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DALLAS THERAPY: COMMON PSYCHOLOGICAL ISSUES

 
Issues: Self-Evaluation Checklists

LEGAL DISCLAIMER: The information presented in this website is provided for informational use only. The information is provided with the understanding that Dallas Psychotherapy Center is not offering treatment advice or recommendations Any information in the publications, messages, postings or articles on this website should not be considered a substitute for individual consultation with an appropriate mental health professional. The Dallas Psychotherapy Center suggests no treatment herein and each individual should be assessed prior to any recommendations, therapy or counseling provided.

 

Depression

 

Depression is one of the most common issues addressed in Dallas therapy and psychological counseling across the country. According to the American Psychiatric Association, up to 25% of women and 12% of men suffer from Major Depressive Disorder in their lifetime.

 

When symptoms are relatively more severe and persistent, the individual is said to be suffering from clinical depression. As there is often a neurochemical (brain chemistry) component to this sort of depression, such individuals commonly make use of both psychotherapy and antidepressant medication. Many individuals, however, suffer much less severe depressive symptoms, and antidepressants are not necessarily essential to the treatment process in these cases. In such situations, the patient works with the therapist to examine the causes and effects of his or her symptoms and patterns.

Whether an individual suffers from clinical depression or only manifests milder features of depression in Dallas, the symptoms are very similar qualitatively. These symptoms are presented in the following Depression Self-Evaluation Checklist, adapted from the American Psychiatric Association's DSM-IV.

 

Depression Self-Evaluation Checklist

Do you currently suffer, or have you recently suffered from, any of the following:

  • Sad or empty mood
  • Loss of pleasure in activities you normally enjoy
  • Weight loss or weight gain, diminished or increased appetite
  • Sleep difficulties, too much or too little sleep
  • Feelings of restlessness or being slowed down
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Indecisiveness, or diminished ability to think or concentrate
  • Recurrent thoughts of death or suicide
If you answered Yes to five or more of the above, you may very likely be suffering from depression.

Depressed individuals commonly report a general lack of energy or motivation, along with significant changes in eating and/or sleeping patterns. Pervasive feelings of sadness and guilt are often experienced, sometimes accompanied by sudden fits of crying or irritability. The libido is often affected by an episode of depression, temporarily diminishing the individual's desire and even ability to have sex, which may fuel the need for Dallas marriage counseling. Activities the individual has usually enjoyed, such as hobbies or other special interests, are experienced as somewhat flat and less fulfilling while depressed. Not all of these symptoms are necessarily experienced by a depressed person, nor do they necessarily interfere with that individual's daily life in a dramatic way. Many individuals, in fact, may experience a somewhat chronic sense of boredom, dullness or low energy, without even realizing they are likely suffering from some form of depression that could possibly be helped by visiting a Dallas mental health professional.

 

Anxiety

Stress, physical discomfort, persistent worrying and obsessing, fear of social situations and other phobias, as well as panic attacks are all various forms of anxiety. Although anxiety is experienced in numerous forms, ranging from the concretely physical to the intensely emotional, it is a condition for which psychotherapy is particularly well-suited. As with depression, anxiety falls along a continuum from mild to severe. Fairly disruptive anxiety, which often results in panic attacks and unhealthy physical symptoms such as high blood pressure, can be addressed with various, highly effective anti-anxiety medications. Even so, psychotherapy is essential to the understanding of the core issues leading to anxiety in such cases. In cases of more moderate anxiety, therapy alone is often enough to treat the unwanted symptoms. As Dr. Robbins' work with The Eugene McDermott Pain Center has shown, the mental, psychological and physical aspects of the individual are intricately intertwined. For this reason, the psychotherapeutic treatment of anxiety in Dallas is one of the most effective means of addressing related patterns of phobia, obsession and physical stress.

 

Anxiety Self-Evaluation Checklist

Do you currently suffer, or have you recently suffered from, the following:

  • Anxiety and/or worry about a number of events, such as work, financial matters, school performance, etc.

  • Difficulty in controlling the worry

  • The worry is associated with three or more of the following: restlessness, feeling keyed up or on edge, being easily fatigued, difficulty concentrating, mind going blank, irritability, muscle tension, restless sleep or difficulty falling or staying asleep 

According to the American Psychiatric Association's DSM-IV, if you answered Yes to the above, you may be suffering from generalized anxiety. There are also more specific forms of anxiety, such as social phobia and panic.  

