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 improve communication in the family?

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

Family meetings for better communication

Once upon a time, families ate dinner together. There was no eating in front of the TV; no texting or answering the phone and no internet. This was a time when families discussed what was going on in the household i.e. news, upcoming events, behavior issues and general discussions. Dinner used to be the natural time for families to discuss their lives, upcoming events and issues of importance.

Today, I find that families rarely eat together, missing the opportunity for family discussion. Child activities including little league, football, soccer, music lessons, dance lessons, and all kinds of after school activities have come to interfere in this essential family event. Families have become ships in the night passing one another as they head out the door. The idea of after school activity is potentially a good one: keep the kids busy and you will keep them out of trouble. However, what has been lost is the sense of family and the opportunity for imparting values and good communication.

When I was a child, dinner time was always between 5 and 5:30pm. I had a lot of freedom but I also knew what was expected of me. In this case, it was “be home by 5pm” for dinner.

We would hear stories, news and discuss family issues. Today parents have become dependent on dual incomes in order to maintain the lifestyle they want to give their family. Both parents feel the need but also the desire to work to maintain a certain lifestyle. However, they often have to work late and have conflicting schedules. This creates a disaster for the their relationship. They too, are ships passing in the night.

Many couples today report they feel disconnected, their communication has suffered and, in turn, so has the level of intimacy they share. This will ultimately lead to bickering, conflict, infidelity and possibly divorce. How sad that an important family event has disappeared without realizing the major negative impact on the family. Even when couples do realize the problem, there is little that can be done since they are trying to stay afloat financially.

Family Meetings: One way to reclaim some of that lost family communication and emotional connection are family meetings. Some families prefer to call them team meetings. Regardless, I encourage families to gather at least once per week to discuss four areas. Ideally, this should be done at the same day and time each week.

There should also be a pre-family meeting for mom and dad to discuss:

1. Issues and connection to one another, such as, affection, gratitude, compliments, and non sexual touch. “Meet and Greet” as it is often referred to, is a hug and kiss when one enters or leaves the home. It is on both to find each other not just the one coming home. This will frequently turn into a family hug, even the dog will want in. This goes a long way in helping maintain emotional connections. In addition, discuss issues with disproportionate work time, me time, family time, and couple time. These will never be proportionate but each should be part of your discussion each week/month.

2. Discuss finances such as bills, budgets, disposable income, spending limits and use of credit cards Assets, savings and retirement should also be discussed periodically.

3. Each plan a date night. Each person plans one date night per month with approval of the other in the pre-family meeting. As far as couples are concerned, I always suggest selecting date nights and putting them on the calendar. You both are expected to plan one date night per month. You select the activity, get it approved by the other and you get the tickets and babysitter. By the way, you each get one veto. In other words, my wife is never going to Chicago Bear game. She hates to be cold; she is just not interested. That’s ok because I’m never going to the opera. Planning is key and date night can’t always fall on the wife to take care of all the details. That takes all the enjoyment away for her.

4. Plan a vacation.

5. Get on the same page for the meeting with the children to ensure parenting as a team.

When the children are included you, of course, want to be a unified front. So, get on the same page with your relationship, parenting, and rules and consequences for the children. How will you handle the morning routine issues in the future. What will consequences be for being uncooperative or breaking the rules.

The general family topics are: News, Compliments, Issues and Feedback. Here are some examples:
1. News: This is a chance to keep everyone up to date of all the family events coming up. The more informed everyone is, the more opportunities to share the scheduled load and the less stress for last minute- must do projects. “We are going to grandma’s house next weekend or Joey has a science project due and he will need craft paper

2. Compliments: Search for things your child is doing well, no matter how small and acknowledge it. It will increase their sense of confidence and self-esteem. Show that you are excited and proud of them. “You did much better getting ready for school on time this week. Let’s keep it up.”

3. Issues: We live in an increasingly complex world that challenges us every day with a wide range of disturbing issues. By initiating conversations with your children you will create an open environment and be able to address the tougher topics i.e. homework, curfew issues, chaotic morning or bedtime routine, alcohol and drug abuse. For example, discuss “the morning routine with Joey outside of the moment because in the moment never works. In the family meeting we say, ‘we all want a more cooperative, peaceful morning to start the day. Let’s try and make that happen.’ This creates a built in reward system even if their is only slight improvement. So you continue that goal until you feel it is consistent enough to move on to something else.

