Tag Archives: Tucson therapist

Assertiveness and Anger Management

Most of the clients I treat for anger management describe themselves as terrible people. Furthermore, they are often described as bullies by their family members and those who are close to them. Typically such a description will come from a spouse who will call in to schedule an appointment on their behalf.

In getting to know these clients, overwhelmingly men, I find that they are typically overwhelmingly nice. To a point where they are inconsistent in setting for themselves healthy boundaries with other people. In close relationships this becomes a problem as the person seldom addresses naturally occurring conflicts with the other person or persons. This leads to stuffing of feelings and chronic pretentiousness in the relationship, until the person can no longer keep his feelings bottled up, the next stage is the angry outburst. In severe cases, particular crisis fueled episodes, the angry person habitually engages in bouts of angry outbursts with strangers.

To others who witness these outbursts, based on their feelings of confusion and feelings of being upset, they come to see the “angry” person as a bully or mentally unstable at worst. Meanwhile the person who engaged in the angry outburst is burdened by feelings of guilt and shame and will typically resolve to double down on his commitment to being the nicest person possible. Unfortunately this plays out as the person failing to exercise assertiveness skills leading to little or no boundaries being set. This then sets the stage for a new cycle where the person habitually stuffs his feelings, bottles up resentment before deciding that he can no longer put up with perceived disrespect. For people in close relationships with these people, it could feel that the angry outbursts are unpredictable, when it fact they are very predictable.

At the beginning of therapy for poor anger management, the person is first introduced to exercises for recognizing his difficult feelings. He is then introduced to cognitive strategies for recognizing and responding appropriately to his difficult feelings.

The core of addressing poor anger management skills is to address the core beliefs of the chronically “angry”  person which influence his episodes of anger. For example,  with someone who has difficulty exercising healthy boundaries in his relationships with others, it will be important to determine what beliefs he holds unto which prevent him from setting healthy boundaries.

It could be a belief about how he communicates with others, or it could be a belief about how he sees himself, these are just two examples of a variety of possible beliefs a person could hold unto. For example, I once had a client share with me that he viewed expressing his disagreement at work and at home as a form of complaining. He then further stated that he saw complaining as a form of being weak minded.

Whatever belief he is holding unto, is going to be an irrational belief. Put simply, irrational beliefs are beliefs which are not true, but feel true to the person who holds unto them. For example, a belief which states that “no one should curse at me,” is a belief which feels true, because people generally don’t like to be cursed at, but is an irrational belief because we have no control over the words of others.

Once an irrational belief has been identified, a healthier alternative is chosen for the person to adopt, along with cognitive behavioral strategies for internalizing the new belief. The process of practicing new beliefs produces a paradigm shift in how the person’s sees the world around him and subsequently how he interacts with others.

For those who are successful in adopting and implementing new healthier beliefs, family members and others close to them come to see them as more genuine, confident and compassionate.

Ugo is a psychotherapist and owner of Road 2 Resolutions PLLC.

Understanding and Overcoming Hopelessness

Hopelessness is a dangerous feeling to experience, this is because once feelings of hopelessness begin to set and fester, people start reconsidering their existence. When clients share suicidal thoughts and feelings with me, I have responded by asking them if they have left “no stones unturned.” Leave no stones unturned is an old figure of speech for searching and exploring all possibilities before considering another alternative. For example, if you lost your keys and you strongly suspect it is in your house. To leave no stone unturned would be that you thoroughly search your house before considering a search at another location.

So if you are experiencing bouts of hopelessness, and you are contemplating your existence, to leave no stone unturned means that you thoroughly explore every possibility to address your situation. In my fifteen years of counseling there are always several things people have not considered, and when they do consider and follow through, their lives improve.

In truth, nothing is worth ending your life over, I have counseled people who experienced feelings of hopelessness over the death of a loved one, people who received a medical diagnosis which changed their lives, breaking up with a romantic partner, experiencing a significant loss of wealth and not experiencing success or loss in reacquiring wealth. In all of these examples there were three recurring reasons which induced feelings of hopelessness. These reasons were all connected to the beliefs and values of the persons, mainly their relationships with these beliefs and values. Given that most of what we believe comes from our formative years, sometimes without realizing it, we sometimes enmesh our old beliefs with our sense of identity. Which makes it even more difficult for us to reconsider revising the beliefs we hold. So, the reasons people struggle with hopelessness are as follows.

