Garth Mintun

Recovering After an Affair

by Margy Davis-Mintun

In the years of practicing couples counseling, I have found that one of the more common reasons couples come to counseling is to deal with a breach of loyalty in the relationship. While overcoming an affair is challenging and navigating the recovery difficult, the ultimate outcome through counseling can foster a healthy and hopeful experience.

Couples who are happy in their relationship do not have affairs; an affair is a symptom that something was already not working well in the relationship and enough space was created between them for a third party to step in. Sometimes I’ll hear one partner say that they thought everything was going well and felt blind sided, while the other one felt distant, ignored and lonely. Partners will talk about not being able to bring resolution to conflict and/or that resentment and anger had become the primary way of communicating. The withdrawal of one partner is another example where the pattern includes increased physical absence or emotional disengagement. The stories vary, however the common theme is that either one or both felt unfulfilled in some way in the relationship.

The initial phase of navigating the therapy process after an affair focuses on helping couples work with the feelings of betrayal and devastation. This phase is often the most volatile, where the emotional charge is intense and pain quickly turns to blaming and pointing fingers. Both partners feel the potential of loosing each other and the fear can quickly convert to anger. Difficult as it may be, it is important for the therapist to help channel these feelings so that partners can talk and listen to each other’s experience.

Once the couple begins to communicate, they also begin to evaluate their desire/willingness to restore and repair the relationship. Counseling at this point is critical so that the damage to the couple is contained and the destruction to the relationship minimized. At this point, couples may openly talk about their hurt, their ambivalence, and the fear that they cannot overcome the trauma to the relationship. Each partner has to make a decision about how much they want the relationship and how much they are willing to commit to work toward recovery.

As the therapeutic process unfolds, the therapist is charged with creating safety for the couple so that they can honestly look at the relationship and their own part in the instability prior to the affair. Here I will often hear couples talk about feeling lonely, ignored, and alone or resentful, angry, and invisible. There may be an external trigger, such as a death, a loss of job or financial stress, or internal patterns of poor communication, fighting without resolution, unmet needs and built up anger.
Regardless of the numerous factors that caused the relationship to become more fragile, or perhaps the relationship was never strong, the healing involves the couple taking stock of their contributions to this breakdown. This can be very difficult when one partner feels like an innocent victim of the other’s action. Here an individual can understand that, because they were not satisfied in the relationship, they maybe gave up, pulled back, exploded with anger, or felt overwhelmed or lost in the partnership.

It takes time for trust to rebuild, and the therapist facilitates steps toward recreating a trusting and strong relationship. This process is time consuming; while trust is building we are working with a leap of faith that trust can rebuild. It is a scary time and a hopeful time, thus it’s important for therapy to happen with regularity, for a period of months. In this phase the couple repairs old wounds, learns and practices new skills and begins to heal from the break created by the affair. Most couples are not successful in achieving a new level of functioning without professional help. It is not unusual for couples to bury the affair if they don’t get the help they need because the process is painful and the support and safety to do the work is generally not created without the expertise of a professional.

Once a couple gets to this point there is new energy and excitement between them. The new relationship is stronger than ever, the honesty and safety in the couple is firmly grounded and the skills to resolve conflict and attend to their individual and partner’s needs are an active part of everyday life. Couples will often talk about feeling important to their partner, feeling validated, and they enjoy spending time together; there is a flavor of new beginnings where the possibilities are numerous and they feel happiness with each other again, there is connection between them.

The affair resolution can also be a process in which couples thoughtfully decide whether or not their investment in the relationship is strong enough to commit to the expense and time it will take to work through the impact of the betrayal and the existing problem preceding the affair. Sometimes couples come to counseling to get help deciding whether or not they are mutually invested in the relationship and willing to move forward to save it or move forward by ending it. Partners are not always clear about whether they want to stay together and the professional can facilitate a safe dialogue to bring a resolution as to the next step for the couple following the affair. The option of ending the relationship can be facilitated with earnest discussion and understanding, rather than an abrupt ending.

Regardless of how the couple decides to move forward, there are key steps in counseling that guide the couple through a very painful and complex situation. The negative impact of an affair has a long life for the individuals affected, so whether or not the couple decides to repair this relationship, the repair to the individuals is imperative so that each can successfully re-engage in a healthy relationship with each other or future partners. Trust is a theme that must be addressed in order to promote healthy intimacy in the future. Building trust has no shortcut; it is a journey of rebuilding that can bring great strides and positive changes if time and attention is given to this process. The devastation of a break in trust is pervasive and recovery means the difference between happiness and growth or repeated patterns of loss and loneliness.

It has been my experience that most couples I’ve had the opportunity to work with through this process of recovery have successfully rebuilt and enriched their relationship and have enjoyed a lasting experience of intimacy.