4. Feedback: Listen to your children and allow them the chance to express their concerns, complaints and express their feelings. You will learn more about your child if you open your ears and close your mouth. Try to have some one on one time periodically with each child. Go to McDonalds, and shut your mouth, and open your ears. You will be surprised what a difference it makes in so many ways. It creates a good emotional connection.

I have found that both parents and children love this opportunity. The only concern is that as much as everyone in the house likes this, parents themselves have a difficult time being consistent. They often report that they were consistent initially but the process hasn’t been repeated in weeks. Be consistent! Family meetings are just one way to address poor communication and help nurture relationships within the family.

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

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, Glossary of terms

Seasonal Affective Disorder (SAD)

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

What is Seasonal Affective Disorder?

SAD as it is known by many, is a type of depression related to the dark gloom of fall and winter with shorter days and less sunlight. SAD is exacerbated by a decrease in activity level that is generally created in the cold winter months. The symptoms are largely the same but not as severe as for other depressive disorders including poor sleep and fatigue, crying spells, irritability, poor concentration, weight gain and loss of sex drive. In some severe cases, seasonal affective disorder can also be associated with thoughts of suicide.

Though symptoms usually improve in the summer, many people have found relief from the use of full spectrum lighting in their homes. These lights come in a variety of shapes and sizes and can be easily found on the internet. Probably the least expensive of these is the 27-watt full spectrum CFL bulb which can be placed strategically in fixtures and lamps throughout one’s residence. These are effective when used on a daily basis. Sometimes, however, these lights are simply not enough. In these cases, many of my clients have found relief by taking an antidepressant for a period of time and by increasing the level of physical exercise especially cardio work.

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 847-733-4300 Ext 638.

http://manageyourmood.net
http://family-institute.org
http://takenotelessons.com   Highly effective SAT, ACT, GRE, standardized test preparation and much more.

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

What are the most common relationship issues and conflicts?

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

How to deal with conflict in your relationship?

For a vast majority of the individuals, families and couples there are common conflict themes. These include: mood disorders, lack of civility and respect, resentment, poor communication, lack of intimacy, infidelity, alcohol and substance abuse, financial and parenting issues. One thing is certain, there is no guarantee of “happily ever after” especially in this day and age when so many things can get in the way of your relationship. Relationships take work and attention to ensure a good marriage. Life has a way of interfering in our relationships. Couples can get lost in the day to day grind of life. We have to make time for one another to keep our connection strong. Many of the common issues listed here are addressed in the following case studies.

Case Scenario – Depression
Dan and Wendy have been married for 14 years. They dated for three years prior to marriage. They have three children ages 6, 9 and 12. Dan’s mother has a history of mood disorder though it was never formally diagnosed. She lives in the past having never gotten over the infidelity of her husband, their subsequent divorce and his marriage to the other women. His Dad is a recovering alcoholic. Dad has been sober for ten years but he is difficult to get along with as his second marriage is also an unhappy one.

Dan is currently unemployed because he can’t get along with co-workers. He has no friends; all have abandoned him because of his temper. Dan tends to hold grudges and he writes people off if he perceives that they have wronged him. He has few interests and spends his time surfing the internet or playing video games. Dan lacks motivation and drive and his concentration is poor. He stays up until four or five in the morning. Wendy is scared because he is unmotivated to look for work and they are now in financial trouble. They bicker over his alcohol use and his inability to share his feelings.

My assessment indicates that Dan has many of the classic signs for clinical depression, his symptoms include lack of motivation and no friends. He isolates himself and his sleep wake cycle is reversed. He is up most of the night and sleeps most of the day which is a way of avoiding people and responsibility. He has been drinking more than usual. Wendy made the appointment and Dan was reluctant to join her but he did. I asked that Wendy come in even if Dan says that he won’t come. Invariably the husband will ask about the appointment. I suggest when asked, “If you want to know you’ll come with me next time.”

I gave Dan the list of depressive symptoms and asked him to put a check next to those that applied to him. He checked 8 of the symptoms listed. I encouraged him to have a psychiatric evaluation for medication to address his depression and use of alcohol to self-medicate. The doctor put him on the appropriate medication. I worked closely with the doctor to ensure a unified treatment approach. Goals were set for him and for them as a couple.

First part of his education was learning about his depression. I pointed out that it was not his fault. More than likely he inherited this from either one of his parents. To start him on his path to recovery, I encouraged him to have more structure in his day. That meant getting up at 8pm and going to bed no later than eleven thirty. He was also to take a walk at least 4 times per week for forty minutes since they could not afford a gym membership at this time. Part of creating his plan was to pick the days that he was to walk each week. He was also encouraged to reconnect with his friends and to avoid the use of alcohol.

