Saturday, August 30, 2008

A Self-Care Program for People with Mood Disorders


by Jan Stephen Maizler,LCSW

Mood disorders like depression or manic depressive illness affect as much as 8 per cent of the world’s population and account for billions of dollars worth of lost wages, salaries, and costs of treatment. No one knows the exact amounts, but the economic, social, and personal costs are staggering. Almost as staggering is the fact that most sufferers of mood disorders are insufficiently informed as to what they need to do to get well and stay well. This article addresses this very question. Finally, this article is devoted to people who suffer from ongoing painful mood states, not those people who have an occasional “blue” day.

DRUG THERAPY- Because bipolar (manic-depressive) and unipolar (depression) mood disorders are often and generally “chemical” in origin, it is essential that you are evaluated by a medical doctor skilled in the evaluation and treatment of mood disorders. This will generally mean seeing a psychiatrist skilled in psychopharmacology. If they are not available, talk with your primary care physician about their comfort and ability to help you with your mood disorder.When drug therapy is used to stabilize and maintain your mood, it is best for you to think of psychotropic medication as a “suit of clothes.” This is to say that you need to “try them out.” In addition, once they are chosen, they may need to be altered along with the inevitable changes inside you and your life. In any event, anti-depressant medication and/or mood stabilizing medication may take weeks to work, because it takes time for “meds” to build to a therapeutic level in your bloodstream. It is important for you not to give up hope during this period, although your suffering might be great: chances are great that some class of medication will work.

PROPER REST- Because mood disorders cause metabolic, and “sleep-wake” abnormalities, it is essential to try to get the proper rest. It is important for you to realize that rest does not need to mean deep sleep. Listening to relaxing tapes or watching fish in a bowl can be restful. People with active mood disorders may need more rest because of the exhaustion of the painful symptoms themselves, or the effort fighting those symptoms.Conversely, people with mood disorders need to avoid stress and over exertive activities, since exhaustion and the triggering of heightened symptoms can result. People with mood disorders need to give themselves regular predictable rest periods for healing and reenergizing: late nights out may simply be too harmful. It is important to realize it is not just the amount of rest-restoration, but the regularity of the rest cycle also that contributes to a balanced mood.

ACTIVITY-EXERCISE- Supplemental physical activity is as important as rest in the stabilization of mood, and healing affective suffering. Features of appropriate activity are that:
1. It is over and above the normal activities of daily living.
2. Be performed daily for at least 30 minutes.
3. Be of a moderate aerobic nature, which raises the heart rate, and involves the entire body, such as brisk walking.Check with your doctor or appropriate health care professional before you begin to exercise. Exercise has been proven to be inherently mood elevating, combats psychomotor retardation, and binds anxiety.

PROPER NUTRITION- An essential part of any self-care program is giving yourself adequate and thorough nutrition. In active mood disorders, nutrition is critical for many reasons.
1. People with active mood disorders are often not hungry and have no appetite.
2. Therefore less food is eaten, and malnutrition is more likely.
3. Malnutritive states can worsen pathological mood states, and also cause illness.
It is not uncommon for people suffering from depression to self-medicate with certain food groups because they may feel temporarily “better.” Common foods that are abused by affective sufferers are sugary foods (like ice cream, candy, cakes, and chocolate), coffee, starchy carbohydrates (like pasta), and wine. Although this may be a micro step above the self-starvation of other depressed people, it is still not adequate and thorough nutrition.The desired goal is for the establishment of proper diet and nutrition. This will ultimately be stabilizing for your mood disorder. Initially, this may mean forcing yourself to eat other foods, or to eat, period. It is important to seek help from your doctor and a nutritionist as well.

