Tag Archives: Resilience

Blaming obese older parents.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Older people

Elderly couple.
Photo courtesy of Pixabay.com

Do overweight older parents produce kids with birth defects?

There have been a lot of articles recently telling us that older parents are more likely to have children with autism, schizophrenia, and birth defects. Is this true? And if it is true how do we explain what is going on here. Clearly, not every older parent has a child with a mental illness or birth defects. Nor do all offspring from obese parents develop autism or schizophrenia, not by a long shot. But the studies suggest an increased risk here. What is really going on? Here is my oversimplified counselor – metaphor explanation.  For a more scientific explanation, you may want to talk with or read doctors and geneticists explanations.

My grandmother would be horrified with the thought that there could be such a thing as a baby or a mother being too fat. In her time skinny babies died a lot more than plump babies. Skinny mothers died more often too.

She was right about that, as far as it goes. Women who are significantly underweight from poverty, illness, or an eating disorder are more likely to have a miscarriage, a low birth weight baby, or a child with birth defects. Not eating as a result of anxiety or depression can cause these problems also. But too skinny mothers are not the major source of problems. Not in this century anyway.

Grandma also had lots of aunts and cousins who had very large families. Women had children starting as young as they could and kept it up as long as they were fertile. That was before birth control. She just might have been right about baby’s needing to have some weight on their bones to survive. But there were some things grandma didn’t know.

Grandma wasn’t near as concerned about the age of the parents either. Older men marrying a very young woman was the norm and for good reasons. In colonial days there were forty sometimes fifty or more men for every woman. So the day that a woman began to have her period the men started calling on this marriage prospect. Lots of women married much older men because the men were financially secure. They married older men and then outlived them and married again.

Men remarried a whole lot more then than now also. People didn’t need to divorce then, their partners kept dying.

Women used to be a lot more delicate than they are now. They died in childbirth and they died every spring of the milk sickness. There were also food shortages and epidemics. Skinny people died a lot. Hence the belief that fat was healthy. Now we know that is not the whole story.

We have long suspected that the father’s age was a factor in some things like schizophrenia or autism. This became more of a theory as there were plenty of young men and fewer old men on their third fourth or fifth wife. Women did not use to have so many children late in life. Now with birth control, postponing children, and fertility treatments there are, percentage-wise, more children born to older mothers. That has started us wondering if the mother’s age matters also.

Grandma would have said that healthy kids and long life were in the genes. She would have been partially right.

Genes are not the whole answer! The same gene can do different things at different times in your life. So there are genes and there is gene expression, how the gene acts when in a certain time and place. Think of this as manners for genes.

My genes gave me that nice dark hair when I was young. Somewhere along the way, they decided I was old enough I needed to look the part so now they give me gray hair. I am pretending they are not turning the gray to white. The Same gene for hair color but different age and different hair color. If I had a child at this age they could inherit the dark black hair of my youth but I am stuck with the old man color for no better reason than that I am getting – well older.

Now no cell is made to last forever. Cells like people need to reproduce. I hear that cells replace themselves every seven years. For argument’s sake let’s say that this is true. Why do cell mutilations keep happening? Why do cells have birth defects?

Think of this as the “copier theory of cells.” Every time a cell reproduces it makes a copy of its self. Have you ever made a copy and then when you can’t find the original had to make a copy of a copy? The more generations the copy goes through the more chance it will be fuzzy and someone will read it wrong. Older cells may get fuzzy also. The more copies the more chance for changes – mutations to creep in. Some of those changes in humans may be good things, adaptive changes. But most gene changes cause birth defects.

So what does being overweight or drinking alcohol have to do with birth defects? Alcohol for the record causes more preventable birth defects than anything else. Why is this?

Ever seen someone mark up an original before copying it? Imagine with me an original with white-out on it and some highlighter marks. Now before this stuff can dry the person puts the original on the copier glass and makes their copy. That messy stuff gets all over the glass. Every copy we make now has all those marks on it. They are all hard to read.

So when there are chemicals in the parents’ bloodstream, like alcohol, the copies that get made are fuzzy. More alcohol and the copies get worse. We know alcohol and drugs blur the mother’s contribution to the child’s genes. We also suspect that some chemicals may blur the father’s contribution also.

We used to think that if the mother took in too few calories bad things happened to her and the potential baby. Excess calories were stored as fat in the mother. No harm to the baby there right? Not so fast.