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EMDR—TWENTY YEARS LATER

By Amy Konkle, M.D.
May 2, 2009

(Accepted for Publication in the Spring 2009 Issue of the Indiana Psychiatric Society Newsletter)

This year marks twenty years since the publication of the first study of Eye Movement Desensitization and Reprocessing (EMDR) for the treatment of post traumatic stress disorder. This article attempts an overview description of the current status of EMDR: what it is, what the research says, and theories as to the mechanism of action. In addition I will share some observations and clinical vignettes from my own practice.

EMDR is a psychotherapeutic approach, rather than a technique or a protocol. EMDR’s underlying theory has two hypotheses: (1) much of psychopathology has its origins in experience implicitly or explicitly perceived as traumatic and (2) there is a block in the central nervous system’s innate ability to process, i.e., to adaptively access and integrate aspects of the trauma into a coherent and temporally updated context. Traumatic experience is understood to exist in a wide range, from a parent’s dismissive remark to an embarrassing childhood experience to the DSM Criterion “A” events that anyone would identify as major trauma. While EMDR appears to “jump start” this innate ability for processing which has become blocked, its mechanisms of action are undetermined and discussions remain lively around just exactly what is happening and what are the minimal essential components of EMDR. Although the preponderance of research looks at EMDR treatment of post traumatic stress disorder (PTSD), most EMDR clinicians perceive little difference in the effectiveness of EMDR in treatment of major trauma and in the reprocessing of the day to day traumas that may appear small but nevertheless shape self-perception, perception of the world, and ways of relating to others. When EMDR is used to treat the lifelong smaller events that shape personality, the duration of the treatment is longer than that of type I PTSD.

A typical EMDR session identifies an event experienced as traumatic by the patient and apparently related to the presenting problem. Even a recent event meeting criterion “A” definition may have an antecedent in childhood which affects the way in which the current event is processed. Components of the trauma—sensory phenomena, negative cognitions about self, emotions and somatic re-experiencing—are elicited. A protocol facilitates the activation of these components so that they are accessible for processing and integration. Desirable alternatives are identified, intensities are measured, and a ground-work is laid to follow progress. These traumatic components are activated and paired with some type of alternating bilateral or dual-attention stimulation, e.g., eye movements, auditory tones, tapping, or vibrating electrodes, which are applied in sets lasting about 20-30 seconds

For example, if eye movements are chosen as the type of stimulation, the assessment is completed as described above. The patient then holds in mind the image representing the worst of the trauma (“I see the truck crossing the median and coming straight at me”), the negative belief about self connected to that image (“I’m going to die”), and where the memory is felt in the body (“my chest, my throat, my shoulders. My whole body feels tense.”) The therapist moves two fingers rapidly from side to side approximately 20 to 30 times in front of the patient, who tracks the finger movement with his eyes. At the end of each set of eye movements, feedback is elicited as to change or lack of change in one or more components, essentially “What comes up now?” If processing is not progressing, that is if some change is not occurring, the therapist has a number of options to help get the processing going again, using the least interference possible. Processing continues until the memory is no longer upsetting, the negative self cognition (usually about safety, responsibility, or choice) is changed to a more positive one, and the body is cleared of disturbance. Ideally past, present and future anticipated triggers are processed to resolution. My experience is that successful processing is in general accompanied by lasting changes in the life of the client, such as decrease or elimination of symptoms, loss of diagnosis, or noticeable difference in life choices. Positive spiritual changes, such as a deep sense of peace, are not uncommon.

Approximately twenty randomized controlled trials exist which positively compare EMDR to antidepressant medication, exposure therapy, cognitive behavioral therapies, and other psychotherapies in the treatment of PTSD. Many treatment guidelines, including the American Psychiatric Association, the International Society for Traumatic Stress Studies, and the Department of Defense, have rated EMDR at the highest level of evidence-based effectiveness in the treatment of PTSD. Numerous meta-analyses show no difference in effectiveness between EMDR and CBT treatments for PTSD, although EMDR requires no homework. The findings in a few studies indicate that it may require fewer sessions than CBT. Although some positive research exists for EMDR’s effectiveness with veterans, children, disaster survivors, and adults abused in childhood, and many clinicians report success with these types of clients, more research is needed for these specific populations. In my own practice childhood abuse survivors have expressed deep gratitude for the transformation that EMDR has brought to their lives. Others have described feeling a “lightness” to life previously unknown.

Although EMDR’s efficacy has been established in the treatment of PTSD, research is still in the preliminary stages for its treatment of other disorders. For example, while EMDR has successfully eliminated secondary depressive symptoms in many PTSD studies, no published study has yet investigated EMDR treatment of primary depression. Similarly, research on EMDR treatment of panic disorder (with agoraphobia) has had uncertain results. It has been suggested that anxious patients may need lengthier preparation before targeting distressful experiences. For example, a recent case study with a woman who had suffered for 12 years from panic disorder with agoraphobia, provided 6 preparatory sessions and 15 EMDR sessions, with complete remission of symptoms and maintenance of positive behavioral changes at one-year follow-up. A clinical series of 4 patients with generalized anxiety disorder were provided with 15 EMDR sessions to each participant to treat etiological memories. At follow-up, two patients were still symptomatic, but all had lost the diagnosis.

