Question:
I'm dealing with an illness that will never go away and I feel like my life will never change for the better. I feel alone and that i have no one.

How can I overcome this pain and learn to be happy alone?

Response: I'm so sorry you're feeling like things will never get better. Try to remember that whatever illness you are dealing with, you are not the only person to have dealt with it and you are not alone! Out there, just waiting for you, is a group of people that will totally understand what you're going through and will be able to share how they coped. Try searching for a support group for your illness - google and www.psychologytoday.com are both good places to start for those groups.


Question: I need help knowing how to deal with stress. What can I do?

Response: Our body reacts to stress typically by breathing more shallowly, increasing our heart rate and tensing our muscles - so one thing that I find really effective is to try to do the opposite of that, which sends the signal to our mind that we are relaxed. So that means, taking slower, fuller breaths and trying to relax any areas where we might be gripping our muscles. Check out meditation apps such as 'Breathe', which can talk you through a relaxing breath exercise. I recommend using the app daily, whether you feel stressed or not, and then also using it when you re feeling particular moments of stress - that way you are practicing the skill when you feel calm(wish) and it'll be ready and able to help you when stress hits hard.


Question:
I am in my early 20s and I still live with my parents because I can't afford to live alone.

My mother says that if I live under her roof I have to follow her rules. She is trying to control my life. What should I do?

Response: You're among many millennials who live with their parents due to financial reasons.Does your mother mean rules pertaining to the way your family household organizes its daily or does she mean something else?Every household needs rules as responsibilities to keep the house clean, who does the grocery shopping, the way costs are distributed for this and all the other carrying charges  and tasks of maintaining the house in decent order, as well as respecting the privacy and noise level requests of others who live in the home.This set of responsibilities applies whenever more than one person lives with another person.Have you tried simply telling your mom that you're willing to be a responsible household member and that you prefer to keep the details of the way you live the rest of your life, to yourself?This would show respect to your mom and start the discussion as to the areas of your life you feel deserve privacy and how you would like to handle when your right to run your own life overlaps with any household duties.


Question: My ex-wife married and used me to have a child. She now uses that child as a pawn. I know my child misses me, but I need to move on and not live in the past. How do I do this? Do I see my child as much as possible or very little? Is it more confusing for the child?

Response: What are the ways your ex-wife uses your child as a pawn?This answer determines the best ways to handle particular situations.Basically, distinguish that your father relationship to your child lasts has great meaning for your child and as the adult, the responsibility for managing this relationship falls on you.Your relationship to your ex wife took place between two adults and therefore you are only responsible for your own actions to repair the damage done to you.From what you write, you already have a plan in progress to do this by separating yourself as much as possible from contact with the ex.In a way the challenge of keeping active as a parent while also distancing and clearing your emotions of the hurt and betrayal done to you, will establish both a solid relationship with your child and grow more acceptance and self-forgiveness of having been taken advantage of and tricked.


Question:
I'm concerned about My 12 year old daughter.

About a month or two ago she started walking on her toes, as well as coloring and writing very messy. This all happened very suddenly. She has never walked on her tiptoes and has always colored and written very neatly.

Is this something I should be concerned abou? Any advice will help.

Response: Have you asked your daughter why she's doing the behaviors you describe?Often the best way to find out why someone does something is to simply ask them their reason.Her answer will give you some guidance as to next possible steps.If she's pretending to be a fantasy figure or trying to find out how being taller feels, or walking on high heels or some other image then knowing this rules out that she has some unbearable pain in her arch which may require more practical answers such as new shoes or even indicate a medical problem.Ask if she's noticed any change in the way she walks.   Maybe she doesn't know she's doing this and maybe she feels embarrassed to tell you she's doing something a bit odd.Since usually 12 year olds don't color, is it new that she started coloring?Maybe given the fact of messy handwriting, she's in a phase of pretending or reflecting on good times as a young child.Then this becomes the topic of examination.Does she feel insecure about being on the cusp of adolescence?Some of these questions can be asked directly and some are for you to first decide based on what you know of your daughter, which questions and what direction to take in understanding your daughter's motivation.


Question:
A few years ago I was making love to my wife when for no known reason I lost my erection,

Now I'm In my early 30s and my problem has become more and more frequent. This is causing major problems for my ego and it's diminishing my self esteem. This has resulted in ongoing depression and tearing apart my marriage.

I am devastated and cannot find a cause for these issues. I am very attracted to my wife and want to express it in the bedroom like I used to.

What could be causing this, and what can I do about it?

Response: First step always is to do a medical rule out so that you're sure the problem is psychological and emotion based, not a medical condition which requires care and attention.If you are medically clear in the reasons for losing your erection, then reflect on what may be creating a loss in confidence in either who you are and what you're doing with your life, or whether your wife has these sort of problems within herself.Often a problem transfers ownership of who shows it.If you are a sensitive person its possible your erection problem reflects your wife's insecurities and self-doubt.  If she is someone who is reluctant to talk about feeling unsure then in a certain way by you showing a problem, she can avoid looking at herself.There may not be a direct cause such as usually exists in a medical problem.Medicine looks for symptoms to treat.Our emotional lives are much more indirect.If you feel stress at work or are unhappy in the place you live, for example, then your frustration may show up in your sex life.Basically, do a broad inward search of your life and what it holds and maybe ask your wife to do the same.You may clear the air within yourselves and between each other so the problem goes away.


Question: I need help dealing with stress. How can I handle it all and feel less stressed out?

Response: In case you feel some relief to know you're feeling the tone of our times.We live with crumbling of our values which then gives rise to insecurity everywhere.  If someone doesn't know what their values are then its difficult to do anything, and right now everyday we hear uncertainty in what used to be our basic assumptions.You're more normal for noticing and feeling stressed than if you imagine life felt fine the way it is!One road to take is to accept that there are no clear roads forward.  This means to change long term goals into shorter ones.Also, in general the more focused you can be as to your particular wishes, motivations, interests, and people about whom you care, the greater will be your sense of confidence that your personal world is as secure as it can be for right now.And, it helps too to know that nothing lasts forever, eventually all of what is up in the air will start to land in a much more clear way.


Question:
I know I need to deal with my depression. But I don't know how and I don't want to tell anyone.

How can I deal with depression without telling anyone?

Response: It can be really tough to tell someone - anyone - that you're feeling depressed. But finding that supportive person that you can share with is a big part of the battle with depression. Depression thrives on being secret, it seems to grow the more we isolate ourselves and hide it away so I'm with Laura Cassidy, when she suggests finding that professional support person so you can start fighting back against your depression. If that feels like too big a step right now, maybe check out a book or two... I'm a big fan of a book called 'Feeling Good' by Dr. David Burns if you want some practical thoughts on tackling depression and on 'Radical Acceptance' by Tara Brach if you prefer something a little more spiritual.


Question:
I've been bullied for years and the teachers have done nothing about it. I haven't been diagnosed with depression, but i have been extremely sad for years.

How can I deal with being bullied at school when the teachers won't help?

Response: That's a very difficult situation that you are in. But you are not alone. I have several school-aged clients who find little to no assistance from their teachers at their schools regarding bullying.There are a few options that are available to you to help deal with being bullied at school. One option that I would suggest is for you to talk to your support network. Friends and family can sometimes be good sources of support. Another option would be to speak with us about your counselor, if you have one. And third, there are some excellent online sources of support regarding the bullying at school (www.stopbullying.org).


Question:
A few years ago I was making love to my wife when for no known reason I lost my erection,

Now I'm In my early 30s and my problem has become more and more frequent. This is causing major problems for my ego and it's diminishing my self esteem. This has resulted in ongoing depression and tearing apart my marriage.

I am devastated and cannot find a cause for these issues. I am very attracted to my wife and want to express it in the bedroom like I used to.

What could be causing this, and what can I do about it?

Response: When I'm working with men with this type of situation, I always suggest a medical examination to rule out any type of organic reason for a difficulty in maintaining interaction. In cases where there is no medical reason for the loss of erection, I find that many men have a similar situation in experiencing negative intrusive thinking during lovemaking. My counseling approach for this situation is to incorporate the use of mindful sex.


Question: I need help dealing with stress. How can I handle it all and feel less stressed out?

Response: Part of handling stress is making sure that your perception of the stress is accurate. Sometimes stress can seem more than it really is. One thing that I encourage my clients to do is to ask themselves, "What is this stressor really about?" Simplifying stress is a key to minimizing stress and leads to feeling less stressed out.


Question: I don't know how else to explain it. All I can say is that I feel empty, I feel nothing. How do I stop feeling this way?

Response: A feeling of emptiness can be from a lack of awareness and acknowledgment for the things, the people, the places that you have in your life. The use of affirmation and gratitudes helps to remind ourselves of all of the aspects of our lives.


Question:
I have a friend that who I used to be in a relationship with. It was brief and turned into us being just good friends.

