Alan Rudolph

Licensed Marriage and Family Therapist


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Gambling Addiction Guide & 8+ Helpful Tips to Stop

Posted on May 20, 2020 at 1:21 PM Comments comments (50)


Gambling Addiction Guide & 8+ Helpful Tips to Stop

Psychiatry experts describe addiction as a brain disorder that involves repeating certain actions despite negative consequences on health and well-being. The statistics aren’t encouraging as it indicates that gambling addiction is among the most common addiction forms these days.
The reason behind it is a large number of land-based gaming facilities throughout the world.

Additionally, you have numerous online gambling websites offering lottery, betting, and casino games. Although these games can be a fun way to spend leisure time, it is essential to be careful. Here is what you need to know about gambling addiction and how to stop it!

What Is a Gambling Addiction?

Gambling addiction is a mental disorder where you cannot control your behavior and stop gambling even when you aware that it affects your health and wellness negatively. Just like a person addicted to substances cannot stop using them, a gambler cannot stop playing. Gambling addiction also shares similarities with impulse-control disorders like kleptomania or pyromania.
According to statistics, only the United Kingdom has around 600,000 gamblers dealing with addiction. The data indicates that more than 2% of players in the United States have a certain type of addiction to gambling. It is a growing problem that shouldn’t be taken lightly. That is why it is crucial to recognize the issue on time and take the required steps to deal with it.

What Are the Main Gambling Addiction Types?

Scientists recognize three different gambling addiction types, and not all of them manifest the same symptoms.
Here is an overview of the most common addiction types:

  • A compulsive gambler – a person who cannot stop playing or thinking about gambling. They will look for any opportunity to play, even if they are already low on finances. Compulsive players do not care about the consequences, but only about gambling. That is why we frequently call them pathologic gamblers, and it is the most severe gambling addiction form.

  • A binge gambler – a player who acts normally, but once they start gambling, they cannot stop. It might seem that they have everything under control until they start playing. Once they place the first wager or buy a ticket, they cannot stop. Binge gamblers do not have to play every day to be addicted.

  • A problem gambler – a person who doesn’t show compulsive gambling symptom, but playing still affects their quality of life. They might lie to their partners about playing, or end up losing more than expected. Problem gamblers can evaluate to binge and compulsive players.

Is Gambling Addiction a Serious Problem?

Yes, gambling addiction is a serious problem, and it is imperative to deal with it as soon as possible. It is crucial not to push addiction issues under the carpet since that could make them worse.

Gambling addiction can significantly affect the gambler’s quality of life, as well as their family, partners, and friends. That is why you should give your best to recognize the symptoms promptly, especially in the case of compulsive gambling.

It is hard to say how many gamblers have an addiction form since many of them use self-help options to deal with the problem. The experts believe that 2-3% of all players deal with some form of addiction.

How Gambling Affects Your Life

It is not an exaggeration when someone says that gambling addiction can change your entire life. Take a look at how it could affect you!
1. Mental health

The critical thing to consider is how gambling issues affect your mental health. Gamblers focus only on playing their favorite game and often forget other aspects of their lives. That means they might not be able to focus on job tasks, miss important events, etc.
Gambling addiction itself is a brain disorder, which means it affects your state of mind. In many cases, mental problems are the reason why people become addicted to gambling. It is also common that a mental health issue occurs after developing a gambling addiction.

2. Relationships

It is the people that are close to the gambler that is the most affected by their negative habit. It might start by forgetting about your partner’s birthday or missing family dinner. Things could take a turn for the worse when loans, lying and stealing to find time and money to play. Gambling issues could cost you the entire relationship with your partner, and make you distant from your family and friends.

3. Finances

Finances might be a category that takes the first hit once you enter gambling problems. Not being able to stop and not winning anything means you need to invest more money. It is only a matter of time when you will start taking cash that was supposed to be used for other things. Gamblers frequently take loans, miss payments for their home, or even sell the property to acquire funds.

What Are the Signs of a Gambling Addiction?

Do you think your friend, or a family member developed a gambling addiction? Would you like to test yourself to ensure you are not addicted?

Here is the list of the most frequent signs that you developed negative gambling habits.

1. Always Thinking About Gambling

It might be your friend’s birthday, and the atmosphere is great. You might have an important work task, but you can’t concentrate because you are thinking about playing casino games. If you are trying to focus on other activities, but you can’t stop imagining visiting a gaming facility, that is among the initial signs of a gambling problem.

2. Developed Gambling Tolerance

It used to be enough to invest a couple of dollars and feel the excitement. However, you’ve discovered that you now need more money to experience the adrenaline rush. The experts explain this by the term “gambling tolerance.” The more you play, the more money you invest.
The first time you invest a big sum, everything changes. Investing small sums doesn’t do the trick anymore, and that can be dangerous for your finances.

3. No Control Over the Losses

You set a gambling budget so that it doesn’t affect your daily routine or threaten your loan repayment rate. However, once you lost the chosen sum, you realized that you want to continue playing. It all started by taking a tiny portion of the funds important to you. Before you know it, you lose the entire salary or savings. Not being able to control your losses is a sign of a gambling problem and an issue that could ruin your life.

4. Gambling Is a Way to Escape Reality

Things are not going great in your life. Your company might have fired you recently, or your partner broke up with you. Going through a rough patch in life makes gambling a fun way to escape reality. In those situations, it can be easy to develop a habit and get yourself into more problems.

5. Experiencing Withdrawal Symptoms

You spend hours a day playing your favorite games. Once you stop, it makes you feel nervous, sad, and depressed. You are anxious to return to gambling, as that is the only thing that soothes you. That is a sign you are going through withdrawal symptoms when not playing. If you compare how you feel about the feelings of a person withdrawing from substance abuse, you will find out the two are similar.

6. Lying to Others

Admitting that you have a gambling problem is hard. You have problems confessing to yourself, and you certainly don’t want others to know. However, if you are going the extra mile to hide from others that you are gambling, that might be a problem. That is especially true if you lie about being sick to miss your friend’s birthday so that you can gamble.

7. Stealing from Others

If you are ready to steal money or valuable items for others to acquire gambling founds, it might indicate that you are in a serious problem. Stealing from your friends is immoral, and stealing from others is illegal. Either way, it is crucial not to let yourself do something like this. And if it happens, it is a surefire indicator that you have gambling issues.

How to Deal with Gambling Addiction

You have several approaches when it comes to dealing with gambling addiction:

  • Self-help – after admitting that you have a problem, you can look for useful gambling guides like this one. Check out the self-help tips offered and use your will strength to deal with the problem.

  • Group support – you can look to join a group with others who have similar issues. If you don’t want to expose yourself publicly, there are anonymous and online groups where you can help each other go through overcoming the addiction.

  • Counseling and therapy – it is always wise to ask for help from a professional. Look for therapists who have experience with gambling and related mental health issues.

  • Medical treatment – you can talk to a medical professional about medications that could help you go through this rough patch. Those could be antidepressants or other drugs that your doctor recommends.

Can You Help Another Person Addicted to Gambling?

Did you notice that your friend has gambling issues? Is your partner spending hours and losing a lot of money on playing casino and other games?