There is also some indication that EMDR may be helpful for somatic symptoms with traumatic etiology. Several case studies provided preliminary evidence for EMDR treatment of phantom limb pain. In one case series, 5 patients with chronic (1-16 yrs) phantom limb pain, previously treated in both inpatient and outpatient settings, received 3 to 15 sessions of EMDR. Post-EMDR, there was a significant decrease or elimination of phantom limb pain, reduction in depression and PTSD symptoms to sub-clinical levels, and significant reduction or elimination of medications related to the phantom pain. There are also promising studies of EMDR as adjunct treatment for chemical dependency, conduct disorder, and sexual offense.

Current theories as to how EMDR works include the following: (1) synchronization of the two hemispheres, (2) de-conditioning caused by a relaxation response, (3) “jump-start” of a process similar to that of REM sleep, (4) the initiation of an orienting response, (5) the promotion of thalamocortical temporal binding in 40 Hz neural oscillation range which helps to integrate somatosensory, sensory, cognitive and affective material, and (6) the activation of the cerebellum, setting off a sequence of information processing which activates the thalamus and eventually the frontal lobes, increasing dorsolateral and orbitofrontal processing. Neuro-imaging studies pre- and post-EMDR show changes compatible with any successful treatment of PTSD but do not really clarify the mechanism of EMDR. Dismantling studies which have attempted to demonstrate whether or not eye movements are an essential component of the treatment, have significant methodological flaws and so far add little information. Numerous studies have shown that eye movements reduce the emotionality and vividness of distressing memories, produce physiological relaxation, and enhance episodic memory recall. While research has yet to investigate the effects of the other forms of bilateral or dual-attention stimuli (auditory tones, tapping, etc.) most clinicians report the various stimulation modalities to be equally effective, although they may prefer one over another.

In my own clinical experience with EMDR over the past 12 years, I find it to be a highly effective treatment approach. As with any treatment, EMDR is not appropriate for everyone. However, I have used it with good results in a wide range of patients, including veterans, rape victims with and without significant childhood trauma, accident victims, those witnessing the traumatic death of a loved one, patients with medical traumas such as awaking during surgery, men with anger-management problems stemming from their own childhood abuse, women with childhood physical, sexual and emotional abuse, selected patients with borderline personality disorder and still others with dissociative disorder.

Most (approximately 75 to 90%) of single-episode adult traumas in an otherwise relatively healthy person can be adequately resolved in one to three 90-minute sessions. The greater the number of traumas and the younger the person at the time the traumas occurred, the greater the care required in the stabilization and preparation phases of treatment, and the greater the care required not to “flood” the person with their traumas, resulting in destabilization and re-traumatization. “Fractionation” of the trauma, i.e., processing one aspect of the trauma at a time, may be required. Treatment in those with complex trauma histories, heavy reliance on dissociative defenses, and involvement of the structure of personality formation remains a lengthy process. However, for a number of such patients, therapy can be shortened significantly with the judicious use of EMDR in the hands of a skilled therapist. For many with fewer traumas even if they are severe, and with basically good ego strength, EMDR can produce results which are rapid and dramatic, unlike anything I have seen with other modalities. Results tend to be long-lasting, and positive effect may actually increase with time.

Amy Konkle, M.D.
May 2, 2009

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Emotionally Wired and Addicted to the Computer

by Garth Mintun, LCSW, ACSW, CSW-G

There has been an awareness of a sharp increase in addictive behaviors to computers, as well as Blackberries, iPhones, etc., in our psychotherapy practice in Indianapolis. Many young adults, older adults and children are wired in and don’t know how to quit. Because of this, some people are jeopardizing their relationships, losing their friends, losing their jobs, and/or flunking out of school. There is an increase in sedentary lifestyle, and the sacrifice includes physical health as well as emotional wellbeing.

We have see couples coming in for marital and relationship counseling because of the significant time a partner is spending (upwards of 17-20 hours per day) playing on the internet. The internet games and interactions (role play games) have begun to replace the real life relationships. Partners and family members are feeling ignored, sacrificed, and replaced. The wired person is so into his/her virtual role that sometimes they struggle to distinguish the line between their real world self and the roles they play (which may include changing one’s age, gender switches, animals or fantasy creatures, etc.) on their internet virtual world. Family members complain that an addicted person spends more time with their fantasy relationships than connected to life with the people in their household. In the absence of contact, some partners have resorted to join them in their virtual world as a means of having a relationship.

It is not uncommon for relationships to be broken and couples to separate over the loss of communication, contact, and engagement from the one who is plugged into the computer.

Internet games are not the only way people are wired to their computers. With the convenience of palm computers and/or laptops, work has now become a 24/7 phenomena. Families now have to compete with work and online entertainment in order to have any engaging interaction with their loved one. This behavior condones and promotes work addiction. The Blackberry and iPhone light up for each email, enticing and compelling a response to work when at home, on vacations, or in other spare time. The poor economy exacerbates this when employees are stretched thin and there are plenty of competent unemployed folks who are ready to replace them.

