I thought I may share some of the topics I will be discussing at that talk.

- Depression is perhaps the most common mental health risk workers have. According to one poll, 22% of workers presently suffer from depression.

- Depression can be effectively treated through psychotherapy. Research suggests that drugs work well on Major Depressive Episodes, but that they are no more or less effective for mild or moderate cases.

- It is OK to allow yourself to feel bad, or blue - but when it begins to impact your behaviour or thoughts, one needs to seek help.

- Perfectionism is a form of anxiety. Simply put, if one were not perfect, one would become anxious. Perfectionism, however, is relative. Exploring the underlying anxiety that accompanies perfectionism is often helpful.

- Enforcing boundaries in terms of how long we work, or not entering into bad situations in our work requires that we have the fortitude to handle the emotions that arise when we say 'no'

- It is rarely about how good you are at your work. The more important factor is HOW WELL you work.

However, it is important to go deeper than this, and ask why depression is treatable - what factors in it make the prognosis seem positive compared to other conditions? In many cases, depression is significantly helped simply by talking to someone about it. Most depressed people do not feel as if they can talk to many people about their thoughts, behaviours or feelings. As such, just getting things out in the open is often a big first step.

Therapists often talk about people who are 'resistant' to therapy. In the case of depressed people, if they are able to get themselves to see a therapist, they are usually very open to the process. The issue becomes more one of pacing - how fast can changes occur, as opposed to a question of whether change will happen or not.

Another factor is that depression is so common that there is no shortage of research into the condition. This research often begins to inform clinical practice and allows for advances to be translated fairly quickly into therapeutic strategies and tactics.

Depression involves three key areas of psychological functioning - behaviour, thoughts and emotions. All of those areas can be targeted by the therapist, and all of those areas seem to respond well to treatment. In fact, with depression adjustment in just one area tends to have immediate impact on the other two. A therapist does not necessarily need to focus on all three areas in order for a depressed patient to see improvement. Once improvement happens in one area, it will likely spill over into others. In fact,just focusing on the 'thoughts' aspect of depression, the thoughts that accompany depression are so readily identifiable and so clear that it is fairly easy for the clinician to spot them and begin to work with them and change the other two areas of functioning.

The phrase 'There is effective help for depression' is not just another platitude, nor is it another way of telling depressed people 'To get over themselves'. Rather, there is a lot of truth to the fact that depression can be helped effectively, even if it may not feel like that to you today.

The incidence of depression is soaring. Major Depressive Episodes have a lifetime prevalence of 12% in the Canadian population - meaning that over 1 in 10 people will be debilliated enough by depression to have their lives seriously impacted by the condition. The World Health Organization estimates that by 2020, depression will be second only to heart disease as the major source of disability throughout the world.

There are a number of reasons why rates of Major Depressive Episodes may be on the rise. First, doctors may be recognizing it more as drug treatments become more readily available. Second, people may be more willing to talk about it. However, it is unlikely that these simple increases in reporting are causing the major increase in depression.

I believe that it is important to look at the psycho-social causes of depression. When I look at these causes, rather than just addressing Major Depressive Episodes, I am going to focus more broadly on why more people in general are prone to depression, or why many of us have what are called 'depressive personalities' - and as you can imagine, if you have a depressive personality, you are more likely to develop depression.

Depressive personalities can be described as people who are overly self-conscious, meaning that they can be overly narcissistic, or at the same time overly sensitive to criticism. They are individuals who do not know how to deal with their sadness, or the emotional impact of the slings and arrows life throws at them, and I see a lot of depressive personalities in my Toronto psychotherapy practice. When people are unable to cope, they lose their sense of self, and begin feeling bad about feeling bad. These bad feelings can be directed inwards towards the self (I am not worthy) or directed outwards (The world is an awful place). These individuals can be prone to Major Depressive Episodes, but can also be prone to more milder forms of depression, or dysthemia - a low grade chronic depression that lasts for more than two years - not a rosy prognosis at all.

Individuals suffering from depression do not know how to 'mourn' or 'grieve' properly. The only difference between mourning, grieving and depression is that mourning and grief have a 'time limit' on them. That is to say, they come to an end - naturally by the person who is grieving the loss. The purpose of mourning is to shut-down the body so that it can focus on dealing with the loss the individual is facing. With depression, mourning and grief have no end, and with no end comes hopelessness and less sense of self - we no longer know who we are because we are so enmeshed in the depression.

The psychotherapeutic cure for depression involves a number of key factors, that are listed in general order:

1) Addressing the 'shoulds' one feels about themselves and their lives, and losening the grip those have on the individual. One primarly reason people slip into depression is because they think they should not feel depressed.

2) Addressing 'Who Am I' and building-up character. This is done indirectly by the therapist asking questions as opposed to giving direct answer to the patient. The therapist begins to ask a patient which part of them is speaking, or which part wants to speak. These questions tend to build character and self-esteem.

3) Restoring sadness and grief. With the other two pillars in place a depressed person will be able to feel sadness. The goal, however, is that the patient will realize two things - the sadness is not as bad as they thought (given that the shoulds are removed, and there is a person who can respond to the sadness), and that the sadness is episodic - that is, it comes to an end... even if just for a moment. As a patient experiences the temporary nature of sadness (even if there is only momentary relief from sadness) they realize that it is possible for sadness to be lifted eventually, and this brings hope to the patient.

In the end, a patient who deals with depression through psychotherapy can expect to build their character while addressing their sadness and turning it into mourning, which is a temporary condition. This brings about hope to the depressed individual - and this is what I am proud of in my therapy practice. I rarely am the one to directly give hope to my patients - through this process (and it can be a very long one), they discover it themselves.

One of the best pieces of advice that I received is working with self-esteem is that 'you never directly work on someone's self esteem.' This makes complete sense for many reasons according to Twerski:

- There are significant cognitive distortions that go on in people who feel that they have low self-esteem. That is a fancy way of saying that people will not believe compliments or praise that is given to them, so a therapist must have many other tricks up their sleeve other than to provide genuine compliments to patients.

- Many of the processes that are involved in creating a lack of self-esteem happen unconsciously, so it is necessary to work indirectly on these issues.

- Self-esteem issues often create poor relationships for patients, so sometimes just building a good therapist-client relationship can be a key component of working with self-esteem issues.

What is truly unique about Twerski's approach to self-esteem is that he recoginzed that he had low self-esteem about 10 years after he became a successful psychiatrist. This link -http://www.torahweb.org/torah/special/2008/dtwe_esteem.html provides an account (and an audio recording) of how Twerski dealt with his own self-esteem issues, and is worthy of a read.

I have a steel rod in my back as the result of fairly severe scoliosis, a curved spine that was diagnosed in my teenage years. The rod was designed to correct the curve, but not cure it. As a result I have poor posture, and that combined with having a hunk of metal in my back produces a fair amount of pain. Also, prior to the corrective surgery, in my early teenage years, I also had a fair amount of back pain due to the severity of the curve in my spine.

The back pain largely came to define me. Since roughly the age of 12 it has always been difficult and moderately painful for me to lift, exercise, walk, dance, exercise, do basic chores and travel. It certainly was not impossibe for me to do any of those tasks, but I believe I masked the pain fairly well.

At the time I was under the care of various physicians, surgeons and physiotherapists immediately before and after the operation. Any time I discussed the pain, which is predominatly in my right scapula, I was told 'It's bursitis. Everyone has pain. Live with it.' The best response I got was from a surgeon, who doing a routine check of my rod in 1997 simply said 'Hey, you have a steel rod in your back - what do you expect?!'

I largely believed this advice, but with the physical pain came an awful lot of sadness. Sadness that I had to live with such pain. Sadness that I could not participate the way others around me could in activities (or if I did, they had little knowledge as to why I got so tired). Sadness that if there was only one chair somewhere, I would often sit in it, even if others needed it. Sadness that my upper body was slightly deformed, and sadness that working at a desk causes me exceptional pain.

About two years ago, I decided I could take the pain no more and began to research and consult my family doctor based on some findings I discovered on-line. Since I am a fairly unique case, he had no clue how to deal with constellation of symptoms and issues I had. Since I live in Canada, it took two and a half years to see a specialist.

I saw that specialist and his associate today. Their view is that the pain in my back is being caused by the fact that the steel rods in it are now rubbing against and irritating the muscles around my scapula, and it is time to remove most of the rods.

If I am scared of anything it is who will I be without the pain that has come to define me? Moreover, could I have had the pain eliminated earlier in my life to have a better quality of living? These questions run deep, and the anxiety that I have is who will I now be once my pain no longer defines me?