The first step in helping someone is to recognize that they have a problem. The next is to understand which steps will truly help them. Covering them for hours while they head to a gaming facility won’t assist the gambler fight with their addiction. Loaning them the money is also pointless because they will probably lose it.

Start by finding the right way of telling them you think they are addicted. Don’t be judgmental, but pinpoint that you would like to help. Recommend potential ways of treatment, such as group support and counseling with a professional.

Compulsive Gambling Stages

According to experts, a compulsive gambler will go through four stages:

  • Winning – a big win is a huge danger for gamblers. Winning hefty sums make people happy and excited. They start thinking that they could win more and change their life for the better. Before you know it, games become the main preoccupation in the gambler’s mind.

  • Losing – the odds are that a gambler will lose the big win, and start losing their own money. That is when they enter the second phase, where they don’t have control over the losses.

  • Desperation – this stage might start with borrowing the money, but few gamblers mention why they need the cash. That means they are lying to their close ones. Other desperate measures could also be taken, such as selling possessions, property, etc.

  • Hopelessness – the last and the most dangerous phase. The gambler feels like they are isolated from the entire world. Suicidal thoughts might appear and become more common over time. The gambler experiences feelings of being “worn out” and lacking a will to do anything, including gambling.

What Are the Risk Factors for a Gambling Addiction?

Are some people at more risk of becoming addicted to gambling than others? The answer is yes, which is why you should take the time to understand the risk factors.

Gambling Availability

Some countries ban gambling, which means you can only play illegally. That reduces the overall number of players, as well as those addicted. But the majority of countries legalized gambling, and you can play in both online and land-based facilities. That means you can access a gaming platform around the clock, which makes it easier to get hooked.

Confidence Overload
Nobody plays a game without hoping that they will win. However, those having overconfidence issues might be at more risk for gambling addiction. They believe they will win every time, which makes it easy for them to start losing money and get addicted.


Gambling addiction is an impulse control disorder, and people who tend to act impulsively are more prone to it than others. That factor can be quite risky if it is combined with overconfidence.

Rough Life Patches

Whether you are out of work, or you lost a beloved person, you might need a way to escape reality. Some people see gambling as the way to do that, which makes rough life patches and feeling vulnerable a risk factor for addiction.

Economic Status

Did you know that people who earn a lot of money tend to act more responsible when it comes to gambling? It depends on the individual, but those with low earnings might resort to gambling to improve their economic status.

Genetics and Family Factors

Some experts claim that those who have parents with a gambling addiction are more prone to developing one. Research indicates that those coming from a family where there are records of gambling addiction, alcoholism, and substance abuse are more likely to get hooked to gambling. Also, the earlier you start playing, the more odds you have to develop an addiction.

Are Age and Gender Risk Factors for Becoming a Gambler?

People of both genders and all ages can develop a gambling addiction. However, it seems that teens and the elderly are the most vulnerable groups. Teens try gambling because they want to look cool, but they might have a hard time putting it under control. Elderly people might be having a hard time making peace with the fact they are retired or going through a divorce, which triggers gambling addiction.

As for gender, more men are addicted to gambling at this moment. However, the number of women is increasing every day.

Common Gambling Addiction Myths

If you are going to overcome or help someone deal with a gambling addiction, it is important to understand the disorder. Take a look at the most common misconceptions people have about this condition.

1. Addiction Requires Gambling Every Day

A gambler might be a fan of a particular lottery game. They might like playing in a specific casino, or they only bet on basketball. The gambling events might not occur every day for the gambler to be addicted. The crucial criteria for determining it is the frequency of wagering and sums invested.

2. It Is Not a Problem If It Doesn’t Cause Financial Issues for the Gambler

Rich people might be able to afford huge losses. However, that doesn’t mean gambling addiction can’t affect your life otherwise. You could experience mental health problems like anxiety and depression, and ruin relationships with other persons. The point is that addiction has severe consequences that could go far beyond finances.

3. Gambling Addiction Happens to Unintelligent People Who Don’t Have a Strong Will

Addiction plays with your brain, and even the smartest and strongest people are vulnerable. For example, if you are a math wizard, you might overthink and trick yourself that it is possible to design a strategy to guarantee a win.

It is crucial to note that people of all ages, genders, nationalities, social statuses, education levels, and intelligence levels can become addicted.

4. You Should Help a Gambler Get Out of Financial Problems

If you give money to a gambler, the chances are they will lose it quickly. That is no long-term solution, and it only supports their addiction. Instead of doing that, recommend them to consult a therapist or start attending group support.

How to Help Yourself If You Have a Gambling Problem

Although gambling addiction is a serious problem, you can overcome it! However, you need to be persistent and ready to invest plenty of time and effort.

Here is a list of tips that could help you in overcoming gambling problems!

1. Admit You Have a Problem

Everything starts by admitting that you have a problem. As long as you are rejecting the idea that your gambling is an issue for yourself in others, it will be hard to get better. Once you understand you have a problem, you can work on the right moves to deal with it.

2. Understand That It Will Be Hard

The second step goes hand in hand with the first one, and it involves discovering the reason why you are gambling. It might be the adrenaline rush, escape from reality, but also the desire to win and improve your finances or life overall.

The thing to understand is that it is virtually impossible to beat an addiction until you start realizing the opponent’s strength. It is important to get ready for the battle and doing whatever is necessary to put your life in control again.

3. Join a Support Group

It is always better to have people by your side than going through a tough period alone. That is why you should consider joining a support group. If staying anonymous is important, you can look for online support groups.

Apart from classic meetings, you can also join classic programs. Gamblers Anonymous implement a 12-step rehab program similar to the one when withdrawing from alcohol. These meetings occur weekly, and you discuss your progress during the recovery.

4. Visit a Therapist

If you feel like you could use extra support, there is no reason why you wouldn’t visit a therapist. Look for a professional counselor who has experience in the gambling industry.
Alternatively, your therapy doesn’t have to focus on gambling. If you feel your relationships have suffered, you can attend couples therapy. Professionals can always assist to go through a rough patch and repair relationships.
5. Are Medications a Solution?

Addiction plays with your brain and might make you anxious and depressed. It might be easier to handle the cravings with medications that would replicate the hormones producing while you are gambling.

A medical professional like a psychiatrist can analyze your current situation, and whether there is a need for medication.

6. Organize Your Schedule
The idea is simple – if you spend time doing something else, you cannot gamble. That is why it is essential to organize your schedule to the smallest detail. Apart from work, try to fill it up with as many fun and exciting activities as possible. The idea is to preoccupy your brain and stop it from thinking about gambling.

7. Handling Gambling Cravings and Potential Alternatives

Be prepared to experience gamble cravings occasionally. Once that time comes, it will take a lot of strength to push through them.

It might be wise to look for alternatives that provide a similar feeling:

  • Adrenaline and excitement – if you are a fan of extreme sports, go with rock climbing, bungee jumping, etc. You can also try Go Kart or playing football with friends.

  • Avoid isolation – head to social gatherings, join classes to learn new activities, and visit your family.

  • Steer clear of boredom – do whatever works for you, whether it is playing video games, reading books, painting, listening to music, etc.

