Context: I snap easy and push people away. I need help before I push my boyfriend away.

Response: Awareness is the first step.  Now that you know that you snap and push people away, you can look into ways to control your anger.  If you give yourself the time to analyze why you experience anger, you will discover that there are other feelings underneath;  shame, frustration, disappointment, and fear are some of the feelings that we cover with anger when we are not ready to deal with them or don’t know how to express them.  So next time you feel angry, even if you snap (with practice you will be able to identify them ahead of time), identify why you are angry, and try to express it out loud.  A therapist can help you to learn assertive communication skill using examples drawn from your daily experiences.If you would like to engage in therapy, I am licensed in Texas and Puerto Rico, you can contact me at 787-466-5478.¿Cómo puedo controlarme y a mi coraje?Exploto fácilmente y alejo a las personas.  Necesito ayudo antes de hacer que mi novio se aleje.Tener conciencia de la situación es el primer paso.  Ahora que sabes que explotas y alejas a las personas, puedes buscar maneras de controlar tu enojo.  Si te das tiempo para analizar porque te da coraje, descubrirás que hay otras emociones escondidas, la vergüenza, la frustración, la decepción y el miedo son algunas de las emociones que cubrimos con coraje cuando no estamos listos para revelarlas, procesarlas o expresarlas.  Así que la próxima vez que estés a punto de explotar, o cuando ya hayas explotado (con la practica uno aprende a identificarlas de antemano), identifica por que estas enojada e intenta expresarlo en voz alta. Un consejero te puede ayudar aprender técnicas de comunicación asertiva usando ejemplos de tu vida cotidiana.Si te gustaría hacer terapia, soy Consejera Profesional Licenciada en Texas y en Puerto Rico, llama al 787-466-5478.


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: Write down your nightmares and discuss them with an analyst or psychotherapist who specializes in dreams, as I do. If you are hearing voices while awake, see a doctor right away.  If the voices are strictly in your dreams, do call for therapy and talk to your caring others about what's happening.


Context: How can I get to a place where I can be content from day to day?

Response: It's important to take a look inside and see what's going on with you to cause you to have these feelings.  Please contact us in whatever way is most comfortable for you and we can get you set up with someone who will help you figure out this space in your life.


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: It's important to take a look inside and find out why you are experiencing these feelings. It could anything and it will change your life to know what your particular issue or trigger is. Please contact us a call with the method that is most comfortable for you.


Context: I am so terrified of having sex anymore because I have been told over and over that sex is dangerous even though me and my partner used both forms of protection. My partner is not happy about this and simply wants more sex, and honestly, I want to give that to her.

Response: Alot of our choices have to do with what we have been taught and partly our fear of trusting ourselves to do what is right. There is so much more going on within you than you realize. We can help you bring it to the surface. Please contact us when you can and in whatever way you can to discuss what's going on with you.


Context: He said he would try and he never did. It's been nine months, and this is making me worse. Today, he said I have to respect whatever decision he makes. Is that true? Am I supposed to respect the decision to leave because he can't handle what I'm going through and leaves me here crying and worried every night? He's constantly changing his mind on if he wants to work it out.

Response: When you are at your lowest, you have an opportunity to learn not just about the people around you and who you can depend on, but also, so much about yourself and why you have come to the place that you have. Take this time to do some introspection and learn yourself. It will give you the power to recover from whatever it is that has broken you. We'd love to talk with you. Please contact us sometime.


Context: I love him, but he doesn’t show me love. He talks badly about me to his friends.

Response: What you are describing is a state of abandonment like no other; a direct lack of respect. The challenge here is: you cannot control another person no matter how hard you try. The only person that you have control of is yourself. So then the question that this reality poses is: What are you willing to change? If you love yourself and know that you have tremendous value, if you can see what you bring to a relationship and that you deserve respect and love and tenderness, then you will get to a point where you will settle for nothing less than that. The change that might be necessary in yourself is to change the way you see yourself, the way you treat yourself and what you accept. Your husband also needs to change and that is something only he can do for himself but reaching out to get help as well. It would be helpful for you both to get help because there is damage on both parts. You have much more power than you realize and talking with someone can help you to hone that power and make a difference in your own life. Sometimes, the difference/change can be walking away from a bad situation or it can simply be changing your attitude and raising the bar. Sometimes our loved ones come with us on the elevation, and sometimes they get left behind.  You must do some deep introspection through therapy to get to the point where you can answer this question for yourself.


Context: He said he would try and he never did. It's been nine months, and this is making me worse. Today, he said I have to respect whatever decision he makes. Is that true? Am I supposed to respect the decision to leave because he can't handle what I'm going through and leaves me here crying and worried every night? He's constantly changing his mind on if he wants to work it out.

Response: If your husband is changing his mind about whether or not he wants to stay in the relationship, I wonder if you both might benefit from seeing a therapist who specializes in couples. In my training working with couples, partners come into counseling with one of three goals in mind: strengthening the relationship, getting a divorce, or making a decision. The decision could be whether or not stay together or it could be any number of other things, such as what state to live in.When you ask whether you have to respect whatever decision he makes, respecting his decision does not mean that you have to agree with what he decides. While you do not have the power to change his decision, he also does not have the power to change yours or how you feel about it. Having said that, if he is changing his mind a lot, chances are that the only decision he has made is that he needs to make a decision. Weighing the options of an important decision (any type of important decision) can be anxiety-producing its own right.The fact that you said you were diagnosed with severe depression leads me to believe that you are already seeing a therapist. Perhaps he or she can assist you in navigating through this. I'm wondering how you feel when you are around your husband. I'm not sure whether you are saying that having him there is a source of comfort for you or that it leads you to feel more sad. Maybe it is a little bit of both.


Context: He said he would try and he never did. It's been nine months, and this is making me worse. Today, he said I have to respect whatever decision he makes. Is that true? Am I supposed to respect the decision to leave because he can't handle what I'm going through and leaves me here crying and worried every night? He's constantly changing his mind on if he wants to work it out.

Response: Although the marriage vows say in sickness and health, each person has the right to choose to stay or to leave, depending on their ability to cope and handle marriage challenges.  I know is hard not to focus on him and his choice, but the more you put the focus of attention on him the least support you will receive. Focus on increasing self-care activities and building a support system around you.  A therapist can help you to work with depression symptoms, build up your self-esteem, and developing coping skills.  Also, invite him to a therapy session so he can clarify any questions and concerns regarding your diagnosis.If you would like to engage in therapy, I am licensed in Texas and Puerto Rico, you can contact me at 787-466-5478.Mi esposo quiere divorciarse después que fui diagnosticada con depresión severa.El dijo que intentaría y nunca lo hizo.  Has pasado nueve meses, y esto me está haciendo sentir peor.   Hoy, el dijo que yo debo respetar la decisión que el tome.   ¿Es eso cierto? ¿SE supone que respete la decisión de irse porque él no puede manejar lo que yo estoy pasando y me deja llorando y preocupada cada noche?  El cambia de opinión todo el tiempo.A pesar de que los votos matrimoniales dicen en la salud y la enfermedad, cada persona tiene el derecho de decidir si se queda o se va, dependiendo en su habilidad de lidiar los retos del matrimonio.  Entiendo que es difícil evitar enfocarte en él y sus decisiones, pero mientras más enfocas tu atención en el, más vas a resentir la falta de apoyo.  Enfócate en aumentar el cuidado personal y en desarrollar tu sistema de apoyo.  Un terapista te puede ayudar a trabajar con los síntomas de depresión, mejorar tu autoestima y desarrollar mecanismos de defensa.  También puedes invitar a tu esposo a terapia para hablar sobre tu diagnosis y que aclare dudas sobre los síntomas y expectativas.Si te gustaría recibir terapia, soy Consejera Profesional Licenciada en Texas y en Puerto Rico, llama al 787-466-5478.


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: Are you in the middle of extreme emotional pressure right now?Or, is someone with whom you're close, under stress or somehow suffering?Dreams and nightmares are when our feelings and pressures we feel, try working themselves out without logic and language.Even though the nightmares are horrible, they are one way your psyche is trying to come to terms w extraordinary difficulty in your life or someone's life whom you feel greatly attached.


Context: I am so terrified of having sex anymore because I have been told over and over that sex is dangerous even though me and my partner used both forms of protection. My partner is not happy about this and simply wants more sex, and honestly, I want to give that to her.

Response: Maybe you'll feel less fear by understanding that whoever told you sex was dangerous, was wrong.If this message came from your upbringing, then it may a deeply embedded belief.Since the belief itself instructs to avoid risk, and overturning this belief requires taking the risk to believe the logic that reasonable safe sex measures are adequate protection, give yourself time to absorb this new understanding.Talk w your partner about your psychological difficulty bc their patience will help you.


