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All articles are copyrighted by the author, Elizabeth Ruegg, LCSW, BCD, CAP, CT, CCFS
and may not be reproduced without permission.

Your palms sweat, your hands shake, your heart hammers in your chest. Your face and neck flush beet red. Your muscles are as tense as if you’re being chased by tigers. You are overwhelmed with a sense of doom, certain that something terrible is about to happen. You feel totally out of control.

And what calamity aroused your panic? Perhaps your boss told you to make a presentation at the monthly staff meeting. Perhaps you got lost coming home from the store and found yourself in an unfamiliar neighborhood, not exactly sure how to get home. Perhaps you were invited to a social gathering where you will have to make small talk with strangers. Perhaps your panic was aggravated by something as seemingly small as needing to use a public restroom.

If these symptoms sound familiar, you may have social anxiety disorder (also known as social phobia), the third most common psychiatric disorder in the United States. This disorder is characterized by excessive fear of being judged by others or fear of being humiliated or embarrassed in social situations. The most common fears associated with social phobia include speaking in public; speaking to strangers or meeting new people; and eating, drinking or writing in public. People with social anxiety may also experience difficulty performing other routine tasks, such as ordering food from a restaurant or asking for a raise. In time, the person with severe social anxiety may feel unable to work or socialize with people other than immediate family, and may rarely leave home.

Social anxiety can be generalized, meaning that many or most social interactions are feared, or can be limited to one or a few situations, such as public speaking or performing. Both adults and children with social anxiety disorder often have emotional characteristics including extreme sensitivity to criticism or rejection, poor self esteem, and feelings of inferiority. Also, they frequently demonstrate impaired social skills, such as lack of eye contact or difficulty maintaining a conversation. While some degree of anxiety is normal in situations commonly thought to be stressful (such public speaking), social anxiety disorder is diagnosed if anxious anticipation of the feared event interferes significantly with the person’s daily routine, occupational functioning or social life.

Studies show that social anxiety disorder is slightly more common in women than in men. It also appears to run in families. Symptoms usually begin in adolescence and are often most severe in young adulthood. In about one-fifth of cases, the disorder begins in early childhood. Children with social anxiety may evidence crying spells, temper tantrums or clinginess with familiar adults, and may refuse to speak while at school. They may fail to play with others or participate in structured group lessons or activities, resulting in poor school performance and severely impaired peer relationships.

The long-term economic consequences of untreated social anxiety can be devastating. As many as 85% of persons with this disorder experience academic or occupational failure caused by their inability to meet basic social demands. Nearly 50% of respondents in one recent study were unable to complete high school; 70% earned a less-than-average wage, and about 22% were on welfare. When they are able to work, most people with social anxiety have jobs which are well beneath their capabilities because they fear job interviews, working in positions with public contact, or being promoted to positions where they would have to supervise others. Also, they often have difficulty exchanging information with co-workers or supervisors, which can be a deadly disability in this information age. Other negative consequences are equally severe. For instance, persons with social anxiety are less likely to marry or participate in long-term, meaningful romantic relationships than those without the disorder. Those who do marry experience higher than average divorce rates due to inability to communicate effectively with their partners about their fears and feelings. About 16% of persons with social anxiety have alcohol abuse problems, since alcohol creates a false sense of relief from symptoms. About 70% also meet the diagnostic criteria for major depression.

Social anxiety disorder is left undiagnosed and untreated in an estimated 90% of cases, which is a shame since treatment is highly effective in reducing or even eliminating disabling symptoms. Cognitive behavioral therapy, which teaches the client to change his/her anxious thought processes, is the treatment of choice for most clients. Social skills training is often useful in reducing anxiety around social encounters, and medication can also be used to help reduce anxiety around specific feared events.

If you have answered TRUE to more than three items on this quiz, you may have social anxiety disorder.
Considering consulting with your physician or therapist to learn more about treatment options which are available to you

At 17, Jonathan was already an expert bartender. His father was a renowned surgeon who spent his days and many of his nights at the nearby university hospital. His mother was a drunk who taught him how to mix martinis without bruising the gin and how to hide her empty bottles from the housekeeper. By October of his senior year, Jonathan had already been accepted to the college of his choice. Life was filled with promise.

At 26, Jonathan was known to his friends as the life of the party. He was famous for livening up a room by tap-dancing on tables and performing risqué striptease acts. He could easily put away a 12-pack of beer and a line of mixed drinks during a long night at the bars, but he was almost always able to get up the next day and go to his management-track marketing job without much of a hangover. He didn't have a steady romantic interest, but dates were easy to get, and women enjoyed his generosity and easy sense of humor. Life was good.

At 41, Jonathan was admitted to detox for the third time. He’d lost his job as a marketing director almost a year before and was rapidly burning through his savings. He justified his failure to find another job as the direct result of transportation problems, since he’d lost his license for five years after repeated DUI’s. He was six years divorced from a three year marriage, and spent most of his time drinking or sleeping off a drunk. His girlfriend was a hard drinker, and also enjoyed cocaine. She was poorly educated and rough, but she didn't harp on Jonathan’s drinking and still had her license, which was convenient for making trips to the liquor store. "Life’s a bitch," she frequently remarked, and Jonathan agreed. Life was, indeed, very hard.

At 49, Jonathan was a dying man. Decades of alcohol use had poisoned his liver and severely compromised his immune system. Homeless, penniless and alone, suffering from cirrhosis, hepatic cancer, high blood pressure, and gastritis, which were all directly related to his alcoholism, Jonathan’s life - once full of promise - came to a bitter end.

What is alcoholism?
Alcoholism is a chronic, progressive condition caused by the compulsive use of alcohol. The physically and psychologically addicted person cannot abstain from alcohol use even though he understands intellectually that drinking causes him social, spiritual, occupational and physical harm. In early stages of the disease, the alcoholic is usually in denial of his addiction.

Who is likely to become alcohol dependent?
Alcoholism often runs in families; 55-60% of alcoholics identify a first degree relative who also has the disease. The lifetime risk of alcoholism in the general population of the United States is about 15%, and current, active alcoholics are thought to compose about 5% of the total US population. The majority of those who develop alcohol-related disorders do so by their late 30’s, although some develop signs and symptoms of full-blown alcoholism by the late teens or early twenties. Senior citizens may be first diagnosed with alcoholism in their sixties or later as they use alcohol to cope with boredom, loss or loneliness.