  • Don’t forget to relax – go running or swimming, and if it is your cup of tea, don’t hesitate to try yoga and meditation.

8. How to Treat Gambling Addiction

Here is an in-depth look at how you can treat gambling addiction by visiting various professionals:

  • Rehabilitation programs and treatments – you can find many groups offering a rehab program to follow when dealing with gambling problems.

  • Consider underlying conditions – you might be dealing with anxiety, depression, and even ADHD and OCD. Consider visiting a medical professional and getting medication prescription and advice.

  • CBT therapy – it stands short for cognitive-behavioral treatment. The idea is to alter thoughts and behaviors and learn how to fight gambling cravings.

  • Counseling – you can consider going yourself or asking a family member to go with you. If necessary, visit financial experts to help in managing your problems.

Can Family Members Help a Person Who Has Gambling Problems?

If a gambler is beyond the point where they can help themselves, family members can be of assistance. Everything starts by protecting yourself, and that includes both your finances and emotions. That is especially true if you are part of the same household. You will need to keep things under control, which is why taking care of yourself is imperative.

You can consider asking for help from other family members or friends. It might be a problem to admit that someone close to you has a problem, but the more help you have, the easier you will push through the problem.

Don’t forget to set limits for money spending, and never agree to loan money to the gambler. You can consider a loan to pay their debts, but insist that you make the payment even then.

Remember, gamblers might be lying about why they need money. It is important to stay strong and reject all their requests

Tips for Gamblers’ Partners

  • Try to find the right moment to talk about the problem with the gambler. You need to be calm, and you should also look for moments when they are calm, too.

  • Be polite in explaining that they have a problem, and avoid being judgmental. Explain how the entire family suffers because of their issue, and you only want to help.

  • Avoid lecturing your partner or keeping them isolated from spending time with children or visiting family events.

  • You should be in complete control over the finances. That includes going the extra mile to monitor the gambler’s bank accounts, and any move they might make.

  • You can find tips online, as well as join support groups for gamblers’ partners.

  • Don’t forget it is hard for the gambler to deal with addiction. Your support is important, so give your best to be encouraging. Try to find activities that might allow your partner to show all the positive traits they have.

Frequently Asked Questions

Q: I had a lapse while dealing with gambling problems. What should I do?
A: Lapses are normal because fighting an addiction is difficult. Talk to your mentor, support group, or a trusted person. The important thing is to keep going and ensure lapses are minimized.

Q: My partner has a gambling addiction, and they are mentioning suicide. What should I do?
A:  Always take any suicidal thoughts seriously. Find a national helpline for suicide prevention or consult a medical professional that specializes in that area.

Q: I feel guilty that my partner started gambling. What should I do?
A: Understand that, as adults, we all take responsibility for our own actions. Gamblers might try to rationalize their bad habit by blaming other people or their surroundings. The truth is that they are the only ones to blame. Regardless, you should find a way to help them deal with the issue.

Final Thoughts

We underline once again that gambling addiction is a serious problem. That issue can affect your finances, relationships, mental health, and overall quality of life.
The critical thing is to recognize addiction, whether it is in yourself or a person close to you. From that point, you can consider the right steps to fight it. Always remember to count on your friends and family, but don’t hesitate to rely on helplines and medical professionals for additional support!


A Psychotherapist Goes To Therapy — And Gets A Taste Of Her Own Medicine

Posted on March 30, 2019 at 2:29 PM Comments comments (277)
A Psychotherapist Goes To Therapy — And Gets A Taste Of Her Own Medicine

This is a link to "Fresh Air" with Terry Gross.  If you would like to get a stronger sense of therapy, you might find this episode useful and enjoyable:

Why Won’t My Therapist Just Tell Me What to Do?

Posted on September 15, 2017 at 3:15 PM Comments comments (161)

Why Won’t My Therapist Just Tell Me What to Do?

Dear Therapist,
I’m a woman who’s about to turn 30 and started therapy for the first time last year. I went because it became apparent that what I thought was just “me” was actually “me with depression,” and therapy has really helped me acknowledge it and start to work through it. Now for maybe the first time in my life I know what it feels like not to be moody all the time (I used to think this was “normal”) and that’s been amazing. My point is that therapy has been useful and even life-changing — except for one thing.

I don’t understand why my therapist won’t give me advice! Obviously, I don’t mean all the time, but I feel that in certain situations, she could tell me what she thinks but won’t. She knows that one of my issues is that I didn’t get guidance growing up — that I basically had to figure everything out on my own because my parents either didn’t know they should be advising me (for example, leaving my college search completely to me) or they gave me inappropriate advice (once I almost lost a friend after taking their advice when I was too young to know how bad their advice really was).

It’s not that my parents aren’t well-meaning people. It’s just that in many ways they’re clueless. They consistently made bad decisions in their own lives (some were disastrous, like almost losing our house) so when it came to my own life — friends, dating, college, grad school, career — I didn’t have role models or mentors in my parents the way most of my friends did.
To be fair to my therapist, I understand that I’m not a child anymore and that she wants me to figure things out on my own as an adult, and I get that — up to a point. But if it’s a simple question, something practical or something that isn’t a deep psychological issue, why not just say what she thinks? I’m talking about the kinds of questions people my age routinely ask their parents’ advice on all the time: Does it makes sense to buy a place now since I can afford it, or should I keep my rent-controlled apartment until I’m more settled with a family? Or, if a guy that an acquaintance at work dated for a few months over a year ago is asking me out, is it okay to accept even though this acquaintance will probably be unhappy about it?

I just want to know what she would suggest — not that I’d necessarily do that, but at least I’d have the opinion of a stable adult I trust.

Since you’re a therapist with an advice column, do you ever give people advice in therapy? You must have opinions about whether people should break up with their boyfriends or girlfriends, stop talking to a friend, or (hint, hint) buy a home now or wait to be more settled. Do you ever share this with your patients? And if not, why not give them your perspective? I find this part of therapy so frustrating.

Not Asking for Much

Dear Not Asking for Much,

Guess what? I’m going to give you some advice. Here’s what I think you should do:

1. Buy a place now.
2. Go on the date.

But wait — before you take that advice, let me give you one last piece of advice: Please don’t take my advice. Because if you do, you’re likely to end up as disappointed with me as you were with your parents. My advice — like your parents’ or even your therapist’s (were she to give it) — may be well-meaning, but it won’t help you in the ways that you hope.

For one, despite my good intentions, whatever I suggest will be mediated by my own biases and life experiences. So while I took your living situation into account, it’s also true that I advised you to buy a place partly because I bought my first home in my 30s and in hindsight I wish I’d bought earlier. In other words, my advice was clouded by my personal beliefs about real-estate appreciation. Likewise, I suggested that you go on the date because if it were me — if I were almost 30 and really liked a guy and wasn’t close to a woman who briefly dated him over a year ago — I’d go on the date. But you might have different ideas, values, and tolerance for any potential fallout. What might be a good idea for me might be a disaster for you. And by giving you advice, I might be projecting my own values and beliefs about the world onto you, rather than helping you to gain a stronger sense of your own.