Anxiety may be experienced as a result of some significant life change, or may seem to come "out of the blue". Dramatic shifts in one's life role, such as marriage, changing jobs, going off to college, the loss of a loved one, etc., are likely triggers of anxiety. It takes time to adjust to new expectations and situations, and anxiety is one mechanism individuals may use to keep a sense of security. Perhaps a successful businessman unconsciously grinds his teeth in a stressful business meeting. Similarly, a newly married husband may unconsciously maintain his "personal space" by obsessing about details of work projects, financial matters or even something like lawn care. Anxiety is also commonly experienced when one feels unable to express certain emotions such as fear, anger, or disappointment. If one has anger toward an authority figure, for example, but does not feel free to express this, anxiety may result. The psychotherapist helps the client define him or herself throughout stressful life transitions and situations, teaching more adaptive ways to manage emotion. In addition, developing a stronger sense of self identity helps the individual remain relatively secure even when powerful emotions and stressors are abundant.

Anxiety may manifest in many forms, including substance abuse, unwanted recurrent thoughts, chronic pain or hypertension, panic attacks and many others. One common form of anxiety is social phobia.

 

Social Phobia Self-Evaluation Checklist

Do you currently suffer, or have you recently suffered from, the following: 

  • Fear of social situation(s) in which you are exposed to unfamiliar people or possible scrutiny by others
  • In social situation, fear you will act in a way (or show anxiety symptoms) that will cause embarrassment
  • Exposure to feared social situation provokes anxiety and/or panic
  • You recognize your social fear to be excessive or unreasonable
  • Avoidance or dread of feared social situation
  • Fear of social or performance situation interferes with your normal routine  

According to the American Psychiatric Association's DSM-IV, if you experience several of the above, you may be suffering from social phobia.

 

Panic

Panic is a particularly disruptive form of anxiety.  Many individuals suffer from "panic attacks," relatively brief episodes of compressed anxiety which can seem to arise out of nowhere.  Some common symptoms of panic are listed below.  

 

Panic Self-Evaluation Checklist

Do you sometimes suffer from some of the following?

  • sweating

  • rapid heartbeat

  • nausea, stomach cramps

  • shortness or breath, feeling of smothering

  • chest pain

  • numbness

  • feelings of disconnection or unreality

  • hot or cold flashes

  • fear of dying, losing control or going crazy

  • trembling or shaking

  • feeling of choking

  • dizziness or lightheadedness

  • feeling detached from oneself (depersonalization)

According to the American Psychoatric Association's DSM-IV, if you have experienced four or more of these symptoms during a relatively brief time (less than 10 minutes), you may have had a panic attack.  If such attacks recur, especially if accompanied by a dread of situations which may trigger another episode, you may be suffering from a panic disorder.

As with other forms of anxiety, such as social phobia, panic is often treated with a combination of anti-anxiety medication and psychotherapy.  Whereas the medication addresses the most immediately disruptive symptoms of panic, therapy goes deeper to address core issues that are likely affecting one's life in other seemingly unrelated areas.

 

Sexual Issues

 

Couples of all ages, married and otherwise, commonly report sexual dissatisfaction. Perhaps they feel they are not having sex as often as they once were, or simply that the passion is somehow missing from their sex life. Similarly, many single individuals report sexual issues to be one of the main obstacles to a healthy, intimate relationship. Sexual issues often lead to heated and persistent conflicts and frustration. Unfortunately, many individuals have come to accept such dissatisfaction as unavoidable changes due to monogamy or aging.   Another area of concern that many individuals struggle with is sexual orientation and related lifestyle factors. Although sexual issues may be buried at the core layers of personality, psychotherapy has been particularly effective in helping individuals deal with these issues

 

Due to cultural and family influences, many individuals experience much guilt, shame and embarrassment when it comes to sexuality. At the core of these feelings, psychotherapy has shown us, there may be complicated and unrecognized feelings of anger, confusion and devaluing of the self. For this reason, sexual issues are often treated not as a single, simple conflict in and of themselves, but rather as part of a larger difficulty in understanding and accepting one's own personality. Someone with disruptive sexual issues, for instance, could discover on closer examination other seemingly unrelated life areas that are affected, such as career advancement, physical well-being, creative "blocks" and so on. In psychodynamic therapy, the client examines the ways in which his or her childhood and upbringing unconsciously influenced his or her current sexual conflicts. In cognitive-behavioral psychotherapy, specific goals and behaviors are targeted which allow the patient become more at ease with his or her sexuality and overall self.