I spent the weekend with him and it upset my boyfriend. Was i wrong?

Response: This can be a very complicated situation. The boundaries of relationship include the rules to follow in the relationship. It is important to follow the rules of your relationship  in regards to each person being able to spend time with exes. If you and your boyfriend agree upon a rule about spending time with exes, then there should be no problem.


Question:
A few years ago I was making love to my wife when for no known reason I lost my erection,

Now I'm In my early 30s and my problem has become more and more frequent. This is causing major problems for my ego and it's diminishing my self esteem. This has resulted in ongoing depression and tearing apart my marriage.

I am devastated and cannot find a cause for these issues. I am very attracted to my wife and want to express it in the bedroom like I used to.

What could be causing this, and what can I do about it?

Response: For starters, know that this is a normal experience for many men at some point in their lives. While this can certainly cause some embarrassment, a diminished sexual esteem or relationship problems, it is important to know you are not alone. I am going to move forward assuming that you have already checked with a medical professional to rule out any medical problems that may be related to this. Assuming that is the case, for most this happens for two primary reasons. It is either a short term biological shortage of blood flow to the penis. This can be caused my diet, lack of exercise, even stress. Another primary reason for loss of erections are anxiety. Have their been recent relationship issues? Are you feeling as though you aren't satisfied in the bedroom? These are just a few aspects that can cause subconscious anxiety and loss of erection. My suggestion to you would be to seek out a counselor that specializes in sexuality that can assist you in moving forward with this.  Best of Luck!


Question:
My fiancee and I have been together for 3 years and our relationship has always been good. The only issue we had was that he felt like he wasn't getting enough sexual attention from me.

I recently found out he cheated on me with another women. He says he wants his family back but I'm confused on what to do. Is it possible for us to get past the cheating, or should I just move on?

Response: As a relationship therapist I work with couples all the time that are in the repair phase of their relationship after infidelity. The short answer to this, is not only is it possible to have a satisfying and fullfilling relationship after infidelity, it happens more often that we may know. The current rate of infidelity is high, while it's not important to go into many reasons, it mau be important to know you aren't alone in this! My biggest suggestion for you would be to seek out a professional counselor that specializes in working with couples healing from infidelity. Best of luck!


Question: Does counseling really do anything that can help people?

Response: Hello. Yes, counseling can be beneficial to many people. One of the effective components to effective therapy, is when the client becomes willing to participate in the counseling. I don't mean just show up and listen to the counselor for 45-50 minutes, but also that the client themselves opens up and shares with the counselor the issues that brought them to counseling in the first place. This requires you to be vulnerable, capable of moving past your protective measures of showing the best of yourself, and allowing the counselor to see the sides of you that likely are not as favorable. Therapy works when you and the counselor engage openly, honestly, and with mutual trust that both of you will work for common goals - your improvement of self. It does take time, and there are no quick fixes (usually), so be prepared to invest in yourself and explore the dark places. You'll thank yourself later, knowing that you are more connected to yourself and might even feel more whole after the process. Be well.


Question: Does counseling really do anything that can help people?

Response: I love this question! Some people shy away from counseling because they think since they already talk about how they feel to their relatives or friends they shouldn't need a counselor. However, if you are having a difficult time, counseling can be beneficial in helping you move forward and get your life back on track. Counseling is not like the kind of talking we do to people we know. For one, your counselor does not have a history with you and has no expectations of how you will act and what you will do. In that way, counselors come to a session without judgement and expectation. This gives you the platform to truly explore your thoughts and feelings. A counselor can also help you understand your motivation and help you integrate your past experiences and recommend coping skills that can help you if you are feeling overwhelmed by your emotions. Over time, as you work with a counselor you will get feedback and also be able to share new insights. The work you do is based on you and where you are at. Oftentimes, when we talk to friends they bring their own agenda to a conversation, and while they mean well they may offer solutions that work for them and not you. A counselor will help you uncover the solutions that work best for you and help you find the motivation to follow through with your plan.Best of luck to you!


Question:
I'm dealing with imposter syndrome in graduate school. I know that by all accounts I am a phenomenal graduate student, and that I am well-published. I am well liked by students and faculty alike. And yet I cannot shake the feeling that I'm going to be found out as a fraud.

How can I get over this feeling?

Response: It would be very helpful to identify with you eventual pattern where the imposter syndrome is more or less present. Are there specific situations where you've noticed the feelings of "I'm going to be found out as a fraud" becoming more strong? It seems that shaking this feeling is very important to you. In my opinion, before shaking that feeling, we need to get closer to it and understand its roots. If you would like to get closer to the feeling, you might consider asking yourself questions such: "What is the trigger for this feeling? How does it feel in the body? What is the thought process I engage with after noticing this feeling? All the best. Rossana Mag.


Question:
I have a friend that who I used to be in a relationship with. It was brief and turned into us being just good friends.

I spent the weekend with him and it upset my boyfriend. Was i wrong?

Response: It is not the case of being right or wrong, in my view. If you are asking, I believe you truly care for your boyfriend. It seems like he is having difficulties in establishing trust in this relationship. The ideal would be to come closer to his upsetness and to show him that you are there for him. I hope all goes well. Rossana Mag.


Question:
I have a friend that who I used to be in a relationship with. It was brief and turned into us being just good friends.

I spent the weekend with him and it upset my boyfriend. Was i wrong?

Response: Ideally you and your boyfriend will reach a balance point where you and your boyfriend are each happy with the level of involvement you have with your former boyfriend.Start w a discussion with your current boyfriend as to what specifically he doesn't like about your friendship with your former boyfriend.It is possible that you can answer his concerns as well he can find out from you more as to what the friendship is all about.As a therapist, I've never seen a former romantic relationship become only a friendship.   As sincere as you may be in your intention to only keep the friendship with the former relationship partner, if  your former boyfriend secretly has romantic feelings for you, then at best, you've got an unclear friendship with this person.The obvious possibility is to socialize together with your current boyfriend and your former one. If neither guy would go for this, then this would show there is an undercurrent of competition for your romantic attention.Basically make your romantic partner's feelings and your own, the major considerations and discuss from this perspective.


Question:
I'm dealing with imposter syndrome in graduate school. I know that by all accounts I am a phenomenal graduate student, and that I am well-published. I am well liked by students and faculty alike. And yet I cannot shake the feeling that I'm going to be found out as a fraud.

How can I get over this feeling?

Response: First step is to remove the label of your behavior as a syndrome and instead understand the reasons for it."Imposter syndrome" sounds like a name someone made up to write a book and have lots of people buy it bc it gives the feeling they know themselves by calling themselves this name.Instead, consider your own unique qualities including your fears of being recognized as adding value to people's lives.If you were told growing up that you're worthless, or if your chosen career goes against family advice and expectations, or if you simply are a shy person, then these would be the starting points to understand your reluctance to believe in yourself.The more you understand yourself and trust the truths you find as to who you are, the less you will feel fraudulent.Good luck in your career work!


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: From the very beginning of counseling sessions I emphasize that the work will and must end at some point.In counseling there is an arc to the process. A beginning, middle and end. I am always digging, searching and exploring. There comes a point where things come to there natural ending.I always leave an opening for continuing counseling in the future. At least as a check in.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: There are different reasons why a counselor may seek to terminate with a client and these will each have different processes by which the counselor will come to that decision. Here are a few examples. The counselor may determine that the client's needs are outside what the counselor is competent to be able to work with. A person may have come to the counselor talking about a particular issue but either when they first met or as counseling progressed, it may become clear that the issue is in fact something different or that there is an additional related issue. If that issue is outside the competence of the counselor, the counselor should look for alternatives, the most common of which would be to terminate and refer. Beyond clinical issues, this could also come up around particular other related facts, such as the culture of the client or linguistic issues. This could also be the choice of the counselor if they know someone that they feel would be a better match for the client's issues. Another reason for discharge (and possible referral) would be if the relationship does not seem to be a good fit. No counselor is the right person to work with everyone. If the right level of connection is not happening, the counselor will often look first at what they are doing, might talk about it with the client and ultimately will admit that things don't seem to be working to allow the desired therapeutic process to work. A similar process would be followed if the counselor determined that the client might not yet be ready for counseling as evidenced by lack of engagement such as frequent cancellations, not doing any agreed on work between sessions, showing up late or being really guarded in session. The easiest situation to decide on is when a person has met their counseling goals and have nothing new that they are working on. While this is the easiest one to determine, it is also probably the hardest one for the counselor as they may be like the client in not wanting the relationship to come to an end. However, counselors know that this is part of the process. They will also determine this by regularly reviewing the treatment plan or by sending in the sessions that the work has come to an end. This type of termination maybe final or may be with the intent that the client will return later to address other things that have been identified but for which they are not ready to move into. All of these (and other) situations involves the counselor being open to the relationship ending, to monitoring how things are going, then engaging in self reflection, possibly talking with the client and then coming to a conclusion on which the counselor  follows through.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: This is a question that is very specific to each person. There are definitely some variables, but I can give you some general ideas for when counseling might end:When a client has met all of their goals, at least to a degree when they feel that they no longer need to work on them with the assistance of a counselorSometimes a decision is made that a client is no longer benefiting from counseling at a certain timeSometimes clients have to remain in counseling in order to receive medication. This depends on agency policy, but sometimes it is a requirement. If the medication is necessary and cannot be prescribed by a primary care physician, frequency of sessions is usually decreased greatlyI'm not sure why you are asking this question, but it is also something that is often discussed at the beginning of treatment. Oftentimes "discharge goals" change as treatment progresses because more is known about clients, their goals, changes in their goals, and many other things. Changes are normal, but your counselor probably has discharge goals in mind, at least generally, from the beginning. I strongly encourage you to ask about it!