If the mother develops diabetes that high blood sugar could have an effect. So could all sorts of other hormones. So we think that the more overweight the mother the more the risks to the child. Now, remember risks do not equal disease. You can have a risk factor for a disorder and not get it. Strenuous excesses and severe dieting during pregnancy or when you are trying to get pregnant are not recommended. But the mother’s overall health, her efforts to keep her blood sugar under control, and to avoid toxins, especially alcohol, just may increase the chances of a healthy child.

Being older or overweight may not be reasons to avoid having children but the increase in risk factors may explain why we are seeing more children born with certain mental and physical illnesses like autism, psychosis, and ADHD.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Getting emotionally better

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Life pie

Healthy Pie of Life.
Photo courtesy of Pixabay.com

How do we get better emotionally?

There are so many people telling us we should do this or not do that it is hard to know what to do to really see an emotional recovery. Which method works best?  Recovery is a process. So is resilience. Most of the self-help blogs and books focus on one of the things you need to do to get better but not many integrate all three processes.

1. Become aware that you are feeling something.

This is the providence of mindfulness. Dan Siegel calls this “monitoring.” People who had unhappy experiences in early childhood, we sometimes call this “attachment problems” – they often are numb. Ask someone with emotional numbness what they are feeling and they can’t tell you. So the first step in emotional recovery is simply to become aware that you are feeling something.

Ask yourself where in your body are you feeling this sensation? Is it pleasant or unpleasant? It is not important to name this feeling just yet. Sit with the feeling a while. What else is associated with this feeling? Is it memories? Do you see pictures from your past? Maybe the feeling is part of a story in your head.

In anger management or impulse control treatment this is a common first step. Often people react to an outside event with no realization that they have had a feeling that propelled them into action.

There is also an important connection between feelings and thoughts. We interpret events based on a “schema” or blueprint that is stored in our nervous system. We rarely recognize that this emotional blueprint was created a long time ago and has been biasing our reactions in one direction or another.

Becoming aware of your feelings can involve a variety of data collection techniques. Mindful meditation, thought records and journals, can all be used to capture the fact that you are having feelings. Not sure what you are feeling? Try drawing a picture of your feeling. Crayons are not just for our kids anymore.

2. Find a label for what you are feeling.

In group therapy, particularly with men’s only groups, we find that people have a limited vocabulary to describe their feelings. Developing a larger vocabulary for feelings allows you to discriminate between the various shades of feeling. Many groups use a chart that shows drawings of people’s faces that portray a variety of feelings; all neatly labeled under the picture with a name we can call this expression.

Many people have only three names for their feelings, good, bad, and pissed off. Good and bad are judgments about the feelings not really names of feelings. Does good mean content or excited? There is a world of difference between those two. People have a need for security but too much security may become boredom. We all like a little excitement but too much coming at us can be terrifying.

3. Transform or modify the feeling

This is the tricky part. As long as you insist that you don’t feel but that others “make you feel” you are in a reactive victim place. It is likely that there are some feelings that are primary biological functions but our responses to those sensations are learned. CBT therapists tell us that our thoughts heavily influence our feelings.

For example, when your stomach has a non-pleasant sensation we try to do something to relieve that feeling. Most people who have that feeling think they are hungry and they eat. Research has shown that more than a third of people who think they are hungry are in fact thirsty, they are dehydrated. If they learn to try drinking water first, wait a while, say thirty minutes, many times what they thought was hunger goes away, dissolved by the water.

We learn to interpret body sensations and we also learn to interpret emotional ones. If we have limited names for these feelings we start putting the wrong label on the feeling and we respond incorrectly.

Narrative therapists think we create stories for ourselves about how we “should be” or how things “are.” Creating new stories for ourselves allows us to do new behaviors. So if the schema or blueprint in our head is fuzzy we need to take another look at how it was drawn, correct the faulty parts, and develop a new way of relating to our feelings.

Most thinking is done with words. The more words you know the more potential thoughts you might have. Most of us have learned a lot of technical words, about our jobs, sports, and hobbies. But we lack the vocabulary to talk about feelings.

This three-step process, feel, identify, and transform can go a long way to help us heal from emotional pain.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Sharing made me a new person – group therapy.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Support group

Group.

Group therapy can be very helpful.