With easy access to technology, Twitter, Facebook, instant messaging, text messaging, ebay, social networking, gambling, and dating sites, one can become compulsive and ultimately addictive, much like drugs and alcohol. An individual may have a full blown addiction and might need an inpatient hospital treatment due to the decline of one’s health and family relationships. In these cases, an individual may be literally in danger of harming themselves due to their compulsion with the computer.

Like food addiction, we cannot give up computers or the internet. We need to be wired to live in this modern world; technology is not the problem. However, like food, we need to moderate our use or we become a slave to it. We can overdo anything, even healthy foods, and/or technological applications. It becomes a compulsion or an addiction when we cannot stop it and/or when we have knowledge of its destructive influence in our life and our family.

In the USA, computer addiction is not acknowledged as an addiction or illness. Other countries, such as China, Taiwan and South Korea, take computer addiction as a serious mental health problem. Internet addiction is becoming more recognized in this country. For example, there is a residential program in a suburb of Seattle, Washington (Fall City) which treats individuals addicted to the internet. Hilary Cash, Executive Director for RESTART Center for Internet Addiction, states that three of the following symptoms suggest abuse and five or more suggest addiction:

Increasing amounts of time on the internet
Failed attempts to control behavior
Heightened euphoria while on Internet
Craving more time on Internet; restless when not there
Neglecting family and friends
Lying to others about use
Internet interfering with jobs and school
Feeling guilty or ashamed of behavior
Changes in sleep patterns
Weight changes, backaches, headaches, carpal tunnel
Withdrawal from other activities.

Psychotherapy /counseling help people and families recognize and heal from the fall out caused by “wired in” behaviors. Self awareness, recognition of the patterns, and the use of human supports to help break the compulsive pattern are necessary components of individual psychotherapy. There are also many kinds of support groups ranging from 12-step programs to Smart Recovery programs designed to help regain balance in a person’s life. If the person is in the early stages of neglecting self and the family, often an intervention in therapy to recognize the destructive nature of the compulsion and limit the amount of time on the computer per day can help. Repair of the broken relationships is also needed in the early stages of therapy, which requires finding alternate ways of coping with stress.

The computer and the internet are wonderful in moderation. We all need balance in our lives, and we can achieve that balance if we ask for help from our families and mental health counselor/psychotherapist. We all need other people, and in our “real time” relationships we can experience love and belonging.

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When Symptom Relief Happens, Counseling has Only Just Begun!!

By Garth Mintun, LCSW, ACSW,CSW-G

You and/or your spouse have been engaged in counseling for a few sessions. It is your first time in psychotherapy and you have expressed yourself, you have been heard, you begin to have a fresh look at yourself and your life… and you are starting to feel hopeful; things can be great. Your anxiety is decreased, your relationship with your spouse has improved, and/or your child is remarkably better. Perhaps you are experiencing work to be less stressful now. Maybe you have some relief from depression. You are not in the midst of a crisis anymore, so you think about quitting the counseling. After all counseling is expensive and you feel better now, so why not quit?

This belief is often attached to the notion that it is time to quit because you feel better. Weeks or months go by, however, and the problems not only come back, but seem to get worse. What happened? Was therapy not effective?

As a new client (especially as a new client who is in psychotherapy for the first time), it is important to understand the following:

1. When you start counseling, often you feel better quickly because you feel symptom relief.
2. Symptom relief is good because it often means that there is awareness of old patterns of problems and therapy begins to solve the surface problems.
3. Symptom relief does not heal the underlying deeper problem/patterns; that process takes a longer time.
4. If you quit too soon when you experience the first symptom relief, you will not undo the fundamental patterns, therefore new symptoms or old symptoms often return more forcefully. This is because you have not yet changed the deeper systemic nature of the problem.
5. It is best to stay long enough to work on the deeper pattern, so you will substantially decrease the likelihood that the old problem will reemerge in other aspects of your life. It may take a little longer, but in the long run it saves money and creates a higher degree of success.

When the initial symptom relief occurs, it probably means that you have just started therapy and feel good about your work, but your work is not yet done. Now the real work starts, which often involves grappling with the underlying issues, such as old fears and traumas. At first this next step may create a little angst; you might feel a bit uncomfortable accepting that is part of the healing. Yes, the painful process starts after the initial symptom relief. Therapy helps you uncover fears, sadness, grief, and trauma that you may have previously ignored. Furthermore, therapy helps you make the connections between patterns and problems, so that you can get to the root or source of the problem and explore new behaviors and beliefs. This has the potential to enrich your experiences.

So, roll up you sleeves, take a deep breath, and know that you are in a safe and supportive environment which will help you address the issues that keep you stuck in old familiar and destructive patterns. You can now begin to make lasting changes that will create a healthier sense of yourself and help your relationships to thrive and be more resilient.

Keep up the good work, because you are not in crisis mode! Continued counseling pertaining to underlying patterns will enable you to avoid continued years of emotional pain. This may be hard work in the short term, but it will be beneficial for many years to come.

