Baggage Check Live: Get thy butt to therapy

Aug 20, 2019

Licensed clinical psychologist Dr. Andrea Bonior will be online to take your comments about her advice column, Baggage Check, and any other questions you might have. These comments may appear in an upcoming column running in Express and online.

She’ll discuss her recent columns and answer any questions you may have about relationships, work, family, mental health and more.

Waiting for the chat to go live? Read Baggage Check columns.

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Hi, all! How are you doing this week?

It's so good to see you in the queue.

In this week's print Baggage, a wedding kerfuffle — what happens when others expect you to be in charge of your Ex's behavior? And in L2, a Mom's cruelty is not helped by the aging process.

What have you got for me? Let's get started!

 

I'm having a strange issue that just cropped up. I speak in public for a living, basically. I used to get nervous about it sometimes, but it was normal nerves and I worked through it. Now, years (decades really) into my career, and I have gotten panic attacks twice during one specific type of speaking I do. Ironically, it's something I have done regularly (meaning nothing has changed), and it's the most minor thing I do in my job. It's infrequent enough that the one anxiety self-help book I found is not useful, because my attacks are so rare. They are full blown attacks too, not anxiety leading up to the event. I have almost no warning. Is therapy the best way to address this? It seems like a bazooka for an issue that's affecting only .02% of my life, but the attacks are embarrassing and debilitating. Help!!

I think you have your answer right there — "embarrassing and debilitating." Granted, it may be only .02% of your life by hours in the day, but by emotional importance, I'm guessing it's much farther up there. (Something like 43.25648576398%, if my calculations are correct.)

There may very well not be any deep-seated issue that caused the attack, which is just as well. Conditioning is everything when it comes to panic attacks, and so that one specific aspect of those types of speaking gigs has now become conditioned to add to your anxiety about having a further one, and the whole way that panic attack works is that your anxiety about having a further one can send you into Vicious Cycle-ville.

So, yes, a few sessions with a CBT or ACT therapist who specializes in panic would be an excellent choice, not a bazooka. It's basically about learning the tools in the moment — physically and cognitively — to get your central nervous system out of overdrive and recondition yourself not to view the situation as so threatening. Not sure exactly how well those specific speaking gigs could be simulated in a therapy environment, but that would be ideal.

Please keep us posted!

Asking the ex not to bring a date is definitely something the bride should handle. But ... this is the OP's BEST FRIEND. Why is the ex going at all? He should politely decline at this point rather than going full throttle and bringing a date. Not, of course, that we can change his behavior ...

Yeah, it definitely sounded complicated. My guess is that if they were together for four years, then Ex may very well be pretty ensconced in the social scene and perhaps got close with bride's mate as well. So the invite was extended to the couple, not to LW Plus One. Excising the ex completely could be the equivalent of busting out the bazooka.

That’s extremely weird behaviour by the ex, and I wonder about his motivations. Perhaps he’s being passive-aggressive? Trying to get back at his ex? Is there even really a new girlfriend, or is it bizarre mind games? Or maybe he just doesn’t understand social conventions around a) RSVPs and/or b) being invited as your partner’s guest (and therefore uninvited by default when partnership ends). His intentions notwithstanding, it’s the bride and groom’s problem to deal with, and it’s the LW’s right to push this back to them. Her ex is not her concern anymore.

Thanks.

Yeah, I think the most benign explanation is a batch of wedding etiquette cluelessness coupled with perhaps just not wanting to be dateless and perhaps ostracized at the wedding. But again I'm not certain he was invited as a Plus One — they were a longstanding couple so technically the invite probably went to them both.

LW, are you out there?

I need help on getting motivated to organize my messy house, to exercise, and to eat healthy. I am on an antidepressant but it doesn’t help me feel motivated. Everything is overwhelming to me. If I make a nutritious meal the cleaning up is too much. I live in a state where medical marijuana is legal. I am thinking of trying it. Do you have thoughts? Have any of the people participating in this chat tried it? Thank you!

Let's be clear — of all the potential benefits of medical marijuana, "getting motivated to eat healthy and clean my house!" does not exactly top the list.

I imagine we will hear from others, though.

I think I need to hear more about your depression and what role it plays in your lack of motivation, first. It's possible that trying different things that target the depression could significantly and automatically improve your motivation. Or, there could be another issue causing your motivation issues that is actually MAKING you depressed.