The group really helped me, sharing made me a new person. The client was trying to describe the way that being in group counseling had benefited them. I am a believer in group therapy. I have seen the things that happen when a group is on task and working. The clients can see it also.

There is a saying in groups that “we are only as sick as our secrets.” One powerful way in which groups can help people is to allow them to tell their stories in a supportive environment.  When it works it can be magic.

Twelve-step groups are self-help group’s not professional therapy. But in the addiction field, we quickly learned the value of being in a group that understood what you are going through and who were all supportive of your recovery. In mental health groups, we see the same results. People all sharing about their life struggles makes us feel more connected and less alone. Powerful things happen in peer support groups.

Some professionals are leery of groups. They have suggested to me that group counseling is a lesser sort. They tell me that “real therapy” takes place with one client and one therapist in the room. I try to avoid arguing. Then why do we do couples counseling and family counseling if it is best done in an individual session I ask? I try to listen politely to their answers.

Most of life is about relationships. We are wounded in our relationships and most often we are healed by a helping, supportive relationship. Sometimes that relationship is a counselor, sometimes it is a group.

Not all groups are safe places to tell your most painful life events. In therapy groups, it is up to the leader to make groups a safe place. In self-help groups, it can be riskier. We talk about confidentiality and anonymity but that is no guarantee that someone will not break the rules and repeat what another person said. The longer the group has been together the safer people feel but it is never without risks.

What I often see happen is that people try to keep things secret in group, that everyone else in the group knew already. When someone is arrested for a DUI it is in the paper but when they come to a group, they hint vaguely about a self-control problem and demand confidentiality.

More than once a client has told me something in a private session and then a few weeks later their courage now turned up a notch, they tell the whole group. In almost every case the result was that the group understood and supported them in their disclosure and the person, now having publicly admitted their defects of character, finds they have unburdened themselves and are no longer kept in pain by that secret.

Some of us have spent our whole life’s trying to hide our true selves from others. There is something very freeing about opening up and sharing about our total selves, warts and all. People who have to hide themselves from others not only cover up their flaws, they cover up their endearing qualities also.

Sharing who you really are can indeed make you a whole new person.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Five Axes Diagnosis Esoterica

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By David Joel Miller MS, Licensed Therapist & Licensed Counselor.

Medical record

Diagnosis.
Photo courtesy of Pixabay.com

Five Axes Diagnosis Esoterica.

Update –

With the release of the DSM-5 using 5 axes may soon be a thing of the past.

Professionals will be looking for this information or most of it. We just won’t be separating it and reporting it this way. I left this post up for those who would like to see the way things used to be.

So in a previous post, we talked about some of the reasons clinicians might be reluctant to tell you about your diagnosis, how the diagnosis is based on the DSM-4 (soon to be the DSM-5) from the APA and how diagnosis are categories while people are on a continuum so sometimes people do not fit the diagnosis neatly. We left off with the ideas that there are 5 axis and that most people stop after knowing more or less their diagnosis on Axis one.

Axis One.

The DSM has over 400 diagnoses. Not just mental illnesses but all sorts of other problems that might take you in to see a counselor. They include mental illnesses, emotional and behavioral problems. This section covers about 750 pages of the DSM. My list below is VERY oversimplified

The major sections, not in order are things most of us have heard about:

1. Adjustment Disorders – life’s problems grown large.

2. Anxiety.

3. Mood disorders meaning Depression and Bipolar.

4. Psychosis, like Schizophrenia and Schizoaffective.

5. Disorders first seen in childhood – like ADHD, learning disorders, and Autism. (But NOT mental retardation!)

6. Sex, eating, and sleeping.

7. Substance abuse.

8. Dementia, physical stuff caused by emotions.

There is a section in the back where other codes, mostly the “V” codes are listed. “V” codes are largely about relationships like parent-child conflicts and partner conflicts. While counselors work in these areas many insurance plans to not pay to treat these things.

Axis Two.

The things we put on axis two are things that we used to think were untreatable – that is just the way you are stuff. This includes personality disorders and mental retardation, a strange mix. Both issues now have appropriate treatments.

Personality disorders are treated using therapies like DBT. Most women in prison are diagnosed with Borderline Personality Disorder. Sometimes in practice, the boundary between Borderline and Bipolar gets fuzzy.

Most men in prison get a diagnosis of Antisocial Personality Disorder. This is also generally treatable if the client wants to change.

