All posts by James DelGenio

Individual, Family, and Couples Counselor with over forty years of experience as therapist, author, and continuing education provider.
Alcohol Dependence, Bipolar Mood Disorders, Substance Dependence

What you should know about dual diagnosis?

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

What is dual diagnosis?

Dual Diagnosis means that two or more independent disorders exist in the same individual. Specifically, for our purposes, when I speak of dual diagnosis, I am referring to mood disorder and alcohol abuse or drug dependence. Each exists independently of one another and yet each makes the other worse. Both are biological and psycho-social disorders with similar symptoms. They are lifelong disorders, which cause the person to be prone to relapse. Both require integrated treatment that includes psychiatric treatment, medication, psychotherapy, education, symptom management and additional supportive treatment such as Intensive outpatient (IOP), group therapy and Alcoholics Anonymous as needed.

Mood disorders and alcohol and substance abuse do not interact well. In fact, each makes the other worse, especially when one is using and/or not taking medication as prescribed. One must manage both disorders simultaneously and treatment must be a collaborative effort with the level and the array of services necessary to maintain stability, sobriety and consistency.

It is helpful to think of someone you know who is diabetic and what it means to be a diabetic. Mood disorders may not be as visible as sitting in a wheelchair, but you do have a disability. Mood Disorders, addiction and diabetes are comparable in many ways. Each is a lifelong, biological problem that requires daily attention, education and support.

Medication, when taken as prescribed, stabilize each condition but knowledge and training play a very important role in healthy functioning. The comparisons demonstrate that mental disorders, like other physical handicaps, can become manageable handicaps; not the global disability it is for some. It is a result of genetics, an imbalance in the chemistry of the brain. No one is at fault, and no one is to blame. Management of a Mood disorder may well be a lifelong pursuit.

  • Manage both disorders simultaneously.
  • Take medication as prescribed by your doctor.
  • Use coping skills, ie., cardio, socialization, hobbies.
  • Limit or abstain from alcohol use.
  • Your ability to maintain sobriety and manage your mood determines. the level of support needed.
  • Each failure requires an increased level of support, esp around alcohol or substances.

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.

Alcohol Dependence, Anxiety Panic Grief Depression, Bipolar Mood Disorders

What are the causes of relapse to symptoms of depression

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

What causes relapse?  

The causes of relapse to active symptoms of mood 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, isolation.

Non-compliance with medication and alcohol or substance use or 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 also need to be addressed.

Alcohol and/or substance abuse will cause relapse to active symptoms of depression, panic and anxiety. If you are not an alcoholic, I recommend no more than 2 drinks twice per week but never in back to back days. If you mood dips in the days following you should consider abstinence.

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. 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.

Zoom!   Now I can work via Zoom with anyone, anywhere in the country and it may 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.  I am currently doing Zoom only.

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

Alcohol Dependence, Anxiety Panic Grief Depression, Bipolar Mood Disorders, Coping skills, Glossary of terms, Premarital Issues, Relationships, Substance Dependence

Issues to discuss before Marriage. What you will learn in premarital counseling?

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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 psycho-education 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.

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.

Couples, Marital Family Issues, Premarital Issues

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 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.

Finances: Current debt, student loans, savings goals, retirement, pension, pool money or keep separate?
Family: Family relationships and issues, do you get along with in-laws, how often will you see them?
Religion: What are your religious views, what religion will you use to raise the children, will you attend services regularly?
Children: Do you want children, how many, thoughts on education, do you have similar values, parenting styles? What if you can’t have children?
Leisure and fun: What do you like to do in your spare time, common interests, vacation styles?
Spending: What is discretionary spending, how much is ok without consulting the other. Do you gamble?
Work and school: Will you be going to school? Will you both work; would you be willing to relocate for your spouses job? Are your work schedules compatible?
Roles: Parenting, paying bills, chores, traditional roles: women as homemaker, man as bread winner?
Lifestyles: What lifestyle are you aiming for? Where do you want to live?
Alcohol & drug use: Are there issues now that need to be addressed? Are you willing to seek help?
Holidays: What is your respective family traditions around the holidays? Will there be conflicting family expectations? How will you handle it? Will you really want the children to open gifts and then rush to get in the car to go visit family? It might help to think of you and your spouse as your own family unit, most especially, once you have children. Definitely worth the conversation especially if it has not come up already.

Zoom! Now I can work via face time 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.

Divorce, Marital Family Issues, Relationships

How to parent effectively after a divorce?

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

The answer is as simple as it hard!

What is in the best interest of the children?

Remember, it is not about you or your ex! It’s not about who lied, was uncivil, disrespectful or unfaithful. It’s about making this difficult time in your children’s life as easy as possibly under extremely difficult circumstances.

It goes without saying, physical  abuse, alcohol, drug abuse, neglect, endangerment or what ever the reportable event will require legal authorization for supervision, limits and boundaries. Despite the obvious, each parent must ask themselves:

Am I doing all I can do?

Act accordingly, despite the feelings involved. The following provide a point for self-reflection. What is in the best interest of the children?

1. Try to parent as a team. Co-parenting can be difficult at best after a divorce. However, I have seen many couples who still attend family functions together and make a point of going out to dinner as a family on occasion. It goes without saying that they will swap visitation dates when their schedules dictate. This is more common then you might think. Regardless of the state of your relationship, try to be more cooperative. Try to made a little easier for the children. It can be done if you really are interested in doing what is best for the children.

2. Communicate with civility and respect. Remember the walls have ears. No badmouthing your ex. No matter how angry you are; you still need to do what is in the best interest of the children.
There are several apps that help couples collaborate on their schedules and calendars. These apps give parents the ability to coordinate their schedules in order to stay on the same page. This can be very useful when there is still tension with your ex.

3. If your ex grounds a child, you should honor that decision and continue it even if it’s your weekend. I do recommend that there be parameters put on such consequences.

4. Don’t bring a new love interest around the children. Some people ask me for a time when it’s OK to bring someone around. I think it depends on the children and their age and how they are adjusting to the divorce. If I’m forced to give a time, I say one year. Parents really need to examine their own feelings and keep those emotions separate from what is in the best interest of the children.

Zoom! Now I work via Zoom  and it is still be covered by BCBS PPO 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

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

How to cope with depression, panic and anxiety?

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

How to distract yourself from your depression and anxiety?

Socialization, Exercise, Hobbies, and 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.

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

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, Severe mental illness, Substance Dependence

Why do people resist taking medication for depression?

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

Resistance to 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 create relationship issues. In most cases, 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, when necessary, provides that solid foundation.

Therapy addresses the psycho-social treatment issues including identification and management of symptoms, daily living skills, coping skills, and the relationship issues and conflict 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 the use of coping skills will have an impact an impact on your symptoms. If the use of coping skills does not work, I will revisit the medication issue.” If it does that’s great. If not, I will try to deal with the denial and the refusal of medication.

For instance, 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, you wouldn’t like it, but chances are, you would take the insulin injections in order to live! 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 (6 to 18 months) for periods of stress that caused 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, many of my client’s check-in at least three or four times per year, once they are stable and consistent in management. This is especially common for couples whose disorders affect their relationship.

Unfortunately, some people with severe clinical depression or bipolar 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, recurrence of symptoms and possibly hospitalization 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 medication 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 sleepiness, nausea, diarrhea, blurred vision, 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 substances!

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 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.

Couples, Marital Family Issues, Relationships

How to improve communication in the family?

80 Comments

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
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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.