Is some cognitive-behavioral therapy out of the question? I can't help but see its obvious potential here. You need some behavioral activation, and to potentially have some distorted thought-patterns addressed (maybe there's some all-or-none thinking in there about how you view the house/eating/exercise goals. Maybe there are behaviors that sabotage you. Maybe there's an anxiety piece in the "overwhelming" aspect that needs to be treated, too. Maybe the conditioned behavior of your habits has become so ingrained that you need some accountability.)

Also, it may be worth a medical checkup to look at your energy level and sleep patterns, too.

I'm the OP from last week with the pre-weekend cloud/depression. I took your advice and dug deep. I sat down, closed my eyes, and dug. There was guilt and regret. I said to myself, "You really need to forgive yourself." Out of nowhere, an image came to me of a rolling pin rolling out cookie dough. Soothing. I "went to" that image over the following days. Friday came. The cloud did not. I had a lovely weekend. Cloud has not descended since. I honestly feel ... healed. Thank you.

This is either the loveliest and quickest triumph of various cognitive-behavioral techniques ever, or an attempted trolling of epic proportions.

I'll choose to go with the former. So glad to hear it!

I'm in an affair that is winding down. I'm not particularly sorry for my actions and I'm not going to tell my husband. How do I refind an attraction for my husband going forward? I don't hate him, I'm not angry (any longer. We/I did have other issues in the past). Will time and concerted effort to spend quality time with him bring me there? Our relationship is still intimate, but sex without love can be awkward and uncomfortable.

Are you really asking if "sex without love" can somehow morph into love just through the passage of time?

Hoo boy.

Yes, a concerted effort to spend more quality time together will help with your emotional intimacy. But as I see it, there is a big gaping wound in your emotional intimacy already. And your affair is "winding down"— you didn't even end it yet.

I fear you are looking for magic here that doesn't exist. 

In my mind, you either commit to building the genuine marriage that both of you want, taking ownership of the issues between you and the actions that you took and what they mean, or you half-ass it and expect things to magically get better, all while sort of granting yourself permission to do things behind your husband's back that go directly against the marriage he believes he has, refusing to really show yourself to him.

Which do you choose?

[In response to last week's chat] Sad to say, I was like your spouse a couple of times during stressful points in my career. Luckily for me, my husband had a very high tolerance for my need to debrief my work day to him over dinner. Of course, I did the same for him, but he didn't need/want as much talk time about his job at the end of his day. But, we both realized it was an unworkable habit we were slipping into. When I took a job with a one hour one way commute, I found that I basically "debriefed" myself during the drive and arrived home able to set aside my work life and focus on home life instead. Maybe your husband needs a space in between the end of his work day and returning home. Perhaps stopping at the gym for a work out would provide him with a way to disconnect from work, recharge his energy for home life, and be better able to engage in non-work conversation.

Great advice. So glad that you two were able to figure out what was workable!

Just to echo in with others from previous chats. In my opinion, all emotions around having a miscarriage are completely valid. I have an 8 year old daughter. When she was 3, I delivered a stillborn daughter at 23 weeks and then had a miscarriage at 7 weeks. My 3 year old was born about a year later (at the age of 39 for me). I share this because we do not talk much about miscarriage as a society but we really do not speak about stillbirth. I am very open about it because it is how I process it. We all process these things differently. Just please know that you are not alone. Also one thing that is often not talked about is how the dad is. More support needs to be there as well. We are with you.

Thank you for this compassionate note. I am truly so sorry to hear what you experienced, and I imagine that loss was particularly isolating, as you mentioned. Bravo for you for finding a way to voice it and process it that worked for you.

I too wish there was so much more support in the aftermath of these experiences.

Thank you again for writing.

University psych departments and med schools often have low(er)-cost mental health clinics where clients see shrinks-in-training (baby shrinks?) under supervision. Is this a worthwhile alternative to expensive private therapy? Or can someone with limited training and experience do more harm than good? And does a clinic, where multiple people have access to your notes and records and even meet to talk about you, put your confidentiality at risk?

All therapists have to start somewhere — thank goodness — so there are a lot of such training programs, and they can be a godsend for their lower cost and also for the fact that you may very well be getting every drop of expertise of a much more experienced person anyway. In other words, the supervision is very close and done by someone experienced (often your entire sessions will be video or audio-taped), and you also get a two-heads-better-than-one approach. These programs have a very streamlined and clear-cut policy approach to confidentiality issues, so it shouldn't be a problem. Now, if someone is suffering from acute suicidality or a very rare and extreme disorder or they have some interpersonal characteristics that make therapy particularly trying or atypical, then it's not a good fit. But most programs make it clear exactly what kind of clients would be ideal (because they all might be teaching different types of therapy for different types of issues) and are good at screening to make sure it will truly benefit the person receiving the help.