Mental retardation can be treated using behavioral techniques as long as we have realistic expectations. The distinction between mental retardation and developmental delays can get fuzzy. Some people call all of these delays and avoid the politically sensitive issue of saying someone has mental retardation. It is also possible for someone with mental retardation to have an axis one problem like depression.

Axis Three

Did you know that medical conditions can cause symptoms that look like a mental illness? All good therapists like to have clients see a primary care doctor, specialists if needed, to make sure this the problem is not a brain tumor or hormone issue. Things like pregnancy, brain injury and poisoning all get confused with mental illness. In seniors, a lot of this dementia and cognitive decline is the result of the side effects of medications the senior is taking. Please, however, do not start or stop meds without talking with your doctor first. Ideally, your doctor and your therapist should be talking and on the same page if you have any medical conditions that may affect your mental state.

Axis Four – Psychosocial and environmental problems

Stressors for short. Not having friends or a family or having a poor relationship with them can cause lots of emotional problems. We also include people with social and educational problems. Being arrested or a victim of crime might get you an Axis Four diagnosis, as would not having medical care or living in poverty. We don’t always talk with clients about these issues as much as we should but these issues are at the core of client’s problems a lot of the time. Note that no matter how severe your unemployment problems are if you can’t qualify for an Axis One diagnosis like Depression you may have difficulty getting counseling for your employment or other problem.

If stressors are interacting with your mental health you might want to see a professional or clinician counselor who specializes in individual therapy centered on both these areas. In California, we call this specialty Licensed Professional Clinical Counselors (LPCC’s.)

Axis Five.

This is a summary scale. Imagine how hard it is, to sum up, a client’s whole life on a 0-100 scale. Imagine getting a pass-fail grade on your life. Imagine trying to grade someone’s life. Lots of other scales have been suggested for this. Insurance types like it because if your GAF number goes up it shows the therapy is working. This makes them happier about paying. Mostly we use this in making decisions about hospitalization or urgent care.

I don’t ever remember telling a client their GAF because it does not much matter unless there is something that needs doing right now and in that case, I want to talk about what it is we need to do now.

So there we have it in two brief posts a very simplified look at the process of diagnoses.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

What is wrong with me?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is wrong with me?
Photo courtesy of Pixabay.com

Ever wonder what is wrong with you?

Lots of clients ask me that question. Occasionally they want to know their diagnoses. Most of the time they are asking a whole lot more.

Discussing a diagnosis with a client is a controversial thing. Some clinicians feel that a diagnosis is a label and the client is a whole lot more than their label. What a client needs right now may have very little to do with their long-term diagnosis. Someone who has the symptoms of schizophrenia may come to see the counselor because they can’t get along with their spouse. The schizophrenia may make the situation more complicated but what they need right now is relationship counseling just like any other person. I see the point of avoiding labels but don’t always agree about withholding the diagnosis.

Other people tell me that knowing their diagnosis is empowering. If you can put a name on your problem and you know there are treatments for this problem, then you have some hope of recovery. If the professionals can’t tell you what is wrong you may start to think there is no hope for you. Alcoholics Anonymous encourages its members to admit they are alcoholics. If you know that you have this disease then you know what or do. Don’t drink! But if you think you have a “lack of control” or poor willpower you can keep on trying to control your drinking while racking up more DUI’s.

I take the approach that if the client asks me what the diagnosis is then I owe them an answer and an explanation. Personally, I don’t think “Why is it important for you to know that?” is an answer. It annoys me when clinicians do that. Lots of clients tell me it annoys them when their counselor says things like that. So how do therapists come up with these diagnoses that end up in the client’s charts?

A warning here. Diagnosis is not a do it yourself program. What I am saying here is meant as general information, not a personal assessment. That said, if you have questions ask your provider. If you don’t like the answer ask for a second opinion.

Some basics first. The way in which mental illness is diagnosed keeps changing as research and our understanding changes. There are also some gray areas in which the clinician needs to make a judgment call.

Diagnosis of mental illness is most often made by using a book called the DSM-4-TR. This stands for the “Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. The DSM-5 is due out soon but so far there is lots of disagreement about the changes that may be made. This book is published by the American Psychiatric Association (NOT the American Psychological Association type APA) so while we all have to go by their book, the psychiatrists get to write the book.

There are a lot of complicated rules about who gets to hand out Diagnoses and whether or not they need to be cosigned by a Psychiatrist. I won’t try to explain all that just now.