Grief and Loss

The loss of a loved one can be an especially painful experience, particularly when that person passed away before his or her elderly years. However, grief and loss is not limited to the loss of a loved one, it also deals with the loss of income, the loss of a relationship, the loss of perceived status, and the list goes on.

I have noticed the pain of grief and loss is especially unbearably for parents who have lost children. In cases where this was the only child or first child of the person, the grief appeared to be so unbearable that they had almost stopped functioning in their daily lives. The loss was a situation they never contemplated and refused to accept. I have never been a fan of the stages of grief model, which involve denial, anger, bargaining, depression and acceptance. This is because the first four stages typically occur together, and what keeps the person from coming to a place of acceptance are the beliefs they hold in relation to the grief. So if I am working with a client who lost her only child, and she continues to repeat that a parent should never bury a child, the statement is a testament to what she believes, which is keeping her sick. In truth, it is a sad day when a parent buries a child, but the statement, “a parent should never have to bury a child is false,” because there is no force or entity that can guarantee the prevention of such a tragedy. In truth this client can come to peace and make a new meaning of her life, even though the pain from the loss might never go away.

Pride

Pride may seem like an odd reason, but I rank pride as number two on my list because it is very common. Human beings are innately wired to function in a hierarchal structure, this means for most people who are not aware of this, from the cars they drive, to the clothes they wear, a certain level of status within a micro and macro hierarchal system is being communicated. For those who are not aware of this, and for those who are aware of this and cherish it, when there is a loss of status, due to changes in the person’s life, a sense of hopelessness can set it. This sense of hopelessness is often due to a set of beliefs which state that the person can exist and function in no other state other than the previous state he had grown accustomed to. This is called pride, so in maintaining consistency with the term, leave no stone unturned, an effective solution would be for the person to explore what it would be like to actually live his or herself without his perceived status enhancer.

Hardship

People don’t like doing hard or difficult things, especially when the prospect of engaging in a difficult task does not guarantee any favorably outcomes. For example, a gold digger is less likely to dig for gold in an area where there is no evidence for gold. Or a high school senior is less likely to apply to attend a college or university if he or she does not believe that a college degree would be beneficial in their life. Given that change is a constant in our lives, it is inevitably that we will all come to crossroads in our lives where we have to consider committing too hard and difficulty work in the hopes of an outcome that improves our lives. If the work is hard and time consuming and the reward is not guaranteed, this can be discouraging to some people and influence the onset of hopelessness. A solution to this would be to explore the belief of promised or guaranteed outcomes. In truth, nothing is guaranteed, however the work we put in helps to add meaning and purpose to our lives, as well as experience.

Hopelessness can be overcome; it is a matter of moving past our difficult feelings and revisiting the messages we have come to believe.

Ugo is a psychotherapist and owner of Road 2 Resolutions PLLC

What You Believe Influences Your Mental Health

I came across a question today regarding the treatment of PTSD, someone else then gave a long winded response regarding the treatment modalities for PTSD and concluded that there is no end to severe PTSD. In short the advocacy for CBT and EMDR was simply an advocacy for treatments that temporarily help relieve symptoms.

Sufferers of PTSD to include severe cases of PTSD can experience full recovery. It all boils down to what you believe. A common example given for the cause of PTSD is war. A veteran who suffers from PTSD as a result of combat makes sense. War is bad, war is bad because engaging in hostilities against other human beings resulting in the killing of those human beings is detrimental for the mind. Human beings are inherently good, this is why we function the best when we feel good, and we feel really good when we are helpful towards other people. Furthermore, people who experience good feelings from committing any form of harm towards other people are seen as mentally ill, with labels of sociopaths and psychopaths assigned to their character.

