Blog

The following are articles written by Jeffrey Crouch, LCSW-C

Anxiety

People who are anxious have the following symptoms: anxiety; nervousness; panic attacks; excessive worry; depression; fatigue; sleep problems; stomach problems and sweaty palms. Many people who suffer with anxiety worry about the future. They will think about what may happen in the future - often worrying that something bad will happen. The future maybe later that day or in a week, a month, or years. People who are anxious try to predict the future so as to prepare themselves for anything bad that might happen. They believe that if they think of all of the possibilities, they can feel safe. The problem with this thinking is that the person rarely feels safe, instead, they worry a lot and feel nervous.

Another thing that people who are anxious do is what I call the “what if game.” What if my car breaks down, what if I get sick, what if I lose my job, then I will lose my house and so on. People who are anxious tend to feel that everything is catastrophic – meaning seeing small problems as huge problems. For example, if a person’s boss is annoyed about something minor, the person thinks that he/she will be fired. Also, people who are anxious don’t see all of the times that things worked out for them in the past. They will tell themselves “that was luck” or “that doesn’t mean it will work out in the future.”

The good news is that people who are anxious can feel calmer and learn to think differently which will lead to feeling good. I provide therapy for people who have anxiety using cognitive behavioral therapy and other experiential therapies to overcome anxiety.

The “Blues” and Depression

Depression goes by many names – depression, the blues, sadness, and despair to name a few, but it all refers to the same thing – feeling hopeless, problems concentrating, suicidal thoughts, irritability, and loss of pleasure. A person who is depressed feels unmotivated to do just about anything.

What people call the “blues” are feelings of sadness and low energy that lasts only a short period – a couple of weeks. Usually, the “blues” have an identified source of stress such a relationship, job, or financial issues. Often times treatment for these stressors can be helpful for developing healthier ways for dealing with the source of grief or stress.

If you are feeling depressed, consider seeking treatment if you answer yes to any of the following questions:
Is your mood interfering with your personal relationships or your job performance?
Have these feelings lasted for longer than two weeks?
Are you feeling worthless, hopefully, or guilty?
Are you having problems with sleep?
Are you having problems concentrating?
Are you feeling nervous or worrying more often?
Are you having suicidal thoughts?

Therapy has been proven to be effective to treat depression. By understanding his/her feelings and setting attainable goals, a person can get back to feeling like him/herself again.

“Confusion” Related to Diagnosis of Bipolar vs. Depression

Many of the symptoms of bipolar and depression are similar. Both bipolar and depression can have the following symptoms: depressed mood; sleep problems; irritability; fatigue; difficulty with concentration; feeling hopeless; and others.

The main differences are that people with bi-polar have mood swings. Their mood changes from depressed to higher energy and euphoria that can occur daily for some people or weekly/monthly for others. People with bipolar usually will have manic periods with the following symptoms: euphoria; thinking which is faster than normal; need for less sleep; risky behavior such as sexual acting-out, and more anger episodes.

Sometimes the changes in mood are milder. The person will have days or weeks of feeling mildly/moderately depressed followed by days or weeks feeling better or happier. The difference is that with bi-polar there are usually more mood changes and there are higher energy moods than with depression.

Therapy for depression or bi-polar is equally important. People with bipolar need to learn to identify changes in mood and ways to feel centered during changes in mood. People who have bi-polar will also benefit from medication to help stabilize their moods.

People with depression will benefit from either changing their negative thoughts (cognitive therapy) and/or working through issues from the past. Both bipolar and depression can be treated effectively and usually, a person can start to feel better in a few weeks.

Treatment for Depression Caused by Life Stressors

Life stressors can cause depression and/or anxiety. Life stressors include relationship problems, job problems; health issues; problems with children, death of a family member or friend; financial stress; and many others.

In many cases, therapy can be helpful for developing healthier ways for dealing with stressors. Usually, in only a few sessions you can feel better and more like your true self.

Adolescent Depression and Psychotherapy

Parents often tell me that their teenager stays in his room a lot; she is more angry and irritable, and he doesn’t talk to me anymore. These behaviors are usually normal but can be signs of depression.

As we all know, our teen behavior changes a lot from ages 11 through 17. Teens are separating from us emotionally and physically. Adolescents are working to develop their identities and are testing out who they are and who they are not. Teenagers’ feelings are often confusing and overwhelming to them. There are a lot of pressures from society and peers to be or act a certain way to be accepted and liked. We as parents sometimes don’t understand our teen’s feelings and needs which upsets them. Parents can get so focused on grades that we forget to talk about their feelings and interests.