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Luxury of Anxiety

In my thirty plus years of working with people in Indianapolis Indiana, struggles with anxiety have come up most often in therapy sessions. Most people that I see are anxious about a variety of issues. They may ask themselves the following questions for the future:

Will I have enough money?
Is my partner right for me?
Will he/she leave me?
What will I do if ________ dies?
Will I ever be peaceful?
When will somebody love me?
Will I ever find happiness?
Will I lose my job?
How will I sabotage this?
What is the matter with me?
What is wrong with me?

Or a person may have anxiety about the past:

Why was I so stupid?
Why did I do that to myself?
Why did I make so many mistakes?
Didn’t I take in consideration of the consequences?
How I was blind sighted and didn’t see it coming?

Anxiety is a luxury in the sense that we really don’t need it. It does not help us survive. If a tiger charged at us we would either flee if we could or, if backed into a corner, we would fight for our life. If a tiger is not present, however, we could worry about what might happen if a tiger were to come into our space. Perhaps we may even believe that our anxiety about a tiger may help us prepare for survival if a tiger were to approach us one day.

Most people who come to see me don’t worry about tigers, but they do have their symbolic tigers that create anxiety. In the present economy, a person may worry about money. One may read about job losses and imagine losing their job. They could even take it to the imagined worse case scenario and think about homelessness. Anxiety often is the worse case scenario and, as we brace for the worst, our adrenaline is pumped, our heart beats faster, and we become mentally involved in our fantasy of anxiety. Our body is equipped for this sudden burst of energy when there is danger, but not all the time when we experience constant anxiety. Consequently, we may become physically tired and sometimes unwittingly cause the worse case scenario to happen because we are not in tune to the present.

The luxury of anxiety keeps us from enjoying the present. Generally, in the moment, we are actually quite safe. Anxiety often causes people to be less safe, however, particularly if something in our reality needs to be responded to. For example, if you are anxious about your relationship while driving in the car, you may fail to see that red light in front of you and could expose yourself to danger. If you are overly pre-occupied with the luxury of anxiety, you may not see your significant other person’s non verbal signs that they are unhappy. For example, you may not see or hear the verbal and physical cues around you and become “blind sighted” when your partner tells you that they are leaving. When we receive the consequences of not paying attention, we may self-loath, which is again the luxury of anxiety bordering on depression. If we continue on the treadmill of the luxury of anxiety, we continue to not see the world around us, with the consequences of a loss of intimacy, job or self-respect.

Some of us may take this anxiety and obsess and create rituals to keep our anxiety at a low level, which may include compulsive acts of counting or creating patterns to feel safe. This continues to debilitate us and make us more vulnerable, and we may not even notice the proverbial tiger in the room.

The key is to lessen anxiety and gently return to the reality of the present:
Some ways to reduce anxiety are the following:

Stay in the present moment (you are doing just fine sitting in that chair)
Breathe with your belly not with your shoulders or chest (deep breathing)
Remember that anxiety usually does not help you
Remember that life has infinite possibilities and your anxiety has just a few
Anxiety is just one or two of thousands of thoughts that you attach to in one hour
Engage in physical exercise to have an outlet for your anxiety
Nurture yourself and love yourself just the way you are
Focus on how you are safe this present moment
Ask if your negative anxiety thought is 100% true (Byron Katie)
Think of anxiety as apart from you and try not to engage or make it personal
Develop a meditative process to practice letting anxiety go

If anxiety is overwhelming, compulsive, and restricting your life, you may need some help to lessen anxiety by going to psychotherapy. If you believe that you cannot cope with your anxiety, talk therapy and/or medication is essential. A therapist can help you get to the root of the problem, as well as offer you some useful techniques.

Anxiety cheats us out of the safety of the present. Anxious thoughts are always about the future or the past; they are never about the present. Anxiety limits us from viewing all of the options available to us. Anxiety is a luxury we simply cannot afford.

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Couples Fighting Text Message Wars

by Garth Mintun, LCSW, ACSW, CSW-G

Imagine you’re sitting at home, your significant other is out and suddenly you receive a text message on your mobile phone. You read, “I am breaking up with you, I don’t love you anymore”. You then reply, “What…..what did I do to deserve this” . Hours later both are still texting on the cell phone with short cryptic angry, hurt messages with all thumbs. This has become a common ineffective avenue of fighting. These are unskillful methods of conflict resolution!

Does this sound like science fiction? In our private practice in Indianapolis, text messaging has become the norm for communication with traditional and non-traditional couples. It is happening with all ages from age 15 to age 55. Why are couples not talking directly to each other?! What happened to old fashioned verbal face to face discussions?
Text messaging is a very effective mechanism to send short few word messages like, “I am running late”,” pick up the kids at 5pm” “give me a call when your done”,etc… How did we go from practical short communication of easy to respond to questions and comments to expecting to have emotional intimacy via text messaging?