So you take a good person, introduce said person to propaganda about how awful another group of people are, train them for combat and then send them into combat. After everything has been said and done, they come to realize that they are not at peace with their actions. Those who are more astute realize that the people they fought against are also people like themselves who were fed similar propaganda against themselves and trained to engage in combat for what they believe was a good and greater cause. To make things even more complicated, most veterans who suffer from PTSD, will encounter people who strongly believe in combat against other groups of people and will praise them for their past actions. This creates a dissonance, where they receive significant acceptance and recognition for actions they have come to disagree with, which also contributes to their illness, and potential rejection if they voice their disagreement for their previous actions.

PTSD can be cured, it is a duel process of utilizing EMDR to engage both hemispheres in getting past the difficult feelings associated with the trauma and using CBT to address detrimental beliefs and practice new and healthier beliefs.

Consider another example, let’s a say you have two men who experience extreme physical assaults and both men develop PTSD. Of the two men, the one the most least likely to fully recover from the incident is the man with rigid beliefs associated with the assault he experienced. For example, if the idea of being assaulted signifies a blow to his manhood, and he continues to hold unto these beliefs throughout treatment, the best EMDR will do for him is to temporary alleviate his symptoms before his next meltdown. He will then experience a meltdown every time he reminded about being humiliated. Such meltdowns can easily be triggered by consumption of media or association with people who voice reminders of his rigid beliefs he still holds unto.

While if the other man is more flexible with his beliefs associated with the physical assault, he is most likely to experience a full recovery. This is because after he has learned to move past his difficult feelings related to his ordeal, he is least likely to be triggered into an emotional meltdown. He is least likely to be triggered because it would be relatively easy for him to abandon any beliefs and values that prevent him from accepting the true nature of his ordeal.

Ugochukwu is a psychotherapist and owner of Road 2 Resolutions PLLC

The Blame Game

From blog posts, video logs to headlines news stories, most of us as inundated with stories about “bad” people and how these people affect our lives. The idea of someone or a group of people doing bad things to us can be emotionally triggering, to the point where you can lose yourself playing the role of the victim. You then find other people who can either relate to your story of victim-hood or at least sympathize with you on how you have been victimized.

The problem with this mindset is that, if you are indeed experiencing any degree of victimization at the hands of another person or group of people, you will continue to be victimized until you recognize your role in the story. While it is true that good people from time to time do experience bad experiences and sometimes at the hands of other people, a majority of the time when we have recurring bad experiences it is a result of the role we have unintentionally played in keeping the bad experience alive and well.

The ego can be fragile, it is an instinctual source we turn to, to find a sense of confidence in regards to how we navigate through life. However primary reliance on the ego to get you through challenges in life is a mistake. You need to be able to identify your flaws and weakness and the role they play in your recurring bad experiences or victim-hood, specifically in your relationships with others.

From personal to formal relationships in order to change our daily experiences for the better, we need to recognize the bad things we ourselves do and change them for the better. Seldom can you truly be absolved of all guilt during conflicts with others. In cognitive behavioral therapy, the client is introduced to the standard format of experience + behavioral response = natural and logical consequences. With the behavioral response being the most important variable in that simple equation. This is because, while you cannot control what other people do to you to include other experiences caused by other sources, your response to your experiences determines just how manageable your life is going to be.

In short, worrying too much about what others might do, does nothing to facilitate growth in our lives.

Ugo is a psychotherapist and owner of Road 2 Resolutions PLLC.

3 Steps for Treating OCD

If you suffer from obsessive compulsive disorder, (OCD) and you are experiencing difficulty in getting yourself to adapt healthier behaviors in your life, there are no easy solutions. However, there is a solution, the solution is three part, defining what the problematic behavior is and picking an alternative and healthier behavior, understanding the genesis of the problematic behavior and learning and practicing how to get past your difficult emotions so you can practice your new behavior.

Defining what the problem is.

Let’s say you have a ritual with touching door knobs three times before entering any room. This is a problematic behavior because it is an oddity and people around you are bound to notice. Furthermore, the stressful urge that pushes you to engage in this behavior puts you in an anxious and stressful mood any time you enter any room, especially a room with a person or persons that you are required to engage with. Furthermore, it is also problematic as the obsession with performing this ritual prevents you from being present with others. So it stands to reason that the solution for this problem would be the opposite of what you are doing which would be two part, first that you no longer go through the awkward ritual of touching door knobs three times before you enter any room. Secondly, that you relive yourself from the strong mental urges to engage in such a ritual.