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: Voices and dreams could be suppressed feelings or thoughts that result from negative experiences.  Many times when people go to trough traumatic incidents or changes in their lives without being equipped to manage them and as a result they start having similar symptoms. It is helpful to find a therapist to talk to about those dreams and voices, once you get them out, you could analyze the concerns and fears that they reflect and normalize them, which will also be a good time to discuss their source, if any traumatic event has occurred in your life.  Also, I recommend to journal your dreams, especially if they keep you awake at night, and meditate after, so you could go back to sleep.   ¿Cómo puedo hacer que los sueños y las voces desaparezcan?Durante las últimas cuatro semanas he estado teniendo pesadillas y escuchando voces que me dicen cosas horribles.  No son voces que hablan al azar, pero voces de las personas que me importan.Las voces y los sueños pueden ser sentimientos supresos o pensamientos que resultan de experiencias negativas.  Muchas veces estos síntomas surgen cuando las personas pasan por situaciones traumáticas o cambios que no estaban preparados para enfrentar.  Es útil encontrar a un terapeuta con quien puedas hablar de esos sueños y voces, y aprender a normalizar el contenido de los mismos.  También sería un buen momento para discutir cualquier situación traumática que te haya ocurrido. Además te sugiero que escribas tus sueños, especialmente si te mantienen despierto  en la noche, y que medites luego de escribirlos para que puedas volver a dormir.


Context: I am becoming a Water Safety Instructor but I didn't have enough for a proper swimsuit. I was told by a boy in class that my top was displaying everything. I was very embarrassed.

Response: First I think we have to acknowledge that you are doing something amazing.  You are putting yourself out there and becoming a Water Safety Instructor.   We often times will focus on the negative and forget about the positive.  Next, you had an incident where someone pointed something out which may have caused embarrassment.  Whether or not it was malicious on his part I think the important thing to focus on is what is called "Common Humanity".  Common Humanity is one of the three elements of self-compassion.  Common humanity essentially recognizes that suffering and personal inadequacy is part of the shared human experience.  While you may have had this embarrassing moment at this time, that boy may have had an embarrassing moment another day.  We all have embarrassing moments.  When we recognize that we do not suffer in isolation then we are able to move past that suffering.  Additionally another element to self-compassion is self-kindness.  My question is why must you forgive yourself?  Rather, be kind to yourself for learning an amazing new talent.


Context: I am so terrified of having sex anymore because I have been told over and over that sex is dangerous even though me and my partner used both forms of protection. My partner is not happy about this and simply wants more sex, and honestly, I want to give that to her.

Response:
I am wondering who is telling you that sex is dangerous.  Is this medical advice, or is this someone’s
opinion trying to scare you from having sex?
And if so, how old are you? Is it ok to have sex, do you want to have
sex?  It sounds like you want to make
your partner happy, and that you are taking care of protecting yourself and
your partner, but maybe you are forgetting to consider what do you really want.  Having sexual relations is a very personal decision;
you and your partner have to consent.  It
is also important to talk about the possible consequences and being responsible
for them as well.  But sex should be something
that you enjoy, not that you should be fearful of.  A therapist can help you to process those
negative thoughts and feelings that may impair you from enjoying your sexual
life. ¿Cómo puedo superar mi miedo de un
embarazo no deseado y poder tener sexo otra vez?Estoy
aterrorizado de tener sexo porque me han dicho una y otra vez que el sexo es
peligroso, inclusive cuando yo y mi pareja usamos dos métodos de protección.  Mi pareja no está contenta y simplemente
quiere más sexo, y honestamente, yo quiero darle lo que ella quiere.Me pregunto quién
te está diciendo que el sexo es peligroso.
¿Esto es aviso medico, o es alguien intentando asustarte para que no
tengas relaciones?  ¿Y si es así, que
edad tienes?  ¿Es apropiado que tengas
sexo a tu edad?  ¿Quieres tener sexo? Me
parece que estas enfocado en hacer feliz a tu pareja, y te estás protegiendo y protegiéndola,
pero tal vez están olvidando analizar que tu quieres realmente.  Recuerda que tener una relación sexual es una
decisión personal, en la que tú y tu pareja deben de estar de acuerdo.   También es importante hablar de las posibles
consecuencias de tener relaciones, como un embarazo, y discutir sus opciones e
intenciones, si eso ocurriera.  Ya que
han tenido comunicación al respecto, el sexo debe ser algo que disfruten,  no que temen.
Un terapista te puede ayudar a procesar esos pensamientos negativos y
los sentimientos que te pudieran impedir disfrutar de tu vida sexual.


Context: He said he would try and he never did. It's been nine months, and this is making me worse. Today, he said I have to respect whatever decision he makes. Is that true? Am I supposed to respect the decision to leave because he can't handle what I'm going through and leaves me here crying and worried every night? He's constantly changing his mind on if he wants to work it out.

Response: The fact that you mention that he is "constantly changing his mind on if he wants to work it out," suggests that Discernment Counseling might be a really good fit for you both. Discernment counseling is a protocol for partners where one or both aren't certain they want to remain in the relationship. It's a brief (1-5 sessions) and intentionally focused on helping partners talk through (primarily individually) their reasons for and against staying in the relationship - as well as confront their own contributions that lead to the relationship crisis. It's aimed at helping the couple reach a clear understanding of which path they are going to take, not asking anyone to change just yet, so it can be a lot less intimidating and more to the point than couples therapy.  You can look to find a local therapist providing this service here. That said, I agree with other respondents that if he is deciding to leave, seeking out support for yourself would be incredibly helpful. You may need to accept his decision, but you can certainly feel whatever emotions you have.  You are allowed to feel exactly how you feel, and it's likely you'll be sad, or angry or hurt or disappointed or scared, or any combination of any/all of those. Having someone there who can validate those emotions and help you to process the grief that naturally comes with the end of a relationship can be a huge help in finding a place of healing and regaining a sense of self, a sense of hope.


Context: I've been like this ever since I was in school; back then I transferred to another school. Now I'm thinking about changing my job.

Response: There's a quote I love that says, "Wherever you go, there you are" and the book by the same name by Jon Kabat-Zinn may be very helpful for you. The thing about changing things up when they get tough is that they often aren't the things that need changing. The awesome (and challenging) thing about it is that when you work on the internal aspects that may need attention, you can learn to find a sense of centeredness that comes with practicing mindfulness and asking yourself who you really are and want to be. Through this deeper work, you can actually be in the midst of chaos and still feel that calm and peace within yourself. If you look for support in this journey from a counselor or therapist, I'd recommend looking for someone offering Acceptance and Commitment Therapy (ACT) or Mindfulness-Based Cognitive Behavioral Therapy (MCBT). Also helpful may be the online program of Mindfulness Based Stress Reduction (MSBR) found here. There are in-person programs across the country, but this online self-guided version is free and a great resource!


Context: I've been like this ever since I was in school; back then I transferred to another school. Now I'm thinking about changing my job.

Response: Sometimes changes make sense. It may be helpful to talk to someone who you trust to get a sense of whether the changes that you are making are those that are considered adaptable or important changes that allow us all to grow. Another possibility is that you are changing things in an effort to get away from something that is uncomfortable or difficult. There are many other possibilities along this continuum.I would ask you to consider the following:What is leading you to want to change your job?What feelings are associated with this change? (Happy, sad, scared, anxious/nervous, confused, motivated, etc.)How is the job that you are looking to transfer to going to be better or different? Are the concerns that you have now going to travel with you?If you are hesitating to get another perspective (from trusted friends or family or some sort of career advisor in your area), where is the hesitation coming from?


Context: For the past four weeks, I've been having nightmares and hearing voices telling me of horrible things. They're not random voices, but rather, the voices of those I care about.

Response: I would recommend that you talk with a mental health professional near you about the details so you can have some really specific support for what you are going through.I don't know if you can understand when the voices are saying, but I wonder how you feel about what you are hearing? If the voices are just at night, is it possible that they are part of a nightmare or a dream? If you recall your nightmares, consider writing them down so that you can remember their content and work with a mental health professional to look for patterns.One thing that may help you while you are awake is to try to stay connected to the room you're in. For example, take time to notice your feet on the floor, hips in the chair, and shoulders against the back of the chair. You can also try mindfulness techniques, such as noticing what is around you or changing your breathing patterns. These ideas may help in the meantime prior to having more specific ideas from someone near you.Thanks for reaching out!


Context: I am so terrified of having sex anymore because I have been told over and over that sex is dangerous even though me and my partner used both forms of protection. My partner is not happy about this and simply wants more sex, and honestly, I want to give that to her.

Response: I would suggest possibly talking with a physician about all the different types of protection. They may be able to help you to know about all of the options that are available.It sounds like your partner is open to understanding your concerns. Perhaps until you have the chance to speak with someone about the effectiveness of different contraception and forms of protection, are either of you open to other forms of engaging in sexual intimacy (without penetration, but with use of vibrators, toys designed for sexual interactions, etc.)?


Context: I have cheated on my husband of five years roughly ten times. I pretend we aren't married at my work. Recently, he has caught on, but I lie to cover it. He use to talk to girls online, but I have caught myself constantly having a affair.

Response: It may be helpful to have this emotionally impactful conversation in the context of couples therapy.Whether or not you should get a divorce is not the first question that comes to mind for me, but more along the lines of do you want to be together and what kind of relationship do you want to create?For some people, polyamorous relationships (those involving more than two people) are acceptable. This does not work for everyone, but if each of you agree that that is okay, it may work for you and your husband. If it is something that you are both open to, it is often beneficial to have more than one discussion about the details of what is acceptable for each of you.If you want to be devoted only to each other, what does that lifestyle look like for each of you? What can you start or stop doing right now to move your relationship in that direction?Neither of you can make the other partner change. That does not mean you cannot talk about what each of your goals are together and support each other in working toward those goals you have for yourselves.Sometime having discussions like these is easier when there is a structure and/or someone in the room (like a therapist) who can help keep the conversation on topic and work on having each of you communicate in a way that expresses your wants, wishes, and desires in a way that is not blaming of your partner.If either of you wants a divorce, that could be part of the discussion. Divorce is not the only choice here, depending upon what each of you wants and is willing to accept, learn, and grow from as it relates to yourself and your partner.