I think the funny thing is that in Toronto we have so many healt-care options, whether it be traditional medicine, chiropractic, physiotherapy, accupuncture, basic exercise, sports medicine and other treatments. Though I have seen most of these practititioners and they have all been knoweldgable and earnest in their efforts they were largely ineffective. I wonder if I saw them just to keep on having the pain that I lived with and the pain that defined me for so long.

**Addition** The following is a useful link regarding the psychology of illnesshttp://www.onlinepsychologydegree.net/2013/03/04/the-psychology-of-illness/ I hope you find it as useful as I do.

It is worthwhile to examine why this occurs. There are really two primary reasons. The first is talking about issues that you have not discussed before may bring-up certain feelings in you either about yourself, about your therapist or about the process in which you are engaging. Second, it becomes important to manage expectations about the pace of improvement or therapy in general. For example, a therapist may want to take a number of sessions in order to get to know the client's history before shifting focus towards doing a lot of deeper therapeutic work.

I think one of the key things to come out from the fact that things may get worse before they get better is to ask yourself what do you do in general when things get worse for you? Do you just plod along in therapy without telling your therapist, or do you discuss the fact that things seem to be getting worse, or are not improving? This will all depend on the realtionship you have with your therapist. In theory though, you should have a good enough relationship with the therapist such that you can communicate anything to them.

Also, it may be worthwhile to examine why things are getting worse - is it the thearpeutic process itself, or are things happening in your life to make it that way? Expressing this dilemma may help you continue on in therapy in a way that will lead to healing. It is my view that knowing how you may be affected by therapy before the process starts is an important part of good treatment.

Now let's understand very clearly that we cannot necessarily control all the situations into which we get - car accidents, medical emergencies, even who our birth family is. The only thing that we really can control is our reaction to these situations.

So, boundary setting involves avoiding situations we can control, or controlling our responses to situations that we cannot control. But where does self-esteem come into the picture? Self-esteem is like our bottom-line - we basically say 'No, I won't do that!' or 'No! I won't go there' or 'No! I deserve better', and then we act accordingly.

And this is really important to note. There are two parts to self-esteem - the cognition of really 'I won't allow myself to do that', and then the behaviour that follows it. The funny thing is that it is possible to exhibit the cognition, without the behaviour and it is equally possible to exhibit the behaviour without the congition. In either case, proper self-esteem is not being enacted. Self-esteem requires both the thought and the behaviour to work in tandem.

Why is this the case, and how can both the thought and the behaviour work together? As a psychotherapist in Toronto that largely practices psychodynamic therapy, the thought and behaviour need to be properly joined by emotion. That is to say setting-up boundaries has to involve emotions that simply cannot be ignored. An example will suffice.

Say a married female patient constantly has affairs. Slowly - over decades - she realizes that these affairs are taking a toll on her personally, financiall and on her children. The thought in her head becomes 'I am better than these sordid and torrid affairs'. The self-esteem has kicked in. Thenthe behaviour that comes about as a result is to stop them. But what of the emotions involved? The emotion of sadness in being lonely? The anxiety involved in meeting a person with whom she could have an affair but must not. The grief involved in still being in a poor marriage? If these emotions are left unprocessed, raw and even ignored, I will bet that it will only be a short while before this woman goes back to her philandering ways.

Self-esteem is thus a triumverate of thoughts, behaviours and emotions. The goal of my psychotherapy practice in Toronto is to work on all three of these areas with my patients, with a recognition that once the thoughts come into awareness, behaviour will likely follow quickly - but it is understanding the emotional consequences of the boundaries that have been enacted to improve self-esteem that will yield long-term results.

The reactions we have to other people in our lives are often called "Transference".  That is, we take what we know about someone in our past and put it onto a person in the present.  As a psychotherapist in Toronto, I work with tranference regularly. Transference is a completely normal function for us.  Think of it this way - if we had to treat every experience we ever had as a new experience, we would be overwhelmed with data.  It makes much more sense for us to rely on our past experiences to inform our present.

However, two things happen during this transference.  The first is that we often skip over important emotions that are brought-up by the encounter with another person, and the second is that we often miss the person or encounter altogether.  One of the goals of psychotherapy is to slow down and illuminate the largely unconscious process of transference in a patient.

Two questions arise with this - why is this beneficial to the patient, and how does the therapist accomplish this task?

The first one is that transference is one of the key components of many types of psychotherapy.  One of the key issues facing most patients in psychotherapy is the relationships they have with other people.  Working with a patient's transference will allow them to change how they relate to others so that they can have a better and more nurturing relationships with others. I see a lot of patients in my Toronto psychotherapy practice that want better relationships.

The second question is how the therapist works with a patient's transference.  This is what is called counter-transference. This is a really fancy word for describing the feelings that a therapist has about a patient.  That's all.  Just as a patient will have feelings towards a therapist, whether conscious or not, the same occurs in the therapist in regard to the patient.  The reason why this happens is because therapists are human too, and our emotions are not turned off by any means in a therapy session.  Rather, the therapist is trained to spot their emotions and feelings about the patient and begin to work with the patient on those feelings.

Healing in this kind of environment occurs when the patient is able to slow down their process of transference enough to work through the feelings that they have in particular situations such that they are able to better take-in the support being offered by the therapist.

For more information on this topic, and to express my thanks, click here and go to ThePsychFiles.com  This is truly one of the web's greatest hidden gems on the topic of psychology and psychotherapy.  I listen to their podcasts on a regular basis because the very knowedgable host, Michale Britt, makes difficult psychological topics approachable and very easy to understand.

It is one thing to feel depressed. It is another thing to feel depressed about being depressed.

It is one thing to feel angry. It is another thing to be angry about being angry.

It is one thing to feel anxious. It is another thing to be anxious about being anxious.

It is one thing to feel sad. It is another thing to feel sad about feeling sad.

OK... I think you get the point.

Psychotherapy often does not work on the feeling itself, but rather it works on how we feel about ourselves when we have strong feelings and emotions. In reality, anger, sadness, depression and anxiety are all normal behavoiurs and emotions (though chroinc displays are a concern, frequency is NOT the subject of this post). Therapy does not seek their elimination, rather it simply seeks to look at how one handles these issues when they come-up.

Sometimes, people think I am talking about acceptance when I address this topic. That is if someone 'accepts' their anger, does that mean they are handling it appropriately, or that they are cured? The answer is largely 'No'. Acceptance, or becoming aware of one's feelings is important, but not curative. Acceptance doesn't do much to actually address how we feel about ourselves when we have intense emotions - Acceptance largely means that one should feel OK about something, but when that person does not feel OK they are left feeling confused.

The goal of therapy is to address that confusion so that when emotions are felt, a person feels more grounded and secure in themselves. Instead of confusion, or other feelings that occur during intense emotions, the goal of therapy is to give a clarity of thought to individuals during intense emotional experiences. A good outcome is when someone indicates that they feel depressed, but does not feel so down on themselves. Similarly someone who has trouble with anger may say 'I feel anger a lot but I have more sympathy for myself and the other person with me. I feel anger and no longer want to cause a fight.' When therapists hear these statements, they know that they are doing their job.

1) The Relationship Between Patient And Therapist Needs Time To Form Opening up to a relative stranger about the key concerns in your life takes time, as I'm sure you can imagine. Sometimes a patient may want to go very quickly into their problems or issues, but the therapist may slow things down a bit inorder to get a fuller picture of what is really affecting the patient.

2) Issues Have Taken A Long Time To Form, So They Take A Long Time To Solve This is not the theory that all of one's issues are rooted in childhood and that we must go back to explore such issues. That is actually not how I work. However though, psychological issues that you face are like any habit you may have - you may be unaware of the habit, you may have been doing the habit for a while and you may be reticent to give it up.

Another analogy is this - the main reason why many kinds of cancers, especially pancreatic cancer, are so lethal is because by the time the first symptoms show, the cancer has taken a very large foothold within the body. Though the outlook is much more positive with psychological conditions, the first time one becomes aware of a psychological symptom or concern, it is highly likely that the condition has already taken a strong hold within someone's psyche.

3) It May Get Worse Before It Gets Better As you begin to really discuss and examine psychological issues and concerns in a deep and meaningful way, it is possible that one may feel worse before one gets better. This is common and therapists are trained in working through these situations. However, patients need to realize that there is a process to therapy that takes time, and that it is important to discuss such feelings if and when they happen.