Hi, Andrea. I love your work. Question: I am a 70 plus woman recovering from 6 rounds of leg and ankle surgery occurring over 5 years. I have been diagnosed with clinical depression and have been on antidepressants and anti anxiety drugs over 20 years. Since my most recent surgery in December 2018, I've healed physically well. However, I seem to need 12 to 15 hours of sleep out of every 24. When I wake up in the morning, all I want to do is roll over and go back to sleep - and so I do. Should I be concerned about this? Could I be sinking into deeper depression rather than answering a physical need? And how would I know? Thanks so much.

First, I've got to say — not only thank you for the kind words, but it sounds like you have seriously been put through the wringer with those surgeries. I am glad that the latest physical recovery has been good, though.

It's true that the sleep/depression cycle can get tricky. For a lot of people, excessive sleepiness is a symptom of depression. For still others, it contributes to their depression and even predates it. And of course, there could be something else causing both the depression and the sleepiness together.

The key for me is what your mood is like when you finally DO get out of bed. Which you presumably do, right? The hours of the day you are awake and moving around — how would you characterize your depression (or lack thereof) then? How are the tasks of daily life? How is your interest in activities? What about social relationships? Energy?

I don't want to automatically say that this means that your depression is getting worse. But it is definitely worth bringing up with your prescribing physician. Depending on the meds (which I note you are taking for anxiety as well), this might be considered a side effect and it may warrant switching.

I would also consider getting a sleep study. Has something happened that has changed the quality of your sleep? How does a lack of mobility figure in?

And how much sleep did you need before, compared to now? What times of day are you at your most active?

I'm throwing a lot of stuff at you because I think these are all the types of considerations I would have if you were presenting to me in my office. Hopefully they may give you some direction. Keep us posted!

I have a friend of about 10 years who is a lovely person: thoughtful, kind, fun, etc. For the past couple or so years, she has been dealing with escalating depression, anxiety, and panic attacks. In that time, she has become increasingly difficult to be around in that she has become very opinionated (to the point of sometimes being cruel), entitled, angry, judgmental (again, it sometimes lead to cruelness), etc. Also, she often takes things personally that have nothing to do with her and then gets angry with us, sulks, cries, storms off. We, her friends, are trying to be patient with her and chalk up the bad behavior to her mental health issues but we're becoming increasingly frustrated and not sure how to deal with her and her issues on an ongoing basis. We try to give her positive reinforcement when we can but we also 'give in' to her on a lot of things as to not upset her (there's a lot of walking on eggshells) but then we end up being the ones who get upset. I'd love your thoughts and suggestions on how we can support her without enabling her bad behavior and getting frustrated. Thank you!

This is such a common issue — and I know how frustrating it can be. You want to be empathetic, but you also don't want to be mistreated and frustrated and worried through all of your interactions, which don't seem to be improving. And let's face it, having to walk on eggshells is the death blow to emotional intimacy... whether among family, friends, or partners.

You ask how best to support her — and therein lies the key. She is not getting the support she needs. Why? Is she in therapy but it's not a good match? Is she on medication that is doing nothing? Is she self-sabotaging? Has she even tried treatment? The fact that you call this "escalating" tells me that she is clearly not getting the help she needs.

And that's what your new focus could be. It is no longer about managing the little picture — it is about zooming out to the big picture and having a larger talk with her about your concerns, how she doesn't seem happy, how things don't seem to be improving, how you worry about her, how it's hard to see her be so hard on herself, how you feel like you try to help but can't do enough..... THIS is the conversation to have.

Because at some point, it really does become like any other type of issue that someone is going through where they refuse to seek treatment (if that's what's going on)-- you can't continue to stand by and be part of the destruction.

Appeasing her in the moment may very well be denying you the opportunity to nudge her toward the help she needs.

Does this make sense?

It's great to be on them to treat depression, but isn't it possible that not every anti-depressant works for everybody and maybe changing meds could help?

For sure. A med shake-up seems an important consideration.

I've recently moved to a new community. In the course of getting to know people, I'm occasionally asked about my family of origin. This is a difficult and painful topic for me! My parents (both deceased) were abusive, and my only sibling is in prison for child pornography crimes. How can I respond to (or deflect) questions without either lying or revealing more than I'm comfortable with?