Question: How does a person start the counseling process?

Response: Usually people call me by phone, they introduce themselves, we chat for a bit, then we schedule a time for their appointment


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Hi there, There are a number of reasons why a therapeutic relationship might end including, but not limited to the client reaching their goals, the client reaching a place of acceptance where they wish to remain or even a breach within the relationship.  The last aspect should likely be taken to supervision in order to be fully processed.  All of these things could happen, and usually happen organically (again, except for the last example). Your question, however, was about the counselor ending treatment. This is a bit more difficult and can be very nerve-wracking.  It may be beneficial to take this with you to supervision, as well.  It's important to understand why you feel the need to end or terminate with the client, as well. Do you feel that they would be better suited for another therapist, have they achieved their goals or is it something else?In regular, open-ended sessions, I try to make a point of checking in with the clients fairly frequently. In these check-ins, I use the time to ask the client how they feel about the sessions and if there is anything they wish to focus on more astutely.  I also ask if they have any immediate goals that they would like to prioritize.  In goal-oriented sessions, I check in more frequently to ensure that both the client and I remain focused and, should they wish to shift their focus, that they recognize it is part of my responsibilities to make sure we move back to the desired goal. Often, especially in longer term therapeutic relationships, we as clinicians can see that the client has reached their goal, however they are apprehensive about ending therapy.  This is actually a great place to go with them; why would they feel unable to handle issues in their external or internal environment without you? Often, having this open discussion can increase empowerment and mastery. That said, it could also highlight other issues which the client may have been apprehensive about going into within therapy and now, as the relationship seems to be ending, feels more confident in bringing these up. In the case where the relationship is a toxic one, terminating with a client may be the best option for both of you. It's a difficult conversation, but recall that part of the role of the therapist is to model that these discomforts can be managed. I hope that this brief response can assist you going forward!


Question: How does a person start the counseling process?

Response: Hello, There are many ways to approach a counselor and starting the process, however they all start with picking up the phone.  It's most definitely an uncomfortable feeling, but once that first step is taken it is often met with a wave of relief. My recommendation is always to call and speak with a therapist over the phone before scheduling an appointment. Listening to how they converse, use their tone and inflection, may give you a brief insight to how they will respond to you and increase your comfort right away. You may also discover, rather quickly, that this therapist is not the right match for you.Regardless of how you go about it, I like to remind all people who call, email, text or walk-in, therapists are a bit like pizzas - if you don't like the toppings, send it back! There are hundreds of therapists offering all kinds of styles of therapy - take the time to pick one that suits you.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: There are typically three reasons why therapy is terminated:1) Client has met therapy goals2) Client is not progressing 3) Therapist is not a good fit for clientIn order to properly assess whether therapy is helping and what progress is being made, the therapist needs to have ways of consistently checking in with clients sessions-by-session to determine what is helping, what isn't, and where the client is at in relation to their original therapy goals. When a client has met their goals, that is a good time to end counselling sessions unless the client has new goals or simply wants to check-in periodically to make sure that they are still on track (sometimes referred to as relapse prevention). When a client is not progressing, and feedback has been taken and attempts have been made to make the therapy more helpful for the client but to no avail, than it is considered unethical to continue to work with the client. In these circumstances, referring out to another therapist who may be a better fit is a good idea.


Question:
I'm in my late teens and live with my dad. The only time I go out is for my college classes. Sometimes when I see my friends I want to talk with them, but sometimes I won't want to talk to them for days or even weeks.

Sometimes I feel i'm not worth knowing or i'm never going to do anything right.

Are they right, am I depressed?

Response: I'm alway wary of assigning a term to a feeling, as often that term becomes more important than the feeling itself. From the very little that you have written, it is clear that you are going through something that has made you extremely low, affected your self-esteem and motivation, limits your enjoyment of formerly pleasurable activities and affects your feelings of self-worth. All of these are aspects of being depressed, though you can be depressed and still not have "depression". Counseling is definitely a place where you can go and sort out why you have had such a sudden a drastic change to your mood. Sometimes our mood can be effected by changes in our routine, losses or significant disappointments. Talking with someone will not only help you to better understand why you are feeling this way, but they will also help you to ground yourself and learn strategies and tools to help you to manage your mood and strategize for the future. I do hope that you will reach out. Feeling alone can be harmful over long periods of time, as it can stop us from seeking out the support we need.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Hello. The end of the counselor/client relationship is one of mutual respect and engagement. Counseling sessions can end for any number of reasons. Among them are the client's inability to make forward progress in therapy; the clinician's inability to help the client (for a variety of reasons); a mutually agreed upon time frame for a number of sessions to be provided; or the financial challenges of the client who decides that they need to put their resources elsewhere. In this last case, a counselor should never cancel sessions with a client simply on the basis of the client's inability to pay. That is traditionally seen as an unethical practice. Other arrangements can be made to provide care to the client, which in itself should be paramount.When the client and therapist decide that services are done, it is best if there is at least one or two more sessions to allow a case file review to occur, and to bring an appropriate psychological sense of closure to the client (and vicariously to the clinician as well, those this is perhaps not as important). This transition gives both a sense of having reached the end of a journey...rather than some abrupt departure from it. (An abrupt ending in therapy can have a varying level of impact both emotionally and psychologically on the client and therapist). Sometimes the closure of therapy is the result of a program of therapy being formally completed, in which there is a mutually known (albeit perhaps approximate) date of when that program will be finished. In this case, the client is likely feeling that impending closure and has time to prepare mentally and emotionally from a place of being the client in therapy, to a place of healing, growth and situational resolution.I have always worked in therapy with the following slogan (if you will), that I learned years ago during graduate school: "Not every therapist is good for every client, and not every client is good for every therapist." It is perhaps one of the most important guiding views I hold in working with clients. The therapeutic relationship is driven by mutuality - the desire of the client to get better at living life, and the therapist's desire to truly see the client heal and grow. When there is a block in this process from either side that prevents that synergy from occurring, the relationship that should be established may not be able to form. Or, if already formed, may at some point be unable to move forward. In these instances, referring the client to another type of service or clinician is appropriate. Usually, this can be seen pretty quickly by either party, though sometimes it is not always clear.Ultimately, the client and counselor need to work together to discover if the needs of the client (which is paramount) are being met in the therapeutic engagement with their current counselor, or if other arrangements need to be made to go elsewhere. If both are observant in this process, they can work together to maintain that sacred space and continue to reach the goals that have been set. Eventually, therapy will end, but hopefully based on the client's successful journey to the place where they wanted to go, and thus opening the next chapters of their life to a space that is more whole and brighter.


Question: How does a person start the counseling process?