How To Make Effective Use Of A Therapist Given That It Is A Committment

Just like exercise, eating well, maintaining good dental hygene, and even keeping-up a property attention to one's overall psychological health is an on-going committment. One need not, and in fact should not, see the same therapist or seek the same treatment for one's entire committment to psychological health. Given this, there are two very important things you can do to work with your therapist to ensure that you get the most out of the time you spend with them.

The first is to ensure that the therapist is the person you want listening to your problems and helping you along the way. There are many therapists out there using many modalities - some will fit with you and some won't. The sooner you decide, for yourself, whether you and the therapist are a good fit, the faster the process will take.

The second thing that can be done is to be clear on your goals in therapy, and to ensure that the therapist knows them. It is quite likely that in order to reach the goal, therapy will touch on a number of different topics. So, if one has social anxiety, the therapist may spend a lot of time on something seemingly unrelated, such as your posture or even how you breathe. Though these issues may be somewhat unrelated to the driect issue of social anxiety, if you can begin to see improvement in the condition, then the therapy is working. It is important however, that you are able to see improvement, or hope of improvement in the condtion as you continue therapy.

So, when 80% of people fail to keep their New Year's resolutions what is more than likely happening is that their resistance to something is coming-up and preventing them from reaching the goal that they wanted. As such, the real value in making a New Year's Resolution is not necessarily keeping it, but rather in examining why the resolution has been broken. If you are in the 8 of 10 people who will inevitably break their resolution, you can still salvage something from it by asking yourself some of these questions that are designed to illuminate and highlight the resistance you may be facing:

1) Why did you make the resolution in the first place? What is it about your life that you really want to change?

2) What behaviours, attitudes and feelings came-up in you that prevented you from reaching your goal? How many times in your life have these blocks come-up for you before and prevented you from getting what you wanted?

3) Is it possible that your goal was too lofty to begin with? Again, how often do you set goals that are too unattainable for yourself? What is the end-effect of setting goals that are too high?

4) What would it take for you to stay with your resolution longer? What kind of emotional sacrifice or even pain would it cause you? Is it possible to make resolutions around those psychic needs as opposed to just external, goal-oriented resolutions?

When you look at these questions, they are designed to highlight your resistance, and get you to focus on changing it, as opposed to giving you strategies to keep your resolution in the first place. Most therapists believe addressing the resistance to the resolution is really where change happens. In other words, coming up with tactics to maintain the resolution is somewhat easy - addressing why we don't want to keep the resolution is where real growth occurs, and maybe that should be your resolution for 2013!

Happy New Year !

This means that anyone can call themselves a psychotherapist. You could literally be a plumber today and a therapist tomorrow (not to disparage plumbers in any way - I am simply choosing an occupation that is somewhat antithetical to being a therapist). It also means that a therapist could have bad experiences with clients in one area of the city, and open-up shop in another area of the province with no one being any the wiser!

This is not meant to scare anyone as much as it is to say that regulation is something that is needed in this province for many different reasons. Fortunately, in 2007 the Government of Ontairo mandated that the profession of psychotherapy be regulated. However, it is almost 2013, six years later and it is worthwhile to examine what has been done.

A Transitional Council has been very active and busy getting ready for the process of regulation, but just a few months ago, the Ministry of Health in Ontario recently rejected a significant part of the plan put forward by the Transitional Council, so it means that the organization must go back to the table to revise their hard work and effort. I find this unfortunate because it leaves therapy in this province largely in limbo. I do not think that it affects the service or quality that consumers or patients receive, but regulation is largely for everyone's benefit, and I find it unfortunate that the worthwhile effort has taken a step backwards.

I am fortunate enough to initmately know how marketing works, as I continue on occaion to consult to large national corporations and government agencies on their marketing strategies. So I know that marketing largely needs a promise, a hook, a gurantee, something that makes you stand head and shoulders above the rest. Sergio Zyman, a consultant and former SVP of marketing for Coca-Cola defines marketing as 'sellilng more product, to more people, more often for more money.' This is a great definition of marketing for a large multi-national corporation like Coke, but do you ever - and I mean ever - want your therapist to operate in a way of 'selling more stuff to you'? A therapist knows your inner-most thoughts and motivations, and there is no way from any ethical or professional standpoint that this person should ever be in a position to sell you anything. Yet, this is what marketing does, and this is why I dislike my website.

The above two paragraphs are really just a prelude to this linkan article from the Sunday NY Times shared with me by a client. It describes how psychotherapists have to market themselves in order to survive. Perhaps the most interesting point in the article is something with which I am already familiar - therapists are getting creamed by coaches when it comes to marketing. Why - because coaches make the promises that therapists fail to do.

A coach will guarantee results, will promise 'happiness' and will be there to push you towards 'unimaginable goals that are attainable to every living person'. Each one of these propositions is fundamentally antithecial to the therapeutic process, and coutless brilliant works of literature have been written on why these aspects enroach on the efficacy of the therapeutic endeavor.

However, I choose not to present a theoretical rebuttal of each of these marketing-driven propostions... but rather, I simply ask you this - if someone, anyone, be it a coach, therapist or any other kind of healer ACTUALLY LIVED UP TO THESE PROMISES CONSITENTLY AND EFFECTIVELY then everyone would be using such a person to get healed. That person would have a waiting-list that stretched into centruies, and could charge fees of $100,000 a session. The fact that such a person does not exist suggests one fundamental thing - human beings are different and so is the healing process for everyone. If there was actually someone that could cure the human condition, then and only then should the make a gurantee, package it and sell it like carbonated sugar water. And lest that person be me, I will continue to go on disliking both this website and claims that people can be 'healed' or 'cured' in a matter of five tele-sessions.

Last week, I had a very scary conversation. The topic wasn't serious. It wasn't about ill health, bad finances or dividing family issues. Rather, my conversation was simply honest - more specifically, it was emotionally honest. I was aware of my feelings, I let myself actually feel them and then I acted and spoke accordingly. The person to whom I was talking did exactly the same, and by the end of it, there was a radical sense of trust in each other as people and renewed confidence in ourselves and each other. When we have emotionally honest conversations like this, we give and receive in two ways. First, we are giving of ourselves, and we are willing to receive everything that the person to whom we are talking has to say.

The second way we give and receive in these conversations is that even though they are difficult, and require us to be vulnerable, it is safe to say that they always work-out better than ones where we stifle ourselves. The more I have these conversations in my everyday life, the more I realize that what I do as a psychotherapist is much of the above. There are tens of thousands of books written on psychotherapy and psychoanalysis, and there are dozens if not hundreds of modalities. However, somewhere at the front and centre of each of them is the same formula - the therapist, and then eventually the patient will become aware of their feelings, let themselves feel them and then act accordingly, but not reactively.

What is interesting is that in this simple formula, there are various 'rules' that are incumbent on the therapist in having these emotionally honest conversations with patients. I bring this up because those rules similarly apply to the emotionally honest conversations that you have in your own lives. For example, it is one thing to feel an emotion and speak from it, as opposed to 'acting' on it. When I feel angry with a patient, I cannot act on that emotion - how many of you have ever heard of a therapist throwing a client out of their office? However, what I can do is explore the emotion in me and feel it. I can even ask myself 'why am I feeling anger right now, and how can I incorporate that into this conversation with this person in front of me?' When you can come close to perfecting this art, you will notice two amazing things. First, your conversations become less reactive and second, you feel more at peace with what you have said in the conversation.

When being emotionally honest, even confrontation is made easy. In fact, it is viewed as an efficient way of dealing with things. In another emotional conversation I had, I said 'I feel as if you are not interested in what we are doing.' The reply back was simple and direct - 'That's your issue and not mine, because I can tell you that I am.' That curt reply sat just fine with me - logically we were having an honest conversation, so why not believe the response to my inquiry?

In closing, as we give and receive during these holidays, keep in mind that it is entirely possible to give and receive emotionally. It may be both the hardest and most valuable gift you can give to yourself and others close to you.

I started-out very jaded, assuming that apps could not really impat mental health, but as I read, I began to realize some of the power of these apps. I think that they would make excellent ways of tracking moods, thoughts, emotions and behaviours and the data that is collected on them can be brought to therapy sessions to be discussed further.

Friends and family may not have enough time
Many people see a therapist on a weekly basis, or twice a month in order to discuss what is going on in their lives. If a situation gets detailed or requires a lot of working through, friends or family may not have the time needed to assist in the matter fully. It is possible that seeking too much help or time could put a strain on the relationship. Therapists are skilled at setting boundaries in the relationship so that patients do not become reliant on the therapeutic process in their lives. However, friends and family may not know how to negotiate these boundaries up-front, and both you and they could be in a situation where you need more time than they have available to give.