After a few weeks on the medication he began to feel better. In the meantime, I continued to educate both he and Wendy about his depression. Once Dan was feeling better, we began to address the marital issues created by his depression. He was encouraged to make “I feel statements”. These types of statements help address emotional withdrawal by allowing the partner to understand what their loved one is thinking and feeling, ultimately helping them feel more connected. Saying “I feel,” is also a signal to alert Wendy that Dan is trying to communicate effectively. Hopefully this signal will help both Dan and Wendy to be less defensive in their communication.

I also encouraged a date night at least twice per month and advised that these dates do not have to cost a lot of money. Just getting out together, walking or going for coffee or ice cream was fine. The idea is to spend some quality one-on-one time.

Mood disorders are a chemical imbalance in the brain but also include environmental issues and personality traits. About one in seven individuals will at some point in their life experience it. Situational depression is created by marital conflict, job loss, grief and ongoing health issues. These will surely affect your relationship.

Many disconnects in a relationship begin when with mood disorder, alcohol or substance abuse and situational depression. If these issues are not addressed, it is unlikely that progress will be made in couples counseling.

Studies show that there is usually a history of mood disorder or alcoholism on one or both sides of the family. It is imperative that the therapist be direct with their clients about the assessment, and encourage a psychiatric evaluation to determine if medication is appropriate. Once this is addressed, it is very possible to resolve many of the couple 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://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.

Couples, Relationships

How to nurture your relationship?

6 Comments

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

Nurture your relationship.
It is a hectic world we live in. Everything seems to take precedence over our relationships. Health issues, kids’ activities, work issues all take precedence. The next thing you know when you look back is that you haven’t had time for just the two of you in months!
All-in-all life just gets in the way so it’s easy to lose your connection to your significant other. The way to deal with this is to plan your quality time. Trade who gets to pick what you will do. Gentlemen don’t let her do all the planning; it takes the joy away for her. When you do get out that is not the time to talk about the kids or your issues with one another. Some couples even plan for intimacy which I have also seen work. The goal here is to reconnect but if it’s going to happen planning will be necessary. Put it on the calendar and have fun. It’s good to have fun. Have fun together! I’ll bet your level intimacy will improve also.

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 carrier for details.  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.

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

How to recover from depression?

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

How to be well when you have depression!
Coping with a mood disorder is no easy task! It takes professional support, medication, in some cases, psychoeducation and experience to manage the debilitating symptoms. With the necessary supports and monitoring, persons with mood disorders can learn to have long-term stability and consistency.
I have also found that it takes an average of about one year to reach those goals. In addition, many people will need some level of support on and off for their entire lives. The bottom line is you can’t do it alone. Initially, you need a psychiatrist to manage your medication, if necessary. Once you are on the right medication at the right dose you can get your prescription from your family doctor. The therapist will provide guidance for symptom management and relationship issues.

