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Couples Communication: The Rules

An experienced couples therapist once told me that “good communication and persistence would cure most problems.” I recall challenging his advice at that time, suggesting that some people marry for the wrong reasons, that sometimes there has been “too much water over the dam” – that is, their problems have persisted and become so complex that they can’t be resolved. Clearly there are a myriad of challenges to developing and maintaining a healthy and balanced relationship. After years of treating a wide variety of couples, I would agree that persistence and good communication are integral components of the coping strategies that couples require as they face challenges in their lives. With these thoughts in mind, here are a few communication basics that may assist you and your partner as you hit the speed bumps of life.

Active listening requires you to repeat the other person’s words in your head as they are speaking. If you practice this technique it forces you to pay acute attention to everything that they are saying. You are actually using active listening right now as you read the words on this page and repeat them in your mind. O.K. you each have one another’s attention so try some other techniques.

Avoid accusations by using “I Statements” like: I think…, I’d like…, I feel…, rather than “You Statements” such as : you never…, you always… . “ You Statements” are accusatory and will result in the escalation of an argument. “I Statements” simply tell your partner about your needs. “I think you’re an idiot” doesn’t work! That is an accusation using “you are” as the preface to your comment. “I am an idiot” would be O.K. – it is an “I Statement” and might be appropriate at the moment.

Stay in the here and now by focusing on the present. Obviously, we can’t change history and ,as someone once said:”those who ignore history are bound to repeat it.” So we may need to work though issues of the past but that is accomplished by using all of the communication techniques in concert with each other. If we want to modify behavior, we can be aware and sensitive to issues in the past but it would be advisable not to beat each other over the head with them. “There you go again just like you did last week(bringing up history), you’ll never change!”(accusation – you statement). This is ineffective and just escalates the argument so let’s agree to focus on the problems as we are experiencing them now. I usually tell couples who are in treatment to only discuss the past when they are in the office and, at least initially, have access to a referee.

Honesty is integral to any relationship. If you don’t have it, there will be problems and a rocky road ahead. This is not just being honest – telling the truth about what you have done or what you are doing. This concept also includes honesty with respect to your feelings. Hopefully, as we have all matured, we realize that it is always easier to tell the truth. So, it is important to express our feelings to one another in an open and honest manner.

Emotional expressiveness is a necessary component of an effective relationship and is often a criticism that individuals level against their partner. That is: “my partner doesn’t tell me how he/she feels.” In fact, effective couples therapy should focus on helping couples to relate to one another on a feelings basis. A useful communication tool is the use of this phrase: “When X.. happens, I feel Y… .” For example: “When you watch the television news at the dinner table, I feel ignored.” This is more effective than: “You’re ignoring me!”(accusation). Remember, accusations may lead to escalation of arguments. So, when your partner says or does something that makes you feel good, or bad, give them feedback.

It is critically important that we are each sensitive to the impact of our behavior on the other person. If we practice this concept in our relationships there would be an improvement in all of our interactions. In addition, both members of the couple must agree to use these techniques or they will not be very effective. Finally, and perhaps obviously, you can’t make a relationship happen by yourself ! If both members of the couple have the same goals, then persistence and good communication will solve most problems.

If you and your partner have reached an impass in your relationship and might benefit from seeing a couples therapist, call the Center for immediate, professional response to your concerns.

Dr. Ken Ellis is the Executive Director for the Columbia Counseling Center

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The Most Powerful Treatment for Depression

The title of this 2008 study says it all: “Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone”. The study of over 650 patients with depression compared medication treatment alone to medication treatment plus psychotherapy. The results were clear: patients on medication and therapy recovered from chronic (meaning repeated episodes of) depression faster than patients on either treatment alone.

Many studies over the years have identified both cognitive-behavioral therapy and interpersonal psychotherapy as being just as effective as medication in reducing symptoms of moderate depression. Other studies have shown that the improvements gained in therapy alone can last longer than the improvements gained from medication alone.

In my opinion, it’s the minority of cases that improve on just medication. The job of antidepressant medicine is to reduce the most immediate and troubling symptoms that interfere with your ability to function at home, at work, and socially: low energy, loss of interests, poor concentration, crying spells, hopelessness, and suicidal thoughts. The job of therapy is to identify the life issues that have led to depression and make changes in how you deal with those issues so they stop depressing you.