There are situations which you may not want to discuss
Money, sex, the deep issues with a marriage, previous trauma, illness, thoughts of suidice, serious addictions, infidelity, illegal activity and other secrets may be difficult to discuss with a family member or a friend. It is possible that you may find yourself seeking help from a friend or family member, but leave out a few key pieces of information that may be at the root of your problem.

They may break confidentiality
There are really three aspects to this. The first two involve gossip. There is the standard gossip, where a friend or family member may discuss details of your conversations with others when there is no good reason to do so. The second issue is gossip related, but the person in whom you confide may themselves feel the need to discuss something with another family member or friend, either for their own self support, or they may take matters into their own hands and intervene on your behalf without you knowing it. This could have very negative consequences. The third issue involves a friend or family member disclosing your thoughts or behaviour to authorities or medical practitioners because they are worried about what you are saying to them. There may be nothing wrong with this, per se, but if the parameters are not set-out in advance, then such disclosure, even if it does help you, may leave you feeling betrayed. Moreover, there are certain situations by lawwhere a friend or family member must report certain aspects of a conversation. These primarily involve any sort of harm at any time (past, present or future) to children and utterances of doing harm to other people. Therapists are trained to set-out these parameters at the start of the relationship and know when to report, and how to tell a patient that they have to report.

It may put a strain on the relationship
The above three factors and a few others indicate that supportive relationships between you and friends and family members has the potential to put a strain on the relationship.

Friends and family members are not self-help experts
How much drinking is too much? Is someone experiening a serious episode of mania or depression? Is someone experiencing distorted thinking, or even a psychotic break? When does depression become dangerous? Is it possible that your spouse has a mental illness that is affecting you? Do all mentions or thoughts of suicide need to be 'cracked-down' on? Is someone (especially in their late teens or early 20's) showing signs of develpoing a serious psychiatric condition? Are changes in behaviour a result of medication? In many cases, these issues are rare and managable - but it is also like asking a friend's opinion on a persistent cough that does not go away. There are certain things that therapists look for to help determine if more serious interventions are needed.

Overall, I do believe there is a strong place for friends and family members to provide support. However, I was brought-up with a saying 'you get what you pay for'. Over reliance on support from friends and family, and the occurence of any of these situations has the potential to do more harm than good - both in the supportive and personal relationship you have with your friends and family. As such, these are important factors to consider if you are thinking of seeking help from a therapist.

Have Your Emotions or Moods Changed?
Many of us, when we have physicial symptoms, know when things seem different. For example, we may have had a cold that has gone on longer than normal, or a cough that seems different. Perhaps your existing back pain has changed and is now in your chest. You know when you are not right physically. The same thing occurs emotionally. We generally know how sad, happy, outgoing, anxious, withdrawn or even depressed we normally are or when our reactions are in-line with our circumstances. When those emotions and moods change in either intensity or duration, it may be time to seek professional help. For example, it is completely normal to be sad, withdrawn or even depressed if a family member passes away - but if that feeling lasts for longer than you expect, or if it is accompanied by other symptoms such as anxiety, regret, undirected anger or a change in your relationships with people close to you, it may be time to get some assistance.

Are Your Behaviours or Activities Changing - And If So, To What Degree?
One of the fundamental things a mental health professional will look at are how some of your basic routines have changed or been impacted. Are you showing-up to work two hours late, or are you becoming a workaholic? Has your diet or sleep changed? Has your weight gone up or down regardless of diet? Have your relationships changed in any significant way? Are you engaging in addictive or destructive behaviour such as drinking to excess, eating much more than normal, or spending money irresponsibly? A normal shift in mood or change in circumstance may cause any one of these factors to be impacted, but a significant or sustained change in any one of these may be a sign that it is time to see someone.

Have Your Thoughts Changed?
Are you noticing that your thoughts, such as your hope for the future, your thoughts about your job, family or finances have changed? Do you feel either helpless, or perhaps have sudden bursts of energy or thoughts that you did not have previously? Have you given thought to suicide, even if it is just a passing thought? Are you thinking about taking a somewhat drastic action like quitting work, or leaving a relationship without significant reason for doing so? These changes in your thoughts may be a sign that it is time to see someone?

Are You Having Difficulty Coping With A Situation Yourself, Or Do You Find Yourself Stuck?
Unfortunate circustmances happen to people all the time. Job loss, marital strife, sudden illness or even the death of someone close unfortunately occur. Sometimes, we may just find ourselves stuck and are not able to move forward. In situations like this, even if you are coping well, or have a good support mechanism, it may be time to talk to someone about your thoughts or feelings, especially if you feel that you have difficulty moving forward from the circumstances in which you find yourself.

Are You Sick And Tired Of A Certain Behaviour Or Trait?
Sometimes we may finally realize that a certain behaviour or trait that we have is not serving us well and we wish to change it. This kind of reason to see a therapist falls more under the rubric of general self-improvement, but it is an area that many therapists specialize in. So even if little is wrong psychologically or behaviourally, if you have an engrained habit or thought that you want to change, and you feel that it is really time to change it, it may be worthwhile to see someone.

Do Others Notice A Change In Your Behaviour?
Sometimes you may be experiencing any of the above traits or symptoms, but you may not notice it at all. Or rather, you may not notice the impact the above is having on you. For example, people may notice that you are more tired, irritable or withdrawn. In some cases, your relationships with people may change altogether. In situations like this, it may be worthwhile to speak to someone who can help you understand why your relationships have changed.

Now quite frankly I am absoultely inclined to agree with this, but it is not based on the statistic alone. I have read, or purused, many self-help books. As a therapist I cringe at most of what I see written - calling a lot of it tripe would not be an understatement. I would call it pseudo-tripe, but the term pseudo-tripe in and of itself is somewhat ambiguous. Is pseudo-tripe something that is better or worse than actual tripe itself?

Though I jokingly create my own confusion, I cannot feel that self-help books tend to leave us more psychologically confused than before we have read them. Now on the surface, these books appear to give us hope, inspiration and direction - but as a therapist I am not concerned with those surface things. I am concerned at what is going on deeper inside of us. 'Hope for what?' is a question I often ask? Also, I fundamentally wonder if 'inspirational' books fundamentally contradict the very term self-help. That is to say, if one needs inspiration from a book (i.e. external inspiration), then one is not able to generate internal inspiration, or one is not able to help one's self, the very semantic definition of self-help.

As a therapist, inspiration is like a narcotic. That is to say, it is really the only 'drug' I can dispense to people, and I need to do so carefully and with full regard for how my patient will use it. Over inspiration, on my part or the part of self-help books simply feeds an addiction that people have to being inspired from the outside. Self-improvement, by it's very definition needs to come from the inside. I remember one client who had a brilliant breakthrough because I made an inspirational statement to her. After the comment, I said 'You know, that wasn't some hippy-dippy-trippy piece of bullshit inspiration I was giving you.' She said 'I know, you're not the type to say something you don't mean.' So, on a fundamental level, did her breakthrough come from the inspirational comment I made to her, or did it come from the fact that I dosed it correctly and at the right time? I don't even need to let my rhetoric stand - I provided the right inspriational intervention at the right time. Self-help books have no such discretion or regard for their readers. Inspiration, much like any narcotic, will 'sell' to those that are addicted to it, so it makes sense for authors to give reades as much of it as they want. However, in the long run, such inspiration is not what readers really need.

In closing, it is worthwhile to examine that statistic again - that people seem to buy more and more self-help books. The one positive I see in that is that good self-help takes years of dedicated hard work. It does not happen over night, so people, in my view will need to read more than one book. However, here is both the catch and my caution - given that you are engagin in this self-improvement on your own, how do you know if anything is really working deep inside of you? I'm not talking just about achieving results - I mean how do you know whether you are getting the penetrating, soul-changing work done that needs to get done for real self-improvement by continually reading such books? If this question gives you pause or some doubt, you may want to think twice before you fork-over $24.99 for the next big thing.

However, there are so many people who do not feel that therapy is right for them. In this regard, I am not here to advertise or arm-twist. However, two of the characters on the show, Walter and Alex are people who would appear 'perfect' by any standard, yet they come in with the same existential issues that most everyone comes into therapy with. HBO is good enough to provide character sketches for these two individuals.

I encourage you to watch them, and I hope you will note a number of things:

- How 'perfect' these characters seem to be, and how good a job these character sketches do at illustrating how their hubris is the real root of their problems.

- How these characters have the same issues as you and I do, regardless of how they appear on the outside.

- How the therapist, Dr. Paul Weston, stays with them in their hubris every step of the way. He is not there to challenge them or change them. He is there to give these individuals a place to talk, and all too often that is really all that we need.

