Life Changes can be Stressful. When to see a Therapist

Adjusting to Major Life Changes

Are you going through a big change in your life? Sometimes, you can get thrown in ways you could not anticipate. Some of the big changes that people typically struggle with:

  • Death of a loved one, or anticipating a death.
  • Divorce, the end of a significant relationship.
  • Betrayal and loss of trust.
  • The arrival of a new baby, and struggles with parenting.
  • Moving across the country, or across the world, and starting anew.
  • Major illness or injury.
  • Job loss.
  • Empty nesting.

If you’re feeling teed up, drinking more than usual, struggling to find ways to cope, sunk into a withdrawn state and feeling helpless or adrift, it may be time to seek out therapy.

Therapy can help you manage stress, normalize the reactions you’re having, and point to any precedents that might be related to the reaction you’re having. It can help you navigate difficult transitions. If you’re considering therapy, here are some indicators that it could be right for you:

1. You feel shut off from your intimate partner.

2. You feeling disconnected from your friends and family.

3. You’re struggling to adjust to a new job, school, or living situation.

4. You’re experiencing more than the usual conflict in your relationships.

5. You’re feeling overwhelmed, anxious, or depressed.

6. You’re drinking or smoking too much as a way to cope, and this is having negative impacts on work and relationships.

If you’re inhabiting emotional states like these, therapy could be of use to you. Major life changes bring about a need for adjustment. There may be a need to grieve, a need to process anger or disappointment, a need to reevaluate your values. It helps to have a grounded and reliable presence by your side in facing a major change, especially when you feel alone and have few people to rely on. Don’t hesitate to reach out for help if you’re having a rough time coming to terms with a major life change.

Searching For Self Esteem

Finding a sound basis for your self-esteem can be a serious challenge when the world encourages you to look in the wrong places

When you’re not grounded in your true self, you measure your own worth by how others measure your worth. You try to prove how fast, how successful, how great you are.

Unhealthy Self Esteem

Have you ever felt good about yourself because you did well at work? Because you made a good financial decision? Or because you did well at a competitive sport? These are ways of obtaining self-esteem through your performance in the world.

Another way you may increase your self-esteem is by seeking other people’s approval. If they approve, you’ll be accepted, you’ll be ok.

And then, you might sometimes buy things to feel better about yourself, to feel that you matter because of the things we own.

These are common ways of meeting a need for self-esteem that becomes unhealthy when taken too far. In this article I’ll look a little more into these fragile ways of feeding the self-esteem, and then consider some healthier options.

Performance-based self esteem

I can value myself if I land a big sale for my company. If I pull long hours to get the product out the door, and then let my colleagues know that I made it happen through my own heroic efforts. More privately, if I can be a superstar lover and please my partner, I’ll know I’m worth something.

The problem is, you’re only as good as your last performance. And then, there’s that younger, more determined guy waiting in the wings who could be a threat. He’s hungrier, doesn’t have kids, is willing to give it all for the prize.

How fragile it can be to base your self-esteem on your performance! There is always the knowledge that sooner or later you will be outdone. It’s a cold world out there and you have to keep fighting for what you have. You spend a lot of energy fighting to avoid the shame of failing to outperform.

Your family won’t appreciate your work ethic so much as resent your absences. And you end up feelings curiously empty, privately uninspired, but assume that this is just the way it works. Workaholism exemplifies the person with a performance-based self esteem.

Basing self esteem on your Possessions

What is a consumer, but the buyer of products? You get something you wanted, but there will soon be something you need next. The message is, you are not enough as you are. You feel the need to supplement what you have with a shinier gloss.

The messages of advertising completely saturate our screens with images of luxury and beauty that we aspire to attain. “I deserve it, after all the work I’ve put in.” And I didn’t make the cut, unless I have the luxury life.

The things you buy provide you with an inanimate entourage, a collection of artifacts that reflect your aspirations. The hope goes, if you have the new AirPods, the right bag, the right e-bike, a great apartment or kitchen remodel, a luxury car or a luxury girlfriend, you have arrived.

But the feeling of satisfaction is fleeting and ultimately leaves one feeling empty. “What is happiness?” asks Don Draper. “It’s the moment before you need more happiness.” You will never be satisfied this way, but may go on chasing it regardless. The insatiable consumer exemplifies the person with self esteem based on their possessions.