PSYCHOTHERAPY- Another essential pillar of self-care for mood-disordered people is psychotherapy, or as it is commonly known, therapy. The definition of therapy is a verbal means of ameliorating symptoms and/or promoting growth with an appropriately trained professional. Although you might be able to choose amongst clinical social workers, clinical psychologists, psychiatrists, psychiatric nurse practitioners, and mental health counselors, it is essential that you pick one that has extra training and experience in the evaluation and treatment of mood disorders. In addition, because psychotherapy complements drug therapy, it is extremely desirable for the therapist to have a thorough knowledge of all psychotropic medication. Sometimes an initial goal of therapy is to provide emotional support for your suffering during the drug stabilization process: imagine having a therapist that does not know it takes antidepressants at least a few weeks to show their possible benefits! My experience in over 25 years of private practice is that there are comparatively few mood disorder expert therapists. The most important thing in choosing your therapist is to inquire and ask!Some of the things you’ll be discussing and working with in therapy are:
1. Coping with the pain of your symptoms
2. Discussing get-well strategies
3. Working on changing your depression-feeding ideas into healthier ones
4. Venting your feelings
5. Discussing and managing your stressors
6. Learning to read your symptoms to prevent relapse
7. Discussing your family’s or marriages’ reactions to your suffering
8. Learning to avoid relapse-inducing situations or behaviors, such as any drug or alcohol use.Important qualities to look for in a mood disorder therapist are expertise, patience, and availability, amongst others.

SUPPORT GROUPS- Support groups differ from therapy groups in that they are frequently leaderless, cost nothing or little, and encourage active supportive relationships and friendships outside the group. Although support is the primary function of these groups, they also offer you a way out of your isolation, a sense of fellowship, and opportunities for education and insight about your mood disorder. It is important to add membership in a support group to your list of self-care “must-do’s.”People who suffer from mood disorders are much more likely to get better and stay well longer when they follow a cogent and effective self-care program.


Jan Stephen Maizler, MSW, LCSW is a veteran mood disorder therapist practicing in Miami for over thirty years. He is a highly published author with numerous books and articles to his credit. He can be reached at 305-940-1564

Friday, August 29, 2008

Relationship Skills by Jan Maizler


Relationship skills are the tools that build deep functional relationships. The most important amongst them are


1. Self-ownership
2. Good listening behavior
3. Effective needs negotiation
4. Ability to stay in the present moment
5. Toleration of differences
6. On good behavior forever
7. Golden Silence
8. Nonreactivity
9. Ability to internalize and work through conflicts
10. Readiness to provide emotional support
11. Sensitivity to partner's feelings


SELF OWNERSHIP - If partners are willing to assume ownership of their feelings and behaviors, a strong healthy foundation is created. If either partner feels bad, they are willing to embrace that feeling as THEIRS, and will communicate that feeling to the other partner as an "I" message. such as, " I am tired, angry, etc."


GOOD LISTENING BEHAVIOR - Good listening creates an atmosphere of mutuality, respect, self-control, and communication simplicity. In relationships, good listening requires clearing one's mind and hearing the other's utterances with- out any inner clutter.


EFFECTIVE NEEDS NEGOTIATION - Each partner has their own needs that inevitably will differ from the other partner. This occurs even in highly compatible relationships. Effectiveness in gratifying these needs differences involves the old-fashioned art of compromise. Compromise allows each partner's needs to be gratified in a smaller or postponed measure for the good of maintaining relationship harmony.


ABILITY TO STAY IN THE PRESENT MOMENT - One of the biggest sources of relationship difficulty is the inability to stay in the present moment. Distortions in the communications process are often caused by the listener contaminating the process with their inner historical issues. Problems they encountered in past relationships influence their behavior with their current partner.


TOLERANCE OF DIFFERENCES - Any difference between two people is a potential for conflict. Conflict breaks out when needs negotiation fail and tolerance is absent. No two people are alike, even the highly compatible. The most functional relationships strive to neutralize as many incompatibilities between the partners as possible, compromising the differences when possible, and tolerating the differences when not.