Response: Hello. Counseling often begins way before the client ever actually calls the local therapist. There is often a tipping point in the internal struggle that the client experiences, where they can no longer deal with the issues on their own and thus giving the motivation to seek external help. That said, clients usually go seeking therapists based on what their insurance will cover, or what is likely to be more and more the case in the near future...what they are able to pay for out of pocket. That first phone call to a prospective counselor can often feel like torture, but it doesn't have to stay that way. Counselors are well trained to acknowledge the inherent goodness of all clients, and should be able to see and hear the sense of fear in the client of being judged or put down in some way. The counselor you select should be compassionate, caring, able to join with you on your journey to resolving your issues or concerns, and to do so without negative judgment of you as a person of worth.Once you have found a counselor you want to work with, you would then schedule an appointment to meet. That first session is often very low key. There might be some forms for you to complete, which will help the counselor address your concerns and learn a bit more about you. The counselor will typically provide you with what we generally call in the profession a professional disclosure or practice statement. This document (which may be several pages long) usually outlines the counselor's credentials; practice rules; forms of payment; office hours; emergency contact details; and confidentiality guidelines under state and federal law, among other details. All of this benefits you as the client, so that you are well informed and can focus your attention on why you are meeting with the counselor.In the first session, it is absolutely okay to be nervous. Here's a really big secret (which is important to keep in mind as counseling begins): Counselors are often as nervous (if not more) to meet a new client, as the client is to meet their new counselor. It's true. We as professionals are trying to put our best foot forward to impress you with our awesome counseling skills. While simultaneously hiding all the troubling unwanted issues that we ourselves have in our life too, and being worried that we might not know if we can help the client sitting in front of us. What makes it even more challenging, is that counselors are often put on a giant pedestal of perfection by clients (all while we as counselors tend to look at it like we're standing on a three legged stool). This is normal for us when seen from the eyes of the client. Counselors and clients are both human, and we both make mistakes. Coming from that place of understanding, might bring a sense of ease to both the client and the therapist as they seek to work together. Part of this perception of perfection held by clients toward counselors, is that the skills of the counselor might look like they have all the answers. We honestly do not, plain and simple. Counselors come from life experiences (where they might be farther down on life's road than you); they hold completion of various forms of training; and have advanced education. Yet we are in the end, imperfect beings struggling to help imperfect people. This makes it easier to be compassionate to new clients walking through our door with the hope that we will receive that same compassion in return. Very often, we can find ourselves reflected in our clients' lives with their struggles and can become more effective at helping if we have resolved similar issues in our own life. So as you begin to seek out a therapist, try looking for one who is aware of their own life issues and is actively working on them too. Someone who can meet you where you are at emotionally and can understand your sense of your struggle that you are facing at the present moment. That counselor may be a good example for you as you enter into therapy and build your own strength, and thus begin dealing with the issues more effectively you bring up in therapy.


Question: I'm dating this guy, Peter. My friend Jennifer used to date him a while ago, and she's fine with us dating. My ex-boyfriend, Paul, broke up with Jennifer, and she's devastated about it. Peter and I are going through a rough patch in our relationship. All of a sudden, Paul is in "love" with me, and he wants me back. I don't know what to do because I can't hurt my friend or my boyfriend, but I think I might Paul again.

Response: Hello. The dynamics of having a romantic relationship with someone is not always clear. Sometimes we jump from one relationship to another without giving ourselves a chance to adjust and grieve for the one we had to leave behind. When you find yourself in a situation where a previous partner is coming back into your life and desires to be with you again, it is important to ask yourself what the motivations are prompting that return. Is the person afraid of being alone? Are they jealous of your current relationship? Do you feel the same way about this returning relationship as you did before it was ended? How long and/or how committed is the current relationship you are in now with your current partner? Does your former partner not like being "dumped" and maybe they just want to get back together with you so that they can "dump" you instead? Some of these questions you may not be able to answer, and some of them might require your own internal reflection.You likely want to make a good decision, and you also might want to consider who it will impact, and how that will happen. Other friends might be upset at this sudden change, and it could create a strain on your friendship. You will want to carefully consider the value of that friendship before you take any actions that could damage it. Also perhaps think about what led you to end the relationship with your previous partner in the first place. Has there been a change in events or behavior that would cause you to think of a valid reason to give that person a second chance? How it will it impact your current relationship?Going into relationships should be done with reflection, patience, and full awareness. Ultimately you choose who is in your life, so you want to make those choices based on appropriate decision making, and with the ability to protect yourself from harm. No one else can make this choice for you. However, gaining the insight of friends or family can be helpful, as can seeking out the counsel of a therapist. In your heart, you will likely find the right answer. Learn to trust that more, as that is where the core of emotion tends to be when you need it. Use your mind to analyze things, but allow yourself to also feel your way through the situation too. The answer will arrive if you let it.


Question:
I am in a high stress position for a tech company. I am being overworked and underpaid for my contributions and it is not only giving me anxiety, but also demoralizing.

What can I do to manage my stress?

Response: Hello. Workplace stress is one of those areas of living that troubles many people who need an income to survive. The interactions between you and coworkers is a mixed bag, and sorting that out can be difficult. Also, if you are feeling under appreciated and not well paid, this can add bitterness to your lot of emotions. A few questions can be kept in mind as you work through your situation. Do you have the option of talking to your employer about your experiences and feelings with regard to your current work? Do you have local resources that you can use to find different jobs in your field? Do you have connections with employment counselors or agencies that can support you with strategies in dealing with workplace stress? These questions might cause others to bubble up, and could begin a new journey into a new field.While still at your job, what can you do to take care of yourself? Are you taking breaks? Do you eat lunch at the office, or do you go somewhere away from the office to eat? What do you do when you have a few moments to breathe? Understanding that you can indeed find even the smallest strategies useful for self-care, can help bolster your energy and give you some support as you move through the day. Seeking the support of family and friends can be helpful as well. Knowing your personal limits and when to pull back and take a break will give you a chance to recharge your mental and physical energy, thus helping you face the demands of your job.


Question: How does a person start the counseling process?

Response: Hi! Great question! My suggestion would be to google therapists in your area.  One great website is called Psychology Today, which is a National site.  You can search for therapists in your zip code and search more specifically for the issue you are seeking support about.  It's a great way to find out if they therapist has a speciality, accepts insurance and whether they offer a free phone consultation. I would then make a list of the ones that may be a good fit and then give them a call!  :)  Hope this helps. Remember you get to ask anything you need to, to determine if someone is a good fit.  Don't be afraid to ask anything!  :)  Best of luck!


Question:
I crossdress and like to be feminine but I am attracted to women, but yet that seems to bother girls I date or ask out.

How can I approach them about it? should I hold back and keep it a secret, or should I just be up-front about it. I wonder if i should stop or if I should continue to do it since it makes me happy. What should I do?

Response: Thanks for asking this question. I think the most important part of what you mentioned was that you do it because it makes you happy. For that reason, I would encourage you to keep doing what makes you happy.As far as telling girls or keeping it a secret, I don't really think that it's necessarily one or the other, at least not the first time that you meet. In other words, one part of your decision-making could be whether it is something that you always want to address in the first date, or perhaps something that you address after you've known each other for a couple of meetings. The answer to that question may also change depending on who you are dating. I would imagine that each person that you are with mainly due to a different decision this was when to disclose this. It sounds like this is an important part of you, so I would think that if you were going to date someone long-term, you would want them to know about the most important parts of you, including that.I also encourage you to remember that if you meet someone who is not comfortable with this, that does not mean that there is anything wrong with what you are doing, but rather something that the other person is in some way deciding not to continue learning about or choosing to have someone they are dating like to cross-dress.I'd also ask you to consider this: Are the people who you say this to expecting it? My guess is that the answer is probably not. Along with that, Are they going to have questions? I would imagine so.Are you comfortable answering questions?I wonder if you could figure out yourself or with friends (or perhaps even with a therapist) how you would answer these sorts of questions:What exactly is cross-dressing?Does that change the gender that you're attracted to?What does it mean to you?Why is it important to you?And what you want your listening person to know about you related to cross-dressing.There could even be ways that you can start the conversation by asking them to be open to listen to you and ask questions about what they are thinking before they make any quick decisions about you or the relationship.I certainly hope that you find the right person for you. I imagine that having this conversation could be stressful, especially considering the idea that you have had some negative reactions in the past. Remember that talking this through with a therapist could be very helpful.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Hopefully both the client and counselor would together decide when to terminate counseling sessions. It's really helpful for the client to leave counseling with a solid sense of what he or she has accomplished in counseling, so it can be a good idea to spend some time acknowledging that in the last session or sessions. Sometimes, however, a client has needs beyond the scope of the counselor's expertise. That's a good time for a conversation about those needs and ideas of  how best to meet them, whether by adding in care with an additional mental health professional or transferring care entirely to a new mental health provider.


Question:
My daughter seemed to be developing at a normal rate until about the age of 10. She then started to act younger than she is.

Now she only wants to play with younger kids and she doesn't act her age. I don't know why this is happening. Is this normal?

Response: Good for you to know your daughter's friendship circles and to notice when these have changed.While friendships are key relationships, they are not the only indicator of someone not developing normally.Is your observation and opinion that your daughter isn't normal based on other factors or just this one?If this is the only factor then start with reflecting on what circumstances may be influencing your daughter to socialize with younger kids.Has she ben ostracized or bullied by her peers and may be retreating to avoid further emotional hurt?Is she keeping up with her school work?Sometimes kids who feel overwhelmed by schoolwork will regress into conditions in which they feel more success and control.Are there family circumstances such as the death of someone with whom your daughter felt close?  Or, is there a new younger sibling in the family or a younger sibling who due to their own circumstance receives more attention than your daughter may wish for herself.Once you've reflected on which areas may be affecting your daughter, gently ask her some questions about her comfort with what you theorize may be the source of the problem.Its also possible that offering her your extra time and interest may increase her sense of self so that she feels secure enough to increase her social time with her age group.


Question: After first meeting the client, what is the process that a counselor facilitates?