What are some signs and symptoms of alcoholism?
Common short-term symptoms include tremor, unsteady gait, insomnia, dry mouth, nausea, vomiting and gastritis. Consequences of long-term use include increased risk of infection, certain cancers, stomach ulcers, high blood pressure, memory impairments and even psychotic symptoms. Male alcoholics in the active stages of the disease often experience erectile dysfunction, while women may experience menstrual irregularities. Pregnant alcoholics are at risk for spontaneous abortion.

What treatment is available?
Short-term inpatient admission to a medical hospital or detoxification unit may be necessary for the alcoholic who is at risk for seizure or stroke during alcohol withdrawal. Longer term residential rehabilitation, which is designed to teach the individual how to live without use of alcohol, may last 28 to 90 days, but typically there are long waiting lists for these programs and they are often very expensive. Alcoholics Anonymous, the self-help support group, is the best known and perhaps the most effective of the outpatient options. Individual counseling is often used as an adjunct to participation in AA, where the individual learns to identify feelings such as anger or frustration which may trigger a relapse, and develops strategies to cope with these.

Do You Have a Drinking Problem?
Take this 10-question quiz to evaluate your relationship with alcohol

5. Have you ever gotten into trouble at work or school because of drinking? YES / NO

6. Have you ever neglected your obligations, your family, or your work for more than
two days in a row because you were drinking? YES / NO

7. Have you ever gone to anyone for help about your drinking, or been asked to by your family? YES / NO

8. Have you ever had severe shaking, hallucinations or "blackouts" while you were drinking,
or as you sobered up? YES / NO

9. Have you ever been in a medical or mental hospital because of your drinking? YES / NO

Even one "yes" response suggests you might have a drinking problem. Please see your family doctor or your counselor for more information about treatments options which are available to help you.

For the past month, she had been positively paralyzed by feelings of sadness and emptiness. Ordinarily an organized, efficient woman with impeccable personal habits, she’d called off from work for nine days in a row for no reason other than she just couldn’t face the thought of getting out of bed. "Take a shower, wash my hair, dry my hair, get dressed, get ready for work... it’s too much. I can’t." She hadn't seen a friend in three weeks, and let the answering machine fill up with messages instead of talking to the people who called. Her pastor had asked three times if he might stop by and visit because he was so concerned about why she had suddenly dropped out of sight. She hadn't done a load of laundry in weeks. She was barely eating, barely sleeping. When she did sleep, she had strange, confusing dreams during which she was being chased by something in the darkness, and every time she ran from it, she fell off a cliff into an enormous void.

And the strange thing was, nothing was wrong. Well, obviously something was wrong. But nothing terrible had happened to precipitate this sudden withdrawal from the usual activities of her life. She’d heard of people who went through severe losses - a spouse dying, loss of an important job, a serious illness - and became upset and withdrawn. But nothing like that had happened to her. She just... didn't care anymore. She felt worthless. Hopeless. What frightened Jeannie most were the thoughts she’d begun to have. "Maybe I should just... maybe it would be better if I wasn't here anymore." She’d begun looking long and thoughtfully at the small .32 revolver she kept in her bedside table.

One afternoon, her pastor rang her doorbell unannounced. He visited with her for a hour and asked if she would be willing to talk to a counselor he knew. She agreed mostly to placate him, but in her heart, she didn't believe anything or anyone could help her. The next day, Jeannie went to her first therapy appointment.

Signs and Symptoms
Major depression is characterized by appetite and sleep disturbance (eating or sleeping too much or too little); poor concentration; difficulty thinking or making decisions; fatigue and decreased energy; lack of interest in previously enjoyed activities; feelings of worthlessness or guilt; irritability or sadness; hopelessness and recurrent thoughts of death or suicide. Other common complaints include tearfulness, anxiety, difficulty in intimate relationships, unsatisfying social relationships, and loss of sexual interest. For diagnosis, at least four of these symptoms must be present most of the day, nearly every day, for at least two consecutive weeks. Major depression can occur in childhood, adolescence, adulthood and old age and affects both males and females, although recent studies indicate that females are about 50% more likely than males to experience a depressive episode. A significant percentage of women with a history of major depression indicate their symptoms worsen several days prior to the start of their monthly menstrual period.

An untreated episode of major depression typically lasts at least six months, after which the symptoms generally resolve and the depressed individual returns to his previous level of functioning. In about 10% of cases, though, severe symptoms may persist for two years or even longer. About 40% of those who have had one episode of major depression recover fully and never have another episode. The remaining 60% will probably have at least one more episode in between periods of normal, healthy functioning.

Treatment Options
Major depression is the most commonly diagnosed mental disorder in the United States, occurring at some point during the lifespan in 20-25% of women and 9-12% of men. The good news is, it’s also one of the most readily treatable. The most common treatment options for major depression include medication management and/or psychotherapy. Several studies indicate that Cognitive Behavioral Therapy (a form of psychotherapy) is at least as effective as medication management in the treatment of depressive symptoms, although you should always consult with your therapist and your physician about all treatment options available to you. A less common form of treatment for major depression is Electroconvulsive Therapy (ECT, or "shock treatment"), which may be quite effective in stabilizing the mood of a severely depressed person who has not responded well to psychotherapy or medication management.

1. I feel downhearted and blue

2. Morning is when feel best

3. I have crying spells

4. I eat as much as I used to

5. I still enjoy sex

6. I have trouble sleeping

7. I notice that I am losing weight

8. I get tired for no reason

9. My heart beats faster than usual

10. I have trouble with constipation

11. My mind is as clear as it used to be

12. I find it easy to do the things I used to do

13. I am restless and can't keep still

14. I feel hopeful about the future

15. I am more irritable than usual

16. I find it easy to make decisions

17. I feel that I am useful and needed

18. My life is pretty full

19. Others would be better off if I was dead

20. I still enjoy the things I used to do

21. I think about killing myself

____

Sometimes

____

Most of the time

____

SCORING:
Give yourself one point for each "most of all of the time" answer to questions 1, 3, 6, 7, 8, 10 and 15.
Give yourself one point for each "none of the time" answer to questions 4 , 5, 11, 12, 14, 16, 17, 18 and 20.
Give yourself one point for each "sometimes" answer to questions 1, 3, 6, 7, 8, 12, 14, 15, 16, 19 or 21.
Give yourself five points if you answered "most or all of the time" to question 19.
Give yourself five points if you answered "most or all of the time" to question 21.

