treatment, medication, psychotherapy at the very least, on an intermittent basis most probably for life.

Couples may be married or unmarried, gay or lesbian. I believe that mood disorders and the accompanying relationship issues are for the most part universal.

Dual Diagnosis means that two or more independent disorders exist in the same individual. For our purposes here, mood disorder and alcohol, substance abuse complicate and exacerbate one another. Specifically, a mood disorder and alcohol and/or substance abuse exist independently of one another, but each makes the other worse. Both are bio-psycho-social disorders with similar symptoms. They are lifelong disorders which cause the patient to be prone to relapse to symptoms and alcohol or substance abuse. Both disorders require integrated psychiatric treatment, psychotherapy, a social support network and array of supportive services for effective treatment.

Delusions are false or irrational beliefs, psychotic in nature and are typically associated with severe and persistent mental illness such as with a diagnosis of schizophrenia. This includes illogical thinking, irrational negative beliefs and behavior often accompanied by grandiosity and suspiciousness. The person is out of touch with reality and no amount of reasoning, logic, begging or pleading will help the individual. The only appropriate intervention is regular psychiatric support and medication taken as prescribed. This is typically the active phase of a psychotic disorder that has yet to be treated or is caused by non-compliance with medication. Hospitalization may be necessary to ensure the safety of the client and the community.

Expressed Emotion (EE) Lack of civility and respect are known to have a detrimental effect on marital and family relationships. The expression of negative emotions toward or even in the presence of a person with a mood disorder is a major contributor of relapse to active symptoms. Negative expressed emotion includes critical comments, hostility, anger and conflict over involvement of relatives toward a person with a mood disorder in an attempt to help the individual in the management of the disorder. High EE, as it is known, is easily internalized and is known to cause family conflict, risking relapse to active symptoms and abuse of alcohol and substances.

Family Conflict refers to the disruption of family and other relationships due to depression and other mood disorders. “Though family conflict is not a symptom per se, it is present often enough that it be given symptom status”. (Samuel J. Keith, 1985) Mood disorders or dual diagnosis almost always affect relationships. As a consequence, a person afflicted may eventually become isolated without the support of a spouse, family or friends because the conflict created by the disorder becomes an obstacle to maintaining the relationship.

Hallucinations are a positive symptom (they are present and active) and refers to hearing, seeing, feeling, even smelling things that are not real. Auditory hallucinations (hearing voices), for example, is the most common symptom associated with a diagnosis of schizophrenia. These voices may warn of impending danger, tell a person what to do, and are typically critical of the person. Medication non-compliance is typically an issue for someone already diagnosed with the disorder who is experiencing hallucinations.

Thyroid refers to thyroid dysfunction which can have a major impact on mood. There are many other physical disorders which can also affect your mood. Check with your doctor and have yearly physical exams.

Lack of Civility and Respect includes yelling, screaming, swearing, name calling and sarcasm. This is a major cause of marital discontent and resentment. It undermines the foundation of a relationship.

Case Scenarios are used to show common symptoms and relationship issues. Any semblance to a real person, family or couple is purely coincidental.

Medication Non-Compliance means not taking the medication as prescribed. This is undoubtedly the most common cause of relapse to symptoms, possibly resulting in hospitalization and unfortunately increases the risk of dangerous behavior and suicide. Medication compliance means “I take my medication every day as prescribed.” If you have concerns or medication side effects, contact your doctor or go to the emergency room.

Medication Education is typically done by the psychiatrist and therapist and is designed to discuss:
1. The benefit of and reasons for the use of medication including the risks of not using medication.
2. Importance of medication compliance i.e., taking it as prescribed.
3. The possible side effects and the potential allergic reactions.
4. The importance of psychotherapy in conjunction with medication.
5. The effects of alcohol, substance use, nicotine and caffeine have on symptoms and medication.
6. Relapse Warning Signs indicating the presence of active symptoms (positive symptoms) usually controlled by medication. In this case, a reevaluation of the medication by the Psychiatrist is indicated.

Mood Disorder is a generic term for psychological disorders which include situational depression, mild to severe depressive disorders, bipolar disorders, anxiety disorders, phobias, and other disorders which include personality disorders and alcohol or drug dependence. Alcoholism and addiction are commonly associated with mood disorders. Sixty to 70% of those with a mood disorder are likely to have issues with alcohol and substance abuse. If you don’t currently have an alcohol issue, studies show you may be at risk with just casual use.

