Adolescent Depression Among 18 Year Olds: Child or Adult?

Adolescent Depression Among 18 Year Olds: Child or Adult?

Adolescent Depression Among 18 Year Olds:  Child or Adult?

Over the years, I've seen a number of parents who come to psychotherapy to deal with their own fear, frustration, and anxiety related to an 18 year old daughter or son who refuses to get help for depression. With regard to mental health decisions, in New York State, we consider an 18 year old to be an adult who can make his or her own decisions about getting mental health treatment. A concerned parent, who is worried about the welfare of his or her child, cannot force an 18 year old to get help if the teen doesn't want it. This raises a lot of complicated issues:

• Even though the law considers an 18 year old to be an adult with regard to participating in mental health treatment, does an 18 year old always have the psychological maturity and judgment needed to make this decision?
• Given all the hormonal and psychological changes that go on during adolescence, does an 18 year old always know what's in his or her best interests regarding psychological health?
• How does teenage rebellion against parents and authority figures factor into this issue?
• How does the depression itself affect an 18 year old's ability to make sound decisions for him or herself in this situation?

What is Adolescent Depression?

What is Adolescent Depression?

Adolescent depression is a psychological disorder that occurs during teenage years with symptoms of persistent sadness, loss of interest in his or her usual activities, loss of self worth, and discouragement. In many cases, teens will start to isolate themselves from family and friends. In some cases, teens might turn to alcohol or drugs to self medicate their depression. In more severe cases, teens might make impulsive attempts or gestures to commit suicide. There might be other symptoms from other psychological disorders such as anxiety, anorexia, bulimia, compulsive overeating, self mutilating, hair pulling, and other similar symptoms. See below (What Are the Symptoms of Adolescent Depression?)

What Causes of Adolescent Depression?

What Causes Adolescent Depression?

Depression during adolescence is not unusual. Some of the causes of depression in teens might be:

• hormonal changes that occur during adolescence
• stress associated with the normal process of maturing and developmental change
• a reaction to a disturbing event: the death of a friend or loved one, the breakup of a relationship, problems at school, and other similar issues

Teens who are Most Vulnerable to Depression:

Teens Who Are Most Vulnerable to Depression

• have low self esteem
• are highly critical of themselves
• have little sense of control over stressful events that occur to them
• have been sexually, physically or emotionally abused or emotionally neglected
• often come from a family with a history of depression
• often have poor social skills
• often feel that they don't "fit in" with their peer group
• have an unstable home life
• often have parents who are divorced
• experience the loss of a parent

What are the Symptoms of Adolescent Depression?

What Are the Symptoms of Adolescent Depression?

• acting out behavior (misbehaving in school, acting defiant with parents)
• changes in appetite (either increase or decrease)
• criminal behavior (shoplifting, alcohol or drug abuse, selling drugs, etc)
• persistent sadness
• irritable mood
• difficulty concentrating
• difficulty making decisions
• problems with memory
• sleep problems (either problems with insomnia, excessive sleeping or day time sleepiness)
• excessively irresponsible behavior
• excessive guilt
• problems in school, including failing grades, fighting with teachers or other students, cutting classes, etc.
• thoughts about suicide, making plans to commit suicide or actual suicide attempts
• substance abuse or other forms of addictive behavior (gambling, acting out sexually)
• excessive worry or preoccupation about death
• significant weight change (either gaining or losing)

Is it Depression or Something Else?
Depression is difficult to diagnose in teens due to hormonal and other developmental changes that go on during this phase of life. Some of the above symptoms are just a normal part of being a teen and do not necessarily mean that your teen is depressed. A psychotherapist or psychiatrist, who specializes in working with teens, should be consulted to make a differential diagnosis. Also, it's a good idea to consult with your medical doctor to rule out any medical causes. A doctor who is knowledgeable about substance abuse can also rule out alcohol or drug abuse.

Depression Before and After Age 18:
Prior to the age of 18, as a parent, you can make the decision as to whether or not your child gets help. It's always better to include teens in on the decision making process, if you can, rather than trying to force them to get help. Also, when teens become involved in criminal activity, the court can mandate that they attend treatment and will often monitor their compliance in treatment.

But when teens turn 18, getting them into treatment for depression can be a thorny issue, if they are either afraid to get into treatment, they feel stigmatized, or they refuse to participate in treatment as part of their rebellion towards you.

What to Do If Your 18 Year Old Refuses to Get Help:
Recognize that, ultimately, as scary as this might be, in most cases, the decision is up to your 18 year old. But there are some steps that you can take to help your 18 year old to get help:

Normalize What Your Child is Feeling
As previously mentioned, it's not unusual for teens to be depressed. Your 18 year old might feel that he or she is the only one who is going through depression. This can be especially painful because teens often have a strong need to "fit in" with their peer group. If they think that what they're going through is "weird" or "crazy," it would be helpful for them to know that they're not alone.

Provide Your Child with Psychoeducational Material about Depression
Organizations like NAMI (http://www.NAMI.org) have websites that provide psychoeducational information about depression. So, even if your 18 year old won't listen to you, he or she might be more receptive to information that is online.

Elicit the Help of Someone Close to Your 18 Year Old
During the adolescent phase of growing up, teens are striving to have some degree of autonomy and control. This often translates into alternating behavior of over dependence and rebellion towards parents and authority figures. An 18 year old's decision not to participate in mental health treatment for depression can be adversely affected by his or her need to feel autonomous and independent from parents. So, even though you might be the one who is most familiar with what's going on with your teen, you might not be the one that he or she will listen to about this. In many cases, it's helpful to find someone who has some influence with your teenager--that might be an older sibling, an aunt or uncle, your child's medical doctor, or a coach. They might be more persuasive than you.