Therapists and counselors have to take at least one master’s level class, sometimes two in using the DSM and they get thousands of hours of supervised training while pursuing their license. You would think that would take all the guess-work out of diagnoses – it doesn’t. Let me explain why.

Diagnoses are categories. The client gets a named diagnosis like Depression. People don’t always come in nice discrete categories. Everyone gets sad or depressed sometimes. When is it severe enough that we say you have depression, not just normal sadness? We have 32 different shades of mood disorders (296.xx’s) plus specifiers for each and say 6 or more other flavors tucked away in other places. (Cyclothymic, Dysthymic, Adjustment Disorder with Depressed Mood etc.)  See why your psychiatrist might have a headache even before you get to their office? See why we might each have a few “favorite diagnosis” that we use more than others? But the problem doesn’t end there.

Let’s take one diagnosis category – Major Depressive Disorder.  To hand this one out the client must meet criteria A, B, C, D, and E. AND under criteria A there are 9 “Notes.” The client needs to have note one or two and at least four other of the noted characteristics. So we interview you and you sort of have note one but not note two. Then we see you have the three of the others, but we are just not sure if you have the fourth one or not. Now we have a problem.

If we say no to either of the maybe’s you are out. You do not have depression. But if we say yes to the two questionable calls you are in – you get the diagnosis. This makes me want to scream.

In research studies, they use “strict” criteria. Any doubt and they do not give out the diagnosis. In practice, if you come close and we think you need help and that you might get worse, then you are in. If you are suicidal, does it matter how many times a week you are able to feel pleasure or how much you sleep?

We should be done now but we are not. Not by a long shot. There is a hierarchy of diagnosis. Sometimes one diagnosis trumps another, sometimes not.  You can have depression and anxiety but not depression and Bipolar disorder.

Stop screaming.

Lots of people come in and tell me they have been diagnosed with Depression, Manic Depression, and Bipolar. I nod my head yes and let it go.

Bipolar is the new name for manic depression, the same thing, new name, mostly to confuse us. Bipolar may not be any better a name than manic depression. Both make it sound like you are either manic or depressed. Kay Redfield Jamison says, and I very much agree, that it is possible to have both at once, we call this mixed states. Some psychiatrists want to take it out of the next DSM. I think it needs to stay, but who am I to argue.

Why can’t you have depression and Bipolar? Because the description of bipolar includes having one manic or hypomanic episode! Most people start out diagnosed with depression but once you have even one teensy weensy bit of hypomanic episode we change the diagnosis to Bipolar.

I want to thank DeeDee whose post suggested the idea for this post. Her post on the GAF got me started about how we keep the diagnosis a secret. It is now clear I will not get this all into one post. So watch for a future post in which we tackle the mysteries of five-axis diagnosis and other esoterica.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

New Counseling Website

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New Counseling and Therapy Website

Update.

After trying this for a while, I discovered I didn’t have the time to write two blogs. I am still teaching and writing books, as well as producing a few videos for my YouTube channel. I do still see a few clients for counseling but these days this is all done by distance counseling methods. 

The new website for my counseling practice launched yesterday. Honest. This is no Joke. That I got this up and running is truly amazing, me, that old guy, who used to think that a “computer” was that guy in accounting, has my own therapist website. Mostly it is about information for my clients in private practice here in Fresno California. There is a page of “Frequently Asked Questions” about counseling and therapy that some of you may want to look at. Shortly there will also be a page of suggested resources. So check it out and let me know what you think.

I would never have gotten it done had it not been for the experience of using WordPress to do this blog. Don’t panic though. The counselorssoapbox.com blog will continue also. That’s it then.

Best of Blog Recap March 2012

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Counselorssoapbox.com

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Here it is – The Best of Blog Recap for March 2012 –

Thanks so much! A big thanks to all of you that read this blog. This has been another great month at the counselorssoapbox.com blog thanks to all of you. Hope some of the things I have written have been helpful and thought-provoking. Feel free to comment and especially pass along the link to anyone you think might want to read this effort.

This month there were a few days with no post but when we reached the month end there were more posts than I had originally planned. We will see what the next month holds.

Here are the top read blog posts of the last month with the links.

