When President Obama addressed the nation in his January 2015 State of the Union speech, he made only two vague references to mental health, despite it being an issue that impacts millions of Americans either directly or indirectly. There was no mention of increasing funding for mental health programs, no urging of Congress to explore ways to treat mental health more compassionately, and no message to communities encouraging them to find creative solutions to complex problems. Instead, mental health as an issue was largely ignored, as it often is.

Each year, an estimated 590,000 Americans, who would be receiving mental health care in a better system, fall through the cracks. Without proper resources and support systems, these people are at high risk for ending up in the country’s jails, prisons, homeless shelters, on city streets, and, too often, in the morgue. Even if we vote or choose to ignore the problem through reduced funding, decentralized resources, and archaic treatment, it’s an issue that won’t resolve itself. Although we’ve come a long way since the 18th century, the mental health system in America today is seriously flawed and in desperate need of attention.

From Mental Institutions to Prisons

If you talk to someone about how mental health care was performed in the past, he or she might scoff at the poor “treatment” some people received at mental institutions that were often indistinguishable from prisons. However, that same person might be surprised to learn that the largest single-facility provider of mental health services in the United States today is not a mental health facility, hospital, or community center at all. It is, in fact, the Cook County Jail in Chicago.

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In 2012, more than 350,000 people with mental health conditions were living in jails and prisons, whereas only about 35,000 people were treated in state-funded impatient psychiatric institutions. According to the 2012 National Survey on Drug Use and Health, almost 40% of adults diagnosed with schizophrenia or bipolar issues remained untreated in the previous year, and as many as 60% of adults diagnosed with a mental health concern went without any treatment. Of those who do manage to receive treatment, few get the level of care they need; the system nationwide is massively underfunded. Texas, for example, spends just $40 per capita on mental health care but in 2012 led all states in the number of prisoners in its jurisdiction. The historic relocation of many of those experiencing serious mental health issues from hospitals to streets to prisons, however, isn’t good fiscal policy, and it’s downright shameful from a human rights perspective, especially because it allows society to facilitate an “out of sight, out of mind” attitude toward the issue.

A majority of mental health experts agree that that the current system is in shambles, but, as was evident in the most recent State of the Union address, few significant efforts have been made to improve it. Now that you’ve read about some of the problems, let’s talk solutions. Here are four suggestions we believe would go a long way toward fixing the mental health care system:

1. Increase Mental Health Care Funding

Mental health concerns are estimated to cost the United States more than $444 billion each year. However, only about a third of those estimated costs actually go toward treatment. The majority the $444 billion is spent in the form of disability payments and lost productivity. The real cost to society as a whole is significantly higher, as this total doesn’t include the cost of incarceration or lost earnings for caregivers.

Despite the high cost to the country, mental health budgets are usually among the first to be cut in times of economic hardship. From 2009 to 2012, states cut $5 billion worth of mental health care services and the nation eliminated more than 4,500 public psychiatric hospital beds. Because of poor policy moves like this, in a crisis many people who experience serious mental health issues wind up in emergency rooms because there is no place else for them to go. When all other services have been cut, an emergency room is one of the few places where they won’t be turned away.

The reality is that by increasing rather than cutting mental health care budgets, the country would ultimately save billions. With increased budgets, people would have more access to care and be less likely to end up in emergency rooms, jails and prisons, homeless shelters, on the streets, or worse. Furthermore, many who need treatment and actually receive it will likely recover completely or be able to control symptoms enough to contribute to the economy by returning to work or by volunteering their time or services. This is not only good for the person who needs treatment, but also for their families, neighbors, and communities.

2. Provide Better Care and Services in Jails and Prisons

While this isn’t the ultimate answer, it’s sometimes best to heed the advice of Theodore Roosevelt: “Do what you can, with what you have, where you are.” As previously stated, there are approximately 10 times more people with mental health issues incarcerated than there are being treated in state-funded hospitals. What is perhaps saddest about this statistic is that as states have cut funding for mental health services, they have increased funding for jails and prisons.

Many prisons have few, if any, mental health treatment options. Too often, prisoners don’t get the medication they need and they’re unlikely to receive therapy or any other type of meaningful support. Since prison beds appear to be replacing the beds in psychiatric units, trained mental health professionals should be employed in the penitentiaries, not just for brief evaluations but for continued care and support. Inmates should be given equal access to quality mental health care in order to give them a fair shot at making a recovery and reintegrating into society, which many studies have shown would lower recidivism and thus the burden on taxpayers. Until better alternatives come about, prison time should be used as an opportunity for healing and transformation.

3. Create More Community Centers and Inpatient Facilities

When the Community Mental Health Act was passed in 1963, officials proposed a national network of community-based mental health facilities to provide a point of access where people could quickly receive all forms of mental health care in the same place. This legislation led to the closing of several large, state-funded mental hospitals across the country, as it was thought these new community centers could drastically reduce treatment times and return people to society rather than keep them locked up in institutions. This was the last piece of legislation President Kennedy signed just weeks before his assassination, and while it ushered in a newfound optimism toward mental health care, its vision was never fully realized.

Regrettably, most of the necessary support for the proposed community mental health facilities was never provided, resulting in less than half of these centers being constructed and many people getting lost in the transition from state facilities to community-based facilities. Though much has changed in society since 1963, the vision of a comprehensive mental health care system is still an important one.

In addition to outpatient services, individuals experiencing mental health conditions deserve access to adequate inpatient care, supported housing, family therapy, and addiction services, as well as supported employment programs. These types of facilities are not only fiscally responsible, they localize treatment and make it easier for people to connect with the resources they need to improve their quality of life.

4. Provide Compassionate Care and Support

On the surface it appears lofty and idealistic, but this is perhaps the most important change we can make to improve mental health care. Many psychologists have attributed poor mental health outcomes in America to overmedication and lack of validation for the individual’s experience.

John Weir Perry was a Jungian-oriented psychiatrist with more than 40 years of clinical experience working with individuals experiencing psychosis and/or schizophrenia. He believed that the best way to care for an individual experiencing these conditions was to support the conditions themselves rather than trying to suppress or reverse them in any way. Through his clinical practice, he found that when a person’s experience was validated and supported in a positive way, even many of his most challenging patients would become reality-oriented within as little as two to six days. The integration phase that followed took about six to eight weeks on average. Perry found that 85% of the people he treated at Diabasis—an alternative crisis center he created—improved without any medication and continued to improve after leaving his facility.