Teen depression is very common due to “separating’ from parents and other pressures. Some symptoms of teen depression include isolation from others; anger; grades dropping; not participating in their favorite activities; spending less time with friends; often appearing sad, and arguing more often. Sometimes a teen will say “I wish I was dead.” No matter what the reason is for saying this, it is important to take it seriously and seek help immediately. Because teenagers have such strong feelings and can be impulsive, suicide is a real risk.

Most teenagers who are depressed can benefit from talking to an adult outside their family. Adolescents who attend therapy often feel better in a short period of time. They can identify their feelings and learn ways to experience them in positive ways.

I have 32 years of experience helping teens who have a wide variety of problems including depression; anxiety; school problems; autism; behavior problems; substance abuse; ADHD and parent-child relationship issues. Please give us a call to discuss your needs.

Adult Children of Alcoholics

There are many types of alcoholic parents including: the angry alcoholic who yells and sometimes throws things and hits; the controlling alcoholic who is demanding and controls the family’s activities and feelings; the withdrawn disturbed alcoholic who does not interact much and is passive; the alcoholic who is passive-aggressive; the alcoholic who creates chaos in the house; and the alcoholic who is loving at times and angry and/or withdrawn at other times.

Children who grow up with an alcoholic parent have to adapt their feelings and reactions to survive in an attempt to feel safe and loved. Most children in this situation have to hide and deny their feelings due to the fear of being hurt or abandoned. These children grow up confused about what they are feeling and wonder if what they are feeling is normal.

Some children take on family roles to cope with confusion and pain. Some children will try to take care of the family’s feelings and needs, others will overachieve and be the ‘perfect’ child, and others will act-out and get into trouble to take the attention off the parents.

Most children growing up with an alcoholic parent feel lost, alone, scared, sad, and angry. Some children will turn to the parent or grandparent who is not drinking to get their emotional needs met. Sometimes this can be a helpful bond that can safeguard the child’s feelings. At other times the non-alcoholic parent may be needy and the child has to emotionally care for him/her.

When the child becomes an adult, he/she may fear intimacy or become dependent on someone to meet their unmet emotional needs. In some cases, they will be attracted to someone who can’t meet their needs such as an alcoholic partner.

Some adult children of alcoholics will not understand or be aware of their feelings and what drives them to meet needs in unhealthy destructive ways. Some will be depressed and anxious and some will turn to drugs and/or alcohol to cope with their anxiety and depression.

Many adults will go on to have healthy happy lives. They express their feelings about their childhood and accept themselves.

It can often be important to go to therapy to explore your feelings about growing up with an alcoholic parent. Please feel free to call to discuss your needs and ask questions.

Holiday Feelings and Coping with Stress and Depression

The holidays are here and many people are looking forward to enjoying them. The holidays also can be stressful, hectic and for some people more depressing. The holidays can add a lot of emotional and financial pressure. We want to make our kids happy and meet family expectations, as well as our own expectations. We may worry about disappointing our families. It can be difficult to negotiate where to spend the holidays. Our parents can put pressure on us to spend the holidays with them.

The holidays can also trigger feelings from our childhood. For example, if our parents fought more or our dad drank more, or we did not get the things we wanted. These triggers can lead to anxiety, sadness or anger. They can lead to family conflict, either in our own family or with our parents/relatives. When we are ‘triggered’ it is important to ask ourselves where the feelings are coming from and to talk to someone about them.

Some of us may also suffer from seasonal depression which is partially related to less sunlight and feeling stuck inside. Sometimes with seasonal depression, it is important to go to a therapist to work it through.

It’s important during the holidays to set realistic expectations for ourselves and not plan to do too much. It is also important to set limits on how much we will do for others and how much time we will spend with our families. It is okay to say no to some family activities. It is essential to take care of our own needs like exercising and getting enough rest. Taking time for ourselves is vital to preventing anxiety and depression.

If you are feeling too anxious or depressed for more than a week, therapy will help bring you back to feeling happy.

The Benefits of Psychotherapy and Medication

Many people benefit from psychotherapy without needing medication while others do better with both psychotherapy and medication. Recent studies have clearly shown that for a patient taking medication, psychotherapy dramatically improves the person’s treatment outcome as compared to a person just taking medication alone. In other words, for a patient who needs medication, combining psychotherapy with medication provides for the best outcome in terms of how well a person feels and functions.

