Below you find my list of services and information about each one.
Click on the service to read more.


What is depression?

Everyone experiences feelings of sadness, disappointment, or ‘the blues’ from time to time. Depression however refers to a range of mood and other symptoms that are more intense, pervasive and long-lasting, are distressing to the person, and interfere with their day-to-day life and relationships.

Signs and symptoms

The key symptoms of depression include one or both of the following:

  • Feelings of sadness, emptiness or lowered mood that lasts for most of the day, nearly every day
  • Loss of interest in activities that were previously enjoyable, like going out, seeing friends, or pursuing interests and hobbies.

These symptoms are experienced persistently for at least two weeks, along with several other symptoms over the same period. These vary from person to person, but can include:

  • Significant changes in appetite and/or weight in the absence of dieting
  • Difficulty sleeping or excessive sleeping
  • Sluggishness
  • Restlessness
  • Fatigue and loss of energy
  • Feelings of worthlessness, helplessness or hopelessness, or excessive guilt
  • Trouble concentrating or making decisions
  • Decreased interest in sex
  • Thoughts of suicide or a feeling that life is not worth living.

What causes depression

There is no one cause for depression. In some individuals, stressful life events such as the loss of a job, long-term unemployment, physical health issues, family problems, the death of a loved one, or the loss of a close relationship might trigger depression. For other people, there is no obvious cause.

Some factors that might place a person at a higher risk of developing depression include:

  • Family history: Having a close relative with depression can increase a person’s chances of developing the condition. This doesn’t mean that depression is inevitable – other factors increase or decrease a person’s risk.
  • Social factors: Some people who experience neglect or abuse during childhood might be more likely to develop depression as adults.
  • Personal psychological factors: People who tend to dwell on negative events, worry excessively, or attend more to negative information about themselves, the world or the future are more prone to depression.
  • Neurochemistry: Changes in the levels or activity of certain chemicals in the brain like serotonin, norepinephrine, and dopamine play a role in depression, though the specific processes are not fully understood.

Evidence-based psychological interventions

There are many effective psychological treatments for depression. Certain specialised forms of psychological intervention tend to be more effective than general supportive counselling, as they address current issues and symptoms and also aim to reduce the likelihood of having future episodes of depression.

Cognitive behaviour therapy (CBT)

Cognitive behaviour therapy (CBT) focuses on unhelpful thoughts about the self, others, and the future which may contribute to depression. The goal of this type of therapy is to identify, examine, and modify these unhelpful thoughts and the behaviours that follow, and increase behaviours that might improve mood and quality of life. This includes ensuring a balance of enjoyable activities throughout each day, and a range of activities that give the individual a sense of achievement, Problem-solving, to help address possible causes of stress and lowered mood, is also an important component.

Interpersonal psychotherapy (IPT)

Interpersonal psychotherapy (IPT) involves addressing problems in the person’s relationships and expectations about others that might be contributing to the symptoms of depression. The aims of this type of therapy include helping the individual to find new ways to develop and nurture relationships, resolve conflicts with others, express emotions and communicate more effectively, adapt to life-role changes, and improve social support networks.

Short-term psychodynamic psychotherapy (STPP)

Short-term psychodynamic psychotherapy (STPP) can help the person to become more aware and reflective of their own feelings, desires, motivations and thoughts. The goals of this therapy are to identify and change unhelpful defences which may be getting in the way of a healthy life, decrease vulnerability to depression, and build resilience.

How a counselor can help

The counselor will ask some questions about the individual’s history, circumstances, thoughts, feelings and behaviors. They might also use questionnaires to gather more information. Together, the client and counselor work towards an understanding of factors that might be contributing to the person’s difficulties. A treatment plan is then developed between the client and the counselor. The counselor might use CBT, IPT, STPP, or other psychological strategies such as mindfulness and relaxation to help in the client’s recovery.

Other professionals who might be involved

A medical review with a GP is often recommended to help rule out whether a medical condition might account for the symptoms of depression. Where medication might be of benefit, a review with a GP or psychiatrist might be suggested.

Exercise and diet can be important in the treatment of depression, so a nutritionist, dietician or exercise physiologist might also be consulted.

When to seek professional help

When low mood persists for over two weeks and is affecting a person’s work, school, home life, or relationships, psychological assistance should be considered.


What is anxiety?

Anxiety refers to feelings of worry, nervousness, or a sense of apprehension, typically about an upcoming event where the outcome is uncertain, or where the person feels he or she might not be up to the task. Anxiety is commonly experienced in high pressure situations, for example, prior to a making a speech or sitting an exam. Feelings of anxiety can also arise following a stressful event, like an accident where the person is left feeling shaken. Anxious feelings are usually accompanied by physical sensations such as a churning stomach, light headedness, and a racing heart.

Signs and symptoms

Although the experience of anxiety will vary from person to person, feeling stressed, worried, and having anxious thoughts are common symptoms. Other common symptoms of anxiety include:

  • Difficulty concentrating
  • Restlessness
  • Avoidance behaviour
  • Rapid heartbeat
  • Trembling or shaking
  • Feeling lightheaded or faint
  • Numbness or tingling sensations
  • Upset stomach or nausea
  • Sweating.

Anxiety disorders

While anxiety is considered a natural reaction to a stressful situation, for some people anxious thoughts, feelings, or physical symptoms can become severe and upsetting, interfering with their ability to go about their daily lives.Where symptoms of anxiety occur frequently, occur over a period of time, and interfere with daily life, it is typically considered an anxiety disorder.

Anxiety disorders are the most common type of mental disorders diagnosed. There are a number of different types of anxiety disorder, including:

Generalized Anxiety Disorder  (GAD)

GAD is characterised by persistent and excessive worry, often about daily situations like work, family or health. This worry is difficult to control and interferes the person’s day-to-day life and relationships.

Specific phobia

People with a specific phobia experience extreme anxiety and fear of particular objects or situations. Common phobias include fear of flying, fear of spiders and other animals, and fear of injections.

Panic Disorder

Panic Disorder is characterised by the experience of repeat panic attacks – sudden surges of overwhelming fear and anxiety and physical symptoms such as chest pain, heart palpitations, dizziness, and breathlessness.


Agoraphobia involves intense anxiety following exposure to, or anticipation of, a variety of situations such as public transportation, open spaces, crowds, or being outside of the home alone.

Obsessive Compulsive Disorder (OCD)

Individuals with OCD have recurring, persistent, and distressing thoughts, images or impulses, known as obsessions (e.g. a fear of catching germs), or feel compelled to carry out certain repetitive behaviours, rituals, or mental acts, known as compulsions (e.g. hand-washing). These thoughts and acts can take over a person’s life and while people with OCD usually know that their obsessions and compulsions are an over-reaction, they are unable to stop them.

Social Anxiety Disorder

In social anxiety disorder the person has severe anxiety about being criticised or negatively evaluated by others. This leads to the person avoiding social events and other public situations for fear of doing something that leads to embarrassment or humiliation.

Post-Traumatic Stress Disorder (PTSD)

PTSD refers to a set of symptoms that can occur after exposure to a frightening and traumatic event. Symptoms include a sense of reliving the traumatic event (through ‘flashbacks’ or nightmares), avoidance of places, people, or activities which remind the person of the event, feeling numb or detached from others, having negative thoughts about oneself and the world, feeling irritable, angry, or wound up, and having trouble sleeping.

What causes anxiety disorders?

Whilst there is no single known cause of anxiety disorders, there are a number of risk factors or triggers that may contribute. These differ between the different anxiety disorders too. In general, the following factors may play a role:

  • Genes: certainanxiety disorders appear to have a genetic component, with some anxiety disorders running in families.
  • Physical health: Poor physical health can increase a person’s vulnerability to developing symptoms of anxiety.
  • Thinking style: patterns of thinking characterised by anticipating the worst, persistent negative self-talk, low self-esteem, and unhelpful coping strategies (e.g., avoidance) are linked to problem anxiety.
  • Stress: stressful eventssuch as a marriage breakdown, work or school deadlines, financial hardship can act as a trigger for anxiety.

Treatments that work

Cognitive-behavior therapy (CBT) has been found to be the most effective treatment for anxiety disorders. CBT is a type of psychotherapy that helps an individual to change unhelpful thoughts and behaviours which can contribute to anxiety.  CBT combines some of the following strategies for identifying and challenging unhelpful thoughts:

Problem solving

Problem-solving skills can help a person cope with situations or thoughts that are making them stressed or anxious. Structured problem solving involves identifying the problem, developing and selecting a solution to the problem, implementing the solution, and evaluating its helpfulness.

Exposure therapy

In exposure therapy the psychologist guides the person through a series of real or imaginary scenarios to confront specific fears. Through a gradual process of exposure, the person learns to cope more effectively with these fears, and with practice, the anxious response naturally decreases.

Cognitive restructuring

Feelings of anxiety sometimes stem from an individual’s negative or unhelpful thoughts. Cognitive restructuring is a technique used by psychologists to help a person to challenge negative thoughts and develop more helpful and constructive ways of thinking.


In mindfulness-based therapy, distress about the experience of anxiety, rather than anxiety itself, is the focus. As such, the psychologist assists the person to focus on the bodily sensations and thoughts that arise when he or she is anxious, and instead of avoiding, withdrawing or fighting against these symptoms, he or she remains present and aware of them. As a result, the person becomes more open and accepting of the thoughts and sensations associated with anxiety and less overwhelmed by them, enabling them to engage more fully with life.


Many individuals who experience high levels of anxiety often report that they have trouble relaxing. Learning a form of relaxation, such as meditation or progressive muscle relaxation, and practicing it regularly, has been found to be an effective treatment for anxiety.

In addition to the above psychological techniques, making simple changes to a person’s lifestyle can help lower stress and anxiety. Including regular exercise, lowering or eliminating alcohol and caffeine, engaging in enjoyable activities, improving time-management skills, and having adequate sleep can help to lower anxiety.

How a counselor can help

Through discussion with the client and the possible use of questionnaires, the counselor develops an understanding of the potential factors that might be contributing to the client’s anxiety. A treatment plan is then developed by the counselor together with the person. For anxiety disorders, this can involve CBT, mindfulness, exposure therapy, relaxation and other helpful strategies.

The counselor might also assist the person to address any lifestyle factors which may increase his or her capacity to better manage difficulties, and reduce symptoms of anxiety. They may also suggest involving a supportive family member or friend to assist in the understanding of the person’s situation and to support treatment.

When to seek professional help

If anxiety is affecting a person’s work, school, home life, or relationships, psychological assistance should be considered.


The word ‘trauma’ is derived from the Greek term for ‘wound’. Very frightening or distressing events may result in a psychological wound or injury – a difficulty in coping or functioning normally following a particular event or experience. Everyone’s reaction is different, but most people who experience a potentially traumatic event will recover well with the help of family and friends and will not experience any long-term problems. If people do develop problems, they may appear directly after the traumatic event or they may not emerge until much later.

What is a potentially traumatic event?

Potentially traumatic events are powerful and upsetting incidents that intrude into daily life. They are usually defined as experiences which are life threatening, or where there is a significant threat to one’s physical or psychological well being.

The same event may have little impact on one person but cause severe distress in another individual. The impact that an event has may be related to the person’s mental and physical health, level of available support at the time of the event, and past experience and coping skills.

Situations and events that can lead a person to experience psychological trauma include:

  • Acts of violence such as an armed robbery, war or terrorism
  • Natural disasters such as bushfire, earthquake or floods
  • Interpersonal violence such as rape, child abuse, or suicide of a family member or friend
  • Involvement in a serious motor vehicle or workplace accident.

Other less severe but still stressful situations can also trigger traumatic reactions in some people.

What are the symptoms of psychological trauma?

Many people have strong emotional or physical reactions following experience of a traumatic event. For most, these reactions subside over a few days or weeks. For some, the symptoms may last longer and be more severe. This may be due to several factors such as the nature of the traumatic event, the level of available support, previous and current life stress, personality, and coping resources.

Symptoms of trauma can be described as physical, cognitive (thinking), behavioural (things we do) and emotional.


  • Excessive alertness, on the look-out for signs of danger
  • Easily startled
  • Fatigue/exhaustion

Cognitive (thinking)

  • Intrusive thoughts and memories of the event
  • Visual images of the event
  • Nightmares
  • Poor concentration and memory
  • Disorientation
  • Confusion


  • Avoidance of places or activities that are reminders of the event
  • Social withdrawal and isolation
  • Loss of interest in normal activities


  • Fear
  • Numbness and detachment
  • Depression
  • Guilt
  • Anger and irritability
  • Anxiety and panic

As long as they are not too severe or last for too long, the symptoms described above are normal reactions to trauma. Although these symptoms can be distressing, they will settle quickly in most people. They are part of the natural healing process of adjusting to a very powerful event, making some sense out of what happened, and putting it into perspective. With understanding and support from family, friends and colleagues the stress symptoms usually resolve more rapidly. A minority of people will develop more serious conditions such as depression, post-traumatic stress disorder, anxiety disorders, or alcohol and drug problems.

Tips on managing psychological trauma

There are several things you can do to look after yourself and promote recovery from a traumatic event or situation. The following points provide some general advice.

  • Recognise that you have been through a distressing experience and give yourself permission to experience some reaction to it. Don’t be angry with yourself for being upset.
  • Remind yourself that you are not abnormal and that you can and are coping.
  • Avoid overuse of alcohol or other drugs to cope.
  • Avoid making any major decisions or big life changes.
  • Do not try to block out thoughts of what has happened. Gradually confronting what has happened will assist in coming to terms with the traumatic experience.
  • Don’t ‘bottle up’ your feelings – share your experiences with others when opportunities arise. This may feel uncomfortable at times, but talking to understanding people that you trust is helpful in dealing with trauma.
  • Try to maintain a normal routine. Keep busy and structure your day.
  • Make sure you do not unnecessarily avoid certain activities or places.
  • Allow yourself time to rest if you are feeling tired, and remember that regular exercise is important.
  • Let your friends and family know of your needs. Help them to help you by letting them know when you are tired, need time out, or need a chance to talk or just be with someone.
  • Make time to practise relaxation. You can use a formal technique such as progressive muscle relaxation, or just make time to absorb yourself in a relaxing activity such as gardening or listening to music. This will help your body and nervous system to settle and readjust.
  • If the trauma that you experience stirs up other memories or feelings from a past unrelated stressful occurrence, or even childhood experiences, try not to let the memories all blur together. Keep the memories separate and deal with them separately.
  • Express your feelings as they arise. Whether you discuss them with someone else or write them down in a diary, expressing feelings in some way often helps the healing process.

When to seek professional assistance

You should seek professional assistance if the symptoms resulting from the trauma are too distressing or last for more than a couple of weeks. Warning signs may include:

  • Being unable to handle the intense feelings or physical sensations
  • Feeling numb and empty
  • Continuing to experience strong distressing emotions
  • Continuing to have physical symptoms of being tense, agitated, and on edge
  • Continuing to have disturbed sleep and/ or nightmares
  • Having no-one to support you and with whom you can share your feelings and emotions
  • Having relationship problems with friends, family and colleagues
  • Increasing your use of alcohol or drugs.

How is psychological trauma treated?

Most people who experience a traumatic event will not require treatment. Most will work through their anxiety with support from close friends and family. However, for some people the response to the trauma can be debilitating and treatment from a trained mental health professional will be needed to help the person to recover.

Treatments for a severe trauma response include trauma-focused psychological interventions. These focus on providing education, stress management techniques, and helping the person to confront feared situations and distressing memories. Medication, particularly some of the new antidepressant drugs, can often be useful alongside trauma-focused psychological approaches.

Post-traumatic Stress Disorder (PTSD)

PTSD is a clinical condition that may develop in some people following exposure to a traumatic event. PTSD involves three main groups of symptoms:

  • Re-experiencing the trauma in the form of intrusive memories, nightmares or flashbacks
  • Avoidance of reminders and numbing of emotional responsiveness
  • Hyperarousal – feeling jumpy and on edge.

PTSD is very distressing and can lead to serious ongoing problems with social relationships and the ability to work or carry out normal daily activities. PTSD usually requires professional assistance as these problems tend not to resolve by themselves with the passage of time.

Depression, anxiety disorders (such as panic, phobias, and general anxiety) and alcohol or drug disorders may also develop following trauma in some people. These conditions may occur with, or in the absence of, PTSD.


What is Addiction?

Addiction is a condition that results when a person ingests a substance (e.g., alcohol, cocaine, nicotine) or engages in an activity (e.g., gambling, sex, shopping) that can be pleasurable but the continued use/act of which becomes compulsive and interferes with ordinary life responsibilities, such as work, relationships, or health. Users may not be aware that their behavior is out of control and causing problems for themselves and others.

The word addiction is used in several different ways. One definition describes physical addiction. This is a biological state in which the body adapts to the presence of a drug so that drug no longer has the same effect, otherwise known as a tolerance. Another form of physical addiction is the phenomenon of overreaction by the brain to drugs (or to cues associated with the drugs). An alcoholic walking into a bar, for instance, will feel an extra pull to have a drink because of these cues.

However, most addictive behavior is not related to either physical tolerance or exposure to cues. People compulsively use drugs, gamble, or shop nearly always in reaction to being emotionally stressed, whether or not they have a physical addiction. Since these psychologically based addictions are not based on drug or brain effects, they can account for why people frequently switch addictive actions from one drug to a completely different kind of drug, or even to a non-drug behavior. The focus of the addiction isn’t what matters; it’s the need to take action under certain kinds of stress. Treating this kind of addiction requires an understanding of how it works psychologically.

When referring to any kind of addiction, it is important to recognize that its cause is not simply a search for pleasure and that addiction has nothing to do with one’s morality or strength of character. Experts debate whether addiction is a “disease” or a true mental illness, whether drug dependence and addiction mean the same thing, and many other aspects of addiction. Such debates are not likely to be resolved soon. But the lack of resolution does not preclude effective treatment.

Symptoms of Addiction

  • The cardinal symptom of addiction is the inability to limit use of a substance or activity beyond need leading to clinically significant impairment.
  • There is a craving or compulsion to use the substance or activity.
  • Recurrent use of the drug or activity escalates to achieve the desired effect, indicating tolerance.
  • Attempts to stop usage produce symptoms of withdrawal—irritability, anxiety, shakes, nausea.
  • Recurrent use of the substance or activity impairs work, social, and family responsibilities, creates psychological impairments and interpersonal problems, has negative effects on health, mood, self-respect, exacerbated by the effects of the specific substance itself.

There are many symptoms created by the specific substance/activity that is used.

All addictions have the capacity to induce feelings of shame and guilt, a sense of hopelessness, and feelings of failure. In addition, anxiety and depression are common conditions among those with substance and behavioral addictions.

Causes of Addiction

There are no specific causes of any addiction aside from use of a substance or activity, and there is no way to predict who will become dependent on use.

Any substance or activity that has the capacity to be pleasurable can provide the conditions for addiction.

All addictions impact various neural circuits of the brain, including those related to reward, motivation, and memory.

Treatment For Addiction

Addiction is a treatable condition. The first phase of treatment from is withdrawal from the problem substance/activity. There are both physical and psychological effects that occur when substance-taking stops, including such physical signs as nausea and vomiting, chills and sweats, muscle cramps and aches, sleeplessness, shifts in heart rate, even fever. Emotional effects include depression, anxiety, irritability, and mood swings. Withdrawal symptoms typically last three to five days. While they are rarely life-threatening, medical supervision is usually provided in residential treatment programs, and medications may be given to ameliorate the acute discomfort of withdrawal.

Behavioral therapy and counseling are important elements of treatment. Cognitive behavioral therapy is often used to help patients identify, avoid, and cope with situations in which they are most likely to abuse drugs or activities. The technique of motivational interviewing is often employed to remind people of their values, as a way of avoiding use. Family therapy may be provided to help the patient maintain a supportive environment and improve family functioning.

Rehabilitation programs are often needed to help patients regain necessary job and other skills.

Relapse of Addiction

Relapse is now seen as the rule rather than the exception in addiction recovery. And it is no longer viewed as a catastrophe but as an opportunity for learning more and better strategies for overcoming urges and for identifying the moods and situations that are likely to be difficult.

What is inappropriate is black-and-white thinking about success that turns a slip-up into a disaster and sees it as a sure sign of defeat. The fact is that it takes time to change all the mental apparatus that supports any particular habit-the memories, the situations that trigger craving, and more. Addiction changes brains, and it takes time to change brains back.

Compulsive and Addictive Behaviors

Addiction is not limited to biochemical substances such as cocaine, alcohol, inhalants, or nicotine. It is increasingly possible for people to experience so-called behavioral addictions. Activities such as gambling, eating, pornography viewing, and playing video games are particularly conducive to addiction because they provide the opportunity for immediate reward. The fast feedback that occurs in a gambling setting can quickly turn a pastime into a compulsive pursuit of reward, where one can’t voluntarily disengage from the activity and harmful consequences occur-from losing large amounts of money to disruption of relationships.

Similarly, the frequent cell phone texting that many young people do, in which they send and receive hundreds of messages a day, contains the conditions for addiction. Many observers contend that it is especially problematic because it can interfere with one of the major tasks of development-developing effective mechanisms of impulse control.


Codependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual’s ability to have a healthy, mutually satisfying relationship. It is also known as “relationship addiction” because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive. The disorder was first identified about ten years ago as the result of years of studying interpersonal relationships in families of alcoholics. Co-dependent behavior is learned by watching and imitating other family members who display this type of behavior.

Who Does Codependency Affect?

Codependency often affects a spouse, a parent, sibling, friend, or co-worker of a person afflicted with alcohol or drug dependence. Originally, codependent was a term used to describe partners in chemical dependency, persons living with, or in a relationship with an addicted person. Similar patterns have been seen in people in relationships with chronically or mentally ill individuals. Today, however, the term has broadened to describe any co-dependent person from any dysfunctional family.

What is a Dysfunctional Family and How Does it Lead to Codependency?

A dysfunctional family is one in which members suffer from fear, anger, pain, or shame that is ignored or denied. Underlying problems may include any of the following:

  • An addiction by a family member to drugs, alcohol, relationships, work, food, sex, or gambling.
  • The existence of physical, emotional, or sexual abuse.
  • The presence of a family member suffering from a chronic mental or physical illness.

Dysfunctional families do not acknowledge that problems exist. They don’t talk about them or confront them. As a result, family members learn to repress emotions and disregard their own needs. They become “survivors.” They develop behaviors that help them deny, ignore, or avoid difficult emotions. They detach themselves. They don’t talk. They don’t touch. They don’t confront. They don’t feel. They don’t trust. The identity and emotional development of the members of a dysfunctional family are often inhibited

Attention and energy focus on the family member who is ill or addicted. The codependent person typically sacrifices his or her needs to take care of a person who is sick. When co-dependents place other people’s health, welfare and safety before their own, they can lose contact with their own needs, desires, and sense of self.

How Do Codependent People Behave?

Co-dependents have low self-esteem and look for anything outside of themselves to make them feel better. They find it hard to “be themselves.” Some try to feel better through alcohol, drugs or nicotine – and become addicted. Others may develop compulsive behaviors like workaholism, gambling, or indiscriminate sexual activity.

They have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Codependents often take on a martyr’s role and become “benefactors” to an individual in need. A wife may cover for her alcoholic husband; a mother may make excuses for a truant child; or a father may “pull some strings” to keep his child from suffering the consequences of delinquent behavior.

The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the “benefactor.” As this reliance increases, the co-dependent develops a sense of reward and satisfaction from “being needed.” When the caretaking becomes compulsive, the codependent feels choiceless and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Codependents view themselves as victims and are attracted to that same weakness in the love and friendship relationships.

Characteristics of Co-dependent People Are:

  • An exaggerated sense of responsibility for the actions of others
  • A tendency to confuse love and pity, with the tendency to “love” people they can pity and rescue
  • A tendency to do more than their share, all of the time
  • A tendency to become hurt when people don’t recognize their efforts
  • An unhealthy dependence on relationships. The co-dependent will do anything to hold on to a relationship; to avoid the feeling of abandonment
  • An extreme need for approval and recognition
  • A sense of guilt when asserting themselves
  • A compelling need to control others
  • Lack of trust in self and/or others
  • Fear of being abandoned or alone
  • Difficulty identifying feelings
  • Rigidity/difficulty adjusting to change
  • Problems with intimacy/boundaries
  • Chronic anger
  • Lying/dishonesty
  • Poor communications
  • Difficulty making decisions

Questionnaire To Identify Signs Of Codependency

This condition appears to run in different degrees, whereby the intensity of symptoms are on a spectrum of severity, as opposed to an all or nothing scale. Please note that only a qualified professional can make a diagnosis of co-dependency; not everyone experiencing these symptoms suffers from co-dependency.

1. Do you keep quiet to avoid arguments?

2. Are you always worried about others’ opinions of you?

3. Have you ever lived with someone with an alcohol or drug problem?

4. Have you ever lived with someone who hits or belittles you?

5. Are the opinions of others more important than your own?

6. Do you have difficulty adjusting to changes at work or home?

7. Do you feel rejected when significant others spend time with friends?

8. Do you doubt your ability to be who you want to be?

9. Are you uncomfortable expressing your true feelings to others?

10. Have you ever felt inadequate?

11. Do you feel like a “bad person” when you make a mistake?

12. Do you have difficulty taking compliments or gifts?

13. Do you feel humiliation when your child or spouse makes a mistake?

14. Do you think people in your life would go downhill without your constant efforts?

15. Do you frequently wish someone could help you get things done?

16. Do you have difficulty talking to people in authority, such as the police or your boss?

17. Are you confused about who you are or where you are going with your life?

18. Do you have trouble saying “no” when asked for help?

19. Do you have trouble asking for help?

20. Do you have so many things going at once that you can’t do justice to any of them?

If you identify with several of these symptoms; are dissatisfied with yourself or your relationships; you should consider seeking professional help. Arrange for a diagnostic evaluation with a licensed physician or psychologist experienced in treating co-dependency.

How is Codependency Treated?

Because codependency is usually rooted in a person’s childhood, treatment often involves exploration into early childhood issues and their relationship to current destructive behavior patterns. Treatment includes education, experiential groups, and individual and group therapy through which codependents rediscover themselves and identify self-defeating behavior patterns. Treatment also focuses on helping patients getting in touch with feelings that have been buried during childhood and on reconstructing family dynamics. The goal is to allow them to experience their full range of feelings again.

When Codependency Hits Home

The first step in changing unhealthy behavior is to understand it. It is important for co-dependents and their family members to educate themselves about the course and cycle of addiction and how it extends into their relationships. Libraries, drug and alcohol abuse treatment centers and mental health centers often offer educational materials and programs to the public.

A lot of change and growth is necessary for the codependent and his or her family. Any caretaking behavior that allows or enables abuse to continue in the family needs to be recognized and stopped. The co-dependent must identify and embrace his or her feelings and needs. This may include learning to say “no,” to be loving yet tough, and learning to be self-reliant. People find freedom, love, and serenity in their recovery.

Hope lies in learning more. The more you understand codependency the better you can cope with its effects. Reaching out for information and assistance can help someone live a healthier, more fulfilling life.


Psychological support, necessary for almost all people as they make their ways through life, does not need to be a service paid for, or provided in the rooms of a meeting or counseling session, or even established by an official appointment to be healthy, healing or helpful. A conversation with an old friend or even the smile of a stranger might be enough of a spark of connection to be of psychological support to the person needing the assistance. Psychological support can be formal or informal, intimate or between relative strangers or an inner versus an outer-based experience. Regardless of its characteristics, it can be classified as supportive if it helps, instructs or reinforces a person’s coping skills.

Examples of formal types of psychological support systems could be a parenting class, meeting with a religious leader, a counseling appointment with a therapist or participation in a group meeting such as Alcoholics Anonymous®. Each of these interactions provides a means for a stressed or troubled person to express his feelings and garner feedback from other participants, the teacher or the counselor regarding appropriate and healthy responses. In some cases, simply receiving validation that he is not the only individual undergoing such stresses or feeling such emotions provides the psychological support. Other situations might require concrete action, instruction or feedback for the stressed person to process. Within such formal support systems, the individual is afforded the time for self-expression and learning helpful reactions in future situations.

Meeting a friend for lunch, having dinner with family or running with an exercise buddy are examples of informal types of psychological support situations. Psychological support can be as helpful informally as in formal situations if the stressed person is helped to cope with life situations in a healthy way. Often, the reinforcement of a person’s social support network is enough to provide positive feedback and supportive measures without discussing the details of a situation as might be expected in formal systems. It is often necessary to remind troubled individuals of the very real need and importance of an informal support system. These types of supports are often the first to be sacrificed in a busy lifestyle.

Formal and informal social support systems are not the only types of psychological support. Prayer, meditation or introspection can be of value if the stressed individual is a believer in a particular faith. Pets, too, can provide invaluable emotional and psychological support to those lucky enough to share a home with them. Those requiring such support need only reach out in most situations.

Life Transitions

Adjusting to change can be difficult, as even positive life transitions tend to cause some stress. Over the course of a lifetime, a person can expect to experience a significant amount of change. Some of these changes, such as marriages, births, and new jobs, are generally positive, although they may be accompanied by their own unique stressors. Other major life transitions, such as moving, retirement, or entering the “empty nest” phase of life may cause a significant amount of stress. Those who find themselves experiencing difficulty coping with life transitions may find it helpful to speak to a therapist in order to become better able to adjust to changes they cannot control.

How Can Change Be Beneficial?

Certain changes, such as entering school, starting a new job, or starting a family, can often be exciting, even when they cause some amount of stress, because they are generally considered to be positive changes. Many people look forward to obtaining a degree, rising in their chosen field, or having a home and family.

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Changes, and especially difficult changes, can influence personal growth, and dealing with a change successfully may leave one stronger, more confident, and better prepared for what comes next in life. In other words, even those changes that are neither expected nor wanted might still produce some beneficial outcome.

Change can encourage the development of skills or knowledge, and might also bring about greater awareness of a condition or group. For example, the family of a person diagnosed with schizophrenia might become more aware of severe mental health conditions and their effects. Or the parents of a child who comes out as gay might become interested in LGBTQIA issues and equal rights and work to increase awareness. Change can also make clear what is important in one’s life and allow for greater self-discovery and self-awareness.

The Holmes-Rahe Stress Inventory

In 1967, Thomas Holmes and Richard Rahe developed a social readjustment rating scale that was designed to roughly approximate a person’s likelihood of future illness based on his or her stress level. The scale is a list of common stressful events, both positive and negative, all of which are assigned a numerical value of “life-changing units.” For example, marriage, the basis for comparison, was assigned 50 life-changing units. Some other events on the scale include the death of a spouse, which has a value of 100 life-changing units, being fired (47), and revision of personal habits (24).

The scale was developed and validated by male subjects, but data from both male and female subjects in cross-cultural populations has provided fairly useful results and has shown correlations between stressful events and health concerns such as heart attacks, pregnancy complications, diabetes, and broken bones, as well as non-medical difficulties such as poor performance in school or work.

Because responses to stress can vary greatly between individuals, the scale is meant to be only an estimation of the ways that stress can affect life, not a predicting tool.

Coping with Change

Because change can cause stress, it can have an effect on one’s daily life. A person facing a big change might, for example, experience depression, anxiety, or fatigue; have headaches; develop trouble sleeping or eating well; or abuse drugs and alcohol. Persistent symptoms of stress might improve with treatment in therapy, but an individual may also be able to prevent some of these symptoms by:

  • Researching an upcoming change. Often, stress can develop out of fear of what is unknown. When one is well-informed about a change, it may be easier to face.
  • Attending to one’s physical and mental health. Being healthy in mind and body may make it easier to cope with changes in life. Sleeping well, exercising, and eating nutritional foods regularly may all be beneficial in improving both physical and mental health.
  • Taking time to relax. Remaining calm in spite of stress may be easier when one’s life is well-adjusted and includes time for leisure as well as work.
  • Limiting change. It may be helpful to avoid making a large change immediately after another change. Generally, adjusting to a change takes some time, and making multiple changes at once, even smaller ones, may not allow enough time for an adequate adjustment period, which can cause stress.
  • Discussing any difficulties adapting with another person. Family members may be able to help one adjust to change, but professional help may also benefit those experiencing difficulty or stress as a result of life changes.

Adjustment Disorder

A diagnosis of adjustment disorder can occur when a major life stress or change disrupts normal coping mechanisms and makes it difficult or impossible for a person to cope with new circumstances. According to the Diagnostic and Statistical Manual, symptoms of this condition tend to begin within three months of the stress or change and often include a depressed or anxious mood, changes in daily habits, feelings of overwhelming stress and panic, difficulty enjoying activities, and changes in sleeping or eating. For example, a man whose wife died suddenly might become anxious and panicked as he tries to cope with his new situation, finding it difficult to go on his typical daily walks or prepare meals.

This condition may also lead an individual to engage in reckless or dangerous behavior, avoid family and friends, or have thoughts of suicide. A diagnosed adjustment disorder generally indicates that a person is experiencing more emotional turmoil than others facing the same situation might experience. For example, a young woman who cries frequently after the death of her mother is likely experiencing distress typical to the major life change she has experienced, but a man who quits his job and stops speaking to his children after the death of his wife might be experiencing a significant amount of difficulty adjusting to his changed situation.

Therapy for Change

There is no particular treatment for adjusting to change, but several different tactics may be helpful. Talking about changes in life with a therapist, such as a marriage, the death of a family member, the loss of a job, or the approach of middle age, can be helpful to some. Any type of therapy is likely to be well suited to helping a person cope with dramatic changes in life.

When life changes prove difficult and lead to stress, anxiety, or depression, a therapist can also help treat those issues and help one explore coping strategies. When people know that they do not cope well with change, speaking with a therapist before any significant changes in life occur may be warranted. In this way, one can prepare for changes and become better able to face them in the future, even without prior knowledge of potential changes.

Support groups and group therapy sessions also might benefit some individuals who have experienced a particular type of change, such as a life-altering illness or disability or a divorce.


Individual therapy—also known as psychotherapy, talk therapy, or counseling—is a collaborative process between therapist and client that aims to facilitate change and improve quality of life. Therapy can help people confront barriers that interfere with emotional and mental well-being, and it can also increase positive feelings such as compassion, self-esteem, love, courage, and peace. Many people find they enjoy the therapeutic journey of becoming more self-aware, and they may pursue ongoing psychotherapy as a means of self-growth and self-actualization.

What Does Individual Therapy or Psychotherapy Treat and When Is It Recommended?

Psychotherapy can treat specific, diagnosable mental health conditions such as anxiety, depression, or ADHD, in addition to everyday concerns, such as relationship problems, stress management, career ambitions, or other issues that may affect a person’s mental well-being.

When specific issues or mental health conditions begin to cause distress and interfere with a person’s normal activities, it may be time to seek therapy. Distress can manifest in the form of problematic beliefs, feelings, behaviors, and sensations in the body. A therapist can facilitate lifestyle changes, serve as a listening ear, help identify underlying causes of symptoms, and provide specific strategies or techniques for changing unwanted thoughts, behaviors, or emotions. Through therapy, people gather tools to manage symptoms, alleviate stress, and face challenges.

Who Provides Psychotherapy and How Does It Work?

A number of specialists can provide psychotherapy to clients, and qualifications to be a psychotherapist are generally determined by a state licensing board. In most cases, therapists have at least a master’s degree, though students in the process of obtaining a master’s degree may perform therapy under the direction of a supervisor. Therapist titles include licensed marriage and family therapist (LMFT), licensed clinical social worker (LCSW), psychologist, and licensed professional counselor (LPC).

There are many different types of therapy and psychological approaches to understanding and helping, and therapists may use a single treatment approach, or combine several. These treatment approaches are called modalities, and examples of psychotherapeutic modalities include humanistic, cognitive behavioral, emotionally focused, feminist, and psychoanalytic.

How Are Therapy Goals, Frequency, and Duration Determined?

In general, the goal of psychotherapy is to talk through mental health issues and help clients heal, grow, and move toward more productive, psychologically healthy lives. Good therapy is client-driven, and specific goals for therapy will be determined by you and your therapist.

Individual psychotherapy sessions typically last between 45 and 60 minutes. The frequency and duration of therapy will depend largely on your needs, treatment goals, and progress. Many concerns are readily resolved with short-term therapy, and other chronic or more complex concerns require long-term commitment before improvement is realized.

Is Psychotherapy an Effective Form of Treatment?

Ultimately, the individual’s desire and determination to heal play an essential role in whether psychotherapy is successful. Finding the right therapist is also an important component of effective therapy.

Research has shown that psychotherapy results in fewer relapses of common conditions such as moderate depression and anxiety, and that the positive effects of good therapy extend well beyond treatment. In fact, many clients report improved conditions long after therapy has ended. In general, psychotherapy is often more effective than psychotropic drugs or medical treatments alone, which may cause harmful side effects. In addition, many therapeutic modalities are evidence-based, meaning they have been subject to research studies and clinical observations, and they have been analyzed for effectiveness.

History of Psychotherapy

The term psychotherapy is derived from the Greek words for soul and healing. The ancient Greeks were probably the first to treat mental health conditions as ailments rather than as a result of demonic possession as was common in other cultures at the time. Unfortunately, treatments for severe mental health concerns were harsh and inhumane for many centuries before reformers lobbied for improved conditions beginning in the 18th century.

While it’s likely that informal types of psychological counsel were practiced throughout time, modern psychotherapy developed toward the end of the 19th century in Western Europe. The first laboratory for psychological research was established by Wilhelm Wundt, and Sigmund Freud’s “talking cure” laid the foundation for psychoanalysis. A number of psychotherapeutic techniques flourished in the 20th century, inspired by the dominant paradigm of the day, such as behaviorism, established in the 1920s, and existentialism, which took root in the 1950s. Today’s psychological treatments are innumerable and varied, incorporating such diverse fields as mindfulness and neurobiology.


Couples or marriage counseling is offered to support people in relationship who may be considering separation or seeking improved intimacy and understanding. In couples counseling, the relationship is the focus, although each partner should also expect to focus on self-improvement and self-awareness.

When Is Couples or Marriage Counseling Recommended?

People in relationship seek counseling for any number of reasons, from power struggles and communication problems, to sexual dissatisfaction and infidelity. Though counseling is recommended as soon as discontent arises in a relationship, studies show that on average, partners will not seek therapy until they have been unhappy for six years. And yet, the more time has passed, the more difficult it may be to repair the relationship. In some cases, a couple who has already decided to separate may pursue therapy in order to end the relationship amicably and respectfully.

Effective therapy will likely address many aspects of the relationship, although communication tends to be the primary focus of relationship therapy. When partners repeatedly employ conflict avoidance or engage in heated power struggles, communication problems ensue; resentment builds, and repairs are never made. John Gottman, who collected decades’ worth of data on marriage and relationships, identified that the lack of adequate repair following an argument is the biggest contributor to marital unhappiness and divorce. Counselors know that one of the first steps in improving a relationship is to teach each person how to regulate their emotions, stay calm, and use healthy communication skills to resolve problems new and old, and many partners see their communication improved as a result of counseling.

Expectations and Goals

Successful therapy depends on each partner’s motivation and dedication to the process, and couples can expect to become better listeners and communicators and to find new ways to support one another. Goals will be established by the couple under the guidance of the therapist, and in order to achieve these objectives, each partner must be prepared to acknowledge and understand his or her role in the relationship. It is not uncommon for conflict to arise within therapy sessions, but ethical therapists will strive to remain neutral and avoid taking sides.

Some relationship counselors offer supplemental individual sessions to each partner as a matter of course, and some may offer individual sessions upon request. Therapists who specialize in relationship counseling are likely to have a marriage and family therapist license (MFT).

Frequency, Duration, and Effectiveness

Relationship counseling is often held once per week, but this may vary depending on your therapy goals and whether you are also attending individual or group therapy sessions. Some relationship counselors offer supplemental individual sessions to each partner as a matter of course, and some may offer individual sessions upon request. Couples and marriage counseling is offered in a wide variety of settings, including private practices, university counseling centers, and group practices. Counseling is often short-term, though healing takes time, and ultimately, the therapy will proceed for as long as the couple is committed to seeing it through or until resolution is reached.

Research evaluating changes in marital satisfaction after therapy indicated that approximately 48% of couples demonstrated either improvement or full recovery in relationship satisfaction at five-year follow-up. Relationship deterioration resulted for 38% of couples and 14% remained unchanged.

History and Types of Relationship Counseling

When relationship counseling was in its infancy in the United States in the 1930s, it was known as marriage counseling and reserved for people who were already married or engaged to be married. Marriage counselors educated clients about marriage and family life, and partners were rarely seen conjointly. The field was transformed with the emergence of family therapy and the increase in divorce rates in the 1960s and 1970s; conjoint therapy became the norm, and modern couples counseling evolved. Present-day couples counseling was heavily influenced by family therapy, which was designed to treat the family system and all members in it. Family therapy pioneers such as Murray Bowen and Virginia Satir helped shape the profession.

Presently, there are a multitude of different approaches to relationship counseling. For example, Imago Therapy explores how we unconsciously choose partners who reflect back the very things that we must work on ourselves. Emotionally focused therapy encourages partners to examine how communication styles or attachment experiences present themselves in interactions. Through Internal Family Systems Therapy (IFS), individuals learn to heal trauma and find balance by identifying the different parts of themselves, acknowledging that some parts may be overactive or ignored, and taking responsibility for their reactions and emotions. This allows partners to better understand the patterns that play out in their relationship and to better understand one another.


Family therapy or family counseling is designed to address specific issues that affect the psychological health of the family, such as major life transitions or mental health conditions. It may be used as the primary mode of treatment or as a complementary approach.

The Benefits of Family Counseling

Families can benefit from therapy when they experience any stressful event that may strain family relationships, such as financial hardship, divorce, or the death of a loved one. In addition, it can be effective in treating mental health concerns that impact the family as a whole, such as depression, substance abuse, chronic illness, and food issues, or everyday concerns, like communication problems, interpersonal conflict, or behavioral problems in children and adolescents.

Family counseling aims to promote understanding and collaboration among family members in order to solve the problems of one or more individuals. For example, if a child is having social and academic problems, therapy will focus on the family patterns that may contribute to the child’s acting out, rather than evaluating the child’s behavior alone. As the family uncovers the source of the problem, they can learn to support the child and other family members and work proactively on minimizing or altering the conditions that contribute to the child’s unwanted behavior.

Meeting with a Family Therapist

Family counseling is provided by licensed marriage and family therapists (LMFT). Other mental health professionals—such as professional counselors, social workers, and psychologists—who have received formal training in family therapy approaches may incorporate those principles into their own work.

This mode of therapy is solution-focused and short-term, with as few as nine sessions required, on average. Meetings are often held once per week and typically last for 50 minutes. The number of family members who attend each session may vary, depending on therapy goals, and often a therapist will offer individual sessions to supplement the family sessions. Family counseling is conducted in a variety of settings including family counseling services, community agencies, and residential treatment centers.

Family Therapy Approaches

Most forms of family counseling borrow heavily from systems theory, though there are others based on psychological approaches such as experiential, cognitive-behavioral, and psychodynamic. Family systems therapy contends that the internal dynamics of the family system can produce and sustain problematic behaviors in family members. All family therapy approaches are designed to help families improve communication, problem-solving, and coping skills, and enhance their sense of connection to one another.

History of Family Therapy

Elements of family therapy can be found in the family-focused social work of the early 20th century and the work of child psychoanalysts, such as Nathan Ackerman, in the 1930s. But it wasn’t until the late 1950s that family therapy was developed in earnest, as many psychiatrists and psychoanalysts—including Virginia Satir, Murray Bowen, Milton Erickson, and Jay Haley—were seeking a novel, alternative approach to traditional individual therapy. Family therapy was formally accepted in the psychotherapeutic community in the 1960s and has continued to evolve over the years.


Parenting, though rewarding, may still be one of the most difficult and time-consuming aspects of a person’s life. In addition to tending to an infant or child’s daily needs, parents are also generally responsible for teaching each of their children life skills and helping them develop social skills and appropriate behaviors, while accounting for the unique personality of each child. Parents who become overwhelmed may find the support of a mental health professional to be helpful, particularly when faced with a difficult situation or behavioral concern.

What Is Good Parenting?

Most parents will, from the moment that a pregnancy is announced, receive multiple suggestions and pieces of advice on how to raise their child. Pediatricians provide information to new mothers regarding the health and safety of infants, various media sources offer extensive and often conflicting advice on childrearing, and one’s family members may have widely varied opinions on what is best for a child.

New parents may often be overwhelmed by this advice and, unsure of what is best for their child, turn to a pediatrician, therapist, or other health professional for advice. Experts in the field of child psychology and development generally agree that there is no one method of parenting that is “best” and that parents may wish to try different styles of parenting to see what works for their family. While extensive research and studies generally back the advice that is given by pediatricians and other health professionals–such as that encouraging parents to place infants to sleep on their backs to reduce the risk of SIDS–other advice may be less valid. Regardless of where the advice came from, parents may wish to speak to a health care professional before following any advice that makes them uncomfortable in any way.

According to the National Institute of Child Health and Human Development, parents are generally responsible for:

  • Keeping children safe.
  • Listening to children and spending time with them.
  • Providing affection, order, and consistency.
  • Setting and enforcing limits for children.
  • Monitoring friendships children make.
  • Seeking help for any medical or behavioral concerns.

Understanding the Challenges of Parenting

Raising a child can be difficult for many reasons. Caring for a child, especially an infant or toddler, can take up a significant amount of time, and it may be challenging to maintain strong relationships with one’s spouse or romantic partner, or with friends, while raising a young child.  Many parents face financial challenges or find it difficult to coordinate schedules and arrange child care. A parent who stays home with a child or children may feel overworked in the home and resent the other parent for working outside the home, which may put strain on a partnership. Parenting is also often physically demanding: Some parents with young children spend a significant part of their day cleaning, doing laundry, and performing other household tasks, and many report insufficient sleep.

Parenting may become even more difficult when a child exhibits signs of a behavioral challenge, physical or intellectual disability, or mental or physical illness. It may be especially difficult to cope when a child who requires extensive medical treatment or other extra care is not the only child in the home, and parents may find it difficult to give all children equal amounts of attention. This may lead some parents to experience guilt along with greater levels of stress.

Research has shown that when parents are not united, do not communicate well, or otherwise send confusing messages to children, it may be difficult for children to understand what is expected of them. The child may react to this inconsistency with misbehavior, creating further challenges for parents. Thus, child psychologists and other specialists emphasize the importance of presenting a cohesive parenting team.

The Influence and Limitation of Parents

A parent is often the most influential person in a child’s life, even after the child becomes an adult, and children will often look to their parents for guidance on ethical and moral topics as well as the typical concerns of daily life. Because a parent’s behavior, ideas, and beliefs will often largely influence those of their children, especially in a child’s early years, the biases and prejudices of a parent are often learned by the child.

Children who overhear parents using language that implies a certain group of people is somehow lesser than other groups, making disparaging remarks about other individuals, or giving voice to negative and stigmatizing beliefs about other people may adopt these attitudes as part of their own beliefs. Similarly, a parent’s religious and political views often become the child’s views, at least until the child is of an age to question belief systems. This may only be concerning when a parent strongly encourages a child to support the parent’s beliefs and discourages the child from seeking out other ideas, as this can lead a child to develop a limited worldview and be less likely to seek out other viewpoints in adulthood.

A child will typically also learn attitudes of acceptance from parents. When a child is raised in a household that embraces equality and diversity, by parents who do not discount the ideas and viewpoints of others, it is likely that the child will grow up to be accepting of all people and experiences.

A parent’s influence is often limited, however. Children learn new ideas from friends, from the media, and at school. A traumatic event may also impact a child’s development or behavior, and peer pressure can lead a child to develop a problematic behavior in spite of a parent’s efforts to keep the child safe. Many parents choose to use their own parents’ style or method of parenting, believing that what worked for them will work for their own children. However, each child and family is different, and a particular method of parenting may not work for all children.

Many parents continue to offer support and guidance to children who have reached adulthood, especially in the case of a child who is coping with a chronic or temporary issue. However, some adult children may resent what they see as continued parental influence and refuse assistance. Some children may engage in risky or destructive behaviors, and parents may be unable to reach them or be unsuccessful when encouraging them to seek help. This powerlessness is likely to be difficult and distressing for parents, but a therapist or other mental health professional can help parents explore ways to cope with these circumstances or reach out to their children, when possible.

Parents coping with issues outside the home, in their personal relationships, or with finances or health may find the challenges of parenting especially stressful and difficult to cope with at times, especially when a child is also facing an issue.

Single Parenting

The number of single-parent households in the United States is increasing. Some parents are single by choice, while others may lose a spouse or partner through death or separation. A single parent often experiences increased stress due to an increased amount of parenting responsibility. When a parent suddenly becomes single, children may be traumatized and have difficulty coping with the loss of the other parent, which can often lead to behavioral difficulties. When divorced parents share custody of children, the children may find that rules and routines differ from one house to the next, and this inconsistency may be difficult for them to adapt to. Single parents might find it difficult to enforce rules and discipline children without support, and they may also experience the added stress of financial difficulties.

Single parents, especially those with small children in the home, may find it challenging to meet potential romantic partners and go out on dates. This may lead to isolation and loneliness, and conditions such as depression and anxiety may develop, causing further stress in a person’s life. Staying connected with relatives and friends, creating a support system, and making time for self-care as well as child care are all ways that single parents may be able to cope with challenges and reduce stress in their lives. When specific challenges arise, a therapist may be able to help an individual address those concerns.

Therapy for Parents

Counseling and therapy can help parents in various ways. Some parents may become stressed by a particular parenting challenge, be it a one-time event or recurring situation. When a child faces a mental health concern or behavioral issue, a parent may find help for the child but leave their own emotions and feelings unaddressed. This can be harmful in some cases, as stress may accumulate and leave the parent overwhelmed. In therapy, a parent can address their feelings about a certain issue, find support and guidance, and seek professional help for parenting issues and concerns.

Parents may seek out a therapist that specializes in child development or behavioral health concerns or a family therapist to address issues affecting the whole family. Family therapy may be helpful because each member of the family can bring up individual concerns that connect to the family dynamic, and parents can become aware of issues that need to be addressed and resolved.

Individual therapy can also be helpful, and some parents may find that couples counseling can also strengthen their parenting skills, as strengthening their partnership may help couples become better able to resolve disagreements about childrearing or family life.

When parenting issues lead to stress, this stress may manifest itself through worry, depression, irritability, or anger. Some situations, such as the loss of a child or partner, may lead to grief, depression, or post-traumatic stress. When these conditions go untreated, the well-being of any other children may be affected. Therapy can help address and treat these issues. A therapist or other mental health professional is also likely to encourage parents to make time for themselves whenever possible and maintain a self-care routine.

Some parents have mental or emotional issues of their own that make parenting particularly challenging. For example, parents with conditions such depression, bipolar, or schizophrenia may find that the normal stresses of parenting are difficult to handle without help, and they may worry that the well-being of their children will be negatively impacted as they attempt to cope with their condition. Individual therapy that reduces the symptoms of an individual’s condition can reduce worry in this area as parents work to achieve wellness.

A parent with anger management or control issues may find therapy helpful for developing healthy and safe ways to address and manage thoughts and emotions and thus become better able to communicate with a partner or child.

Parenting while Coping with Mental Health Concerns

Statistics reported in 2014 show that about one in six parents will experience a mental health concern, with single parents being twice as likely to have some sort of mental health issue. Past the age of 35, women are more likely than men to experience a mental health concern. Financial status can also play a part: Those in lower socioeconomic groups are statistically more likely to experience mental health issues. Further, being part of a lower socioeconomic group and facing a mental health challenge are both factors that put a person at higher risk for substance abuse and other health concerns.

About one in six parents will experience a mental health concern.Parents, especially single parents, who are coping with a mental health concern may feel isolated, helpless, and hopeless. They may be afraid to seek help out of shame, embarrassment, or worry that disclosure of their condition may lead to custody battles or the loss of their children. Parents may feel guilty because they are not well, and they may find it exhausting to complete chores or care for children. Many individuals experiencing a severe mental health concern find it difficult to work; leave the house; or provide their children with necessities, guidance, or affection.

Treatment can help parents address and resolve many of their concerns. A therapist, counselor, or other health professional can work with parents to develop strategies and methods to get through the times when they are most affected by their condition, and therapy to address the issues causing their condition can often help reduce symptoms or even eliminate them. Therapy can be beneficial in the treatment of any issue faced by parents but may be especially helpful when a parent has an underlying issue that affects the parent’s ability to care for a child. When parents are able to address and treat issues affecting their health, they are likely to find themselves better prepared to face the varied challenges of raising a child.


As children and adolescents grow, they are constantly in the process of developing the social skills and emotional intelligence necessary to lead healthy, happy lives. When children experience emotions or engage in behaviors that interfere with their happiness and ability to thrive, they may benefit from meeting with a mental health professional such as a therapist or counselor. Parents and children often attend therapy sessions together in order to create a safe space to address what everyone is experiencing in order to grow together and live more happily as a family.

Developmental Stages from Birth to Adolescence

As they grow, children will experience changes in their moods and behaviors. Some of these changes are relatively predictable and, though they may be challenging, most are completely normal aspects of child development. In general, as long as children are behaving in ways that are consistent with their age range, the challenges they experience should not create cause for concern.

There are many theories addressing the developmental phases that children go through, and recognizing these phases can be invaluable to parents and caregivers in understanding child behavior and developmental needs. Erik Erikson’s theory outlining the stages of psychosocial development from birth to adulthood is one of the most widely recognized stage-based theories. Erikson, an influential developmental psychologist, identified eight stages in life, five of which take place in childhood and adolescence:

  • Infancy: Trust vs. Mistrust. In the first stage of human development, infants explore the world and learn whether their environment is a safe, predictable place. Infants require a significant amount of attention and comforting from their parents, and it is from the parents that they develop their first sense of trust or mistrust.
  • Early Childhood: Autonomy vs. Shame and Doubt. In the second stage of psychosocial development, children begin to assert independence, develop preferences, and make choices. Defiance, temper tantrums, and stubbornness are common. It is in this stage that a person first begins developing interests, a sense of autonomy, and shame or doubt.
  • Preschool Years: Initiative vs. Guilt. In this stage, children learn about social roles and emotions. They become active and curious. Imaginary play is a crucial part of this stage. Defiance, temper tantrums, and stubbornness remain common. As they develop, children will begin exhibiting behaviors of their own volition. The way parents and caregivers react will encourage a child’s initiative to act independently or cause the child to develop a sense of guilt about inappropriate actions.
  • School Age: Industry (Competence) vs. Inferiority. Relationships with peers and academic performance become increasingly important in this stage. Children begin to display a wider and more complex range of emotions. This is a time when problems or disappointment in academic and social settings may lead to mental health conditions such as depression or anxiety. As academic and social tasks become more demanding, conditions such as attention-deficit hyperactivity and oppositional behavior may interfere.
  • Adolescence: Identity vs. Role Confusion. Adolescents become more independent and begin to form identities based on experimentation with new behaviors and roles. Puberty usually occurs during this stage, bringing with it a host of physical and emotional changes. Changes during these often volatile adolescent years may strain parent-adolescent relationships, especially when new behaviors go beyond experimentation and cause problems at school or home, or if emotional highs and lows persist and lead to experiences such as anxiety or depression.

Triggers and Risk Factors

Each developmental phase presents specific challenges for children that they tend to work through as normal parts of growing up. Mental health problems can exacerbate these challenges, though, and in many cases, mental health issues arise as a direct result of events in a child’s life, whether those events are traumatic experiences such as being bullied or ordinary experiences such as moving to a new home.

Every child will respond differently to changes in life, but some of the events that may impact a child’s mental health include:

  • Parental divorce or separation.
  • The birth of a sibling.
  • The death of a loved one, such as a family member or a pet.
  • Physical or sexual abuse.
  • Poverty or homelessness.
  • Natural disaster.
  • Domestic violence.
  • Moving to a new place or attending a new school.
  • Being physically or emotionally bullied.
  • Taking on more responsibility than is age-appropriate.

A child’s age, gender, and other factors will influence his or her resilience to changes and challenges in life. Younger children and boys, for example, often have an easier time adjusting to divorce than do girls or older children. Genetics play a role, too, as some mental health issues, such as bipolar, tend to run in families.

Child and Adolescent Mental Health Issues

According to the National Institute on Mental Illness (NAMI) about 4 million children and adolescents experience a mental health issue that significantly impairs them at home, school, or in their social groups. The Centers for Disease Control and Prevention (CDC) estimates prevalence rates for the following diagnosable mental health conditions among children ages 3 to 17:

  • Attention-deficit hyperactivity (ADHD): 6.8%
  • Behavioral conditions: 3.5%
  • Anxiety: 3%
  • Depression: 2%
  • Autism: 1.1%
  • Tourette syndrome: 0.2%

These mental health conditions represent a portion of those experienced by children and adolescents, but they are certainly not inclusive of all conditions experienced.

Child abuse and neglect are also prevalent concerns among the various stressful life events that can lead to mental health challenges. The U.S. Department of Health and Human Services recorded 686,000 cases of child maltreatment in the year 2012 alone. Children who are abused or neglected may be unable to share what they have experienced due to overwhelming fear or shame. However, most professionals who work with children—including therapists—are mandated by law to report child maltreatment to appropriate authorities, regardless of any agreements about confidentiality.