Context: How can I get to a place where I can be content from day to day?

Response: One thing that comes to mind is making a list of some things that happen each day. It could be that there are things that are affecting how upset you are, but because so many other things are going on, you may not notice.Another idea to try is to keep a list for a month of one good thing that happened each day. This way, when you're having a rough day, you have a list to think of and take a look at.Are you eating and sleeping in ways that are typical for you (typically at least two meals per day and roughly 8 hours of sleep that night (may be different depending on your age)? These two ideas are closely related to changes in your mood.From where do you have support? Friends or family?Can you take 5 or 10 minutes per day to do something that you enjoy?If you think back to the last time that you felt "content," what was contributing to that?Another possibility is to try to be mindful of things that you do every day. For example, rather than eating a turkey sandwich as fast as possible on your lunch break, consider actually tasting it and enjoying it. Also consider giving yourself praise for doing something well. For example, when you finish your paperwork, take a moment to notice that and maybe reward yourself by checking your e-mail, reading five pages of a book, or something else that can be done quickly before you get back to your next task.


Context: I have anxieties about everyday stressors, i.e. finances, work, relationships, kids, and maintaining a household.

Response: Something to remember about anxiety is that it's a useful and necessary response to stressors, and we all have a level of anxiety that falls somewhere on the spectrum from very slight to very overwhelming. Anxiety is our brain's way of prompting us to deal with the stress in our lives by getting us geared up for action. Some helpful ways of managing anxiety are actually very simple. The first I'd recommend is a calm breathing technique - breathe in for 4-5 seconds, and then out for 7-8 seconds. Try to repeat this for 3-5 minutes. Another suggestion is to pay closer attention in the moments you feel the physical symptoms of anxiety and see if you can describe - without judging - the sensations to yourself. Try to be very specific, such as "my palms are feeling very sweaty, and I can feel the slight tightness and fluttering in my belly of the butterflies." Then try to sit with these sensations without deciding if they are good or bad - just experiencing them as intentionally as possible.  Combining the calm breathing with this technique can also be very helpful. If you feel that these techniques don't help and your anxiety about everyday stressors are inhibiting you from being able to engage in life the way you want to, then I'd highly recommend going for an assessment or even just consultation with a professional. This professional can help you determine if therapy/counseling would be helpful for you to develop additional skills for managing those interfering anxiety symptoms.


Context: I have bipolar disorder, paranoid personality disorder, posttraumatic stress disorder, anxiety and obsessive-compulsive disorder. I last self-harmed a week ago. When I am stressed, overwhelmed, hurt, or angry, the urge to self-harm is all I can think of. I am trying to seek help.

Response: Seeking professional help does not mean that you will necessarily be admitted into an inpatient setting - though  to be honest, that can become an option if you feel unsafe or if you are unable to plan for safety. However, many clients who struggle with self-harm can find help in outpatient settings - particularly those which offer a treatment called Dialectical Behavioral Therapy (DBT). Looking for a DBT professional or group therapy setting may be particularly helpful, but a skilled professional can help you to figure out how to identify other options even when you are experiencing overwhelming emotions. Without knowing your location, I also recommend searching to find your local helpline or suicide prevention hotline. The volunteers on the other end of the line can be very helpful even if your intention is not suicide and they are likely also to be able to connect you with resources in your area. Calling into the helpline may also be a first step alternative to self-harming when you're feeling overwhelmed.


Context: I've been like this ever since I was in school; back then I transferred to another school. Now I'm thinking about changing my job.

Response: Many times when things become difficult to manage, is because we are getting out of our comfort zone, so we seek growth and change.  Coping with the difficulties does make you more resilient and helps you to build the confidence you need to solve problems in the future. Now I wonder:  are things getting tough in a way that you are not able to resolve them?  Do you need to move or change to save yourself or prevent any harm? If so, it is OK to know when to remove ourselves form situations that harm us more than helping us.   On the other hand, are the things getting tough because you need to learn a new skill?  If so, how can you learn them and is there someone who can help you overcome this challenge?  I help my clients to identify their strengths and areas where they can achieve growth, things like polishing up your resume and evaluate new job opportunities could help you discover a new you.If you would like to engage in counseling, I am licensed in Texas and Puerto Rico, you can contact me at 787-466-5478. Cada vez que las cosas se ponen difíciles, hago cambios en mi vida.He sido así desde que estaba en la escuela; antes me transfería de escuela.  Ahora pienso cambiar de trabajo.Muchas veces cuando las situaciones se tornan en difíciles de manejar, es porque nos sacan de nuestra zona de comodidad, con el propósito de buscar el cambio y el crecimiento.  Manejar las dificultades si te vuelve más resistente, y desarrolla tu autoestima para que puedas resolver problemas en el futuro.    Ahora, te pregunto: ¿se están poniendo las cosas difíciles al punto que no puedes manejarlas?  ¿Necesitas removerte de la situación para evitar que te hagan daño? Si es así, entonces está bien reconocer cuando nos debemos remover de una situación dañina que nos daña más de lo que nos permite crecer. O por el otro lado, ¿Se están poniendo las cosas difíciles porque necesitas a prender una nueva destreza?   Si es así, ¿cómo puedes aprender esa destreza y quien te puede ayudar?Ayudo a mis clientes a identificar sus fortalezas y áreas de crecimiento, el actualizar y pulir tu resume junto con explorar opciones de empleo, te puede llevar a descubrir nuevos talentos en ti.Si te gustaría hacer una cita, soy Consejera Profesional Licenciada en Texas y en Puerto Rico, llama al 787-466-5478.


Context: I have suffered many things at home and school. We never went to the doctor to diagnose depression or anything like that, but I always feel like a part of my heart is missing. I try to fill it in with objects or, in this case, a woman.

Response: There are a lot of ways to look at this. It sounds as if there is a part of you that is looking for support. I wonder what it is that you feel when you're not in a relationship?Because of the way you asked the question, I'm getting the impression that you are referring to romantic relationships. I wonder if you have close friendships that could form a network to help with this when you are not romantically involved with someone. Even when you are in a relationship with a romantic partner, having friends is still an important element.I wonder if you could also notice what changes for you inside of yourself (as far as emotions) when you move from not being in a relationship to being in one.Perhaps you could take a look at what you value about yourself.In general, it is natural for people to want to be in relationships with others (in this case, relationship has many meanings and degrees). Most of us enjoy sharing elements of our days, thoughts, feelings, etc. with someone else who we trust and care about – also hoping they care about us in return.


Context: A year ago, the love of my life left me and never looked back. Our son was two months old at the time and it broke my heart. I miss her so much and can't seem to get over  being so heartbroken.

Response: I recognize that you say you are missing being with the love of your life. At the same time, I don't understand whether you are able to see your son. I'm curious as to the relationship dynamic between you and your son's mother.When you say that she "never looked back," I imagine you are conveying that getting back together is not something that she is interested in.I would suggest that you talk with a therapist and your local area so that you have the ability to discuss the loss of this person who you love so much. Most people think of grief related to the loss of someone who has died, But it also applies to people who have a significant loss, whether that is a relationship, a job, or any number of other things.In the meantime, try finding something about yourself that you value and can focus on.


Context: I stress over everything. If I don't have enough "quality time" with my boyfriend, I start to feel resentment towards him. He has three children, and they are great kids, but I find we don't have much time together. I break down easily and find myself depressed.

Response: Everyone has some level of anxiety - it's what helps us respond to stressors in our lives and clues us into the fact that we need to respond to something going on. However, if you're feeling overwhelmed by racing thoughts, feeling like you spend a lot of energy worrying about something specific or even pretty much anything at all, and you're starting to find that it's getting in your way when it comes to living your life the way you want, then I'd suggest seeing a counselor or therapist for an assessment for anxiety. Your other concerns, though, seem pretty "normal" for someone who is in a relationship with a partner who has children. As a married stepmother, I've been there, and as a therapist, I can tell you that the boundaries and communication skills you have in your relationships need to be healthy for you to feel healthy. Finding some support from a group of others whose partners have children might be really helpful - being able to hear from others that you aren't alone in feeling like this can really lighten the load, and they might have some good ideas for handling certain situations. Another option is to find a counselor or therapist who has experience working with step/blended family dynamics - because even if you're not officially married, those dynamics come into play whenever there are kids from another relationship involved. You may even consider couples counseling so that both of you can learn to talk about your relationship needs and concerns in a way that will encourage connection and strengthen your sense of partnership.


Context:
I have been with my boyfriend for more than a year. He recently got a new job and travels a lot. I’m not used to him being gone all the time. I feel as though he has forgotten about me because he does not talk with me as much and doesn’t keep me up to date on everything that he does throughout the day, which he used to.
I feel lost, sad and unwanted. This is really a tough new challenge. I just want to break up with him, but I love him so much. I don’t know why he is acting this way lately. I believe I have separation anxiety. Is there anything that I can do to help me cope with this while he is out of town?

Response: Relationships at any amount of distance can be so hard! It makes sense that you are encountering more anxiety than usual given that major change in your relationship. And you're right that being separated from our partners can heighten our insecurities and worries about not only our relationship security but about our partner's interest. Have you talked with your boyfriend about this struggle you're feeling? It can be hard to have this kind of conversation without triggering a sense of blame and subsequent defensiveness in our partners, but it really is possible. If you have any concerns about being able to do this, then a session or two with a local counselor or therapist might be really helpful - and it really can be just about finding the way to share what you're feeling.As far as coping with anxiety, there are a lot of options but I highly recommend an app called Self-Help for Anxiety Management. There's so much good information in this app to help you learn to pay attention to what kinds of thoughts are helpful or unhelpful, and there are also lots of activities for calming down and decreasing the intensity of that anxiety. The best part is, it's free!


Context: I have cheated on my husband of five years roughly ten times. I pretend we aren't married at my work. Recently, he has caught on, but I lie to cover it. He use to talk to girls online, but I have caught myself constantly having a affair.

Response: Clearly you seem interested in being other people, and you are also concerned about your husband being unfaithful online.  But it seems like there is something that keeps you with your husband.   And I have so many questions for you: What are you looking for outside of your marriage?  Are you willing to give that up if your husband is not able to provide it?  Do you want to stay together and make it work? Do you want to open the lines of communication with your husband, so you could analyze the situation together?I suggest attending couple’s therapy or even couple’s mediation to assess and discuss where you want to go whit your relationship.  It will also help to establish healthy lines of communication, where you could express the pros and cons of the relationship, analyze if you are willing to work to stay together, or have some closure and process a separation. I provide a combination of counseling and mediation in couple's therapy, you can call 787466-5478 to make an appointment.¿Deberé divorciarme?Le he sido infiel a mi esposo al menos diez veces en los últimos cinco años.   En el trabajo pretendo que no soy casada.  Recientemente se fijo, pero mentí para cubrirlo. El hablaba con mujeres por el internet, pero yo he tenido varias aventuras.Claramente tu estas interesada en ver a otras personas, y estas preocupada de que tu esposo haya sido infiel.  Pero al parecer hay algo que aun sostiene la relación.  Tengo varias preguntas para ti: ¿Que estas buscando fuera de tu matrimonio?  ¿Estás dispuesta a dejar lo que encuentras fuera del matrimonio, si tu esposo no puede dártelo?  ¿Quieres quedarte con él y hacerlo funcionar? ¿Te gustaría abrir las líneas de comunicación con tu esposo, para que puedan analizar su relación?Les sugiero hacer terapia de pareja o inclusive mediación, para asesar y discutir a donde quieres llegar con tu relación.  También les ayudaría a re-establecer líneas  de comunicación de manera que puedan expresar los pros y contras de estar juntos, ver si pueden trabajar para mejorar su matrimonio o partir amigablemente.  En mi consultorio proveo una combinación de consejería de pareja y mediación, puede llamar al 787-466-5478 para una cita.


Context: I’m a man, and I’m soon to be married. I have been messing around with other men on the side. It started as a once in a while thing, but it’s been happening a lot. I don't know what to do.

Response: Hello, and thank you for your question. When faced with these kinds of difficult challenges, I usually encourage people to look to their values for help in determining what their behavior should be. Indeed, it is usually when our behaviors conflict with our values that we don't feel very content with our lives. Perhaps you can take some time to think through a couple of these questions: What kind of person do I want to be deep in my heart? What kind of character do I want to have when in public and in my private world when nobody is watching? How would I want others to describe me? Let's say that you want others to see you as being authentic, and YOU also value authenticity as something you want to live by. You may feel like this value is currently at odds with the behaviors you are engaging in right now. That you are not being the person that you really are deep in your heart. This is not an unusual struggle when it comes to sexual behavior and sexual orientation. So please, try not to feel alone. We all know quite well how unacceptable it may be to be seen as gay, lesbian, bisexual, etc. And I am not just talking about being unaccepted by others, but a person may have a VERY hard time accepting themselves. Thinking about your values and living a life based on them can bring a lot of freedom, but I won't lie, it can also bring a lot of pain at the same time. For example, someone with the value of living authentically may decide they have to tell others who they are and what they stand for, even if that means people may disapprove. That may cause a lot of pain, but it may also come with a sense of freedom to live a life based on honesty and authenticity. It may be helpful to find a counselor who is trained in affirmative therapy, which is recommended for people who are navigating their sexual behaviors and figuring out what is right for them. I would also sit down and think through some of the questions above and consider what your values are... both as an individual and as someone's fiancé.Above all, I wish you well in this journey. Robin J. Landwehr, DBH, LPC, NCC


Context: I told her that if daddy dies, we will never see him again. She started crying because I wouldn't make her daddy die.

Response: Children often have a difficult time expressing emotions accurately. It is also very likely that your daughter does not understand  the permanence of death. Having said that, she is using some very specific ideas here and I would recommend contacting a local mental health professional with some experience working with children.I would also wonder where she is getting this idea. Sometimes children hear things on TV or from an adult and we are not even aware of how much they are remembering.It may be helpful to teach her things that she can do when she is angry, like say that she is mad because she cannot have the toy that she is asking for.I'm curious as to how long it is that she stays mad like this and whether she talks to her dad after she is no longer angry. Does she say the same sorts of things about you?It may also be helpful for you to work with a mental health professional (possibly the same one who is working with your daughter) so that you can have some support with this as well.


Context: I get very nervous and anxious/scared before sex.

Response: I first wonder what your anxiety or fear connects to. I don't know whether it is about sex itself or about ideas of worthiness or feeling desirable.There is also a difference between having self-doubt about the actual physicality of having sex (performance-related) or having doubts about whether you want to have sex with a particular person.Having sex can lead to feelings of great vulnerability. If your partner is someone you trust, consider discussing what it is that comes up for you around the issue of sex. This is the certain things that your partner would be willing to do that and the ease your discomfort, like staying with you for some time before and after sexual interactions.Another idea to consider is spending time with your partner and using nonsexual touch for each other (perhaps first you to him and then him to you) and communicating very clearly about what you like and do not like. Some people like to be spoken to during physical touch and other people do not. All of this can be part of your discussions. When you feel comfortable with that, you could move into sexual touch in this manner and actually look at what you do and do not like. You may also consider discussing things that are totally off-limits for you all the time and things for which you would like warning or awareness before they happen. There are really a number of different ways to work on becoming more comfortable if you trust your partner and if your concern is about sex itself.If this feels pretty structured, it is initially. Generally, the idea is to learn more about each other and yourselves and then the process becomes much more natural.If the concern relates more to self-esteem related sex, consider asking your partner to list several things that he or she likes about you. Even if you don't necessarily see yourself in the same light, consider that this is how your partner sees you, so these are some of the things that make you attractive to them (perhaps both in sexual ways and in a wider discussion of the relationship).If this is difficult for you to sort out on your own, consider seeing a therapist with experience working with couples or relationships.


Context: Both of my parents committed suicide together, and I was the one who found them. I suffer from overwhelming depression, which is having an extreme effect on me and my husband’s sex lives. He does not understand at all and is always making me feel so uncomfortable about sex.

Response: Hello, and thank you for your question. First, I want to tell you how sorry I am for the experience you had with your parents. That is a grief and trauma that is certainly hard to imagine. Trauma and grief can affect us in many ways, and certainly deeply personal things like our sex lives. It may be difficult for others to make the connection, but it is there. So, for example, if stress and trauma make you feel like you are not interested in sex, a partner may take it as a personal rejection rather than response to stress, trauma or grief. If your husband will agree to it, couple's counseling may be your best bet. A counselor can help you with your communication and may be able to provide some education to your husband about trauma and how it can have an impact on intimacy. If he doesn't agree to go, it may be worth it to go on your own. You still have a lot you are dealing with yourself. And sometimes our personally therapy can influence others, so it may be a good idea. It is important to remember that even though you are married you have the right to make decisions about your body, and that includes when you want to have sex with it. I hope this is helpful, and some of my colleagues may have ideas, also. Be well.Robin J. Landwehr, DBH, LPC, NCC


Context: I have suffered many things at home and school. We never went to the doctor to diagnose depression or anything like that, but I always feel like a part of my heart is missing. I try to fill it in with objects or, in this case, a woman.

Response: There could be many reasons but often people feel validated when they are in a relationship, the need to be in a relationship can be related to a belief of unlovability which often stems from our childhood. The relationship sort of soothes this temporarily and the others interest or desire helps counteract the ingrained belief. There are many questions that may help understand why, how was your relationship with your mother (caregivers)?  How was your childhood etc.? Many people describe having a hole or void they try and fill with material things or people but it only is a temporary fix which usually drives the person to the next relationship, or object in hopes it will be fulfilling but it never is because fulfillment is work we need to do ourselves. This journey involves finding acceptance and love for ourselves. Once we have that we don't need to look elsewhere for fulfillment.