Understanding the Genesis of the problem.

From my experience in treating obsessive compulsive disorders, a commonality is usually a stressful childhood. The sufferer’s childhood was either blatantly abusive, such as physical abuse or covertly abusive, such as emotional abuse. Usually when someone suffering from OCD or any other type of mental health issues insists that they had a great childhood, they often will immediately contradict themselves in reporting on stories and experiences that the average person would consider to be terrible. Regardless, when an adult or child is chronically exposed to a stressful situation for which they lack the cognitive skills to properly address, the consequence that follows is usually the development of some type of mental health illness. Clinical evidence of this can be attributed to a research study where University of Berkeley researches showed that chronic exposure to stress leads to long term changes in the brain which the researches argue predisposes people to mental illness. Regardless, from a place of understanding and forgiveness, it is beneficial to explore any and all past traumas, big and small and understand how they have shaped you and influenced your problematic behaviors.

Practicing how to get past your difficult emotions.

So now you have defined what the problematic behavior is, and you have successfully explored how you came about developing this maladaptive behavior, there remains one major problem. This problem is getting past your strong urges and feelings of anxiety to engage in the problematic behavior in this first place. OCD is the result of brain damage, primarily to the basal ganglia. While biological infections have been known to cause damage to the basal ganglia, a common cause for such a damage would be atypical neurological wiring. Such atypical wiring can be attributed how a person lacking the cognitive skills to deal with a prolonged stressful situation, adapts with unhealthy behaviors which work in the short term.

A good example would be learning to read others for signs of anger, irritation or moodiness. This leads to a belief fallacy that the person can control others based on their astute observations of others and it also leads to an underdevelopment in assertiveness skills, in which the person unintentionally recreates familial stress in their lives by walking on egg shells around others and getting into personal relationships with difficult people. In most cases, people who suffer from OCD report a false feeling of having control over the situation when they engage in their rituals.

Regardless, having become armed with the knowledge of how their daily behavior influences their neurological wiring, most suffers from OCD become motivated towards practicing their alternative and desired behavior in response to emotional urges to engages in old rituals. For best results I would recommend OCD suffers to work with an experienced cognitive behavioral therapist.

Ugo is a psychotherapist and owner of Road 2 Resolutions PLLC.

Why Feeling Comfortable is Overrated

The number one obstacle for people accomplishing any measure of change in their lives is the belief that they should be comfortable. The problem with always feeling comfortable is that it takes away your will to strive for any measure of accomplishment, in getting your needs and values met. When you are comfortable, you no longer have a sense of urgency to address challenges in your life and make the necessary changes. This is not to suggest that you must always be in a state of urgency to accomplish change in your life, but it does mean that if there any changes you want to make in your life, it is a mistake to wait to get to a state of comfort before you begin practicing change. If you wait to get to a place of comfort, you will simply revert back to old behaviors.

Feelings of discomfort are actually an evolution advantage; in that they motivate us towards taking action. For example, a hungry stomach will motivate you to get some food for yourself, however if you are surrounded by delicious junk food which influences your health for the worse, once you have satisfied your hunger with the junk food, you become less motivated towards acquiring and preparing for yourself healthier foods that will benefit your health. This is because the latter is more time consuming and requires significant effort.

In order to exercise the change, you need in your life, you will need to adopt a mindset where you come to appreciate all feelings and sensations as helpful. This means that even when you experience feelings of discomfort, you come to see these feelings as messages from your brain and body. These messages can be about things either going your way or things not going your way. When greeted with feelings that communicate any measure or severity of discomfort, ask yourself why you feel this way and then make a commitment to attend to the message without seeking to alleviate yourself from the discomfort. Often times this commitment can be made in writings. Over time, you will become more tolerable of uncomfortable feelings and more skilled at attending to the daily challenges in your life which require you to exercise change.

Ugo is a psychotherapist and owner of Road 2 Resolutions PLLC.

4 Intervention Steps to Practice during Sleep Paralysis

I recently came across an article regarding a neuroscientific intervention for sleep paralysis. What I find fascinating about the article is the heavy reliance of mindfulness and meditation the neuroscientist prescribes for sleep paralysis.

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Sleep paralysis occurs when you find yourself awake but unable to move. This lack of movement can last from several seconds to a few minutes as the sufferers’ experience sheer terror and agony in their inability to move their bodies. In some cases, people who suffer from sleep paralysis also experience hallucinations, most commonly reported is a shadowy presence in the bedroom.

The four steps for regaining control of one’s body during sleep paralysis are:

  1. Reappraisal of the meaning of the attack
  2. Psychological and emotional distancing
  3. Inward focused-attention
  4. Muscle relaxation

Step 1, “reappraisal of the meaning of the attack” is another way of saying that you should give the attack another label. The idea of waking up from sleep without the ability to move is so terrifying for most people that some sufferers develop extreme anxiety about going to sleep in the first place. For some people they spend the entire experience of their paralysis in a state of fright until they are able to move again. This leads to learned dread and a host of other issues. By relabeling the paralysis, you begin to experience a shift in your perception of what’s going on. For example, if you found yourself in this situation, you could tell yourself that you are experiencing a phenomenon that occurs in 20% of the population and is temporary.

Step 2, “psychological and emotional distancing” means that you should practice adopting an objective view of the situation. Since you have already told yourself that this is something 20% of population already experiences and is temporary, you should readily observe that your feelings of fright and panic are understandable but irrational.

Step 3, “inward focused-attention” this means that you should practice positive thinking. The author of the article recommends focusing on a loved one or a positive event. I would recommend you envisioning yourself getting out of bed and walking about. A mindset that can help with this vision is to inform yourself that while your mind is awake, your brain and your body haven’t yet received the signal to awake and move and are merely playing catch up. So soon you will be out of the bed and walking about.

Step 4, “muscle relaxation” from what clients who have struggled with sleep paralysis have told me, while they may not be able to move, they discover that there are aspects of their body that they can still control, such as their breathing and their ability to flex certain muscle groups. As tempting as it may be, forcing yourself to move only worsens the experience. Instead you are recommended to practice easy breathing and relax your muscles, by doing this you are adopting an attitude of acceptance towards the entire situation, which reduces the likelihood of experiencing a panic attack during the paralysis and shortens the duration of the paralysis.

The more people are able to successfully practice these steps during sleep paralysis, the less dread and anxiety they will have about sleeping, which in all likelihood will reduce the frequencies of the sleep paralysis.

This is the link to the article.

Ugo is a therapistand professional life coach.

Therapeutic Solutions for Anxiety and Panic Attacks

I recently came across a two year article about the popularity of Xanax, and it reminded me of the number of patients I have worked with who had already been taking medication for months and sometimes years, before they decided to try the therapeutic route. I suspect that most people who stick with their medication, even past the point of diminishing returns are unaware about the specifics of how anxiety and panic attacks are typically addressed in therapy.

When treating anxiety, there are three therapeutic models, I use interchangeably , the cognitive behavioral model, the exposure model and the hidden emotion model.

The cognitive behavioral model approaches anxiety from the idea that it is the beliefs and subsequent actions of the person that is making the person anxious. So when the person holds unto beliefs that create anxiety, that person becomes sensitized to situations that can arose anxious thoughts, with the anxious thoughts being a product of what he believes. Take for example, if a person believes that all dogs are dangerous and vicious. This person then becomes aroused by concerns for his safety whenever he finds himself in the presence of a dog, or when he learns that there is a dog close by. Furthermore this person’s anxiety might become even more amplified if he engages in behavior he believes will keep him safe from the dog. So in this situation, we can say that the person’s anxious thoughts are caused by his beliefs about dogs. So in order to help the person get past his fear of dogs, we have to work on helping him adopt a more healthier belief about dogs. In the short term we will get him to practice healthier behaviors to cope with his anxious thoughts about dogs, when he is in the presence of dogs.