This isn’t to argue against medication, as it can be a crucial factor in many peoples’ stabilization and recovery. The problem is, with a lack of funding for other options, many people seeking mental health treatment are sent home with bottles of rainbow-colored pills to treat their symptoms and are left with little or no therapeutic support to accompany them.

Providing compassionate, nonthreatening, and nonpathologizing care should be at the forefront of reform efforts.

We’re All Responsible for Mental Health Care

Even if all these suggestions were immediately implemented, there would still be many holes to fill to make the current system successful and equitable for those in need of treatment. These are just a few steps forward for policymakers and a system that is long overdue for a transformation.

Through the people we elect, the programs we lobby for funding, and the day-to-day interactions we have with people who inhabit this world with us, we’re all responsible for mental health care. Our greatest hope, and what will ultimately inspire more change, is that more people choose to become involved this year and every subsequent one.

References:

1. Appelbaum, Paul S. (2014). How to rebuild America’s mental health system in 5 big steps. The Guardian. Retrieved from http://www.theguardian.com/commentisfree/2014/may/29/-sp-fix-america-mental-health-system-ideas
2. Dansky, Kara (2014). A Mental Health Crisis Shouldn’t End in a Jail Cell. The Nation. Retrieved from http://www.thenation.com/article/181924/mental-health-crisis-shouldnt-end-jail-cell
3. Kliff, Sarah (2012). Seven Facts about America’s Mental Health Care System. The Washington Post. Retrieved from http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/17/seven-facts-about-americas-mental-health-care-system/
4. Szabo, Liz (2014). The Costs of Not Caring: Nowhere to go. The financial and human toll for neglecting the mentally ill. USA Today. Retrieved from http://www.usatoday.com/story/news/nation/2014/05/12/mental-health-system-crisis/7746535/
5. Whitaker, Robert (2010). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Basic Books.
6. Williams, Paris (2012). Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis. Sky’s edge Publishing.

The recent news that troubled country singer Mindy McCready took her own life has thrust the debate about the efficacy and ethics of “rehab” television shows and the people behind them, such as Dr. Drew and Dr. Phil, into the spotlight. McCready is the fifth cast member from Celebrity Rehab with Dr. Drew to die, prompting one well-known musician to take to Twitter to compare host Drew Pinsky to assisted-suicide icon Jack Kevorkian: “Same results,” Richard Marx wrote.

We wanted to know what our Topic Experts think, so we asked them the following questions: Is the criticism of Dr. Drew, Dr. Phil, and similar so-called experts-turned-media personalities warranted? Is it enough? After all, for many Americans, they are THE faces of therapy. Is that fair? Are they doing more harm than good? Is what they do simply exploitation, or is there more to it? With the popularity of reality TV on the rise, how can therapy professionals counteract any damage done by Dr. Drew, Dr. Phil, and others whose platforms extend into living rooms from coast to coast and beyond?

Here’s what they had to say:

• Deb Hirschhorn (relationships and marriage): “Money is a problem, and even ‘real’ therapists get green eyes. I cannot count how many Internet marketers have advised me to have ‘real clients’ give video testimonials on my successful website—and I have refused. ‘But,’ they complain, ‘all the therapists are doing it!’ That may be true, but it’s still wrong. ‘But,’ comes the reply, ‘the clients want to do it. Aren’t they adults who can make their own decisions? If you don’t think so, then aren’t you treating them like children and isn’t that disrespectful?’ The question is good and deserves a response. It was my first child’s fourth birthday when my second child was born. The second needed a C-section, but that didn’t stop me from feeling the strong need to make a special birthday party for the first child. After all, I certainly didn’t want to provoke sibling rivalry by unduly fussing over the newcomer. I rushed to the grocery store and started shopping. Unfortunately, that provoked some pain and I phoned the doctor. ‘What?’ he asked, ‘You’re running up and down the grocery aisles? No ma’am! You need to sit and take it easy after a C-section.’ The moral of this story is that although I am an adult and quite capable of making decisions, I did not see the ramifications of my actions. The same is true for clients who go live on the air to tell their stories: They do not see the ways in which they may be hurting themselves by airing their troubles, their weaknesses, their mistakes, and their pain in front of an audience of strangers. Therapists, on the other hand, although not clairvoyant, have enough experience with people to be able to ‘see’ into the future and know that this is a formula for disaster. And the reason is actually quite simple: People of all ages need a higher number of positives in their life than negatives in order to go forward. They need to believe there is something good about their choices, their history, and who they are as people in order to be able to meet each day with the strength it takes to master challenges. Focusing on the problem instead of their resources is a formula for hopelessness. A good therapist will build on strengths and only dab a little drop of problem talk into the session as necessary to know what, exactly, needs fixing. Airing all this publicly does just the opposite.”

• Darren Haber (addictions and compulsions): “I think the criticism is actually too polite by half. It would help, for starters, if these guys were experienced clinical psychologists, but they’re not. Dr. Drew isn’t even a psychologist, he’s an internist, and Dr. Phil is more practiced at expert witness work for courtrooms—which makes sense, given his sensationalizing, sometimes prosecutorial style (‘you need a backbone,’ ‘and this was a good idea why?’ etc.). The bigger problem is the awkward marrying of psychology with entertainment, a devil’s bargain to begin with. Real clinical work is slow, repetitive, ambiguous, and often plain boring. It can also be exhilarating and tremendously moving … but after the kind of slog I’m describing herein. The big Hollywood cathartic breakthrough (a la Good Will Hunting) is rare, and only occasionally leads to change. (I’ve witnessed crying jags that are forgotten the following week.) The values of entertainment—of, let’s face it, tabloid TV—are contra the values of psychology, which in its authentic form is probably better suited to something found on PBS or NPR—or, better yet, as a book or classroom discussion, etc. To take one example of how the medium corrodes the message, via Dr. Drew: Many people in recovery have narcissistic tendencies; life is itself often a ‘performance’ in a desperate seeking of approval and attention. Sticking a camera into a therapy group is exactly what so many recovering people don’t need. (It doesn’t help those who are painfully self-conscious, either.) A camera changes the equation, period. It is naive and even dangerous to pretend otherwise.”