Context: I’ve been on 0.5 mg of Xanax twice a day for the past month. It hasn't been helping me at all, but when I take 1 mg during a big anxiety attack, it calms me down. I was wondering how I can ask my psychologist to up the dose to 1 mg twice a day without her thinking I'm abusing them. I just have very big anxiety attacks. Should I stay on the 0.5mg and deal with the attacks or should I ask to up the dose? I'm afraid she will take me off them and put me on something else.

Response: Hello, and thank you for your question. While counselors work closely with medical providers, and sometimes have discussions about medications with people, we rarely make recommendations about how much or what type of medication a person should be taking. This is because prescribing and advising on medication is out of our scope of practice. The only exception would be if a counselor is also a physician, nurse practitioner, physician's assistant, etc. Having said that, I certainly understand that anxiety is a real serious problem that many folks struggle with. If you are currently not in therapy to help you with these panic attacks, you should consider it. Medications can be helpful for anxiety, and medications like Xanax may help for immediate relief, but they do nothing to deal with the root of anxiety and may not help with anxiety long-term. Therapists who have experience in exposure therapies would be good people to start with. Exposure therapy has good outcomes for people with anxiety disorders and panic attacks. If you are interested in speaking with your provider about the Xanax, I think explaining it the way you did on here is just fine. The provider will then decide if they feel comfortable increasing your medication. Please remember that medical providers are not trying to give people a hard time. Medications like Xanax really are highly addictive. The more you take, the more you may feel you need. The more often you may feel you need to use it. Depending on the frequency and amount of use, some people suffer serious withdrawal symptoms when they do not take the medication. It is a good idea to talk to medical provider about all of those things so that you can partner on right course of action to manage this anxiety. I certainly hope that you get some relief.... I know anxiety is awful.Robin J. Landwehr, DBH, LPC, NCC


Context: Sometimes, I'm fine and can go out or meet people, but other days, my heart races and words physically cannot come out of my mouth. I've always thought it was normal and I was just nervous, but the other day, it took me almost 30 minutes of sitting in my car to find the courage to enter Target by myself.

Response: It is possible that you could have or be developing an anxiety disorder. There isn't really enough information provided here to suggest a particular disorder, but it might be worth meeting with a counselor or therapist to do a formal assessment. Some of the questions they might ask could be what other kinds of physical symptoms you experience, how frequently these physical symptoms happen, what's going on for you when they tend to happen, and how frequently/intensely you find yourself worrying in general. Anxiety itself is a really natural thing - it's just when it starts interfering with your ability to "do life" the way you want that we start to consider potential disorders. It might be that for the most part, the anxiety you feel is normal and you simply have some triggers that intensify it more than usual. Working on your own or with the support of a counselor/therapist to both address those triggers at the root and also to develop ways of managing the actual anxiety symptoms. This two-fold approach can be really helpful for not letting anxiety keep you from engaging in life the way you'd like.


Context: I have been feeling more and more down for over a month. I have started having trouble sleeping due to panic attacks, but they are almost never triggered by something that I know of.

Response: It could be really helpful to see a counselor/therapist about your increasing depression/panic symptoms. Finding out the cause of depression/anxiety isn't always as straightforward as it seems, since both issues tend to become patterns we engage in rather than solely related to a specific trigger/reason. For example, if I am feeling down about a particular circumstance in my life, then I start seeing life through this lens of feeling down, and typically I'll start to see a lot more that I get down about, and it can really build very quickly on itself. Same with anxiety. Obviously, this is a very simplified example and it can be very difficult to see how the pattern is maintained, but that's where working with a counselor/therapist comes in. I would be curious about whether you can start to notice the initial sensations of panic, and if you can (through the panic attack) continue to maintain awareness of the actual physical sensations. Even better if you can talk yourself through the sensations you're feeling - such as saying to yourself "Okay, I'm breathing really rapidly, and my heart is racing, now my palms are sweaty and my chest is feeling really tight..." Reminding yourself that it's just your body's reaction to stress, and while it might be overreacting right now, you're okay and eventually it will go away. I highly recommend the SAM for Anxiety Management app for the anxiety piece, and I wouldn't be surprised if addressing the anxiety helped to address some of the depression too.


Context: Her father and I have been dealing with this problem for quite some time now. She is an adolescent, and the problem is mostly food. She is now overweight, and we just don't know what to do anymore. She can be disrespectful and doesn't listen to or respect what we say.

Response: I would be curious about there potentially being some emotional or physical trauma in your daughter's history that she is struggling with. Physical trauma is usually easier to identify, but emotional trauma can be feeling a lack of emotional connection in her important relationships, having experienced bullying, or some other emotional injury. The fact that there are some defiance symptoms going on suggests that she might be in need of a safe place to process what she's going through, and the potential issue with control or meeting emotional needs with food is also concerning. I would recommend looking for a therapist/counselor who works with children/adolescents in the area of addressing trauma for an assessment. They may be able to ask the right questions to see whether trauma is truly the issue.


Context: I'm in my late 50s. I never loved or have been loved. I need deeper help than is offered in my small town, but I cannot leave this town because of agoraphobia. I find myself losing hope more and more. My brain barely works anymore, and my memory so small, I forget in a moment. I serve no purpose. I'm incapable of work or anything of value, and I never have been. I’m a complete waste of time and resources, and yet I keep trying. Why? Why does God insist that I continue to exist? I’m not suicidal, just tired.

Response: The fact that you're reaching out says that there is something in you that wants this to be different, and that drive might be something worth tapping into. "Why do I keep trying?" is a question that might give you some insight into what it is in you that keeps you going. A lot of therapists/counselors are now offering video therapy. As long as you're in the same state as a therapist offering this service, you could connect with someone helpful from the comfort of your home, even being in your small town. I'd recommend looking into this option, because you're asking a lot of really deep questions and might benefit from having those conversations with someone who can help you find your own answers.


Context:
I have been with my boyfriend for more than a year. He recently got a new job and travels a lot. I’m not used to him being gone all the time. I feel as though he has forgotten about me because he does not talk with me as much and doesn’t keep me up to date on everything that he does throughout the day, which he used to.
I feel lost, sad and unwanted. This is really a tough new challenge. I just want to break up with him, but I love him so much. I don’t know why he is acting this way lately. I believe I have separation anxiety. Is there anything that I can do to help me cope with this while he is out of town?

Response: Consider talking with your boyfriend about times that you may be able to talk together while he is away. This way, you have an idea when you'll be able to contact him. Does he recognize the feelings that you have while he is away? How do you feel when you are together with him and he is home?I'm also curious as to how the level of your anxiety (on a scale of 1 to 10, perhaps) changes during the parts of his trips. Maybe there are certain parts that are more or less related to anxiety for you. Perhaps you have less anxiety while working or involved in a specific activity, for example, spending time with friends.When you are both in the same area (when your boyfriend is not traveling), do you do some things independently with friends? Do you know what leads to your anxiety when he is away? I don't know whether it is a general feeling of wanting him to come back or anxiety that something specific will happen to you or him.Do you ever recall feeling this way in your past? If so, what was happening then?What do you have that makes you feel very safe and comfortable?Consider working with a mental health professional in the area. Perhaps it would be helpful for the two of you to meet with a therapist who specializes in couples to see what kind of relationship you want to have and what you can each do to contribute to that relationship. There could be things that you could both start or stop doing to help your relationship move in the direction where you would like it to go. As an example, perhaps you would like a text before your boyfriend goes to bed, no matter what time zone or time of day it is. Perhaps he would prefer a good morning text or call/voicemail from you.


Context: Sometimes, I'm fine and can go out or meet people, but other days, my heart races and words physically cannot come out of my mouth. I've always thought it was normal and I was just nervous, but the other day, it took me almost 30 minutes of sitting in my car to find the courage to enter Target by myself.

Response: First, be aware that each end every one of us has anxiety at some point. That certainly seems to fit what you're describing here, but that doesn't mean you have an anxiety disorder, necessarily. That's where there is a difference. Anyone who has a hard time with public speaking or feels uncomfortable in large crowds, for example, is experiencing anxiety.It sounds like it would be helpful to look at the differences between the days when you are more comfortable on the days that you are not. If you notice your anxiety is keeping you from doing things that you need or want to do, it may be helpful to talk with and mental health professional.I wonder also whether your appetite and sleeping patterns are the same or similar to how they were before you experienced this anxiety, when your anxiety started, and whether you feel more comfortable when someone you trust is there with you.If you have an idea of times or situations in which you feel anxious, consider carrying a small smooth rock or another object that makes you feel calm and centered. Perhaps you can keep it in your pocket and remember specific comfortable times while you have it in your hand.


Context: I’ve been on 0.5 mg of Xanax twice a day for the past month. It hasn't been helping me at all, but when I take 1 mg during a big anxiety attack, it calms me down. I was wondering how I can ask my psychologist to up the dose to 1 mg twice a day without her thinking I'm abusing them. I just have very big anxiety attacks. Should I stay on the 0.5mg and deal with the attacks or should I ask to up the dose? I'm afraid she will take me off them and put me on something else.