In many instances, individuals struggling with sexual issues may be helped with appropriate medication. As sexual dysfunction is sometimes associated with other health issues, a general health screen is recommended. 

 

Couples Counsleing

Many couples experience certain persistent conflicts, such as sexual issues, that seem to resist resolution. It is not uncommon for a couple which seems to be otherwise comfortable and intimate to complain of some particular area in which they feel stuck. Typically, in such cases, these seemingly isolated areas of conflict are discovered to be much more pervasive than originally perceived. Sexual issues, for instance, may be tied to longstanding tensions regarding male and female roles, financial matters or in-laws. By the same token, if a couple experiences difficulties in communication, for example, those same conflicts may underlie other close interpersonal relationships. Issues with one's employer may parallel issues with one's romantic partner. Power struggles with one's children may mirror conflicts with one's spouse. One of the principal goals of psychotherapy is to understand how certain emotional and cognitive patterns tend to pervade one's life and relationships. In psychoanalytically-oriented counseling, the patient works to bring those subtle patterns more to the surface in his or her relationship with the therapist, a process which is known as transference. The therapist can then work with the individual to become more aware of these tendencies, thereby allowing for a safe place to resolve persistent conflicts.

 

Finding the Right Relationship

Many individuals struggle to find or sustain their ideal romantic relationship. Clients are often frustrated with dating, feeling that certain unwanted patterns play our over and over again, seemingly outside of their control. The therapy process can help "update" dating patterns, bringing to light the various ways in which the client tends to defeat him or herself by choosing the wrong partners, and illuminating ways in which the individual may unconsciously push away more healthy partners.

Oftentimes, clients play out unrecognized family patterns when dating. They may inadvertently be drawn to certain negative characteristics that trigger "unfinished business" with their parents or siblings. The therapist helps the client to become more aware of such hidden motivations when dating. The counselor may work with the individual very directly, coaching him or her to maximize online dating, or to meet suitable dates through the local scene. The therapist helps the client resolve any sexual issues or fears of intimacy that may be sabotaging the client's search for a satisfying relationship. At times, social anxiety may present a temporary obstacle to meeting new people.           

 

Family Issues

In virtually all schools of psychological thought, the family unit is treated as one of the most essential mirrors of individual personality and unresolved developmental issues. Because individual issues are so intricately intertwined with family matters, individuals often find themselves in some very heated and persistent conflicts with family members. Whether it is a mother struggling with issues of independence with her adolescent son, a father who seems to have difficulty being emotionally present with the rest of the family, sibling rivalry or any other core family conflict, it can often be difficult to sort out such issues without help. By definition, we are typically closer to our family members than most other individuals, so certain strong feelings we have toward one another can make it difficult to keep a relatively objective point of view. 

 

As psychodynamic therapy emphasizes, family issues tend to be so compelling that we feel the need to unconsciously play these dynamics out in our other close relationships. A daughter who complains of an angry, emotionally volatile father, for instance, oftentimes finds herself marrying the same type of man later on.  Similarly, parents often unconsciously repeat certain patterns and behaviors of their own parents, both  desirable and undesirable, and can find themselves stuck in a kind of repeating loop over generations.

 

When working either with entire families or individual members of a conflicted family, the therapist brings a less biased third party perception into the conflict. Certain issues which may seem impossibly complicated within the closed system of a family may seem considerably less intimidating to a trained psychotherapist. Similarly, individuals who have unknowingly inherited certain undesirable traits from parents and other early figures may find that a therapist offers a more detached, helpful viewpoint when discussing the issue. This allows the client to bring more awareness to the his or her interpersonal relationships and to make more informed life choices as these issues rise to the surface.

 

Chronic Pain/Medical Issues

In the last few decades, there has been increasing cooperation between Western medical and psychological communities. In the same way that psychotherapy has benefited immensely from the development of more and more effective medications for treating emotional issues such as depression and anxiety, the medical community has begun to use psychological treatments as an adjunct to medical treatment for a variety of illnesses. In short, the fields of medicine and psychology are beginning to believe that the body and the mind are much more connected than Westerners have previously realized. As Eastern culture has long been aware, some illnesses seem to be closely related to mental and emotional distress. As continuing research indicates, even clients with illnesses such as cancer or severe neck injury, for example, can benefit from psychotherapeutic treatments. Although such illnesses rarely entirely dissipate strictly through psychological intervention, symptoms and symptom management may be significantly improved. Learning to deal with physical pain, as well as the constraints it puts on one's emotional and cognitive experience, is a particular specialty of cognitive-behavior therapy.  Similarly, many troublesome physical conditions may improve through a careful and intensive exploration of one's core psychodynamic issues.

