Bluegrass Professional Counseling

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Robert Cassman

Anger Management Basics

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Written by: Robert R. Cassman, LPCC-S, NCC, CCMHC

Anger can get out of control for any of us. This can lead to trouble with our loved ones, our employer, and even the law. It is vital that we know how to control our anger to prevent such consequences. Below are some basic points that all anger management treatments should address.

  1. Trigger awareness. A “trigger” is something unique to each individual that starts that person down the road to unhealthy anger. For some of us, a boss talking down to us could “trigger” us to anger. For others, it could be traffic that leads us to anger. Knowing what our own specific “triggers” are is an important step to controlling anger.
  2. Warning signs. Once we are “triggered” our body creates warning signs. These may be a flushed face, clenched fist or jaw, upset stomach or the fact that we are pacing. When we recognize these warning signs, we are recognizing that we are getting upset.
  3. Time out. This is the first of the actual coping skills. Knowing our triggers and warning signs can help us to know when to take a break from the situation. This break is also known as a “time out.” If I am at work and a co-worker “makes me mad” I can take a break to cool off. If I am at home and my children “make me mad” I can go to my room to take a break. Sometimes removing ourselves from the situation can help us calm down. A vacation is really just an extended time out. Don’t feel bad about needing to take a time out!
  4. Deep breathing. Right away some people will read this and said “yeah right.”  But regulated deep breathing works! Think about when we get upset. What is happening from a physiological point of view? Why does our skin get reddened? Our heart is pumping blood faster and causing more blood to rush throughout our bodies. That’s blood that is causing the flushed face. We know that the faster our blood is flowing the more agitated we are likely to get. So if we can control our blood flow we can calm down. One way to control blood flow is to regulate our breathing, which controls the blood flow.  The deeper and slower we breath, the calmer we become. Here’s how to do it: slowly breathe in through your nose, hold the breath for four seconds and then slowly breathe out through your mouth for four seconds. Remember to do it slowly! Do this entire process four times and your heart rate will go down. This has been studied and whether you believe it works or not, it works!
  5. Diversion skills. Distraction can work wonders. If I am upset at a relative and am getting mad, I can do something else. As I clean a room, file some papers, do the dishes, or go for a walk, I am less likely to get angry. I fill my life with something else other than anger to keep me busy. Have a couple of planned distractions in place so when you get mad you can immediately go to them.
  6. New thoughts. Normally if someone tells us “just don’t think about it” we then begin to think about that same thing! But if we introduce a new thought to “compete” with the old thought we are less likely to dwell on the original thought. If I am getting mad at the traffic I can create a new thought to take the space in my mind.  Here’s an example: “I need to get going on that deck in the backyard. I probably need to purchase some lumber. I’ll need to use my circular saw to cut the wood. I think I need a new blade for the saw. I’ll also need an extension cord and some screws. What time does Lowes open?” In that example I filled my mind with something completely unrelated to the traffic. For that moment I was not thinking of the traffic and therefore not getting any more upset. The new thought can be anything! It doesn’t have to be serious. As long as you go into some detail and fill your mind with a new thought, the “angry” thought will take up less space!

Turn Toward Your Partner: Steps for Greater Psychological Intimacy

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Written by: Robert R. Cassman, LPCC-S

One of the key steps in the world-renowned Gottman Marriage Counseling program is the idea of “turning toward one’s partner” and not away.  This creates more “psychological intimacy.” This intimacy is the kind that one has for only a very select few persons in the world. This is more important than physical or sexual intimacy because it is deeper and longer lasting.  An older couple who are never sexual intimate but are psychologically intimate can still be healthy. The more we turn towards our partner the more we deposit in our emotional “bank account.” And just like a bank account, we can withdraw from our relationship. Excessive withdrawal from our emotional bank account can lead to stress and even a breaking of the relationship.