Response: In general, Xanax is very short-acting. You mentioned that you are afraid that your medical provider will take you off of the Xanax and put you on something else. If the Xanax is not working well for you, I wonder if something else may work better. What is your reasoning there? Also, sometimes there are medications that you can take in addition to Xanax.In addition to talking with your medical provider about changing the medication, try to track your levels of anxiety on a scale of 1 to 10 throughout the day so you can get a pattern of what is happening. Also consider writing down what is happening before you have anxiety attacks. This may help your medical provider know what medication may be helpful to you or what changes could be made.As far as how to discuss this with your medical provider, I would suggest mentioning the symptom changes you are having (anxiety attacks that are not helped with 0.5mg of Xanax) and ask what they would suggest that might help. If your medical provider suggests taking you off of the Xanax, I would recommend talking about the reasons why you would prefer to stay on the Xanax and what your concerns are about coming off of it. You could also ask whether anything could be combined with Xanax.There are also many other anxiety medications. I have seen lots of people that take more than one medication to lessen anxiety that they are having.I would also consider talking with a therapist (unless the person who is prescribing a medication is also doing therapy with you). Getting more information about your anxiety and how it is affecting you may be greatly helpful to you.


Context: I’m a man, and I’m soon to be married. I have been messing around with other men on the side. It started as a once in a while thing, but it’s been happening a lot. I don't know what to do.

Response: If you are happy with the person that you are about to be married to and are also enjoying time with other men, it could be possible that you are attracted to people of more than one gender.Having said that, some people have feelings toward people of more than one gender that are not really related to romance or attraction, but any number of other feelings, such as trust and communication. I don't know whether your use of the phrase "messing around" was related specifically to being romantically or sexually involved with the people who you are or referring to or if you are saying that you are enjoying spending time with them. These terms have different definitions for almost everyone.I would definitely recommend speaking with a local mental health practitioner in your area, not because there is anything wrong about the way you are feeling, but because there are a lot of different parts of what is happening in your life right now and it may be helpful to talk about the feelings and thoughts with someone who can help you to learn more about yourself and the people are most important in your life (yourself included).I also suggest looking at a few things that you love and appreciate about yourself.


Context: He wants to wear makeup and heels. He even tucks his penis away to resemble a vagina. He wants me to wear a strap on and have anal sex with him. I have tried this for him, but I don’t like it and have told him so. He keeps making comments about it and says he can't live without it.

Response: It sounds like you may be asking two different questions.With regard to what you said about your husband dressing as a female in your bedroom, I wonder if you would consider asking him more about this. If you choose to do that, I would suggest that you ask him whether a certain time is a good time to have a conversation and asking questions for five minutes or more that are related to you learning more about his experience. This can be difficult to do at times, particularly when you may want to offer your own opinions or become very anxious or of type. Consider thinking of a phrase that may help you to stay calm during the discussion. It may be helpful to think of yourself as asking questions as if you were an investigative reporter and using questions that start with words like "what, how, who, where, when." Questions that start with "why," can be very difficult to answer for some people and can be overwhelming because it often links to answers involving emotions that may or may not be understood. Also try restating what your husband is saying to make sure that you are understanding correctly. If what he is telling you is different than what you have heard or thought of for many years, it may be challenging to follow his meaning initially. Remember that listening to your husband does not imply agreement with what he is saying, just that you are following and looking to understand what he is experiencing. I also recommend sticking to one topic for the conversation, but this could be done with many different topics over time.You could also see if he would be willing to have a discussion where he listens like an investigative reporter to learn more about the experience that you are having.As far as what you mentioned about the sexual experience, maybe if you can discuss what it is that you don't like and/or understand what it is that he does like, you could see if there is some middle ground here. It depends on what you both prefer.These types of conversations can be difficult to have for some couples, at least initially. Having structured conversations, such as the ones I've described briefly above, can feel awkward initially, but the reason it can be helpful is because it can lead to further understanding in a way that decreases the chances of having an argument.Also consider seeing a therapist in your area who specializes in couples to discuss some of these ideas.


Context: Sometimes, I'm fine and can go out or meet people, but other days, my heart races and words physically cannot come out of my mouth. I've always thought it was normal and I was just nervous, but the other day, it took me almost 30 minutes of sitting in my car to find the courage to enter Target by myself.

Response: Your, sitting in your car for 30 minutes, story sounds so sad and frustrating.Yes, you're describing classic symptoms of anxiety.Anxiety itself is the indirect result of repeatedly being in positions of feeling helpless or frightened.Are you able to recall from your growing up years of feeling insecure?You may not have felt loved and nurtured as much as you needed.Some people develop anxiety from missing enough love.  They feel lacking in ability to take care of themselves, similar to the lack of being sufficiently taken care of when younger.Try understanding if you felt neglected emotionally.If "yes", then start the slow process of emotionally rewarding and acknowledging yourself.Progress will be slow.Eventually you'll stabilize the way you feel toward yourself.This will gradually result in decreased anxiety.


Context: I have known I was always different. This year, in December, I found out that I never felt female. I did research and have identified myself as male but don't know how to tell my dad.

Response: I admire your courage.If you are concerned about telling your dad regarding your gender identity, I would suggest a couple of things. There are a lot of groups or other supports for people who are working through some of the same changes that you may be going through now. I don't mean to convey that everyone thinks, feels, or acts the same by any means, but rather that it may be helpful to talk to others who have had some similar experiences.I was trying to include some links for you, but that particular button isn't functioning window. If you search for "transgender support" on Google, you'll find GLAAD and PFLAG, both of which are national organizations. This does not mean that you have to identify as "transgender," but researching that term may help you to find both national and local resources.As far as telling your dad, if that is particularly concerning for you, I suggest either talking through the details with a local therapist or considering if you have a trusted friend or family member (one who will respect your privacy with regard to who you would like to know about what you are experiencing at this time) so that you can talk with some people to have support. This may help with two things: allowing you to find some support for yourself as you work through the changes that you are going through now and also possibly talking with someone who knows your dad and may be able to talk with you regarding how or when to tell him.One thing that I tell anyone who wants to discuss something that is very important to them is to ask the person they want to talk to whether this is a good time for an important conversation. That way, you have greater chances of having the person's attention and/or not needing to end the conversation quickly. Also, please remember that you know yourself best, as each of us does.


Context: I'm a girl, and I can't tell whether I'm bisexual or gay. I like girls a little more than boys, but I don't really know.

Response: Sexual orientation is not always something that is clearly definable. Some people look at it on a continuum where being attracted to only boys is at one end, only girls is at the other, and bisexual is in the middle. Anywhere in between those points can be any amount of attraction to boys or girls.If you don't know whether you are gay or bisexual, that is okay. A lot of people don't know for quite some time. In addition to that, after people do know who they are attracted to, a lot of times they do not use the terms "gay" or "bisexual" for quite a while.It's okay not to know.Think about what sorts of expectations you have for your ideal relationship. Some examples may include trust, respect, availability for conversation or connection, etc. Whatever it is that you find important in a relationship is likely what matters most.If you are struggling with learning what it is that you would like in a relationship or any other feelings connected with what you are thinking and feeling, I would suggest connecting with a local therapist so you have a place to talk about what you are experiencing.


Context: I went to my ex-boyfriend to reach out to one of his high school friends who's attempted to commit suicide. When I went to him to reach out to his high school friend, he told me that I put him in a terrible position and put an enormous load on his shoulders. He was very angry that I went to him to do that. Am I in the wrong for going to him to reach out? He helped me so much with my depression and bad habits, so that's why I thought of him to reach out. He made me feel awful for thinking highly of him to help. Why did he react this way towards me? I think he's being selfish.

Response: I'm glad you think so highly of your boyfriend and his ability to be there when you would like to talk about things that are important to you.I see why you would want them to reach out. I also wonder about how close he was with his friend and what he thought you meant when you asked him to reach out. It sounds as if he is thinking that doing so would mean that he is responsible for his friend's well-being, although I can't say that for certain.Would you be willing to have a discussion with your boyfriend where for a few minutes (five minutes or so), you ask him about what made him react that way? During this time, try to listen and ask questions is if you are an investigative reporter and are trying to learn more about his experience. You can also summarize what you are hearing to make sure that you understand it as he does. This does not mean that you have to agree with what you say, but just that you follow. I hear you saying that you think he's being selfish. I'm suggesting that just during this conversation, you ask questions to focus on what he is thinking and feeling. In one sentence, the goal would be to learn more about his experience.I would not be at all surprised if he is scared.Are you aware of what kind of support he wants through this time?


Context: I’ve been on 0.5 mg of Xanax twice a day for the past month. It hasn't been helping me at all, but when I take 1 mg during a big anxiety attack, it calms me down. I was wondering how I can ask my psychologist to up the dose to 1 mg twice a day without her thinking I'm abusing them. I just have very big anxiety attacks. Should I stay on the 0.5mg and deal with the attacks or should I ask to up the dose? I'm afraid she will take me off them and put me on something else.

Response: Staying on the lower dose may give you more room to learn strategies for coping with your anxiety.  Medications are so helpful, and needed at times, but it's also important to have a variety of tools you use to manage your responses to stress.  If you are not already seeing a therapist, consider finding one who can help you learn some effective strategies, like replacing self-defeating thoughts with ones that work better for you, or mindfulness, relaxation, or other tools to keep your anxiety in the manageable range!


Context: He is always telling me our fights are only and all my fault, he bashes me to our young child, and he is addicted to a few substances.