• Sarah Swenson (Asperger’s / autism): “Electronic communication is like any other form of communication in one very misunderstood way: Most of what is communicated is nonverbal. We can see the truth in this when we are speaking directly to someone and we incorporate tone of voice, gesture, facial expression, and other cues into our comprehension of what we hear. But when we are watching reality TV, which is a misnomer at best and an outright lie at worst, these cues are scattered to the wind. Viewers can be lulled into a false sense of reality, by design, and it would be a natural next step if they were to take these TV performances seriously and consider the outcomes of the treatments and advice as if they were valid and complete. Individuals who are less skilled at ‘reading between the lines’ to begin with are all the more vulnerable to the illusory nature of the reality being portrayed on reality TV. Even the so-called experts, such as Dr. Drew and Dr. Phil, are not working as psychotherapists, whose work takes place session after session in an environment of building interpersonal trust and a therapeutic liaison in which healing can occur. Yet these TV experts proffer advice through the airwaves, advice which often suggests that there are quick fixes to even the deepest problems, such as substance-abuse issues or mental illness. If a viewer sees someone (a celebrity, for example) take her own life after experiencing the supposed advantage these so-called experts proffer, and that viewer has an even less supportive environment than the celebrity, he or she runs the risk of thinking that if someone who has it all can commit suicide, can fail, then the odds against solving personal problems are overwhelmingly bleak. It is ingenuous to suggest that copycat suicide is an unlikely event. These TV experts do all psychotherapists a disservice. Most significantly, however, they do a gross disservice to their viewers, who are primed to fall into despair for having taking them seriously when their own clients, their so-called success stories, choose to end their lives.”

• Moushumi Ghose (sexuality / sex therapy): “I have asked myself this question, too: Did media kill psychology, or did it bring it to life? I think Dr. Phil and Dr. Drew definitely have a lot of insight, advice, tips, and suggestions to offer the greater public, and to help many to make changes in their lives. However, in the field of psychology, one of the rules of thumb is that the client is the expert. So, in this medium—whether it be Internet, TV, or otherwise—the client is an audience of millions subscribing to the same views. With the plethora of self-help and coaching, it seems that there is a lot of advice out there being misconstrued somehow as psychotherapy. Dr. Drew and Dr. Phil are educators giving insight into the process of self-growth, and should be seen as such. Their work is to reach a broader audience to get the ball rolling but in no way should be seen as a substitute for working on yourself. Media to reach a larger audience is great, but it’s too easy to fall into the trap of seeing their word as gospel. These shows don’t encourage individuals to find a path of growth that is unique to themselves; it encourages a sheep-like mentality, which is not the goal of psychotherapy at all. We also have an overabundance of coaches nowadays who base their teachings on personal experience and their practice on advice giving. I believe all of these have a tendency to water down the field of personal growth. There is a lot of information out there and much of it is free, so one must weed out the self-help information and TV shows, decide what is entertainment and what is real, and recognize which do not suit their needs and which ones may actually prohibit their own journey of personal growth.”

• John Sovec (LGBT issues): “As the market for reality television shows expands, many more therapists are being asked to step up to the plate and represent the field of psychology, with all of its benefits and challenges. The major players in the television field often seem to be playing for the television ratings rather than looking out for the best interests of the clients. The well-known television therapists are often represented in an omnipotent role with an expertise in every subject that is presented to them. The reality is that therapy is a personal and ongoing experience and that it is virtually impossible for a client’s issues to be resolved in 50 minutes and then neatly wrapped up in a bow. Clinicians need the time to establish rapport, learn about the challenges that are facing their clients, and then work together with their clients to find the appropriate tools for success. As a therapist who has appeared on television, it can be a very tricky balance to respond to the needs of the clients you are working with and at the same time create a sense of safety in the middle of a chaotic filming experience. Much of what the television audience sees is only a small part of the actual therapeutic process that goes into the making of these shows. The challenge is that most people are now viewing therapy as a sensational, dramatic, and immediate solution to their issues, and place unrealistic expectations on the process and their relationship with their therapist. Are media therapists doing harm? Maybe to the perception of what therapy is and how the process works, but at the same time, if television therapists can remain ethical and authentic, they can demystify the experience and open the doors for more people to consider the benefits of seeking therapy.”

• Jill Denton (sexuality / sex therapy): “ ‘Good therapy’ in the truest sense is therapy that provides safe, private, confidential space for a client to truly ‘go deep’ and explore their hopes, their fears, and their dreams. I’m deeply saddened when someone equates what Drew, Phil, or ‘rehab TV’ offers to the healing work that happens in my office, which is sacred space. What these charlatans are doing is downright reprehensible!”

• Sarah Noel (person-centered / Rogerian): “I have very mixed feelings on this issue. In some ways, the Dr. Drews and Dr. Phils of the world have increased the awareness of mental health issues and normalized seeking treatment. This decreases stigma and has probably led some people into therapy who may not have considered such a thing in the past. That said, what gets good television ratings and what qualifies as good, quality psychotherapy are, more often than not, very different things. While that seems an obvious distinction within the professional community, it is quite possible that your average viewer is not making such a distinction and therefore they believe what they are seeing on television is what psychotherapy is supposed to look like. This seems to lead to very dangerous territory that could be the tipping point into doing more harm than good.”

• Judith Barr (power: healing to the root): “For television personalities to be the face of psychotherapy—even TV personalities who were once practicing medical doctors or psychologists—is a huge disservice to the essence of psychotherapy. And it is a limitless disservice to members of the public who don’t yet know the best of what psychotherapy can be and who need, want, and could be deeply helped by real depth psychotherapy. Having TV personalities be the face of psychotherapy coast to coast and even abroad is not only a disservice, but also a misuse and abuse of power. The true essence of psychotherapy is “soul work.” It originally meant the healing of soul or spirit. With the best of psychotherapists, it remains so today … but that is in the privacy of the therapy room. Once someone takes psychotherapy into the public media for the purposes of entertainment, financial exploitation, and money generation off the backs and hearts of vulnerable people, the essence and process of psychotherapy becomes disfigured, and the healing of the person’s soul becomes secondary or tertiary to showbiz. A huge part of my intention and commitment of my energy has already been to help people widely get a better sense of how deep psychotherapy is and can be, when the therapist does his/her own inner healing work to the root, and then offers the same depth to his/her clients. I am not sure how else to fulfill this intention and to help counteract the damage of the abuse done to therapy and its name in many ways—including by TV personalities. Perhaps if those of us who are like-minded work together, we can help educate the public on the possible dangers of ‘TV therapy’ and help to give a more accurate representation of the best therapy can be.” For more from Judith Barr, click here.

What do you think about so-called “rehab TV”? Do you agree or disagree with our Topic Experts? Please share your thoughts in the comments section below.

You entered therapy feeling broken, lonely, anxious, dissatisfied with your relationships and your career. Now you feel whole and healthy; your relationships have improved, and you’ve made some professional changes that have led to a more fulfilling career. You feel good about yourself. Life isn’t perfect, but you have come to accept these imperfections, and you feel equipped to handle life’s challenges when they come your way. Congratulations! The time, effort, and willingness to openly and honestly explore the most complex and painful areas of yourself and your life have paid off. Therapy worked. Now what? You have a standing weekly appointment with your therapist, and you have probably developed a strong therapeutic alliance with him or her. But lately you have noticed that you don’t feel a need to go to therapy and you struggle to find ways to fill the hour. These are some strong indicators that you are ready to leave therapy.

For most people, therapy is not forever. Very few people have reason to be in therapy for life. In fact, many of the people who make therapy a way of life are therapists. They have a personal and professional responsibility to maintain high levels of self-awareness. They must take precautions to ensure that their issues are not getting in the way of helping their clients, and that they are not letting their clients’ issues prevent them from living their own lives. Weekly therapy sessions can create the time, space, and support for therapists to do just that.

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Certainly, there are some people who are not therapists who also come to view therapy as a way of life. These people are often deeply dedicated to self-growth, and therapy may provide the support they need as they pursue constantly evolving personal goals. However, the vast majority of people who come to therapy do so with the intent of getting help with something specific. Whether it is something as broad as wanting to feel better or something as narrow as making a decision about a career move, people usually bring a specific goal to therapy. For some, these goals can be achieved in a few short months, while for others, it can take years. But ultimately there is a resolution and they feel ready to end therapy. The question then is how to do it.

One of the things people find most useful about therapy is that there is nothing you can’t talk about in a session—including your relationship with your therapist. In fact, a growing body of research indicates that much of the positive change produced by therapy comes as a result of the therapeutic relationship. For example, if your relationships improved while you were in therapy, it is likely, in part, because you learned new ways of being in relationships by actively participating in your therapeutic relationship. So take the well-honed skill set that you developed in therapy and open a discussion with your therapist about ending the therapeutic relationship.

This will likely come as no surprise to your therapist. He or she knows what you came in to work on and knows that you have achieved your goal. Plus, this is a natural part of the process—all therapists in training learn about how to help clients work through this final stage, called termination. This is a prime opportunity to review the goals that brought you to therapy and to reflect on the growth that allowed you to accomplish them. This part of therapy is kind of like a graduation ceremony—it is an opportunity to step back, look at how far you have come, and revel in your success. And, as with graduations, it is an opportunity to ponder and plan for what comes next. Part of termination involves reinforcing the coping skills that evolve during therapy and reminding clients to continue to draw upon them in the future. Another important part of this process is to identify indicators that may signal the need to return to therapy in the future.

Finally, working through the process of termination with your therapist will allow you the opportunity to process the ending of a powerful and unique relationship. While this is a deeply genuine relationship, it is also one that exists within strictly prescribed boundaries—within the therapist’s office during appointment times. Of course, there may have been phone calls and additional meetings scheduled during times of crisis, but there isn’t a healthy way to continue the relationship you have formed with your therapist outside of therapy. Feelings of grief, loss, and anxiety about ending the therapeutic relationship often come up, and termination is designed to address these feelings. Like all aspects of therapy, this can be a difficult process, but seeing it through can be invaluable in helping you continue to develop and implement the kind of sophisticated relational skills that enable you to have deeper, more meaningful, and authentic relationships.

Well, maybe not real fireworks. But according to MeiMei Fox—a speaker, depth psychotherapy life coach, and author of a recent article—feeling as if fireworks are exploding is one of the 10 sure signs that you’ve found your true love. Fox, who has had her share of failed relationships, worked with her new husband to come up with 10 signs that partner is Mr. or Mrs. Right:

1. Sexual attraction: Even though fireworks may eventually smolder, sexual attraction to your partner is a must and serves as a foundation for love, honesty, and intimacy.
2. Authenticity: Partners should be comfortable with each other exactly as they are, with no pressure to act like someone they’re not.
3. Commitment: If one partner is not able to commit wholeheartedly to the relationship, it could mean they have doubts. Commitment is at the core of a true loving union.
4. Honesty: There is no place for secrets in the most important relationship of your life. “When it’s true love, you should find yourself wanting to share everything,” Fox says. “Your love is made simple and true by being honest.”
5. Unity: Each partner must put his or her needs behind those of the relationship. As the old saying goes: “There is no ‘I’ in team.” True love is about teamwork.
6. Priority No. 1: The relationship should come before anything else. The love you share with your soulmate should be the most valuable thing in both of your lives, and you should stay committed to letting nothing get in the way of working toward and sharing in its success.
7. It’s romantic: Relationships should not be all work. They should be fun, and each partner should be living in the fun of the relationship rather than talking about the relationship and its problems.
8. Your friends are happy: People sometimes worry too much about what their friends will think of a new love interest. Fox agrees that outsiders may be able to see things in your partner that you can’t. When family and friends like the person who makes you happy, it’s a good sign.
9. You want to be home: Looking forward to returning home to the arms of your partner reinforces that you’re with someone you love, value, and enjoy being with.
10. Having that lucky feeling: Fox says that she feels as if she’s won the lottery every morning she wakes up next to her husband. Although that might not happen all the time for most people, you can be pretty sure you’ve found a keeper if you feel darned lucky that he or she found you too.

Reference:
Fox, MeiMei. 10 Signs You’ve Found “The One” (n.d.): n. pag. The Huffington Post. 12 Sept. 2012. Web. 12 Sept. 2012. http://www.huffingtonpost.com/meimei-fox/10-signs-youve-found-the-_b_1870841.html

The pain of divorce is often unbearable. The experience can be so awful that you wonder whether it would have been easier to stay married or even to be dealing with some other horrific life event like death. The depth of pain is often surprising, particularly when you know you don’t want to be married anymore. What many people forget is that divorce is just a fancy word masking what is truly a broken attachment between two people. Divorce is more than separating assets and belongings.  It’s the severing of a very strong bond founded on deep feelings of dependency and need. Believe it or not, you developed an attachment to your partner over the course of dating and marriage that connected you on an emotional and physiological level beyond what you realized.

When two people get married they are vowing to be committed and to love one another, but they are also pledging to become “attached.” This attachment is unspoken and unknown to both, but it is the most powerful connection anyone can have to another person in a love relationship. According to author Helen Fischer in her book Why We Love, our “cuddle chemicals,” namely oxytocin and vasopressin, contribute to the sense of closeness and attachment couples feel toward each other in a love relationship. These bonding hormones promote a sense of fusion between lovers that deepens attachment and a sense of oneness. This biological phenomenon explains the depth of devastation felt when the attachment is broken and the physiological symptoms that become activated when attachments are severed. The response is often primal, leading to thoughts, feelings, and behaviors that might never surface in any other context of life.

The end of a marriage is one of the most emotionally painful human experiences. Thinking about the experience of divorce within the context of attachment generates a greater sense of empathy for what you might be feeling. It explains the levels of rage, vindictiveness, grief, and despair that so often accompany this common life transition. We too often think of divorce as a noun or a verb, but it is actually a relational trauma that has a physiological and emotional effect. You may be creating more suffering for yourself by resisting what you are feeling or telling yourself that you are overreacting.

Recognize that the end of your marriage represents much more for you than you may realize. If you were a small child and the person you depended on most was suddenly unavailable to you, there is no doubt you would have a strong reaction. The end of your marriage is no different. Give yourself the time and space to heal and repair. You are not damaged, just temporarily devastated, and the recovery will come with time. Divorce is not just a matter of the heart but an experience that impacts the whole person on a multitude of levels. 

My last piece on focusing ended with a definition of felt sensing as a “temporary wave, from the sea of being” (Madison, G.). What is meant by a temporary wave from the sea of being?

It is time to introduce Gendlin’s conception of human being. Note that I said “human being,” not “a human being.” For Gendlin, human being is “interbeing”—what we think of as an individual being is a “livings in the world, and living with” (Gendlin, 1978-79). He calls this principle Interaction First.

Gendlin conceives of human beings experientially not as separate “things” in interaction with each other. More radically, he sees our environments and us as a continuous co-creative process. We are not “inside our skins, but are our living-in the world, and living-with others” (Gendlin, 1978-79). Even our physical being is a continuous process with its inner and outer environments. Hence, in his view, it is impossible to conceive of human being as a separate entity. We are interbeing.

What is a living body such that it has the intricacy of our situations? … With the old concepts, people might say that Focusing is “subjective.” But clearly, if the situation is carried in the body, then a felt sense is not subjective. Objective then? No, also not, since “objective” means the units and patterns to which science limits anything it studies. We could fashion a new sentence that is neither subjective, nor objective, nor both: The body IS an interaction process with the environment, and therefore the body IS its situations. The body isn’t just a sealed thing here, with an external situation over there, which it merely interprets. Rather, even before we think and speak, the living body is already one interaction process with its situation. The situation is not out there, nor inside. The external “things” and the subjective “entities” are derived from one single life-interaction process (which they always bring along with them). (Gendlin 2004)

This is a radical view and paradigm shift that is difficult to absorb. We are used to thinking about ourselves and the environment “around us” through the lens and language of a Cartesian world. We are imbued with philosophical assumptions idealizing objectivity and neutrality and a mechanistic relationship of mind over body. For example, we may have heard of such concepts as the “observer effect,” yet we go about living in a way that leaves context out of the equation.

For Gendlin, the making of meaning is a pluralistic, contextual, constructed process; it is changing and dynamic, not static and eternal (Mitchell, 1993). Our lived bodily sense of things is a function of our interbeing, and our capacity for felt sensing extends us beyond the confines of our delimited physical body.

Recall that I started my first piece by saying that you have within you—“beneath” your everyday practical use of language—another dimension, an inner language that is an imagistic dialogue between you and your immediate experiencing. It is you speaking to yourself (and listening to yourself) in your own code. Gendlin calls it the zigzag between the everyday use of language and the way we may actually hold our experiencing in a bodily felt way.

Gendlin says that this kind of processing exists preconceptually, beneath our everyday use of language and concepts and the assumptions we have about how the world works. In focusing, we find our own language and meaning that is in fact much more specific and precise than our usual use of language. We find language from the sea of our being.

A client with a traumatic history sits quietly, with eyes lowered, pausing to find a way to articulate why his time in boarding school (60 years ago!) is still so meaningful to him. His life before boarding school was consumed by his father’s collapse into psychosis. He is sensing into the situation regarding boarding school—without any explicit reference to his catastrophic childhood history. After a full few minutes of silence, he finds one word that fits: Life at boarding school was “manageable.” At the point that he says “manageable,” tears come to his eyes. He doesn’t know why, but his felt sense tells him, preconceptually, that “manageable” feels right.

The therapist, attuning to her client, takes in “manageable” and acknowledges it. As it resonates within her, she realizes how much is contained in this word “manageable” for her client. Then she drifts into her own felt sense of his childhood and finds ‘unmanageable’ experientially embedded in the world of her client’s meaning making, the therapist quietly offers the newly emerging word “unmanageable” without any reference to his history, and the client considers it.

A few moments later, the client’s full catastrophe of life with his father’s illness impacts him, but in a different way. His therapist has offered a word that touches into his world precisely and with great specificity. What is captured here in two words—manageable and unmanageable—is much more than the common meaning of these words. The client is referring to the experiential world of living-with and living-in his father’s psychosis, as well as to the emergent significance of what boarding school provided for him. The unmanageable and the manageable.

 Notice that the felt sensing came first. With “manageable,” he has begun to capture the world of his experiencing—the profound relief of finding himself for the first time in a world that he could handle (boarding school). Then “unmanageable” is intoned, and he resonates with the years of struggling with the catastrophe of his father’s psychosis. “Manageable” arose as a temporary wave from the sea of being. “Unmanageable” emerged from their shared sea of being.