Therefore, we have two powerful and effective tools to treat depression. Use them together and you are likely to get the fastest and most enduring relief from your symptoms. At Columbia Counseling Center, the psychiatrists and therapists are all under one roof and we work with each other to ensure that your treatment is coordinated and efficient.

Written by: Dennis Glick, M.D. Board Certified Psychiatrist at The Columbia Counseling Center

Generalized Anxiety Disorder (GAD) is a common and recurring condition. Typical symptoms include near-daily worry, anxiety, tension, feeling on edge, irritability, and sleep disturbance. Features of panic attacks and/or social anxiety may also be present. Your primary care doctor may have already ruled out medical causes such as thyroid, electrolyte, cardiac, or nutritional abnormalities.

Cognitive-behavioral therapy (CBT) is a very effective form of treatment, typically requiring 6 to 12 weekly sessions that may include the use of workbooks and homework. The SSRI and SNRI antidepressant medications (Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Cymbalta, and Pristiq) are highly effective and should be continued for a period of 6 to 12 months following symptom reduction. Benzodiazepines such as Xanax, Ativan, and Klonopin are best used on a temporary basis due to the risks of addiction, memory impairment, physical incoordination, and potentially endangering combinations with alcohol and pain killers. Other medicines such as Buspar, Vistaril, Gabapentin, and Seroquel are occasionally used but are not specifically approved for treatment of GAD.

Many patients will benefit from the combination of CBT and medication. The Columbia Counseling Center is uniquely able to provide coordinated treatment as our staff includes both psychiatrists and psychologists specifically trained to diagnose and treat GAD and other anxiety and mood disorders. Your clinicians work together to ensure you are receiving the most effective treatments for your condition.

Conflict Resolution vs Separation

By Dr. Susan Minsky

Couples often believe the easiest solution to frequent arguments that appear unresolvable is to threaten separation and divorce. Divorce is the last choice to resolve what initially may appear as unreconcilable differences. Marriages require the willingness on both parties to rebalance needs, expectations, hopes, on a consistent basis at various stress points and change which occur throughout a long term relationship. Clear, direct communication, hearing each other in an accurate manner is necessary to produce effective changes for both parties. Couples often require refresher courses and new skills to promote a growth oriented exchange during stressful times, in particular.

Come join the Columbia Counseling Center team who provide an integrated approach to promoting and strengthening the bonds between partners in relationships. Individual and couples therapy are offered simultaneously to promote more rapid and productive identification of issues that require resolution to enhance the lost intimacy and positive communication and interaction between partners.



Overweight and Mental Health

According to the Centers for Disease Control more than a third of American adults—over 72 million people—were obese in 2005 and 2006 and they predicted that, unless we change our eating and exercise habits, 86 percent of the American population will be overweight or obese by the year 2030. People who are obese are more susceptible to serious health problems, such as high blood pressure, type 2 Diabetes, heart disease, orthopedic problems and stroke. But being overweight or obese doesn’t just affect your physical health. You may also have feelings of guilt, embarrassment, low energy, isolate yourself socially, and feel depressed. These feelings can definitely impact your physical health and even shorten your lifespan.

The Social Consequences of Being Overweight

While being fat was once seen as a sign of wealth and comfort, most people almost automatically assume that someone is overweight or obese because they overeat on pizza, cheeseburgers and ice cream. But it’s not that simple. We live in a society in which you can get great tasting, high-calorie, high fat foods at any time of the day or night. They actually have a name for this: “the obesogenic society.” Some obese people may have jobs that require them to work seated for long hours and just don’t have the time or energy to exercise. And, food is ALWAYS THERE. This results in eating many more calories than their level of activity can burn off and leads to constant gain weight.

Overweight and obese people may feel strongly stigmatized and experience discrimination because of their weight. Discrimination usually begins during early school years, when overweight persons are not chosen for school teams, and this discrimination extends into adult life. In schools and colleges, obese students face harassment, rejection from peers, and biased attitudes from teachers. At work, obese people commonly report they have experienced humiliation and discrimination related to their weight – such as not getting promotions. Obese employees are often viewed as less competent, sloppy, and lacking in self-discipline by co-workers and supervisors.

What can be done to reduce the stigma of obesity?