The exposure model approaches anxiety from the idea that the anxiety is being caused by the person’s decision to avoid her identified stimuli for the anxiety. An example would be a fear of negotiating one’s way through a crowd of people. So the person’s anxiety would be triggered every time she encounters what she considers a crowd. Using the exposure model, the person would be encouraged to gradually immerse herself into crowed situations, during which she will go through the process becoming desensitized to crowds.

The hidden emotion model approaches anxiety from the idea that anxiety is caused by a fear of confrontation with others. As a result, people who fear confrontation mask their emotions through a facade of being nice. The hidden emotion model posits that through the chronic process of forcing niceness, people sweep their true feelings “under the rug.” Which leads to the repressed feelings being expressed through chronic anxiety and in worse cases, panic attacks. The hidden emotion model addresses anxiety through a process of helping the person become more aware of his feelings, alongside strategies for helping him become more assertive through the practice of assertive building strategies.

In practice what I have learned is that regardless of which model I use to address a client’s needs, it all comes down to identifying maladaptive beliefs the person holds unto and helping the person adopt and practice healthier beliefs. Anxiety is treatable, and in worse cases such as recurring panic attacks, a person can learn to bring the episodes of panic attacks to an end.

Ugo is a psychotherapist and life coach.

What Are Impossible Realities?

So what is an impossible reality? An impossible realities can be best described as an experience that you have determined to be detrimental to your well being. However this is an experience you have actively pursued, and quite possibly prepared for your entire life. An example would be an abusive relationship or a toxic work place.

What makes experiences like these impossible realities is that you will most likely have strong beliefs and values that encourage you to continue with the experience despite the fact that in the long run you will not benefit from the experience. In the video below I discuss more about impossible realities, how they lead to mental health issues such as panic attacks and how to get past impossible realities.


 

Ugo is a psychotherapist and author of

Why Getting Angry Solves Nothing.

 

When I  was a young teen, I remember getting so frustrated with trying to solve an algebraic equation that in anger I broke my pencil. My teacher then gave me the advice to practice taking breaks from problems I couldn’t solve and coming back to them.  Specifically, he shared with me to accept that I  couldn’t solve the problem then take a break from the problem, and in situations where feasible, sleep on the problem.

 

From then on,  when  I couldn’t solve a math problem and I came to a place of acceptance, I found myself more at peace with the situation when I took a break from the problem. Nine out of ten times when I came back to the problem, I would have a fresh perspective on the problem leading me to solving the equation.

 

It is easy for us to get angry at things that don’t go our way, but even more challenging being able to admit that the anger we experience is a  sign that we are experiencing a situation that calls for us to use our problem solving skills. Often times I either read or hear about people calling for others to get angry when their rights are being violated. The funny thing is, that you don’t need to get angry when your rights are being violated, it is a natural reaction. The question is what are you going to do about it?

 

It actually takes more courage to put aside your anger in order to access the prefrontal cortex of your brain to solve a problem. If you find yourself getting angry and perhaps hostile in response to any type of disrespect towards you, it is because you did a quick risk assessment and determined that you would not experience major penalties for acting in aggression, or that you could afford to experience major penalties for acting in aggression.

 

This is why people who come face to face with others who are equipped to respond with even more hostility, then to go the passive route. It is much similar to an angry and unruly child, who becomes passive and quiet upon encountering an adult disciplinarian. When we attempt to solve problems from the primitive region of our brains we either go into a fight or flight mode, specifically a flight mode when faced with overwhelming force from the opposition.

 

This is why go to war units in the military train soldiers to not respond with anger when faced with things not going their way but with assertiveness. Not being angry does not mean that you don’t get upset when things are not going your way, nor does it mean that you go into denial mode and pretend to be happy. The best response to dealing with things not going your way, is to get past your feelings of anger, acknowledge the situation for what it is, and assertively go about in addressing it.

 

If you are reading this and asking yourself how this can be done, I provide the answer to that question in my book, Anger Management 101: Taming the Beast Within.

 

Ugo is a psychotherapist and life coach.