Response: Great question which I imagine many other people have as well.The therapist will want to know your main source of life discomfort.  In what areas are the problem interactions which you hope will disappear?The therapist is trained to listen for your emotions to your story.  And to open these up to you in a kind and safe way so that you'll start to see your circumstance in a new light in which you feel more of your own authority to handle the troubling conditions.The therapist and you will refine your thinking and theories.   The therapist will ask questions to help you prepare for any stumbling blocks along your way of creating your own new answers to the problem you brought to counseling.I hope you'll enjoy learning and creating new thinking and interacting patterns!


Question:
I am in a high stress position for a tech company. I am being overworked and underpaid for my contributions and it is not only giving me anxiety, but also demoralizing.

What can I do to manage my stress?

Response: Recognize your reason for continuing to work for this place.Sometimes "overworked and underpaid" is tolerable bc of the valuable learning which the person will take with them when they've decided the time has come for these lessons to end.Or, are you in this place bc it is an easy commute to your home or fits well with other parts of your life such as education or some health related program?As long as you have a good reason to be there, you will feel there is good purpose.If there is no good purpose and every day you wake up to work for a place you can't stand, then its time to look for a new position.


Question:
My son was diagnosed with autism a few years ago and I stopped working so that I could take care of him. I also was dealing with an abusive relationship (mentally, physically, and emotionally). Now I live like a recluse and I always feel nervous around people.

How can I feel more comfortable around other people?

Response: Probably a good portion of living like a recluse was necessary so you had time to rest and recuperate from so much major adjustment in your life.Have you told some of the people in your life about the many changes you've been through?   It is possible people sense something different about you and aren't sure whether to ask or not ask questions.Also, understand what type of qualities you'd like to offer and receive in a friendship.   Given that raising a kid who has autism takes a lot of energy and time, the way you socialize will change.Start with one person whom you're pretty sure would welcome you and whom you would gain by bringing them into your life.As a result of how this interaction goes, how you decide to spend your time together, what you'll discuss, you will know more about yourself and what you require to feel good around other people.Then, you can consider if you're ready to add others into your world.


Question: What are the basic skills a good counselor needs to have?

Response: To be non-judgemental, know who they themselves are, be able to step forward and ask questions with ease and grace into painful emotional areas.Also to respect human difference in accomplishing basic life tasks and everyday living.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: In my therapy practice the decision to end therapy is mutually made together with the patient.Otherwise, the person can end up with a sense of tremendous rejection and abandonment.The way you'll both know therapy is coming to a close is that the discussion will feel lighter and move easily.The person's mood will be better, they will smile more, sit in their seat in a more relaxed way, look more at ease, take better care of their appearance.One of the ways to end therapy is to gradually decrease the frequency of the sessions.Sometimes people who are in my practice start to come each three weeks, then monthly, then every three months.This gives a sense of security, friendliness, and casualness to the therapy, and de-medicalizes it as though the person was treated for a medical symptom and the symptom stops completely one day.Talk therapy is about life and life problems usually end gradually.I end my therapy in a way which mirrors the life process in which many interaction and situation problems show their effects gradually and show different effects over time.


Question: How does a person start the counseling process?

Response: Phone or email a counselor whose profile you've read and which feels right for you.Ask to get a feel as to the way the person would handle your problem and work with you.In my practice I offer a phone consult which generally continues for twenty minutes.I feel it is only fair that a prospective patient has a feel for the service they are about to purchase before they can be expected to pay money for a service which may not be to their liking at all.


Question: I don't understand why this is happening. Why do I feel this way?

Response: The first step to answer your question is to reflect on what is going on in your life overall.  If you're in the midst of severe stress, whether within your relationship or effort to establish a relationship, upheaval in family dynamics, some type of significant loss like a job or someone with whom you feel closely attached, then you may simply be creating the solitude which is necessary to better understand and absorb the meaning of these changes.I assume you mean you are by yourself when you are indoors.What you write sounds like you're not happy with this recent urge rather than that you and someone or others are having great and fun times together.One way to encourage yourself to go back outdoors is to connect w a friend or search for an interest within you to develop.This way with either of these, you'd feel a little bit of motivation to join and get more involved with either of these.


Question:
I'm in my late teens and live with my dad. The only time I go out is for my college classes. Sometimes when I see my friends I want to talk with them, but sometimes I won't want to talk to them for days or even weeks.

Sometimes I feel i'm not worth knowing or i'm never going to do anything right.

Are they right, am I depressed?

Response: The answer to the question of whether or not you're depressed, is less meaningful than what you are doing to feel strong and secure in your life.Otherwise, people shortcut themselves to go deeper in understanding who they are and what they'd like to do with their lives, and accept "depression" as though it is their new name.What you write sounds like classic depression.What to do about this feeling is to get closer to yourself in an accepting way.  Assume that what you do in daily living is somehow necessary.  Unless you are doing immoral or illegal actions to other people, to accept your own wishes as truth will open you to appreciate why you do what you do.Make believe you're interesting and find out more about who you are, if you have trouble to start with thinking of yourself as worth understanding.The more you appreciate who you are and your unique strengths, vulnerabilities and fears, the more these will dissolve by what seems on their own.In fact they will disappear bc you are believing in yourself and your ways.Good luck!


Question:
I'm in my late teens and live with my dad. The only time I go out is for my college classes. Sometimes when I see my friends I want to talk with them, but sometimes I won't want to talk to them for days or even weeks.

Sometimes I feel i'm not worth knowing or i'm never going to do anything right.

Are they right, am I depressed?

Response: Hello. Being a teenager in our society today can cause depression quite easily. We look at the world in which we live, and the doubts we have about being able to make a contribution, or to have value and worth with the people around us, and we begin to internalize those messages of self-worth. If that alone were not enough, you are trying to figure out where you want to go in life, and who you are supposed to be in the world. Teens are faced with pressures of being judged by your peers for how you present yourself; following current fashions; possessing the trendy things; and hanging out with the "in crowd." Here's a "secret" that might help with most of those issues: Not much of those problems I've just described will really matter as they might seem to right now, in the real world. If you are feeling depression because you feel you lack some of those things that are seen as important by others (like your peers), I can assure you that being someone who is kind; compassionate; understanding of another person's suffering; and the effort you make to be the best person you can become in the world, will far outweigh anything you experienced in your teen years.When we are young, we judge everything based on what our peers have, what they say, the way they dress, who's popular, who's not popular, and for the most of it, all of that is external. So the question becomes, are you trying to fix the feelings on the inside (the internal stuff), with the trappings of all the stuff on the outside (the internal)? That is to say, do you feel that if you had what your friends have, you would be happy and less depressed? Depression is usually a symptom of something much bigger, it is not typically a problem by itself (just as a person who experiences a high temperature may likely have a cold). So fixing the symptom requires looking at the possible causes. In your post, you mentioned that you live with your dad. Are your parents divorced or separated, or has your mom passed away? Either of these circumstances could certainly cause depression. Finding out when you started feeling depressed, might be able to pinpoint the trigger that caused it, which requires looking at when you last felt really happy. It is also important to keep in mind, that as a teenager, your emotions are often being experienced very randomly, and sometimes without cause. It is part of your emotional development, but as you grow older can learn how to manage those emotions better and practice doing things that help you feel better (without causing harm to yourself).Have you tried talking to your dad about your feelings, or maybe another relative if you feel safer doing so? Do you have a friend who is your best friend...someone who is there for you no matter what? If not, there is a service you can use that is a national number for teens to talk with teen peer counselors. They are teens like yourself, but they have some insights that might be helpful. Its called Teen Line (https://teenlineonline.org/). It helped me when I was in my teens, and has helped lots of other teens as well. You might find a place to get some referrals to other local services in your area. If you want are in Washington state and would like to connect with me directly, you call link to me via my profile page. Or perhaps finding a counselor in your local area might be useful. Most towns and cities have some form of low cost counseling. You might also check with your school for assistance.Don't be afraid of not always knowing how you are supposed to feel. Adults don't always have a handle on it either. Being a teenager carries a lot stress, fear, and uncertainty. But you are not alone, and there is help if you reach out for it. I wish for you the very best, and bright future.


Question:
I have a relative who is in his twenties. He was in a drug rehabilitation program and got kicked out for using drugs again. No one informed family that he was using drugs again. He subsequently overdosed and was found dead.
Is their accountability of counselors, therapists or the halfway house for not reporting that he had relapsed? Is there a legal case for failing to report?

Response: I am so sorry for your loss.  Generally therapists only have a duty to report self harm to ones self or others if it is expressed to them.  Often times they will not report relapses due to the fact that proper releases were not signed or patient has specifically asked them not to for fear of shaming or failure again.  I understand this may not be the answer you were hoping for.  I would encourage the family to seek therapy themselves for help coping with such a loss.