Ten Steps to Wellness
1. Take the medication as prescribed by your doctor.
• “I don’t miss often; maybe once per week.”
The number one cause of relapse to symptoms is medication non-compliance. This is definitely a tough one. In order for psychiatric medication to be effective, it must be taken daily as prescribed. I consider compliance to be missing no more than 5 pills per year! Many people don’t like to take medication, especially if it means daily for life. Let’s take one step at a time and see what it’s like to function to your capacity for a year or two before you make decisions about the rest of your life.
But remember, clinical depression is a lifelong illness and it’s all about a chemical imbalance. It is a biological problem first and foremost. It’s like being a diabetic: you must take the medication as prescribed in order to be well.
2. No caffeine, substance abuse, or alcohol.
• “It’s not the caffeine. I like coffee. It doesn’t affect me. I’ve always drank coffee.”
Whether it’s coffee, power drink, soda or tea, caffeine can interfere with sleep and create anxiety. It is the most obvious reason for poor sleep. With your doctor’s supervision to avoid anxiety and headaches, gradually reduce your daily caffeine use. Eventually, when you are caffeine free, I believe, you will feel and sleep better.
I would certainly recommend gradually reducing caffeine use before asking the doctor for a sleep aid. Caffeine may interfere with your sleep/wake cycle. As far as your mental health, I recommend keeping caffeine to a minimum and before noon.
I also don’t recommend working the night shift i.e., midnight to 8 AM. It is difficult for your body to adjust. For a person with a mood disorder, this is not recommended. The back and forth between day and night shifts and the social isolation are risky to one’s mental health. It also wreaks night havoc with the sleep/wake cycle. Lack of sleep for a client with a bipolar disorder may bring about rapid mood fluctuations and jeopardize stability. Tell your doctor or your therapist if you are not sleeping. Wouldn’t it be better to reduce the caffeine rather than take a habit-forming sleeping pill?
• “What? I can’t have a glass of wine with dinner? I don’t do it often. It’s just one glass. It’s not like I’m an alcoholic.”
The second leading cause of relapse to symptoms is alcohol and substance use. Some doctors and even therapists say that it is alright to have one or two drinks if you have no alcohol abuse or dependence issues. I still question this because alcohol and pot are depressants. Why would you take a depressant when you are depressed or taking an antidepressant under any circumstance?
Alcohol may affect your mood for days. At least track your mood on the calendar after you have been drinking to see if it has made your symptoms worse. As far as alcohol and substance use, it is as simple as it is hard. If it interferes with your life, your daily functioning or your relationships, don’t do it!
There is a definitely a negative correlation between the use of alcohol or drugs and a mood disorder. The increased chance of dependence and risk of relapse to the symptoms of your mood disorder are just not worth it. Connect the dots! The bottom line is that for many people USE IS THE SAME AS ABUSE!
I recommend you discuss this with your doctor. If you already know you have a problem, get into Rehab. It’s never too late to turn your life around. Get professional help and go to your Alcohol or Narcotics Anonymous meetings as often as it is necessary to maintain sobriety. Even if you are not dependent, alcohol or pot may not be a healthy choice for you. Don’t deny the obvious. So remember, the healthy use of alcohol for one person, may not be a healthy for you. Make healthy choices!
3. Take care of your physical health.
Be sure to have annual dental and physical exams. Some medications require regular blood testing. Some physical ailments can cause depression. See your doctor regularly.
4. Exercise (cardio)
People with mood disorders tend to be sedentary. They need to walk and get exercise as much or more than any of us. You don’t have to join a gym; all you need to do is take a brisk walk. You don’t have to run but you do have to hustle a little bit. Studies going back thirty years or more say that cardiovascular exercise lifts one’s mood and reduces anxiety. The more recent studies show that those old studies are true but the walk needs to be at least 40 minutes to get the full benefit toward lifting your mood and reducing anxiety.
Walk at least 4 times per week. I also recommend that you pick your days, otherwise you will say, “I don’t feel like it today; I’ll do it tomorrow.” Tomorrow comes and the same thing happens. If you make a schedule and stick to it (say, Monday, Wednesday, Friday and Sunday), the day of the week makes the decision for you. “Oh darn, today is Monday. I have to walk.” Remember, depression affects one’s motivation; if you wait until you feel like doing it, it may never happen.
Note: Always consult with your doctor before starting any exercise program.
5. Plan to have fun
It’s good to have fun; have fun! When my son was about four years old, I remember distinctly, it was a beautiful summer day. Our front door was open and he stood there and saw children outside playing. He said, “Dad, there are kids out there! Can I go out and play?”
My point is that when you are a child, all it takes is something as simple as finding other kids and the party is on! As an adult, it takes planning, especially if you have a mood disorder. You need to take time to plan to have fun. Join a bowling league, take a pottery class or cooking class, take ballroom dancing, or take a photography class at the local park district. Take an adult education class at your local community college or park district. It’s not about the grade so you can also skip the tests and homework if you want. Check out meetup.com or adventsandadventures.com These may also help provide some structured socialization. These are inexpensive and fun and a great way to meet your socialization goals!
• Do it to be more social.
• Don’t do it for a grade.
• Do it because you are interested in it.
• Do it to help manage your symptoms and your free time.
6. Make time to nurture your relationship.
Line up sitters so you can have time alone with your spouse or significant other. Planning is key! This may feel awkward at first, but keep it up anyway. Gentlemen, don’t let the wife be responsible for all the social and vacation planning. Do your share. Plan a date night. Take turns choosing what you will do. When you go to dinner, discuss your next date night, event, or do vacation planning. Don’t use the date night to discuss difficult issues. This is should be a fun time and a way to nurture your relationship. If you are going to have fun, you are going to have to plan ahead!
7. Be social
A common symptom of a mood disorder is social dysfunction or social isolation. Human beings are by nature social creatures, but unfortunately, a common symptom of mood disorders includes social isolation and/or withdrawal. Call a friend and make a lunch date. Have people over to play cards or watch a sporting event. If you don’t have a large social network, use the park district or local community college to meet people. Taking a class or joining the volleyball league at least gives you an opportunity to be with people and make a friend. While meeting strangers may seem intimidating, think of it this way: if you don’t know them to begin with, then you really have nothing to lose if things don’t work out. On the other hand, you never know when a stranger can turn into your new best friend, business partner, or love interest!
8. Hobbies
Try woodworking, sewing, knitting, crossword puzzles, gardening, toy trains, arts and crafts, or whatever you choose! Go to a hobby shop and look around but pick something and stick to it. Work on your hobby several times per week or when you are feeling low, negative, or worrisome. It is quite possible you will enjoy the activity so much that you will forget about your symptoms for a while. Hobbies are a great way to distract yourself from troubling thoughts when one else is around.
9. Chores
Most any physical activity is a good distraction from your negative thoughts and symptoms. Chores are another way to distract yourself and give you a clean environment. When you have depression, the idea of cleaning the entire house or apartment can be overwhelming. Break your chores down into one or two chores each day. For example:
• Monday is vacuuming
• Tuesday is bathroom cleaning
• Wednesday is washing the floor
• Thursday is cleaning the kitchen
• Friday is changing the sheets and towels day
• Saturday is laundry day
• Sunday is a free day. It is your reward for doing your chores all week long.
Chores are a great way to distract yourself from your symptoms. Most any physical activity will help. Make a schedule and stick to it. Try to come up with your own list of distraction activities. The more things you try, the less likely you will be a victim of your disorder.
10. Make healthy choices
This is my generic one. This one may very well be different from person to person. A healthy choice for one person may not be healthy for you. If you have a mood disorder, poor sleep, too much caffeine, alcohol or drug use, and social isolation are mental health issues. Remember! You manage it or it will manage you!