In our experience, text messaging stalking/warring is becoming widespread. One person is angry/hurt with the other, and texting is used to stonewall and/or attack the significant other. A barrage of “ why are you ignoring me”, verbal attacks, or worse still, “ are you with him/her, you expletive deletion #!!#!#!#”. Then the re-dial button with the text copied is hit, 50 times per hour and this starts the cyber stalking process. This sometimes escalates to physical violence when both parties meet.

As a psychotherapist I ask clients to stop fighting with text messaging. What I am told is that they “cannot stop”. Simple questions without intonations can sound like an innocent question/comments, however there is no insurance that the other will interpret the message as it was intended. It could sound like a demand or accusation to check up on a person like “WHAT ARE YOU DOING”, which could be interpreted as yelling. If the two people are not getting along, that simple question could be interpreted in many different ways and too often it is the worse case scenario that rules the mind. Assumptions and misinterpretations are common place without the benefit of verbal and nonverbal cues, in the absence of both of those the only data comes from cryptic text.

Text message is the worse way for couples to communicate emotional intimacy or to problem solve. E-mail is bad enough but at least you can be verbose. Text messaging is short and laborious, and often an impulsive expressions on a little phone screen where much of the message is left to the imagination and interpretation and the reaction is based on the FANTACY of what is meant.

Clients say to me, “it is much harder to talk face to face, we argue too much”. Lets examine that response. When two parties argue face to face, they see each other’s body language, intonations and can better know how their words are affecting the other. The couple can ask each other for clarification in real human time in front of each other. The tone of the words and remarks are more clearly communicated, thus preventing the imagination of the other to determine the tone in text messaging. Each person takes personal responsibility for what they say because they are saying it in actual real time with their words, body language and voices. There is less left to the imagination, hence less misunderstanding and misinterpretation which often escalates conflict and fallout.

I have a guess to why text messaging is so popular in these times. For many couples texting is used as a means of courting and is felt to be romantic, interpreted as a means of flirting, showing interest, and signaling to each other that they are being thought of, touching base. The problem is that when people use text messaging to communicate emotional intimacy and/or to avoid emotional intimacy, the consequence too often results in unresolved hurt feelings and anger. Text messaging is too often used to avoid the face to face communication of difficult topics.

I ask my clients not to text unless it is purely logistics, like, “I’m not able to pick up the kids on time, can you? or running 10 minutes late” . I encourage them not to communicate their pain, or try to resolve problems via text messaging. I also indicate that if an innocent communication begins to become conflictual via texting, that they table that dialogue until they can sit together and discuss or have a telephone conversation.

Some people are emotionally addicted to text messaging and I ask them to ban text messaging completely unless it is used for work. This is difficult for many clients because they feel at a loss without the constant contact with the other person and actually feel emotional pain of withdrawal and feel rejected. I ask them to talk about their feelings with the other person face to face, and if that is too difficult they can both come in and talk with me in the office.

If you find yourself dependent on emotional text messaging, make an effort to stop. This medium does not work effectively and can be guaranteed to cause you emotional distance with your partner. If you cannot stop texting, get professional help, you probably have difficulty in expressing yourself with the other person and this points to emotional intimacy difficulties. You and your partner have a better chance at achieving a meaningful conversation if you make a phone call or wait to see each other in person. If you continue to have problems, you may want to contact a professional relationship counselor/psychotherapist for help in improving the communication with your partner.

Remember direct one to one contact with your loved one is what attracted you in the first place. Don’t sell your relationship short by text message wars.

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Don’t Wait to Save Your Relationship

by Garth Mintun, LCSW, ACSW

In my Indianapolis Indiana private practice, often people come in when they are at the breaking point in a long troubled marriage and about to separate or feel hopeless about a long standing “loveless marriage” for many years. In other words, the relationship or marriage is in an emergency or dying state and only intensive crisis work can save the relationship. Often one partner does not have the patience to wait, the desire for change or the hope of repair to invest in the intensive relationship work that psychotherapy or couple work requires.

When couples come in with emergency status, there often are so many long standing negative patterns that it is challenging, even with professional therapy, to salvage the relationship.

The optimal time for a couple to seek counseling is when the problems are relatively young, the couple is not disenchanted with each other, and contempt and or detachment have not taken over the relationship. This early intervention increases the chances of working out their relationship satisfactory.

The best time to begin couple counseling is when there are small troubles with the relationship. Let me list the possible signs that signal need for help:
1. He/she does not listen to me
2. He/she is holding back their feelings
3. He/she roll their eyes
4. She/he is physically present but not emotionally with me
5. I miss the romance that I once had with him/her
6. We never seem to resolve our verbal fights
7. We don’t seem to ever make time together
8. I imagine how my life would be simpler if I was single
9. I lost my best friend
10. She/he does not seem happy
11. I am not as happy as I used to be in my relationship
12. She/he is never home
13. She/he says hurtful things and doesn’t seem to care about my feelings
14. She/he never validates me or gives me appreciation I want
15. We don’t have sex very often and it is not as good as it used to be
16. I constantly find myself jealous of others
17. He/she is constantly jealous of me for nothing
18. I love him/her but I am not in love
19. We constantly verbally fight about little things that don’t matter
20. Every time we fight, he/she throws the kitchen sink at me

These signs can be alerts that harmful relationship patterns are forming, and seeking help when these behaviors and responses are few increases the success of the relationship.
All twenty signs are symptomatic of larger relationship stressors and if not addressed will mushroom and beget many smaller problems until there are significant relationship breakdowns and serious symptoms. These symptoms can come in the form of emotional and physical affairs, separation and sometimes domestic violence.
With one or just a few of these problems taken care of early when they first arise by seeing a professional psychotherapist, often at this stage the relationship is strengthened resulting in more intimacy and satisfaction. However untreated, these problems spiral out of control and couples go into crisis mode, often beyond the point of recovery.