Depositing in our emotional bank account can be expensive such as a pricey gift, or free such as an act of sacrificial kindness. When we do things for the relationship then we have made a “deposit.” If we have deposited on a regular basis, then we are in less danger of getting charged an emotional “overdraft” fee. This can happen when we have been withdrawing over and over without properly depositing. For instance, if I fail to take out the trash once but I do other kind things for my wife, then I am not in danger of “overdrafting.” But if I routinely do things that hurt the relationship then I am endangering the relationship.

Another major step to greater psychological intimacy is having “stress-reducing conversations.” These conversations, if done properly, should increase psychological intimacy and reduce conflict.  Here are some tips to stress-reducing conversations:

  1. Take turns. This is easier said than done, but allowing your partner to finish what he was going to say goes a long way. While you are listening….listen! Don’t simply be preparing your reply.
  2. Show genuine interest. We show interest in those things that we like. If you like your partner then you’ll like what she likes. Show this through proper attention. Do not play on your phone while she is talking; don’t interrupt or do other unnecessary things while she is talking with you. Be careful about your body language as well.
  3. Do not give advice. Unless it is explicitly asked for, do not give advice to your partner. Just because she is complaining about something does not mean she wants you to “fix it.” Sometimes the “fix” she wants is simply to be heard and supported.
  4. Communicate you understand. Understanding is vitally important. But it needs to be communicated! This can be done by paraphrasing and summarizing through active listening. Active listening is when we consciously and purposely listen. Hearing is done by our ears but listening is done by our mind. We communicate our partner is important by showing we paid attention to him.
  5. Take your partner’s side. A major step to have a healthy relationship is being on each other’s side. So often I hear in counseling that one partner undermined the other or spoke ill of the other or did not stand up for the other. When given the opportunity take your partner’s side. Even in cases in which you disagree with your partner, you can still show support without completely agreeing. Do not be okay with others tearing down your spouse. You can defend your spouse’s honor without agreeing with your spouse.
  6. Express affection. One-way people feel lonely is not receiving an adequate amount of affection. This can be done physically but it can also be done verbally, emotionally, and psychologically. Affection can be shown through the five love languages discussed here.
  7. Validate emotions. Show you understand your partner by supporting or validating her emotions. Don’t call her emotions “stupid” or “childish.” This only increases the hostility during the conversation. Her emotions are her emotions. Period. Discuss the issue but don’t talk negatively about her emotions.
  8. It’s “we against the world.” This is the proper extension of number 5. Having a common goal and a common “enemy” helps bring people together. If your relationship is the most important thing in your life, then all the other issues can be dealt with, because you’re not alone.  Standing with your partner when no one else does shows him how important he is to you.

Turning toward our partners when we converse is one of the key indicators of a healthy relationship. When we turn away it is a major red flag that something is wrong in the relationship. Following these steps can help improve our conversations as well as the relationship.

 

 

Credentials: What do All Those Letters Mean?

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Written by: Robert R. Cassman, LPCC-S

Navigating the field of therapy is difficult enough, especially when there are so many credentials. These letters that follow the names of therapists can be quite confusing. In this brief article, I will attempt to explain some of those letters.

MD: A “medical doctor” is someone who has gone to college, then medical school, and then to a residency to specialize in a particular type of medicine. An MD can prescribe medication for a variety of illnesses. A psychiatrist is an MD with specialized training in psychiatric medication.

LPCC: A “Licensed Professional Clinical Counselor” is a therapist who has obtained his or her master’s degree and has earned a license to practice professional therapy. To obtain this license, at least two years’ worth of professional experience and training is required. Someone with an LPCC is a professional counselor who views the mental health issues people struggle with on an individual level.

LMFT: A “Licensed Marriage and Family Therapist” is similar to the LPCC except the training is more focused on marriages and families and not so much the individual.