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
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.

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

Psychiatric Treatment – Help the Doctor Help You

2 Comments

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

How to prepare for your psychiatry appointment?

Help the doctor help you to avoid relapse to active symptoms of depression, anxiety or panic.  The Psychiatrist is an integral part of the treatment team. S/he needs your honest input to best help you. If any of the following are problematic, report them to the doctor. Write things down so you are prepared for your appointment.

Report any changes in your symptoms to your doctor including:

1. Changes in sleep patterns, little or no sleep.

2. Changes in Mood often accompanied with negative thoughts, seemly on repeat.

3. Poor concentration, poor short-term memory

4. Disturbing thoughts of self-harm or harm to others

5. Drug and alcohol use/abuse

6. Medication side effects or allergic reactions

7. Social activity or isolation

8. Poor self-care

9. Physical activities, hobbies, chores

10. Poor money management

11. Unusual behavior

Psychiatric Medication

Psychiatric medication is useful in controlling symptoms of mood disorders. Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and often times create relationship issues. Medication and medication management are essential in the management of the biology or the chemistry of the disorder. I consider this to be the foundation of treatment. It is difficult, if not impossible, to treat a severe mood disorder without medication. You can’t build a solid house without a good foundation. Medication provides that solid foundation.

Therapy addresses the psychosocial treatment issues including identification and management of symptoms, daily living skills, coping skills, and the relationship issues which often accompany these disorders.

Refusal to take medication is a common issue. I do on occasion have clients who refuse medication. In the past, I have said, “I will work with you to see if we can make an impact on your symptoms.” If we do, that’s great. If not, I will try to deal with the denial and the refusal of medication.

What if I told you that you are a diabetic and will have to be on insulin injections the rest of your life? Of course, most people wouldn’t like it, but chances are, they would take their medication. Why is medication for a mood disorder any different?

Let me remind you that alcohol is a drug and if you are drinking, you are self-medicating with a depressant. This may lead to alcoholism or substance abuse and addiction. Wouldn’t it be wiser, safer, and more productive to let a doctor prescribe the correct medication to help you get on the path to recovery?

Medication and Support

Many people remain on medication their entire lives. Some people with mild depression or situational depression are able to use medication intermittently for periods of stress that cause their depression to re-emerge. Others don’t want those periods of regression in their life, so they chose to just stay on the meds. I encourage clients to consult with their doctor for recommendations.

Therapeutic support may also be intermittent or as needed after a time. Depending on the severity of the disorder and how well a person learns to manage, I recommend that my clients check-in at least three or four times per year. This is especially common for couples whose disorders affect their marriage.