Question:
My husband has had issues with alcohol addiction in the past (he'd never admit to this). A while back (3 years ago), I asked him to stop drinking so much, and he agreed. I caught him one night drinking behind my back. I confronted him and he lied, but I told him I knew he was lying because I counted the beers in the fridge and four of them were missing. He admitted and apologized and promised he wouldn't do it again. Lately, my husband has been drinking on and off, but I noticed it was every single night. I didn't like this. For our New Years resolution, we decided we were going to limit our alcohol consumption. He was on boardno more drinking every night.
The other night, I counted the beers in the fridge just to see if some were missing. It took a couple of days, but tonight, I discovered a few were missing along with a shot of vodka. He was passed out on the couch when I decided to wake him up and confront him (poor timing, but I couldn't wait). I asked him if he'd come to bed with me (when he drinks, he snores and I cannot sleepit's a dead giveaway he's been drinking). He slurred a bit and said no. I asked if he had been drinking, but he snapped and said no. I went into our room to sleep, leaving him on the couch.
I'm not sure if I'm overreacting or not. I just feel like I'm so honest with him about everything, and I expect the same honesty. He is a good husband in every other regard.

Response: It can be very frustrating being lied to.  The one thing that struck me was the sentence he had a alcohol addiction "in the past."  Addiction is not something that comes and goes.  Once you have addict tendencies they are here to stay.  You may be able to fight them off for awhile but the will enviably rear their ugly head again.  Some of the things that we would suggest is taking the access away.  If the alcohol is not conveniently in the house he would have to go seek it out elsewhere.  You can think about it in other terms.  If chocolate cake was your favorite food and you were a diabetic, you would not have chocolate cake lying around all the time because you know you would eventually eat it.  Remember there are no temporary addicts.


Question: I have bipolar II disorder, I'm addicted to alcohol and weed, and I'm hopeless. I keep drinking even though it's harming myself and others.

Response: You are not hopeless, as you can see there are many people who care about your well being and believe you can overcome this.  I would suggest that you first get evaluated for your alcohol consumption.  Alcohol is one of the addictions that you may need to seek inpatient treatment for.  If not inpatient then be monitored by a doctor.  Once you are evaluated and or complete inpatient treatment I would suggest you participate in a form of outpatient therapy on a consistent basis.


Question: I need to speak to someone about sexual addiction and binge eating immediately.

Response: There are plenty of online providers within the mental health field that would me more than happy to speak with you immediately.  Many of them provide treatment on a sliding scale fee.  I would google online mental health treatment providers and that should lead you to a list of providers that can help you.


Question: Or how to send him somewhere that can help him, something like The Baker Act.

Response: Your dad needs to be aware that he has a problem and be willing to make some changes in order for him to be motivated to stop.  Often times individuals will be forced to stop when they were not ready.  Remember we can not ever make someone do something they do not want to do.  There needs to be at least a little willingness on the other party to make some changes.  I would encourage you to reach out to your family or other loved ones and have a conversation with your dad regarding your concerns.


Question:
I'm planning to have baby, so I have to quit smoking - but it's hard. Sometimes it's not a physical need, it's mental.

I cannot help myself from thinking about smoking. What can I do to get rid of this addiction?

Response: It can be challenging to quite anything once we set our mind to it.  We often crave the things more that we know we can not or should not have.  With that being said I would encourage you to become aware of the chemical dependency part that cigarettes have on your brain and your body.  Then make yourself aware of the mental part the habit part.  Often times people will engage in smoking again just from the mere social aspect of it.  Make yourself aware of these and devise a plan of the things you will do instead of going out on smoke breaks, or the ritual of smoking in the car on on the back porch.  There are plenty of support groups out there to help with this as well.  Smoking cessation is a good resource.


Question:
My son was diagnosed with autism a few years ago and I stopped working so that I could take care of him. I also was dealing with an abusive relationship (mentally, physically, and emotionally). Now I live like a recluse and I always feel nervous around people.

How can I feel more comfortable around other people?

Response: I would look at  getting engaged with a support network of individuals who may also have autistic children.  They will understand some of the things that you are experiencing at home and you may also find someone who feels that same way as you. If you have not sought professional counseling for the abusive relationship I would seek out a therapist who can help you process through it so you do not repeat similar choices in your next relationship.


Question: After first meeting the client, what is the process that a counselor facilitates?

Response: A good therapist will discuss what brought you to therapy in the first place and devise a therapy plan with you on some of the things that you may want to work on.  The plan is not set in stone as things may arise during your therapy sessions. You also agree on how often and when you would like to meet.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: In the best case scenario, it's a mutual discussion and decision. If not,  I've had the discussion initiated both ways, by me, when I sense the client has gone has far as they want, by lack of interest in accepting or completing homework assignments, missing or cancelling appointments, usually at the last minute, lack of participation during sessions.  Client initiates by asking me pointed questions about why the need for homework assignments,, by forgetting their calendar, or their checkbook :) , by suggesting that we make appointments over longer intervals (once a week to once a month, for example).  I rarely have had to terminate a working relationship--that's why I don't charge for the first visit, so we know if we are a good fit before we start working together.  Then I periodically ask whether the client feels we are making progress, moving in the right direction, talking about the most relevant issues etc.


Question: Does counseling really do anything that can help people?

Response: Experts have defined counseling as a healing relationship that helps patients by providing a space to vent, process and receive unconditional support.  Many of my clients have expressed that they are able to find their own answers during the session, because they have the right person listening to them.  Some thought they were safe sharing their concerns with friends or relatives who are good listeners, but later they felt ashamed or guilty about what they shared.  So why people should share private issues with a Counselor (a stranger)?  Confidentiality is the key word.  A good counseling relationship should provide a space where people are able to share their deepest thoughts and feelings, allowing themselves to be vulnerable and explore those emotions that are difficult to share without implications.  Beyond the ability to provide a safe place, counselors are trained to identify symptoms and behavioral patterns, and can provide insight on how develop coping mechanisms to improve their life.I am a License Professional Counselor working on a private practice in Puerto Rico: Latitude Counseling, and also I'm licensed in Texas, where I provide theletherapy services.  If you would like to learn more about the services available, you may call 787-466-5478 or visit www.latitudecounseling.com¿CÃ³mo la consejerÃa ayuda a las personas?¿Realmente la consejerÃa hace algo para ayudar a otros?Expertos definen la consejerÃa como una relaciÃ³n sanadora que ayuda a los pacientes proveyÃ©ndoles un espacio para ventilar, procesar y recibir apoyo incondicional.  Algunos de mis clientes han expresado que son capaces de encontrar las respuestas a sus problemas durante la sesiÃ³n de consejerÃa, porque tiene a la persona indicada escuchÃ¡ndolos.   Otros cuentan que se sentian seguros compartiendo sus preocupaciones con su familia o amigos, pero esas preocupaciones afectaron sus relaciones negativamente, o los dejaron con sentimientos de culpa. AsÃ que, ¿Por quÃ© deben las personas compartir asuntos privados con consejero, (un extraÃ±o)?  Confidencialidad es la clave.  Una buena relaciÃ³n de consejerÃa debe proveer un espacio donde las personas puedan compartir sus mÃ¡s Ãntimos pensamientos y sentimientos, permitiÃ©ndoles ser vulnerables y explorar esas emociones que son difÃciles de compartir sin consecuencias. Mas allÃ¡ de proveer un espacio seguro, lo consejeros profesionales estamos entrenados para identificar sÃntomas, patrones de conducta, y proveer perspectiva en cÃ³mo desarrollar los mecanismos de defensa necesarios para mejorar la calidad de vida.Soy Consejera Profesional Licenciada en Puerto Rico, donde practico a travÃ©s de Latitdue Counseling, tambiÃ©n estoy licenciada en Texas, donde proveo servicios de teleterapia.  Para mÃ¡s informaciÃ³n llame al 787-466-5478 o visite www.latitudecounseling.com


Question: My ex-fiancee (whom I am still seeing) left me because of the pressure from all three of his teenage daughters. They wanted him to try to work it out with their mom (his ex-girlfriend of 20 years). He and I split three months ago, but I have been seeing him pretty regularly despite the fact that he is living back with his ex-girlfriend and kids. He is "co-existing" for the kids and fighting all the time with his ex-girlfriend. His daughters Don't want their dad with me because my two boys (grown adults and on their own now) had bad reputations and issues with drugs. His daughters say it is embarrassing for him to be with me. He and I had an absolutely amazing relationship and connect on so many levels. He is getting a lot of pressure from his family and his longtime friends to "do the right thing" and stay with his ex-girlfriend for the kids. He says he wants me to wait. We were going get married last year. He bought me a $1000 dress, we had invitations made, and everything set up, but then his girls told him they'd never speak to him again if he married me. He says hes trying to mend his relationship with them.