Try Not to Get into a Power Struggle with Your 18 Year Old
If your 18 year old refuses to get help for depression, your inclination might be to feel angry and frustrated. You might see all the signs and symptoms of depression and know that you have better judgment with regard to your teen getting help. However, aside from emergency situations, if you try to force, rather than persuade, your teen to get help, your teen might dig in his or her heels about this, making it less likely that he or she will get help.

What About Suicidal Thoughts, Intention, Plan or Attempt?
If your teen is talking about suicide, you need to consult with a psychiatrist who specializes in working with teens immediately. Teens can be impulsive and events that might seem insignificant to you can often be emotionally overwhelming for a teen. When teens are impulsive, often, there is no forethought about suicide--they make the attempt.

If your teen has actually made an attempt, of course, you need to call 911 immediately. If your 18 year old is taken to the emergency room for a psychiatric evaluation following a suicidal attempt or gesture, the psychiatrists can hold him or her for up to 72 hours or more if they feel that your child will be a risk to him or herself or others.

Hopefully, as a parent of a teen, you will never be faced with adolescent depression in your child. But if you are, aside from getting your teen help, the family might need family counseling and you might need your own psychotherapy to cope with this ordeal.

I am a NYC licensed psychotherapist, hypnotherapist and EMDR therapist who works with individual adults as well as couples.

To find out more about more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 or email me

Expressing Your Emotions in a Healthy Way

Many people begin psychotherapy because they either become aware that they're disconnected from their emotions, they can't identify or express their emotions or they are overwhelmed by feelings that they don't understand. 

Expressing Emotions in a Healthy Way

They might know that they're "not feeling right," but they don't know what's wrong. They might be able to see the consequences of their problem in their personal or work relationships or in their difficulty with achieving their goals. 

They might also have problems just getting through the day. But, other than knowing that "something is wrong," they don't know where to begin. Then, on top of that, they judge themselves harshly for not knowing what to do.

It's not unusual to be aware that you're having a certain, vague emotional discomfort but not know what's happening to you. At times, this experience can feel scary because you might feel out of control. 

 Most people like to have a sense of control in their lives, especially over their own emotions. For some people, when they feel out of control, they might feel like they're "going crazy." Or, conversely, some people feel emotionally "flat." They don't feel the highs and lows that others feel and they wonder if "something is wrong" with them.

Often, it's more about never having learned to identify feelings in the first place. This usually occurs in families where, for a variety of reasons, children are discouraged from feeling their emotions. 

 In subtle and not so subtle ways, children in these families learn that emotions are dangerous things to be avoided, especially any type of strong emotion. These children learn to disconnect from their emotions and, if strong feelings do come to the surface despite their best efforts to tamp them down, they find other ways, usually self destructive ways, to dissociate from their emotions.

An Inability to Express Your Emotions Can Ruin a Relationship

Clinical Vignette

The following vignette, which is a composite of many psychotherapy cases with all identifying information changed to protect confidentiality, illustrates how a child in a family where emotions are discouraged grows up into an adult who is unable to identify his emotions:

Tom:
When Tom began psychotherapy, he was in crisis. His girlfriend of two years, Betty, was threatening to leave their relationship because she felt that Tom was not emotionally available to her and her emotional needs weren't being met in their relationship.

On some vague level, Tom understood that Betty wasn't happy, but he was also confused about the problem. He didn't understand what the problem was, why it was happening, or how to change it. He had never participated in psychotherapy before because he thought it was for people who are "crazy." But, at the point when he started therapy, he was at a loss as to what to do. He didn't want to lose Betty and she offered to give him time to figure things out in therapy before she left the relationship.

At the start of therapy, Tom was only able to identify his fear of losing Betty, which he also did not understand. Other than that, in general, he couldn't say if he felt angry, sad, frustrated, or happy. He talked about feeling like, before his relationship with Betty, he was "just going through the motions" for most of his life. He said that he was unaware of any highs and lows most of the time. Aside from how Betty experienced Tom, now that he was faced with the possible loss of his relationship, Tom wasn't satisfied with his inability to identify, feel or express his emotions. He wanted to change, but he didn't know how.

When we explored Tom's experiences as a child, it made sense that Tom was so out of touch with his feelings. As an only child, Tom grew up with parents who provided him with everything that he needed materially, but they were emotionally distant from Tom as well as in their own relationship with each other. They never abused him physically or emotionally. He was not physically neglected in any way.

Tom's parents taught him to be an ethical, hard working person, but they didn't value relationships. They had no friends of their own, and they couldn't understand why Tom would want to spend time playing with other children or why he would even want them, as his parents, to spend time playing with him. It didn't make sense to them. They couldn't understand why he would want them to come to see him in a school play or why he would even want to participate in the play at all. They viewed most things in terms of its utilitarian value: Was it "right"? Was it "useful"? If not, why do it? So, Tom spent most of his time alone.

Tom's parents also discouraged him from having any strong emotions, whether it was happy, sad or angry. Rather than treating Tom as a child who needed emotional nurturing, they treated him like a little adult.

Tom never saw his parents being affectionate with each other. They were often preoccupied and distracted with their own individual projects and concerns in separate parts of the house. Even at dinner, his father often read the newspaper to himself and his mother read a book. Tom usually ate his dinner staring at his plate in silence.