Negative Symptoms refer to those symptoms which are characterized by their absence. This may reflect the presence of chronic depression, mood disorder or severe mental illness. Psychotherapy which focuses on experiential learning, symptom management and coping skills is typically required. Negative symptoms are generally not as well-controlled by medication. It is for this reason that Individual and Family therapy is needed to address management of these symptoms. Manifestations include:
• Lack of goal directed behavior
• Lack of motivation
• Marital conflict
• Poor judgment
• Lack of insight into one’s own behavior
• Lack of pleasure
• Social withdrawal
• Lack of emotional expression

Precipitating Event This is the trigger not the cause of a mental disorder. It is the proverbial “straw that broke the camel’s back.” It is the stressful life event that triggers the onset of a disorder that was genetically inherited from birth and typically begins to show symptoms early in life but more identifiably between the ages of 18 and 35 years old. Some stressful life event occurs such as: death of a relative or friend, failure at school, alcohol and substance abuse, job loss, or marital conflict. Simply put, there is a multitude of life events that can trigger the onset of a mental disorder. It is human nature to attach your feeling to something that is going on in your life. “She is the cause of my unhappiness.” When in reality, a mood disorder that you inherited genetically is a major contributor to your relationship and social issues. I recommend a psychological assessment by a doctor or licensed mental health professional.

Psychoeducation also known as experiential learning. This is the process of learning the management of a mood disorder with the guidance and support of a skilled therapist. Psychoeducation should also be included in the treatment of marital and family issues associated with mood disorders. Knowledge of the disorder and its symptoms are essential in learning How to be well. I strongly recommend that one have a doctor for the chemical imbalance issues and a therapist for psychoeducation, management and support.

Psychotic Symptoms refer to thinking that is out of touch with reality characterized by positive symptoms or the active phase of severe mental illness (SMI) such as seen with individuals with a diagnosis of Schizophrenia or schizoaffective disorders. These symptoms include hallucinations, delusions and illogical thinking. Some severe cases of mood disorders may also include psychotic features.

Positive Symptoms also known as Relapse Warning Symptoms refer to symptoms that are characterized by their presence and are controlled only by medication. These are the active symptoms of the disorder and are typically a sign of relapse. They are:

1. Mood including low or highly elated mood (mania), negative thinking, rumination and thoughts of self-harm or harm to others.

2. Sleep/Wake difficulties include little or no sleep or reversed sleep wake cycle. Sleeping during the day and being up all night also contributes to the social isolation often seen with mood disorders. Protracted insomnia is the quickest way to relapse to symptoms or hospitalization. Take anyone, even without a mental disorder and keep them awake for two, three or four days and they will become psychotic, out of touch with reality. Significant sleep disturbances in individuals with mood disorder can be devastating. This phenomenon is most common with a diagnosis of bipolar disorder.

3. Poor Concentration means inability to focus or stay on task and may include poor short term memory issues. Relapse warning signs are typically a sign of medication noncompliance or the need to change or adjust the dosage of medication. Contact your prescribing doctor immediately. Positive symptoms cannot be controlled without medication.

Rumination refers to the negative thoughts that rerun over and over in one’s mind. This symptom can only be managed with medication.

Social Dysfunction refers to failed relationships, family conflict and marital issues associated with depression or other mood disorders. The most common characteristics of social dysfunction are:
• Hostility, irritability
• Conflict
• Withdrawal, Isolation
• Lack of close personal ties
• Relationship issues
• Employment issues

Situational Depression is a mood disorder that manifests itself typically around a specific loss or grief. This may include marital conflict, divorce, job loss, health issues and death of a relative or friend. This form of mood disorder requires therapy to work through the grief issues and may be helped by the use of antidepressants for a period of six to eighteen months.

Thought Disorder refers to confusion or the inability to concentrate on a single thought or subject. A person may be easily distracted or may jump from one subject to another (skidding). The speech pattern does not make sense, or the person may become unable to complete a thought (blocking). Short term memory may also be affected.

Work via zoom.

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Effective online, one on one, SAT, ACT, GRE, test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Alcohol Dependence, Anxiety Panic Grief Depression, Bipolar Mood Disorders, Relationships, Substance Dependence

Mood disorders and alcohol don’t mix!

