Problems Treated

DEPRESSION is your response to life stressors.  Depression varies in duration, frequency and severity.  There are two main types of depression.  One is situational depression.  Situational depression is caused by a job loss or other event.  The other type of depression is caused by body physiology and/or genetics, which is long-standing persisting in spite of life events or changes.  Both types of depression can be extremely intense and debilitating.  The experience of depression tends, but not always, includes a feelings of sadness, pervasive feelings of tiredness, heaviness, no motivation, loss of life interests, sudden changes in weight, feelings of hopelessness, feeling overwhelmed, concentration difficulties, memory loss, difficulty making decisions.  Social withdrawal, short temper, easily hurt can accompany depression.  Suicidal thoughts, homicidal thoughts or thoughts of engaging property damage may occur.

Why do many people experience depression at one time or another in their lives?  You could consider depression as your mind's way of alerting you that something needs to be changed in your life.  Problems that contribute to depression may have been ignored, long neglected, avoided, or not managed effectively.  If you feel depressed, it is your body's wisdom letting you know that something is wrong.  Something needs to be changed.  What is wrong and what needs to be changed may be not be clear, that is why professional help is needed.  When depressed some people think about everything at once which feeds a vicious cycle of becoming increasingly depressed.  What life elements that need to be changed may not be clear, that is where professional help can assist you in getting a handle on your problems.

The objectives for resolving problems with depression commonly include understanding your current problems and their origins, finding viable solutions and engaging in life changing activities.  Proactively therapy can assist a person to identify the early warning signs of problems and resolve them before difficulties accumulate.  Changing the ways you evaluate problems can be successful in empowering you to direct intrapersonal, interpersonal and situational changes.

ANXIETY is another reaction to life stressors.  A reaction is experienced by most, if not all, of us at one time or another.  Minor anxieties are in fact useful, it heightens your ability to perform tasks or develop novel solutions to perplexing problems.  Intense anxiety, however, can impair your performance and cause diverse other problems in living.  Intense anxiety the emotional response of anxiety is usually accompanied by physical sensations.  You may have a general feeling of being tense or uptight.  You may have specific symptoms such as racing heart, upset stomach, neck or back tension, headache and an increase in localized pain.

In time, prolonged anxiety will in all probability take a toll on your physical and mental health.  Physical health tolls may include high blood pressure, irritable bowel syndrome, acid reflux, chronic headaches, joint pain, immune system repression, stomach ulcers as well as a host of other problems.  Mental health tolls include development of anxiety disorders.  Panic attacks are one of the common anxiety disorders prevalent in our high-pressure hurried world.  Symptoms of panic attacks can include sudden difficulty breathing, chest pain, racing heart, dizziness, upset stomach, feeling like you are going crazy, fear of death/dying and feeling like you are watching yourself from a distance like things are not quite real.  Panic attack symptoms often mimic heart attack symptoms.  As a precaution during a panic attack, you must go to an ER to determine if you are having a heart attack or panic attack.

Sometimes anxiety or panic attacks become situation specific and is commonly classified as a phobia.  Some people experience phobias or panic attacks when they are in crowds of people, while driving their cars or other situations.  This may influence them to shop at twenty-four stores during off hours or only leave their homes when the roads are nearly deserted.  For some their phobias may become so intense that they may avoid leaving their homes.

When one's response to anxiety of out of proportion to the event or circumstances, it is likely that your response is more reflective of the problem in coping or ways of evaluating the situation rather than the actual danger imposed by the external event.  The treatment objectives for people presenting with problems with anxiety often include teaching people how to practice calming techniques as well as identifying negative automatic thoughts and cognitive distortions.  Objectives also include directing individuals to gradually adjust to and be at ease with formally anxiety provoking situations.  Anxiety provoking situations can be constructively used to broaden your repertoire of coping skills.  When people adjust their evaluations of anxiety-provoking situations while improving their coping skills, this contributes to success in overcoming problems with anxiety.  In the case of long standing problems, your coming to terms with the basis and origins of fears may empower you to reduce and effectively handle stress reactions.

ASSERTIVENESS is an essential communication skill.  Effective communication includes the appropriate use of assertiveness includes the ability to choose from a variety of direct appropriate and tactful statements to use in a given social situation.  Assertiveness communicates respect for others while maintain your own self-respect.  In contract, less desirable communication styles such as aggressive, passive, passive aggressive communication styles are tend to be the most common.  These communication styles are often glamorized by actors whether on stage or on television.  Assertive communication is what many of us strive to perfect.  Sometimes our best intensions of using assertive communication are interpreted by others as being aggressive on inappropriate.  Granted, even when we have carefully rehearsed how to be assertive, when given the complexities of situations combined with emotions, we have problems responding spontaneously.  We appreciate the complexities of human interactions when we consider the choices we have in addition to the response choices of others.  When we practice assertive communication styles in both response and attitude, we make ourselves more managing and rewarding.  This is true for both ourselves and others.

If assertive communication is so desirable than why is it so difficult?  Our fear of others, social situations, lack of knowledge or experience has much to do with an appropriate and mature way of managing our world.  None of us is perfect in being great communicators.  We all make seemingly foolish mistakes in our interactions with others.  If however, one has difficulty one or more situations with friends, family or at work, your therapist serves as a mentor or a coach.  The objectives are to identify the particular situations where problems are experienced and to find ways to better respond to those situations.  The causes for persons' difficulties are identified so that these weaknesses can be recognized and overcome.  The therapist suggests alternative approaches to clients they might not have considered.  Your therapist may be your sounding board for new ideas.  Implementation of communication styles can be trial tested through role playing, considering various alternative responses and receiving feedback.  Trial testing responses in the safety of the therapist's office and then trying them out on an unsuspecting friend or relative are often the most effective ways a person can strengthen communication skills.