Again, if you look at this site, it is really rare for me to call something an advertisement, but I honestly believe that these are good advertisements in terms of the fact that many normal people come to therapy, and how I as a theapist will treat clients. I have often said that a good therapist is like a bad steak - tough but tender.

Enjoy...

The video below gives some thoughts on how you should choose a therapist. However, before you view it, know that perhaps the most important factor in effective therapy is the relationship that you have with your therapist. It needs to be open, trusting, caring, honest, professional and respectful from both parties. In otherwords, you need to feel very comfortable with your therapist.

However, in the video below, I briefly discuss the concept of selecting a therapist that you may not have an immediate connection with, or a therapist that may seem to rub you the wrong way. I preface this by saying if you feel that there is no chance at a good relationship, or if you feel the therapist is not professional - don't stay. However, though sometimes a therapist that may not seem to be an immediate or natural fit could wind-up giving you more benefit than you think.

More specifically, in life we cannot always go around choosing people that we always have the best fit with. We cannot choose our co-workers or even most of our family members. So, how you work through issues that require you to speak-up or work through things that may be difficult is a very important life skill. While this is by far not the primary focus of therapy, a therapist that may not be a perfect match may still be one you wish to consider, as it is very likely by the time the therapy is up, you will have learned a bit more life skills than if you stuck with one that always made you feel comfortable and never took you out of your comfort zone, even if just for a little bit.

Here is the video...

It is worthwhile to understand what anxiety actually is. Anxiety is something that is naturally occuring in human beings, and it is related to our fight or flight response. To be more specific, we perceive a danger and feel anxiety. That anxiety powers us into some sort of action, which largely dissipates the initial feeling of anxiety. However, what happens if we constantly feel danger, or are constantly put in situations where we cannot take an action to dissipate the anxiety? This is the root of an anxiety disorder.

However, this condition becomes more nefarious when the anxiety disorder becomes a part of who we are. That is to say, when we want to try to get rid of the anxiety disorder, we cannot because that in and of itself makes us anxious. In other words, change makes us anxious - so if we are trying to rid ourselves of anxiety, we are making a change that causes us anxiety. This is why anxiety is so difficult to work with.

There are no shortage of methods of working with anxiety, and this makes sense given both how common it is, and how difficult it is to work with. Some methods focus on working through the anxiety, while others like CBT attempt to 'pull-out the wiring' of the anxiety loop, and this includes exposure therapy. In fact, many of these methods can be quite effective when dealing with a qualified practitioner.

The method of therapy I practice, Gestalt psychotherapy (which is an humanistic psychotherapy), works with anxiety in a slightly different way, and one that I think is a broader approach with more benefits to it in the long-term. Instead of working to pull-out the wiring, or cross-circuit existing thoughts that are created by anxiety, an attempt is made to 'integrate' the feelings of anxiety into the patient. What, however, does integration mean in this context? If you think it simply means 'acceptance', you would be incorrect. I once had a very bright patient tell me after an initial session 'If you think that I'm simply going to accept my condition, I can tell you that it won't work.' And he was right.

Acceptance of anxiety is not necessary to treat it, but it may be a by-product of treatment, or it may help to move therapy forward. Rather, as I mentioned, moving forward beyond anxiety likely causes anxiety! As such, one must attach a meaning to their anxiety, or to their life in general. Though it may not be discussed directly, it is worthwhile to understand what anxiety says about a patient in general. Is someone nervous because they want to do a good job? Does someone honour deep connections with individuals instead of more social or superficial ones? What does one's quest to get over anxiety say about them, and their overall goals in life? When a client begins to attach a meaning to their anxiety, they begin to get over it. The part of the person that the anxiety is covering-up is free to come through.

This, however, is only one type of meaning from anxiety. As I mentioned, when we begin to change, we can become anxious about the change. As such, it is necessary for the indivdiual to look more broadly at their life - what do they want from it? What do they want to accomplish? When we can take the first meaning that we find and apply it to broader life goals, one really begins to engage in living.

The search towards meaning that is the cornerstone of this article largely comes from my most recent readings of Viktor Frankl's 'Search For Meaning' and the concluding chapters of Irvin Yalom's 'Existential Psychotherapy'. In both these works, they make reference to Dostoevski's quote - 'There is only one thing that I dread: not to be worthy of my sufferings.' Moving forward and engaging in life is largely an anxiety-producing event. These two noted therapists say that full engagement in life is not an antedote to anxiety, but a way of putting it in perspective and working through it. And if you want to live a fully engaged life, you would be wise to start by understanding what your anxiety says about you.

However, are there limits to responsibility? Over the past few years, I have noticed this concept of responsibilty taken to absurd extremes among lay-people and other non-psychologcally trained self-help experts alike. There seems to be this concept of 'absolute responsibility' - everything that happens to you is your responsibility, or that you can control everything that happens to you - no matter what. Some self-help experts will actually say you can control, or are directly responsible, if you are randomly hit by a drunk driver. While I believe that psychoolgocal health will be significantly improved for an individual who 'accepts' that they have been hit by a drunk driver, it is hogwash and psychologically damaging to have someone take responsibility for the fact that they were hit by a drunk driver.

In my view this hyper-focus on responsibility has the potential to do much more psychological harm than good for people. To be clear, it is my contention that people cannot be responsible for everything that happens to them - our world is random, and in many cases cruelly so. To assume that we can be responsible for fate is simply crazy-making. However, what people can always be responsible for - or assume 100% absolute responsibilty for - is how they react to any situation that happens to them whether or not they were responsible for the situation to begin with.

To give three recent examples of this:

1) My wife was involved in a chat group which was torn apart by a debate around whether people who got or could not be cured from diseases like cancer did not want health badly enough so as to let the disease take hold, and subsequently ruin one's health. There is no doubt in my mind that people are responsible for their health by the lifestyles they lead, but to somehow extend this concept to the fact that people are responsible for whether or not they get cured from a disease like cancer is simply not prudent. Things like smoking, over-eating, poor exercise and much of poor health is a person`s reaction to other events in their lives to begin with. By taking responsibility react to those situations is when we begin to take action for our health.

2) I was reading an account of a Large Group Awareness Training (LGAT) session, where the leader of the group would get participants to take responsiblity for their being late to the session because there was an accident en-route to the session. While it is possible that one could have left earlier, taken a different route, stayed closer to the LGAT seminar to avoid driving - are these really decisions or choices for which one should be held accountable or responsible? Even our courts of law do not place this amount of responsibility on someone. Rarely, if ever (though I have not searched to confirm this) have courts held that the victim of a drunk driver was somehow `responsible` for the accident.

3) I attended a coaching seminar on 'Responsibility'. The coach encouraged us to take responsibility for 100% of our lives 100% of the time. She demonstrated this by having group members stand in a circle and give each other a brief massage, and then asked us who wanted to continue their massage after we had stopped. I told her I did, but that it would be crazy of me to ask for more massage for a number of reasons. Primary among them, I have very tense muscles in my back, and have worn-out some of the best massage therapists in Toronto - so there was no way that a massage like that would be curative for me in any way. Second, this was her seminar - not a massage therapy session. For me to turn it into that, or to take responsibility for that, would be narcissistic on my part. She then asked me if I would be willing to take 100% responsiblity for my life, and my reply flummoxed her - I said 'I take responsibility for about 10% of my life, but in taking responsibility for that 10% I take 100% responsiblity for it. So by taking 10% responsibility, I am taking 100% responsibility.'

The bottom line is this though - we cannot be responsible for everything that happens to us. It is psychologically damaging to assume this posture, because it begins to erode our own self confidence and self-trust. The thinking goes 'If I am responsible for being hit by a drunk driver, what is WRONG WITH ME that I let this happen?' or 'If my cancer is not in remission, what part of me WANTS TO BE SICK?' This is one of the biggest problems among people who practice self-help without understanding psychology. These hard lines of responsiblity are more damaging than they are helpful - they make us second, or third guess every action we take and become hyper-controlling of those around us. If those around us are responsible for our fate, then we better control them before they mess things up for us. That kind of thinking is what creates oppression.

I am about to fly on a plane from Vancouver to Calgary in two days - if there is an accident, am I responsible? There are a number of individuals who changed their flights during the 9/11 attacks for various reasons and were not on the planes that crashed. Do we hear any of them saying 'I was responsible for not getting on a flight that crashed, and those who did not change their flight were somehow responsible?' or do we hear them say 'Wow, I'm just lucky to be alive?'

