Category Archives: Relationships

What you need to know about depression.

James E. DelGenio LCPC Licensed Clinical Professional Counselor

Mood, Depression and Relationship Disorders, Common Questions 

The following is a list of commonly asked questions and answers. I believe this will give the reader an overview of mood disorders and common marital and premarital issues associated with mood disorders. Please review them carefully; I also recommend that these questions be reviewed periodically.

1. What is a mood disorder?
A Mood disorder is a generic term for people experiencing mild to severe depressive disorders, bipolar disorders, situational depression, grief, panic and anxiety disorders, phobias, personality disorders and other disorders which may include alcohol or drug abuse or dependence. (Brown, Wang and Safran, 2005)
Clinical depression and bipolar disorders have become more commonly accepted by society generally and thanks, in part, to high profile actors and professional athletes who have disclosed their disorders to the public. Clinical depression and bipolar disorders are biological/genetic problems that you most likely inherited and are considered no different than the diagnosis of other medical conditions such as diabetes or epilepsy. These require education, medication, and ongoing treatment.

It is also important to note that not all mood disorders are lifelong or require medication.

For the purposes of definition here, I use two very different definitions to describe severe mood disorders. The first reflects denial of a problem and the second reflects acceptance of what is. Which one will you choose? The first definition is as follows:

Various forms clinical depression and bipolar disorders are lifelong disabilities, episodic in nature that may cause chronic dysfunction, asocial behavior, and failed relationships.
Here is a breakdown of this definition:

• Lifelong means there is no cure to date, though new medications, if taken as prescribed, have made many people relatively symptom free.

• Episodic means that sometimes the symptoms are worse than at other times for no apparent reason though stressful life events can also have an impact on active symptoms.

• Chronic Dysfunction includes inability to manage day-to-day events, unemployment, and often failed relationships.

• Asocial Behavior is that behavior which is irrational, inappropriate showing poor judgment and a lack of insight into one’s own behavior. This can include poor self-care and appearance. It may also include behavior that is harmful to one’s self or others.

• Failed Relationships include social dysfunction, isolation, withdrawal, marital and family conflict and divorce.

The second definition is as follows:

Clinical depression or bipolar disorder are lifelong disabilities, episodic in nature that the individual can learn to manage with medication, education and a skilled therapist. Other mood disorders may require a skilled therapist for ongoing support but may or may not require medication.

In some instances, denial will create failed marriages and conflictual relationships. These two definitions are separated only by education, psychiatric treatment and ongoing therapeutic support. The key here is management of a disability. You manage it or it will manage you! How do you want to live your life?

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

Alcohol also “washes out” and therefore may negate the usefulness of the medication. Remember, it takes four to six weeks to get the medication to a therapeutic level. When you drink heavily you affect that level. In addition, one should never use alcohol or substances when taking prescription medication. This can be fatal. It is understood that if you are an alcoholic you can’t have any alcohol. If you are not an alcoholic, you still need to check with your Doctor for approval of one or two drinks on very special occasions. In the days after, monitor yourself to see if it has affected your mood. If it does, use is the same as abuse!

3. Why is a mood disorders and alcoholism often found in the same individual?
The answers here are not completely understood. Some doctors have told me that the sites in the brain that are affected by mood disorders are the same sites affected by addiction. Regardless of the chemistry, research has shown that just casual use of alcohol by a person with a mood disorder may eventually result in abuse or dependence. If you have a severe mood disorder, you shouldn’t have any! The consequences are just not worth it.

4. 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 dependence or addiction. Each exists independently of one another and yet each makes the other worse. Both are biological and psychosocial 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.

5. What is addiction?
An Addictive Disorder is the preoccupation with acquiring alcohol and/or drugs, compulsive use of alcohol and drugs despite adverse consequences and a pattern of relapse to alcohol and drug use despite the recurrence of adverse consequences (Miller, 1991).

6. What are the symptoms of a mood disorder?
Clinical depression and bipolar disorders are biological disorders that can usually be traced through family history whether it was formally diagnosed or undiagnosed. Check the symptoms under A and B with a check mark. If you have four or more related symptoms, discuss these symptoms with your psychiatrist or therapist.