And this shared moment deepens their therapeutic journey.

References

1. Gendlin. E. T. (1978-79). Befindlichkeit: Heidegger and the philosophy of psychology. Review of Existential Psychology & Psychiatry 16, 43-71.
2. Gendlin, E.T. (2004). Five philosophical talking points to communicate with colleagues who don’t yet know focusing. Staying in Focus. The Focusing Institute Newsletter, 4 (1), 5-8. From http://www.focusing.org/gendlin/docs/gol_2187.html
3. Madison, G., www.gregmadison.net.focusing_way_being.
4. Mitchell, Stephen A. (1993). Hope and dread in psychoanalysis. New York: Basic Books, pp. 285.

Fear can be a strong motivator. People who are afraid of living in poverty may be motivated to pursue any career option in order to avoid financial destitution. In a similar way, individuals who are afraid that they may develop specific health-related problems may work tirelessly to maintain optimal physical condition. Fear often has been linked to motivation, both positively and negatively. Until recently, however, few studies examined how fear of failure affects activity-related performance.

Jocelyn J. Bélanger of the University of Maryland sought to determine how negative feedback on specific tasks affected motivation in individuals fearful of failure (obsessive) and those who were passionate about their activity but less worried about setbacks (harmonious). In a series of experiments, Bélanger found that individuals who are passionate about achieving their goal perform differently based on their style of commitment. In particular, those with obsessive passion responded with positive motivation to negative/failure cues while those with harmonious passion saw no change in performance. In fact, the harmonious passion participants maintained the same level of performance throughout the experiments, regardless of whether they received success or failure feedback.

“Obsessive passion, associated with defensiveness, predicts performance aimed at avoiding failure, whereas harmonious passion, associated with a secure self-concept, predicts stable performance,” Bélanger said. These findings suggest that fear works as a motivator for individuals with obsessive passion. Bélanger believes that people who feel their sense of self is threatened by failure of goal attainment may unconsciously respond to that threat by increasing their performance. However, those who have harmonious passion traits are less threatened and view the feedback, positive or negative, merely as information needed to continue the process of attaining their goals. The results of this study offer valuable information that could be used for the development of goal-attainment strategies in the professional, academic, and sports arenas, and could help clinicians better understand an individual’s reaction to goal-achievement outcomes.

Reference:
Bélanger, J. J., Lafrenière, M.-A. K., Vallerand, R. J., Kruglanski, A. W. (2012). Driven by fear: The effect of success and failure information on passionate individuals’ performance. Journal of Personality and Social Psychology. Advance online publication. doi: 10.1037/a0029585

A client that drops out of therapy is one who does not complete the recommended course of treatment. Many therapeutic approaches, such as cognitive behavioral therapy, do not have a specific treatment deadline, and clients are considered dropouts when they have voluntarily stopped therapy prior to resolving the issues and symptoms that brought them there to begin with. Dropout is a serious concern for the medical community and the general population. Individuals who drop out of therapy are more likely to have future psychological complications and seek services multiple times, which places an economic burden on society. Because they do not learn adaptive coping strategies and fail to address the issues that plague them most seriously, they are likely to be less than productive in their careers, families, and communities. Additionally, therapists who experience client dropout may begin to question their ability to help clients and their own adequacy.

Understanding the factors that contribute to dropout can provide clinicians with the information they need to address the problem. Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage wanted to explore this problem further and made it the focus of his most recent study. Swift analyzed over 650 studies that included more than 83,000 clients and looked at factors such as client age, therapy setting, therapist experience, type of therapy, issues addressed in therapy, and clinician definition of dropout.

Swift found that nearly 20% of all the clients in the studies ended their treatment early. He found that some variables, such as therapy setting, influenced the rates of dropout. He also discovered that rates of dropout were highest among the youngest participants and those seeking treatment for personality or eating problems. Swift believes that more work is needed to determine specific nuances that effect retention. He hopes efforts will be aimed at isolating psychological issues, such as anxiety or depression, and approaches, such as psychodynamic or behavioral therapy, in order to get a clearer idea of the different dimensions affecting treatment completion. Swift said, “By paying attention to these variables and making adaptations where needed, clinicians may be able to reduce rates of premature discontinuation in their work with clients.”

Reference:
Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology80.4: 547-559.

If you don’t get the right nutrients, your body won’t function to the best of its ability. Some general health conditions can be linked to nutritional deficiency, but it’s up for debate whether the same applies to specific mental health conditions. Some nutrition experts do claim that unique cases of social anxiety can actually be caused by a nutritional deficiency. In the condition several experts refer to as pyroluria, once the nutritional deficiency is taken care of, the social anxiety is relieved. Other experts are quick to dismiss the validity of this diagnosis.

Trudy Scott, a food-and-mood expert who said in an email that she has suffered from pyroluria, is a certified nutritionist, immediate past president of the National Association of Nutrition Professionals, and author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings.

“The person experiences shyness, inner tension, and social anxiety,” Scott said in regard to symptoms of pyroluria. “Symptoms usually start in childhood and are made worse under stressful situations. The wonderful thing is that the symptoms can be completely alleviated with taking these supplements: zinc, vitamin B6, and evening primrose oil. People typically start to feel less anxious, less shy, and more social within a week. The important thing is that if you do have pyroluria, you do need to take the supplements always.”

Generally only zinc and Vitamin B6 are recommended for pyroluria, but “gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, is also beneficial for those with pyroluria because its levels are often low, and supplementing with GLA improves zinc absorption,” she added. In her book about anxiety, mood, and food, she wrote a whole chapter about pyroluria.

“I am … very passionate about the subject because I have pyroluria myself and used to suffer terribly from social phobia and shyness, anxiety, unexplained fears, waking with a sense of doom and even panic attacks,” Scott said. “I have used the amazing healing powers of foods and nutrients to completely heal. I now help women find natural solutions for anxiety and other mood disorders.”

She has posted a questionnaire on her website for pyroluria. It includes a long list of symptoms, and if 15 or more items are checked on the list, it is likely a person has pyroluria: http://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/

She said that in research studies, pyroluria is also called “the mauve factor.” “Much of what we know about pyroluria is based on the work of Humphrey Osmond, Abram Hoffer, and Carl Pfeiffer,” Scott said. “Much of the original work was done with schizophrenic patients in psychiatric hospital settings. Although pyroluria was first identified in the 1960s, the medical and mental health communities have been slow to recognize it, and many mental health practitioners and physicians remain unfamiliar with this condition.”

