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“Our greatest glory is not in never failing, but in rising every time we fail" Ralph Waldo Emerson

“Only in the darkness can you see the stars.” MLK Jr.

What We Treat

Anxiety, Phobias &
OCD

Everyone worries or feels nervous from time to time. Anxiety is a normal human reaction to stressful situations. But for people with anxiety disorders, those fears and worries aren’t temporary. Their anxiety persists, and can even get worse over time.

Anxiety disorders can severely impair a person’s ability to function at work, school and in social situations. Anxiety can also interfere with a person’s relationships with family members and friends. Fortunately, though, there are effective treatments for anxiety.

In some cases, medications have a role in treating anxiety disorders. Yet research shows behavioral treatment, alone or in combination with medication, is a highly effective treatment for most people with an anxiety disorder.

Understanding Anxiety

Anxiety disorders are common in both adults and children. About 18 percent of U.S. adults and 25 percent of adolescents age 13 to 18 will experience anxiety, according to the National Institute of Mental Health. About 4 percent of adults, and nearly 6 percent of teens, have anxiety disorders classified as severe.

There are several major types of anxiety disorders:

    • Generalized anxiety disorder is characterized by persistent worry or anxious feelings. People with this disorder worry about a number of concerns, such as health problems or finances, and may have a general sense that something bad is going to happen. Symptoms include restlessness, irritability, muscle tension, difficulty concentrating, sleep problems and generally feeling on edge.
    • Panic disorder is marked by recurrent panic attacks that include symptoms such as sweating, trembling, shortness of breath or a feeling of choking, a pounding heart or rapid heart rate, and feelings of dread. Such attacks often happen suddenly, without warning. People who experience panic attacks often become fearful about when the next episode will occur, which can cause them to change or restrict their normal activities.
    • Phobias are intense fears about certain objects (spiders or snakes, for instance) or situations (such as flying in airplanes) that are distressing or intrusive.
    • Social anxiety disorder is also known as social phobia. People with this disorder are fearful of social situations in which they might feel embarrassed or judged. They typically feel nervous spending time in social settings, feel self-conscious in front of others, and worry about being rejected by or offending others. Other common symptoms include having a hard time making friends, avoiding social situations, worrying for days before a social event and feeling shaky, sweaty or nauseous when spending time in a social setting.
    • Obsessive-compulsive disorder is characterized by persistent, uncontrollable feelings and thoughts (obsessions) and routines or rituals (compulsions). Some common examples include compulsive hand washing in response to a fear of germs, or repeatedly checking work for errors.
    • Post Traumatic Stress Disorder (PTSD) can develop after a severe physical or emotional trauma such as a natural disaster, serious accident or crime. Symptoms include flashbacks of the trauma, nightmares and frightening thoughts that interfere with a person’s everyday routine for months or years after the traumatic experience.

Seeing a Psychotherapist About Anxiety Disorders

People with anxiety disorders tend to become easily overwhelmed by their emotions, and they tend to have particularly negative reactions to those unpleasant feelings and situations. Often, people try to cope with those negative reactions by avoiding situations or experiences that make them anxious. Unfortunately, avoidance can backfire and actually feed the anxiety.

We are trained in diagnosing anxiety disorders and teaching patients healthier, more effective ways to cope. Various forms of psychotherapy we use are highly effective at treating anxiety disorders. Using these models of psychotherapy we help patients learn to identify and manage the factors that contribute to their anxiety.

Patients learn to understand how their thoughts contribute to their anxiety symptoms. By learning to change those thought patterns, they can reduce the likelihood and intensity of anxiety symptoms.

Psychotherapy for Anxiety Disorders: What to Expect

Psychotherapy is a collaborative process, where we and our patients work together to identify specific concerns and develop concrete skills and techniques for coping with anxiety. Patients can expect to practice their new skills outside of sessions to manage anxiety in situations that might make them uncomfortable. However, we won’t push patients into such scenarios until they’re sure they have the skills they need to effectively confront their fears.

We sometimes recommend other therapies to treat anxiety disorders in addition to Individual psychotherapy. Group psychotherapy, which can be effective for both treating anxiety and providing patients with support. Family psychotherapy can help family members understand their loved one’s anxiety, and help them learn ways to interact that do not reinforce anxious habits. Family therapy can be particularly helpful for children and adolescents suffering from anxiety disorders.

Anxiety disorders are very treatable. The majority of patients who suffer from anxiety are able to reduce or eliminate symptoms after several (or fewer) months of psychotherapy, and many patients notice improvement after a few sessions.

Adapted from: APA.

Depression

Everyone feels sad or “blue” on occasion. It is also perfectly normal to grieve over upsetting life experiences, such as a major illness, a death in the family, a loss of a job or a divorce. But, for most people, these feelings of grief and sadness tend to lessen with the passing of time.

However, if a person’s feelings of sadness last for two weeks or longer, and if they interfere with daily life activities, something more serious than “feeling blue” may be going on.

Depressed individuals tend to feel helpless and hopeless and to blame themselves for having these feelings. People who are depressed may become  and exhausted and may stop participating in their routine activities. They may withdraw from family and friends. Some may even have thoughts of death or suicide.

There is no single answer to the cause of depression. Some depression is caused by changes in the body’s chemistry that influence mood and thought processes. Biological factors can also cause depression. In other cases, depression is a sign that certain mental and emotional aspects of a person’s life are out of balance. For example, significant life transitions and life stresses, such as the death of a loved one, can bring about a depressive episode.

Depression is highly treatable and it is critical for people who suspect that they or a family member may be suffering from depression seek care immediately. Simply put, people with depression who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen a depression; therefore, the importance of getting appropriate help cannot be overemphasized.

Our therapists can help you recover from depression and to identify the factors that contribute to their depression and to deal effectively with the psychological, behavioral, interpersonal and situational causes. We can work with you to:

  • Pinpoint the life problems that contribute to their depression and help them understand which aspects of those problems they may be able to solve or improve.
  • Help you to identify options for the future and set realistic goals that enable them to enhance their mental and emotional well-being. Therapists also help individuals identify how they have successfully dealt with similar feelings if they have been depressed in the past.
  • Identify negative or distorted thinking patterns that contribute to feelings of hopelessness and helplessness that accompany depression.
  • Explore other learned thoughts and behaviors that create problems and contribute to depression by helping you to understand and improve patterns of interacting with other people that contribute to their depression.
  • Help people regain a sense of control and pleasure in life
    Psychotherapy helps people see choices as well as gradually incorporate enjoyable, fulfilling activities back into their lives.

Having one episode of depression greatly increases the risk of having another episode. There is some evidence that ongoing psychotherapy may lessen the chance of future episodes or reduce their intensity. Through therapy, people can learn skills to avoid unnecessary suffering from later bouts of depression.

Relationship/Marital

How do I know if I need couples counseling?

Studies show that couples wait on average six years from the time they sense something is wrong with their relationship to the time they come in for help. A frustrating thing for all marriage counselors is that often the people who come have come too late. So if you think you might need some help, chances are you do. Please give us a call to discuss with you your need and desire to come in for a consultation.

What are the signs of a marriage in trouble?

A study by Dr. John Gottman has shown that there are four signs of a marriage that is in danger of breaking up.

    • CONTEMPT
      If one or both partners disregard each other, make belittling comments, or role their eyes, it shows they are closing off from one another.
      CRITICISM
      This is a general kind of blanket character assassination.</li>
      DEFENSIVENESS
      Not being willing to admit much of anything or grant the partner any credibility.
      STONEWALLING
      This is a rather complete shutdown and turning off of feeling.

Any one or combination of these four patterns indicates a relationship headed for trouble. Something must be done to stop the downward spiral or it just gets worse and worse.

What happens when I first come in?

You, or you and your significant other make a mutually agreed upon appointment for a consultation. The therapist will do an assessment, discuss options with you, and together you will decide on a plan, if you wish to continue.

How long does it take?

We usually ask people to commit to relationship counseling for three to six months. You will know during that time if it is helping you and if you want to continue. Many people come for relief of a few specific symptoms, others need more comprehensive help and support. The important thing is to get the help you want, and to know that if you need further assistance in the future you can call upon your relationship counselor.

What if my spouse won’t come in?

It happens often that one person or another in the relationship has resistance to couples therapy. Maybe they have had a bad previous experience, or they mistrust all therapists. Maybe they find it difficult to talk to a stranger about personal problems, or to ask for help about anything. Maybe they feel secretly to blame for a lot of the problems and are afraid to admit it. Whatever the reason, in our opinion it is fine for the person who wants to get started to begin. Many changes and improvements can be made from one side of the equation; change in one spouse often leads to change in another. Often the other person can be invited to participate at a later date.

Trauma

A traumatic event is a shocking, scary, or dangerous experience that affects someone emotionally. These situations may be natural, like a tornado or earthquake. They can also be caused by other people, like a car accident, crime, or terror attack.

There are many different responses to potentially traumatic events. Most people have intense responses immediately following, and often for several weeks or even months after, a traumatic event. These responses can include:

  • Feeling anxious, sad, or angry
  • Trouble concentrating and sleeping
  • Continually thinking about what happened

For most people, these are normal and expected responses and generally lessen with time. Healthy ways of coping in this time period include avoiding alcohol and other drugs, spending time with loved ones and trusted friends who are supportive, trying to maintain normal routines for meals, exercise, and sleep. In general, staying active is a good way to cope with stressful feelings.

However, in some cases, the stressful thoughts and feelings after a trauma continue for a long time and interfere with everyday life. For people who continue to feel the effects of the trauma, it is important to seek professional help. Some signs that an individual may need help include:

  • Worrying a lot or feeling very anxious, sad, or fearful
  • Crying often
  • Having trouble thinking clearly
  • Having frightening thoughts, reliving the experience
  • Feeling angry
  • Having nightmares or difficulty sleeping
  • Avoiding places or people that bring back disturbing memories and responses.

Physical responses to trauma may also mean that an individual needs help. Physical symptoms may include:

  • Headaches
  • Stomach pain and digestive issues
  • Feeling tired
  • Racing heart and sweating
  • Being very jumpy and easily startled

Those who already had mental health problems or who have had traumatic experiences in the past, who are faced with ongoing stress, or who lack support from friends and family may be more likely to develop stronger symptoms and need additional help. Some people turn to alcohol or other drugs to cope with their symptoms. Although substance use can temporarily cover up symptoms, it can also make life more difficult.

Post-Traumatic Stress Disorder

PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.

Signs and Symptoms

Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

A licensed professional who has experience helping people with trauma, can diagnose PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms
Re-experiencing symptoms include:
  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:
  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include:
  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:
  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.

It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

Do children react differently than adults?

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children (less than 6 years of age), these symptoms can include:

  • Wetting the bed after having learned to use the toilet
  • Forgetting how to or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Risk Factors

Anyone can develop PTSD at any age. This includes war veterans, children, and people who have been through a physical or sexual assault, abuse, accident, disaster, or many other serious events. According to the National Center for PTSD, about 7 or 8 out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes may make some people more likely to develop PTSD than others.

Not everyone with PTSD has been through a dangerous event. Some people develop PTSD after a friend or family member experiences danger or harm. The sudden, unexpected death of a loved one can also lead to PTSD.

Why do some people develop PTSD and other people do not?

It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most people will not develop the disorder.

Many factors play a part in whether a person will develop PTSD. Some examples are listed below. Risk factors make a person more likely to develop PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder.

Risk Factors and Resilience Factors for PTSD

Some factors that increase risk for PTSD include:

  • Living through dangerous events and traumas
  • Getting hurt
  • Seeing another person hurt, or seeing a dead body
  • Childhood trauma
  • Feeling horror, helplessness, or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • Having a history of mental illness or substance abuse

Some resilience factors that may reduce the risk of PTSD include:

  • Seeking out support from other people, such as friends and family
  • Finding a support group after a traumatic event
  • Learning to feel good about one’s own actions in the face of danger
  • Having a positive coping strategy, or a way of getting through the bad event and learning from it
  • Being able to act and respond effectively despite feeling fear

Treatments and Therapies

The main treatments for people with PTSD are medications, psychotherapy, or both. Everyone is different, and PTSD affects people differently so a treatment that works for one person may not work for another.

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.

Psychotherapy

Psychotherapy involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD can last 6 weeks for acute symptoms  and upto 12 months or more for complex trauma. Research shows that support from family and friends can be an important part of recovery.

How Can Psychotherapy Help People Overcome PTSD?
Therapy can teach people helpful ways to react to the frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:

  • Teach about trauma and its effects
  • Use relaxation and anger-control skills
  • Provide tips for better sleep, diet, and exercise habits
  • Help people identify and deal with guilt, shame, and other feelings about the event
  • Focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.

Many types of psychotherapy can help people with PTSD. Here at Ivy Counseling Group our clinicians have advanced training in the following modalities that have been found effective in treating trauma.

Internal Family Systems (IFS) is an evidence-based therapeutic intervention that is particularly effective in treating trauma by focusing on the critical components of treatment such as facilitating self-development, resolving developmental trauma, understanding the function of the symptom, dealing with affect, integrating disowned parts of self, working with resistance, and facilitating intra-psychic intimacy.

EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapeutic intervention, developed by Francine Shapiro in 1991, that enables people to heal from the symptoms and emotional distress that are the result of traumatizing life experiences. Research shows that by using EMDR people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR shows that the mind can in fact heal from psychological trauma in a shorter amount of time than once thought. Using hand pulsars or tapping, the therapist facilitates bilateral stimulation of the brain while a client processes an emotionally charged traumatic memory as a way to activate their natural healing processes. Many clients experience a significant reduction in the emotional charge of the distressing memory and are also able to shift negative core beliefs about themselves that are attached to the traumatic memory. EMDR is also useful for installing positive thoughts and emotions that empower individuals to make the personal and relational changes necessary for a meaningful and fulfilling life.

Cognitive Behavioral Therapy (CBT) can include:

  • Exposure therapy. This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
  • Cognitive restructuring. This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

Your therapist may combine different therapies depending on your needs.  These psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. We encourage you to talk about all treatment options with our therapist. Treatment should equip you with the skills to manage your symptoms and help you participate in activities that you enjoyed before developing PTSD.

ADD/ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

Signs and Symptoms

Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity.Most children have the combined type of ADHD.

In preschool, the most common ADHD symptom is hyperactivity.

It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:

  • are more severe
  • occur more often
  • interfere with or reduce the quality of how they functions socially, at school, or in a job

Inattention

People with symptoms of inattention may often:

  • Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
  • Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
  • Not seem to listen when spoken to directly
  • Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
  • Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
  • Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers
  • Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
  • Be easily distracted by unrelated thoughts or stimuli
  • Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Hyperactivity-Impulsivity

People with symptoms of hyperactivity-impulsivity may often:

  • Fidget and squirm in their seats
  • Leave their seats in situations when staying seated is expected, such as in the classroom or in the office
  • Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
  • Be unable to play or engage in hobbies quietly
  • Be constantly in motion or “on the go,” or act as if “driven by a motor”
  • Talk nonstop
  • Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation
  • Have trouble waiting his or her turn
  • Interrupt or intrude on others, for example in conversations, games, or activities

Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.

ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.

ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.

Risk Factors

Scientists are not sure what causes ADHD. Like many other illnesses, a number of factors can contribute to ADHD, such as:

  • Genes
  • Cigarette smoking, alcohol use, or drug
  • Exposure to environmental toxins during pregnancy
  • Exposure to environmental toxins, such as high levels of lead, at a young age
  • Low birth weight
  • Brain injuries

ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are common in people with ADHD.

Treatment and Therapies

While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.

Medication

For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.

Psychotherapy

Psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.

Behavioral therapy is a type of psychotherapy that aims to help a person change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:

  • monitor his or her own behavior
  • give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting

Parents, teachers, and family members also can give positive or negative feedback for certain behaviors and help establish clear rules, chore lists, and other structured routines to help a person control his or her behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

Cognitive behavioral therapy can also teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.

Family and marital therapy can help family members and spouses find better ways to handle disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.

Education and Training

Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. For school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. Parents and children may need special help to overcome negative feelings. Mental health professionals can educate parents about ADHD and how it affects a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.

Parenting skills training (behavioral parent management training) teaches parents the skills they need to encourage and reward positive behaviors in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors that they want to discourage. They may also learn to structure situations in ways that support desired behavior.

Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.

Support groups can help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

Grief and Loss

The other side of any change is loss. Loss, especially the loss of a loved one, is often difficult to manage alone.  The process of mourning a significant loss often takes far longer than people realize.  We have expertise in guiding individuals through the grief process with the goal of easing the pain of loss. Sometimes seeking the help of a trained professional for a short period of time while one goes through a major life transition can be enormously helpful.

Career

Most people spend roughly a third of their lives at work: that fact alone should stress the importance of being happy with what you do. Below are some questions to reflect on:

  • How satisfied are you with your current role and career progression?
  • Do you enjoy your work environment and your colleagues?
  • Is your full potential being realized with your current job?
  • Are you happy with your current work-life balance?

If you have answered these questions in the negative, you would benefit from and should consider career counseling.

Life Changes

We know that periods of transition in one’s life can be exciting and challenging, but also highly stressful.  Examples of life transitions are: career change, marriage, separation and divorce, starting a family, infertility, adjustment to empty nest, caring for ailing parents (sometimes while simultaneously raising one’s own children) and retirement. While many of these transitions are “normal” parts of life, they can produce intense feelings that can be difficult to manage.

Eating Disorders

In a society that continues to prize thinness even as Americans become heavier than ever before, almost everyone worries about their weight at least occasionally. There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. People with eating disorders take body image concerns to extremes, developing abnormal eating habits that threaten their well-being and even their lives. Obsessions with food, body weight, and shape may signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

It’s important to prevent problematic behaviors from evolving into full-fledged eating disorders. Anorexia and bulimia, for example, usually are preceded by very strict dieting and weight loss. Binge eating disorder can begin with occasional bingeing. Whenever eating behaviors start having a destructive impact on someone’s functioning or self-image, it’s time to see one of our highly trained mental health professionals, experienced in treating people with eating disorders.

Signs and Symptoms

Anorexia nervosa

People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, and eat very small quantities of only certain foods. Anorexia nervosa has the highest mortality rate of any mental disorder. While many young women and men with this disorder die from complications associated with starvation, others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders.

Symptoms include:

  • Extremely restricted eating
  • Extreme thinness (emaciation)
  • A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
  • Intense fear of gaining weight
  • Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

  • Thinning of the bones (osteopenia or osteoporosis)
  • Mild anemia and muscle wasting and weakness
  • Brittle hair and nails
  • Dry and yellowish skin
  • Growth of fine hair all over the body (lanugo)
  • Severe constipation
  • Low blood pressure, slowed breathing and pulse
  • Damage to the structure and function of the heart
  • Brain damage
  • Multiorgan failure
  • Drop in internal body temperature, causing a person to feel cold all the time
  • Lethargy, sluggishness, or feeling tired all the time
  • Infertility
Bulimia nervosa

People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or relatively normal weight.

Symptoms include:

  • Chronically inflamed and sore throat
  • Swollen salivary glands in the neck and jaw area
  • Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomac
  • Acid reflux disorder and other gastrointestinal problems
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration from purging of fluids
  • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to stroke or heart attack
Binge-eating disorder

People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Symptoms include:

  • Eating unusually large amounts of food in a specific amount of time
  • Eating even when you’re full or not hungry
  • Eating fast during binge episodes
  • Eating until you’re uncomfortably full
  • Eating alone or in secret to avoid embarrassment
  • Feeling distressed, ashamed, or guilty about your eating
  • Frequently dieting, possibly without weight loss

Risk Factors

Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image. For example, men may have muscle dysmorphia, a type of disorder marked by an extreme concern with becoming more muscular.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Researchers are using the latest technology and science to better understand eating disorders.

One approach involves the study of human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

Treatments and Therapies

Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment. Treatment plans are tailored to individual needs and may include one or more of the following:

  • Individual, group, and/or family psychotherapy
  • Medical care and monitoring
  • Nutritional counseling
  • Medications

Psychotherapies

Psychotherapies such as Internal Family Systems (IFS) helps the client 1) identify the self-protective function of polarized cognitions regarding eating and resultant eating disorder behaviors; 2) identify and address the emotional and physical triggers driving this internal dialogue particularly the anticipation of loss of control, fear of others’ negative self-evaluations, and self-blaming, self-shaming thoughts; 3) identify the ambivalence behind healthy vs. inappropriate eating patterns, and 4) identify fears and other feelings that arise in response to shifting to healthier choices., appear to be very effective in helping people gain weight and improve eating habits and moods.

We may incorporate cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.

Addictions

To assess whether you or loved one may have a problem with substance use or addiction, here are some questions to ask.

In the past year, have you:

  1. Had times when you ended up drinking/using more, or longer than you intended?
  2. More than once wanted to cut down or stop drinking/using, or tried to, but couldn’t?
  3. Spent a lot of time drinking/using? Or being sick or getting over the aftereffects?
  4. Experienced craving — a strong need, or urge, to drink/use?
  5. Found that drinking/using — or being sick from it — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  6. Continued to drink/use even though it was causing trouble with your family or friends?
  7. Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink/use?
  8. More than once gotten into situations while or after drinking/using that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  9. Continued to drink/use even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  10. Had to drink/use much more than you once did to get the effect you want? Or found that your usual amount of drinks/drugs had much less effect than before?
  11. Found that when the effects of alcohol/drug were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

If you have any of these symptoms, your use may already be a cause for concern. The more symptoms you have, the more urgent the need for change. Our licensed professional can discuss options to help you make a change and recover from addiction.

However severe the problem may seem, most people benefit from treatment. Unfortunately, less than 10 percent of people needing help receive any treatment. Ultimately, receiving treatment can improve your chances of success in overcoming addiction.

Wellness Counseling

Increasingly more clients engage in counseling, not as a result of a problem, but instead to enhance their overall well-being and to live life more fully. At Ivy Counseling Group, we believe in the value of self-examination and encourage those who are interested in this process.  Delving into one’s own thoughts and feelings with the guidance of a trained professional can only enhance an individuals quality of life, reduce anxiety and stress, expand consciousness, improve intimacy, and permanently release past hurts.