There’s always going to be a gap between what the therapist might advise, and what’s best for the patient. A therapist might see a couple and think they should divorce, but some people prefer to be in a highly conflictual marriage than to be alone, no matter how much the therapist might personally champion being alone for a time over a highly conflictual marriage where one partner refuses to change. Our patients’ lives are theirs to live, not ours.

Our patients’ lives are theirs to live, not ours.

Even so, you’re not alone in wanting your therapist to tell you what to do. I’m asked all the time questions like which job a person should take, whether they should have another kid or freeze their eggs, and whether they should go to their chaotic family’s house for the holidays or do something more pleasant instead. And when I don’t meet that desire, it can feel like I’m sadistically withholding “the answer” that, in their view, I can easily provide and that will solve their pressing problem.

One of the surprises of becoming a therapist has been how often people want to be told exactly what to do, as if I have the “right answer” — or as if “right” or “wrong” answers exist for the bulk of choices we make in our daily lives. Taped up over my desk is the word ultracrepidarianism, which means “the habit of giving opinions and advice on matters outside of one’s knowledge or competence.” As a therapist, I’m trained to understand people and help them sort out what they want to do, but I can’t make their life choices for them. I’m not a real-estate specialist, career counselor or, most important, soothsayer. Part of what people want from my advice is relief from uncertainty — if my therapist says X, I don’t have to sit with my anxiety around ambiguity. But one thing that’s certain about life is its uncertainty, and the inability to tolerate the uncertainty of what will happen if they decide X or Y or Z leaves people trapped in indecision. Learning to slow down and reflect on their choices and anticipate the potential consequences of their actions helps to decrease their anxiety in the long-term. Taking a therapist’s advice alleviates anxiety in the moment, but it won’t last.
Early in my training, I felt tremendous pressure to give advice of the benign (or so I thought) sort, until I realized that people resent being told what to do. Yes, they may ask — repeatedly, relentlessly — but after you actually tell them, their initial relief is often replaced by resentment. This happens even if things go swimmingly, because ultimately humans want to have agency over their lives, which is why children spend their childhoods begging to make their own decisions rather than have them made for them.

But if you were a certain kind of child, a child like you, NAFM, a child who had to make decisions for yourself before you were ready — either because nobody offered, or you couldn’t trust the advice you got — decision-making and the agency that comes with it may feel crippling. Instead of asking for more freedom on the way to adulthood, this type of child will likely grow up and plead to have that freedom taken away.

So you ask your therapist: Should I do this? Should I do that? C’mon, just tell me: What would you do?

Behind these questions lies the assumption that your therapist is a more competent human being than you are. The thinking goes: Who am I to make the important decisions in my own life? Am I really qualified for this? Your therapist, on the other hand, is believed to be the expert, the surrogate parent, the One Who Knows Best. And you are the child in the adult body who fantasizes about how nice it would feel to abdicate all of your responsibility and let a capable adult do the heavy lifting of making hard choices. Even if it goes badly, having somebody else decide seems safer. What a relief to be able to blame someone else for a wrong decision, so that the pain of a bad outcome isn’t amplified by having been the one to create the “mistake” in the first place. (And thus think: Oh, God, I’m just like my parents — I make terrible decisions!)
That’s a deceptive kind of protection, though, because your therapist’s advice will actually make you feel angry and unsafe. You may beg, plead, and cajole until your therapist, at 5 p.m. on a Friday, is so worn down that despite herself, she offers the advice you want. And your first reaction might be elation! Finally! Initially, you might feel supported and taken care of in a way you didn’t with your parents.

But what might you do with this nugget, this actual therapist-given, expert-approved, and longed-for gift of concrete advice? Despite getting exactly what you asked for, you might not do it. You might procrastinate, coming up with all sorts of reasons why you haven’t gotten around to it yet. And then you’ll feel bad for not doing it. And you’ll start to think, I feel bad because my therapist made me feel bad by trying to tell me what to do. How dare she! I’m not doing this, dammit, just because she told me so. Who is she to boss me around? And you’ll sit on her couch every Friday at five, not telling her that you didn’t do the thing she suggested, because you resent her for intruding on your voice, for making you feel like your own opinion doesn’t matter; and on top of that you’ll be consumed by the shame you feel for displeasing her by not doing the thing she wants — which is what this whole interaction will have gotten twisted into in your mind, even though the ostensible point of her giving the advice was to please you, not her. In the end, nobody’s happy.

That’s why getting advice is not the solution to your problems, NAFM. Underlying all this hand-wringing about what to do with your apartment and the guy who asked you out and the dozens of other pieces of advice you may have pushed for is your therapist’s hope that you will leave her. Not now, but when you’re ready, and her goal in each and every session is to help you get ready. From Day One, we are thinking about how to get our patients to leave us, not because we don’t care, but because we do. We don’t want you to struggle so much. We want you to learn to trust yourself. We want you to stop asking us to play God with your life because we are not gods. We are mortals who do our best to understand our patterns and tendencies, our pain and our yearnings, so that we can take responsibility for our lives. And we want you to do the same.
We all wage this internal battle to some degree: Child or adult? Safety or freedom? And no matter where we fall on those continuums, ultimately, every decision we make is based around two things: fear and love. Sometimes fear wins, and sometimes love does, and sometimes it’s wise to listen to the fear, other times to the love. If there’s one thing your therapist is trying to show you, it’s how to tell the two apart. And she’s showing you by asking you to practice listening to yourself so that you can use those feelings like a compass to point yourself in the best possible direction.

Therapists may not give advice, but we do give guidance. And if there’s one thing your therapist knows, it’s that the most powerful truths — the ones people take the most seriously — are those they come to on their own.

Lori Gottlieb is a writer and a psychotherapist in private practice.

This is your brain on gambling...

Posted on June 22, 2017 at 9:03 PM Comments comments (46)