ON GOOD BEHAVIOR FOREVER - A garden needs sunlight, water, nutrients, and bug maintenance, and so do relationships! Often people get the crazy idea that relationships are self- maintaining, and without the necessary active, ongoing care, the garden-relationship withers and dies. We should always be on good behavior in our relationships. Why would we not be! The sunlight, water, and nutrients of good behavior are tact, politeness, and gratitude. *Tact means thinking about our words and behavior before they are "released" by us; particularly how it will effect our partner.
* Politeness refers somewhat differently to the formal respect and importance we give to our partner, such as please, and thank you.
* Gratitude is an attitude that expresses our appreciation not just for our partner's efforts, but particularly for who they are, and for the radiance they bring to the relationship. Politeness is saying "thank you"; gratitude is being thankful.


GOLDEN SILENCE - In deep relationships, words are often essential, but at times, words can be COUNTERPRODUCTIVE. The times when Golden Silence should prevail is when words and facts will cause the partner to suffer, and also times when silence can be used to prevent the upward spiraling of conflict, such as a "time out". Silence, however, should never be used as a weapon of chilly anger, withdrawal, or rejection.


NONREACTIVITY - Nonreactivity is a special relationship skill that is dependent on one's temperament, communication style, frustration tolerance, listening ability, insight, and humility. It is a challenging skill for some people to develop. Partners who are competitive, immature, litigious, aggressive, or addicted to being "right" are at the highest risk for reactivity. This skill needs ongoing monitoring and perfection, so calmness versus conflict will prevail.


ABILITY TO INTERNALIZE AND WORK THROUGH CONFLICT - When we are able to solve our problems internally, we sometimes feel some personal discomfort, but we avoid the potentially greater discomfort of drawing our partner into a problem that may be entirely our own. This can create considerable simplicity, when it is either unnecessary or nonproductive to involve our partner in personal conflict resolution. For instance endlessly coming home to someone and complaining repeatedly about the same problem without fixing it can cause eventual damage.


READINESS TO PROVIDE EMOTIONAL SUPPORT - Firm relationships are maintained when it is clear to both parties that each person is committed to providing the interventions needed to help the other when necessary and appropriate. This indicates active caring that increases comfort and safety between people.


SENSITIVITY TO PARTNER'S FEELINGS - Sensitivity to the other partner's feelings provides emotional support, but is a far more ongoing state NOT CONTINGENT on a problem situation, but rather a demonstration and commitment because of the other person's importance to us.


About the Author


http://www.relationshiphandbook.com/

Jan Maizler, MSW, LCSW, is a veteran psychotherapist practicing in Miami, Florida.

He has authored eight books and over three hundred articles.

More by Jan Maizler, MSW, LCSW

For more on Jan Maizler, search his name on Yahoo.com
Grief Work Transformation

By Jan Maizler


Loss is an experience that affects us all at various times during our lives. Our society tends to deal with loss the same way it deals with death and dying - as a painful event to get over rather than as a natural process that can cause growth and transformation. Every loss leaves us with an emptiness - an opening inside. This opening provides a doorway through which we can move forward and begin the journey to the rest of our lives. That journey, and the effort we make to step through that doorway, are called grief work.


What is loss? Loss is the process of suffering we go through when we lose something that we value in our lives. Loss is inevitable and universal - no matter how hard we try to avoid it, we will all experience loss at some time. Nothing is permanent. Loss is subjective - each person experiences loss in his or her unique way. We all experience certain kinds of loss, but the way in which we process it differs tremendously.


What is grief? The normal human emotional reaction to a significant loss is grief. It is also known as mourning or bereavement. Although sadness is the most common symptom, there are many others such as crying, anger, anxiety, hopelessness, and emptiness to name a few. All types of loss carry a certain amount of grief. The way we grieve is often different for different types of losses.


In order to fully understand grief, it is important to be aware of the different types of loss we experience which can help the healing process.

One type of loss, abnormal (unexpected) losses give us little time for emotional preparation, re- arrangement or integration. They challenge us to adjust quickly. Abnormal losses may be acute or chronic. A diagnosis of Alzheimer’s Disease is unexpected, yet is a chronic loss that may provide years of gradual decline for the patient and loved ones to adjust to. The sudden death of a previously healthy loved one is an acute unexpected loss.