For individuals struggling with chronic pain and related issues, a general health screen is recommended.

 

Career

Oftentimes, people come to psychotherapy feeling a lack of life direction or dissatisfaction with their career paths.  They may feel that they are not living up to their potential, or simply that something is missing from their vocation or other significant life projects. 

 

It has been noted in psychotherapy that some individuals have a strong unconscious need to thwart their own success. This hidden desire to fail may be the result of unrecognized  guilt and shame, as well as buried feelings of worthlessness and insecurity. 

 

According to psychodynamic therapy, there can be numerous sources for this desire to frustrate one's success and gratification. For example, for many individuals, the idea of being more successful than one's parents or other family members is very uncomfortable. Similarly, at a certain stage of personality development, some individuals learn to control behavior by punishing themselves through negative feelings such as guilt and shame. Although such a process has a much-needed place in civilized society, it is common for the individual to over-learn this mechanism, feeling guilty for having thoughts and fantasies he or she finds socially unacceptable. Within this context, the therapist helps the client to let go of maladaptive self-punishing behaviors that may be frustrating his or her success and achievement of deserved satisfaction. Toward this same end, CBT (cognitive-behavioral therapy) employs structured, systematic techniques to refine the individual's focus, clarity and concentration. By reducing many of the distractions contained in one's unwanted thoughts, feelings and behaviors, CBT greatly enhances the potential for goal-directed behavior.  

Death and Dying

It is very common for individuals to seek psychotherapy in times of grief. The death of a loved one is perhaps the single most intensive emotional experience an individual must face. These feelings are often intense enough to be quite debilitating and disorganizing. Although a certain period of anxiety and/or depression is expected throughout the natural grieving process, these intense emotions sometimes activate deeper layers of psychological unrest that have not previously been recognized. The therapist can help explore seemingly insurmountable feelings of pain and loss by providing a stable context from which to understand the natural process of grief. Oftentimes grieving individuals must continue to maintain normal functioning in the context of career or simple day-to-day tasks, and feel unable to experience their pain at its deepest levels. As psychotherapy has shown, the more the individual is able to truly experience and accept his or her intense feelings of loss and suffering, the grieving process is less likely to be complicated by overwhelming and extended feelings of anxiety and depression.

 

Faced with the death of a loved one, an individual may begin to struggle with existential issues, grappling with the inevitability of death. This could include questions about the nature and permanence of the self, as well as questions regarding beliefs about religion and spirituality. These issues are also likely to arise in the context of terminal illness, aging, or deteriorating health.

 

Although the therapist does not claim to be an absolute authority on such matters, he or she can help the client achieve a stable psychological base from which to consider these issues. From this more stable emotional context, the client is then encouraged to begin to re-examine and sort out these issues.

 

Existential Issues

 
  • What, if anything, is the ultimate meaning of life?

  • What is my purpose for being here?

  • How does the inevitable fact of death affect ongoing struggles in life?

  • Is there a god?

  • Am I all alone in the universe?

 

Each of these questions may arise when an individual struggles with religious, spiritual, or existential issues. Examining existential issues in the context of counseling can help to deal with the conflicts and struggles that necessarily surround the phenomenon of existence. Although psychotherapy cannot answer any of the above questions with absolute authority, it can help individuals clarify their own beliefs. At times, relatively simple emotional conflicts such as depression or anxiety confuse the individual's basic perceptions of life and may lead to feelings of hopelessness or meaninglessness in life. Once again, the therapist does not claim to solve these issues directly so much as help clear the way for the client to more easily make up his or her own mind about some basic life questions.

 

Heather Robbins, Ph.D.  •  James Robbins, M.A.  •  972-755-0996  •  Contact Us

 Dallas Location: 6380 LBJ FRWY, Ste. 299, Dallas, TX  75287  •  Fort Worth Location: 815 Houston Street,  Fort Worth, TX  76102