1. Bipolar genetics research study.  

2. Trauma steals your sleep.  

3. More ways to mess up your mind.       

4. Why relationships fail – two large reasons.

The all-time top read posts were::

1. How does therapy help people? (still in first place!)

2. Do drugs cause mental illness?

3. How much should you tell a therapist?

4. Treatment for teen’s risky behavior.

Many of you have viewed the home page and “about the author” page also.

Thanks to all my readers new and old.

Next month we will explore some other topics and see what we come up with.

Till next time, David Miller, LMFT, (Soon to be LPCC licensed also)

Bury the past – put it in a box.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Coffin

Bury the past, put it in a coffin.
Photo courtesy of pixabay.

Wish you could get rid of your past?

“Wish I could bury my past, ” the client said. “I would like to put it in a box and bury it.” We talked a while about that client’s pain, the history of trauma. We spoke of things that should have been in childhood and weren’t and of things that had happened, that shouldn’t have. We talked about the burden of carrying around the pain and how hard it was to put the pain down. I thought about the topic after the client left. How might I help them to bury that pain?

We grieve for people when they die. Sometimes we miss them. Sometimes we only grieve for what should have been. We have a ceremony, often with a casket, there is a viewing, a graveside service and then we get a period of time to mourn. Friends and family support us in this process but eventually we start to move on. We remember the departed. We may think that we will see them again, but we shouldn’t stay stuck in the past. Life goes on. Why can’t we do that for the pain and the trauma of the past?

Why is it so hard to let go of the past?

Sometimes we tell substance abusers to write a letter to their drug of choice. Addicts get closer to their drug of choice than their family or their friends.  Friends come and go. Crystal Meth or Sherry wine, she is always there. It is easy to remember the good times. Remember the time we took them to a party? The time they made us think that we were charming or witty? We forget the times they took us to jails and hospitals.

We tell people in substance abuse recovery to write a goodbye letter to their drug of choice. They write a Dear John letter to their addiction. Tell the drug you have to say goodbye. Get that drug out of your life. Some people burn that letter. Others flush it away. We perform a ritual to signify an end, a divorce from the old addiction, and the start of new relationships with yourself and with other humans.

What kind of ritual should we have to get rid of the pain and hurt? How does someone who was abused, molested or neglected, get an end to the hold that emotion holds over them?

There are cultures that have rituals for these sorts of things. Some religions have ceremonies to clean and rebirth. America has fewer rituals, more religions, less faith.

Would we really give up all the pain if that were a choice? Sometimes do we hold onto our suffering like some earned war wound, some badge of moral courage? What if instead of holding on to our suffering there was a simple ceremony we could perform? Would we do it? Would our friends support us in this?

When we get married there are often people to wish us well. When we get divorced there is a judge and a piece of paper. The paper says that thing we had hoped for has been dissolved. It has ceased to exist. Some people hide the change. Friends don’t give us a hug and wish us well on this new chapter in our journey.

How long do we need to hold on to the baggage we have accumulated? At the airport, they lose bags. We look for them for a while, file a claim, and head for our destination. We can replace a shirt or shoes. Why is it so hard to let go of the life baggage of pain and sadness?

Imagine if you will, packing your bag, fill it with the pain, the hurt and the trauma you wish had never happened. Drop that bag off at the airport or the bus station and send it off. How do you feel now? Do you miss your baggage? Do you feel free? Are you glad your pain is behind you?

What if that pain could be buried? Would you hold a funeral for all the things that are still holding you back? Would you be willing to but your past pain and suffering in a box and bury it?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Getting your tools dirty.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Assorted tools

Tools.

Your recovery tools.

What shape are your tools in? We all have our tools. Many men and some women like new shiny ones. Other people have craft tools or cooking tools. I was thinking a lot today about tools and how we use them.

Counselors talk with their clients about learning new tools, relationship tools, anger management tools, tools for sober living.

In school, they taught us the “tools” we would need to do our jobs once we graduated. When I teach classes for beginning counselors they learn not only the tools they will need to teach their clients but also the tools they will need to be good counselors.

So with all the tools out there why is this job of recovery so difficult? Why do people try things in life over and over and still they don’t seem to come out right? What is wrong with our tools?

Recently I moved. We had looked forward to the new place. It was larger and it was in a better neighborhood, besides it had a nice yard. In preparation for the move, I bought some new tools. They were so nice and shiny. I had a few old ones from the last place but a new home requires a few new tools. I put them on the workbench in the garage when we moved in. A brand new circular saw, a good shovel for planting in the yard, I had all the tools I thought I would need.