Response: The behaviors you describe are boundary violations.  You can not change your spouse, but you can respond to his behaviors in ways that protect your boundaries and ensure your safety.  This is very hard to do without support.  Finding a therapist who understands the dynamics of abusive relationships may be helpful.  If you are not ready to do this, I recommend the book "Boundaries" by Dr. Henry Cloud and Dr. John Townsend.  It's a great resource for helping one recognize boundary violations and learning how to respond to them in ways that are constructive!


Context: I’ve been on 0.5 mg of Xanax twice a day for the past month. It hasn't been helping me at all, but when I take 1 mg during a big anxiety attack, it calms me down. I was wondering how I can ask my psychologist to up the dose to 1 mg twice a day without her thinking I'm abusing them. I just have very big anxiety attacks. Should I stay on the 0.5mg and deal with the attacks or should I ask to up the dose? I'm afraid she will take me off them and put me on something else.

Response: Do you think you're abusing xanax?It is a highly addictive drug so maybe one reason you feel compelled to take more is bc you already are addicted.Drugs don't do anything helpful in solving life's problems.   Once the effect wears off, the stressful situation is once again waiting for you to address it.Think over your reason for not directly asking your psychologist about upping your dose.Also, do you ever talk about your life problems with this psychologist or only your need for drugs?    The more gradual path to a better life is to not need drugs in the first place. This consists of your willingness to face the matters that are creating such terrible feelings inside you.


Context: I have terrible anxiety and depression. I've tried various therapists and pills, but nothing's helped.

Response: Is it possible you simply didn't mix well with the particular therapists with whom you've worked?   If this is possible, interview a therapist before  starting therapy.   Then you will be choosing a therapist who feels compatible with your way of seeing yourself and your life.Also, therapy isn't for everyone.Read about the different healing modalities and see if one of these speaks to your interest in feeling better.What matters most is finding among all the legitimate healing methods, what you believe will be effective.


Context: I've been dealing with this for years. My mom thinks I'm overly emotional and refuses to offer any help, like therapy or seeing a doctor. She's seen me when I'm having a panic attack and just said I was faking for attention or that I'm a hypochondriac. I just want to get better.

Response: How old are you?Are you old enough in your State to have therapy without your mother's consent?Your mom's attitude toward you may be one significant reason on why you feels so much tension in the first place.Don't let her opinions and beliefs get in the way of what you know about yourself.Are you in school and does that school have a guidance counselor?Would you talk with that person about your difficult getting your mom to retain helping services for you?Keep looking for local resources which will support you either directly or indirectly by advocating for your right to receive mental health care.


Context: These "jokes" are made about everything. They seem to have the need to say something "funny" about everything. It's not funny, just awkward.

Response: I agree, it is awkward when people make jokes about subjects which may not be funny at all.  And, if a person only jokes, then after laughing and realizing the person has nothing of themselves to offer, this can also be quite tedious.Realize that you are more aware of human interaction having many levels of expression.  You could start avoiding people who irritate you by the way they behave.


Context: I'm in my early 20s. I've worked since two months after I turned 18. I have “plans.” I could become an electrician, or I could operate heavy machinery. I have goals, but I do nothing to try to meet them because I don't feel I can. I just want a better life for my fiancée and the kids than I did.

Response: For starters, commend yourself for being committed to working. You have no idea what is going to happen in the next second, so focusing on thinking you will never have a good career or amount to anything financially is creating a fictitious story.  Remind yourself of that every time the thought pops up.  The false belief that nothing good will happen is sucking out energy you can use on pursuing your career dreams. Next, do you know what you need to do to become an electrician or heavy machinery operator? If not, find out. Then, set up a realistic schedule for yourself to accomplish the steps. As you accomplish each step, see your progress.  Notice that you are moving closer to your goal.  Every day remind yourself why you are pursuing this career.  In fact, write it down and tape it on your bathroom mirror.  When you start to feel discouraged, remember your goal and remind yourself that you have no idea if you'll make it or not but you are going to give it everything you have to find out. Anything worth pursuing is going to take a lot of persistence and hard work. Stay with it! You and your family are worth it!


Context: My husband had an emotional affair with his ex-wife in November. She invited him to dinner, alone, with their daughter. I wasn’t aware of this until after 11pm when I asked where he was. He had been drinking, and I told him not to come home that night. The next morning, we talked about going to counseling. He went out that night with friends and said his ex-wife wasn't going. I found out in April that she did go. I gave him the chance to get everything out in the open. I found out that he stayed that second night with her. I asked if they slept in the same bed, and he said yes, both nights. His daughter wasn't there the second night. He claims they didn't have sex, but what else should I think?

Response: My answer is going to be super simplistic but I believe this may be what you need. Ask your husband if he wants to stay married to you.  If he says yes, then it would be helpful to go to a marriage counselor and work this out with a professional.  If he says no, then you can file for divorce.


Context: I believe it is wrong for men to look at inappropriate content. The father of my child has agreed to respect my beliefs. His co-worker sent him an inappropriate video. He got mad because he does not think he should tell his friend to not send him things like that.

Response: In my book, this is a boundary issue. Although you do not like inappropriate content, it is not up to you what your child's father looks at or what his friend sends him.  It is really hard not to monitor other people's lives, but in the end, your rights begin and end with you.


Context: I’m a man, and I’m soon to be married. I have been messing around with other men on the side. It started as a once in a while thing, but it’s been happening a lot. I don't know what to do.

Response: Divorce is expensive emotionally and financially. If your fiance is not ok with an open marriage, it would be a good idea to seek the help of a counselor before you get married.


Context: I told her that if daddy dies, we will never see him again. She started crying because I wouldn't make her daddy die.

Response: It's normal for a child to be so angry she wanted someone to die, but this seems to be heading into a dangerous realm. I think it would be wise to have her seen by a child psychologist just to rule out anything more serious.


Context: Sometimes, I'm fine and can go out or meet people, but other days, my heart races and words physically cannot come out of my mouth. I've always thought it was normal and I was just nervous, but the other day, it took me almost 30 minutes of sitting in my car to find the courage to enter Target by myself.

Response: Though I don't know for sure, it sounds like anxiety to me. I think it would be helpful if you work with a therapist who specializes in anxiety disorders.


Context: I have terrible anxiety and depression. I've tried various therapists and pills, but nothing's helped.

Response: I'm sorry that you have tried several different things and not had much relief.I will say that there are several different types of medications that may help and each therapist is different, so it is quite possible that a different combination of things you've already tried may be helpful.I would encourage you to continue trying different therapists. I would say to give each one at least six sessions before you decide that the approach that they are using is not working for you. Also, most places have a certain sort of structured initial session that must be done, but after that, the decisions are largely up to what you and the clinician feel is helping. If something is or is not working, communicate this with your therapist. This is a big deal. Most therapists I know actually welcome this feedback.There is a fair amount of research into the idea that the therapeutic alliance (the relationship that you have in the context of working through the reasons that brought you into therapy) is very important. Also, sometimes anxiety and depression can make it difficult to go to therapy on a regular basis. If that is something with which you are struggling, I would encourage you to talk about that as well.In addition to a solid relationship with a therapist who you connect with, you may consider trying something like yoga or meditation. Mindfulness is sometimes helpful as well.Here's a link to questions for finding suitable therapists: http://www.pharmatherapist.com/12-tips-for-finding-a-suitable-therapist


Context: I've been dealing with this for years. My mom thinks I'm overly emotional and refuses to offer any help, like therapy or seeing a doctor. She's seen me when I'm having a panic attack and just said I was faking for attention or that I'm a hypochondriac. I just want to get better.

Response: I don't know how old you are, but in Pennsylvania, if you are over 14, you can have therapy without your parents' consent. If you are young enough to use their insurance, that could be complicated, but depending on the state, there may be ways to work around that as well. If transportation is a problem, call a local mental health agency and see if they can connect you with assistance.In the meantime, try searching for a phone helpline in the county where you live. They may be able to help you figure out where you can get help.Another idea is that if you are in school, your guidance counselor may be able to provide links to where you can go for help. He or she may also be able to give you more specific ideas to help with your panic attacks.I know you said your mom refuses to offer help, which included seeing a doctor, but I wonder if she trusts the doctors that is your primary care physician (also called a family doctor) who you see when you have a minor medical ailment that may need medication. That doctor may be able to help you as well.Some of the information here may be helpful to you because it explains some of what anxiety is and there are some quizzes there that may give you information to discuss with a doctor or therapist when you get connected with one. http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disorders This may give you other information to speak with your mom about. Remember that I'm not asking you to actually diagnose yourself with one of these things, but just offering some basic information that may help you be able to talk about what is going on.If you are having a panic attack or having a moment of anxiety, try focusing on different things in the room around you. It may help to shift your focus briefly outside of what you are feeling and that may lessen the feeling a bit. Also remember that sometimes anxiety leads to more anxiety about having a panic attack in the future. Remember that they usually and after a few minutes.It would also be helpful for you to keep track of what leads up to your anxiety.Best wishes to you and keep trying until you get connected to someone.


Context: Sometimes, I'm fine and can go out or meet people, but other days, my heart races and words physically cannot come out of my mouth. I've always thought it was normal and I was just nervous, but the other day, it took me almost 30 minutes of sitting in my car to find the courage to enter Target by myself.