I think your actual answer can depend on the wording of the question, but the key component is to give yourself permission to share as much or as little as you want. I know you already get this, but I think there's a smidge of putting their need-to-have-an-answer or the typical rules of etiquette as a higher priority than your own ability to not have to rehash this. Just by virtue of your having asked this. So, don't overthink here. Just be you. You might use humor, you might use turning the conversation back on them, or you might use brutal honesty.

"So, where does your family live?" "Oh, to be honest, my parents are deceased and I am not in touch with my sibling. The people I'm closest too don't tend to be family."

"So, do you have any siblings?" "I do, but it's a complicated situation. What about you?"

And so on. I of course have a somewhat skewed view of this given my profession, but I honestly feel that tricky/taboo/difficult/upsetting family backgrounds are far more common than people realize. You might be surprised how easy it is for you to find a comfort level with a simple answer and then just use it over and over (and then if you get very close to someone and choose to confide more, you can.)

Been there. Took me years between ending it and taking ownership of my/our issues and going to couple counseling. End the affair, take whatever time you need, then get thy butt to therapy.

Get thy butt there indeed.

Thanks.

Well...I have to disagree with this. I would hate to have some kind of competition set up between miscarryers and stillbirthers as to which is worse.

Oh, I certainly had no such competition in mind!

I’m really struggling right now with my husband over a pretty serious issue. Our dog is very old. She’s got some health conditions that will continue to get worse slowly but right now her overall quality of life is still high. However, due to mild incontinence, she often wakes me up during the night to go out but then seems to forget why she’s outside. This happens several times a night and I can’t ignore it. Doggie door is not an option for many reasons. Similarly, she can’t be left alone for more than a couple of hours without having an accident. So our schedules are pretty restricted. We can’t vacation together except for when we bring her with us, can’t really board her or find a dog sitter, and we barely go out together in the evenings. My husband now sleeps in the guest room just so he can get some rest. I recognize the situation as temporary (although it has been like this for a year) and as a gift given to a sweet and dear companion as she nears the end of her life. I am well aware that we will probably have to put her to sleep when her quality of life declines too far, but vet says that we are not anywhere close. Husband and I agreed that we would give her the best life we can for as long as we can. But this morning, my husband said he’s ready to put her down now. I flat out asked: “So you want to kill the dog so we can sleep better?” And he said: “Yes, I am.”

I honestly don’t even know where to go with this. We’ve been married for ten years and I had this dog before we were even dating. I am feeling like he only admires my devotion to animals as long as it doesn’t inconvenience him. I'm feeling angry, disappointed, disgusted and I definitely don’t know how to engage with him on this topic. I feel like my choices are: 1: Remove him entirely from all pet care and avoid mentioning my lack of sleep. 2: Pack up all the pets and leave. I’m pretty sure neither of these is the right answer, so what would you suggest? Both of us are too angry right now to communicate in any productive way. At this second, if I had to pick the poopy old sleep-interrupting dog over him, I would do it in a heartbeat.

Oh, this just breaks my heart.

Of course, this is a fraught issue and I don't want to oversimplify it. And I also know that we will probably hear from a LOT of folks for whom this strikes a pretty strong chord.

It sounds like something happened overnight that made this a hot button issue for Husband, and he's reacting to that. And it's escalated pretty highly for both of you. So, the first thing I would advise is no rash decisions and not even any rash words. Sleep deprivation can make people act out in ways that are — to put it euphemistically — not in line with their best selves.

But I think you need some added support here. Yes, your vet said that this beloved pup is not near the end yet. Can that vet also have some solutions to help with these issues? They are not uncommon....and yet they are driving you and your marriage into the ground. You should not have to shoulder this totally alone, and if your husband was on board before, it's realistic that he still can be — with some adjustments.

Actually, I don't want to spend a moment more on this before sending it out to the chatters, because I suspect we will get a breadth of ideas and support there. In the meantime, please, take a moment to breathe, to remind yourself that there is love there all around, and that the three of you are a family and with proper communication and strategizing, you will get through this together.

FWIW, there shouldn’t be a “plus one” or “and guest” on invites, ever, technically. So the maid of honor was invited with her long term partner. That change meant the guest (the ex-boyfriend) should have written the bride and asked whether he was still invited, offering to remove himself since obviously the MOH is still attending. That correspondence would have given rise to the answer (no longer invited or invited solo or invited with a new partner). Unfortunately not wanting to be attending alone is not a reason to try to invite someone who wasn’t invited along, ever, to any event. Only hosts my issue invitations, not guests. And if you attend alone you get to make new connections rather than spend all your time with existing social connections. Which is, at least in part, some of what one should do at social functions (hence rules that one does not sit next to or dance with one’s spouse all the time).

Oh, for sure. I never meant that his fear of not wanting to be alone was a valid excuse to wedge an extra guest into the equation. I just meant that it was the more benign explanation; that he was not necessarily the antichrist, etc.

What you spelled out here for how he SHOULD have behaved, though, is lovely. If only we had a time machine!

Fatigue is can be a symptom of autoimmune diseases or Lyme Disease. Please ask your doctor for blood work!

Another vote for bloodwork! Thanks.

Yes, autoimmune issues in particularly seem really important to rule out.

When I've gone through this (rolling over and going back to sleep), it's because I'm dehydrated. It especially happens during the shoulder seasons because of allergies. I hope OP considers some physiological explanations, given what he/she has been through, physically!

Yes!

Dehydration makes a heck of a lot of things worse.

(Including kidney stones. Oof.)

Especially since aging, and the mere passage of time even if not through getting into one's 70s, can bring about different reactions to medications as well as interactions. A thorough review is needed by all the physicians involved.

Yes, indeed!

My father had many sleep issues as he aged, and went from very few hours of sleep to many many, plus naps. A complete physical identified some issues, including low thyroid, very low vitamin B12, low vitamin D, etc. A good geriatric doctor may be able to find physical causes that are unrelated to the surgeries or depression.

Good to know! Thank you.

Vet here. Why can’t you get a pet sitter? Why can’t you leave her for more than a few hours? You can make a litter box for her. She can wear dog diapers on an occasional, temporary basis (and get checked and cleaned after) so you can still have a date or a day trip. There’s more options. Sleeping separately may be needed if she wakes your spouse. You may want to look into changing continence care, treatment for senility, and medication to help regulate her day/night to help her sleep at night. Also, quality of life is for everyone in the house, not just the dog. Please forgive your husband for having differences of tolerance for sleep deprivation and lifestyle change. Good luck.

I think I love you.

Just what I was hoping for.

Thank you.

Just writing to say thanks to the man who took the time to write in last week about being attracted to women in their fifties — very kind.

Glad it went over well!

Maybe also try getting a hold of your local Toastmasters organization for help "simulating" the speaking environment.

That could help!

(I am growing more and more curious what the specific aspect of speaking that brings out the panic attack is...)

I could have written this letter. Fine for years, then began having panic attacks while speaking in public, with no warning. Fortunately, my doctor prescribed a drug that works: propranolol. I take a pill thirty minutes before I speak in public. I have not had a panic attack since I started taking it. It works great for me.

I am glad it works for you!

As a dyed-in-the-wool CBT/ACT therapist I am desperate to add additional tools in there beyond meds, but it's worth a mention. Thanks!

Thank you so much for responding. You said what I knew in my head was probably true. I just got off the phone with my EAP service — I'll set up an appointment as soon as I get their list of therapists. I just needed a kick in the rear to take the first step.

Fantastic!

How about puppy pads? I'm not sure what your yard, sidewalk, basement situation is but it could be an option instead of going outside at night. They worked for my cat when she was having trouble getting in and out of the litter box because of arthritis.

Wonderful.

What?? He made a perfectly reasonable statement about something you had both agreed on and you flew into a rage and accused him of cruelty? BTW, you may not realize that sleep deprivation is a known torture device.

Things got escalated, for sure. But I can also see that that's what it felt like for her, legitimately. With sleep deprivation making things worse on both sides.

When you're just get to know people it tends to be small talk. The main thing is to return the conversational ball. This makes it hard when it can be a painful topic. For example, people ask me if I have children. It doesn't tend to be painful for me luckily — but I reply "No, but we have eight nephews and no nieces — can you imagine!" That gives them something to run with and the conversation moves on. You know this topic can be difficult so you could say "Oh, my family is not close — but now my dog, we're best buds. Do you have a pet?" Plan what you want to say in advance that gives the person traction to continue the conversation.

This is spot-on. That conversational volley-back is often more important than what was even said in the first place. Thanks.

You can also answer with true things that are vague or answer part of the question. “I grew up in Detroit, but after my parents passed away, I haven’t been back.” “Oh my favorite memories are of summers with my grandmother upstate” “I’d tell you but then I’d have to kill you. Seriously, though, I’m a military brat so we lived all over.” “My parents lived in Chicago until they passed, and I haven’t talked to by brother in years. My holidays are mostly spent with friends I’ve had for 30 years. You? Have you been in the area long?”

Great examples. Much appreciated!