If your score is higher than FOUR points, you may be clinically depressed.
Please contact a licensed medical or mental health professional for a more comprehensive depression evaluation

"When I was 15 years old, my family and I headed upstate one Saturday to visit my grandmother. One second my kid sister and I were goofing in the back seat, singing along to 'Hotel California' The next second, chaos. I remember a hard swerve, screaming, a smash-crash impact and the chitter of shattering windshield glass. The car went upside down and I hit my head and smelled leaking gasoline. Weirdest thing, though: the radio kept playing. I remember the chorus: ‘such a lovely place, such a lovely place. I couldn’t hear anything but the radio playing on and on.

My father and little sister were killed outright. My mother survived, barely. I walked away with nothing more than cuts and bruises. The drunk driver who hit us got off easy too; just a broken arm and a little cut above her eye. I remember the smell of booze coming off her as she sat on the curb, and 'Hotel California' playing over and over in my head.

In the weeks afterward, I was sort of numb, like in shock. And then strange things began to happen. The smell of alcohol on someone’s breath made me run to the bathroom, vomiting. I was angry and snappy, even with good friends. Every night, I’d awaken in heart-pounding panic from the same dream: goofing with my sister in the back seat, the swerve and screaming and 'Hotel California' and the greasy gasoline smell and the chitter of broken glass. I couldn’t listen to the radio, afraid I’d hear that song. And once, months later, I walked past a spray of pebbly green windshield glass on the road and wham! - I was inside the nightmare, trapped again in that upside down car, and when I came back to myself I was crouched on the sidewalk, wailing, surrounded by strangers who must have thought I was absolutely psycho.

I thought so too, and started going to therapy. The therapist says I have PTSD, like some combat vets used to get when they spent too long in the war. I’m nineteen now, and putting my life back together piece by piece, but I still have the nightmares and can't hear that song or smell gasoline or booze on someone’s breath without getting sick to my stomach. I spend a lot of time wondering why I survived."

Post Traumatic Stress Disorder (PTSD) is a mental health condition that can develop following a terrifying life experience. Events which may trigger PTSD include military combat (as far back as World War I, it was known as "shell shock" or "battle fatigue"); violent personal assault (sexual or physical attack, torture); being kidnapped or taken hostage; severe automobile, train or airplane crashes; and man-made or natural disasters, such as bombings or earthquakes. PTSD is thought to affect an estimated 5.2 million Americans at any given time. Women are more likely than men to develop symptoms of PTSD, and even children as young as 18 months who have been victims of horrifying life events have shown symptoms of this disorder. PTSD often leads to – or is complicated by – other mental health problems including clinical depression, panic disorder, and substance abuse.

PTSD is diagnosed when an individual has been exposed to a traumatic event which involved actual or threatened death or serious injury to self or others, and his response to this event was intense fear, helplessness or horror. Often, the person with PTSD experiences persistent, frightening thoughts and memories of the ordeal which traumatized him. He may have vivid nightmares in which the ordeal is re-created, feel emotionally detached from others, and startle easily. He may lose interest in previously enjoyed activities, be easily irritated, and even behave aggressively when feeling threatened or overwhelmed. Commonly, he will take active steps to avoid thoughts, feelings or conversations associated with the trauma, and will try to avoid activities, places or people that remind him of the event. He may also have incomplete memories of events surrounding the traumatic incident. The person who develops PTSD may have trouble experiencing and expressing emotions, and may develop a fatalistic outlook (for instance, not expecting to have a meaningful career or normal lifespan). He may also have dissociative flashbacks – hallucinations which can come in the form of images, sounds, smells or feelings – during which he may briefly lose touch with reality and believe that the traumatic event is re-occurring. In severe cases, the person with PTSD may have trouble working, socializing or even leaving home.

Not all persons who survive life-threatening trauma will develop PTSD. The severity and duration of the traumatic event appear to be important factors affecting the likelihood of developing this disorder. That is to say, the worse the trauma, the more likely it is that symptoms of PTSD will occur. For instance, in one recent study, as many as 58% of survivors of a severe natural disaster evidenced symptoms of PTSD within three months of the event. Researchers also suggest that some factors may protect individuals from developing PTSD, including an active social support network and absence of family history of any predisposing condition such as a mood or anxiety disorder.

Forgive yourself.
If you survived a life-threatening traumatic event – especially if others died there – you may feel guilty that you are still alive. Maybe you have even wished you died, too. You end up feeling guilty for having survived and then feeling guilty for wishing you hadn’t. Forgive yourself for all these confused and confusing feelings. Forgiving yourself is the first step to healing.

Start psychotherapy.
Find a licensed counselor who has experience treating PTSD. Be truthful with your therapist; what you don’t tell can hurt you.

Consider medication.
Your therapist may want to refer you to a psychiatrist (a medical doctor specializing in mental disorders) to see if medication would help you cope better with PTSD symptoms and related problems such as depression and panic.

Get a medical check-up.
PTSD often manifests itself with somatic (physical) symptoms, including respiratory distress, irritable bowel syndrome, insomnia and chronic headaches. However, you should confirm with your doctor that there is no underlying medical cause for these symptoms.

Just say no!
You may justify your decision to use drugs/alcohol because it helps to numb your feelings, to forget, to make you sleep, to help you cope. The bottom line is simple: in order to survive PTSD, your drug/alcohol use has to stop. It may make you feel better in the short term, but all you’re doing is re-traumatizing yourself, by keeping yourself stuck in patterns of behavior which will kill you in the end.

Find support.
Quite frequently, survivors with PTSD become loners who struggle with the most basic trust issues. You are more afraid than anything of people or events which can hurt you (again), or trigger your PTSD symptoms. As afraid as you are, you must reach out if you are to heal. Check out AA, NA and the Internet newsgroup alt.support.trauma.ptsd for help from those who’ve been there.

Commonly seen in individuals who have been diagnosed with major depression, anxiety disorder, and adjustment disorder, insomnia is a frustrating – and exhausting – problem, with side effects including irritability, poor concentration, reduced energy, and deterioration of mood and motivation. Given that adults require an average of 8 hours of sleep in any 24-hour period for optimal physiological and psychological functioning, you may have clinically significant insomnia if you have had impaired sleep (less than 6 hours nightly) for at least one month. If you are among the sleep deprived, know that you are in good company; more than half the adults in North America have had at least one episode of disturbed sleep lasting a month or more. And you will be relieved to know that there are a number of steps you can take to improve both the quantity and quality of your sleep. Following the steps and suggestions below should help you get back on track.

First, see your doctor.
If you have experienced a sleep deficit for more than two consecutive weeks, schedule an appointment with your primary care physician. Insomnia - though most commonly the result of tension or depression - can be a symptom of any one of a host of physical disorders, and these need to be ruled out as the cause of your problem.

Develop a regular sleep-wake cycle.
In this age of 24-hour convenience, more and more of us are required to work during non-conventional hours. Some people can adjust to a night-shift life fairly easily. Others simply cannot make the change. If your company requires you to work during non-traditional hours and you can’t obtain adequate sleep during the day, seriously consider making a career change. Your health should always be a higher priority than your job.

Get some exercise.
As little as 30 minutes of strenuous exercise during the day will give your body the activity and oxygen it needs to help you relax more and sleep better. However, you should not exercise within one hour of bedtime.

Avoid daytime napping.
The more sleep you get during the day, the less you’ll want at night. Naps feel great, but they undermine your ability to get sustained, healthy sleep at night-time.

Avoid caffeine, alcohol and tobacco.
Caffeine and tobacco are stimulants to the nervous system, and studies have shown that alcohol disrupts healthy sleep and prevents deep rest.

Wake up at the same time every day.
Yes, even on weekends. Developing a predictable sleep-wake pattern is one of the most important things you can do to ensure good quality sleep.

Drink warm milk before bed.
Studies show that foods with a high concentration of the amino acid L-tryptophan, including milk, eggs, cottage cheese, chicken, turkey and cashews, have naturally sedating qualities.

Drink herb tea.
If you don’t like warm milk or are avoiding dairy products, make yourself a cup of hot chamomile, anise or fennel tea shortly before you’re ready to turn in for the night. All contain natural ingredients which will help you sleep. Most health food stores also sell special blends of herb tea designed for their ability to relax and soothe you.

Sleep in a well-ventilated room.
You’ll rest better if your room is cool (60-65 degrees is a perfect ambient temperature) and there is active airflow from an overhead fan.

If you can't sleep after 45 minutes, get up.
You’ll only frustrate yourself by tossing and turning in bed, and the more aggravated you are, the less likely it is that you’ll be relaxed enough to sleep.

Don’t read or watch TV in bed.
You should associate your bed with nothing but sleep and sex. Also, reading and television stimulate your thoughts, and an over-stimulated mind is probably what’s keeping you awake in the first place. Develop a quiet mind before bedtime by practicing progressive relaxation, deep breathing and visualization. Your therapist can instruct you in these easy techniques which help calm your mind and body and prepare you for satisfying, restful sleep.

Go on, admit it. At some time or another, you’ve made a new year’s resolution.

Maybe you wanted to quit a bad habit, to start a new, healthier pattern of living. You decided that January first was the perfect target date, and awoke on that morning as motivated as you’d ever been to go to the gym, or quit smoking, or never eat three fudge brownies at one sitting again. For a day or two (maybe, if you were very committed, for as long as a week or two) you lived up to your own expectations. And then… Well, and then real life got in the way. The stresses and demands of your daily responsibilities took their toll on your time and patience and nerves. Bit by bit, you went back to the unhealthy habits you’d pledged to forsake forever.

The bad news is that fewer than 5% of resolutions made in January produce lasting life change. The good news is that life changing resolutions do have a fighting chance of coming to pass if you understand that the "bad habits" you’re trying to break are simply coping strategies gone awry. Improving your ability to cope with change, stress, anger, unhappiness and loneliness will inevitably ease your dependence on negative patterns of behavior.

Some of the most "popular" negative coping strategies include all-or-nothing thinking (not allowing for the shades of gray which are a like-it-or-not fact of life); denial (lying to yourself, minimizing or ignoring problems); bad habits (such as use of tobacco, marijuana, alcohol or other non-prescribed drugs to relieve tension); excessive worry (obsessing endlessly about things that cannot be changed, imagining the worst in every situation); and indulging in obviously poor choices (such as impulse buying, poor eating and exercise habits, angry outbursts and rigid thinking). Recognize yourself? Well, of course you do. Most everyone has one or more favorites on the "negative coping skills" hit parade. If you want to, though, you can resolve to substitute those negative skills for more healthful and beneficial options. See the list below for some positive coping skills which you might choose.

Group psychotherapy is a form of counseling in which six to twelve people meet regularly together under the guidance of one or more professionally trained psychotherapists to talk about and resolve their problems. It is designed to help people improve their interpersonal relationships and relieve feelings of isolation, depression and anxiety. Group therapy has been a widely used treatment option for more than 50 years, and is an effective means of helping people solve their problems. In fact, studies show that group may be more effective than individual counseling in helping people with specific difficulties such as substance addiction, coping with physical illness and dealing with loss and grief.

How does group work?
Groups are formed by a psychotherapist who selects individuals likely to be helped by the group experience and who are capable of being "therapeutic helpers" to others. A typical group session lasts 90 minutes, during which members discuss the problems which brought them into therapy. Under the direction of the leader, other group members express their thoughts and reactions as honestly and freely as possible, offering constructive feedback and support. In this way, group members improve their ability to relate to others and learn new ways of coping. Those prone to depression, isolation or social anxiety begin to realize that they are not alone, and feel encouraged when they see that others have similar fears and feelings.

How is group therapy different from a self-help support group?
Group therapy helps people cope with their problems and provides for individual change and growth under the guidance of a professional counselor. Self help groups are designed to provide emotional support but are not geared toward change. Also, they are not professionally led.

If I am in a group, do I also need individual therapy?
Group therapy is used as the main treatment approach for some people and is an adjunct to individual counseling for others. Often, people find it very useful to work simultaneously in group and individual counseling. If this is your situation, you may see two different therapists. This should not hinder your treatment at all, as long as you give the therapists permission to communicate with each other periodically about your progress.

Will there be people like me in my group?
While some people in group will have similar circumstances, it’s unlikely that all group members will have exactly the same problems unless the group is organized around a specific issue such as "surviving divorce," or "resolving depression." There may also be a demographic mix in the group, with males, females and various age ranges represented. Some groups are limited to specific populations such as lesbian/gay, older adults, adolescents, etc., as a means of helping the group members bond more quickly than might happen with a mixed group.

What does group therapy cost?
Typically, group sessions are charged at about half the rate of individual therapy. However, it is often possible to find low-cost groups through your community mental health center or alternative medicine clinic. Local clergy are also a good source for referrals to psychotherapists who run low-cost groups.

While others are busily enjoying the parties and family gatherings of the season, you are lonely, anxious and stressed. Maybe you live far from loved ones, or you have a troubled relationship with your parents and siblings. The emphasis on gift-giving at this time of year may be an unhappy reminder of your financial difficulties. Perhaps house guests are stretching the limits of your patience and generosity. You’re jumping through hoops, feeling irritable and sad, experiencing tension headaches or sleeping problems. Maybe you’re eating or drinking too much to help get you through until the holiday hubbub dies down.

You should know that there is a difference between "holiday blues" and clinical depression. The blues usually aren’t too bad, don’t last very long, and go away on their own without treatment. Clinical depression, on the other hand, is experienced by feelings of emptiness or hopelessness over a period of weeks or even months. The depressed person usually loses interest in previously enjoyed activities and withdraws from friends, family and work. She has a lot of trouble coping with the demands of daily life, and may even think about suicide as a way out of her pain. Are you clinically depressed or just experiencing the blues? Only you and your healthcare provider can figure that out for sure. In the meantime, here are some common sense strategies for coping with Holiday Blues.

Minimize Stress. Plan ahead, so you’re not taking care of everything at the last minute. Procrastination is never a great idea, but is particularly damaging at this time of year.

Avoid too much alcohol. It may temporarily make you feel like the life of the party, but there’s no question about it: alcohol is a depressant, and will only aggravate your holiday blues.

Try something new. Take a few hours off and visit a place you’ve never been before. Recharging your batteries is a must if you want to banish the blues.

Make peace. What better time of year to let go of an old grudge? Open the door to better communication (yes, even if it was all his fault ). You’ll feel better for having made the first move.

Take a hike! If not a hike, how about a nice long walk with a friend? Physical activity will help get you out of the gloomies.

Do something for someone else. There’s nothing like a little volunteer work at your local shelter to help you remember the many blessings in your life.

People who know you best describe you as mercurial, quickly changeable, even volatile. You have a lot of trouble maintaining basic emotional stability. You have episodes of deep depression which can last for weeks, during which you want to see no one and do nothing but sleep. After the depression fades, you have episodes of super-activity and unlimited energy when you are likely to begin a million projects all in the same afternoon. During these episodes, you may sleep only an hour or two a night for weeks on end. You may impulsively spend money - a lot of it - buying things you don't really want or need. You may abuse drugs in an effort to maintain a better emotional balance. You may have been diagnosed with depression, anxiety, or impulse-control disorder. In fact, you may be bipolar.

Bipolar Disorder (which used to be known as manic-depression) is primarily characterized by unstable mood and episodes of depression and/or mania. Mania is often understood as a euphoric or "high" state, but it can also be dysphoric, resulting in agitation, anxiety, rage or feelings of self-destruction. The person with bipolar disorder may also have mixed mood, during which he experiences symptoms of mania and depression at the same time. Persons with bipolar disorder may also have transitory psychotic symptoms, such as delusions (false ideas), paranoid thoughts or hallucinations.

There is no blood test or brain wave exam which can definitively prove the presence of bipolar disorder. There is no cure either, but like other chronic diseases such as diabetes, bipolar disorder is an illness which can be well-managed with medication and psychotherapy. Usually, both are necessary for the bipolar individual to maintain good functioning. Medications used for the treatment of bipolar disorder include mood stabilizers, such as Lithium and Depakote; and antidepressants, such as Prozac or Paxil. Sometimes anti-psychotics are also prescribed if the individual has symptoms such as hallucinations or grandiose delusions. Psychotherapy is useful in providing the individual with insight into his illness, so he is less likely to resist or fail to comply with treatment. Therapy also provides the client with skills to detect early signs of an impending episode, and to improve the interpersonal and family relationships which are affected by the illness.

Has there ever been a period of time when you were not your usual self and…

1. You felt so good and so hyper that other people thought you were not your normal self?

2. You were so irritable that you shouted at people or started fights or arguments?

4. You got much less sleep than usual – 2 or 3 hours a night for more than a week – and found you didn’t really miss it?

7. You were so easily distracted by things around you that you had trouble concentrating or staying on track?

8. You were much more social and outgoing than usual: for example, you telephoned friends in the middle of the night?

If you answered "yes" to six or more of these questions, you should get a full evaluation
for bipolar disorder from your mental health and medical practitioners.

We search for it, we strive for it, we struggle toward it, we curse our inability to keep it. We feel ourselves doomed to fail in its pursuit. We dread its alternative. When we are alone, we dream of the perfect partnership in which we will feel safely held. When we are badly coupled, we feel smothered and cramped, cornered and criticized. Is there no hope for reasonable balance? Is that wildest of dreams, the healthy relationship, simply myth?

Well, no, of course not. Many people have maintained healthy, happy relationships for years… even decades. What’s their secret? Like an architect, study the plans below and you will learn that with work, practice and patience, anyone willing to be flexible can build a healthy, happy, long-lasting relationship.

A healthy relationship allows you both to grow and change. You know those pretty paperweights, wildflowers preserved for eternity in blocks of glass or Lucite? Relationships aren’t like that. You cannot freeze time and keep your wildflower lover exactly the same as s/he was when you first met and fell in love. Life means growth, and growth means change, and there is no way around that fundamental truth. Your partner will not stay the same over time, and neither will you. Instead of resisting that fact, learn to embrace it. Growth is good! Change is life! A relationship which cannot allow for the individuals within it to grow and change is a relationship which will inevitably fail.

Get to know your partner, down to the smallest details. The truth is, every relationship eventually hits bad weather, and intimate familiarity with your partner’s strengths, weaknesses, preferences and most secret fears is absolutely essential if your relationship is to ride through the storms. For example, let’s say you’re totally excited about the possibility of starting your own business. It’s going to take most of your savings, and you’re going to have to give up the steady job you’ve had for the past ten years, but you’re absolutely certain you can make a go of your dream. Your partner, on the other hand, grew up dirt poor, feeling inadequate and less-than, and has spent his entire adult life determined never to be poor again. To him, security is all-important, and means money in the bank and a steady job with a reliable paycheck. It’s important for you to know about your partner’s fear of poverty and to understand his need for security, so that when he balks at the idea of your business venture, you’re clear that his hesitation isn't related to his doubts about you as much as his old demon fears of poverty and inadequacy. This will help you avoid taking personally his lack of enthusiasm for your project. Understanding your partner’s feelings – and having confident assurance that he understands yours – will go a long way toward keeping your relationship strong through the worst of stormy weather.

Do not expect your partner to read your mind. We say out loud or to ourselves, "if you really loved me you’d already know what I need." This totally unreasonable expectation leads to disappointment, resentment and the dissolution of some otherwise solid relationships. Exactly how is your partner supposed to know what you need if you’re not willing to tell her? Unless she moonlights on the Psychic Hotline, give yourself and your lover a break and talk about whatever is on your mind. Clear, straightforward communication is absolutely essential to any well-functioning relationship. Seething and stewing, on the other hand, will lead to nowhere but emotional and physical separation.

Turn toward each other, instead of away. Every human being needs affection, attention and support. We can't help it; we’re just wired that way. Pay attention to your partner’s desire for these fundamental requirements, and offer them freely and frequently. Often, we neglect our partners out of distraction. There’s always so much going on; so many responsibilities; so many completing demands for our attention. Unfortunately, lots of otherwise strong and vital relationships wither and die from benign neglect, the unnecessary casualties of lives which are too busy. If this is your situation, consider adjusting your priorities. Spend more time with your partner, rather than spending more money on her. Fact is, it really doesn’t matter how busy you are or how poorly your schedules mesh; you absolutely must take time for and with each other if your relationship is to thrive. On the other hand...

Find a balance between shared and separate interests. Sometimes, couples tell me very proudly that they do absolutely everything together. That must be the sign of a committed couple in a healthy relationship, right? Wrong!! You must each pursue activities and interests separate from the other in order to bring life and energy back into the relationship. I’ve seen couples who work together, play together, socialize together, eat together, sleep together… and within six months they’re bored to death and ready to move on. Sometimes, couples do this because they’ve been in relationships in the past where they did not spend enough time with their mate and the relationship expired from neglect. As a result, they over-react and determine to do absolutely everything with their partner. This over-involvement kills a relationship as surely and swiftly as under-involvement can. In relationships, as in most things… moderation is the key.

Accept disappointment. When you’re in love, you become fuzzy-headed, dim-witted, three-quarters deaf and mostly blind. You see near-perfection in your beloved. You do not see the quirks, the foibles, the annoying traits, the irksome habits. At least, not until the heady intoxication of falling in love wears off a bit, when you may become annoyed at your partner for not being the perfect soul you imagined him to be. Turns out he’s a messy mortal just like you! When this happens, accept the reality of your partner’s imperfection. Remember, he never claimed to be ideal; the ideal is what you hopefully imagined. Practice loving unconditionally, even when you see him in a more realistic light. No, he’s not perfect. You know what? Neither are you.

When do you need professional help? You will likely benefit from couples or individual counseling if you have not succeeded in accepting differences between your partner and yourself, or if you find yourself repeatedly leaving relationships – or being left – because you cannot tolerate closeness or distance within the relationship. Counseling is an absolute must if you are abused in a relationship, or if you are abusive. Abuse can be verbal/emotional (put-downs, insults, threats, isolating you from friends and family), physical (shoving, hitting, pinching), or sexual (forcing you to have sex or putting you in sexual situations where you are uncomfortable). If this is happening to you, you should get help immediately.

"IF YOU’RE NOT OKAY, THEN I’M NOT OKAY!": FOCUS ON CODEPENDENCE
(August, 2001)

What it is
Codependence is defined as "the tendency to repeatedly place the needs and wants of others first, to the absolute exclusion of one’s own needs and wants." The self-esteem of the codependent individual is typically contingent upon earning approval from others.

Why it Happens
The roots of codependence are frequently found in an unhealthy childhood unbringing. Early research focused on adult children of alcoholics, who demonstrated enabling behaviors such as covering up a parent’s alcohol use, lying to outsiders and suppressing personal feelings in an effort to keep the peace or maintain the status quo within the family system. Codependent behaviors also occur in children of families where there is no substance abuse but the parenting style is controlling, rigid or autocratic. In these families, independent thought is discouraged, and positive feelings about the self are conditional upon emotional approval from the parent. When these enabling or excessively dependent/compliant children grow up, the behavioral patterns learned in childhood disrupt their ability to form and maintain healthy emotional ties. These dysfunctional patterns most commonly result in unsatisfying and unproductive social relationships, and can severely impair the codependent’s quest for emotional independence.

Common Symptoms
If you are codependent, you are so busy taking responsibility for the feelings of others that you barely have time to meet you own basic needs… yet you respond with exhaustion and resentment to the impossible burdens you create for yourself. You have very low self-esteem, yet do not trust others with important tasks for fear that they will not perform up to your expectations. In fact, because your expectations are impossibly high – for yourself and everyone else – people frequently disappoint you. Ironically, you believe yourself to be flawed, less-than, and inadequate. You are sensitive to criticism or disapproval, are intensely insecure, and require frequent reassurance that you are valued. Unfortunately, you rarely get that reassurance, because you have a lot of trouble asking for what you need, and desperately try to avoid appearing vulnerable to others. You feel incomplete if you are not in a romantic relationship, and try to work frantically to avoid being single. If you are partnered, you may feel lonely even when you are with your significant other, because you have such difficulty getting close to or trusting others. You may compromise your values in order to be accepted by or win approval from your partner. You encourage your partner to be dependent upon you, which makes you feel needed, secure, and safe.

If you have more than five "yes" responses, codependent behaviors may be interfering with your life

"For me, a panic attack is almost a violent experience. I feel like I’m going insane. It makes me feel like I’m losing control in a very extreme way. My heart pounds really hard, and things seem unreal."

A panic attack is a short period during which an individual experiences intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. Symptoms of panic attack often include shortness of breath, heart palpitations, chest pain, dizziness, nausea, sweating, chills or hot flashes, and fears of "going crazy" or losing control. Panic attacks have a sudden onset, and typically build to a peak in ten minutes or less.

A person may be diagnosed with Panic Disorder when s/he experiences recurrent, unexpected panic attacks followed by at least one month of persistent concern that s/he will experience another, or if s/he changes daily routines and behaviors to avoid experiencing another. Panic Disorder affects about 2-3% of the population, and is thought to be about twice as common in women as in men. Symptoms can first occur at any age, but are most frequently experienced between adolescence and the mid-thirties.

If you have Panic Disorder, your life has probably become very difficult. You may have difficulty working outside the home due to your avoidance of driving or going out alone. You may be willing to leave home, but only in the company of trusted friends or family members. Perhaps you are so fearful of having a panic attack while away from home that you avoid going out at all. This condition, known as agoraphobia, develops in about one-third of people with Panic Disorder.

How can Panic Disorder be treated? How long does treatment last? Most studies indicate that cognitive-behavioral psychotherapy and medication management are effective in successfully treating as many as 90% of people with anxiety disorders, with "significant improvement" typically noted in the first 6-8 weeks of treatment. Cognitive-behavioral therapy teaches the individual to reframe her thoughts in relation to the panic attacks, and to gain control of the symptoms rather than being victimized by them. It is common in this type of therapy for the counselor to teach techniques such as breathing exercises and guided meditation in order to help the individual reduce the frequency and intensity of the panic attacks. Medications may also be effective in helping the individual manage her symptoms. Two types of medications which are known to be useful in the treatment of Panic Disorder are benzodiazepines (such as Xanax) and selective serotonin re-uptake inhibitors (such as Prozac or Paxil).

I think I might have Panic Disorder. What should I do? First, see your doctor to rule out any medical conditions which might be causing your symptoms, and to see if you are a candidate for medication management. Then, find a reputable therapist who is experienced in treating anxiety. You may need to attend two or more sessions each week in the first few weeks of treatment, while you and the counselor stabilize your condition by eliminating the worst of the panic symptoms. Expect the therapist to ask you to keep track of the frequency and severity of your symptoms so you can gauge your progress in treatment. You will likely experience at least some relief from your symptoms within the first few weeks of treatment, and should be feeling and doing markedly better within the first month.

When I’m having a panic attack, what can I do to help myself? Try the time-tested techniques below to take control of your symptoms:

"I am safe. I am not dying." "These feelings are unpleasant, but not harmful." "I can handle this. Nothing terrible will happen." "There is nothing that can hurt me here."

Splash cold water on your face or take a cool shower. Count backward from 100 by threes. Recite the names of all the states and their capitols. Stroke your favorite dog or cat. Focus on the flame of a candle while breathing deeply and slowly.

Ask for (and accept) reassurance from your loved ones. Call friends. Call your counselor.

Keep a journal to remind yourself what helped you get through your panic attack. Strategies that worked before will work again.

Maybe you race around with a constant knot in your stomach, or your jaw aches because you grit your teeth without even being aware of it. Maybe you’re short-tempered with those you love and downright hostile to strangers. You’re scattered and overwhelmed, irritable and impatient, restless and preoccupied. You feel like you’re juggling so many obligations that you don’t have enough time to be effective anywhere. More than anything, you just want all those competing demands to stop.

The fact is, stress can be both a positive and a negative force in our lives. On the positive side, stress provides us with the ability to adjust and respond to a continually changing environment. Back in the caveman days, stress is what dumped enough adrenaline into the systems of our ancestors that they were able to run away from wild animals. In this millennium, stress is what enables us to meet deadlines, accept the demands of a job promotion or tend to the needs of a new baby. Positive stress enables us to function optimally. Negative stress, on the other hand, can lead to health problems such as high blood pressure, ulcers, heart disease, or stroke, as well as depression, anxiety, lack of life satisfaction, and a host of other emotional disorders.

How can you successfully manage stress in your own life? The answer lies in a three-fold approach which requires nothing less than that you change your thinking, change your behavior, and change your lifestyle. The payoff for all this change? A healthier, happier, less-stressed you.

Practice pet therapy. Studies show that interaction with our four-footed friends measurably reduces stress in those who have had open heart surgery. Fortunately, you don’t need to suffer a medical catastrophe to reap the benefits of pet therapy. Cuddle, groom and stroke your favorite non-human pal at least fifteen minutes each day. It’s sure to be good for both of you.

Are you struggling with feelings of anxiety, depression, and anger in the aftermath of the terrorist attacks on New York and Washington? If so, you’re not alone. Symptoms such as insomnia, poor concentration and fearfulness are definitely on the rise as we try to cope and carry on while living in an uncertain world.

One of the best ways of working out these fears and feelings is to write about them in a journal. Journaling as a therapeutic tool has many advantages; it’s an inexpensive, private and effective means of helping you sort out and ventilate what’s on your mind.

You should also know that there are lots of different ways to journal. For example, a woman I know spoke with me recently about how frightened she has been since the September 11 attack. "It’s all I can think about," she told me. "I worry that I’ll never feel safe again." I encouraged her to write a journal about her fears, but she resisted. "I’m not a writer," she said. "I’ve never been good at putting my thoughts on paper."

I suggested that, instead of writing a traditional journal filled with sentences and paragraphs, she might start a simple "lists" journal. I gave her some suggestions to get started.

This woman, previously so convinced that she was "not a writer," and so couldn’t benefit from journaling, was gratified to discover that writing a lists journal really helped! "Sitting down and thinking up things to say in a regular journal is too unstructured for me," she said. "Just the thought of it is overwhelming. But making lists is different. When I thought about places where I feel secure and peaceful, I listed my garden, and the beach, and my sister’s house. When I thought about people who comfort me, I listed my sister, my baby niece and my best friend. Then I realized that I haven't gone to the beach in God knows how long, I’ve only visited my sister and my friend once or twice in the past two months, and I’ve neglected my garden terribly since the terrorist attack. I suddenly realized that I know what makes me feel centered and secure, and I haven't been allowing myself access to those things!"

"I listed things that make me afraid," she continued. "It was a long list, and it kind of depressed me. But then I moved on to making a list about things I could do to help myself feel less afraid. And it turns out that I had a long list of those things, too. I decided to join my neighborhood watch association, and I made an appointment to give blood. Those are things I’ve been meaning to do for a long time now, but I’ve never gotten around to them. I figured out that I can sit around and be worried, or I can do things to help myself and other people be safer and healthier. I can’t save the world," she finished. "But I’d rather do something than nothing."

This woman, a journaling skeptic, discovered that a simple lists journal could lead her away from immobilized anxiety and toward action and better health. She did it, and you can too, even without benefit of a therapist-coach. Numerous books are available in your local library about journal styles and techniques. Lists journaling is only one style among many; you’re sure to find one which suits you. You might also want to attend a journaling workshop, such as the one I’m offering later this month.

You can work through and resolve feelings of anxiety, depression, and anger. Journaling helps. Why not give it a try?

           A. To be jolly
           B. To be overwhelmed and/or depressed
           C. To cope with stressful family demands
           D. All of the above

If you’re like most people, the tumultuous weeks between Thanksgiving and New Year’s Day are a mixture of enjoyment and distress. You may visit with members of your extended family whom you don’t often get a chance to see (which can be a good thing or not, depending on your family ties), and you may be under greater financial pressure due to the commercialization of the holiday season. The stores are busier, the lines are longer, the traffic is worse, and everywhere the pace of life is quicker. If all this leaves you feeling stressed, irritable or emotionally empty, you need to know you’re not alone.