LCSW: A “Licensed Clinical Social Worker” has some similarities to the LPCC and the LMFT but some differences as well. The LCSW tends to view the issues a client struggles with from a perspective that looks at the society at large. LCSWs tend to advocate for social change and social justice. A LCSW can get a bad rap because many employees from social services and DCBS-type agencies have social work degrees. But not all LCSWs are out to take away your children! An LCSW is a professional therapist too.

PhD/PsyD: A “Doctor of Philosophy” (PhD) is usually a psychologist who has received a doctorate and focuses primarily on testing. If you child needs an ADHD test, or someone needs an IQ test more than likely a psychologist would do the test. A “PsyD” is a Doctor of Psychology and does mostly what a PhD-psychologist would do. Both of these tend to be professors in universities as well.

A therapist can be called a “doctor” if he or she has a doctorate degree in any field. This may be confusing as some will think of a “doctor” as only someone with a medical degree.  But a doctorate can be earned in many different fields.

Professional licensing boards require that therapists provide proof to the public that therapists are who they say they are. This leads to the credentials being placed on the walls of offices etc. Therapists also do this by listing their credentials after their names.  There are also credentialing organizations that give credentials to individuals who have obtained certain types of experiences and training. Above I have listed some of the basic credentials. There are many more. If you are unsure, simply ask the therapist. All therapists would be happy to explain all the letters after their name. Just ask.

Types of Parenting

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Written by: Robert R. Cassman, LPCC

While this article doesn’t attempt to provide an exhaustive list or description of parenting styles, we will discuss three of the major styles. None of the three parenting styles are pathological but there are differences and it will be clear which is the healthiest one.  

Permissive parenting involves a parent who wants to be a friend of their child. The permissive parent constantly buys the cooperation of the child. In Walmart, this is the parent who has the out-of-control whiny child who only stops crying when promised something in return. Permissive parents are afraid to discipline the child. “I don’t want her to hate me” a permissive parent is likely to say when asked why discipline isn’t used. Permissive parents feel guilty when they do attempt discipline.  These children grow up to be demanding, permissive and excessive. They have poor relationships because they are spoiled and don’t know how to give toward someone else.

Authoritarian parenting may look like a “drill sergeant” to others. These parents show very little physical affection. This parent is orderly and structured. The children are, therefore, orderly and structured as well. In Walmart, this parent does not need to redirect his or her children. The children are quiet and control themselves. This parenting is colder and tends to be isolated. There is very little room for special circumstances. These children grow up to have distant relationships and have a difficult time interacting with others who are dissimilar.  They may also have a hard time standing up for themselves and tend to get taken advantage of in relationships.

Authoritative parenting is a good mixture of both. The authoritative parent gives a healthy dose of affection and a healthy dose of discipline to the child. This parent disciplines because the child is loved. These children tend to grow up to be healthy adults.

The Five Love Languages

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Written by: Robert R. Cassman, LPCC-S

We all communicate love to one other. We just don’t do it the same way. Gary Chapman has written several books on the “Five Love Languages.” These are the five styles that people use to communicate their love to others. It is important to understand that these are not simply love languages for the romantics. These can be communicated toward anyone we love. Understanding these will help couples, in particular, to better communicate.