You have a voice at work and at home. You don’t have to accept discrimination in school or in your workplace. It’s okay to share with your co-workers that YOU ARE NOT YOUR WEIGHT.  Also, if you are trying to lose weight you should be sure to surround yourself with supportive, caring friends and family members. Be open about your weight loss goals and ask explicitly for a helping and motivating hand. Supportive friends and family are a vital part of your weight loss program

Finally, take the word “diet” out of your dictionary and vocabulary. Diets don’t work. Lifestyle change does. Eat healthier foods…eat smaller portions…exercise at least 30 minutes a day. And think happy thoughts.

Columbia Counseling is here to help you on your journey to a natural, healthy weight. Our caring therapists and medical staff can help you to look at your lifestyle and help you understand what you might do to successfully achieve your weight loss goals. Call us  at 410- 992 – 9149 for an initial appointment to begin a rational, sustainable and effective weight loss program.

Winter Depression

My favorite season is winter. My wife calls me “a bear with furniture,” and like a bear, in winter the cold weather and shorter days give me the opportunity to slow down, pull my energy back into myself and prepare for spring. However, many men and women in winter have low energy, become irritable and gain weight because they eat too much, especially foods that contain a lot of carbohydrates. They don’t exercise as much, lose interest in getting out of the house and being with other people, sleep more and just stay “tired” all the time. In reality, all of these symptoms may be signs of depression. Some people get depressed because they lose their job or don’t like their job, get a divorce or there is a death in the family. There may also be a genetic basis for depression because it seems like everyone in the family is depressed. But some people get depressed every winter even without experiencing a stressor that would make any of us feel depressed and without a family history of depression.

Winter depression is sometimes called Seasonal Affective Disorder (SAD) and affects between 5 to 10 percent of the U.S. population. Another 10 to 20 percent of the population may suffer from more mild winter “blues.” SAD is more common in women, between the ages of 20-50, and is thought to be caused by the shorter hours of daylight the winter brings during its colder months of the year January and February.  Although the specific cause of this disorder isn’t known, some biological factors such as the circadian rhythm, which helps regulate the body’s internal clock, may be disrupted with the decreased amount sunlight in fall and winter. Also, the decreased amount of light may also cause a biochemical imbalance of the neurotransmitters serotonin and the sleep-related hormone melatonin in the brain.

As a psychiatrist I usually treat winter depression with antidepressant medication and individual or group psychotherapy, but I also use “light box therapy.”  Light box therapy uses a very strong source of broad-spectrum light for a half-hour or hour each day during the winter months to replace the missing hours of daylight. Research has shown that some people with SAD who are exposed to bright light treatments experience relief from depression because the light therapy mimics outdoor light and is thought to cause a biochemical change in the brain that improves mood.

Tips for Coping with Seasonal Affective Disorder

Besides using anti-depressant medication, individual group and light box therapies there are other very effective ways to deal with SAD and other types of depression.

Exercise – Physical exercise has huge health benefits. It’s one of the most powerful ways to prevent and treat depression. One of the first things I ask my patients is to become more active, “just start moving.” For example, instead of eating lunch at your desk, take a midday walk to get as much sun as possible (there’s that light thing again) and to breathe in fresh air.

Work space-try to locate where you sit in your office so that you are next to a window and are exposed to sunlight during the workday.  One of the things I’ve always put high on my priorities is to always have a window in my own office. Open the window for fresh air even in winter.

Sugar-Cut back on the amount of sugar and high fructose corn syrup (HFCS) in your diet. They have been shown to cause increased swings in mood and directly impact your brain function. All of us have experienced a “sugar rush” and “sugar crash” as your body uses up the sugar in your blood.

Foods-Eat protein and complex carbohydrates such as whole grains, fruits, and vegetables at every meal. Less sunlight means less Vitamin D and you can get Vitamin D from milk, most whole grain cereals and fish, especially cod, herring and sardines.

Greyhound Therapy- If it’s in your budget, get out of town and go someplace sunny. Just a change of scenery by itself can help you feel better.

Seek Professional Help-if the depression gets so bad that you find it difficult to get through the day, it’s important that you talk with someone about your struggles and depression. You are not alone and we can get through this working together.

Remember, if you have SAD, unless you live in Alaska or Greenland, the sun will shine, the air will get warm and you will feel better and more alive as the depression melts away with the snow.