When children reach adolescence, relationships, romantic or otherwise, can be a point of significant strife. Relationships between parents and children are crucial to healthy development, but may become strained by the many ups and downs of adolescent life. For example, most teenagers worry about romantic relationships. However, for some teenagers, worrying about relationships may excessively drain their energy and make it difficult to enjoy life.

Disordered eating, a condition that, according to the American Academy of Child and Adolescent Psychiatry, affects about 10% of young women in the United States, may be attributed in part to the social pressures and stress of adolescent life. Two common forms of this condition, anorexia nervosa and bulimia, are more common in the female population but also occur in the adolescent male population. According to Dr. Kim Dennis, CEO and medical director for residential treatment center Timberline Knolls, disordered eating also frequently co-occurs with substance abuse.

When searching for a therapist or counselor, it may help to seek advice from a school counselor or pediatrician who can refer you to someone with specialized training and experience in working with youth. Treatment, whether it’s medication or therapy or a combination of both, works for many adolescents experiencing mental health issues, but it must be accessed in order to work. In late 2009, a study partially funded by the National Institute on Mental Health found that only about half of all children and adolescents experiencing generalized anxiety, panic, disordered eating, depression, attention-deficit hyperactivity (ADHD), and conduct issues actually received professional mental health services. The study also found that while prevalence rates were roughly the same across races, fewer African-Americans and Mexican-Americans were likely to seek help, which indicates gaps in access and/or barriers to treatment among minority adolescents.

Substance Use in Adolescents

Experimentation with alcohol and drugs is fairly common among adolescents and can lead to serious developmental, social, and behavioral issues. The CDC has estimated the following prevalence rates for problems associated with substance use among adolescents ages 12 to 17:

  • Problematic illegal drug use: 4.7%
  • Problematic alcohol use: 4.2%
  • Physical dependence on cigarettes: 2.8%

Many programs exist for adolescents that experience problems associated with use of drugs or alcohol. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that supportive caregivers be involved in treatment for adolescent substance use. Supportive caregivers can play an important part in treatment by monitoring the adolescent’s use of substances, holding them accountable to therapy goals, and by helping find new and healthy ways to cope with the stress or conditions that may have led to substance use. SAMHSA also recommends that treatments address other mental health conditions that may co-occur in the adolescent receiving care. In some cases, residential treatment programs may prove beneficial. Residential treatment provides a safe, supportive environment and medical supervision, promotes camaraderie among residents, and removes residents from their daily lives where triggers may compel them to continue using substances.

Other examples of treatments for adolescent substance abuse may include:

  • Teen Intervene: This is a fairly brief intervention for teens who show early signs of problems with drugs or alcohol. The treatment helps adolescents set goals and recognize their own values that may help them avoid using drugs and/or alcohol. The treatment also helps adolescents identify healthy coping strategies for dealing with stress without the use of substances.
  • Adolescent Community Reinforcement: This treatment approach addresses substance use by identifying factors from the adolescent’s life and family that may have led to substance use. The treatment then helps the family develop a support system for the adolescent trying to move away from substance abuse.
  • Multisystemic Family Therapy: This is a highly-individualized treatment that works to address problems that may occur at school, home, or in friendship circles. A combination of therapeutic approaches, including behavioral, cognitive behavioral, and family therapies are used to help families address substance use and other mental health conditions that occur for the adolescent in treatment.

Therapy and Counseling for Youth

Many types of therapy emphasize talking and thinking about feelings and experiences, which can be particularly challenging for young children. In working with children, counselors often use therapies that allow children to express themselves non-verbally, such as play therapy, sand tray therapy, and art therapy. In some cases, eye movement desensitization and reprocessing therapy (EMDR), which relies very little on verbalization of experiences, can be appropriate for work with youth.

Youth of any age may feel uncomfortable, afraid, or ashamed about communicating what they are experiencing to an adult they do not know. If you are a parent or caregiver, these tips can help when talking to children about therapy and mental health treatment:

  • Find a good time to talk and assure them that they are not in trouble.
  • Listen actively.
  • Take your child’s concerns, experiences, and emotions seriously.
  • Try to be open, authentic, and relaxed.
  • Talk about how common the issues they are experiencing may be.
  • Explain that the role of a therapist is to provide help and support.
  • Explain that a confidentiality agreement can be negotiated so children—especially adolescents—have a safe space to share details privately, while acknowledging that you will be alerted if there are any threats to their safety.

When searching for a therapist or counselor, it may help to seek advice from a school counselor or pediatrician who can refer you to someone with specialized training and experience in working with youth. Some therapists specialize in family therapy, in which multiple family members may attend sessions together, as well as independently, if necessary. There are also treatments designed to address parenting skills, such as parent-child interaction therapy. These treatments may be useful when a child’s behavior becomes difficult to manage.

Medication and Therapy for Children and Adolescents

Many prominent bodies of research highlight the efficacy of a combined treatment approach, or the use of both medication and therapy, when medication is prescribed by a physician or psychiatrist for a mental health issue. In fact, the American Psychological Association’s Practice Guidelines Regarding Psychologists’ Involvement in Pharmacological Issues encourages, whenever possible, to include psychotherapy when medication is prescribed. Many mental health professionals argue that medication is over-prescribed as a “quick fix,” while therapy, which may teach a person long-term coping strategies and self-management, is not encouraged enough. If your child is prescribed an antidepressant, antipsychotic, anxiolytic, stimulant, or other psychotropic drug, consider finding a therapist or counselor to pair with the drug treatment.

Cognitive Behavioral

Cognitive behavioral therapy is a common type of mental health counseling (psychotherapy). With cognitive behavioral therapy, you work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. Cognitive behavioral therapy helps you become aware of inaccurate or negative thinking, so you can view challenging situations more clearly and respond to them in a more effective way.

Cognitive behavioral therapy can be a very helpful tool in treating mental disorders or illnesses, such as anxiety or depression. But not everyone who benefits from cognitive behavioral therapy has a mental health condition. It can be an effective tool to help anyone learn how to better manage stressful life situations.

Why It’s Done

Cognitive behavioral therapy is used to treat a wide range of issues. It’s often the preferred type of psychotherapy because it can quickly help you identify and cope with specific challenges. It generally requires fewer sessions than other types of therapy and is done in a structured way.

Cognitive behavioral therapy is a useful tool to address emotional challenges. For example, it may help you:

  • Manage symptoms of mental illness, either by itself or with other treatments such as medications
  • Prevent a relapse of mental illness symptoms
  • Treat a mental illness when medications aren’t a good option, such as during pregnancy
  • Learn techniques for coping with stressful life situations, such as problems at work
  • Identify ways to manage emotions, such as anger
  • Resolve relationship conflicts and learn better ways to communicate
  • Cope with grief, such as after the loss of a loved one
  • Overcome emotional trauma related to abuse or violence
  • Cope with a medical illness, such as chronic fatigue syndrome or cancer
  • Manage chronic physical symptoms, such as pain, insomnia or fatigue

Mental health conditions that may improve with cognitive behavioral therapy include:

  • Sleep disorders
  • Sexual disorders
  • Depression
  • Bipolar disorders
  • Anxiety disorders
  • Phobias
  • Obsessive-compulsive disorder (OCD)
  • Eating disorders
  • Substance use disorders
  • Personality disorders
  • Schizophrenia
  • Post-traumatic stress disorder (PTSD)

In some cases, cognitive behavioral therapy is most effective when it’s combined with other treatments, such as antidepressants or other medications.


In general, there’s little risk in getting cognitive behavioral therapy. Because it can explore painful feelings, emotions and experiences, you may feel emotionally uncomfortable at times. You may cry, get upset or feel angry during a challenging session, or you may also feel physically drained.

Some forms of cognitive behavioral therapy, such as exposure therapy, may require you to confront situations you’d rather avoid — such as airplanes if you have a fear of flying. This can lead to temporary stress or anxiety.

However, working with a skilled therapist will minimize any risks. The coping skills you learn can help you manage and conquer negative feelings and fears.

How You Prepare

You might decide on your own that you want to try cognitive behavioral therapy. Or a doctor or someone else may suggest therapy to you. Here’s how to get started:

  • Find a therapist. You can get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs). You can also find a therapist on your own — through a local or state psychological association or by looking through the phone book or on the Internet, for instance.
  • Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans cover only a certain number of therapy sessions a year. Also, talk to your therapist about fees and payment options.
  • Review your concerns. Before your first appointment, think about what issues you’d like to work on. While you can also sort this out with your therapist, having some sense in advance may provide a starting point.

Check qualifications

Before seeing a psychotherapist, check his or her background, education, certification and licensing. Psychotherapist is a general term, rather than a job title or indication of education, training or licensure.

Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master’s or doctoral degree with specific training in psychological counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.

Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training.

Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline. The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.

Cognitive behavioral therapy may be done one-on-one, or in groups with family members or with people who have similar issues.

What You Can Expect

Your first therapy session

At your first session, your therapist will typically gather information about you and determine what concerns you’d like to work on. The therapist will likely ask you about your current and past physical and emotional health to gain a deeper understanding of your situation. Your therapist will also want to know whether you might benefit from other treatment, such as medications. It might take a few sessions for your therapist to fully understand your situation and concerns, and to determine the best course of action.

The first session is also an opportunity for you to interview your therapist to see if he or she will be a good match for you. Make sure you understand:

  • His or her approach
  • What type of therapy is appropriate for you
  • The goals of your treatment
  • The length of each session
  • How many therapy sessions you may need

If you don’t feel comfortable with the first therapist you see, try someone else. Having a good “fit” with your therapist can help you get the most benefit from cognitive behavioral therapy.