  1. Words of Affirmation. This person communicates love to another through words. One person may say “you look nice in that dress” while another person may say “you are so smart.” Another common one is simply “I love you.” These words affirm the other person. They communicate “I love you.”  If you like to hear nice things said to you, then you feel less loved if you don’t receive those nice words. You may say “I don’t think he loves me because he never tells me so.”
  2. Acts of Service. The person who favors this love language has the motto “actions speak louder than words.” They know they are loved because of all the things done for them.  You may say “I know he loves, he does so many nice things for me.”  Doing something special for a loved one is an important love language. A wife may clean the gutters for her husband; a husband may make coffee for his wife in the morning. Whether big or small is not the point. The act itself was done simply out of love.
  3. Receiving Gifts. A boy may buy flowers for his girlfriend as a way of saying “I love you.” A father may buy his son a new car. These are ways of communicating love. These gifts don’t have to be expensive. Many people see a homemade gift as representing more love than a purchased one. Understanding that everyone has their own love language is particularly important with this one. A dad may never say words of affirmation but will lavish his children with gifts. That does not mean he doesn’t love his children. It simply means that he communicates his love differently than the use of words. Realizing, “maybe my dad DID love me after all” is a powerful moment.
  4. Quality Time. One of the most popular love languages comes from the idea that if we love someone, we spend time with that person. If a husband gets off of work and spends the night with his buddies at bar his wife may wonder “why doesn’t he love me?” She may speak the love language of “quality time” and think “if he loved me he would spend time with me.” But just because he doesn’t speak his wife’s love language doesn’t mean he doesn’t love her. She could look for HIS love language. Naturally, he should learn her love language and “speak it” more fluently. And the flip side is true. If your husband has never bought you flowers or other gifts, but spends QUALITY time with you, maybe he really does love you. Maybe his “gift” IS his time.
  5. Physical Touch. Some people will say they can’t remember a single time their parents hugged them. This may be an example of someone who communicated love through affection but never felt it reciprocated. Physical touch is a natural love language. At a funeral we attempt to console others through a hug. With a wounded child they may sit on our laps. On a date we hold hands. Sex can also be a form of the love language “physical touch.” Maybe the man expresses his love through sex. But the woman would prefer “words of affirmation.” She turns him down and he begins to think “she doesn’t love me.” They both would do well to learn the other’s love language.

One of the most important parts of a relationship is communication. We use language to communicate to others. But this language may not help if it is not the RIGHT language. For instance, if I were to go to Germany, I would not communicate very well if I didn’t speak the German language. To better communicate, I would need to learn THEIR language.  The same is true in relationships.

The Behavior of Happy People

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Written By: Robert R. Cassman, LPCC

What’s the secret to happiness? What do happy people do that depressed people don’t do? Let’s find out.

  1. Laugh & smile. In a study, researchers gave a happiness test to college students. Those who scored high were put aside. Those who scored low were then told to walk around the campus for the next week smiling and laughing. They were told the study was measuring social acceptance. In reality it was measuring their own happiness. After the week, those students who laughed and smiled had increased their happiness substantially… and the only thing they changed was how much they laughed and smiled. Happy people laugh and smile more than those who aren’t happy.
  2. Exercise. Happy people exercise more than those who are depressed. As the body gets healthier, the mind gets healthier. There is much science to the chemistry of the body but suffice it to say that happier people exercise.
  3. Sun exposure. In a previous article, I discussed the benefits of the sun. Happier people get more sun as they tend to get outside more often. Whether it is working on a flower bed or going to the pool, happy people find reasons to be outside. Depressed people stay indoors with the shades drawn. The sun increases the amount of the brain chemical Serotonin. This is the brain’s natural happiness drug.
  4. Socialize. Loneliness is a trademark of the depressed. Having friends, a spouse etc. can safeguard us against the deep depression that so many suffer from.  Getting out and being with others has been shown to lead to more satisfaction and belonging.
  5. Volunteer. Happy people help others. Happy people are generous with their time and talents. If you are struggling with depression, then do something for another person!  Sometimes depression is so selfish that it clouds our judgment into thinking of anyone else.
  6. Life goal. Happy people are striving toward something. Even better, they have reached their goal and are fully satisfied with where they are in life. They are grateful where they work, who they are married to etc. Depressed people settle for the same old job they have hated for ten years.
  7. Diet. Along with # 2, happy people eat healthier than those who are sad.  Again, it is quite simple: a healthy body leads to a healthy mind.
  8. Religious. For a couple of potential reasons, those who describe themselves as religious tend to be happier over their lifetimes. Going to a church may lead to a community feel and more socialization. Others have theorized that believing in God and an afterlife brings more hope to their lives and allows them to have more purpose.
  9. More books and less TV. Depressed people watch many more hours of TV each week than those who are happy. There have been studies to show the effects of TV viewing on mood. Also, those who are happier, on average, spend more time reading than those who are not happy.  Reading uses more brain power than watch TV (one study even showed that the brain is used more during sleep than during TV viewing!)
  10. Healthy sleep.  Depressed people actually tend to sleep more hours per day than happy people. We know it is not simply the amount of sleep but the quality of sleep. So many people still feel groggy after ten hours of sleep! Finding a good routine to help one fall asleep is very important.  Even top athletes understand the importance of healthy sleep.
  11. Physical touch. Those who are physically touched are those same people who tend to be happy.  In a classic but heart-wrenching study, half of the newborn babies were shown to die without being touched or looked at beyond the absolute necessity. In this 1944 study, the babies were fed and cleaned but were not given any affection. This has also been shown in monkeys and other animals. Touch is vitally important. Hugs, a hand being held etc. can go a long way. Some studies have shown an increase in Serotonin and Dopamine by simple physical touch.
  12. Positive thinking. This is the granddaddy of them all. Those who are optimistic show a greater level of happiness in the same situation as those who are depressed. People with gratitude for what they have tend to take responsibility for their own problems and refuse to be victims.  They tend to see the source of change within themselves and not from someone else. They “don’t sweat the small stuff” and are able to see that there is a solution to most problems.