What we can be responsible for, however, 100% of the time is the responsibilty for our actions in the face of adversity. This is called dignity, and this is called self-respect. We can be responsible for how we face our illness. We can be responsible for how we react to injuries caused by a drunk driver (heck, we may even forgive the drunk driver). This is where we have 100% responsibilty. It is to take action based on what has happened to us, and this is the realm of responsibility that psychotherapy practices in. The goal of therapy is not to realize that we are responsible for everything that happens to us, but rather, we are responsible for how we react. It is said that we create our lives by the actions that we take, and I believe this to be true. However, we cannot prevent all bad things from happening to us - that is not our responsibility - and must be assigned to fate. When we realize this, we may be able to forgive ourselves and others, and realize that at worst, fate is ironic and not cruel.

As a relatively new psychotheapist in Toronto, I have been looking for creative ways to promote myself, and TV seemed like a great way to reach a large audience. However, after some contact with producers, it became appearant that most TV is NOT about imparting quality psychological advice, but rather it is much more about entertainment. I mean I've certainly been around the block in my lifetime, so I know TV is a bubble-gum medium. However, I had not peered behind the scenes, nor had I had my TV-Q commented-on, nor had I realized the extent to which TV 'experts' do not have any significant psychological training (though they are very well-versed in creating good TV and good entertainment). This is not to say that therapy and TV are incompatible - but TV must allow time for the therapist to provide details of how therapy works, or how advice should be used. Most people know that psychotherapy is not a quick-fix process, yet somehow TV demands that we provide just that. I am reminded of a phrase from Dr Irvin Yalom that he wrote in 'Love's Executioner' which was something like 'Now that the initial excitement wore off [between him and a client].... we settled in to the long-haul and difficult process of therapy.'

I think the most telling thing thing about TV-Psych is the fact that according to Wikipedia, Dr. Phil does not maintain his license to practice psychology or psychotherapy 'because his show involves entertainment and not psychology.' Sure - any professional therapist will often cringe watching Dr Phil, but I'm not sure the extent to which the public knows that Dr Phil is not practicing therapy or sound psychology. I get very concerned that people confuse TV-therapy for the real thing. In fact the line of 'this is just entertainment' is usually employed by psychics or televangelists who will rely on it as a crutch when they are 'proven wrong' or need to get out of a sticky situation. I really don't want therapy to be lumped-in with these groups.

In fact, I cannot help but feeling that this is one reason why most 'self-improvement' experts on TV are generally coaches, or those who are untrained in psychology or therapy and wish to promote their latest books (I think I saw one last week called 'The Law Of The Secret', to be followed up with 'The Secret Of Attraction'). Those who are trained in therapy know that it is very difficult to explain how therapy works, or apply blanket rules or steps to real self-improvement. Any time you ever see a 'Five Steps To Coping With Depression' or 'Three Easy Ways To Have A Difficult Conversation' turn and run away fast - the advice is not worth the medium it is provided on!

Now let me be clear - I do believe that there are many people who have been, and can be helped by non-therapeutic means, and they deserve the right to promote their successes. In fact, I've always lived by the 10% rule - 10% of indivdiuals will always outperform or achieve wildly successful results based on anything they do (and the same 10% rule holds for therapy clients as well). However, I think that self-improvement authors and therapists on TV should have a warning under them on TV which says 'Results not typical' or 'Does not reflect actual psychotherapeutic technique or advice. Viewers are cautioned about employing such advice in their lives.'

I am not suggesting that we ban therapists or self-help indivdiuals from TV. They do have some value - many people feel that TV therapists and self-improvement experts are a source of 'inspiration'. My fairly harsh view, however, is the fact that good therapy should not be about external inspiration as much as it should be about building the mechanisms in a person to create self-inspiration, or the mechanisms to build self-esteem or create awarenesses that dissolve depressive or other psychologically harmful thoughts. If you want inspiration see a good movie. But if you want to build your own resources for self-support, see a therapist in person, and settle-in for what Yalom calls 'the long and trying process of therapy.'

Now - let me first say - that I COMPLETELY DISAGREE WITH THE INTENT, THEORY AND GOAL of the therapy on personal, moral and professional grounds. This is not a post about being gay, judgments around it or therapy involved in the LGBQT community. I have not done any research on the theory behind the therapy, and nor would I, because I simply disagree with so many aspects of the goal of this therapy. I in no way practice, endorse or agree with any aspect of this.

However, I am using this series to highlight one of the very common issues in psychotherapy - how the therapist and the client view the therapy session. What we see from the CNN series is a HUGE DISPARITY in how the therapist and the clients view the session. My question, and what I wish to talk about, is this - should there be disparities in how therapists and clients view the session, and if so, how large should that disparity be?

First to address the CNN series itself - I am very worried about the different views that the psychologists and clients have about the therapy sessions as presented in the CNN series. In my view, this disparity shows that there is something quite nefarious going on with this supposed kind of 'straight-therapy'. It seems to me like the therapists are fraudsters trying to cover their tracks.

However, do legitimate therapists and their sessions have similar disparities, where the client and practitioner view the session as 'night and day'? Dr Irvin Yalom did a simple yet powerful experiment. He set an agreement with one of his patients, who was an author, that both would write detailed and narrative accounts of their therapy sessions, and then compare notes. The results were quite interesting according to Yalom - both practitioner and client had completely different views of the sessions. In a sentence - Yalom felt that the client responded much more to his warmth and humanity and less to his 'brilliant' psychiatric or psychological observations. I find this exceptionally fascinating, and it is something that I try to do in my sessions - give much less 'interpretation' or 'gifted insight' and much more 'contact' with the client.

However, my view is that there will be a lot of minor disparities in therapy - in that the client and the therapist view the session, or parts of it, a bit differently. My view is that when these differences happen they should be explored, and in some cases, significantly explored because the difference in view represents a neurotic distortion either on the client's end (transference) or on the therapist's end (counter-transference).

How many times does a client hear in his or her life 'You're blowing this out of proportion' or 'That's not what I meant at all'? Similarly, how many times in a client's life do his thoughts get the better of him, and before he knows it, he slips into thinking that causes anxiety or depression? It is these kinds of distortions that cause problems for the client that can be addressed in therapy sessions.

I have found the best way to work with client distortions in the therapy session is to be completely honest at all times with the client. Sometimes clients view therapists as 'playing games' or 'doing tricks'. In my very early days under supervision, I learned that doing such is not a fruitful enterprise because I am directly creating a distortion in the mind of a client, and the client simply learns therapeutically how to spot my games and the games of others - and this clearly does not lead to a well-integrated person.

However, I have found that if I am honest and myself, and at the same time manage my own counter-transference and personality quirks properly, then anything that the client distorts from my behaviour is more than likely something that they need to work-on. Far from a Freudian blank-screen, on which a client projects, the therapist becomes a living, breathing thing to which a client can and must respond (and vice-versa). Working to solve disparity among these two types of individuals invariably makes the client better-off.

When you look at it this way, it is quite simple to see that the relationship between therapist and patient is what becomes curative. However, the therapist has to take very special care in the relationship with the client so that it is curative when it needs to be. A number of examples illustrate this:

1) I recently had one of those gifted insights about a client's past that I shared with her (e.g. As she's talking about her work, I asked her 'Did you ever fail a grade in school?' to which the response is 'How did you know THAT?!'). Sure enough, the insight was true, but as I shared it the client did not look at me in amazement for knowing such an obscure fact about her. What I realized at that moment is that those unique insights are no more than lubricant in the overall relationship with a client. They do not heal or cure, but they indicate that the intimacy that is required for healing to occur can happen. The therapist is attuned enough to the client, and at the same time the client is willing to be open enough on an unconscious level to display various aspects of themselves.

2) There was another time that I experienced a major counter-transference episode with a client. The client was having a MAJOR shift in thinking during the therapy session, and was producing insight after insight in his mind. My thoughts were 'Is this happening too fast for him? Is he about to leave the session and go off the edge? Will others in his life blame ME for such a radical departure in his thinking?' I have been taught to use my counter-transference to create interventions for my clients - however, this felt different. My counter-transference in this instance was my own narcissism, and my own thoughts were confused - so I sat with my thoughts and my client for 12 minutes straight without saying a word. Though every second of it was uncomfortable for me, it took every ounce of strength I had to give my client the space he needed to sit with his thoughts. When I look back on the session, I suspect that others in his life have not given him such space, and instead have smothered him with their own intense thoughts. I have realized that a healing relationship takes significant discipline.