RELATIONSHIPS satisfy our basic love and belonging needs, the very center of our personal sense of satisfaction.  Relationships may partially define who we are.  When we are privileged to have healthy, strong relationship.  We feel better about the world, tend to be less effected by the stress of life change, we are happier and feel better about ourselves.  Strong, healthy and positive relationships can provide with support as we achieve success or pursue interests.  All relationships will have their problems at one time or another.  Problems can either be seen as opportunities to strengthen the relationship or stumbling blocks that threaten the relationship.  When relationship problems persist across time we feel isolated, neglected, undermined, depleted, trapped, resentful, deprived, and/or overwhelmed.  These feelings commonly occur in destructive or abusive relationships.  Destructive or abusive relationships can damage our self-esteem, kill our ambitions, and influence us to view ourselves as victims.

Jointly seeking solutions and finding ways to repair damage done within a very significant relationship is the primary objective of Marital/Couples Counseling.  Therapy can be a safe place where a couple can find opportunities to work through issues that threaten the viability of the relationship, causing suffering to one or both individuals.  This is true when the same issues seem to arise repeatedly after one or both have made a concerted effort to resolve these issues.  Another goal is improvement in conflict resolution skills.  Enhancement of listening and communication skills leads to improved understanding leading to improved health of the relationship.  In therapy, we can observe and identify the interaction patterns that influence the relationship in positive and negative ways.  With identification of interaction patterns, a couple can make intelligent choices rather than taking adversarial roles.  A joint commitment to overcoming past relationship problems is the key to success.

ADDICTIONS, addictive lifestyles and relationships present multi-dimensional problems to overcome.  Addictions can manifest as gambling, porn, voyeurism, sexual compulsions, over eating, hoarding and chemical dependencies.  While there are variations on how specific addictions are treated, many commonalities are shared by all addiction treatments.  Dr. Thomas advocates client involvement in a twelve step programs.  Commonly people think of Alcoholics or Narcotics Anonymous when they think of twelve-step group.  However, there are twelve steps groups available for all common addictions in major metro areas.  Clients do best with individual and group therapy in combination with active involvement in a twelve-step group.  Education is an important component, many clients benefit from a structured Recovery Education program.

In addition to engaging in all therapeutic resources, a person must be motivated to work their recovery program one day at a time.  Abstinence from the addictive substance or behavior is necessary.  There is never a point where an addicted person has "arrived" at permanent recovery.  A relapse prevention plan must be a part of daily lifestyle.  If fact, certainty in commitment that the addiction will never occur again is a common relapse warning sign.  Recovery also includes lifestyle and philosophical changes.  People become addicted because of their relentless striving for instant gratification or relief.  People who are addicted often feel like they are fighting an uphill battle.  Addictions are often used to avoid or cover over issues or feelings of fear, grief, loss and low self-esteem.  When the strength of the addiction is diminished then these feelings return sometimes several times stronger than when the addiction began.  Individual therapy to address these issues and feelings is an essential part of effecting behavioral change.  Through therapy, individuals are assisted in developing and strengthening adaptive/alternative coping strategies.  Individuals also need to develop an understanding of how their problems developed and progressed.  Without this understanding and awareness, persons are at significantly higher risk for relapse to old behaviors and their addiction.  As persons progress in recovery, increasing self-awareness is important for daily self-monitoring and identifying potential problems early on.  Persons maintain their recovery by identifying problems early, interrupting the relapse thus averting lapses early.  At times learning effective relapse prevention skills involve the realization that relapses can and will occur.  If they occur there are learning opportunities to sharpen management skills as we continue on the recovery journey. 

Optimal recovery from addiction includes an active daily relapse prevention program; management of transient lapses is a long-term goal for those in therapy for addiction and addictive behavior.

WORK typically occupies forty to fifty hours of our week.  Often we spend so much time at work, we feel like work is our second home.  How our work satisfaction and we work is influenced by many factors.  Some of these factors are within our control; others are outside of our control.  When we choose to exercise creative strategies in handling and addressing these issues, we can make a significant difference in our everyday workday experience.  Some common workplace issues may include:

-Friction with co-workers
-Lack of motivation
-Trouble concentrating
-Burnout
-Workaholism
-Lack of meaning and purpose in your career
-Unexpected pressure to change career
-Career change challenges
-Fantasy that one can work in one career all of their lives
-Problems with Boss
-Problems with upper level management personnel
-Family or medical issues that interfere with job performance
-Downsizing
-Outsourcing

Resolving our career issues help us find meaning and purpose in our work as well as making our work enjoyable.  Contentment with work can assist us to be more available to others who are important to us including ourselves.


SELF-ESTEEM mental health care professionals, motivational speakers and others emphasize the importance of having good self-esteem.  To weather life trials and stress it certainly is good to have a lot of this characteristic that many have discussed.  What is self-esteem?  This simple question is at best hard to answer.  One can consider self-esteem to be the evaluations one has for oneself.  It also has elements of self-worth and level of self-respect.

Your self-esteem, how you feel about yourself is related but different to your self-image.  Your self-image is your internal view of yourself.  It is often impacted by external norms and standards.  Self-esteem operates on a deeper level.  It may be thought of foundation of your personality.  As the foundation of your personality, it can exert a powerful influence on your daily functioning and feelings of well-being.  If you make positive changes in your foundational self-esteem, you are empowered to make significant improvements in your life.

One of the objectives of therapy is to assist you in examining the reasons for impairments in your self-esteem.  If needed, you will also receive assistance toward striving and identifying approaches to increase it, thereby promoting healing and repair.  An ultimate goal of therapy for self-esteem issues is for you to gain greater internal satisfaction and strength.

Copyright © 2008 Rick D. Thomas Ph.D., LLC

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