Unfortunately, some people with severe mood disorders may go in and out of the hospital their entire lives if they remain in denial. This is usually a result of non-compliance with treatment and medication, combined with alcohol and/or substance abuse. Mood disorders and addiction can be global disabilities or manageable handicaps. Which one will you choose?

The number one cause of regression and recurrence of symptoms is not taking medication as prescribed. This is not like having a headache. When you have an ordinary headache, you take two aspirin and twenty minutes later your headache is gone. In order for antidepressants or mood stabilizers to work effectively, the drug must maintain a certain level in the body. When that level is not maintained, debilitating symptoms reappear. These medications take four to six weeks to reach their peak level of effectiveness. When you miss doses of medication, drink or use drugs, you negatively affect that level.

Medication Side Effects and Allergic Reactions

All medications have side effects. Even aspirin can cause ringing in the ears if you take too much. The pharmacy must list all side effects, but that does not mean you will experience any or all of them. Most of the common psychiatric medications for depression and mood disorders have very few, if any, side effects after the first week or so. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Severe allergic reactions typically include but are not limited to rash, hives, and swelling (of the tongue). Always read the medication information given to you by the pharmacist. He or she is also a good source of information on medications.

The most common and less serious side effects are typically nausea, diarrhea, blurred vision, sleepiness, insomnia, dizziness, or headache. These usually go away in the first week or two. If any side effect becomes severe or you simply have concerns, contact your doctor or go to the ER. Know the possible side effects and allergic reactions of your medications. You should always know the name of your medication, frequency, and the dosage in milligrams. Carry a card in your wallet that will tell emergency personnel exactly what you are taking. If you have questions or concerns, direct your questions to your doctor or pharmacist. Dial 911 or go to the emergency room for serious allergic reactions and side effects. Ultimately, the more you know, the safer you will be.

Mental Illness is a disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage severe depression and other mood disorders. Some say you just have to be tough. “You just have to pull yourself up by your bootstraps and try harder.” This is false and it won’t work. The only way to successfully manage a mood disorder is with education, medication, structure, ongoing treatment and support.

Always contact the doctor when faced with positive (active) symptoms. Do not self-medicate. A doctor never operates on himself or his own family. Don’t play doctor! Remember, the leading causes of relapse are medication non-compliance and drug and alcohol use. The doctor can’t possibly medicate you properly if he does not know honestly what the patient is or is not taking including alcohol or substance use!

Rule of thumb: Never lie or withhold information from your doctor or therapist.

It is extremely important to learn to make healthy choices. Sometimes people do not recognize that the choices they make may not be healthy. Once stable and consistent, some people simply need to check-in with their therapist a few times per year. Others need ongoing supportive therapy every two to four weeks to remain stable. The frequency will depend on the individual and how well one manages their disorder. Together with your doctor, therapist, and ancillary supports, if necessary for dual diagnosis, you can learn to manage your symptoms and cope with the day-to-day stress of depression, mood disorder, or dual diagnosis. This is the reason that ongoing support from your doctor and therapist is essential for management.

You should call your doctor, 911 or go to the hospital if you are experiencing medication side effects or an allergic reaction. If you have thoughts of hurting yourself or someone else call your doctor and therapist immediately. If you are actively considering hurting yourself, call 911, go to the emergency room, or call the National Suicide Prevention Helpline, 1-800-SUICIDE (1-800-784-2433).

The Leading Causes of Relapse

The causes of relapse to active symptoms of a mental disorder have been well documented over the years. It’s no surprise that these reflect the relapse warning signs listed below.

They are:

  • Medication non-compliance (Not taking the medication as prescribed).
  • Alcohol and substance use and abuse.
  • Little or no sleep.
  • Lack of social support.

Non-compliance with medication and alcohol or substance abuse are by far the leading causes of relapse to symptoms. These are self-explanatory. However, little or no sleep and lack of social support may also need to be addressed.

Sleep is an important issue for most with mood disorders. People with Bipolar disorders usually report that they don’t need much sleep. They have a tendency to play with their sleep/wake cycle. They like the euphoric hypomanic feeling that lack of sleep creates. It is very much like the moth and the flame. There is an attraction to the high that one gets when they are sleep deprived. Unfortunately, you can take anyone in the world and keep them awake for two, three or four days, they will become actively psychotic or out of touch with reality. For people with a mood disorder, sleep is a mental health issue.