When he got a little older,Tom became convinced that he was "a mistake," and they never intended to have children at all. Whenever his parents heard about a couple who wanted a child or someone who was happy about having just given birth, they were mystified. Without any awareness of how it might affect Tom, they often openly expressed their bewilderment about why couples would want children at all. They talked about how "expensive" it was to raise a child and how it limited people's lives because it was so "time consuming."

As a result, as a child, Tom was careful not to be "a nuisance" to his parents. He was diligent about his studies and got good grades because he knew it was expected of him. Throughout his life, he often had only one friend at any given time. Most of the time, it was someone who was outgoing and saw something about Tom that was appealing and endearing. Usually, this person made most of the effort to keep the friendship going.

Tom felt that he went through the motions in college. He neither enjoyed it nor disliked it. He didn't think in those terms. Going to college was something that was expected of him, and he knew he needed to do it to get a decent job. He dated very little in college. He was accustomed to spending most of his time on his own, so he didn't miss companionship and he didn't feel especially sexual.

After college, Tom understood that his parents expected him to move out on his own. His parents felt they had done their duty as parents to raise him to the age of 21, and now he needed to take care of himself. He obtained a good paying full time job as a technical writer, and he also worked part time in a book store to be able to afford his own apartment in Manhattan.

His parents never came to see his apartment nor did they express any curiosity about it. After he moved out, Tom only saw his parents occasionally. They always seemed surprised when he called them and he said he wanted to come over to see them. When they did get together, it was often at times when Tom could help them with some household project. So, after he moved out, this became the focus of Tom's relationship with his parents. Once again, the focus was utilitarian and not based on mutual love or affection.

When Tom met Betty, he sensed immediately that there was something very different about her. Aside from being very bright and sharing similar values, she was an affectionate, enthusiastic young woman. At first, he wasn't sure if he liked how emotionally effusive she was with him. It felt somewhat strange and unfamiliar. Although he didn't understand it, he tolerated it. But he also felt she was "a good person" and he wanted to get to know her better. Initially, she told him that she was drawn to him because he seemed so "emotionally independent." Early on, she teased him sometimes about being somewhat aloof, but she also cared about him a great deal. For his part, Tom felt himself drawn to and curious about Betty. It was the first time that he felt sexually drawn to someone. They also both cared about the environment and worked on local ecological projects together.

The problems began in the second year of their relationship. At that point, Betty wanted to take the relationship to the next level. She felt committed to their relationship, but she said she was never sure how Tom was feeling about it. She knew that she loved him and that he cared about her, but she wasn't sure if he loved her or not. They were both in their mid-20s, and she wanted to get married and have children. She told Tom that she wanted to make a life with him, but she wasn't sure how he felt. When Betty told him this, Tom was somewhat bewildered by it. He felt fine about how their relationship just the way it was. He didn't see the need to change it to get married, and he certainly didn't see the need for children.

As time went on, Betty began to express her dissatisfaction with what she described as Tom's emotional distance. What she once saw as Tom's "emotional independence" she now perceived as his being cold and too distant. She told him that she loved him, but he was not meeting her emotional needs. When Tom heard this, he realized that he had never really thought about his own emotional needs before. It wasn't until Tom was faced with the possibility of losing Betty that he even considered his emotional needs.

As Betty became increasingly aware of the extent of Tom's problems, Betty suggested that Tom seek out a psychotherapist to get help. Tom contacted his doctor, and his doctor referred Tom to me.

When Tom started therapy, Betty agreed to be patient and to give Tom a chance to change in therapy. Tom came to our psychotherapy sessions diligently once a week. Slowly, over time, Tom began to identify his feelings.

At first, Tom was most aware of the fear that he felt about losing Betty. Gradually, he began to be able to identify other feelings, including a deep sadness, which had been buried since childhood, about his parents' emotional aloofness with him. He struggled to mourn what he didn't get from them as a child and how lonely he had been.

At first, experiencing his emotions was frightening for him. We worked on Tom developing coping strategies, including daily meditation, for when he felt overwhelmed. But struggling with these emotions also heightened his appreciation for Betty's love and affection.

Over time, Betty told Tom that she noticed a difference in him that she liked. She felt that Tom was more emotionally available to her. For his part, Tom expressed feeling like he was waking up from a long, dull sleep. He was a naturally curious person, and he approached these changes with a mixture of curiosity, real excitement for the first time that he could remember, and also some fear and sadness. But, as he became more accustomed to feeling his emotions, Tom also felt that his every day world was opening up to him. He approached his relationship, his work and life in general as if he was given a new pair of eyes where he could see and sense things he never felt before.

As he developed a greater capacity to identify, feel and express his emotions, Tom's relationship with Betty became much closer. He realized what he had been missing for most of his life, and he felt a deep sense of gratitude that he had finally found it and could appreciate it. Within a couple of years of starting therapy, Tom and Betty were planning their wedding and talking about having children. For the first time in his life, Tom felt he understood that he had something to offer a wife and family on an emotional level, and he could also take in emotionally what they had to offer him.

There are so many reasons why people have difficulty identifying, feeling and expressing their emotions. In Tom's case, it was due to being raised in a household where his parents were very aloof and discouraged the expression of emotions or even the recognition of emotional needs. For other people, it might be the opposite--maybe they grew up in a family that was explosive where they learned that emotions were dangerous.

Getting Help in Therapy
The good news is that it's never too late to learn how to identify, feel and express your emotions in a healthy way. 

 Psychotherapy offers the possibility to understand and express your emotions so that you can lead a fuller and more satisfying life. 

Getting Help in Therapy

 Depending upon your particular challenges with emotions, it often takes a willingness to make a commitment to therapy and work through earlier issues. But the rewards for doing this work are often life changing.