If some of these problems are present in your relationship, don’t hesitate to get help from a professional. If you catch these problems earlier, you will go to counseling for a shorter time, will be less expensive in time and money and emotional harm, and you will probably develop a more loving and satisfying relationship.

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Controlling Anxiety about the Economy

by Garth Mintun, LCSW, ACSW, CSW-G

Many people come to my Indianapolis Indiana private psychotherapy practice alarmed with “stress”, “anxiety attacks” and “panic attacks”. The common themes of concern are often external events like relationships, the economy, hardships of the family and financial issues. Often people judge themselves based on their past decisions and worry about how they will handle future events. Stress, anxiety, anxiety attacks and panic attacks can be traced on a continuum of fear, with the severity of stress on the one side and panic attacks being the most severe. Full flung panic attack consists of a simulation of the person losing control and being “blind sighted” into abject fear.

Many of us have fear about the economy. We read the papers and internet bloggers about where the economy may go in the future. We hear the pundits on TV warning us about the “Great Depression”. Perhaps we go to survivalist web site and hear their dire predictions of the end of the world as we know it. Our imaginations can be crueler than the reality of the present situation. We scare ourselves with our imagination and that can be augmented by the joining of other people’s imaginations. Unfortunately we also torture ourselves by the worst case scenario over and over , sometimes on a daily basis.

My suggestion: Be here in the present now! Look at the situation right now. Are you breathing? Do you have food on the table and a roof over your head today? If the answer to those questions is yes, reality is kinder than our imagination.

When you think of the worst case scenario, are you dismissing the infinite scenarios of the universe? Perhaps with an economic recession we will have to tighten our budgets. For example, we may have to take a job that pays less for awhile, which is not the worst case scenario of being homeless. Are you homeless now? Maybe your are looking for another job and sent out 10 resumes over the internet. Perhaps a reframe is that money is tight, but I have a roof over my head right now, I have food today and I sent out ten resumes towards a potential new job.

Even if the worst case scenario happened, the reality of it would be kinder than our imagination. People lived through the Great Depression and people lived through the double digit inflation times of the 70’s with a gas shortage. When we have a real and present danger in life, we act and don’t have to think about it. If we are in danger we are either in fight or flight. If a bear comes after us, we either protect ourselves from the bear or we run. and we don’t imagine what to do, we just do it. When we imagine a bear attacking us, we still go through the fight or flight survival mode in our minds, even if the bear is not really attacking us. We tend to go in survival mode, have heart palpitations, adrenalin is released and we go into “bear survival mode”. Often anxiety and stress takes place when there is no bear in the room, no homelessness, no starvation, we just worry about those possibilities by creating the “bear survival mode”. After doing this over and over again, we become exhausted and tired. Either we cannot fall asleep or sleep too much. The stress of our imagined future fears or anxiety may cause us to overindulge in food, alcohol, chemical substance, shopping, gambling or a host of other compulsive activities to numb us from feeling the pain of “bear survival mode” If we keep this going then we can make ourselves physically weaker from the stress and then we have new problems to worry about. All this is un-necessary if we stay with the reality of the present.

Please understand I am not encouraging you to be passive. Instead, focus on what can be done, become pro-active and plan for the future without scaring yourself about the future. Look at job options, the second part time job to earn more money, and manage problems with your health and your prized relationships. Be interested and curious about your process of “catastrophizing” and exaggerating the future, allow yourself to catch yourself in those dire thoughts and fantasies, and notice that in the present those events and circumstances are not present in your life at this moment, and remind yourself the future is still unknown. Name your projections into the future so that you begin to distinguish the present from future fears, and remember your own history of overcoming adversity, take stock of the wisdom of your life experience.

In summary, when you are emotionally triggered to go to the worst case scenario , go back to the present reality and ask yourself what is going on that minute. Are you breathing, do you have a roof over your head tonight , do you have food ? Ask if the less adverse scenarios are equally true or more true the worst case scenario. Finally be kind to yourself because the only thing any of us have is the present reality and all the other dire thoughts are negative places. Be kind and be present!

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Coping with the stress of our U.S. economy

By Garth Mintun, LCSW, ACSW, CSW-G

What a stressful time for US citizens! The price of gas and food is rising, our equity in our house is going down and our citizens are over their heads in debt from un-regulated credit card interest and bank charges. The people making most of the money are 1% of the wealthiest among us and the rest of us make the same or less money. To top that off, many of our jobs are in jeopardy because of the economy slowing and borrowing restrictions from banking to employers.