Response: Hello. It seems you are in a set of circumstances that are highly uncomfortable for you. Do you feel those circumstances are healthy? Do you find pleasure being in such a place of uncertainty? Why do you continue to be in this situation? Without meaning to appear that I might be lacking in compassion, you do have the option to leave the connection completely if the harm it is doing is more that the pleasure it brings you. Is there a benefit to being in this relationship? Do you consider this situation to be for your highest good? Is it healthy to be involved in something that is not likely healthy or perhaps could even be seen as dysfunctional? In truth, only you can decide the answers to these very important questions. I would encourage you to think of who benefits by being in this situation, and how you might be able to find happiness in other relationships that are healthier and more positive. In my clinical view based on what I read, this particular relationship does not carry the joy I am sure you want, nor the healthy interactions you would expect in a functional romantic engagement with another person.Beating yourself up about potentially wasting all this time waiting for the other person to come around will not serve a positive purpose. It likely will only lower your self-esteem. There is a time to wait to see how things develop, and a time to move on to other experiences. You are the one to make that choice, but I would encourage you to connect with your inner higher self, for the most clear answer. Chances are, you already know the answer, you just need to embrace it. Getting in touch with a counselor in your area can also help ferret out some of the deeper issues that you might not have felt comfortable expressing here.


Question: I was raped a couple months ago, Since then, along with other unfortunately events that have occurred, I have been having trouble feeling emotions. It's almost as if I'm a sociopath lacking any feeling. What can I do to change this?

Response: You are describing a very legitimate reaction to trauma.  Rape is an aweful experience and I am very sorry that happened to you.  When horrible things happen, people often react in a way that interferes with the ability to live a normal life and function the way they did in the past.  This is very common and the goal is to help you manage the stress caused by dealing with negative events and with help you can regain emotional well-being.  This is especially important if you have had more than one negative thing happen.  Oftentimes, the unconscious reaction is to become numb and avoid all feelings, especially if more than one negative event occurred.  A big part of what causes people trouble are feelings of guilt.  We often blame ourselves when bad things happen. It is actually difficult to comprehend the concept that we don't always have control of what happens in life.  In addition, when you mentioned feeling like a sociopath, it sounded like you feel like your reaction is wrong.  The first thing you can do is realize that your feelings and reactions are o.k., you aren't doing anything wrong, and nothing is wrong with you.  The next step is to start dealing with the impact of these traumatic experiences. Identifying your feelings, and knowing the thoughts and beliefs that are behind those emotions can help you regain your sense of happiness.  Research shows that understanding and expressing those thoughts and feelings can help.  If doesn't sound like you need to do anything to change yourself, but talking to a counselor can be helpful in managing your reaction to a incredibly traumatic experience.  I hope this helps you understand your feelings and can get to a place where you enjoy life.


Question:
I am in my early 20s and I still live with my parents because I can't afford to live alone.

My mother says that if I live under her roof I have to follow her rules. She is trying to control my life. What should I do?

Response: That is a really tough situation that a lot of young people are experiencing right now. The first thing to under is that you can't change who your parents are and cannot change their behavior. The thing to keep in mind is that you can control your responses and actions.  You may need to keep living at home with them for the next few months or years and the best way to do this is to have a plan. The second thing is to keep in mind that their controlling behavior is most likely not about based your behavior. Controlling parents are often driven by their concept of what will keep their children safe and happy. Unfortunately this is not always accurate but keep in mind it is not a personal attack.  There are ways you can deal with controlling parents' and most of them require creating a plan of action.Examples of action plans:Decide in advance how you'll calmly and rationally respond to your parents when you feel theyre trying to control youArrange to phone a friend or trusted adult when you feel like you're losing controlTalk in person to an adult you trust. There aren't any quick tips on how to deal with parents who want to control you; you need to find strategies that are geared to your specific family situation. Get specific coping tips from books about family dynamics, such as:Toxic Parents: Overcoming Their Hurtful Legacy and Reclaiming Your Life by Susan ForwardCutting Loose: An Adult's Guide to Coming to Terms with Your Parents by Howard HalpernA counselor can be a good resource and provide support and guidance about issues addressing normal growth and development during periods of transition.


Question:
I'm planning to have baby, so I have to quit smoking - but it's hard. Sometimes it's not a physical need, it's mental.

I cannot help myself from thinking about smoking. What can I do to get rid of this addiction?

Response: Quitting smoking can be difficult. It's also true that there is part that is sometimes a physical need and a part that is often connected to emotions in some way. From the way that you wrote this, it sounds like you may have been able to stop smoking physically, but still have cravings.One thing you can do is talk with your primary care physician or OB/GYN about whether there is anything that you can take to help with the cravings. Sometimes that can very helpful.As far as the more emotional or mental piece, these things come to mind:Sometimes a crucial part is looking at the habit of smoking and seeing what else you can do to keep your mind and hands busy. There are sometimes toys, like those available at Office Playground, that may help to keep you physically occupied.There can also be changes or additions to your routine because I imagine that smoking took up a great deal of your time. Maybe when you have the temptation to get up and go to have a cigarette, you could have several other things that you can get up and do instead. The list is endless, but a few examples could be doing some physical exercise (with the permission of your doctor) just for a couple minutes because that could help with the craving as well, completing a puzzle, learning a new activity that requires using your hands (painting or knitting, perhaps).Another piece of quitting smoking is often linked to anxiety or other emotional changes, perhaps irritability. Depending on what it is that you may be feeling,  learning other strategies to use can be helpful as well.This can all be quite overwhelming and a very big life change. I would recommend that if things do not become easier for you, consider talking with a therapist. Then you could not only have some more strategies or ideas directly related to you, but you could have very direct support for what you are trying to do.I give you a lot of credit!


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response:
Goodbyes can be hard.
Chances are most of the goodbyes you have experienced in your life have been
difficult. Saying goodbye to a therapist can be different. It can be an
opportunity to create a healthy ending in a positive relationship in your life.
If you work with a therapist who is skilled, then saying goodbye can be just as
transformative as the therapy itself. Ending therapy is also known
as termination. I know, termination does not have a great ring to it!
However, it is what it is. It is an ending of the relationship as it existed.
It is reality cold and stark. Of course, when I talk to clients I Don't use the
word termination, I usually say our goodbye.  Under what circumstances does therapy usually
end? Therapy should end when a client does not need further assistance, is not
receiving any benefit from therapy, or might be harmed by continuing to work
with a particular therapist.In the best case scenario
the decision to move on from therapy and say our goodbyes happens when both
the therapist and the client feel like the client is ready to move on and move
up!  Ending the therapeutic relationship
should actually be worked on from the very first session. What I mean by that
is, there should be an understanding that the work we do together will have an
ending and that is a good thing because it means the client has gained the
skills to continue working on themselves independently. So the first session I
have with clients usually outlines a plan where the end goal is discussed and
we both have an understanding of the skills the client wants to learn or what
they hope to achieve. Now sometimes there are
situations where the therapist ends the relationship and the client may take
that personally, it is hard when any relationship ends and it might bring up
feelings of sadness, and fear or abandonment. Any good therapist will end the
relationship based on what is right for the client. What are some situations
where a therapist might end the relationship?If the situation the client
is dealing with is out of the therapist's scope of practice, the therapist may
end the relationship and refer the client to someone else. This is in the
client's best interest. Another reason a therapist might end the relationship
is that the therapist is in a place in her life which prevents her from being
objective and helpful.  A therapist who
is going through a painful divorce may have difficulty working with a couple
that considering divorce. A good therapist may see that their judgement may be
clouded and want to refer the client to see someone else. This is good practice
and helps the client.If a client is actively
suicidal or actively using substances then the therapist may end the
relationship and refer out for a higher level of care. The client may need to
be hospitalized or may need an inpatient substance abuse treatment program.
Therapy may be terminated while they are being treated and may continue after
the intensive program is completed.
Ending therapy should be a
time for connection and bringing together accomplishments, or reviewing the
next important step the client needs to take. It should not be an experience of
abandonment. A skilled therapist will help a client gain a new perspective on
closure. For some clients, it may be the one time in their lives when they get
a clean ending in a healthy relationship and they get to feel a sense of
control on creating that ending. Good luck to you!


Question:
I'm planning to have baby, so I have to quit smoking - but it's hard. Sometimes it's not a physical need, it's mental.

I cannot help myself from thinking about smoking. What can I do to get rid of this addiction?

Response: It is very good news that you realize the risks of smoking cigarettes while pregnant and are willing to stop.Thinking about smoking is a typical and frequent reaction to being without the substance.Be creative with what you know about yourself to distract you when this psychological urge comes up.  My suggestions are to imagine smoking if you find this would relieve the sense of wanting to smoke.Or, do the opposite and remind yourself of all the good reasons to not smoke.Also, since you're planning pregnancy then ask your partner for ideas on how to make the psychological feeling to want to smoke, feel less intense.Another suggestion is that your partner is your texting buddy to stop smoking.   With AA groups, a sponsor is always available for the alcoholic who feels distress about the urge to drink.   Having a trusted and caring person to tell about your problem helps in many situations.  Maybe it will help you to stop smoking.Good luck!