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By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

When you have a mood disorder, the use of alcohol may be the same as abuse!

Where mood disorders are concerned use may very well be the same as abuse!  Alcohol impairs functioning and it affects thinking, behavior and relationships.  Substances also affect thinking and behavior.  Don’t do anything that would make you relapse to active symptoms.  It is known fact that alcohol and substance abuse make the symptoms of a mood disorder worse and vice versa.  Alcohol is a depressant; one drink at a family gathering may affect one’s mood for days.

Alcohol also “washes out” and therefore may negate the usefulness of the medication.  Remember, it takes four to six weeks to get the medication to a therapeutic level.  When you drink you affect that level. In addition, one should never use alcohol or substances when taking prescription medication. This can be fatal. It goes without saying that if you are an alcoholic you can’t have any alcohol. If you are not an alcoholic, check with your Dr. for approval of one or two drinks on very special occasions.  In the days after, monitor yourself to see if it has affected your mood. If it does, use is the same as abuse!

  • Drugs and alcohol make mood disorders worse and can lead to drug/alcohol dependence.
  • Conflict often related to alcohol use and mood disorders.
  • Two drinks, beer or wine only; never back-to-back days, no more than twice per week with doctor approval.
  • If the doctor approves of one or two drinks, monitor your mood in the days that follow. If your mood is off, you need to consider abstinence from alcohol.

Zoom! Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Highly effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Bipolar Mood Disorders, Relationships

Depression and high expressed emotion

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By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

Depression and high expressed emotion.

High Expressed Emotion (High EE) or lack of civility and respect are known to have a detrimental effect on marital and family relationships. The expression of negative emotions toward or even in the presence of a person with a mood disorder is a major contributor of relapse to active symptoms. Negative expressed emotion also includes critical comments, hostility and overly involved critical family toward a person with a mood disorder. High EE, as it is known, is easily internalized and is known to cause family conflict, risking relapse to active symptoms and abuse of alcohol and substances.

Case scenario: Mary is 39 years old, and she has a severe mood disorder. She was sitting on the couch while her husband was arguing with his business partner on the phone. As the conversation became more heated, she began to shake with anxiety.

If you have a mood disorder, just being in the presence of high expressed emotion can have severe effect on the individual listening. Now imagine if that emotion was directed at her! The point is when a spouse or family member has a mood disorder, high expressed emotion or lack of civility and respect even if it is not directed at the individual will have a detrimental effect and may even lead to active symptoms. All the more reason to be civil and respectful!

Zoom

Now I can work via zoom with anyone in the country and it will still be covered by BCBS Insurance. Call 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Bipolar Mood Disorders, Marital Family Issues, Relationships

How can family help a loved one with depression?

14 Comments

By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

How can family help a loved one with depression?

The role of the family in treatment is simply to monitor and report. The family should observe the patient’s behavior and report anything that may be important to the stable functioning and health of the patient. The patient should not be interfered with directly unless, of course, s/he is a danger to themselves or others. The family’s role in treatment is a collaborative effort in communication. The family should think of themselves as team members. We are all on the same team! Keeping secrets from the doctor or therapist interferes with treatment and may ultimately have serious consequences. Families should call their doctor, therapist immediately or 911 if the patient has any of the following behaviors or symptoms, especially if they are new, worse, or worry you. Report when the patient is:

  1. Not taking their medication as prescribed.
  2. Abusing alcohol, substances or medications not prescribed by a doctor.
  3. Severely depressed, irritable, threatens violence or has thoughts of suicide or dying.
  4. Exhibits behavior which may result in injury or harm to the individual, family or community.
  5. Experiencing of any relapse warning signs, especially no sleep.
  6. Experiencing panic attacks, uncontrolled anxiety or restlessness.
  7. Acting on dangerous impulses.
  8. Exhibits unusual behavior that is out-of-character for this individual.

Family should:

  1. Avoid placing blame or guilt.
  2. Avoid enabling. You are not responsible for the patient’s wellness. S/he is!
  3. Make regular opportunities to get away from each other. Have outside interests, hobbies and social activities.
  4. Get regular exercise (doctor permitting). Join a health club or walk at least 40 minutes on regularly scheduled days each week. In the winter if needed, use a treadmill or stationary bicycle.
  5. Learn all you can about mood disorders but do not try to be a therapist.