3) Another therapist told me an incident where she unwittingly found herself on the verge of having a major argument with her client. Knowing that arguments are not part of a healing relationship, the therapist gathered her thoughts and simply said to the client 'I can sense that things are getting a bit heated in here. Is this anything like the other relationships that you have in your life?' The therapist told me that suddenly her client snapped into the present and said 'Most definitely it is!' It is a reminder that in order for the relationship between therapist and patient to be truly healing it must every now and again be brought out into the open and be examined, but the timing of such an examination must be done very carefully, or else it could be construed as being self-serving on the part of the therapist.

In psychodynamic psychotherapy, the relationship is king, and how the therapist takes responsibility for it is critical. And it is on this point that therapy is much more of an art that a science. It is clearly impossible to get a computer to feel, heal and relate to an individual, and as such it is impossible to program a therapist to do the same without it actually hurting the relationship as such. In this way, just as relationships are messy, therapy can be the same way. However, just as many of us know that just as relationships with our close friends and family can heal us, so can a properly managed relationship with our therapist.

Now it is critically important to understand the tone and timbre with which this verbal advice and admonition is given. If you wish to hear an example, listen to an interview with Canadian Musician Stephen PageThere are four black rectangles on the page, with audio clips. Click the first (Stephen Page on Depression). You can listen to the whole thing, but if you want to hear an example of what I'm talking about, just go to the 8:00 minute mark until about 8:40

To me, the tone of someone saying 'Get a good therapist', or even 'Get a fantastic therapist' is very interesting to me - it is somber, metered and wise. I contrast that to the current world of self-help that we live in. I hear so many people say - in almost a manic state - 'Oh, this guy's such an inspiration - he's AMAAAAZZZZZING!!!!' or 'That coach completely changed my life' or 'I took this seminar and I attracted millions of dollars to my business.'

I'm not against anyone attracting millions of dollars to their business, but I am very concerned about the fervour with which these individuals state their admiration for those who engage in self-improvement with them. When you listen to Stephen Page say 'I have a fantastic therapist', the fervour is NOT there. Instead, it is replaced by muted enthusiasm, and to me that is very telling about the kind of relationship that Page has with his therapist.

The therapist not only works behind the scenes, but without providing direct inspiration. The therapist serves as someone who is not wise, but promotes wisdom within clients. When I hear Stephen Page talk about his therapist, I see a therapist who is both challenging and someone who is able to provide agape love at the same time. The therapist does not demand or expect change, but rather empathizes with and explores the struggle. There is no kind of 'solving' going on in this kind of therapy. It is two individuals who simply examine what it means to be human - and perhaps that is what Page finds so mutedly fantastic about his therapist.

This is very important, however, to the average reader who does not know much about therapy training, therapy in general and other forms of self-help. See, being a therapist was something that I always wanted to do (and for those who know me really well, the other thing I always wanted was to be a commercial airline pilot). I wanted to do it because I thought I had an innate understanding of certain aspect of psychology. Moreover, I really wanted to help people, and I wanted to use the psychology of therapy to better control my everyday life. Even though much of these thoughts were influenced by childlike fantasies, there was no doubt a twinge of these thoughts in me as I entered training as a therapist.

For those unaware, I took six and a half years of training before I saw my first client solo, and within that time I had every opportunity to discontinue being a therapist. I mention that because within my training, it became exceptionally clear that the reasons I wanted to be a therapist would absolutely, positively not suit me or my clients well if I continued to let such rationale dominate my therapeutic approach.

See, what I learned is wanting to help people is not really a good stand-alone reason to want to be a therapist. I know that this may seem counter-intuitive, but wanting to help turns 'people' into 'objects to be helped.' The one thing I have learned is that clients want help, but in order for therapy to be effective, they must build the support in themselves to do it on their own. I, and my help, cannot do it for them - they have to do it themselves. So, one of the downsides of being a therapist is actually staying with a client long enough and patiently enough to let them do their 'work'. In this way, the client is not an object, but rather someone who is their own 'subject'.

In the end though, I am a therapist because I enjoy the core of what it is that I do. Though there are a lot of frustrations with the job, the core of being able to contact another person is something that is exciting to experience. However, I have found that with my other careers, there were equal amounts of 'frustration' and 'reward'. I guess, though, that I would never return to them, because in some small way, I do know that being a therapist truly does help people, and no avoidance of narcissism can take that away from me.

Now, you may ask yourself why I have bolded that term. The reason is that I don't think any of us have given thought to the fact that we may be bad at wishing, or that our wishes may undo us. I think that may of you reading this right now are thinking that I'm probably nuts just spending time on the topic. The fact is this though - how we wish is extremely important to us.

Now, let's understand I'm NOT talking about the standard 'goal-setting' exercise here, where we figure-out where we want to be in six months based on our strengths, the environment, our finances, etc... That's not wishing. That's practical stuff that comes much after the wishing stage. Also, wishing is not Brainstorming, in the way we traditionally think of doing something like 'If nothing stood in your way, what would you want?'

To me wishing is what we want, based on an authentic view of our selves and our emotions. Thus, to be a good wisher, we need to be in contact with ourselves, and our emotions. What I have realized is that how we deal with our emotions is how we deal with our wishes. So, if we stunt, hide and otherwise suppress our emotions, then our wishes become no more than impulses - or pulses. They're mini-wishes - ideas that are not fully formed, and things that we chase for reasons that we never truly know. If however, we tend to languish in our emotions, our wishes become burdens to us - things that we should do or albatrosses around our necks that cling to us every step of the way.

A wish that works - a wish that fuels us to change is a fully experienced wish. It is not a goal, an impulse or an imperative. Rather it is something that gives us support. It is not something that consumes us, it is something that gives us strength. It is something that we may or may not achieve - and in either way we won't care. A wish is something that allows us to say that 'No matter what the outcome, I am OK' - and that may be the common denominator in any good wish overall.

What happens is that individuals become victimized by their own disability label. The label becomes a separate entity in the individual - taking on its own life and characteristics. A person is often left split between 'themselves' on the one hand, and the 'label' on the other. To that extent, I often hear statements like 'I want to be more outgoing, but it is my anxiety that stops me.' A person is then really left fighting two battles - their own desires and wants to be more sociable, and the anxiety that holds them back.

Most therapeutic modalities seek to make a person more integrated, or use the 'responsiblity principle'. The goal is to give the patient the awareness that they - and not their conditions or disabilties - are responsible for their actions. This allows a person to examine their life more holistically. The condition, label or disability becomes something that is owned or integrated into the whole person, thus allowing the person to better live with and mitigate it. The goal is to have someone say 'I am anxious, and I know I am going to still give that speech infront of 5,000 people.'

However, there are both positive and practical reasons for a label. First, they do help in treatment of a condition, espeically if pharmaceuticals are involved. A label helps plan treatment and measure the effectiveness of treatment against various goals. Also, getting a label or a diagnosis is often a relief to patients. I work with many adults with ADHD, and virtually all express significant relief and comfort when they are told they have the condition. They feel that they are not alone or unique. Moreover they become more aware of how their specific behaviours impact themselves and others. This gives them the opportunity to change or better mitigate their behaviour or relationships.

Regardless of whether labels are good or not, it is critical that an individual take responsibility for themselves and their circumstances. A label should make someone aware of their behaviours and conditions - but it should not take-on a life of its own. For example, there is a difference between someone saying 'I am depressed, therefore I don't like talking to people', versus someone saying 'I feel as if I don't make a connection when I talk to people, therefore I do not like it.' The latter statement allows someone to understand the issue that is really at the heart of the matter. We are no longer wrestining with someone's depression or disability, but rather we are shedding light on someone directly. There is no label - or disability - to hide behind. That may seem scary or it may seem hopeful. In either case though, it is what will lead to change.

Instead, I'm the kind that helps you find the support you need to do the best job as a parent that you can. I help with self-doubt, relationship issues, flying-off-the-handle, managing stress, working through your emotions and how you relate with your children and all the people in their lives. Naomi Aldort, who is a psychotherapist that specializes in the type of work that I do with parents says 'When you come to me and tell me about your children, in the end, I know nothing about your children, but everything about you.' It is that kind of expertise that I provide as a therapist to you.

To give you an example of how I help, I can easily turn to an example in my life. When my son was just over two-and-a-half, I dropped him off at daycare. Immediately, one of the other kids in the class pointed at my son and yelled 'Look - A MONSTER!!!! Everyone, there's a monster in the class. Aren't you scared of the monster?' Well, I was absolutely livid at the kid and the daycare. How could the daycare let this happen? At the tender age of just over two years old, my son was being made fun-of. Other kids were taunting him saying that they were scared of him. I was going to call the daycare and arrange a meeting both to find-out what was going on and to give them a piece of my mind!!