What is grief work? Grief work is the mental, emotional, and spiritual work of the grieving process. How you do your grief work determines whether growth and healing can occur. Grief work trans- formation is the process that transforms us from the suffering victim of loss to the more complete person we can eventua- ly become. Grief work will proceed on its own accord and momentum and will only require time, provided nothing interferes with the process.


The Four Steps of Grief Work Transformation:

Recollection - the first step is the active remembrance to that which is being lost or has been lost. This may be accompanied by longing for the pleasures recollected before the loss occurs.

Review - The second step is to review the loss from your current perspective and see the impact and effect it has had on your current life. Then try to speculate about the future implications of the loss.

Realization - The third step, realization, is the result of the experience gained through the recollection and the array of feelings and ideas derived from the review. The realization comes from recognizing what parts of the loss are permanent and can not be negotiated back, and what parts of the loss have opened new possibilities for the future.


Resolution - this is the final conscious step of grief work transformation. It is when we resolve to live life acknow- ledging the loss. We accept the loss and try to learn from it. Resolution is firmer when it permeates our feelings and ideas and changes our behavior.


The life cycle entails an ongoing series of coming to- gether and letting go through loss, bereavement, and reinvolvement. Grief work is the part of that cycle that allows us to move past the loss and bereavement and prepare ourselves for reinvolvement. It allows us to step into the holes in our lives and fill them up with new growth.


This is an excerpt from “The Transformation Handbook” written by Jan Maizler, MSW, LCSW, a psychotherapist in private practice in Miami, Florida at 3050 Biscayne Boulevard, auite 605.


Author's Bio:
Jan Maizler, MSW, LCSW is a psychotherapist in private practice in Miami, FL for the past 25 years. He has written and published numerous articles on the topics of loss and self-improvement. For more information about his book "The Transformation Handbook" go to http://www.transformationhandbook.com/

Review of the Relationship Handbook by Patti Pocsik

Book Reviews

The Relationship Handbookby Jan S. Maizler

What a moving book.

THE RELATIONSHIP HANDBOOK by Jan S. Maizler


Review by Patti Pocsik Green Meadows Reviews


What a moving book. Our author, Jan S. Maizler explores many regions of our existence, allows us to delve deep into our own fears, and find a great reason to be alive and confronting our problems. We should read this as youngsters, just like he remarks. Our mental and spiritual health depend on knowing who we are. But why do we spend so little time remembering, thinking, and knowing ourselves.


His premise is that the foundation on which we build relationships, friendships, and all we do in life, is that we have to know ourselves. Be a whole person before we can ask anything from anyone else is such a down-to-earth approach to all the self-help books out there that want you to shout that is all your fault and beat yourself up over the enabling and overloving.


Like a workbook, we can refer to this book and re-read it. And it is just not written for women, who may be the biggest audience for books like this; it is non-gender written. I have been reading it over and over again because it is a great tool to break on through to the other side.

The author is no novice to counseling and giving advice. He has outstanding credentials and has a long-standing practice in Miami.


So many times you find yourself in a relationship that is less in touch with your reality than you want to believe. But you continue it because maybe for the moment, it makes you feel better than not having one.


Jan makes us take a different approach and allows the reader to believe in themselves. He doesn't make you feel bad because we are not perfect. This is the kind of book that makes me feel better and I hope that there are more readers like myself that want to find truth and happiness and realize that it is inner happiness that allows you to be a good person, walking on this planet.


www.relationshiphandbook.com

Struggle and Human Growth.....

Struggle and Human Growth


by


Jan Maizler



Let’s define struggle to mean any personal goal achievement accompanied by discomfort and resistance. This leaves out struggles of an interpersonal kind. There are many forms of struggle, but for simplicity’s sake, let’s divide struggle into negative, positive, inevitable, and chosen.


Negative struggle is goal achievement to eliminate a deficit state. This occurs when you are attempting to get back to the norm, such as mastering a life-limiting phobia.


Positive struggle is goal achievement that involves transformation from your steady state into a more evolved, grown, or developed state of being. Positive struggle, in contrast to negative struggle does not involve overcoming pathology. Examples of positive struggle are going to graduate school or writing a book. Positive struggle may still certainly involve overcoming resistance and discomfort.