I, too, have trouble shaking the feeling that I have to respond to an unwelcome question because I "don't want to be rude." I've found that Dr. Bonior's suggestion works great - say something vague then pivot the conversation. And I'll pivot big! "Yes, I have siblings. It's complicated. So, have you lived here long?"

Thanks! Sounds perfect to me!

I knew you didn't, but I thought the LW came dangerously close to suggesting it.

Got it. Thanks.

Hey, person with the issues getting motivated! There's a word for that: Executive Dysfunction. It's when you know you have to do the thing, and you want to do the thing, and you know you'll feel better when you do the thing, but you just. can't. get. started. because you're so overwhelmed. I've dealt with it before, usually coming out of depressive episodes. Absolutely see a CBT therapist, but what worked for me was living by the phrase, "If it's worth doing, it's worth doing poorly." Can't motivate yourself to do the dishes? Just wash one plate with a sponge. Can't motivate yourself to cook or know you won't clean up? Get some carrot sticks to eat with your takeout. Can't motivate yourself to exercise? Go for a walk around the block, or if that's not possible, draw the blinds and have a one person silly dance party like you did when you were a kid. It's incomplete, but it's done. And sometimes, accomplishing SOMETHING will crack that executive dysfunction.

Yes, yes, yes.

So many times we wait for the motivation instead of understanding that it's the action — even a relatively tiny one —that actually creates the action.

You'd never believe whom I first heard "If it's worth doing, it's worth doing poorly" from. A mentor on my dissertation committee! ha! One of the best gifts I've ever been given. (And thankfully, no, he didn't happen to say that after reading my dissertation. It came in another context entirely, but the message sure helped me get through that slog on days when it was tough.)

Boundaries, boundaries, boundaries. You can let them flex a little in times of crisis, but figure out — will you hang up/leave/speak up when she’s angry and nasty? Adjusting your expectations is good, eggshells will burn you out. And keep in mind, you can probably be a better friend/help long-run if you don’t let her burn the bridge! So hang up if she’s nasty, and keep taking the calls.

Yes. In my over-arching concern with the nudge toward getting the friend in treatment, I overlooked mentioning the importance of these day-to-day boundaries.

"It's hurtful for me to hear you talk like that, so I'm going to need to end the conversation now, unless we can change the subject."

Being empathetic is not a free pass to be treated poorly over and over again. Thanks for the reminder.

Thanks so much for your response. My friend actually is in therapy and is on medication so the big picture "should" be under control (but obviously isn't) so we need to know how to deal with the day to day. By "how to support her," I meant how to deal with her negative behavior while still being sensitive to her mental health issues. Hope that helps. Thanks again, love these chats!

Got it.

Well, shucks, there goes the crux of my answer! Ha!

So then it really does become about the boundaries. Using "I" statements that express your feelings in a calm way, but also that lead to firm lines about how much you are willing to take.

"I feel sad when I hear you say that. This has been a draining conversation for me, and I imagine for you too, and I'm afraid I'm going to have to take a break from it."

And let's address the elephant in the room — how much longer should the therapy and medication be given— with things ostensibly getting worse — before she looks to switch things up a bit?

I was sort of friendly with a colleague/acquaintance who has now lost all of her friends because of her increasing neurotic behavior and refusal to seek help because everything is somebody else's fault. I hope the LW and his/her circle can survive the friend's behavior, but it might not be possible.

Ugh, I am sorry to hear it.

Yes, unfortunately, I've seen this happen.