The fact is, the holidays are supposed to be a time of happiness, optimism for the coming year, and fellowship with friends and loved ones. Unfortunately, these expectations can trigger many unresolved issues, including a focus on past losses, disappointments, and a sense of increased isolation and loneliness. This phenomenon is commonly described as "the holiday blues." People with the blues tend to either focus on how bad they’re feeling or to try and avoid the bad feelings. Unfortunately, neither strategy is effective; staying overly focused on negative feelings will not help you get through them, and avoidance behaviors such as social isolation and abuse of alcohol or other drugs can easily make your other problems even worse than they were before.

Rethink how you approach the holidays. Are you overwhelmed financially or feeling spiritually empty because of the emphasis on material gift-giving at this time of year? Consider an alternative plan, such as giving your loved ones an IOU for the gift of your time. Does your mother/sister/spouse really need another marble cheese board or bottle of perfume? Write a letter to her instead, telling her what you love about her and thanking her for being in your life.

Plan ahead. If you know you’re likely to be overwhelmed by social obligations during holiday time, try to avoid accepting more invitations than you can comfortably manage. If you and your partner both need to visit with family at this time of year, consider spending Christmas eve with your family and Christmas day with your partner’s family, rather than trying to visit both places on both days. You’ll save yourself some stress, and will better be able to enjoy the spirit of the season.

Practice gratitude. No matter how hard your life is, rest assured you can easily find someone who has it even worse. If you’re feeling blue during the holiday season, find a charitable organization whose mission you support and volunteer your time there. You might consider offering your services to a battered women’s shelter, a homeless shelter, a hospital or hospice, or some other organization.

Make amends. This is a very good time of year to reach out to people who have hurt you, or who you’ve hurt. Ask for forgiveness. Accept an apology. Move into the new year by dissolving old resentments and bitterness. Live out the children’s hymn:

Let there be peace on earth, and let it begin with me.
I wish you and yours a peaceful and joyful new year.

By now, you’re sick to death of hearing it. "Where did the year go?" and "I can’t believe it’s time for the holidays again," and "this year went by so fast." Ready or not, the new year is upon us.

The end of each year is a natural time to take stock, to evaluate your life, to figure out where you want to go from here. Did you accomplish what you set out to do at the beginning of this year? What were your goals? Can you even remember what were your resolutions at the beginning of 2001?

Michael Gerber, author of a number of business and self-improvement books, writes, "the difference between great people and everyone else is that great people create their lives actively, while everyone else is created by their lives, passively waiting to see where life takes them. The difference between the two is the difference between living fully and just existing." Which kind of person are you? Are you charting your own course, or being led wherever the current takes you? If you’re actively steering your life, you wake up each morning invigorated, challenged by activities which stretch your skills, spark your imagination, allow you opportunities to use creative energy, and put you in the path of other people who are motivated, as are you, to live as fully as possible.

If you are being passively drawn along in life’s current, on the other hand, you may feel stuck in a life which brings you little satisfaction, autonomy, or pleasure. You may feel trapped in an unhappy relationship or in an unsatisfying job. Perhaps you see few alternatives for yourself other than life as it is. You may be afraid to risk making a change.

When I lived in New York, I had a great job as a therapist at an amazing school for mentally ill children. The work was gratifying, and I stayed for almost ten years. It was hard to imagine leaving that comfortable, stable life for something new, because I was not fond of change. I could have stayed there my entire career, as many others did. And yet… and yet...

I knew I could do more. I knew I could be more. I braced myself for monumental change and moved to Florida. I didn’t know what to expect, except that I would have to use all my skills and resources to build an entirely new life.

Almost five years later, now, I am still surprised at – and proud of -myself for the thunderbolt of courage it took to leave everything I knew for the pleasures and pains of something different. It was a risk, absolutely, but how glad I am that I dared to try!

What risks will you dare to take in this new year? What changes can you make in your work life and your personal life so that you feel energized, vitalized, and passionately engaged in life’s process, instead of going wherever circumstances happen to take you?

Ready or not, welcome to 2002. May you find abundant opportunities in the next twelve months for growth, creativity, and change!
~ ER

So here it is again, the month of St. Valentine’s, when all the lovers in the world woo one another and those who are without partners (or who are unhappily coupled) do their best to willfully ignore the whole scene.

You shouldn’t disregard the spirit of St. Valentine’s day though, especially if you are not in a relationship. What is the day about, after all, if not celebrating love? And who better to love than yourself?

We forget this, you know, in our mad-dash haste to partnership. We focus so fully on loving and giving to our partners that we forget a fundamental truth: you can’t give it unless you’ve got it; you can't fully love another unless you love yourself first.

During my initial session with every new client, I ask, "what are your weaknesses?" and I typically hear a long laundry list of self-hate. "I’m impatient. I’m jealous. I procrastinate. I’m too quick to anger. I don’t trust. I don’t forgive. I’m lazy. I’m stubborn…" and on and on. Then I ask, "what do you love about yourself? What are your strengths?" There is usually a long and painful silence. Then, "well… hmmm… I guess… I’m generous?" or "...I’m punctual?" Sometimes, the silence is broken only with, "I don’t really have any strengths. There’s nothing I love about myself."

Sometimes, people resist acknowledging their strengths because they’ve been raised to believe that having unconditional positive regard for oneself is wrong; is aggrandizing, will lead to vanity. Not true! It is at least as important to know and cherish your strengths as it is to honestly acknowledge your weaknesses; being appreciatively aware of one’s strengths and capabilities is the primary ingredient of healthy self-esteem.

If you struggle with finding value in yourself, and have low self-esteem as a result, consider trying these techniques for making peace with the person in the mirror:

Write a letter of recommendation for yourself. Identify your outstanding qualities; what makes you a good worker, friend and human being. Don’t be modest; this is the time to trumpet your strengths with grace and style, even if no one else but you ever reads that letter.

Ask your friends and loved ones what makes you special. It may be hard to hear these compliments, especially if you struggle with low self-esteem, but it’s important that you listen to what they have to say. Resist the temptation to brush those compliments aside as invalid or – even worse – insincere. Trust these important people in your life. They value you for some very good reasons. Find out what those reasons are.

Every day, remind yourself of your strengths. Read that letter of recommendation you wrote out loud, every day, until you believe and have internalized those positive truths about yourself. You might also want to invest in and read a book of daily affirmations.

The ability to love others is a great gift. Share it. But don’t skimp on loving yourself.

2. I might as well give up because I can't make things better for myself.
True False

3. When things are going badly, I believe they’ll stay that way forever.
True False

4. I don’t have good luck and there’s no reason to think I ever will.
True False