In most cases I have treated over the years, I have seen the client get annoyed with friends and family when they say, “You seem crabby, did you take your medication today”? The typical response is “just because I’m angry or upset doesn’t mean I’ve skipped my meds”. The way I see it, if you have a history of noncompliance, you don’t have the right to be angry when asked! Take the medication as prescribed so your family doesn’t worry about compliance or need to be intrusive in your life. They should be relatively assured that you are compliant with medication and treatment. Regardless, it is the responsibility of the family to ask because the consequences of not taking it as prescribed can lead to injury and possibly suicide.

    • Monitor and report on medication compliance.
    • Monitor and report on the use of alcohol and drugs.
    • Avoid over involvement unless the person poses a danger to himself or others.
    • Avoid trying to help motivate compliance with treatment.

Zoom!

Now I can work via Zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information. Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://jamesdelgenio.com
http://family-institute.org
http://takenotelessons.com   Effective online, one on one, SAT, ACT, GRE, test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.

Couples, Marital Family Issues, Premarital Issues, Relationships

Homework for couples

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By: James E. DelGenio MS, LCPC
Senior Staff Therapist,
The Family Institute at Northwestern University

Homework for couples.

As a cognitive behavioral therapist, I assign homework between sessions to the couples I counsel. Homework will not solve conflict, communication or resentment issues. Those issues need to be addressed in session. Homework will, however, help and typically addresses the following:

Civility and Respect
This one is a must. Civility and respect is the foundation of your relationship. When a couple loses civility and respect, their relationship is in serious trouble. They feel distant and as a result intimacy suffers. There is never a good reason to scream, swear, name call, or act out like mooning your spouse. If you have gotten into these habits, you may need professional help to get it under control. It will take some time; it is a process – but if you work at it and strive for consistency you can regain civility and respect. As in any process, owning your errors is important. Don’t hesitate to acknowledge it if you say something that is not civil or respectful. Say, “I am sorry I should not have said that.” and mean it. All couples need rules of engagement for conflict. You can never allow yourself to lose control. It is the foundation of your relationship. You can’t build a house without a good foundation. Couples can’t permit yelling, screaming, swearing and name calling to undermine their relationship.

Call Time Out
When conflict becomes too intense and one or both of you are in danger of losing civility and respect, call a time out. The words time out will become a signal for both of you to settle down. Never follow your spouse when they are trying to retreat from the conflict. Standing outside the bathroom door and continuing the discussion is out of bounds. If you decide to go for a walk or to a movie, say so your spouse knows when you are coming back. It is cruel to just walk out without regard for the other’s feelings. The rule of time out is you must get back to the discussion within 24 hours. Far too often couples will just let the issue go unresolved, swept under the rug. This creates resentment and distance. Hopefully, after a day to reflect, you will be able to discuss the issue calmly. If not, hold the issue for the next therapy session.

Reduce Alcohol/Drug Use
Many fights occur when too much alcohol has been consumed. Alcohol reduces inhibitions making it easier to allow yourself to lose control. If you are drinking daily, you may have a problem. Denial is a huge part of alcoholism. I typically say, can you stop drinking for a week, a month? Note: If you are a binge drinker, you still are an alcoholic. If you make excuses and refuse the challenge, you have an alcohol problem. There is no good reason one should be drinking on a daily basis. When alcohol is at the basis of conflict, you have to stick to two drinks twice a week. If you can’t, you need professional help!

Date Night
A night out alone is a common suggestion among both therapists and self-help books. As I have said, couples lose their way because of all that life throws at them. Don’t forget to nurture the relationship by spending time together alone. This does not have to be a big money issue. Many people with financial stress will simply go out for coffee or ice cream. I find it a statement of the current economic times and somewhat sad that couples will go out after therapy because they can’t afford a babysitter twice in one week.

Meet and Greet
Meet and greet is another way to address the lack of affection that many spouses feel. Touch is very important. This is not sexual touching. This is simply affection. Offer a hug and kiss when you leave and when you return. The responsibility is on both of you to find one another and do this when one of you walks in the door or leaves for work. Reaching out and holding hands when walking or just watching TV is also a way to address lack of affection.