How the Brain Gets Addicted to Gambling
Ferris Jabr
10-13 minutes

When Shirley was in her mid-20s she and some friends road-tripped to Las Vegas on a lark. That was the first time she gambled. Around a decade later, while working as an attorney on the East Coast, she would occasionally sojourn in Atlantic City. By her late 40s, however, she was skipping work four times a week to visit newly opened casinos in Connecticut. She played blackjack almost exclusively, often risking thousands of dollars each round—then scrounging under her car seat for 35 cents to pay the toll on the way home. Ultimately, Shirley bet every dime she earned and maxed out multiple credit cards. “I wanted to gamble all the time,” she says. “I loved it—I loved that high I felt.”
In 2001 the law intervened. Shirley was convicted of stealing a great deal of money from her clients and spent two years in prison. Along the way she started attending Gamblers Anonymous meetings, seeing a therapist and remaking her life. “I realized I had become addicted,” she says. “It took me a long time to say I was an addict, but I was, just like any other.”
Ten years ago the idea that someone could become addicted to a habit like gambling the way a person gets hooked on a drug was controversial. Back then, Shirley's counselors never told her she was an addict; she decided that for herself. Now researchers agree that in some cases gambling is a true addiction.
In the past, the psychiatric community generally regarded pathological gambling as more of a compulsion than an addiction—a behavior primarily motivated by the need to relieve anxiety rather than a craving for intense pleasure. In the 1980s, while updating the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association (APA) officially classified pathological gambling as an impulse-control disorder—a fuzzy label for a group of somewhat related illnesses that, at the time, included kleptomania, pyromania and trichotillomania (hairpulling). In what has come to be regarded as a landmark decision, the association moved pathological gambling to the addictions chapter in the manual's latest edition, the DSM-5, published this past May. The decision, which followed 15 years of deliberation, reflects a new understanding of the biology underlying addiction and has already changed the way psychiatrists help people who cannot stop gambling.
More effective treatment is increasingly necessary because gambling is more acceptable and accessible than ever before. Four in five Americans say they have gambled at least once in their lives. With the exception of Hawaii and Utah, every state in the country offers some form of legalized gambling. And today you do not even need to leave your house to gamble—all you need is an Internet connection or a phone. Various surveys have determined that around two million people in the U.S. are addicted to gambling, and for as many as 20 million citizens the habit seriously interferes with work and social life.
Two of a Kind
The APA based its decision on numerous recent studies in psychology, neuroscience and genetics demonstrating that gambling and drug addiction are far more similar than previously realized. Research in the past two decades has dramatically improved neuroscientists' working model of how the brain changes as an addiction develops. In the middle of our cranium, a series of circuits known as the reward system links various scattered brain regions involved in memory, movement, pleasure and motivation. When we engage in an activity that keeps us alive or helps us pass on our genes, neurons in the reward system squirt out a chemical messenger called dopamine, giving us a little wave of satisfaction and encouraging us to make a habit of enjoying hearty meals and romps in the sack. When stimulated by amphetamine, cocaine or other addictive drugs, the reward system disperses up to 10 times more dopamine than usual.
Continuous use of such drugs robs them of their power to induce euphoria. Addictive substances keep the brain so awash in dopamine that it eventually adapts by producing less of the molecule and becoming less responsive to its effects. As a consequence, addicts build up a tolerance to a drug, needing larger and larger amounts to get high. In severe addiction, people also go through withdrawal—they feel physically ill, cannot sleep and shake uncontrollably—if their brain is deprived of a dopamine-stimulating substance for too long. At the same time, neural pathways connecting the reward circuit to the prefrontal cortex weaken. Resting just above and behind the eyes, the prefrontal cortex helps people tame impulses. In other words, the more an addict uses a drug, the harder it becomes to stop.
Research to date shows that pathological gamblers and drug addicts share many of the same genetic predispositions for impulsivity and reward seeking. Just as substance addicts require increasingly strong hits to get high, compulsive gamblers pursue ever riskier ventures. Likewise, both drug addicts and problem gamblers endure symptoms of withdrawal when separated from the chemical or thrill they desire. And a few studies suggest that some people are especially vulnerable to both drug addiction and compulsive gambling because their reward circuitry is inherently underactive—which may partially explain why they seek big thrills in the first place.
Even more compelling, neuroscientists have learned that drugs and gambling alter many of the same brain circuits in similar ways. These insights come from studies of blood flow and electrical activity in people's brains as they complete various tasks on computers that either mimic casino games or test their impulse control. In some experiments, virtual cards selected from different decks earn or lose a player money; other tasks challenge someone to respond quickly to certain images that flash on a screen but not to react to others.
A 2005 German study using such a card game suggests problem gamblers—like drug addicts—have lost sensitivity to their high: when winning, subjects had lower than typical electrical activity in a key region of the brain's reward system. In a 2003 study at Yale University and a 2012 study at the University of Amsterdam, pathological gamblers taking tests that measured their impulsivity had unusually low levels of electrical activity in prefrontal brain regions that help people assess risks and suppress instincts. Drug addicts also often have a listless prefrontal cortex.
Further evidence that gambling and drugs change the brain in similar ways surfaced in an unexpected group of people: those with the neurodegenerative disorder Parkinson's disease. Characterized by muscle stiffness and tremors, Parkinson's is caused by the death of dopamine-producing neurons in a section of the midbrain. Over the decades researchers noticed that a remarkably high number of Parkinson's patients—between 2 and 7 percent—are compulsive gamblers. Treatment for one disorder most likely contributes to another. To ease symptoms of Parkinson's, some patients take levodopa and other drugs that increase dopamine levels. Researchers think that in some cases the resulting chemical influx modifies the brain in a way that makes risks and rewards—say, those in a game of poker—more appealing and rash decisions more difficult to resist.
A new understanding of compulsive gambling has also helped scientists redefine addiction itself. Whereas experts used to think of addiction as dependency on a chemical, they now define it as repeatedly pursuing a rewarding experience despite serious repercussions. That experience could be the high of cocaine or heroin or the thrill of doubling one's money at the casino. “The past idea was that you need to ingest a drug that changes neurochemistry in the brain to get addicted, but we now know that just about anything we do alters the brain,” says Timothy Fong, a psychiatrist and addiction expert at the University of California, Los Angeles. “It makes sense that some highly rewarding behaviors, like gambling, can cause dramatic [physical] changes, too.”
Gaming the System
Redefining compulsive gambling as an addiction is not mere semantics: therapists have already found that pathological gamblers respond much better to medication and therapy typically used for addictions rather than strategies for taming compulsions such as trichotillomania. For reasons that remain unclear, certain antidepressants alleviate the symptoms of some impulse-control disorders; they have never worked as well for pathological gambling, however. Medications used to treat substance addictions have proved much more effective. Opioid antagonists, such as naltrexone, indirectly inhibit brain cells from producing dopamine, thereby reducing cravings.
Dozens of studies confirm that another effective treatment for addiction is cognitive-behavior therapy, which teaches people to resist unwanted thoughts and habits. Gambling addicts may, for example, learn to confront irrational beliefs, namely the notion that a string of losses or a near miss—such as two out of three cherries on a slot machine—signals an imminent win.
Unfortunately, researchers estimate that more than 80 percent of gambling addicts never seek treatment in the first place. And of those who do, up to 75 percent return to the gaming halls, making prevention all the more important. Around the U.S.—particularly in California—casinos are taking gambling addiction seriously. Marc Lefkowitz of the California Council on Problem Gambling regularly trains casino managers and employees to keep an eye out for worrisome trends, such as customers who spend increasing amounts of time and money gambling. He urges casinos to give gamblers the option to voluntarily ban themselves and to prominently display brochures about Gamblers Anonymous and other treatment options near ATM machines and pay phones. A gambling addict may be a huge source of revenue for a casino at first, but many end up owing massive debts they cannot pay.
Shirley, now 60, currently works as a peer counselor in a treatment program for gambling addicts. “I'm not against gambling,” she says. “For most people it's expensive entertainment. But for some people it's a dangerous product. I want people to understand that you really can get addicted. I'd like to see every casino out there take responsibility.”
This article was originally published with the title "Gambling on the Brain"

Seven Good Reasons to Blame Your Partner (And Why None of Them Are Good Enough)

Posted on June 4, 2017 at 3:20 PM Comments comments (62)

Seven Good Reasons to Blame Your Partner (And Why None of Them Are Good Enough)

Robert Solley

Reason #7 — It’s Easy!
Under stress it’s often easier to see what someone else is doing wrong than what you are doing wrong. It’s easier to see the food stuck in your partner’s teeth than your own. To see your own you would first need to locate a mirror and then look into it. And then you would need to open your lips to be able to see your own teeth. And we’re not even talking yet about finding the motivation to locate and look in the mirror, much less to expose the ugly condition of your teeth to yourself.

Reason #6 — It’s Fun
Well, OK, maybe not fun fun. But it feels good at some level. At it’s worst, blaming someone else feels good in a vengeful, “I gotcha” kind of way. More often there’s a venting, energy-release part that’s somewhat satisfying. But then there’s another part feels not-so-good, in an out-of-control, guilty kind of way. However, even the bad part of this feeling may be more comfortable than it should be. For example, how you would you feel right at that point if you really took responsibility for whatever part of the conflict was yours.
Because there’s almost always some part that’s yours.
To really take responsibility you might have to fight through a wall of shame. In the moment, that would be painful — to really acknowledge that you did something wrong, were bad, screwed up, were unthinking, or whatever it might be. See Reason #5!

Reason #5 — Accepting Responsibility and Feeling Bad Are Hard
This is a corollary to Reason 2. What makes accepting responsibility especially hard is shame, which most of us feel to varying degrees (psychopaths are an exception). This is the feeling that fundamentally we aren’t good enough as human beings, that we’re flawed, inadequate, broken, defective…need I say more? So if we start to accept the idea that we might have done something a little wrong, for some it can tap into this big pool of “I’m all bad.” And that just feels awful! Since the function of shame in society is to act as a sanction against violating important social norms, it leaves one feeling alone. At its worst you can feel totally isolated in your badness, cut off from any possibility of love from anyone else, for eternity. Wow, no wonder it feels better to blame your partner! But wait, there’s more…

Reason #4 — We’ve Been Taught All Our Lives to Blame
Starting as little kids we were taught right and wrong — and especially wrong. First by our parents, and then by our teachers through the long years of school into adulthood. Right and wrong behaviors, right and wrong answers, right and wrong everything. That highlighted and underscored those feelings of shame for the most significant, tender formative years of our lives (to say nothing of adulthood). We also learned that if you can successfully deny it, or push the responsibility off onto someone else then you don’t have to feel that shame as much. “I didn’t do it, Gertrude did!”

Reason #3 — We Use Ourselves As the Standard
We each tend to think that “The way I do it is the best way.” Of course! We’ve spent our whole lives improving on (or working against) what our parents taught us, so this must be the way to do it! Perhaps the only way to do it! “If you would only do it my way!” Well, it turns out there are lots of ways to do things, and in many cases either it doesn’t really matter, different conditions may demand different ways, or at any rate it’s probably not worth losing your relationship over. But giving up ideas, beliefs, or ways of doing things, can be scary. It can feel like something terrible would happen, or you might lose yourself.

Reason #2 — It’s Hard to Fully Accept That Your Partner Is a Different Person
This is a corollary to #3. Things would seemingly be much easier and smoother if your partner just thought about and did things the way you do. But your partner is a different person, with his or her own ideas, personality, and habits. At some level we’re aware of this, but too often if our partners do something differently from how we would, we feel anger and frustration. And we bolster our anger will all manner of justifications and rationalizations. “But my way really is better. No, really.” And sometimes it is.
But how much of the time is it worth sacrificing your relationship for being right, or wanting your partner to respond the same way you do?
Coming to terms with those differences can be painful, can make you feel separate from them, can scare you that maybe you and your partner are too different after all. But it can also bring you closer in the long run if you can talk about and learn to accept each other’s differences.

Reason #1 — It’s Animal Nature to Bite Back
When we feel criticized or blamed it’s natural to criticize or blame back. This is an extension of our protective reflex to attack sources of physical threat or pain. So it makes perfect sense that when we are hurt emotionally we would try to hurt back in an effort to relieve our own pain. This instinct may be one of the most powerful forces behind blame, and especially the kind of reflexive retaliatory blame that gets us stuck in miserable escalating fights. Our best intentions can be little match against mother nature’s hard-wiring. But again, we can become more self-aware, learn the signals that precede blaming, and do something else instead.

Why None of These Reasons Are Good Enough
Think of a time when you have felt blamed or criticized. Remember how it felt inside? Think of a time when you were in a fight with your partner. Chances are, at least part of what you were feeling was blamed, criticized, hurt, and angry. Now think of how you felt the next day or perhaps days later (assuming that you did have some recovery from that fight). Remember how much more clearly you could think about the topics, how much broader your perspective was? Remember how much more you could think about your partner’s point of view in a more open way? Perhaps you were even able to come to some resolution with your partner in that calmer place. If not, or if it’s hard to even get to a calmer, clearer place after a day or so, then perhaps the pain you are causing each other is becoming chronic and this would be a good time to seek counseling.

When we feel blamed, criticized, or misunderstood, the feelings of hurt and anger take over our minds and bodies, making it almost impossible to have a decent conversation. Not only are we unable to think clearly, but it becomes much more difficult to really listen to our partners. Furthermore — since it is natural to retaliate in an effort to get relief from the pain, we strike back, inducing all of those same bad feelings that we are having in our partner. So now we are both not only impaired, but caught in an unpleasant cycle with each other that’s only getting worse.

Knowing how bad it feels to feel blamed or criticized, and knowing how it cripples the conversation and relationship, wouldn’t it seem worthwhile to learn to retrain those reflexes? Here are two alternatives to think about next time:
  • Identify and name your vulnerable emotions. Anger and frustration are usually the easiest to name — and better to name them than to act them out. But they are not the most vulnerable feelings. See if you can locate some sadness (loss) and/or fear and talk about those.
  • Push yourself to have compassion for your partner. Are they having a bad day? What other stresses are acting on them? What vulnerabilities do they have or are they guarding? Is this a pattern that was adaptive for them in childhood, in the face of painful events back then?
Learn to catch your blaming tendencies before they come out and hurt someone — especially your partner.

Why Is Therapy So Expensive?

Posted on May 7, 2017 at 4:13 PM Comments comments (155)
Why Is Therapy So Expensive?

Nicole Pajer

After a bout of breakup-induced anxiety and depression, 31-year-old New York City resident Emily Taylor decided to look for a therapist. But finding a mental health professional to accept her Anthem Blue Cross and Blue Shield insurance plan proved to be nearly impossible.

“I spent days looking for therapists near me that were covered by my insurance,” Taylor said. “For the very few I did find, I spent over five hours on the phone trying to get appointments, [only] to find that they were either not accepting new patients or the wait time was two months.”

Taylor was able to locate plenty of highly reviewed therapists available for private pay, however. But since the average cost of therapy in New York is $200 to $300 per session, according to one report, that wasn’t a practical solution.

Many people struggle to find talk-based therapy that’s covered by their insurance plans. Of all practicing medical professionals, therapists are the least likely to take insurance. Only 55 percent of psychiatrists accept insurance plans, compared to 89 percent of other health care providers, like cardiologists, dermatologists and podiatrists, according to a 2014 study published in JAMA Psychiatry.

*Note:  While you may find it hard to find a therapist who will take your insurance, there is a good chance that therapists asking to be on your panel are being told, by your company, that there are no openings as they have enough coverage.  This has been my experience in Encino.  With this in mind, I have tried to keep my fees reasonable.---Alan Rudolph

That’s a big problem, since approximately 1 in 5 Americans will experience some sort of mental health disorder in a given year, according to the National Alliance on Mental Illness. Many will also seek counseling for divorce or grief.

Treatment is highly individualized, but experts agree that talk therapy is the gold standard for treating psychiatric problems. A 2015 study revealed that cognitive behavioral therapies were just as effective as antidepressants for treating depression.

So why is therapy so unaffordable for so many people? And why don’t more mental health professionals work with third party payers? It turns out several factors contribute to making therapy unaffordable ― many outside individual clinicians’ control.

Insurance systems don’t support therapists’ diagnoses.

Poor insurance coverage for therapy is largely a reflection of how society views mental health, says licensed psychologist Candice Ackerman.

“Insurance companies tend to see things more from a medical perspective ― where if you get sick, for example, then you take a blood test, they figure out what is wrong with you, they give you a medication and then you are all better,” Ackerman explained.

“But with mental health,” she continued, “a lot of times what we are trying to do is preventative maintenance-type work, and it makes it a lot more difficult to justify medical necessity with insurance companies.”

On the website for Ackerman’s practice in Lakeway, Texas, she explicitly states that some of the professionals there do not accept insurance because she wants to avoid surprising patients.
Even when insurance companies consider a mental health diagnosis a valid billable condition, the coverage may only be temporary. Jennifer Chen, 38, a freelance writer in Los Angeles, is waiting to hear whether her insurance company will continue to cover her therapy, since she’s no longer clinically diagnosed as “depressed.”

“After seeking talk therapy treatment for depression for four years, my mental health insurance provider is reviewing my case to determine if I still need coverage,” she said. 
In other words, Chen’s insurance company may determine that she is well enough to forgo therapy, even if it’s the reason she is well.

“My therapist will be attending a review board where the insurance company will discuss my case and make a final decision if my coverage will end or not,” Chen said. “Currently, my insurance covers about 50 percent of my therapist’s fee. If my coverage ends, then I’ll have to consider discussing a sliding scale fee or reduced therapy sessions.”

Insurers are starting to feel the frustration as well. “There is a well-documented national shortage of behavioral health providers generally ― and in health plan networks specifically ― resulting in patients having to pay out-of-pocket for treatment or forgo it altogether,” said Cathryn Donaldson, a spokeswoman for America’s Health Insurance Plans, an insurance company trade organization.

Therapists honestly can’t afford to accept insurance. 
The gap between a therapist’s hourly fee and the reimbursement rates they receive from insurance companies can be massive.

“I’ve seen it lower than $50 a session,” Ackerman explains. “I charge $140 a session, so that would be a major blow in terms of income for us.”

“We can’t sustain our practices when that kind of value is put on mental health,” she added.
While $140 per session sounds steep, Ackerman says it helps cover $2,500 a month in rent, the cost of business and malpractice insurance, advertising, office equipment and credit card processing fees. And like many of her colleagues, Ackerman has accrued massive student debt. “I was in school for 10 years, and at this point, my debt is six figures!” she said.

“Therapists are health care professionals that all have master’s degrees or higher. Many have doctorates, medical degrees, and [have] graduated from specialized institutes for the teaching of psychotherapy,” said Dr. Thomas Franklin, medical director at the Retreat at Sheppard Pratt, a residential psychotherapy facility in Baltimore.

“Lawyers, accountants and architects generally make $120-$400 per hour or more,” he added. “One should expect to pay the same for therapy from a competent, highly trained professional.” 
Therapists are in a no-win position, says Arika Pierce at the Coalition for Patients’ Rights, an organization for non-M.D. health care providers. “Therapists are almost forced to charge the patient directly because they are not able to be reimbursed at equitable rates as their counterparts that have M.D. or D.O. behind their name,” she said.

Pierce says her organization is continuously advocating to change this to benefit non-physician licensed health care professionals and their patients.

“More equitable rates across all health care professionals would allow patients to have greater choice and access in terms of their health care decisions,” she said.

Therapists are almost forced to charge the patient directly because they are not able to be reimbursed at equitable rates. Arika Pierce, spokeswoman for the Coalition for Patients’ Rights
Filling out insurance paperwork is a full-time job.

It’s a Catch-22: To keep overhead low, many therapists don’t hire staff or assistants. But without them, the job of working with insurance companies is overwhelming.

“Many people who work in mental health don’t have the volume of patients that primary care [physicians] might have,” said Dr. Lynn Bufka, an associate executive director at the American Psychological Association. “They might see seven or eight patients max in a day, where a primary care practice might see many more and also have dedicated staff who handle billing and who are very familiar with what the requirements are with all the different payers out there.”

Submitting a bill to an insurance company can involve jumping through an array of hoops, according to Ackerman, including justifying your services to an insurance representative, providing status report updates and getting on the phone with providers to track down late payments.

This can be particularly complicated because not everyone who sees a therapist has a diagnosable mental illness.

“Common reasons for coming to therapy, like couples counseling and grief counseling, are typically not covered by insurance,” said Ackerman.

In other cases, the diagnosis may be controversial in the field. “I have a client with dissociative identity disorder, which is formally known as multiple personality disorder,” Ackerman added. “I don’t know if that would get reimbursement, just because it’s a controversial diagnosis.”

Some therapists say it’s helpful to accept insurance.

Not everyone agrees that accepting insurance is impossible.

Dr. Patti Johnson has dealt with her share of insurance issues ― excessive paperwork, late payment and the hassle of continuously submitting her clients for coverage authorization. But the Los Angeles psychologist, who is currently maxed out with her patient load, finds that accepting insurance helps keep her schedule full, and along with patient referrals, allows her to sustain a lucrative private practice.

“Individuals generally check with their insurance companies when looking for referrals to a therapist. This is a positive and easy way for clients to know about you and your services without a large marketing budget,” she said.

Johnson also notes that allowing patients to bill their insurance opens up her client base to people of all income levels. “Most people can’t easily afford to pay $600 to $800 a month for weekly therapy, and without the ability to use insurance, they wouldn’t be able to get the care they need,” she explained.

Therapists and patients have to make hard choices.

To make it more feasible for psychiatrists to take insurance, the American Psychological Association would like to see therapy become a standard part of integrative health. So instead of a fee-for-service model, payment would be based on treating a particular condition. (In other words, patients would pay a lump sum rather than a payment every time a service is performed.)

“If it were up to me, our health systems would allow three or four appointments with a mental health provider every year, no questions asked, no need for a specific diagnosis,” the APA’s Bufka said.

This kind of yearly care could help patients address small problems before they grow into bigger ones. For example, a person could learn how to better manage their sleep, work with an anxious child or navigate a complication at work. This would probably lead to better mental and physical well-being, Bufka said, but the current billing system doesn’t support it.

For now, the insurance conundrum for therapists remains. “You struggle with wanting to help people that come to you that seem that they need it, but also keep your lights on in your office and make a profit,” Ackerman said.

Taylor eventually gave in and signed up for sessions with a highly recommended psychologist who charges $250 an hour.

“I’m feeling so much better and am still going, because it’s helpful,” she explained. But even though she thinks her treatment is worth the price, she hopes to cut down her sessions soon.
“I’ve gone about five months and paid about $5,000 out of pocket,” she said. “I just don’t have the money. I used my whole Christmas bonus to help with the costs.”

As part of May’s Mental Health Awareness Month, we’re focusing on treatment and the stigma around getting help. Check out our coverage here and share your story at [email protected].

Living Life, One Day at a Time

Posted on November 14, 2016 at 11:35 AM Comments comments (178)

Living Life, One Day at a Time

Whether you're in recovery or not, the mantra"one day at a time"can help to keep
your feet on the ground. Really, our only option is to take things one day at a time.

But, some days, living life one day at a time can feel incredibly frustrating. We want
to be "better" or "recovered" or changed in some way right now.  Daily progress feels
slow. We get impatient. Why can't the bright future you imagine just be here already?

Instant gratification is only short-lived happiness. Our deepest satisfaction comes
from consistent work and daily effort. A true metamorphosis, an authentic transformation,
takes time.

Embrace the process of change - whether you're new to recovery or years and
decades along in the journey. No one is static. Every person is every-changing. You
have compiled countless experiences, mistakes, and achievements that make you
who you are today.

This moment right now is shaping who you will be tomorrow. So, enjoy it.
Live it. One day is full of a million chances.

Reprinted from


The power of vulnerability

Posted on September 21, 2014 at 10:42 AM Comments comments (81)
Looking to get more from life?  This video can help:

Brene Brown: The power of vulnerability

Therapy: The long and the short of it

Posted on July 10, 2012 at 1:16 PM Comments comments (38)
There is a changing trend in therapy.  Time was a client entering therapy could expect, and perhaps fear, a long stay.  I think being trapped in therapy  was dreaded by many and kept some from going to therapy despite a need for help.
Today the field of therapy has accepted  a reality that many come to therapy because they are experiencing a problem that they need help with, yet are not wanting a long term excavation of their psyche.
I believe that this is a positive change and have seen a change in my practice.  Many come in times of need, ending when things are working better, and return months or years later when another need arises.
That said, I think that something of value may have been lost in this process, like the baby with the bath water.               

How many of us are content with who we are?  Maybe we aren't  having the relationships we want, or the career success.  These problems sometimes require deeper reflection and the courage to own areas of difficulty.  Why did someone else get the promotion?  Why do the girls I want always seem to fall for someone else?
We wrestle with ourselves.  Therapy can help.

Why isn't a man more like a woman?

Posted on June 22, 2012 at 1:42 PM Comments comments (213)
My clients and I spend a lot of time looking at why their partners don't do what they expect.  Simply put, men and women are very different.  Here is an article by Laura Schaefer that helps explain differences:

The Male Brain, Explained
By Laura Schaefer

Women have puzzled over it for years—why the heck do men do the things they do? Why do they profess their love for you one minute, then ignore you the next (say, when an Attila the Hun special turns up on TV)? Why can they not remember our birthdays? Let science explain some of these conundrums—and help you rev up your relationships!

Be patient with his memory
The hippocampus, where initial memories are formed, occupies a smaller percent of the male brain than the female brain. If on your first date he can't remember where you work, even though you told him all about it when you met, just remember that size matters … hippocampus size, that is. Don't take it personally. (Oh, and don't be surprised when, months down the line, he has no clue you've just changed your hair.)

Don't expect him to get hints
Have a crush on him? You may have to put it out there, because men aren't as skilled at women at reading subtle emotional cues. As Dr. Larry Cahill of the University of California at Irvine puts it, "We have been assuming that the ways in which emotions are organized in the brain are essentially similar in men and women," but they aren't. Parts of the limbic cortex, which is involved in emotional responses, are smaller in men than in women. Additionally, scientists at McMaster University have found that guys have a smaller density of neurons in areas of the temporal lobe that deal with language processing. That's why it's probably a good idea to
tell him straight-up how you're feeling ("I'm kind of hurt that you forgot I hate sushi"). Expecting him to infer from your hints could leave both of you scratching your heads.

Don't take conversation lulls personally
Fact is, guys in general just aren't as verbally adept as women are. Large parts of the cortex — the brain's outer layer that does a big part of recognizing and using subtle language cues — are thinner in men than they are in women. A study led by Dr. Godfrey Pearlson of Johns Hopkins University has shown that two areas in the frontal and temporal lobes that play an important role in language processing are significantly smaller in men. Using MRIs, the Johns Hopkins scientists measured gray matter volumes in several brain regions in 17 females and 43 males. Women had 23 percent more volume than men in the dorsolateral prefrontal cortex and 13 percent more volume than men in the superior temporal cortex. "Women," explains Dr. Cahill, "excel in being able to come up with appropriate words, given cues." Men — not so much. Don't expect him to chatter with you on dates with the skill of a girlfriend, and don't assume he's not interested in you if he occasionally lets the conversation lapse. Think of it this way: He's simply basking in moments of quiet companionship.

Appreciate his naturally upbeat nature
Does he seem to be "up" most of the time? It's not your imagination: Male brains produce 52 percent more serotonin (the chemical that influences mood) than female brains, according to a study done at McGill University. And studies show that fewer men than women suffer from depression. Guys may also have an easier time rolling with life's big stresses. If he tells you he recently lost his golden lab or suffered a job loss and doesn't get all teary, it doesn't mean he's heartless; rather, he has healthy stores of serotonin.

Don't expect his take on your relationship history to match yours
He may be incapable of seeing your shared past the way you do. Brain images have started to show that men and women use their brains in vastly different ways. For example, women use the left part of the amygdala — the part of the brain that creates emotional reactions to events — to put memories in order by emotional strength, meaning that something emotionally important to them (like a great first date a couple of months ago) will be ordered in front of what they ate for breakfast yesterday. Men, however, use the right part of the amygdala to put memories in order. Traditionally, the right hemisphere of the brain is associated with the central action of an event, while the left hemisphere is associated with finer details. Translation: You'll both remember your first date, but he might not remember the color of your sweater or the light rain that was falling that night. It doesn't mean he was checked out; it just means he's a guy.

Remember his brain is his largest sex organ
In males of several species including humans, the preoptic area of the hypothalamus is greater in volume, in cross-sectional area and in the number of cells. In men, this area is more than two times larger than in women, and it contains twice as many cells. And what, say you, does this have to do with the horizontal mambo? Plenty. This area of the hypothalamus is in charge of mating behavior.

This small structure connects to the pituitary gland, which releases sex hormones. So if your bf wants to get intimate all the time and you feel like Ms. Low Desire, remember: You're just experiencing normal, brain-based differences.

Laura Schaefer is the author of
Man with Farm Seeks Woman with Tractor: The Best and Worst Personal Ads of All Time.
For the other side of this story, read
Article courtesy of Happen magazine,