Question: I'm a teenager and I've been sneaking out of my house at night for a year now. I've been caught several times. I want to stop doing this but I don't know where to start. How do I stop?

Response: Where do you go and what is your reason to go wherever this is?Try to understand these reasons because the answers may give you good guidance as to other ways to get what   it is your trying to reach by sneaking from your home at night.If for example, you're sneaking out because your parents are arguing and you feel hurt by this and want to escape hearing their arguments, then you can come up with other ways to hear less of their arguments.If you sneak out bc your parents restrict your friends or time to socialize with your friends, and your friends are doing legal and safe behaviors, then maybe you could do some socializing online w them.Also, I wonder the reason why either of your parents isn't aware that you leave the house.  Do you feel your parent would offer and would you ask your parent to give their suggestions so you feel more motivated to stay home?


Question:
I keep having these random thoughts that I don't want. Things like "you aren't worth anything." I know they're my own thoughts but it feels like someone else is saying it.

What is wrong with me, and how can I stop having these thoughts?

Response: Those  critical thoughts most likely came into your mind as the way you understood what one of your parents or some other adult who was very meaningful to you, at a very young age.When we are too young to distinguish whether what a grown person tells us, feels accurate, we absorb their opinions as our own.Your question shows you've reached the point of emotional maturity to know that your opinion about yourself is not the same as what is inside your emotional brain and stored there since you were too young to know that someone else's opinions are not necessarily your opinions.Nothing is wrong with you, everything is right with you to wonder how to more firmly establish your own point of view.Start the habit to revise any viewpoints about yourself which don't feel true.Then replace these thoughts with better ones which you decide on your own.After a while of doing this you'll either automatically think the more positive thoughts about yourself or at least be in the habit to know that negative viewpoints about you are not necessarily true.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: Counseling ends when the client has received the maximum benefit from the therapist. Even if the therapist believes the client is not making progress, the client may feel they are improving and receiving a benefit. And the therapist may see a benefit and the client does not. It is best to have ongoing dialogue with the client to determine when termination is appropriate.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: There are several reasons for a counselor to decide to end counseling.  A major reason to end counseling is if the counselor feels that he or she does not have the skills or experience to work with the client.  This may happen during the intake process or after working with the client for some time.  If the clinician feels that the client is not benefitting from the therapy, it is ethical to suggest that the client terminate the therapy.  The process of termination must not injure the client and, if necessary, the clinician may need to refer the client to other treatment modalities.  Another reason to terminate working with a client is if the client needs a higher level of care.  If the client has a crisis or is at risk of hurting himself or someone else, he or she may need a higher level of care.  In this circumstance, the clinician may need to involve outside services such as a crisis unit.  A third reason to terminate with a client is if the clinician feels that he or she cannot remain professional with the client relationship.  For example, if the issues that the client is working on bring up something significant for the clinician and the clinician feels that he is unable to separate that from the professional relationship.  In this instance, the clinician should refer the client to another therapist.  Finally, if the client has reached her goals for therapy and no longer needs treatment, the clinician and client should terminate treatment.


Question: What are some difficulties that a counselor can encounter when dealing with a client?

Response: Each counselor will have their own list of "difficulties" in doing therapy work with a client.  Even if clinically trained similarly, since counselors are human then their response to your question will reflect their unique differences as humans.On my list is when the emotional pain I feel for someone describing some type of injustice or unfair treatment by another, feels very deep.Sometimes I feel like avoiding the pain I feel by asking questions which will steer the conversation away from the painful areas the client talks about.What in fact is necessary to clear out their pain, is to step further into so as to realize their emotional pain isn't greater than who they are.


Question: Does counseling really do anything that can help people?

Response: Yes, counseling can help people.How this happens is bc the counselor can guide the person or couple into deeper areas of their thoughts and emotions than the person or partners would typically avoid or not even realize they are avoiding.Also, a counseling session offers emotional safety because the therapist will intervene with thoughtful questions if someone's strong emotions overwhelm them.This is different than in everyday circumstances.  When someone feels overwhelmed by their own or someone else's feelings, there is no one who asks reflective questions.Last, people get better in therapy because often therapy is the first time the person has a chance to trust someone with their confidential information and know this information will always be protected.


Question:
I'm planning to have baby, so I have to quit smoking - but it's hard. Sometimes it's not a physical need, it's mental.

I cannot help myself from thinking about smoking. What can I do to get rid of this addiction?

Response: Hopefully you feel you have the time to follow this procedure.1. For a week - log when you smoke - time, place and activity2. Plan on cutting back 10% for a week.Cut out the easiest times.3.Next change the times and and activities for 3 days - consider water or candy or gum if it is very tough. 4. Cut another 10% each week until you are done.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: I will work with clients and continually review progress with them and determine if counseling is helping.  If a client appears to have less to talk about in sessions, appears more stable for a period of time and has reached therapeutic goals I will talk about termination.  Some clients however I may continue with on a monthly or bi monthly process to allow for check-ins to see how they are doing and if they need more help at that time.


Question:
I am in my early 20s and I still live with my parents because I can't afford to live alone.

My mother says that if I live under her roof I have to follow her rules. She is trying to control my life. What should I do?

Response: Hello. It sounds like you and your parents are not balanced in your communication and awareness of expectations. Your growth is not only reflected in your ability to understand and apply new knowledge and skills, it is also reflective of your parents acceptance of your understanding and application. Have you tried talking with your parents to let them know your concerns?This talking is best when face to face and during non active conflict ( can't begin stating rules during an argument, etc). Sometimes it is even helpful to write down ways you feel you can be supported by them and supportive to them. Maybe share this list or reflective piece with them to review, or use when communicating the expectations. Unfortunately, until there are clear expectations stated and expressed, the scale will be uneven and frustrations will increase. Dr. T


Question: After first meeting the client, what is the process that a counselor facilitates?

Response: After meeting a client, many Counselors will ask you lots of questions in order to complete a thorough assessment of what you came to counseling for. This assessment is required by most insurances and allows the Counselor to give a diagnosis, which is also required by most insurances in order for them to pay the Counselor. If you are paying out of pocket, this diagnosis is not really required for payment, but many Counselors will still perform a comprehensive assessment because we really want to know what the issues are that brought you to us. The better we understand what it is that bothers you, what you would like to get out of the counseling, and all the various things that tend to affect people such as family upbringing and medical issues, the easier it is for us to help you reach those goals. How the counseling actually plays out from there depends a lot on the theory that the Counselor uses to direct their approach to counseling, and that information is too much for this little post.


Question: I start counseling/therapy in a few days (I'm freaking out) but my main fear is that I'll cry and embarrass myself, is it something to worry about?

Response: Many people cry during their therapy sessions. Actually most people cry in their therapist's office. I tell my clients that it's safe to cry in my office and crying isn't a sign of weakness. It's a normal human response to pain. People actually do more harm to themselves by trying not to cry than by crying. Crying is very cleansing and an important part of the healing process for many people.


Question: How does a counselor decide when to end counseling sessions or to terminate working with a client?

Response: In general, I usually let the client decide when this should occur, sometimes with some clients it will be a joint agreement, but even in that case it should weigh mostly on what the client feels. In short, therapy ends when you feel your done.C


Question:
I've been bullied for years and the teachers have done nothing about it. I haven't been diagnosed with depression, but i have been extremely sad for years.

How can I deal with being bullied at school when the teachers won't help?

Response: To be bullied is very painful.I'm glad you know the bullies are doing the wrong thing and whatever they are telling you is pure meanness.Depending on how independent you feel, why not tell either your classroom teacher or schedule an appointment with the vice principal?Bullying other students is taken very seriously in some states and schools are expected to address the bullying until the victimized student feels safe.If you hesitate to do this on your own, then would you ask either of your parents or even a friend of yours who is also in the school, to report the problem?In case you are afraid the bullies will retaliate for reporting them, then tell this to whatever school authority you decide to ask for help.You're entitled to be protected by your school.


Question: I need help knowing how to deal with stress. What can I do?

Response: Something different works for each of us.There are the outward answers of self-pampering and making your home and work environment as pleasant as possible.A deeper level way to decrease stress is through exercise or alternative practices like yoga or tai chi.If the stress is more deeply rooted than temporarily feeling irritated for a few days, then give yourself some time to reflect and clarify what the meaning of the stress is to you.Self-understanding and appreciating your efforts to know yourself may decrease stress because you'll be more focused and attentive to who you are.  This will influence you overall to make good decisions for yourself and these will naturally be ones which decrease stress as much as possible.