I wrote in about a month ago about my daughter who was experiencing a mental health crisis and expressing suicidal thoughts. I am extremely grateful to you and your readers for so much help to deal with this. We are definitely in a better place today. The same day I wrote in to your chat, I also reached out to my daughter’s pediatrician. I was very grateful to learn that her doctor’s office employs a therapist. Her job is to 1) connect families who need services to a therapist who is a good fit for their needs 2) counsel parents on the phone about how to manage their children’s crises and 3) see patients for short term care who might need immediate mental health treatment. This counselor was incredibly helpful. She didn’t recommend seeing my daughter directly for counseling since she said that young children take a while to build trust. But she spent an hour with me on the phone immediately and gave me lots of advice on how to handle it when my daughter snapped. Her take on the situation was the same as yours so I felt confident that we were moving in a good direction. The next time I saw my daughter start spiraling and about to explode, I was able to help bring her back to calm based on the therapist’s suggestions. Truly life-changing. She also did all the leg work and reached out on our behalf to three different therapists who she thought would match my daughter’s needs and also took our health insurance. Because she already had relationships with these therapists we were able to get my daughter in for her first session about two week after she first expressed the suicidal thoughts. So far, our therapist seems to be a good match for my daughter and my family. She focuses on families, self-harm, mindfulness, and behavioral issues. So now we are doing the hard work of managing emotions and learning to cope when things don’t go her way. Things aren’t perfect, but are slowly getting better and my daughter seems much happier overall and the outbursts she has experienced have been much less explosive and much more manageable. I feel so blessed that our insurance covers as much therapy as she needs since cost would have been a huge barrier for us otherwise. I also feel blessed that our doctor’s office has this amazing resource in the form of a therapist on staff to help us navigate this crisis. Figuring this out would have been so much more challenging without her amazing support. I really want to thank you and your readers for all your thoughts but most of all for your support to me. It’s very comforting to know so many people out there have your back when you feel so scared and untethered. Some readers raised sexual abuse as a possibility. I took a hard look and also spoke to my daughter directly about this at a time when she was calm. I am convinced that is not going on in this case, but I certainly appreciate that people raised it. Thank you so much for your advice and for hosting this forum.

I am so, so happy to read this update. It was so kind of you to take the time to write it. Thank you for that, and for your generous words.

There are a LOT of people who have your back in this, and I couldn't be more glad that you are directly on a path to receive solid support from some of them. Huge smile here!

I have release envy! I have tried soooo many things including visualizations .......and this person visualized ONE THING and worked through his/her issues. I bow to your happiness.

Release envy!

And I had troll anxiety.

That post was like a Rorschach for all of us! (Though to be clear, I am taking it at face value and thrilled.)

Hi, I’m the “confused in love” girl from the last chat. We talked about the situation again and broke up in good terms since any of us could come up to a solution and his silence just confirmed the fact that he didn’t want the relationship to work as much as I wanted, even hurting, I had to leave. The post-break up sadness is sometimes unbearable and I find myself tempted to call and apologize (for something I didn’t do) out of loneliness and this strong feelings of missing him ... but I don’t want to lose my dignity (if I have any...) Thank you

Thanks so much for writing back in. I am sorry that it had to work out this way, but it's clear that you understand that this is the best thing for you. Take a humongous mental highlighter to that knowledge. Put it where you need to see it. It will get easier with time, I promise.

Carolyn Hax says instead of "getting motivated," remove barriers. Get everything you need for your workout together, and put it where you can reach for it with zero effort. Also, not everything has to be done NOW: After you've eaten your nutritious meal, rinse your dishes and go work out. The kitchen can be cleaned later. For your disorganized house, break it down into micro-tasks: One closet/one weekend hour. And don't beat yourself up if the closet isn't organized in that time. Go back to it next weekend. Baby steps. And reward yourself for tasks accomplished.

Yes. Micro-tasks, and setting your environment up to help you succeed. Thanks.

Even seasoned and world-famous actors can suddenly develop "stage fright." Both Laurence Olivier and Barbra Streisand have written about its sudden onset after decades of performing.

Absolutely.

Seconding this. Those who are aging often see so many specialists that they lose touch with a primary care physician. This happened with my mother, who went too long before seeing a cardiologist who sent her to the ER for a pacemaker. I found her a local geriatrician who now oversees her care and cc's all of her other specialists. If you can't find a specific geriatrician, many internists concentrate on geriatric issues, my niece the nurse tells me.

This will likely help far more people than you realize! Thank you.

I had one. They make doggie diapers- belly bands for males, and diapers for females (mostly used when they're in heat, but this is doable). Try putting in a normal human maxi pad to ease cleanup and increase the amount it can absorb. Take the water up two hours before bedtime- your dog will be okay overnight while you sleep- and take her out immediately before bed. When you're going out for dinner, take the water up two hours before you leave, confine her to an easily cleaned room like the bath or laundry room, and for extra measures, protect the floor with newspaper or potty pads (and stick a diaper on if you're really going overkill). Some pet sitters and boarding kennels offer doggie hospice services- check with your vet or other local pet owners for recommendations. And between you and your husband... maybe check in with a counselor. This has caused some issues, and you don't want to let them fester.

Really well-said and so helpful. Much appreciated!

You are not alone, OP!

But he was speaking from the position that they had agreed "as long as possible" and it turned out they had different ideas of what was possible. That was the point to address, not "killing the dog." I don't know that I'd ever be able to get past an accusation like that.