Inevitable struggle deals with the necessary losses and attendant discomfort that are conditions of your life in this world. As your mother struggled to birth you, you struggled to adjust to a new and less comforting world. During your life, you will struggle with sadness and loss when your friends, parents, or partners die or go elsewhere. These struggles are an automatic condition of your life.

Chosen struggles are the product of personal choice and are not automatic conditions of life. Simple examples of chosen struggles are climbing a mountain, going to graduate school, or becoming a body builder.


The basis of this article is that personal struggle as it has been defined has benefit, and conversely, the avoidance of struggle is often harmful. It may be helpful to you to consider the following ideas regarding your relationship to the active or potential struggles in your life.

1.Struggle should be embraced, not avoided.
2.The basis of all addictive behavior is the avoidance of struggle.
3.The discomfort that accompanies struggle may be neither harmful nor lasting.
4.Discomfort is often an automatic aspect of the growth process.
5.No one can struggle for you
6.You cannot struggle for another person, although they may certainly want you to.
7.Struggle is often a normal part of life.
8.Avoidance of struggle often results in low self esteem and personal atrophy.
9.Embracing struggle can result in increased self esteem and personal growth.
10.Evolution as well as collective and individual development embody struggle itself.

Regarding individual development, some people start life off “ on the wrong foot”. This can happen when well-meaning parents either do something for a child that they can do for themselves or impede a child’s activities because of their own fears. Both of these situations diminish the necessary struggle that the child must engage in to grow, experience mastery, and learn that the world around them and their efforts have a relationship. A sad but effective example of this is parents who excessively hover over, and worry over their toddler-child. The child might even come to believe that falling is dangerous, harmful, maybe fatal. People WILL fall, but they get up as well: this is essential learning for children and for adults with that kind of child “inside them.”

THE GOOD NEWS -
We all have the innate capability to grow “new selves” at any point in our life cycle by embracing and “working” our chosen and inevitable struggles. We can learn a great deal about this capacity from the discipline of body building. Those people that choose to “grow” their muscles are aware of a phenomenon called the “training effect.” This means that when our muscles are systematically and repeatedly subjected to a lifting (resistance/struggle) effort greater than their capacity, they will grow to adapt to and meet the newly-introduced demand. This involves considerable discomfort, BUT YOUR MUSCLES WILL NOT GROW UNLESS THEY ARE SUBJECTED TO A LIFTING TASK GREATER THAN THEIR CAPACITY. The art form in this process is to keep the weight lifted slightly more than your growing lifting capacity. This implies that optimal growth is a process, not a goal.

Muscles grow in another way: they can be stretched. The age-old discipline of Yoga, and the newer Pilates involve retraining of the muscles into a more flexible arrangement of components that create a body with a much bigger range of motion. The physical discomfort that accompanies this work is often referred to as “sweet pain”, because the discomfort is a sign of growth that is occurring.

THE PARADOX OF COMFORT-
Although comfort feels good, it plays little if any role in your growth. Take the concept of routine, for example. Routine means an established way of doing things that is repeated, because it has proved effective and/or useful. Routine feeds on itself because comfort is self-reinforcing. The paradox of comfortable routine is that although it has proven useful, it will eventually severely limit the scope of how you experience the world. You may drive to work and return home the same way, but stop to think of how much you are missing and experiencing by not trying alternate paths.!


GET STARTED NOW!-
You can change your life right now by embracing struggle and discomfort. Start by making your decisions based on how you can best grow and evolve. Spend less time basing your decisions and choices on their comfortability.


Jan Maizler MSW, LCSW
www.transformationhandbook.com
www.relationshiphandbook.com

Introduction to Jan Maizler- Psychotherapist...

This blog is designed for people interested in psychotherapy, be it individual, marital, family, or group. Future entries will run the gamut from mental health, psycho-education, editorials, as well as my personal observations from my "side of the couch."Stay tuned!

Jan Maizler, MSW, ACSW, LCSW