A. Symptoms of depression, anxiety, panic, grief, loss and situational depression
__ Lack of pleasure, loss of interest and energy.
__ Lack of goal directed behavior.
__ Lack of motivation, lethargy.
__ Inability to structure time, poor concentration.
__ Anger, hostility, irritability, resentment.
__ Strained relationships, marital issues, divorce, loss of friends.
__ Withdrawal, isolation, would rather be alone.
__ Difficulty in coping with the past or stuck in the past.
__ Sleeping too much or too little.
__ Anxiety, worry, sadness, low mood, tearful.
__ Paranoia or false beliefs, negative thinking, rumination.
__ Feeling guilty, stressed or hopeless.
__ Poor self-care including hygiene and diet.
__ Aches, pains, dizziness, headaches, or stomach aches.
__ Unintentional weight loss, gain.
__ Crisis prone, police involvement.
__ Low sex drive.
__ Thoughts of suicide, homicide.

B. What are the symptoms of a Bipolar Disorder?
Bipolar Disorder formerly known as manic depressive disorder is a mood disorder in which people may have mixed episodes of mania and depression. These symptoms may also include some of the above and in addition;
__ Rapid mood fluctuations.
__ Feeling high, euphoric or having inflated self-esteem.
__ Irritability, hostility, anger.
__ Aggressive or risky behavior.
__ Pressured, fast speech, more talkative than usual.
__ Racing thoughts, skidding from subject to subject.
__ Delusions of grandeur, grandiose beliefs or behavior.
__ Poor judgment, lack of insight, false beliefs.
__ Poor self-control.
__ Little or no need for sleep.
__ Increased activity, sexual drive and impulsivity including spending.
__ Easily distracted, poor concentration, short term memory issues.
__ Alcohol and substance abuse.
__ Bizarre dress and appearance.
__ Thoughts of suicide, homicide.

The above symptoms of depression and bipolar mood disorders are widely accepted. Since these disorders have a biological basis; a psychiatrist manages the medication while the therapist provides treatment and support. The therapist support often includes psycho-education, symptom reduction and management, increased coping skills and management of other day to day stressors such as job loss, school failure and relationship issues. The psychiatrist, therapist, family, friends and of course, the patient must work together as a team to construct an effective approach to these disorders. The most important aspect of this is good communication.

There are two types of bipolar disorders. They are Bipolar I and Bipolar II. Bipolar I is considered the more severe of the two disorders and has more extreme episodes of mania or depression. It may also have psychotic features such as delusions and paranoia. This generally includes being out of touch with reality. Bipolar II is characterized by milder swings of mania and depression and may have less serious effect on daily routine, relationships, or employment. Both bipolar I and bipolar II need ongoing treatment and medication to manage the symptoms well.

7. What are the symptoms of addiction?

Many of the symptoms of addiction and mood disorder are the same. Seventy to 90% of people with dependency issues also have a mood disorder. A person has to be drug free for one year in order to see if the mood issues are still present. The term dry drunk refers to a person who is drug and alcohol free but the mood issues remain. Common symptoms include:
Depression
Panic
Anxiety
Irritability
Thought disorders, delusions, psychosis
Mania
Restlessness
Confusion
Drowsiness, Insomnia
Slurred Speech
Memory Loss
Tremor
Diarrhea, Constipation
Cold sweats
Dilated pupils, tearing
Itching, hives
Skin flushing

8. How do these disorders interact with one another?
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.

9. Can a mood disorder be compared to a physical illness?
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 illness, 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. Mental illness is a lifelong disability, episodic in nature that one can learn to manage, with hope and with dignity.

10. How does a mood disorder affect thinking and behavior?
The symptoms of mood disorder and addiction are very similar. In fact, the treatment is also similar. Once medically detoxified, a person with mood disorder may be prescribed the same medications as in the treatment of substance abuse. It often takes a year or more of sobriety to determine if the person is suffering the effects of addiction or mood disorder or both as in dual diagnosis. You may have heard of the term dry drunk. This refers to someone who is alcohol free but has not addressed the accompanying mood disorder. This includes irritability, hostility and relationship issues and conflict.

11. What should you report to your Psychiatrist?
The Doctor needs your honest input to best help you. If any of the following are problematic, report them to the doctor. Write things down. (See Doctor reporting form in the appendix)
Report on:
1. Medication compliance.
2. Changes in your symptoms including:
a. Sleep patterns
b. Low mood or manic behavior
c. Concentration, poor short-term memory
d. Disturbing thoughts, nightmares
e. Negative thoughts, rumination
3. Drug and alcohol use.
4. Medication side effects or allergic reactions.
5. Social activity or isolation.
6. Self-care.
7. Physical activities, hobbies, chores.
8. Poor money management.
9. Unusual behavior.
10. Thoughts of self-harm or threats to others.

12. Will you have to be in treatment the rest of your life?
I would like to say no but many remain on medication their entire life. Therapeutic support may or may not be necessary after a time, depending on how well one learns to manage their disability. I have clients who see me a few times per year just to check in and reinforce their self-management. Some people with severe mood disorders may go in and out of the hospital their entire life if they remain in denial. This is usually a result of non-compliance with treatment and medication combined with alcohol and/or substance abuse. I try to point out that though you are not sitting in a wheelchair; it is not as visually obvious a disability but if you have a mood disorder you do have a disability. Mood disorders and addiction can be global disabilities or manageable handicaps. Medication and ongoing supportive treatment may be essential for maintaining healthy functioning.

13. Why is medication compliance so important?
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. For antidepressant medications to work effectively, one must maintain a certain level in the body. When that level in 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 you negatively affect that level.

14. How do you cope with the past?
Many people with mood disorders have difficulty coping with the past. Sometimes they appear to be living in the past, unable to get over some stressful life event. This needs to be explored with a doctor and therapist. This is a clear sign of depression and medication will most likely be necessary. When one dwells on the past, they often have difficulty coping with the present. I like the adage, yesterday is done; worry about today and tomorrow will take care of itself.

15. Why are recreation, exercise, and socialization so important?
It is good to have fun. Have fun! People with mood disorders often become engrossed in the past, their illness, and problems. Recreation and exercise (especially walking) are good for depression and anxiety and are a great distraction when one is experiencing symptoms. Any physical activity is likely to be therapeutic. Distraction from symptoms is an important coping skill. The tendency to isolate and withdraw also need to be overcome. The Internet, video games, TV or reading generally do not qualify as distraction for most individuals.

16. What if you don’t feel motivated to do the things suggested here?
Lack of motivation is often a direct result of a mood disorder. It is a symptom. If you wait to feel motivated, it may never happen. Walk 40 minutes per day at least 3-4 days per week with your doctor’s permission. 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. 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.

17. What are relapse warning signs aka positive symptoms?
Relapse warning signs are also known as positive symptoms. They are positive because they are present, active and uncontrolled by medication. These symptoms are typically a result of medication noncompliance or alcohol and drug use. Without intervention, these symptoms can have serious impact on thinking, judgment and behavior and may also include: psychiatric hospitalization, danger of self-injury and harm to significant others or the community.
Relapse Warning Signs reflect symptoms that include:
1. Thoughts about hurting oneself or others.
2. Changes in one’s sleep/wake cycle, especially little or no sleep.
3. Inability to concentrate, rapid speech, skidding from subject to subject.
4. Rapid mood fluctuations, mania, or depression, especially negative rumination i.e. negative thoughts that repeat over and over again.
5. Hallucinations or delusions.

18. What are the negative symptoms of a mood disorder?
Negative symptoms are traits most often missing in the individual. They are characterized by the absence of:
1. Motivation or goal directed behavior.
2. Pleasure.
3. Insight.
4. Good judgment.
5. Self-care, hygiene.
6. Emotional expression.

These symptoms are only partially controlled by medications. They are often what are left when positive active symptoms are controlled. It is for this reason that a person with a mood disorder still needs guided experiential psychotherapy.

19. What are the most common causes of relapse and regression to symptoms?
1. Medication noncompliance.
2. Alcohol and/or substance use or abuse.
3. Little or no sleep.
4. Social isolation.
5. Family conflict.

20. When should you call your doctor, 911 or go to the hospital?
Call your doctor or pharmacist if you are experiencing medication side effects or an allergic reaction. When you are thinking of hurting yourself or someone else, call your doctor and therapist. 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).

21. What do you do if you can’t sleep at night?
Little or no sleep is a relapse warning sign. Mood disorders cause sleep/wake cycle problems. First stop drinking caffeinated beverages or eating food that contains caffeine. Don’t nap during the day. Take your medication as prescribed. Maintain abstinence from alcohol and substance abuse. Maintain a consistent sleep-wake cycle. Always discuss your sleep issues with your doctor. Insomnia can be a precipitating event for relapse to active symptoms and possibly self-harm or harm to others. In this event, call 911 and/or your doctor.

22. What is the role of the family in treatment?
The role of the family in treatment is simply to monitor and report. The family should observe the patient’s behavior and report anything that may be important to the stable functioning and health of the patient. The patient should not be interfered with directly unless, of course, s/he is a danger to themselves or others. The family’s role in treatment is a collaborative effort in communication. The family should think of themselves as team members. We are all on the same team! Keeping secrets from the doctor or therapist interferes with treatment and may ultimately have serious consequences. Families should call their doctor, therapist immediately or 911 if the patient has any of the following behaviors or symptoms, especially if they are new, worse, or worry you. Call when the patient is:
1. Not taking their medication as prescribed.
2. Abusing alcohol, substances or uses medications not prescribed by a doctor.
3. Severely depressed, irritable, threatens violence or expresses thoughts of suicide or dying.
4. Exhibits behavior which may result in injury or harm to the individual, family, or community.
5. Experience of any relapse warning signs, especially no sleep.
6. Experience of panic attacks, uncontrolled anxiety, or restlessness.
7. Acting on dangerous impulses.
8. Exhibits unusual behavior that is out-of-character for this individual.

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

23. What can family members do to minimize the risk of relapse?
The following are frequent causes of family conflict and should be discussed with the doctor and therapist.
1. Monitor and report on medication compliance.
2. Monitor and report on the use of alcohol and drugs.
3. Avoid critical comments. Use “I feel” statements.
4. Avoid over involvement, enabling, unless the person poses a danger to himself or others.
5. Avoid excessive pressure to achieve.
6. Avoid trying to help motivate compliance.

24. How can family members learn to cope?
Mental illness is no one’s fault. It is a bio-psycho-social problem.
1. Avoid placing blame or guilt.
2. Don’t enable! You are not responsible for the patient’s wellness. S/he is!
3. Make regular opportunities to get away from each other. Have outside interests, hobbies, and social activities.
4. Get regular cardiovascular exercise. Join a health club or walk at least 40 minutes on regularly scheduled days each week. In the winter, use a treadmill or stationary bicycle.
5. Learn all you can about mood disorders but do not try to be a therapist.

25. Who is responsible for your happiness?
Who owns the problem? Don’t blame others for your disorder or problems. We have to play the hand that had been dealt us via genetics. That does not necessarily mean that relationship conflicts are not real or are just imagined but they can be exacerbated by the disorder and may need to be addressed in couples counseling or family therapy. Remember, a mood disorder is a biological problem like diabetes. If you don’t manage it, it will manage you.

26. What are the goals of treatment?
The goals of treatment of mood disorders are typically as follows:
1. Be evaluated by a professional to identify if a disorder is present.
2. Have a psychiatrist identify the need for medication, if any
3. Learn about the disorder and to recognize active of symptoms of the disorder.
4. Learn symptom management.
5. Learn coping skills, especially distraction through structure. Structure is created by having regularly schedule of activities, hobbies, and social support.
a. Encourage regular socialization.
b. Encourage regular cardiovascular exercise at least 4 times per week. (Take a brisk walk at least 40 minutes.)
c. Encourage hobbies and attention to daily chores.
6. Be consistent in the use of coping skills.
7. Learn to identify regressive symptoms, i.e., relapse warning signs and triggers.
8. Learn how to make healthy choices.
9. Learn how to be well.

Medical
1. Take medication as prescribed.
2. Report the presence of symptoms, suicidal or homicidal thoughts.
3. Maintain abstinence from alcohol and substance abuse.
4. Avoid caffeinated beverages, especially if sleep is poor.
5. Maintain a healthy diet and daily living skills.
6. Get medical and dental check-up annually.
7. Maintain psychiatric and therapeutic contact.
8. Have lab testing as directed by your doctor.
9. Report your sleep/wake cycle to your doctor.
10. Report medication side effects and allergic reactions to your doctor.

Social activity and support
1. Have at least one social activity per week.
2. Try to avoid napping during the day.
3. Join a club, call a friend, and take a class get a hobby.
4. Make plans for the weekend.

Coping Skills
1. Read goals daily, put a copy on the refrigerator at home.
2. Take a brisk walk 40 min at least 4 times per week.
3. See your doctor, especially when you are experiencing symptoms.
4. See your therapist regularly for support.
5. Check in with family and friends regularly and express your feeling appropriately. Try to avoid conflict.
6. Work on a hobby a half an hour every day or when you are experiencing symptoms as a distraction.

Note: Always consult with your Doctor before starting any exercise regimen.

Daily Living Skills
1. Bathe daily.
2. Dress appropriately.
3. Do chores on selected days.
4. Do volunteer work on assigned days.
5. Go to work, be on time.
6. Manage your finances.

Personal
1. Always maintain civility and respect in your relationships.
2. Make healthy choices.
3. Spend quality time with your family and friends.
4. Improve your self-esteem.

27. What medications do you take?
You should always know the name of the medication, the amount of medication and the frequency of the dosage. For example: “I take 20mg of Escitalopram (Lexapro) in the morning”. This will help ensure that medications given by other physicians will not be contraindicated. In addition, you should always ask your pharmacist about possible drug interactions. Don’t forget to mention any supplements you may be taking. A list of medications and dosages should also be carried on one’s person in the event of an emergency.

28. Why is psychiatric medication useful in controlling symptoms of depression?
Mood disorders are considered bio-psycho-social disorders. They affect thinking and behavior and frequently create relationship issues. Medication and medication management are typically 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 clinical depression without medication. You can’t build a house without a good foundation. Medication provides that solid foundation. To say it another way, medication does 50% while your management of the disorder does the other half.

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

I do on occasion have clients who refuse medication. In the past, I have either chosen to discontinue treatment or say, “we will have ten sessions and see if we can make an impact on your symptoms.” If it does, that’s great. If it does not, I will try to deal with the denial. In my experience, I have found that men have more difficulty with the notion of taking medication then do women. What if I told you that, “You are a diabetic and must be on insulin injections the rest of your life?” Of course, most people wouldn’t like it, but chances are they would do it. Why is this any different? I will also not hesitate to point out that alcohol is a drug and you are self-medicating with a depressant. This may lead to alcoholism or substance abuse and addiction. At some point, I may give up and discontinue treatment. That doesn’t happen very often because I can be very convincing, but it does happen.

29. What if you are inconsistent in taking your medication?
The key word here is consistency. The medication is extremely important to maintaining mental health. It is the foundation of treatment. If you are not consistent taking the medication, you will have difficulty functioning effectively on a day to day basis. This is not a headache. You take two aspirin and twenty minutes later your headache is gone. These medications don’t work that way. Remember, it takes four to six weeks to maximize the therapeutic effect of the medication. You must build up to a therapeutic level. When you miss medication, you affect that level. You may need to ask for assistance from family or friends. If you miss more than five pills a year, I consider you to be noncompliant with your medication. Always take the medication as prescribed. If you have concerns, side effects or allergic reactions contact your doctor or go to the ER or call 911.

30. What are the possible side effects of psychiatric medication?
Know that 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 them. Most of the common psychiatric medications for depression and mood disorder have very few if any side effects after the first few weeks. First, ask your doctor about allergic reactions and possible side effects and what to do in the event of a serious reaction. Always read the medication information given to you by the pharmacist. S/he is also a good source for questions about medications.

The most common side effects are typically: nausea, diarrhea, blurred vision, sleepiness, insomnia, dizziness, or headache. These usually go away in the first few weeks. If these or 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 which 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. (See Doctor reporting form in the appendix)

31. What are the benefits and purpose of psychiatric medication?
Mental Illness is a disease very much like diabetes. It takes insulin to manage diabetes; it takes psychiatric medication to manage depression and other mood disorders. Some say you just must be tough. “You just have to pull yourself up by your bootstraps and try harder.” This is false. In my opinion, the only way to successfully manage a mood disorder is with education, medication if necessary and ongoing treatment and support.

32. What does one do if there is a medical emergency?
Call 911 immediately!

33. Should the client or family adjust the medication if symptoms reappear?
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 or 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.

34. How does one learn to make healthy choices?
Sometimes people do not recognize the choices they make may not be healthy. This falls under the symptoms of lack of insight, poor judgment. Once stable and consistent, some clients simply need to check-in with me a few times per year. Others need ongoing supportive therapy every two to four weeks to remain consistent. 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 a mood disorder. This is the reason that ongoing support from your doctor and therapist is essential for management.

35. How to be well. Ten Steps to wellness.
Coping with depression or mood disorders is no easy task! It takes professional support, medication, psycho-education and experience to manage the debilitating symptoms. With the necessary supports and monitoring, persons with mood disorders can learn to:
1. Take your medication as prescribed. (Problems: contact your doctor or go to the ER)
2. Control symptoms with exercise, chores, and hobbies.
3. Remain stable by making healthy choices
4. Have a network of friends and supports
5. Maintain employment.

I have also found that it takes an average of 6 months to one year to reach these goals. In some cases, it may even take longer due to sensitivity to medication or allergic reactions. In still others it may be the first try at medication fails to control the symptoms and the doctor must switch to a different medication. Obviously, this will cause a delay in controlling symptoms. A company called Gene Sight can do genetic testing when a person has difficulty finding the right medication at the right dose. They can tell you and your doctor which medications would work best for you.

In addition, many people will need some level of support on and off for their entire lives. The essential point is you can’t do it alone! You need a psychiatrist to manage your medication and a therapist to provide ongoing support. If things don’t go well after a time I would not hesitate to get a second opinion. (See Chapter 15 for more detail on how to be well)

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 a tough one. 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 use/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 all right 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, even weeks. 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 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 essential point 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
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 want to do 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. 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 to structure 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. 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. 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, paint by number, 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 ruminating 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 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
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.

How to nurture your relationship?

James E. DelGenio MS, LCPC

How to keep your emotional connection strong?

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://psychologytoday.com
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.

Issues to discuss before marriage?

By James E. DelGenio MS, LCPC

Issues premarital couples should discuss before marriage.  Check it out!

Finances
You may not realize it now, but this is a big one.  Do you know the extent of each other’s Assets? Debts?  How do you view the sharing of these assets? Do you have the same attitude toward saving?
Will one of you want to put into a pension while the other wants to buy a new car? How much are you saving for retirement?  Are there school loans? Credit card debt? Who will pay the bills?
Family Ties
What sort of relationship do you have with your extended family? Are they good at staying in touch? Are they local? Affectionate? Over-involved? Have you had any major falling out? How will you handle the holidays?
Children
Do you want children? How many? How do you want to raise your children? What sort of values do you want to pass on? Do you have opposing views about the benefits of state versus private education — and should you be thinking now about buying in a college savings plan for a good state school?
Religion
What are your religious views — do you agree on what religion you will bring up the children in? Church/mosque/synagogue? Once a week or once a year? Or no religion at all.
Leisure and fun
Do you like doing the same things in your spare time? Do you share common interests? Is your idea of a holiday lying flat on the beach for two weeks and your partner’s rock-climbing?
Lifestyle
What sort of lifestyle are you aiming for? Where do you want to live? Do either of you have a dream of downsizing at some point and living away from the city?
Spending
Do you have an expensive shoe or gadget habit? Does one of you think of a particular purchase as an essential that the other regards as a “discretionary spending”?  Do you have any other secret spending habits: handbags, chocolate, football?  Do you gamble, online or otherwise?  First, define what is discretionary.  Then, I recommend setting an amount that limits discretionary spending without consulting the other!  Typically, I say $150 to $200.  More than that should be discussed. I have also seen people spend $15 per day at the coffee shop and be unable to pay the rent.  Makes no sense!  Will spending be an issue?
Work
Are your respective career paths compatible, is either of you going to have to make compromises? Are you prepared to? Will you want to give up work when you have children? What does your partner think about this, and can you manage financially? What about part-time working?
Roles – traditional or modern?
Will you expect to live along traditional lines: woman as homemaker and man as breadwinner? Who will organize the finances? Will household responsibilities be shared equally? Who will assume responsibility for paying bills? Do you see yourselves as partners or equals, who generally share all responsibilities equally?
Honesty
Are there any old flames for whom you still hold a candle?  Debt that you have not disclosed.
Drug and alcohol
Are drugs and alcohol an issue? Is the person willing to get help? Are they in denial? If your intended is in denial, you should probably think twice about the viability of this relationship long-term?

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 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.

What are the Benefits of Premarital Counseling?

James E. DelGenio MS, LCPC

The Benefits of Premarital Counseling.

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

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

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

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

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

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

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

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

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

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

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

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

Case Study:

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

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

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

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

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

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

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

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

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

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

Not in the Chicago Area! 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.

For those in the metropolitan Chicago area, I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. 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
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 with your doctor and therapist.

James E. DelGenio offers Tele-therapy with BCBS PPO Insurance accepted

The Family Institute at Northwestern University

James DelGenio LCPC is a senior staff therapist who offers teletherapy and accepts BCBS PPO Insurance.  Teletherapy is HIPAA approved via Zoom.com 

His services include Individual and family counseling, marital and premarital counseling, and treatment of mood disorders and dependence.

Locations:  Teletherapy anywhere via zoom.  HIPAA approved and accepted by BCBS PPO Insurance.

As a practicing Psychotherapist for over 40 years, I employ a variety of clinical approaches including Cognitive Behavioral Therapy (CBT) in the treatment of couples, families and individuals.

Individual Practice: Assessment and treatment of anxiety, stress, panic, trauma, anger, grief, depression, mood disorders, mental illness and alcohol/substance abuse.

Marriage and Family Practice: Lack of intimacy, infidelity, poor communication, conflict over finances, lack of trust, parenting and behavior issues, premarital and divorce issues.

Specialization: Treatment of couples, depression and its impact on relationships and the family.

Zoom!

Now I can work via Zoom with anyone, anywhere in the country and it is 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
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.

The Use of Home Work in Couples Counseling

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

Homework for couples

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

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

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

Reduce Alcohol/Drug Use
Many fights occur when too much alcohol has been consumed. Alcohol reduces inhibitions making it easier to allow yourself to lose control. If you are drinking daily, you may have a problem. Denial is a huge part of alcoholism. I typically say, Can you stop drinking for a week or two month (for binge alcoholics). If you make excuses and refuse the challenge, you have an alcohol problem. There is no good reason one should be drinking on a daily basis

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

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

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

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

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

Not in the Chicago Area! 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.

For those in the metropolitan Chicago area, I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. 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
http://takenotelessons.com  Effective on line, one on one, SAT, ACT, GRE, 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.

How to improve communication in the family?

James E. DelGenio MS, LCPC

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.

In the Chicago area. I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. 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
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.

What are the most common relationship issues and conflicts?

James E. Delgenio MS, LCPC

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 type 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.

Not in the Chicago Area! 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.

For those in the metropolitan Chicago area, I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. 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
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 with your doctor and therapist.

How to nurture your relationship?

James E. DelGenio MS, LCPC

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.

Not in the Chicago Area! 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 carrier for details.

For those in the metropolitan Chicago area, I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. 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
http://takenotelessons.com   Effective on line, 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.

Weekly Family Meetings address many common child behavioral issues.

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.

Not in the Chicago Area! 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 those in the metropolitan Chicago area, I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. 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.