Look over these. Which ones do you not have? Now you know what to increase in your life.

 

It’s all About Me: Narcissistic Personality Disorder

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Written by: Robert R. Cassman, LPCC

We’ve all encountered those individuals with extreme arrogance. These might be politicians, celebrities, or everyday people. Some research has shown that narcissistic personality disorder is on the rise in our self-obsessed culture. These narcissists tend to see themselves as more important than what they really are.  They see themselves as superior to others in almost everything they do. For them, “it’s all about me.”

Narcissists tend to pursue power and control over others. They want to be “the boss” so they can be over others. They feel entitled to this power and only use others as a means to more power. In everyday life, they can come across as very opinionated and forceful with their communication. They are master manipulators and see others as a means to get what they want. Because they see themselves as completely right, there is no room for other opinions. They, therefore, believe they need to stamp out any other “dissenting opinions.” They also have “big plans” for themselves. They want to be famous, to be a politician, to become a singer, etc. Their plans may not always be big, however. They take on roles that provide them with potential admiration and praise.

Narcissists tend to leave a wake of destruction in their path. This happens because they only care about themselves and in order to take care of themselves, they don’t mind to hurt others. Their needs matter more than others’ and they will have their needs met no matter what. They come first, no matter what. If others get in the way of their needs being met, then they will punish those people they feel are responsible. They put themselves first with the simplest things. For instance, they will “forget” to pick up their children because they have a hairstyling appointment.

Image is also very important as they feel as though they are constantly “on display.” They spend more time on their appearance than others.  They can become obsessive about make-up, fitness, wearing new clothes etc. They are more likely to get upset with stains etc.

When narcissists get confronted with some sort of imperfection, they become very defensive. They do not like any sort of perceived challenge.  This is due to their underlying low self-esteem. Yes, narcissists tend to have an underlying low self-esteem. In fact, narcissists have been described as having “higher highs and lower lows” as some research shows they are prone to depression. They overcompensate for this by demonstrating to others (and ultimately to themselves) how good they are at everything. If they were so genuinely confident, then why would they need to hear it from others? This core low self-esteem leads them to desperately protect it. They can become defensive with others when they are challenged. They see any feedback or correction as a challenge to who they are as a human. They may retaliate against these perceived attacks by gossiping about others, shunning friends, or issuing threats. They are fond of saying things like “you’ll be sorry” and “you don’t want to test me.” They may also become physically aggressive.