Response: These types of symptoms can be very disruptive to life!  Anxiety often presents in two key ways:  1) physical symptoms such as: racing heart rate, sweaty palms, dry mouth, shaking or trembling or nausea - often these physical sypmtoms are categorized as a Panic Attack.  2) mentally anxiety presents itself as worry.  Worry that spirals out of control, worry that dirsupts your life and concentration.  Worry that keeps from being present in your life.  Anxiety when it begins to spiral out of control either with disruptive mental or physical symptoms, needs to be addressed formally.  I urge you to see a counselor and/or a psychiatrist soon to begin to address these issues.  Good Luck, Sitka Stueve, LSCSW


Context: I've been with a man for four years. For the last year, he has said he is done, but he still talks, texts, visits, and has not moved on with anyone else. His words do not match his actions. I love this man, but it's hurting so much.

Response: This can be difficult and confusing.If you think your boyfriend would be open to having a discussion, try asking him for a time when he is willing to have an important discussion. When that time matches with a time that is good for you, try discussing the type of relationship that you each want to have and what you can start and stop doing to get there. He may want to be really good friends. He may also be trying to figure out what he is feeling. If you end up talking over one another, try letting one person be the one who is talking about their feelings for about five minutes and during that time, try having the other person asked questions to gain more understanding of their experience. Then you can switch. Also consider asking questions that cannot be answered with yes or no, but lead to more explanations.Questions that start with the words how, what, when, who are usually better than questions starting with "why" because they can be emotional triggers for some people.If this is difficult to do between the two of you, consider seeing a therapist who specializes in couples.


Context: My doctor seems to think I am in danger of having one. I neglected to ask how this was different than an episode. I have been formally diagnosed with bipolar type 1.

Response: I will admit that I'm not specifically familiar with this from my own experience.My best educated guess is that you could have a seizure during which you have some sort of symptoms similar to a hallucination (which is one of the psychotic symptoms) when you hear or see things that aren't really there.In looking briefly online, I was able to find some information here: http://www.epilepsy.com/information/professionals/about-epilepsy-seizures/psychiatric-and-behavioral-aspects/psychiatric-2It sounds like this would be a symptom in addition to an already existing seizure disorder, not a seizure disorder in addition to a mental health problem. If it is the other way around, I'm not sure how that would work. It is common with some types of seizures to have an altered state of reality during or shortly after the seizure, so that could also be related.I would suggest you talk to your physician about this directly so that if they are worried about this, you can learn more about what is making them concerned about it and what, if anything, you could do to lessen the likelihood of it or how to handle it if it does happen.


Context: I've been with a man for four years. For the last year, he has said he is done, but he still talks, texts, visits, and has not moved on with anyone else. His words do not match his actions. I love this man, but it's hurting so much.

Response: Have you brought up the topic as to the way you're feeling?The best way for someone to understand us or to understand someone, is to directly talk about  the specific problem.To start the discussion w your partner, understand your own reasons for continuing the relationship.Given his stated disinterest in the relationship, your mood is probably affected by this.Once you are clear on how the range of your feelings, especially any fears on being alone, suggesting you may be staying w this guy simply to avoid such fears, then you'll be ready w your self-knowledge, to start a conversation w your partner about your relationship.


Context: We had great chemistry, but then he became distant. I had the feeling that I can't be without him. As soon as I felt the difference, I was scared to lose him. I started freaking out if he did not answer, thinking that something bad happened.

Response: The simplest answer is that love feels good, obsessions don't.Love deepens a sense of peacefulness and security.Obsessions give anxiety and worry of feeling abandoned.One suggestion is to study more about yourself and why you'd feel so ill at ease when you aren't w this person.


Context: We had great chemistry, but then he became distant. I had the feeling that I can't be without him. As soon as I felt the difference, I was scared to lose him. I started freaking out if he did not answer, thinking that something bad happened.

Response: People often care deeply for those whom they love. I don't know how long you have been together. It is also common to want to be very closely connected to people who are important to you.It may be helpful to have a conversation about talking more or talking about how you feel when he is not there and how he feels about answering you right away. It may be helpful for both of you to listen to each other and what you are feeling and experiencing so that you can look at what may work for both of you. For example, maybe you could remind yourself that he will answer you when he is not busy or as soon as he can.Sometimes just talking about these feelings can be helpful so that you can both have open discussions about whether the amount or type of communication is too much or in a style that is not working for both of you. You could also consider leaving text messages or something that does not require an immediate response so that when he is busy, you have the ability to write a message, and he has the ability to answer when he can.I also wonder where you are getting the idea that something bad happened. I don't know whether something happen with this person in the past or perhaps at another time in your life.Some people benefit from ideas such as not going to bed angry, but this is difficult for others.I would suggest considering what makes each of you feel loved, valued, appreciated, or special.Also think about what styles of communication you both like and what is and is not okay in the context of an argument.It may be difficult to talk about what has related to him being distant and it may be helpful to talk about ways to communicate about this first (such as taking a 10 minute timeout if it becomes overwhelming).Perhaps talking with a therapist who specializes in couples would be helpful if talking about this between you is confusing or if you do not both feel heard by the other person. Remember that feeling heard does not mean that you have to agree with one another.


Context: I shake and have panic attacks.

Response: One of the first things I would suggest is to see if you can keep track of what is leading you to feel anxious. If you shake all the time, consider talking with your primary care physician. Sometimes that can be a hormonal imbalance or another chemical imbalance (such as thyroid).One of the most difficult things about anxiety is that having anxiety (particularly panic attacks) can lead to anxiety about having more panic attacks. Also remember that panic attacks are typically part of your brain's protective response to what it considers to be some sort of threat. You may have heard of the fight or flight response. When you have an anxiety attack, your body is preparing you to react to something that isn't actually a threat, so it's almost as if you're fight or flight response is overactive. Here is an image that may be helpful: http://psychology.tools/fight-or-flight-response.htmlThere are many different things you can do. You can practice breathing, mindfulness, meditation, or yoga techniques. If you decide to try some breathing techniques, try breathing in for a count of five, holding for a count of five, breathing out for a count of five, and repeating five times.Also remember that it is easier to learn these techniques when you're not having a panic attack. At that point, it can be really difficult to use methods to not panic. Also remember that panic attacks typically last 5 to 10 minutes. Using techniques to slow your breathing or become focused on the room around you is probably most helpful when you first start to feel anxious.Here are some other techniques that may help to decrease anxiety: http://psychcentral.com/lib/9-ways-to-reduce-anxiety-right-here-right-now/As you figure out what is leading up to your anxiety, also consider asking yourself what is making that certain issue a big concern for you. Another important question could be when you have felt that way before.


Context: I just don't know what I want in life anymore. I'm can't figure out what it is that is keeping me distracted and unfocused. I can't put things into perspective at all. I'm just stuck, and I'm disappointed with my lack of accomplishments.

Response: It sounds as if you would benefit from talking with a local mental health professionals so you can discuss some details.Having said that, I wonder if you could consider how you would define yourself to someone who doesn't know you. For example, honest, adaptable, fun-loving, dependable, compassionate, open-minded, dedicated, etc. If you're looking for a list of adjectives, try these: https://www.englishclub.com/vocabulary/adjectives-personality-positive.htm . There is a list of negative ones here too. If you're going to use those, try to use three positive ones for each of the negative ones. You could also try asking yourself what you love about yourself and/or what others love about you. Sometimes it's easier to consider what others see as our positive points and if this is difficult for you, try asking someone who you trust to help you with the list.The idea here is to look at your relationship with yourself. I don't mean this in a way that you would be talking to yourself and receiving answers, but rather looking at yourself in a way that you deserve the same kind of loving and compassion that you give to others or want others to have.I'm also curious as to whether you are eating and sleeping okay, as these things can really affect your focus and many other changes, such as differences in your emotions. Also, you saying that you are struggling to put things into perspective leads me to believe that you are going through some things right now that are not typical for you, if so, consider from whom you have support and the ability to talk about what you are going through.Consider Metta meditation here to help give yourself loving kindness: http://www.mettainstitute.org/mettameditation.html


Context: There are many people willing to lovingly provide me with a home. I have food, clothes, and a university education, but I never feel like I belong. Even when I have a good time with people who are supposed to be close, I feel like I'm just out with friends and I never go home.

Response: For some people, having a sense of belonging takes some time.You mentioned that you have an education and some basic daily needs. I wonder if you may be able to look at your relationship with yourself and what makes you feel happy, safe, and having a sense of accomplishment. If you have those feelings, I wonder how you define trust and who you trust.You say you have a good time with people who are "supposed to be close," so I wonder what keeps them from feeling close. I have also wondering if you have been emotionally hurt in the past, and if so, you may have some protective defenses that you use (maybe on purpose, maybe not) to protect yourself from being hurt again. Remember that this idea comes in degrees where you can be more perfect in certain situations and a little less in others. Being emotionally protected is on a spectrum or continuum, where you can make an infinite amount of adjustments or changes with different people and situations.I also wonder what it is that you want in your "home," and how you define it. Consider giving yourself permission to think about how you would define your perfect home in a world where there were no realistic restrictions (such as money or location). After you have that, consider what parts of that you can have. Perhaps there is a small part that you could make a reality within a week or so.Thank you for reaching out. If this continues to be difficult for you, consider seeing a local mental health professional so you can discuss some more specific details.