Basing Self-Esteem on What Others Think

You ask others, in various ways, am I worthwhile? If you think I’m worthy, I can start to feel worthy, even if I have my doubts. I need you to keep telling me how worthy I am. Isn’t that what friends, lovers, are for? To be supportive, to offer validation?

It can get confusing, because wanting to be loved, cared for, and given attention are basic human needs. However, when you come to depend on the affirmation of others, this can set you up for trouble.

You become like an addict, craving the fix of attention and the engagement of others. If they don’t give you the validation you need or start to have their own needs, it feels bad, and you get irritable and miserly with your attention.

Or you could end up in a relationship where you feel you are being used. Your boss, your partner, or a so-called friend can dangle the reward conditionally, so that you jump through the hoops to earn it. Sex and Love addicts exemplify those who depend on others to shore up their self-esteem.

What you can do about it

Do you might recognize any of your own behavior in what I have described? Were you taught to value yourself? If so, was it along one of these lines?

No matter what you learnt, you are free to question the assumptions you were raised with. In the list below I’ve put a few qualities that offer a glimpse into some healthier forms of relating to ourselves and the world.

  1. Live with humility. When you feel good about your abilities, your work ethic, or creative capacity, you can carry your own supply of self-worth. When others discover your talents and abilities, you can feel good about your skills and talents being recognized.
  2. Speak the truth. It can feel very grounding to speak the truth of your emotions without fear of upsetting others, provided you do it in a way that is not intended to hurt them. This involves risk. Are you brave enough to try it?
  3. Aim not for perfection, but to be good enough. This might be tough for you perfectionists out there! Can you appreciate yourself for the ways you try every day to be better? It can take some work to change a perfectionistic mind. Therapy can be very helpful for those who are curious enough to want to know more about reclaiming one’s life from the urge to be perfect, and the shame around imperfection.
  4. Slow down your reactions. Make it your goal to respond thoughtfully and wholeheartedly rather than reacting impulsively. If you are being a responsible partner and not needlessly stoking conflict with the people you love, you keep them closer.
  5. Be accountable for what you say and do. It can feel like a bruise to the ego to accept criticism. But when we can do so, we can often provide others with the acknowledgment they need to make things right. When you take responsibility for your words and actions, you build your self-esteem.
  6. Claim your own mind. Rather than following the lead of others, try to think for yourself. This doesn’t mean go it alone. It can be more far more rewarding when you can make sense of your thoughts and feelings with a partner.

Developing greater self-awareness

When you start to think about how you value yourself, you can create a more robust source. Developing greater self-awareness is an important path for those who wish to create a more reliable foundation for their sense of self worth. Some people have never known anything but the relentless drive to achieve, to acquire, or to please.

There is no single path that works for everyone. Some try therapy, or a mindfulness practice. Some take up journaling or prioritizing regular conversations with a partner or a close friend. Whatever the path, it can be very liberating when you can stop trying to please the world and develop self esteem that does not depend quite so much on external factors.

Bruce Hearn is a therapist who works with men, women and couples in San Francisco. His work includes a focus on helping people with issues around self-esteem. To book a free phone consultation, call 415-598-8956 or email email hidden; JavaScript is required.

Considering Meds for Depression?

medication for depression?

If you feel down, discouraged, isolated, lack motivation, or no longer enjoy work or personal relationships as you used to, you might be clinically depressed.

Many people consider antidepressants when they get into this state. Anti-depressant drugs are often seen as the first-line treatment for clinical depression, but there are some very good reasons to think twice before signing up for the happy pills. Recent studies have shown anti-depressants are not effective except in cases of severe depression.

When you lose your job, it’s normal to feel sad, discouraged and anxious. When a loved one dies, you can feel a lot of very intense emotions.

A quarter of American adults live alone. Direct emotional contact with friends happens a lot less than it used to. One of the most painful forms of isolation is to live with a partner to whom you don’t feel connected. Many people are affected.

Social changes enabled by technology have increased our sense of isolation from one another. We’re each on our islands, feeling a sense of isolation and meaninglessness that only connection can solve.