Except in very specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to authorities. These situations include:

  • Threatening to immediately or soon (imminently) harm yourself or commit suicide
  • Threatening to immediately or soon (imminently) harm or take the life of another person
  • Abusing a child or a vulnerable adult (someone older than age 18 who is hospitalized or made vulnerable by a disability)
  • Being unable to safely care for yourself

During cognitive behavioral therapy

Your therapist will encourage you to talk about your thoughts and feelings and what’s troubling you. Don’t worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort.

Cognitive behavioral therapy generally focuses on specific problems, using a goal-oriented approach. As you go through the therapy process, your therapist may ask you to do “homework” — activities, reading or practices that build on what you learn during your regular therapy sessions — and encourage you to apply what you’re learning in your daily life.

Steps in cognitive behavioral therapy

Cognitive behavioral therapy typically includes these steps:

  • Identify troubling situations or conditions in your life.These may include such issues as a medical condition, divorce, grief, anger or symptoms of a mental illness. You and your therapist may spend some time deciding what problems and goals you want to focus on.
  • Become aware of your thoughts, emotions and beliefs about these situations or conditions. Once you’ve identified the problems you want to work on, your therapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (your “self-talk”), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a journal of your thoughts.
  • Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioral responses in different situations.
  • Challenge negative or inaccurate thinking. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or on an inaccurate perception of what’s going on. This step can be difficult. You may have long-standing ways of thinking about your life and yourself. With practice, helpful thinking and behavior patterns will become a habit and won’t take as much effort.

Your therapist’s approach will depend on your particular situation and preferences. Your therapist may combine cognitive behavioral therapy with another therapeutic approach — for example, interpersonal therapy, which focuses on your relationships with other people.

Length of psychotherapy

Cognitive behavioral therapy is generally considered short-term therapy — about 10 to 20 sessions. You and your therapist can discuss how many sessions may be right for you. Factors to consider include:

  • The type of disorder or situation
  • The severity of your symptoms
  • How long you have had your symptoms or have been dealing with your situation
  • How quickly you make progress
  • How much stress you’re experiencing
  • How much support you receive from family members and other people

Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life.


Getting the most out of cognitive behavioral therapy

Cognitive behavioral therapy isn’t effective for everyone. But you can take steps to get the most out of your therapy and help make it a success:

  • Approach therapy as a partnership. Therapy is most effective when you’re an active participant and share in decision-making. Make sure you and your therapist agree about the major issues and how to tackle them. Together, you can set goals and assess progress over time.
  • Be open and honest. Success with therapy depends on your willingness to share your thoughts, feelings and experiences, and on being open to new insights and ways of doing things. If you’re reluctant to talk about certain things because of painful emotions, embarrassment or fears about your therapist’s reaction, let your therapist know about your reservations.
  • Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip therapy sessions. Doing so can disrupt your progress. Attend all sessions and give some thought to what you want to discuss.
  • Don’t expect instant results. Working on emotional issues can be painful and often requires hard work. It’s not uncommon to feel worse during the initial part of therapy as you begin to confront past and current conflicts. You may need several sessions before you begin to see improvement.
  • Do your homework between sessions. If your therapist asks you to read, keep a journal or do other activities outside of your regular therapy sessions, follow through. Doing these homework assignments will help you apply what you’ve learned in the therapy sessions.
  • If therapy isn’t helping, talk to your therapist. If you don’t feel that you’re benefiting from cognitive behavioral therapy after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach.
Dialectal Behavioral

Dialectical behavior therapy (DBT) is a comprehensive cognitive behavioral treatment that focuses on problem solving and acceptance-based strategies within a framework of dialectical methods. The term dialectical refers to processes that synthesize opposite concepts such as change and acceptance.

DBT strives to simultaneously support people as they work to accept themselves while facilitating the development of techniques to help them achieve goals with the support of a mental health professional.

What Is Dialectical Behavior Therapy?

Originally designed as a treatment for people experiencing suicidal thoughts or symptoms of borderline personality. DBT is currently used to treat people who experience an array of chronic or severe mental health issues, including self-harm, addiction, and post-traumatic stress. DBT can be used with individuals, families, and groups, in a variety of mental health settings.

DBT incorporates the following five components:

  1. Capability enhancement: DBT provides opportunities for the development of existing skills. For example, skills like emotion regulation, mindfulness, and distress tolerance are taught in treatment.
  2. Generalization: DBT therapists use various techniques to encourage the transfer of learned skills across all settings. People in therapy may learn to apply what they have learned at home, at school, at work, and in the community. For example, a therapist might ask the person in treatment to talk with a partner about a conflict while using emotion regulation skills before and after the discussion.
  3. Motivational enhancement: DBT implements individualized behavioral treatment plans in order to facilitate the reduction of problematic behaviors that might negatively affect quality of life. For example, therapists might utilize self-monitoring tracking sheets so that individual sessions can be adapted to address the most severe issues first.
  4. Capability and motivational enhancement of therapists: Because DBT is often provided to people who experience chronic, severe, and intense mental health issues, therapists receive a great deal of supervision and support to prevent things like vicarious traumatization or burnout. For example, treatment-team meetings are held frequently to give therapists a space to provide and receive support, training, and clinical guidance.
  5. Structuring of the environment: A goal of therapy is often to ensure that positive, adaptive behaviors are reinforced across all environmental settings. For example, if an individual participates in multiple treatment programs within one agency, the therapist might make sure each program was set up to reinforce all the positive skills and behaviors learned.

Development and History

DBT was developed by Marsha Linehan in the 1970s through her work with two mental health populations: people dealing with feelings of suicide and people diagnosed with borderline personality disorder. Linehan, intrigued by the building reputation of cognitive behavioral therapy (CBT), decided to utilize standard CBT in her practice. After conducting research relative to the effectiveness of CBT in her chosen populations, Linehan and her colleagues experienced difficulties. They discovered three major problems with the application of standard CBT:

  1. Participants experienced the change-focused interventions as invalidating. This resulted in withdrawal from therapy, aggression toward therapists, or a fluctuation of both extremes.
  2. Participants and therapists recreated a pattern of reinforcement in which good work was stalled and avoidance and redirection was encouraged. When therapists pushed for change, participants reacted in anger. When therapists allowed a subject change, participants reacted with warmth and positive feedback. This loop seemed to trick both therapist and participant into thinking they were on the right track, when in retrospect, they were not.
  3. Due to the intensity of crisis-related situations, therapists spent a good deal of time addressing safety concerns like suicidal thoughts or gestures, hostility and threats toward the therapist, or self-injurious behavior. This often left little time to teach coping skills or address behavioral functioning.

After analyzing these problems, Linehan devised several adaptations to CBT that directly addressed the needs of the population. Acceptance-based techniques were included to ensure participants felt supported and validated before asking them to focus on change. In addition, dialectics were incorporated to allow therapists and participants in treatment to focus on the synthesis of polar opposites, such as acceptance and change, in order to avoid becoming trapped in patterns of extreme position-taking.

These and other adaptations were added to the practice of DBT, and in 1993, Linehan published the first official treatment manual, entitled Cognitive Behavioral Treatment of Borderline Personality Disorder. Since then, the practice of DBT has grown in popularity. Over the last several decades, a great deal of research has supported the efficacy of DBT, and this form of therapy is practiced in dozens of countries around the world. It is listed in SAMHSA’s Registry of Evidence-Based Programs and Practices.

Dialectical Behavior Therapy Theory

Three major theoretical frameworks, a behavioral science biosocial model of the development of chronic mental health issues, the mindfulness practice of Zen Buddhism, and the philosophy of dialectics, combine to form the basis for DBT.

The biosocial theory attempts to explain how issues related to borderline personality develop. The theory posits that some people are born with a predisposition toward emotional vulnerability. Environments that lack solid structure and stability can intensify a person’s negative emotional responses and influence patterns of interaction that become destructive. These patterns can harm relationships and functioning across all settings and often result in suicidal behavior and/or a diagnosis of borderline personality.

DBT draws mindfulness techniques from Zen Buddhism in order to use here-and-now presence of mind to help people in therapy objectively and calmly assess situations. Mindfulness training allows people to take stock of their current experience, evaluate the facts, and focus on one thing at a time.

Dialectics are used to support both the therapist and person in treatment in pulling from both extremes of any issue. Therapists use dialectics to help people accept the parts of themselves that they do not like and to provide motivation and encouragement to address the change of those parts. Synthesizing polar opposites can reduce tension and help keep therapy moving forward.

Stages and Goals in Dialectical Behavior Therapy

This form of therapy is designed to systematically and comprehensively treat issues in order of severity. Because DBT was initially intended for people with suicidal tendencies and extreme emotional issues, treatment happens in stages so that all problems are eventually addressed. DBT involves the following four stages:

  • Stage 1: The focus of this stage is stabilization. People in therapy may be dealing with things like suicidal thoughts, self-harm, or addiction. They often report feeling like they are at an all-time low point in their lives. Therapy is centered on safety and crisis intervention. The goal of this stage is to help people achieve some control over problematic behaviors.
  • Stage 2: In this stage, behaviors are more stable, but mental health issues may still be prevalent. Emotional pain is typically brought to the surface and traumatic experiences are safely explored. The goal of this stage is for people in treatment to fully experience their emotional pain instead of silencing or burying it.
  • Stage 3: This stage focuses on enhancing the quality of life through maintenance of progress and reasonable goal-setting. The goal of this stage is the promotion of happiness and stability.
  • Stage 4: During this stage, therapists support people in taking their lives to the next level. In therapy, people can improve upon learned skills or work toward spiritual fulfillment. The goal of this stage is to help people achieve and maintain an ongoing capacity for happiness and success.


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