So, what can we do to keep our stress from getting the best of us? First we take a deep breath and realize that economies swing.. I encourage you not to read the “survivor web sites” that describe worst case scenarios and raise our fear and tension. The key to times like these is to feel that we can exercise some control over our lives in the present and keep focused on the moment instead of doomsday scenarios of the future economy.

What are the facts? Most Economists predict a recession until around the end of 2009 and possibly 2010. The energy crisis indicates gasoline will probably be staying high or rising higher until the world demand is lessoned. There is pending legislation and the Federal Reserve is supporting reining in the banks with their gouging interest rates on credit cards and outrageous bank fees. Those are some of the facts as we know today that impact our lives. In my view, everything else is speculation.

So what is a person to do…….? Take control of what we can do right now.! With gas prices for cars, what alternatives do we have for transportation, car pooling, riding bike, mass transit, or bus? How about our jobs? Do you have a plan if your company lays off or goes under?

How about growing some of your own food? . Even if you do not have a yard, most cities and areas have places you can garden for free or minimal cost. Or another option is food cooperatives.

How about joining some community action at the local and national level to pool resources together, coop farming, green life style or pooling together for transportation? I cannot stress the importance of feeling you are taking action to increase your sense of power over your destiny. Organizing a system for bartering a wide range of service would be another alternative. Cooperative groups organizing babysitting, food purchasing in bulk are just a few ways to beat the recessive economy. This kind of action tends to strengthen the community and inherently increase a sense of support, fostering self sufficiency and providing a pooling of resources. Self help community groups provide economic partnerships and decreases isolation in the community.

How about therapy and/or psychotherapy to help with relationship stresses which are magnified by the economy? Many therapists take insurance or have a sliding scale for those with no insurance.. There are Employee Assistance Programs with psychotherapy sessions paid in full by the company. Psychotherapists or “talk therapists” can help you sort out those stress factors that you can do something about and identify the stress factors that create problems with families and marriages. Counseling can also help your with anxiety with your children and the economy, job issues and general stress about the state of the world. How about group therapy counseling as a less expensive form of therapy then individual therapy.

The worst enemy is fear in times of trouble with our economy. The isolation is what hurts us as a nation and hinders effecting the most positive in these times. In the 1970’s the entire decade was recession, gas crisis and double digit inflation and unemployment. Many individuals and families made it by creatively developing cooperatives and altering lifestyle. We can do the same today, and perhaps discover that even in times of adversity, there can be positives in our lives. In summary, take action on the areas which you can do something about, join groups to change laws and try not becoming alarmist about your worries over the future and we don’t know. Again, stick with the reality of the situation right now.

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Talk Therapy changes the Brain and helps with Depression and Bipolar

by Garth Mintun, LCSW, ACSW

This week I watched the PBS special “Depression: Out of the Shadows.” Dr. Dennis Charney, the Medical Director and Dean of the medical school at Mount Sinai, presented on a panel of experts with Jean Pauley. He stated that depression “on average is 35% genetic and 65% environmental.” (This is for the average person; people with histories of depression or who are bipolar will have higher percentages of the genetic factors). He stated that medication and talk therapy access different parts the brain, thus the change these treatments produce take place in different areas of the brain. Research indicates that people who undergo both psychotherapy or talk therapy and anti-depressant or bipolar medications show more progress in lessoning their depression or bipolar symptoms than they would if they simply engaged in one method of treatment. For more information, please go to the PBS web site to see the video clip or read the transcript of the discussion with Dr. Charney, the panel of experts, and Jean Pauley at: http://www.pbs.org/search/search_results.html?q=dr+dennis+charney&btnG.x=8&btnG.y=10

This report is very good news. It is excellent in its ability to help people understand bipolar and depression and it also attempts to deal with the stigma of mental illness. I suggest that psychotherapists recommend this PBS series to their clients suffering from depression. Often in my practice in Indianapolis, I find that clients on medication for depression or bipolar show improvement when participating in talk therapy/counseling. These clients tend to experience a decrease in their levels of anxiety and lessoned feelings of the inertia when they come in to psychotherapy on medication. Consequently, people are able to deal with difficult core interpersonal issues with less anxiety and vulnerability than they would if they were not on anti-depressant and or bipolar medication.

The other piece of good news is that “talk therapy “actually changes the brain as well, producing biological effects. This program shows how people who have been suffering from long-term depression can perhaps see how their “talk therapy” actually changes the way they think in profound ways and compliments the medication therapy approach.

Often people go to their family practice physicians just for medication, rather than also attending talk therapy. After reviewing the research, people suffering from depression and bipolar may want to receive more comprehensive help by adding psychotherapy to their treatment. Again, the PBS show “Out of the Shadows” is an excellent vehicle for consumers to understand depression and bipolar and learn about ways that they might go about receiving help.

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