Parent as a Team
Children learn quickly who to go to get what they want. Sometimes tension between parents is picked up on by the children and they will take sides. As I say, “the walls have ears.” Even when you don’t think they hear your arguments more than likely they do. I have had children tell me, “I listen to their arguments through the heating vent in my room.” A daughter will often side with mom. The result is when dad tells the daughter to get ready for bed, she ignores him. He gets upset and mom steps in often creating even more conflict between mom and dad. Mom needs to back dad and of course vice versa. “Do what your father says”. When mom is angry at dad anyway due to unresolved marital issues, mom unconsciously gets satisfaction from the child’s disrespect toward dad. This will continue for a while until marital issues are addressed and parents recognize how they undermine the others authority, and the child sees that they are consistently parenting as a team. Parents need to support one another in family meetings to address disrespect to the other parent. This is a common issue addressed under family meetings below.

“I feel” Statements
Inability to express feeling is a major issue in many relationships. One of the hardest things for many men to do is to get in touch with feelings. I find that many men have difficulty expressing their feelings at all let alone civilly and respectfully. Yet, lack of expression of feelings is a major cause of marital discontent. Opening up is critical for a good relationship. In addition, expressing feelings out loud appropriately helps dissipate negative feelings. Women, especially it seems, need to know what their man is feeling in order to feel connected and consequently warm and fuzzy in the bedroom. Men are more R rated; they don’t like to talk. Women say about 6,000 words per day: men only 2,000. I believe that good communication is romance, and that communication is needed for marital success. For most women and many men, it is that expression which makes a couple feel connected. I encourage “I feel” statements….” because.” It may at times still be a confrontational statement but much less so than when you begin statements with “you always “. First of all, never say never and always. When you have something difficult to say be nose to nose with your arms around the person. Say, “I feel” and it will more likely be perceived less defensively than things are said from across the room or behind a closed door.

No History Lessons and no skidding off current issues
Stay on the present issue. Many couples allow their conflicts to skid into the past. When this happens there is rarely a resolution to the current issue. This can create hostility and resentment. When you find yourself fighting about where you squeeze the toothpaste tube (he squeezes in the middle you squeeze on the end) obviously you are not addressing the real issues.

Zoom

Now I can work via zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative for more information.  Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com    Highly effective online, one on one, SAT, ACT, GRE, standardized test preparation, via face time or skype.

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material with your doctor and therapist.

Anxiety Panic Grief Depression, Bipolar Mood Disorders, Coping skills, Glossary of terms

What are the best coping skills for depression?

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By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University

Distraction is the best coping skill for depression.

Socialization, Exercise, Hobbies, Chores

Socialization is an important coping skill. It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their illness, and problems. They tend to isolate and withdraw. That is just not healthy and is a common symptom of depression. You should have at least 3-4 social events each month.

Exercise (especially walking) is good for depression and anxiety and is a great distraction when one is experiencing symptoms. Research suggests that a brisk walk for 4o minutes (with your doctor’s approval) will lift your mood and reduce anxiety. Don’t wait to feel motivated. Lack of motivation is often a direct result of a mood disorder. If you wait to feel motivated, it may never happen. Walk or do cardio work at least 4 times per week. Pick your days and let the day of the week make the decision for you. This will help to avoid, “I don’t feel like it today; I’ll do it tomorrow.” Unfortunately, tomorrow never comes. Any physical activity is likely to be helpful.

Hobbies can also be an important coping skill. A hobby can serve as a distraction when you are feeling low or anxious. Go to a hobby shop and pick something. I have had a lot of people choose paint by number sets. It’s the perfect hobby. You can pick up a paint brush and distract yourself and put it down and walk away when you need to. I had one man become a very good artist after starting with just a paint by number set. So, go to the hobby shop and pick something!

Chores can also be a great distraction. Many people with depression are overwhelmed by the thought of cleaning their entire living space. Again, use the pick a day method and choose one or two chores per day. Do your chores and exercise on the days you have picked to do them. Try to have at least one social activity per week. Plan to have fun. Adding structure to your life addresses many common symptoms of a mood disorder but especially lack of motivation.

If these distraction techniques don’t work, you may need to consider medication such as an anti-depressant. Talk with your doctor soon.

Zoom! Now I can work via Zoom with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative.

Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org

Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.