Social support is also very much a part of maintaining good mental health. Even if one is compliant with medication and not using or abusing alcohol and drugs, social isolation can create considerable stress and ultimately cause a relapse to symptoms. It is imperative that people with mental disorders, have an avenue to combat their tendency to isolate and withdraw from people. I encourage my clients to maintain regular social contact. This contact creates reality testing. We don’t think of socialization as reality testing, but it is. For example: You have an argument with your spouse; you call a friend and say here is what happened. What do you think? You get feedback on your situation and behavior. That is reality testing. Lack of social support may result in an inability to test the accuracy of what one is feeling or experiencing. This is obviously a very important component of maintaining good mental health.

Relapse Warning Signs

Be aware of relapse warning signs and symptoms. When one is taking medication as prescribed by the doctor, symptoms are largely under control and the client is stable. The reappearance of certain symptoms is an indication that the medication may need to be adjusted, reevaluated or changed. These symptoms may also be an indication that the medication is no longer being taken as prescribed or alcohol and substance use is interfering with the effectiveness of the medication.

Relapse warning symptoms include:

  • Thoughts about hurting oneself or others
  • Changes in one’s sleep/wake cycle, especially little or no sleep
  • Inability to concentrate, rapid speech, skidding from subject to subject
  • Rapid mood fluctuations, mania, or depression
  • Poor judgment, risky behavior, or lack of insight into one’s own behavior

These symptoms are reflected by poor daily functioning, lack of motivation, loss of interest and conflict. These are considered to be active symptoms and usually are caused by non-compliance with medication and use of alcohol or drugs. In many instances, the medication may need to be changed or the dosage adjusted by the doctor. This may also reflect the need for family members to monitor medication compliance and alcohol/drug usage. Relapse warning signs should be reported to the doctor and therapist immediately. Don’t wait!

Zoom!

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.

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.

Couples, Marital Family Issues, Relationships

How to nurture your relationship!

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

Nurture your relationship if you want to make it last.

It is a hectic world we live in. Everything seems to take precedence over our relationships. Health issues, kids’ activities, work issues all take precedence. The next thing you know when you look back is that you haven’t had time for just the two of you in months!

All-in-all life just gets in the way so it’s easy to lose your connection to your significant other. The way to deal with this is to plan your quality time. Trade who gets to pick what you will do.

Gentlemen, don’t let her do all the planning; it takes the joy away for her. When you do get out that is not the time to talk about the kids or your issues with one another. It’s time to be a couple and have fun together.  I recommend that you each pick 3 date night activities and you should rotate so you have at least two date nights per month.  You each get one veto in terms of your spouses selection.  In other words, if my wife chooses the Lyric opera, I would definitely veto that one.  When you are done with all 6, just start over. Date night twice per month will keep your relationship strong.

Some couples even plan for intimacy which I have also seen work. The goal here is to reconnect but if it’s going to happen planning will be necessary. Put it on the calendar and have fun. It’s good to have fun. Have fun together! I’ll bet your level intimacy will improve also.

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 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.

Marital Family Issues, Relationships

Weekly Family Meetings address many common child behavioral issues.

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James E. DelGenio LCPC Senior Therapist at The Family Institute at Northwestern University

Address common child behavior issues and improve your relationship at the same time!
Once upon a time, families ate dinner together. There was no eating in front of the TV; no texting or answering the phone and no internet. This was a time when families discussed what was going on in the household i.e. news, upcoming events, behavior issues and general discussions. Dinner used to be the natural time for families to discuss their lives, upcoming events and issues of importance.
Today, I find that families rarely eat together, missing the opportunity for family discussion. Child activities including little league, football, soccer, music lessons, dance lessons, and all kinds of after school activities have come to interfere in this essential family event. Families have become ships in the night passing one another as they head out the door. The idea of after school activity is potentially a good one: keep the kids busy and you will keep them out of trouble. However, what has been lost is the sense of family and the opportunity for good communication.
When I was a child, dinner time was always between 5 and 5:30pm. I had a lot of freedom but I also knew what was expected of me. In this case, it was “be home by 5pm” for dinner.
We would hear stories, news and discuss family issues. Today parents have become dependent on dual incomes in order to maintain the lifestyle they want to give their family. Now that the world economy has become more difficult and we have high unemployment and home foreclosures are rampant, parents are working two jobs just to make ends meet. They work late or have different schedules and their relationship suffers. They too, are ships passing in the night. Many couples today report they feel disconnected, their communication has suffered and, in turn, so has the level of intimacy they share. This will ultimately lead to bickering, conflict, infidelity and possibly divorce. How sad that an important family event has disappeared without realizing the major negative impact on the family. Even when couples do realize the problem, there is little that can be done since they are trying to stay afloat financially.
One way to reclaim some of that lost family communication time are family meetings, though some of my clients prefer to call them team meetings. I encourage families to gather at least once per week to discuss four areas. Ideally, this should be done at the same day and time each week. There should also be a pre-family meeting for mom and dad to discuss there issues and get on the same page for the meeting with the kids to ensure you are parenting as a team.
The general topics to discuss are Compliments, News, Issues and Feedback. Here are some examples:

  1. News: This is a chance to keep everyone up to date of all the family events coming up. The more informed everyone is, the more opportunities to share the scheduled load and the less stress for last minute- must do projects. “We are going to grandma’s house next weekend or Joey has a science project due and he will need craft paper”
  2. Compliments: Search for things your child is doing well, no matter how small and acknowledge it. It will increase their sense of confidence and self-esteem. Show that you are excited and proud of them. “You did a nice job getting ready for school on time.”
  3. Issues: We live in an increasingly complex world that challenges us every day with a wide range of disturbing issues. By initiating conversations with your children you will create an open environment and be able to address the tougher topics i.e. homework, curfew issues, chaotic morning or bedtime routine, alcohol and drug abuse.
  4. Feedback: Listen to your children and allow them the chance to express their concerns, complaints and express their feelings. You will learn more about your child if you open your ears and close your mouth.
    I have found that both parents and children love this opportunity. The only concern is that as much as everyone in the house likes this, parents themselves have a difficult time being consistent. They often report that they were consistent initially but the process hasn’t been repeated in weeks. Be consistent! Family meetings are just one way to address the potentially poor communication within the family.
  5. Planning is key
    It is a hectic world we live in. Everything seems to take precedence over our relationships. Health issues, kids’ activities after school, work issues all take precedence. The next thing you know when you look back is we haven’t had time for just the two of us in months! All-in-all life just gets in the way so it’s easy to lose your connection to your significant other. The way to deal with this is to plan your quality time. Trade who gets to pick what you will do. Gentlemen don’t let her do all the planning; it takes the joy away for her. When you do get out that is not the time to talk about the kids or your issues with one another. Some couples even plan for intimacy which I have seen work also. The goal here is to reconnect but if it’s going to happen planning is the key. Put it on the calendar and have fun. It’s good to have fun. Have fun together! I’ll bet your level intimacy will improve also.

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://jamesdelgenio.com
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.


Couples, Premarital Issues, Relationships

Premarital Counseling is a really good idea!

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

Premarital Counseling is a really good idea! 

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 work, finances, 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 psychoeducation and symptom management?
• 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?
It’s not going to get better if your intended is in denial. Get out while you still can!
Civility and Respect
Work on resolving conflicts in a civil and respectful way. Lack of civility and respect will eventually be the undoing of any relationship. It is possible to argue, resolve conflicts, and agree to disagree in a respectful manner. In order to do this, all couples need rules of engagement for conflict. It is important that couples express how they feel, but this needs to be done in a very caring and respectful manner. This definitely means there should be civility and respect when conflict occurs. That means no hitting (of course), no yelling, no swearing, no screaming or name calling or sarcasm. I encourage you to look at yourself and your relationship with your intended. Are you holding onto resentments? If so, you will need a therapist to help resolve this and teach you how to fight with civility and respect.

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 for more information.

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.

Marital Family Issues, Premarital Issues, Relationships

Finances cause of conflict in marriages

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

Arguments over finances are a common issue in many relationships. Here are some tips that will help avoid conflict over finances.

Set Goals and Objectives for your finances.

  • Share detailed financial information regularly.
  • Make financial decisions together.
  • Create a budget.
  • Go over your finances together at least monthly.
  • Who will pay the bills?
  • What is your retirement goal? 
  • How much will you contribute each month to your 401 plan? 
  • How much disposable income do you have each month?
  • How much will you put into savings each month? 
  • Suggestion: If you can’t pay the credit card bill in full when it comes, then don’t make the purchase.
  • Set an amount ($200 for example) that you agree to disclose to each other before making a purchase.
  • Don’t discuss issues, especially financial, on your date night.
  • Have a team mentality. Work together and commit to acting responsible with money. This will also result in fewer financial arguments.
  • Contribute to paying the bills in proportion to your income as opposed to your spouse’s income.

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 PPO 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://jamesdelgenio.com
http://family-institute.org
http://takenotelessons.com   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.