A person who is on medication to treat depression, anxiety, and/or bi-polar needs psychotherapy to learn ways to cope better and express his/her feelings and access their strengths. For example, a person who is depressed and taking medication may need therapy to change their negative thoughts and feelings to more positive, self-affirming thoughts and feelings. Another example is a person who takes medication for anxiety will benefit from psychotherapy to reduce his/her nervousness and/or excessive worrying. People who are diagnosed with bi-polar disorder not only need medication but psychotherapy to learn to minimize the effects of mood changes and improve and maintain the benefits of medication in their day to day functioning.

In short, the research on mental health issues clearly indicates that when a person is taking medication, psychotherapy is important to maximize the person’s overall progress.

Parenting

What Parents Can Do When Children Experience or Hear About Violence

We are all grieving for the tragic deaths of the children and adults in Connecticut. As parents, we all worry about our children’s safety. We don’t expect our children to be victims of violence but the events of last week may lead us to question that assumption.

While working in a Baltimore City school, I provided therapy to many children who lost family members in violent ways. I ran an on-going grief group for the children. I remember one child who talked about holding her dying brother in her arms after he was shot. As we have seen, violence knows no bounds.

It’s difficult to know how to comfort our children and what they need after experiencing or hearing about violence. We feel helpless. How can we help them when we can’t understand it ourselves?

Young children from ages one through eight don’t have the cognitive ability to understand acts of violence. They experience fear, anxiety, and sadness that they usually can’t express verbally. They will express their feelings behaviorally in various ways including clinging to their parents, tantrums, and bedwetting. I advise parents to ‘reflect’ what their children say. For example, if a child says “I feel scared” the parent can say “You feel scared.” This way the child feels the parent understands his/her feelings. I also advise that parents answer any questions in simple ways. If a child asks if he/she will get hurt or killed, a parent can respond “You are worried about being hurt.” The parent can follow up by telling their child that they won’t be hurt. The parent can also say “We will protect you and keep you safe.” If a child asks “Will this happen at my school?” the parent should say that it will not happen and that they will keep their child safe.

If a child has experienced violence, it is important to validate their feelings, to reflect their feelings and tell them that we will protect them. I also advise parents of young children to sit on the floor with their children and engage in “pretend” play. All children express their feelings in pretend play. Allow your child to lead the play – just follow their lead. They will tell you what to pretend and what is important to them. Your job is to reflect what is happening in the play. If for example, your child is playing with figures and having them fight, you can reflect by saying, “Those guys are really fighting hard.” If your child tells you to pretend to be a good guy or a bad guy, do it. If you are being told to act in a different way, just follow what your child asks you to do. I advise parents to pretend play for 45 minutes twice a week. When children pretend play with their parents, their feelings are validated and they feel empowered. When children feel powerless, play helps them feel powerful.

Children from the ages of nine through 17 can usually understand some or most of what they have experienced or heard. They have strong feelings that need to be validated and understood. If a child has experienced violence, he/she may feel anxious, depressed and have flashbacks and nightmares. Some children will develop post traumatic stress disorder (PTSD). If a child experiences symptoms of depression or anxiety for more than a week or two, a parent should seek therapy for their child. If a child directly experiences or witnesses violence, I recommend parents get their child therapy.

If children are listened to and supported, they can work through their pain and fear and feel safe again. Don’t forget to reflect on what your children are saying. Also, remember to pretend play with your children a few times a week. If you struggle with this, I can teach you how to effectively pretend play with your child.

Most importantly, please keep hugging your children.

Autism, Violence, and Humanity

As we have all heard, the man who killed the children and adults in Connecticut is reported to have had Asperger’s Syndrome, a form of autism. Hopefully, we have also heard that people with autism are no more likely to engage in planned violence than anyone else. Autism is not to blame for the killings.

Autism is not a mental disorder. Rather, it is a neuro-developmental disorder that one is born with. The characteristics of autism include problems understanding and reacting to social cues; problems developing social skills; sensitivity to touch; focusing on one interest to the exclusion of all others; language difficulty; echolalia; a need for routine; and a tendency to behave in repetitive behavior such and rocking and hand flapping. Some individuals with autism may also have issues such as ADHD, anxiety, depression and bipolar.

There is an enormous range in the severity of symptoms in individuals with autism. Most people with autism can function very well academically, as well as function well in the workplace and in relationships. I have worked with many people with autism who are married, have children, and have friends. A family member of mine has Asperger’s and is currently attending college and living in a dorm. He has developed good social skills and has friends.

I am working with several autistic young adults who are able to function well with support in the community. Some individuals with more severe forms of autism need to live in specialized schools and group homes. I have seen numerous individuals with autism in therapy over the years, and none of them have had a history of violence towards others.

As you may have heard, a higher percentage of people are being diagnosed with autism than ever before. Why is this? The answer is that we don’t know for sure. Many doctors and therapists believe that individuals with milder forms of autism were not identified in the past. This goes to show that people with autism are just like you and me. They do have some differences, but we all home some differences.

Couples

My partner/spouse does not want to have sex anymore. What can we do to change this?

There are many reasons a spouse stops wanting to have sex including: feeling distant; feeling hurt; not feeling appreciated; stress; anger; children; depression; anxiety; medical problems; body image; low testosterone; and lack of desire among other issues. Many couples who have children are tired and stressed and think it is normal to stop having sex.

It is important for couples to stay both emotionally close and sexually close. When couples feel distant emotionally and stop having sex at least once a week, they are at risk for serious problems. I work with couples to improve both their emotional closeness and sexual closeness.

Infidelity

When a partner/spouse has an affair it is extremely painful. The person who is cheated on usually can’t stop thinking about what their partner did to them and what happened with the other person. The person feels overwhelmed with sadness, anxiety, fear and anger. They feel completely betrayed and lost. They will ask their partner over and over again what happened and why. Many people will feel depressed, anxious and will have problems sleeping.

The person who had the affair will often feel guilty and helpless to know how to help their spouse. In some cases, they may be confused as to whether they want to stay and work on the marriage/relationship.

The affair will send the relationship into a crisis and will threaten the marriage. The good news is that most couples can work through the pain. Many couples make important changes and end up feeling closer than ever. It is important that the person who had the affair is patient, supportive, and caring. It is also important to be as open to your partner’s questions as possible. Don’t forget, it takes months to work through it. Even though there is no excuse for an affair, it is important to look at what each person was feeling before the affair happened. One person may have felt distant emotionally – the other may have felt distant sexually.

What to do After an Affair

The person who is hurt by the affair usually feels betrayed, deeply hurt, angry, depressed, anxious, and confused. They often think and imagine what happened. They usually want to know some or all of the details and what happened. It is important for the person who cheated to be forthcoming about what happened and answer the questions fully. It is important for the person who cheated to be very patient. It can take up to a year for their partner to fully recover and gain trust again. It is also important to look at what may have contributed to the affair in terms of the couple’s emotional and sexual relationship. Most couples can heal and even improve their relationship. Couples can re-dedicate themselves to each other’s needs.

I have worked with many couples going through the pain of an affair. Please feel free to call me at 443-538-1247 to set up an appointment.

I Love Her/Him, but I’m Not IN Love with Her/Him Anymore

I often hear this statement in couples/marriage counseling. What does it mean? How can a person not feel the love for his/her partner? Can a person get the feeling of love back?

When one person in a relationship says that they don’t feel the love, it can mean many things. It can mean that they have been hurt so much that they are afraid of being hurt again. It can mean that they have grown distant due to a lack of emotional and/or physical intimacy. It may mean that they are having an emotional and/or physical affair or that they are uncomfortable with being emotionally close. Also, after a long relationship, couples can grow apart due to putting their energy into work and children. One or both may assume that because they feel distant, that they aren’t in love and can’t get the feelings back.

Can a person feel in love again? The answer is usually yes. Sometimes communicating about hidden feelings of hurt can begin the process of getting closer. Identifying ‘triggers’ is another important step in feeling connected. What are the triggers? Triggers are similar to ‘hot buttons’ – they are feelings that are triggered when your partner does or does not do something. For example, a wife could be triggered if her husband forgets or does not do something she asks. This could lead to her feeling that he doesn’t care enough to assist her. There are many possible triggers, both small and large. Identifying triggers and changing behavior can help each other feel loved.

Another important aspect of feeling closer is sexual intimacy. Once emotional closeness is started, sexual intimacy can build even more emotional closeness. If a couple has good communication, emotional closeness, and sexual intimacy, they are well on their way to feeling in love again.

If you want to feel in love, consider couples counseling. Couples counseling also helps improve communication and understanding and can help work through trust issues and the pain of infidelity.