I was talking to a client today about tools. This is his – well let’s not say how many times he has been in a treatment program. I was talking to him about the tools he needed to stay clean and sober and the tools he would need to keep his mental illness at bay. Then it struck me. What tools could I offer him that he had not gotten at other programs before? That got me thinking about all those tools I had bought for the new house and what had happened to them.

A week after we moved in, maybe two, we bought a couple of bushes to go by the back fence. They were small bushes and the ground was damp. They didn’t need a very big hole. So rather than go to the garage for the new spade, I grabbed the old one that was leaning against the shed in the backyard. It worked OK so I saved a trip to the house to get the new one. To this day the new shovel has not been used.

I needed shelves but never got around to buying lumber. Some used metal ones were available at a place on my way home from work. I bought the used shelves. The new saw is still in the box.

I got busy and so instead of doing the yard work the way I had planned, I paid someone to mow the lawn. The net result? All those pretty, shiny, new tools are still sitting there in their original packaging, still unused.

As I talked with my client he explained what went wrong with his previous treatment programs. What had happened that he learned all those new tools but kept getting the same old result? He didn’t need more tools, he had plenty.

He looked at me and then he said – “I didn’t get my tools dirty.”

Then it struck me. We all have tools. We go to seminars, read self-help books, participate in counseling and therapy but we stay stuck in the same old pain and dysfunction. The reason so much learning does not change us?

Sometimes recovery is a messy business. It takes work and effort. We have to practice new skills. But between the learning and the practice – we forget to use those tools.

We forget to get our tools dirty.

For more on this see the posts on Stages of Change especially the Maintenance Step.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Happy enough to make the bed?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Happy faces

Happiness.
Photo courtesy of Pixabay.com

So how do you know when you are happy?

What things say for you “today I am doing well; today my recovery is on track?” It is most often not the big things, the jobs or relationships. It is easy to feel happy when something great, new, and novel happens. People, most of the time, get happy when something good happens. Not being able to take joy or pleasure out of something that used to make you happy is a sure sign of depression setting in.

Not being able to feel pleasure, professional counselors call that anhedonia is one of the things we look for in diagnosing depression. Happiness is about more than just not being clinically depressed. How do you tell if you are really happy deep down? If someone were visiting with you how would they know today was one of those happy days?

In interviews, I ask clients “What makes you happy.” They tell me not about big things, but mostly about little things, everyday things, that results in them feeling happy. Those things also reflect happiness. Most times it is those little things that are making them happy.

When someone is functioning well, when life is worth living, they take better care of themselves. One way we as outsiders looking in can tell if someone is happy is to look at how they care for themselves. We call these self-care habits “activities of daily life.” Someone who is able to do their “activities of daily life” is headed in a good direction. They are having a good day.

Someone who is unable to do those same activities, we worry about them.

So did you make your bed today? People who get up and make the bed may have a large head start on happiness compared to those who don’t. You need to decide for yourself if making your bed says “happy day” to you. But many people find that on the days they are able to make their bed, this says to them today will be a good day.

It goes farther than making the bed is a barometer for happiness. People tell me that when they get into a habit of doing things to care for themselves it becomes easier to keep up that habit.

Do you feel better or worse on days that you brush your teeth, fix your hair and put on your good clothes? Doing self-care even on days you don’t feel like it can improve your mood.

One client told me he and his partner used to go for walks every morning. He could judge the quality of their relationship by how often they walked. During periods of conflict, they just did not feel like going for the daily walk. If one of them was depressed they did not feel like a morning walk that day. The result was that their communication got worse, the depression increased and the happiness disappeared.

Once we discovered this connection between the morning walk and the feeling of happiness with the relationship, they made a commitment to walk together every morning whether they felt like it or not. They found that more walk time resulted in more and better communication and that created more happiness on both people’s part.

There is an old twelve step expression “fake it till you make it.” That expression is not about being dishonest or showing a false face to others. It is telling us that when we go through the actions of a happy person we become happy. The opposite can happen also. Isolate, avoid others and you become lonely and sad.

So what daily rituals tell you that you are on the right track? Will you commit to yourself to take better care of yourself? Try it for a week and tell us how your commitment to self-care affected your mood and your success.

Are you happy enough to make your bed today?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel