1) higher confidentiality standards (no insurance accepted)
2) Email support between sessions
3) Coordinate care with your medical provider, if you wish
4) Quality Assessments done periodically
5) Progress updates every 6th session
6) Handouts to reinforce what you’ve learned
8) Testing for depression and anxiety, with actual test numbers reported
9) Reduced fee/sliding scale counseling available with Intern Therapists
10) You will leave the first session with a “Prescription” of immediate, practical suggestions
By Amie Koehn, LCS
“I just don’t know if I can do it anymore,” my client said as she cried. “He just needs so much, you know? I don’t think I can do it all.”
Are you taking care of an elderly parent, spouse, sibling or an adult child? Taking care of an adult presents unique challenges. It’s hard enough providing 24 hour care for children, but what happens when the person we’re caring for is someone who has been or “should” be able to take care of themselves but now can’t?
Caregivers are uniquely prone to depression and anxiety. Most often women, caregivers devote their physical energy- meal preparation, being present with the person, perhaps helping that someone walk or feed or even bathe and toilet themselves. They expend mental energy- arranging appointments, arranging services, keeping track of medication, and even providing stimulation and direction when needed, and emotional energy- feelings of sadness, grief, frustration, futility, anger, resentment and guilt are common in caregivers.
The devotion of all this energy often results in depression and anxiety, with the effects of caregiving lasting well beyond their loved one’s death or placement of their loved one in a more structured environment. Virtually all of the caregivers I’ve worked with over the last fourteen years felt guilt. A LOT of it. Guilt about not providing enough care or the right kind of care, guilt about feeling angry or resentful toward their loved one at times, even guilt about wishing sometimes that their loved one’s life would end so that they could both be better off. Caregivers often believe they could have/should have done something more or different to help their loved one- even though they logically can’t put their finger on what that something is.
Caregivers often take increasingly less time for themselves, usually out of concern that something bad will happen to their loved one if/when they leave them to run errands or just get away for a couple of hours; or they feel awkward asking someone else to help. They stop spending time with friends or doing hobbies or fun activities because taking care of their loved one seems to take all of their time. For this reason, many develop tunnel vision about themselves and what needs to be done, and feel isolated. With all of this going on, is it any wonder that caregivers are more prone to depression and anxiety?
There are ways to make caregiving less stressful:
- Ask for help. Adult siblings, friends, neighbors you trust can help with everything from chores and cooking to sitting with your loved one so that you can get a break. Professional respite care is also available.
- Accept help. When someone offers to help, accept it! If they offer to help, but don’t know how to help, be prepared to name a few things that you could use help with- respite care, meal prep, errand running, etc. It doesn’t have to be a major task; even getting help with the little tasks can make life easier for you.
- Stay in touch with community. To the extent possible it is vitally important to keep up your social activities- spending time with friends, faith practices and clubs are examples. These activities “re-charge your batteries” and help you keep perspective on life. Support groups are also quite helpful.
- Know your limits. You are human. Humans are not built for staying up all hours of the night without a break to take care of someone, or physically managing someone who weighs as much or more than we do, or to devote all physical, mental and emotional energy toward another human being on an ongoing basis. We simply are not designed for it. With some disease processes, such as dementia, there comes a time when one person cannot do it all. It’s okay to recruit professional help or consider placement in a structured environment where they can get the 24 hour structure and care they need by a team of people who are specifically trained to deal with your loved one’s condition.
- Keep in mind your feelings are valid. It’s normal and okay to feel angry, frustrated, or resentful at times. These are just feelings and we have them for a reason. Taking care of someone else is very hard work; and it would be surprising if you didn’t feel this way at times. If you’re experiencing these feelings more often than not, it’s long past time to get some help.
How to know when you need professional help:
- Feeling down, depressed, sad or hopeless more often than not
- Loss of interest in fun activities
- Unable to “turn off your mind”- constantly worrying about what needs to be done or what you’ve already done; intrusive random thoughts
- Feeling resentful, angry, frustrated more often than not
- Increased tearfulness
- Increased feelings of guilt or thoughts that you’ve let your family or others down
If you’re having trouble dealing with the aftermath of caring for someone you love, call me! With my solution-focused approach, you can learn tools that will aid in caring both for your loved one AND YOU.
Alcohol Use—or Overuse? Screening Questions to Consider
Have you ever wondered if, or been told that, you drink too much? Contrary to popular opinion, there are standards by which professional therapists measure and diagnose whether or not your use falls into troublesome levels. These standards are based on research produced by the National Institute on Alcohol Abuse and Alcoholism.
It’s not just drinking daily– if it’s no more than 1 daily drink a week for a woman and two for a man, it’s generally not considered problematic—but also HOW MUCH at one time. So, even if you only drink once a month, IF you drink in excess of more than 4 drinks for a man or 3 for a woman in one day, you can be considered alcohol-dependent, have alcohol related problems, or be at risk. Medical, behavioral, and family history will all be taken into consideration. Further testing, such as the SASSI (Substance Abuse Subtle Screening Inventory) may be done by your therapist.
Fill out this form below and submit to your therapist for further evaluation. Take that first step toward your best YOU!
On average, how many days a week do you drink alcohol? ____________
On a typical day when you drink, how many do you have? ____________
On any given day, what is the maximum number of drinks you had in the past month? _________
Have you ever felt you should CUT DOWN on your drinking? Yes No ____
Have people ANNOYED you by criticizing your drinking? Yes No _______
Have you ever felt bad or GUIILTY about your drinking? Yes No _______
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
Yes No _______
If YES to any of these: has this occurred in the past YEAR? Yes No ______
Remember that healing is a process; one day at a time. Your self-esteem wasn’t trashed overnight and true recovery takes a long time. But you will be energized as you begin to feel better.
Pause and listen to the negative messages you send yourself and talk back. Learn to catch yourself and delete negative messages. Generate some new positive images, memories and messages. If you are hearing negative messages about yourself, answer back. Speak up for yourself to others and to yourself. Be your own best friend.
Remove yourself from ‘dangerous’ situations and people. Detach from cruel, selfish, hurtful people. No one can make you feel badly without your permission. Get away from painful people. This may only need to be temporary, but it will help to salvage your self-esteem.
Don’t put a red flasher on your car for everyone else’s crises. Many of us have learned to ‘give without counting the cost’… It is important to count the cost to yourself and your needs. There are people who thrive on chaos and crisis. You aren’t obligated to bail everyone else out. You don’t have to be the designated emotional ambulance driver.
Stop volunteering to be a victim. Many of us who have chronic low self -esteem, cannot bear for anyone around us to be angry. We are afraid we’ve failed. Low self-esteemers go out of their way to be ultra- nice, patient, forgiving, etc. Let them be angry, if you know you have done nothing hurtful. You don’t have to join everyone in their misery
And let people own their feelings. Let people feel their feelings, but don’t stress out over what is essentially their problem. You can say, ‘I’m sorry that happened’ or something like that but don’t apologize for yourself if you have done nothing wrong. If they can’t move on, you can. And pat yourself on the back for being a good friend.
Discover what you need and get it for yourself. Stop taking such good care of others that you don’t care for yourself. Nourish and comfort your mind, soul, body and spirit.
Vent your frustrations. Don’t just smile and say I’m fine. If someone asks, you can say, no I’m not doing too well just now.’ Be honest most of all with yourself. Don’t cover it. Process it. Listen to yourself. Go to therapy.
Encourage yourself. Progress seems slow sometimes. Give yourself a pat on the back for your hard work.
Every day millions of people search online for help with their problems, wondering if it’s finally time to reach out for direction and support to handle sadness, depression, anxiety, stress, fights with their partner or spouse, and family issues, among others. Here are some of the questions and mistaken beliefs we encounter as therapists every day.
Can’t I just talk to my friends about my problems?
Talking to a friend about mental health or personal issues may bring you temporary relief, but will make the problem more deep seated in the long run because you become more identified with the issue the longer you complain without intervention. Remember, you get what you pay for, and zero-cost advice is pretty much worth zero!
Nobody can change my situation, so why pay to see a professional about it?
There is a saying that “your world changes when YOU change.” A professional, licensed therapist is trained in ways to help you respond to your world differently. We have at least two college degrees and extensive supervised training thereafter. There are thinking patterns, usually formed in childhood, of which you are completely unaware. I can show you how you are holding yourself back and perhaps help you find insight and freedom. It’s often a cage of your own making!
I’ve felt this way so long…
If you had a persistent fever, would you just say “oh well” and live with it? Or would you go to a health care specialist who could evaluate, diagnose, and treat it? The average person doesn’t realize how common mood and relationship problems are to the human condition, and that they can be (and are) identified and studied. Whole systems of therapy are developed for common issues, much as drugs are developed for physical ailments.
What will people think?
The people intelligent and mature enough to seek therapy realize that it doesn’t matter what people think! It matters how you live every day of your limited, precious life, and whether you can enjoy that to a higher degree and love more fully. Besides, you would be surprised how many of those “imaginary people” you think are judging you are actually patients themselves.
Is it time for YOU to feel better? It’s time!