If you're having problems identifying, feeling and expressing your emotions, you could benefit from attending psychotherapy with a licensed psychotherapist.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hour or email me.

The Problem with the "Geographic Cure"

In the US, thousands of people relocate to all areas of the country every year. Many people travel to attend college, to start new jobs, to live in a warmer climate, or to seek new opportunities. These are all common reasons for moving.

But among the many thousands of people who move every year, there are many who move to seek the "geographic cure," and who are disappointed when the changes they hoped for don't occur.

What is the "Geographic Cure"?
The "geographic cure" is a term used when people move to another area, hoping that their problems will disappear because they're in a new location. They hope that, by being in a new area, they'll escape their emotional problems. 

The Problem with the "Geographic Cure"

Rather than making internal changes in themselves to change their thoughts, emotions, and behaviors, they think that a change in location is "the answer."

What's the Problem with the "Geographic Cure"?
The most obvious problem is that you can't rely on your external surroundings to overcome your emotional problems. 

Your emotional problems require a search within yourself and the willingness to make the necessary emotional and behavioral changes to overcome your problems. 

Sure, it's possible that you might be more content for a while if you move. A new location can be fun and exciting for a while, and there are plenty of distractions when you're setting up a new household. But after a while, especially if your emotional problems are deep rooted, life will settle into a routine, there won't be as many distractions, and you'll be aware, once again, of the same emotional problems that you were suffering with before.

As the saying goes, "Everywhere you go, there you are."

The following vignette, which is a composite of various clinical cases with all identifying information changed, illustrates why the "geographic cure" doesn't work:

Paula:
Paula grew up in a small town. Her father was a raging alcoholic and everyone knew him as the "town drunk." Her mother was extremely passive and did whatever she could not to make waves with the father so he wouldn't get upset. 

All Paula could think about, as she was growing up, was that she wanted to move away. Her elementary school teachers recognized that she was depressed and advised Paula's mother to take her to see a mental health professional. But Paula's mother didn't believe in psychotherapy. She was also afraid that her alcoholic husband would be furious because he would think that Paula would be talking about him in her therapy. As a result, Paula never got help as a child.

When she was old enough to go to college, Paula applied to a college on the West Coast, wanting to get as far away from her family as possible. Initially, she was happy to get away from her family and she did well in college. But after the initial excitement of living in a new city wore off, she began to be aware of her depression again. 

She was very intelligent, so she did well in college. But she struggled to just get through the day. She made a couple of close friends in college and they advised her to go to the campus mental health center because they recognized that she was depressed. Paula went to a few counseling sessions, but she dropped out as soon as the counselor began exploring issues regarding her parents. She decided that she would deal with it on her own, and when she graduated, she would move to the East Coast to find a job.

Ten years after Paula graduated from college, she had moved from state to state several times. After college, she moved to NYC and landed a terrific job. At first, she thought she had beat her depression because she was feeling good about her job and visiting all the places in NY that she had always wanted to see. But once life settled down, she couldn't distract herself with the newness of the city any more, and she felt the familiar leaden feeling of depression weighing her down again. From NY, she moved to Chicago, then to Atlanta, Florida, Washington state, New Mexico, Arizona, and then back to NYC.

Each time, she experienced the same thing: She felt better for a while and then she began to feel the depression again when she could no longer distract herself. While she was living in NYC for the second time, a friend spoke to her about the "geographic cure." 

Paula had never heard this expression before. But as she listened to her friend speak, her friend's words resonated with her. She began to realize that all of this moving around, ultimately, didn't change anything for her. After a while, she was aware of her depression again and realized that it never really went away--she was just less aware of it because of all of the distractions of moving.

When Paula began psychotherapy with me, she was at a low point. She had a good job, but all the moving, which was expensive, put a big hole in her savings. At that point, even if she wanted to move again, she couldn't afford it. 

Gradually, over time, Paula began to deal with her depression in therapy. After a while, she began to recognize that she was having some good days, as if something had been lifted from her emotionally. There were days when she didn't have that leaden, depressed feeling that had been weighing her down. And as she continued in therapy, she began having more good days. Her only regret was that she wished she had started therapy years ago.

When you're trying to avoid dealing with your feelings, it's very easy to convince yourself that some external change will be "the answer" to your problems. 

Of course, if you're in an abusive environment, as Paula was when she was growing up, it's a good idea not to remain in that situation if you can get away. 

But, just like Paula, many times the emotional damage has already been done. And while it's important to remove yourself from an abusive environment, it's usually only the start. The emotional fall out has already been internalized and, often, you can't overcome it on your own. You need professional help.

Getting Help in Therapy
Emotional problems need to be dealt with from the inside out. Changing the external environment often doesn't change your emotional problems. The "geographic cure" is a form of denial.

If you've been relying on the "geographic cure" to overcome emotional problems and you recognize a recurring pattern similar to what I've described in the composite vignette, you could benefit from seeing a licensed psychotherapist to deal with your problems. 

When you seek a therapist, make sure that he or she is a licensed mental health professional in your state.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, and EMDR therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

The Breakup: When the Need for Closure Turns into Harassment

Breaking up is almost never easy, especially for the person who wants to reconcile the relationship. For many people, there are times when the breakup of their relationship comes as a shock. For those people, who thought their relationship was going well, when they hear their spouses or partners tell them that it's over, the words land on them like a ton of bricks. It seems incomprehensible and unreal--as if they're stuck in a nightmare.

The Breakup: When the Need For Closure Turns into Harassment 

Years later, in hindsight, some people say that there were signs all along that the relationship was not gong well, but they were in denial and didn't see it. 

Many others, even with the benefit of hindsight, say there were no signs that their partners were unhappy. Either way, the end of a relationship can be traumatic, even when it's mutual. 

But when it's not a mutual decision, the person who wants to continue in the relationship often feels abandoned and wants very much to understand what happened and have a sense of closure about the breakup. 

However, the need for closure, especially when the partner who is leaving is not open to further discussion, sometimes leads to desperate attempts (by the partner being left) for a discussion, an explanation, maybe there's even some attempts at bargaining that they'll change whatever the other partner didn't like.

But how do you do you know when you've crossed the line from a need for closure into a form of harassment?

The following is a list of signs that you (or your partner) have crossed the line and are engaging in harassment. There are countless other forms of behavior that would be considered harassment, so this list gives you an idea, but it's not exhaustive:

• Making endless calls and leaving numerous voicemail messages to your former partner, after s/he told you not to call any more
• Showing up at your ex's house uninvited (and unwanted) after the breakup to discuss, plead, or argue
• Calling your ex at his/her job numerous times after you've been asked to stop
• Showing up at your ex's workplace uninvited (and unwanted) after the breakup
• Waiting around at places that you know your ex typically frequents in an effort to see your ex or talk when you know your ex doesn't want you there
• Sending numerous email messages either begging, threatening or arguing about the breakup
• Threatening to reveal information about your ex to your ex's family, employer, friends or others that you know would be embarrassing, jeopardizing your ex's job or other relationships
• Divulging confidential information that you know will be harmful to your ex or talking badly about your ex to people who could use the information against your ex
• Running up credit cards that are in your former partner's name as a form of retaliation for the breakup
• Damaging your ex's property (this can involve his/her car, home or other possessions)
• Stalking or following your ex, your ex's family, friends or new partner
• Calling your ex's relatives, friends, employer or new partner as a form of retaliation
• Making false police reports against your ex (e.g., making a false report of domestic violence)
• Making false reports of child abuse regarding your ex to the local bureau of child welfare

Needless to say, any form of violence towards your ex, your ex's family, friends or new partner is considered an assault and it's a crime.

You should be aware that many of the items on the above list are legally actionable, your ex can file a police report against you and, possibly obtain an order of protection. In some cases, you might be arrested, especially if you persist.

Although breaking up is almost never easy, the vast majority of people eventually grieve the loss, accept the breakup and don't engage in harassing behavior. After a period of time and, sometimes, with the help of psychotherapy, most people heal from the heart break and move on with their lives.

But for some people, the breakup can trigger strong emotions, often, of unresolved feelings of abandonment from their family of origin. When this occurs, the anger and sadness can be intense and overwhelming to bear. But this is never an excuse to harass your ex or people close to your ex.

Getting Help in Therapy

If you find that you're stuck in an obsessive cycle of angry thoughts or compulsive or harassing behaviors related to your breakup, you should seek the help of a licensed mental health professional before it's too late. 

Most experienced psychotherapists have dealt with these issues before, and you don't need to feel embarrassed to seek help.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Overcoming Workaholism

What is Workaholism?
Workaholism is a powerful obsession. It occurs when a people don't have a healthy balance between work and the other areas of their lives: their relationships, family, friends, leisure time, and social activities. 

Overcoming Workaholism

People who work excessively derive their sense of self and feel good about themselves primarily through work activities. They use work to derive a sense of approval, respect and success. They might spend 60-70 hours or more per week working. They have a hard time slowing down and relaxing. 

They often feel irritable and uncomfortable when they're not working. For some workaholics, even if they're not actually working, they're thinking about work most of the time. It's their main preoccupation. Often, relationships with their partners, children, and family suffer.

We Encourage Workaholism in Our Society
In our society, we often, unwittingly, encourage workaholism to the detriment of the individuals involved. Workaholics are often rewarded with praise, status, and money. Rather than encouraging people to have a healthy balance between work and personal life, many work settings take a narrow view only in terms of how their employees add to the bottom line.

But, over time, workaholism takes its toll on the individual's health and his or her relationships. Often, over time, when workaholics can't relax, workaholism will also take a toll on their work life because an extreme workaholic will eventually suffer from "burn out."

Martin (a composite of several cases with all identifying information changed):
When Martin came to see me for his first session, I found him pacing up and down in my reception area, on his cell phone and looking at his Blackberry at the same time. He sat at the edge of my couch and he had difficulty settling down. I encouraged Martin to take a few deep breaths before we began talking because he seemed so agitated. After a few minutes, he was able to calm down somewhat, but he kept glancing nervously at his Blackberry. I could tell that he was annoyed when I asked him to turn off his phone and put away the Blackberry.

Martin was referred to me by his coach, who had been trying to help him achieve more balance in his life. According to Martin's coach, Martin, who had been a successful salesman, was suffering from burn out. His burn out was evident in his insomnia, exhaustion, poor diet, problems at home with his wife, who felt neglected by him and, ultimately, in his sales performance.

Martin's personal life and ability to take care of himself (e.g., learn to relax, get to bed at a reasonable hour, eat nutritious meals, and so on) had been declining for some time. It wasn't until his boss spoke to Martin about his declining work performance that Martin sought out an executive coach. He found it intolerable that his work performance was slipping.

At first, he thought that he could just whip himself back into shape and his sales numbers would soar again, as they usually did. But Martin was running on empty, and if he couldn't whip himself back to where he had been before, he didn't know what to do. He thought that if he hired an executive coach, he could get back to his peak performance. But his coach recognized early on that Martin had more serious emotional problems that were beyond coaching. So, he referred Marin to me.

Initially, Martin had difficulty seeing that his life was completely out of balance. He had worked compulsively for so long that it seemed normal to him to work 80-100 hours a week. Even when he was not physically working, he was thinking obsessively about work. His wife was completely fed up with Martin's workaholism, and when she threatened to divorce him, Martin began to finally admit that he had a problem that could not be solved by beating himself up constantly.

Admitting that he had a serious problem was the first step in Martin's recovery from workaholism. But learning to actually let go of his obsessive need to work was a big challenge for him. As a result, work in therapy went slowly at first. But, gradually, over time, he began to understand that his obsessive need to work was just like any other addictive behavior.

Since he didn't know how to relax, at first, he had to learn to schedule in leisure time into his week. With some difficulty, he learned to meditate in our therapy sessions and he started meditating once a day in the mornings. He and his wife also scheduled a date night once a week. During their date night, Martin learned to turn off his phone and focus on his wife. Gradually, he learned to incorporate other leisure activities in his life.

As Martin learned to relax and take better care of himself, his work performance also improved substantially, even though he was spending a lot less time working. Because he was taking care of himself, he approached his work with much more vitality and creativity. His boss noticed and commended him for his improved performance. But Martin had to learn not to allow that praise to trigger him into starting to work obsessively again.

As we explored Martin's family background, it became evident that praise and admiration were strong triggers that drove Martin's workaholism. His father, who was usually emotionally distant, was a workaholic himself. He only praised Martin and showed any affection for him when Martin achieved perfect grades (all A's). His father could not tolerate anything less than perfection. So, as a child, Martin pushed himself harder and harder to gain his father's praise, which meant everything to him. Martin's relentless need to achieve as a child was the beginning of his workaholism.

Part of Martin's work in therapy was to grieve that he didn't have a father who could express affection to him for Martin just being himself. Martin grew up feeling that he was "not enough" and had to excel at whatever he did, especially schoolwork, in order for his father to love him. He only felt as good as his current grades. He was very competitive with his fellow students and felt that he always had to be the best.

The type of work that Martin chose was also conducive to his workaholic style. He was paid by commission and his salary structure fueled his obsession to earn more and more money. But no matter how much he earned, he only felt gratified for a while before he felt the need to earn more. Prior to coming to therapy, Martin was caught in a vicious cycle of greed. As an adult, instead of measuring himself by his grades, he now measured himself by the amount of money that he earned. In many ways, this was worse than performing for grades because his earning potential was nearly limitless if he brought in the business. The sales numbers for all the sales people were also always available for Martin and his colleagues to see, so that also fueled Martin's obsession to work compulsively.

Martin's therapy was not short term. After he was engaged in therapy and learned to be curious about his problems, he was able to delve deeper into the roots of his compulsively. It wasn't easy for him, but Martin came to his sessions regularly. Over time, he learned to have more balance in his life and he found his life much more fulfilling.

Workaholism Also Shows Up at Home
Workaholism is not just about what people do in their careers. It can also show up at home: The man or woman who cleans obsessively at home is also a workaholic. It's the same obsessive need that drives the person at work.

If you're a workaholic, learning to slow down is often a challenge. Learning not to treat yourself like you're a human being and not a production machine can also be challenging. But the benefits to your overall well being and your relationships cannot be overestimated.

Getting Help in Therapy

People who are workaholics often cannot learn to stop working obsessively on their own.

If you think you're a workaholic, ask for support from your loved ones and get help from a licensed psychotherapist.

About Me
I am a licensed NYC psychotherapist, hypnotherapist and EMDR therapist. I have helped many clients overcome obsessive and addictive behaviors.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Are Your Relatives' Financial Problems Affecting Your Relationship?

As a psychotherapist in New York City who works with individuals and couples, I have been hearing more and more from individuals and couples about the adverse impact that the recession has had on their relationships. Even for couples who have been fortunate enough not to have lost their jobs, they are often dealing with relatives who are in dire financial straits. It's often difficult to turn down requests for financial help from your mother, father, brother, sister, son or daughter.

When Your Relatives' Financial Problems Affect Your Relationship?

You might want to help, but what if the situation is adversely affecting your relationship, either because you and your spouse don't agree about lending the money or because you've been lending your relative money and it's becoming too much of a hardship for you--and there seems to be no relief or end in sight?

How do you and your spouse decide what to do?

How do you keep this type of situation from ruining your relationship?

There are no easy one-size fits all answers to these questions that many couples are now facing. Maybe your brother lost his job and he can no longer pay his mortgage, or your mother can no longer afford to pay her rent, or your sister has asked you and your spouse for money because the court is about to issue a judgment against her and freeze her bank accounts due to unpaid credit card debt. There are so many other variations on these types of situations.

Not only do these situations often place an emotional strain on a couple's relationship, but it also puts a strain on the relationship between the relative who is lending the money and the one who is borrowing it. The person who is lending the money might feel anxiety as to whether he or she will ever see this money back again. And the relative who is receiving the money often feels ashamed for having to ask. Then, there is the question of whether the person who is lending the money has the right to tell the borrower how to spend the money.

The following is a vignette, which is a composite of several actual cases from the past with all identifying information changed to protect confidentiality, that will serve to illustrate some of the complications involved in these types of situations:

Jane and Alex:
When Jane and Alex, who were married for over 20 years, began marriage counseling, they were barely speaking to each other. They started marriage counseling because Alex's son, Bob, from Alex's first marriage, borrowed a sizable amount of money from them more than a year ago, and Bob was not making any attempt to pay them back, even though he started a new job.