She said she learned about the condition mainly from reading the following books:
The Mood Cure by Julia Ross
Depression-Free Naturally by Joan Mathews-Larson
Nutrition and Mental Illness (1988) by Carl Pfeiffer

Her own book goes into the specific details and biological/chemical/genetic aspects of pyroluria. In her book, she cites research prevalence rates from Joan Mathews-Larson, the author of Depression-Free Naturally. Pyroluria is thought to exist in “11 percent of the healthy population” and “40 percent of adults with psychiatric disorders,” according to Scott’s book. For people with alcohol addiction, pyroluria is thought to have a 40% prevalence rate. However, the prevalence rates do depend on the source. In her own experience as a nutritionist, Scott said about 80% of her clients who have moderate to severe anxiety have symptoms associated with pyroluria.

She added that stress can be a major factor for what age pyroluria develops and that it is a genetic condition that seems to affect more women than men. In addition, people who have pyroluria tend to also have gluten sensitivity, especially if they also are dealing with other issues like depression, anxiety, autism, alcoholism, bipolar disorder, and schizophrenia, according to the book. People with pyroluria may also have digestive problems, and they need to make sure to balance out an increased Vitamin B intake with a higher intake of magnesium.

In the book The Mood Cure by Julia Ross, the author includes a discussion of the prevalence, testing, and treatment of pyroluria, as well as a checklist similar to that offered by Trudy Scott. Ross states that the questionnaire was developed by Dr. Carl Pfeiffer, a clinician and researcher. He wrote the book Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry in 1988.

Ross states in her book that pyroluria is fairly uncommon in the general public, but in certain groups of people (like those who have experienced alcohol addiction), it is more common. “I am just getting familiar with this condition, but I can see that it is an important one for certain people, affecting stress levels and mood generally and preventing full response to nutrient therapy until it is addressed,” Ross wrote in her book.

There are a plethora of articles dedicated to nutrition, diet, and mental health in general, as well as multiple research studies suggesting that certain mental health issues can be improved through natural supplements and a healthy overall diet. “Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries and are exceptionally deficient in patients suffering from mental disorders,” according to an abstract from a research study in Nutrition Journal. “Studies have shown that daily supplements of vital nutrients often effectively reduce patients’ symptoms.”

Another abstract from a research article in the journal Alternative Therapies in Health and Medicine concludes the following: “Many patients will benefit from the use of specific dietary supplements, such as a multivitamin-mineral high in B vitamins and omega-3 fatty acid,” according to the abstract. “And no matter what the underlying cause of the mood disorder, patients should be counseled about the relationship between food and mood, for the evidence now substantiates what laypeople and medical professionals have long known intuitively: the way we eat affects the way we feel.”

The research, authored by Tieraona Low Dog, director of the fellowship at Arizona Center for Integrative Medicine at University of Arizona, added in the research abstract that the healthiest diet for improving mental health is a “low-glycemic, modified Mediterranean diet rich in fruits, vegetables, whole grains, and seafood (if not vegetarian) and low in processed, refined foods.”

Other experts remain unaware of the condition and are skeptical of its legitimacy. Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said in an email that he is not accustomed to pyroluria and had to look it up on Google to find out what it was.

“Once I saw that it is connected to orthomolecular psychiatry, which I have heard of, I knew it was in the pseudoscience realm,” said Carroll, who is also an assistant professor at the University of New Mexico School of Medicine. “Not surprisingly, it claims to be the cause of a number of unrelated psychiatric disorders, which is typical of pseudoscience disorders. Like so many ‘cure-alls,’ it sounds plausible, but there is no scientific basis to it, and it allows dubious practitioners to prey on desperate, suffering people.”

He said there are certain cases where nutrition can play a part in mood and mental disorders. “Inadequate amounts of Omega 3 fatty acids, especially from fish or krill oil, have been shown to affect mood and anxiety in a broad way of which social anxiety can be a part,” Carroll said. “Also, low folate, low Vitamin D, and low B12 have all been associated with negative effects on mood and anxiety.”

“However, in people with low folate, it is more often a case of a genetic inability to transport the folate molecule into the brain rather than a low blood level,” he added. “In those cases, which often present with chronic depression and anxiety that has never responded to antidepressants, there are folate precursors that are more lipophilic and can diffuse into the brain without use of a transport mechanism.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at the NYU School of Medicine, said in an email that she didn’t study pyroluria in school and hasn’t read about it in any research studies after graduating from her doctorate program.

“Based on current knowledge it does not appear to be a legitimate health condition,” Garcia-Arcement said. “Further research is required to further explore and understand whether social anxiety or any other mental health condition could be related to improper synthesis in the blood.  Although this theory seems appealing, being able to ‘cure’ a mental disorder with vitamins or supplements … is unlikely.”

“Causes of social anxiety that have been substantiated by research include chemical imbalances in the brain (i.e., serotonin, a neurotransmitter), inherited traits (genetic and through observing anxious family members), negative life events or experiences, and an overactive amygdala (a part of the brain that controls emotions, including fear response),” she added.

She said that good nutrition is important for overall health, but it’s not necessarily linked to mental disorders. “In my experience, the social anxiety could be traced to other causes, not nutritional deficiencies,” Garcia-Arcement said. “Having a healthy and balanced diet is overall beneficial, but it won’t cure social anxiety or a mood disorder. I am more likely to recommend my clients get enough sun exposure to improve their moods (seasonal affective disorder) than recommend diet changes.”

Related articles:
Social Anxiety Can Be a Hidden Problem in College
Breathing Lessons
The Birth of Anxiety

In my practice as an addiction psychologist, it’s probably the most common question I encounter; when it comes right down to it, it’s what most people who are struggling with alcohol really want to know:

“How can I control my drinking or drug use?”

Only a small minority of people come to my practice with the expressed agenda of stopping their drinking altogether. Most seeking psychotherapy for alcohol dependence, misuse, or abuse have experienced some consequences due to their drinking and would like to minimize or stop those consequences but do not want to give up their drinking entirely.