I see what you mean, but I think it's reasonable for "as long as possible" to have been understood to mean as long as the dog was enjoying a good quality of life. So I can understand that it felt like a betrayal for her to imagine differently.

I have high hopes that with better communication and sleep and some of the strategies our chatters advised, they will get through this just fine.

This is a challenge my husband and I have faced, and will probably face again. I think you have to address the husband and the dog as two separate issues almost. My husband and I have had arguments like this, because it is a super intense subject and seems like one of us is always the cruel one and the other is almost blind to reality (and we switch roles even!). Try to give him the benefit of the doubt that he was speaking out of frustration, exhaustion, or even just to see how you'd react. For the dog, she could be having 'sundown' confusion, and maybe there is a medication that could help her sleep overnight. Diapers are an option that might help after an adjustment period, or closing her in a bathroom or crate overnight with a puppy pad.

Super intense indeed. I knew this would be a high-emotion issue, but once again you all just outdid yourselves in the compassion and advice.

Thank you!

My heart breaks for you, because this is a tough one. My old dog was helped a lot by a drug for incontinence, so I agree with speaking to your vet. You might also try one of the newer cognitive drugs, as some of them can be helpful if what's going on is a cognitive issue (dogs get dementia too). As for your husband, I would take him in to the vet with you, so that you can both discuss your concerns, but you both do need to be on the same page - he is affected by this as well (I do NOT deal well with sleep deprivation, so I can sympathize with him a bit). You might also try, as another poster suggested, using puppy pads for when you can't catch her in time.

Yes. And I hadn't mean to minimize the husband's experience at all. He is clearly greatly affected by this, in many ways.

Thank you.

Not sure if you're still collecting these but: "I should have left sooner" or "I should have told the police the whole truth" from a survivor of domestic violence. I know many of us in a similar situation where were we took years to leave, or when police finally got involved, we didn't provide the full extent of the abuse for many many reason.

I know that this discussion had concluded a while back, but I also know that a lot of people struggle with this issue and I think you've probably helped people by writing it. You are not alone! I hope you have gotten some support.

Because you were curious Andrea: it's the most mundane of meetings. I can't express to you how boring these meetings usually are. I'm just relaying very basic information that I could recite in my sleep. My normal public speaking is in . . . adversarial . . . environments, and I do fine with that. Toastmasters isn't something that would really do me much good, I speak far more regularly than any toastmasters is going to meet, and I'm already a good public speaker. I swear! It's just this one meeting. It's been a mystery to me for four months or so. Hopefully a third party can see something I can't that's causing it, or at least how to get out of the loop.

That is a really interesting wrinkle! But I get it, I really do.

Just like I enjoy doing live TV and radio without specifically rehearsed questions far more than scripted stuff or the pre-recorded podcasts. I enjoy Q and As better than the keynote itself. Most people are the opposite, but I need that adrenaline burst or that edge to do my best.

Honestly, for you, it might have just been a quirk of that very day and moment, the first time — a hitch in your heartbeat that you interpreted in a catastrophic way, for instance — that started the panic ball rolling. But solid CBT can definitely help!

When all else fails, burst into tears. Yes, it's the nuclear option, but when prying people refuse to take a brush-off, it's necessary.

haha!

I think that might be a smidge more revealing than OP is going for....

I have one brother I haven't spoken to in years, another who died, a half-brother who I reconnected with after a long separation, and a younger half-sister who died as well. Don't get me started on my parents ... but hey! Here's a picture of my cat! Isn't he adorable!

ha!

Sounds like you have mastered this particular art of conversation.

(Sorry for all of those losses, by the way.)

Or as I got from FLYlady - progress not perfection. We are so paralyzed by perfection,

So true!

I'm going to try that out at work.

Hopefully your job is not performing brain surgery.

There's also, "The perfect is the enemy of the good."

Yes, this is its just-as-helpful sibling!

1. I'm not a troll. 2. It's only been a week (since last week's chat). 3. People differ. You will get the help you need, you will work it out. 4. I love Dr. Bonior.

And I love you too!

What a note to end on. Just beautiful.

Thank you!

Thanks so much for being here. It felt like a mile a minute today, but I loved every bit of it.

Until next time, be well. I will see you in the comments and on social media!

In This Chat
Dr. Andrea Bonior
Dr. Andrea Bonior is a licensed clinical psychologist and the voice behind Baggage Check since its start in 2005. She serves on the faculty of Georgetown University and is the author of the Publisher's Weekly best-seller "Psychology: Essential Thinkers, Classic Theories, and How They Inform Your World" and "The Friendship Fix.”
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