Because they do not see anything wrong with themselves, the idea of counseling can be very difficult. They rarely come to therapy on their own and have to be strongly persuaded to do so. They see emotions from others as well as themselves as weakness and therefore think any talk of them is a waste of time and a potential threat. Remember, they don’t want to be found out that they are unsure of themselves deep down.

The toll narcissistic take is many times, on a loved one. A wife or husband may come to therapy seeking ways to deal with the narcissist. Because narcissists tend to lack empathy, a spouse can feel lonely and misunderstood. And because narcissists use manipulation as their preferred weapon, they tend to not be trusted by their spouses. This can lead to an emotional distance in the relationship. Many times marriage counseling is sought after by the spouse. Individual counseling can also help to develop skills to deal with a narcissistic spouse.  Sometimes the spouse learns to become more assertive, to find other ways to obtain happiness, to not settle for emotional abuse, and to set expectations to fit the reality of the marriage. Finally, understanding that the behavior of the narcissistic is not really about the spouse can go a long way.

 

Five Signs of Borderline Personality Disorder

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Written by: Robert R. Cassman, LPCC

Many times, people will assume someone is “crazy” simply if that person is moody or impulsive. But there may be more than meets the eye. People who are moody, irritable, impulsive and irrational may have a disorder known as borderline personality disorder.

The term “borderline” was first used in the 1930s to label patients with problems that were in between neurosis and psychosis, or on the “border” of these issues. Today we understand borderline personality disorder with more clarity.  Below are five signs of borderline personality disorder (BPD.)

1. Mood swings. People with BPD may have severe and abrupt mood swings. This can lead to a misdiagnosis of bipolar disorder. These mood swings are rooted in their own perceived uncertainty about themselves. They may think they are happy and then come to think they are worthless and sad.

2. A pattern of “push-pull” relationships. People with BPD tend to have intense relationships that rarely last. They will push a partner away in an attempt to sabotage and then desperately try to win back the partner’s love through some extreme measure. This measure may be in the form of buying a lot of merchandise or threatening self-harm or suicide if the partner doesn’t come back. Self-harm is common among those with BPD. People with BPD may resort to violence out of fear. They may destroy their boyfriend’s car, post embarrassing details on the Internet, or stalk an ex.

3. General unstable view of self.  Those with BPD have feelings and thoughts of loneliness, unlovability, and thoughts of rejection. They tend to think they “mess everything up” and deserve punishment.

4. Dramatic. People with BPD tend to be attention-seeking. If they come to a party, they make sure to show up late to be seen. Or they will dress provocatively to garner attention. They laugh louder than others and drink more than is called for. They are more likely to take a bet to “act silly.” They tell inappropriate jokes at work and tend to “always have something going on.”

5. Impulsive. Impulsivity may be shown in many areas of life. They may have sex with four different people in one night or use many different drugs. Those with BPD are more likely to be sexually assaulted AFTER the diagnosis of BPD than those without BPD. Due to the impulsivity, they tend to find themselves in dangerous situations. The danger is what draws them to those situations. Plain and boring is worse for them than safe and predictable. Those with BPD have a history of eating disorders as well.  The impulsivity may be reflected in their spending habits too.

Finally, it should be understood that the overall issue with those with BPD is the extreme all-or-nothing nature of their lives. Everything that is done is to the extreme: relationships, work, play etc. If they are going to remodel a room, they remodel everything. If they are going to go on a vacation, it will be extreme and expensive. If they are going to lose weight, they lose a lot of weight. A person with BPD may cut off all her hair and dramatically change her look. A safe, moderate middle ground is almost allergic to them. They are not comfortable with “normal” or “average.”

In general, women who have suffered some sort of trauma or abuse are more likely to be diagnosed with BPD.  Treatment for BPD will focus on the dysfunctional patterns of thinking, specifically the “all-or-nothing” and the “catastrophizing” extremes. Many times women come to therapy for drugs or anxiety when in fact it can be BPD. Knowing this will help to get the proper treatment.