For some drinkers, controlled drinking or moderate drinking is an option, and for a small portion of the population, about 5%, controlled drinking is nearly impossible. While many people believe “once an alcoholic, always an alcoholic,” many people diagnosed with alcoholism can learn to control their drinking and become social drinkers again. That said, if you have been diagnosed with alcohol dependence, most addiction psychologists, psychiatrists, physicians, social workers, and addiction counselors would strongly recommend abstinence. This is always a very personal decision that should be made with careful consideration of the risks and benefits of drinking versus abstinence.

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If one has never exhibited signs of alcoholism, then controlled drinking, a technique or approach that is a form of harm reduction, is a reasonable yet delicate first step. If one wants to pursue this approach, it is best not to go it alone. Talking to an addiction psychologist or other addiction professional can guide you through some generally recommended techniques.

Notice Feelings and Set Limits

Most addiction therapists will recommend two basic procedures that may differ in numerous ways but have the same central premise. The first is that you cut back your use of alcohol in whatever way you decide and that you then pay attention to what thoughts and feelings emerge. The idea here is that alcohol serves to mediate feelings by numbing, dulling, or blocking them entirely, and when you reduce your use or even stop drinking, your feelings will come back. As this happens, it is often recommended that you keep a journal or that you talk to your friends, family, partner, or therapist about these thoughts and feelings.

The well-known acronym “HALT” captures this eloquently. HALT stands for Hungry, Angry, Lonely, and Tired. These are the types of feelings people will experience as they reduce their alcohol or drug use. It reminds us to halt, or stop, and pay attention to what we need. Somehow, we have to cope with those feelings or risk relapse. If you are hungry, then eat. If you are angry, then tell someone, vent, exercise, pound a pillow, or express your anger in a healthy way. If you are lonely, then surround yourself with friends or start the process of finding new ones if all your friends drink. If you are tired, then sleep. Many people with alcoholism have an inability to take care of themselves, and learning this new skill in recovery is essential even with such basic behaviors as eating and sleeping.

A second basic tenet to alcohol counseling for people who are attempting moderate or control their drinking is to pick an amount of alcohol that they will not exceed and to stick with it. The National Institutes of Health recommend that, to maintain “low-risk drinking,” men consume no more than four drinks per day and no more than 14 per week. For women, the number is no more than three per day and seven per week. My personal belief is that this is fairly generous; a man can drink four beers while at a party on Friday or Saturday night, three or four during the football game on Sunday, three or four at bowling or poker night with the guys, and still have two or three with his partner on another day during the week.

When we can learn to stop at the “buzz,” we are well on our way to having our relationship with alcohol fully in check. For most people, three or four drinks make them feel tipsy or buzzed. Alcohol is a central nervous system depressant, yet the initial effects of alcohol in these amounts are more stimulating and euphoric feeling. People tend not to get into serious trouble from these amounts, but since the initial effects feel good, many people continue to drink past these amounts, assuming more alcohol equates to more good. It does not. It takes time for alcohol to work itself into your system, so people don’t realize how drunk they are getting, and in larger amounts alcohol has a depressing effect. The alcohol you drink today can make you feel depressed days and weeks later, and these small amounts can contribute to depressive feelings over time. Rarely has anyone come into my office with concerns about alcohol abuse because of drinking three or four drinks a few times a week.

Other Useful Techniques

To stick to the above drinking goals, there are other moderate drinking techniques that you can employ, such as avoiding hard alcohol and sticking to beer. Beer has lower ethanol content, and the carbonation can fill you up, so it tends to take longer to drink. Switching from alcohol to nonalcoholic drinks and back can slow you down as well. Holding a drink with lime or lemon may deter others from thinking you are not drinking an alcoholic mixed drink, and they may be less likely to offer you another drink. Remember, you are more aware that you are not drinking your normal amount or that you have reduced your consumption, and others probably aren’t even aware that you made any changes.

One technique to help you be honest with yourself is to take four coins (or as many coins as you are planning to have drinks that night) and place them in your back pocket. Each time you take a drink, move one of the coins into your other pocket. This may be more important if you are planning on drinking larger amounts of alcohol, and many of the people I work with start out reducing their drinks per setting with numbers more like from 10 to five or six, for example, so counting drinks becomes more important. This way, when your coins run out, you can be sure not to exceed the previously determined limit that you imposed on yourself.

Many addiction therapists recommend one drink per hour as another way of limiting oneself. Since alcohol leaves the bloodstream at about .02 blood alcohol content (BAC) per hour, this will most likely keep your BAC at a reasonably safe level. In using this technique, it is recommended that you discuss your upper limit with a certified addiction professional or addiction psychologist.

It goes without saying that it’s important to pay attention to drink equivalents. A typical shot equals one 5-ounce glass of wine, which equals one 12-ounce standard beer. If your favorite bartender is pouring your drinks and he knows you are a big tipper who likes to drink, you might need to have a brief conversation with him. Believe me, bartenders are used to these conversations, and they will not hold it against you. In fact, most bartenders will be very respectful and discreet and will keep an eye out for you thereafter. If your buddies are trying to get you drunk, that’s another story. Watch how much they pour. A Long Island Iced Tea counts for three drinks, not one.

Don’t Try to Drink Away Emotional Pain

While I consider myself to be an open-minded therapist, what would an alcohol blog be without a major caution? Here’s my warning: Don’t drink when you are sad, anxious, lonely, worried, or in any negative feeling state. These are times when you should figure out healthy ways of coping. If you drink during these times, you are at high risk for using your drinking as a crutch.

What happens if you can’t control your alcohol use with these techniques? After trying these techniques and determining your level of success, you should be able to assess whether you can be a social drinker. To the extent that you break any of the rules that you set up as an experiment and exceed these drinking limits with resulting consequences, then it is time to reconsider lowering your upper drinking limits and decreasing the frequency, quantity, intensity (alcohol content), or duration of your alcohol use.

If you are wondering whether you have a drinking problem, please read Do I Really Have a Drinking Problem?

An addiction psychologist or other psychotherapist specializing in addiction can help you answer any questions or develop a plan that, over time, will enable you to understand the role that alcohol plays in your life and make decisions about what, if any, changes you are ready to make. You don’t need to figure this out on your own. It takes courage to seek help for alcohol use. If you are reading this, you are well on your way to understanding yourself better and getting what you want and need in life.