When Your Relative's Financial Problems Affect Your Marriage

Initially, after Alex lost his job, he and his wife could no longer make ends meet on her part-time salary. The bills began to pile up and they were taking out cash advances on their credit cards. When that proved to be too costly, Bob approached Alex and asked for $20,000 to pay off his bills and meet basic expenses. Alex told Bob that he would need to talk this over with Jane. Jane thought the amount was too high and suggested that Alex lend Bob only $10,000. Initially, Alex agreed to this, but when he talked to Bob, Bob pleaded with him, telling him that he needed the full $20,000 because he feared that he would lose his house if he continued to miss mortgage payments.

Alex felt caught in the middle between Bob and Jane. He wanted to help his son and his daughter-in-law, but he didn't want to upset his wife. Alex and Jane talked about this and went back and forth about it for a while.

When they came to speak to me, they both agreed on the story until that point. After that, they each had a different recollection of what happened. According to Alex, he and Jane came to a decision that they would lend the money to Bob and tell him that he could pay them back when Bob and his wife were in a better financial situation. According to Jane, she and Alex agreed to lend the money to Bob, but they wanted Bob to sign an agreement that he would start to pay back the money once he began working. Each of them insisted on his or her version of the story.

They both agreed that the problem between them developed after Bob started working again. Instead of starting to pay Alex and Jane back, Bob chose to invest what was left of the money. Not only did Bob not make an effort to pay back the money to Alex and Jane, he never mentioned it again.

At that point, Alex felt hurt and Jane was enraged. Even though part of the $20,000 was her money too, she felt awkward talking to Bob about it and insisted that Alex talk to Bob. She was also angry because she thought that she and Alex had agreed on specific terms for Bob repaying the money. She felt that Alex was being too passive with Bob and that Bob was taking advantage of their generosity. She and Alex began arguing about this situation and it was causing a rift in their marriage.

After several marriage counseling sessions, Alex agreed that it would be best if he was the one who approached Bob. Although he felt very uncomfortable bringing up the loan with Bob, Alex didn't want this situation to continue to come between him and Jane any more than it already had.

The following week when Alex and Jane came for their next session, Alex reported that when he approached Bob about the money, Bob told him that he thought the money was a gift--he never realized that Alex wanted him to pay him back. Alex said that he was stunned. Jane was extremely angry about this. Alex admitted that, when he lent the money to Bob, he was very unclear about it and, although it seemed surprising to him that Bob would assume that it was a gift, he could see where his lack of clarity might have caused Bob to think this.

Based on our working on this issue in the marriage counseling sessions, Alex was careful not to make it seem that Jane was the only one who wanted the money back. It would have been easy for Alex to try to make Jane seem like the "heavy" to try to preserve his relationship with Bob. Although Bob wasn't happy about it, he agreed to various terms of repayment and began to repay back the loan. For a while, this placed a strain on the father-son relationship between Alex and Bob, but they eventually worked it out.

In the meantime, once Bob began paying back the money, the tension between Jane and Alex began to ease. They learned to improve their communication with each other and agreed that if ever they found themselves in this type of situation again with either of their relatives, they would approach it with much more clarity and mutual understanding.

Jane and Alex Worked Out Their Issues in Couples Counseling

Often, what begins as a gesture of kindness and good will to help a family member can turn into a tension-filled situation for everyone involved.

Here are some tips if you and your spouse decide to lend money to a friend or relative:

• Make sure that you both agree on the situation beforehand.
• Never go behind your spouse's back to lend money to a relative because this can cause serious problems in a relationship.
• Make sure that you and your spouse understand what the money is for before you make the loan.
• Make sure the relative who is the borrower is clear that this is a loan and not a gift.
• Be clear about what your expectations are with regard to repayment and, even though it might sound cold, it's often best to put terms in writing, if only for the sake of clarity.

Getting Help in Therapy
If you and your spouse are having difficulties about money that you've lent to a friend or relative, you might benefit from sorting out this issue in marriage counseling.

When choosing a couples counselor, make sure you see a licensed mental health professional.

I am licensed NYC psychotherapist who works with individuals and couples.

I have helped many couples to work out emotional issues.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

When Job Loss Means Loss of Identity

Aside from the financial loss, job loss can also mean the loss of an important identity for the person who has lost his or her job: One day, you're the head of accounting in a prestigious firm, and the next day you're an unemployed person sitting at home wondering what happened, who you are, and what you will do next.

When Job Loss Means Loss of Identity

As I've mentioned in other posts, prior to being a psychotherapist, many years ago, I was involved in other fields, including banking and finance. Being in the banking and financial field as a human resource manager, I had many occasions to see people laid off from their jobs due to mergers, cutbacks, and "downsizing" (a euphemism that I have never learned to like).

Even though I had seen many employees lose their jobs (through no fault of their own), nothing prepared me for when it actually happened to me.

A few months prior, I had received an excellent performance evaluation and there was no reason to think at the time that I would be laid off. But I can still remember how my mouth went dry and my brain was slowly trying to catch up to my boss's words when she told me that she was truly sorry to be letting me go.

She had tears in her eyes, assuring me that it was nothing that I had done (or not done), she offered to give me an excellent letter of recommendation, and help me in any way that she could.

But, based on company protocol, which I knew well, I had to pack my personal belongings and leave by the end of the day. That protocol, which is generally observed for security reasons (the idea being that an employee might get angry and engage in sabotage) is one of the most dehumanizing experiences you can go through.