Recognizing Depression

Depression can be recognized because of how much it impairs normal functioning. It becomes increasingly clear to friends, colleagues and family that something is wrong, though men and women may show it differently; men tend to isolate themselves, experience fits of anger and turn to substances or sex for comfort. Isolation doesn’t help matters. Energy levels plummet, you can’t bring yourself to eat and lose the sense of pleasure in the things you used to enjoy. Suicidal thoughts can turn towards planning.

If you, or someone you know fits this description, it can be cause for alarm, and it becomes important to visit a doctor or therapist to assess your condition.

In the rest of this article, I’ll be considering the implications around the use of anti-depressants on mild and moderate depression.

The Stats

The Center for Disease Control (CDC) reports that eleven percent of Americans over twelve years old take an anti-depressant. Primary care doctors are responsible for the majority of this prescribing. Most primary care doctors lack psychiatric training in depression, anxiety and ADHD yet are the main prescribers of medications to treat these conditions. Physician office visits tend to be quite brief.

Few people wish to identify themselves as having a mental illness and don’t feel at ease in starting to take a drug. This may partly explain why doctors often don’t record a diagnosis of clinical depression when prescribing anti-depressants.

Americans tend to have trouble staying the course with their medications, and some drop out as soon as they start to feel a little better or a little worse. Side-effects of anti-depressants can range from dizziness, drowsiness, upset stomachs and loss of sexual appetite. It’s no surprise that many don’t want to stay on their meds.

After hundreds of studies, we now know that anti-depressants are only marginally more effective than a placebo in clinical trials for mild to moderate depression. This is a shocking finding given that antidepressants continue to be used as the first line treatment for depression. And it’s the unspecialized primary care MDs who are handing out these pills.

Chemical Imbalance

From a medical perspective, the practice of treating depression with a pill came out of the chemical imbalance theory. This is the idea that chemical imbalances in the brain give rise to mental illness.

This assumption is outdated by modern research but a lot of pill prescribers don’t seem to have caught up. Most of the time, it is not faulty brain wiring, but the effects of one’s isolation, of common sadness and self-defeating thoughts arising from difficult life circumstances or transitions that can lead someone to depression.

Many people who suffer from depression experience constrained thoughts that seem to be stuck in a loop. When feelings of sadness and isolation lead to negative self-evaluations and unhelpful actions or inactions, a vicious cycle can be set into motion.

Taking a drug like an SSRI to alleviate depression does not directly address the cognitive or emotional processes that gave rise to the imbalance. At best, in cases of severe depression, chemical treatment can help the brain to break away from the vicious cycle of depression. At worst, prescribed for mild depression, it can cause severe side-effects. It can also lead to the emergence of psychotic symptoms in some patients, who are then given mood stabilizers and diagnosed with bipolar II disorder.

How about a little exercise?

Exercise is one of the best ways to help with depression in mild and moderate cases. It can be difficult for people who are depressed to get motivated to exercise.

Fast walking for an hour a day has been been shown to be more effective than anti-depressants and leads to lower recurrence rates for depression. Other forms of cardio exercise are also helpful.

Studies of Yoga practice have shown similar results, with two 90-minute sessions of Hatha Yoga classes each week leading to significantly reduced depression, anxiety and pain. Group activities like yoga also help by providing a sense of group membership, which can be very reassuring to people who would otherwise feel isolated.

Therapy for Depression

Even if you’re exercising a lot, you might still have a lot on your mind that could benefit from thinking and feeling more deeply into.

Group therapy, couples counseling and relational psychotherapy all tend to be more effective than anti-depressants and have lower relapse rates.

Couples counseling promotes supportive emotional bonds between couples that shield individuals against adverse conditions, so that you potentially lead a life reassured that your partner has your back.

Groups can offer a valuable sense of community and the sense that you’re not alone, that others face issues as bad or worse than your own. 

The interpersonal connection of individual psychotherapy can allow people to develop internally, reshape their relationships and develop new perspectives on the world.

When therapy provides the space to talk through difficult feelings and foster greater self-awareness, depression may gradually yield, allowing for a more honest accounting of one’s life and prospects.

Bruce Hearn is a Psychotherapist in private practice in the San Francisco Financial District. He works with couples, men and women. He welcomes people who struggle with depression in his practice.