I think some part of me went on automatic and I gathered my things in boxes. There was no time to say goodbye to colleagues (and I don't even know what I would've said to most of them at the time). But, before I left, I called one colleague that I had a close collegial relationship with to tell her that I had just been "let go." She knew and admired my work, and she was shocked. Months later, she told me that she was so surprised when I called her that she didn't know what to do or say, so she just put her head down on her desk.

Afterwards, as I was taking the train home, I was so distracted that I got on the wrong train and only realized it when I had traveled a distance from my home.

I felt like I was in a fog. I was fortunate to have a good emotional support system, and that night, I made up my mind to do what I had been thinking about doing for a long time--completing my undergraduate degree, going to graduate school, and changing careers. So, I was able to channel my emotions into advancing my new plan with determination.

But it wasn't easy at all. Even though I had this new determination, I still went through most of the feelings that people go through when they lose their job: shock, denial, sadness, and anger.

I also come from a family with a very strong work ethic, which has generally been beneficial to me. My grandparents lived through the dark days of the Great Depression and their attitude was: "If you have a job, no matter what kind of job you do, do it with pride to the best of your ability, and be happy that you have a job."

My father, grandfather, uncles, and cousins were all hard workers. Although my cousins and I knew that our grandparents suffered during the Depression, we never dared to ask them about it directly. We heard oblique references to it at times and how hard it was, but that was it.

And, as children, we knew that there were two things that you did not ask my grandfather about because it was too upsetting for him: 1) Did he miss his family in Italy, a family that he was very close to, and that he never saw again after he came to the US by himself when he was 17 years old, and 2) What happened after he lost his job during the Depression?

Of course, by the time my cousins and I arrived on the scene, they were okay: My grandfather had a job as a janitor for the post office that he was very proud of. He talked about the post office a lot when the whole family got together every Sunday for dinner.

Having gone through the Depression, we sensed that it was like a badge of honor for him that he had this secure Federal civil service job. And, through a lot of hard work, before my cousins and I were born, my grandparents also eventually achieved the American Dream of buying their own home: Be it ever so humble in a part of Brooklyn where goats still roamed the streets at the time when they bought their two-family house.

Since both of these topics were so taboo and shrouded in a dark mystery, as children, we grew up feeling that losing your job would be one of the worst calamities that could ever happen to you. Even though I was living in a very different time than when my grandfather lost his job and I was not a child when it happened to me, I still had a sense (as distorted as it might have been) that this terrible thing happened to me, and I was somehow at fault. This is a common initial reaction for many people who are laid off as they try to sort through in their minds what happened to them.

At this point, I'm fortunate to be able to say that losing that job was one of the best things that ever happened to me. I went on to complete my undergraduate and graduate degrees, and obtained postgraduate training. I can honestly say that I've never had any regrets about it. But that's jumping ahead in the story quite a bit and, at the time, I didn't have a crystal ball that would predict a good outcome, so I was worried.

Aside from losing a daily routine that gives so much structure to people's lives and losing the day-to-day affiliations with coworkers, when people lose their jobs, they often lose their sense of identity. No matter how much you might like to say, "I'm not my job" or "I'm not my title," it's the rare person who doesn't go through this kind of loss of identity.

In my case, I went from being a full time assistant manager to being a full-time student. I'm a naturally curious person and love learning.

But, aside from losing a regular income and knowing that there was no cushion of a second income, it was a hard adjustment to being a returning college student as a middle-aged person among people in their late teens and early 20s.

So, to cope with this adjustment and the accompanying doubts and fears, I had to learn to keep very focused on my goal, which was years away for me at that point. I took whatever part-time work that I could find (we were going through another recession at the time, so work was not plentiful), took out student loans, and reigned in my spending immediately.

Tips For Coping With a Job Loss

Even though this occurred to me many years ago, I still remember how it felt for me, and I have a lot of empathy for people who are going through it now. Of course, everyone's situation is different, but in general, to sustain yourself emotionally, I would recommend:

• Stay connected with your emotional support system: Allow your spouse or partner, close friends, and other family members to be supportive of you. As tempting as it might be to not pick up the phone when a friend calls, this is not the time to isolate.

• Stay in contact with former colleagues and supervisors. They are often a valuable resource for references, tips about job openings, and what's going on in the field.

• Join business networks like LinkedIn (http://www.linkedin.com/) to pursue career opportunities.

• Find meaning and value in the other aspects of your life: You're still the same person that you were before you lost your job--father, mother, son, husband, wife, Little League coach or whatever other roles you might have.

• Don't blame yourself if you were laid off due to cutbacks. Chances are the decision to lay you off, which is, of course, very personal to you and your family, was made based on financial decisions. And if you were terminated for cause (for something that you did or did not do), learn from whatever mistakes that you might have made.

• After you go through the initial shock, denial, grief, and anger, work towards accepting what has happened and mobilize yourself to take action. Avail yourself of whatever resources there might be in your local library or State Department of Labor. Take advantage of whatever funds there might be through Unemployment insurance for additional educational training.

• Recognize that you're going through a crisis and take good care of yourself. This is not the time to skimp on medical and dental visits, especially if you are eligible under the new current Federal COBRA law, to extend your health benefits at a reduced rate, if you qualify. Engage in stress management techniques that work for you (like meditation or going for regular walks).

• Remember other times when you went through other crises and you came out of it okay--maybe even better than okay. Maybe you'll be able to make changes in your life, as I did, that you might not have made if you didn't lose your job. Also, remember, that we're often more resilient than we realize.

Stay Connected With Your Emotional Support System

About Me

I am a psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist in New York City who works with individuals and couples to help them lead more fulfilling lives.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 or email me.