Fortunately, as a therapist, my cooler head prevailed. I realized I was engaging in a classic psychological activity called 'Projection', whereby I get so angry at myself, that I take my anger out on everyone else. I knew I needed some time just to cool-off before I called the school or told my wife about this travesty happening to our son, and figure-out the source of my projected anger.

After I got on with my day and let myself cool off, I went to pick my son up. After we got home, I started playing with him. As we were rolling-around on the floor and talking to each other, I noticed that he would come up to me and playfully growl in my face and raise his hands to me. Instinctively, as I was playing with him, I said 'Are you Daddy's little monster?' And then I stopped dead in my tracks...

Everything at that moment fell into place for me. The little boy in my son's class was not 'taunting' my son, but he was simply commenting on how my son was playing with people at the time. They probably made a game out of it, or something like that. What I had done, was taken my own insecurities and my own bad experiences as a child repeatedly being made fun of and transferred them over into this situation. What a fool I would have been to over-react to something like this. In fact, the little boy that made the comment turned-out to become one of my son's 'best friends' - and the two played together recently at our house on my son's first 'play date'.

Note that I am not telling parents how to react to the situation. What I am telling parents is that children trigger a lot of our own unconscious baggage, and it behoves us to work through such baggage for the benefit of our kids. Imagine what would have happened if continued to project my own childhood onto my son - I could have turned him into a victim of a situation that was completely misunderstood by me. In fact, given this kind of authority and power that we have over our children (i.e. to turn them into a vicitm, when victimhood in their minds does not exist), it strongly makes sense to examine our own behaviours so that we can give the best possible childhood we have to our kids.

The kind of therapy that I offer is not for kids - it's for parents to deal with their emotions towards parenthood and the situations that arise in it. When you think about it, this kind of support is needed so that parents can act authentically, and in the present moment with their children. Psychotherapy helps deal with the stresses and problems that face any parent as they attempt to raise their child as best they can. The goal of therapy is not to improve the child, but to improve that parent, and that may be the best gift that you can give.

One part of the book struck me as particularly interesting. Yalom had made comments about how society influences both the kind of neurosis that individual patients have and the kind of psychotherapeutic modalities that arise to treat them. Specifically, he said that Freud's psychoanalytic theories which dominated up until the 1950's were the perfect kind of therapy for a society that repressed many emotions, and had structures/ethics/institutions (e.g. religion, unions, honour) that provided a strong sense of responsibility to its members. In this time, patients seeking psychological help would often have very specific and well-defined symptoms that could be addressed in the therapy session.

However, as the 50's turned into the 60's, the sense of responsibility provided to an individual through society had largely collapsed, or taken a beating. Instead of having a life provided to someone, and instead of repressing many emotions and drives, people were free to express and free to explore. This created a new kind of therapy and neurosis. Yalom began his practice at the time of this societal shift, and he noticed that clients came to see him with problems that were more vague than specific - a general discontent or uneasiness about them. He attributed this, and I think rightfully so, to the fact that individuals in society were confronting their own responsibility and the angst that they faced when they realized that they actually could do anything, but weren't quite sure how to do it.

I would like to pick-up where Yalom left-off. What is it today that is influencing both our neuroses and how psychotherapy treats them? Well, it's far from surprising, IMHO. Just as the 60's placed responsibility back onto the individual, today, we have taken that responsibility and run for a touchdown with it. The assumption today seems to be that if I am going to be responsible, I might as well be 'Great' or 'The Best I Can Be'. I hear people saying 'If I am responsible, then I'll be excellent.'

The effect that this has on people is fairly straight-forward. Rather than having an ill-defined set of symptoms, people come in to therapy because they cannot reach their goal - and therefore they are not happy. They have a vision for themselves that they cannot meet. They know damned-well where they want to go, and just need help getting there. Being excellent, or accomplishing whatever is in one's mind's eye has taken priority, and lack of achievement causes psychic distress.

The kind of therapy that this kind of neurosis is spawning is very simple - get me better quick so that I can continue to accomplish. We see this in three forms. First, pharmaceuticals are widely available and prescribed in the hopes of making people better. Second, we are seeing rapid growth and acceptance of 'Brief-Therapy' like CBT. Third, coaching as a means of goal-attainment has popped-up directly to address the issue of having a 'life the life they truly want' or 'being excellent alwayst' (just look at any coach's website, and that's exactly what they preach).

While Yalom makes a very strong case for how society shapes and moulds the therapy practice, I, and I would assume he, would take very strong issue with how these forms of therapy are responding to the ethic of 'achievement' and 'excellence' that is so driven into our heads today. The main reason for this is that none of the three approaches above address the angst involved in the responsibility that we have attained since the early 60's. All these forms of therapy seek to work-around the sort of fear we have when we realize that we are responsible for our lives. They seek to anesthetize us, reprogram us or reinforce attitudes that are not our own.

If truth be known, I am particularly concerned about coaching as a form of self-improvement for this very reason. Coaching makes the assumption that living involves 'excellence', 'achievement', 'being the best' and creating 'win-wins' all the time. The problem however, is that 'responsibility' does not mean this. The coach will say 'You're responsible for your life - why not make it excellent?' whereas the therapist will say 'You're responsible, what do you want to do now?' The difference is like working 'around' a problem as opposed to working 'through' it. When one can find-out what their life should really be like under the assumption of responsibility is when life truly begins. Otherwise, we'll always be chasing excellence, achievement and happyness - and God only help us if we don't find it.

What, however, does it mean to say 'goodbye'? It is not just about saying goodbye to the loved one. It is about saying goodbye to a part of you. A part that had hopes, ambitions and dreams that were attached to someone special. It is saying goodbye to a part of your own life as well. Without this thorough mourning process, feelings of guilt and sadness often continue to plague us throughout everyday life. The goal of therapy in this situation is to work through the feelings of guilt and sadness as they arise and then go from there.

Of course as well, death also raises concerns about our own mortality. This topic within therapy is not often discussed directly, unless the client brings it up. However, it is critically important for the therapist to know, understand and accept the fact that this kind of thinking may arise in a patient, and give room for it to be worked through in treatment. The anxiety around one's own mortality is exceptionally high, and many forms of psychotherapy and philosophy argue that it is often the primary unconscious driver of our own behaviours in life. The belief is that when this anxiety is thoroughly explored in therapy, the patient will experience significant freedom. However, with this kind of reward comes a great deal of work, and both the client and therapist need to be up for the challenge. More than likely, an individual simply wants to work through the surface issues involved in grief, and that is often the primary focus of therapy at the time. Any deeper exploration is done sensitively and carefully with the patient leading the way.

If you actually want a perfect example of it, I once heard a friend who told me about his wife 'I know that look. She can tell me one thing, but I know she means another.' Though I do not therapize friends, I had to ask 'So what happens?' He said 'I lose it on her. I've got no idea what she wants.' And so ensues another fight based on one person not saying their authentic wants, and the other not knowing how to authentically express their feelings in the situation.

My solid belief is that anyone, at any one time in a relationship can take responsibility to make it right - and I'll repeat that - I said anyone at any one time can fix a relationship. However, virtually none of us do it - and that's the obvious difficulty, and the one thing that makes relationships such a challenge. We don't know how to be authentic and/or we don't know how to respond authentically in a relationship and each missed opportunity like this just adds to the dysfunction in a relationship.

The most important issue in working on relationship issues is ensuring that no one is made to feel 'bad' or 'wrong' for their feelings. What therapy simply focuses on is how to get a person enough support so that they can respond authentically to the demands a relationship puts on them. With authenticity in the relationship comes contact, openness, honesty and trust.

Unfortunately though, the odds of being authentic in a relationship are highly stacked against us. Many of our interactions in everyday life are not authentic, and as children, we often learn that expressing authentic feelings often does nothing for us, so we learn to manipulate to get what we want. When in a relationship itself we often fear upsetting the other person, and in many cases react to past situations in the present, like thinking someone is picking a fight with us like they did last week, when in fact they are not. It is this kind of thinking that therapy aims to address, for the truth is that authentic relationships are much more fruitful than ones based on anything else. That, however, requires very hard work.

A woman with Empty Nest syndrome 'consults a therapist. He soothes her... for so many years she has based her self-esteem on her performance as a mother. Suddenly she finds no way to validate herself. Of course she is anxious: the routine and structure of life have been altered, and her life role and primary source of self-esteem have been removed. Gradually, with the help of Valium, supportive psychotherapy, an assertiveness training women's group, several adult education courses, a lover or two and a part time job... she returns to her level of comfort.' Yalom goes on to describe how this patient, part of a research study, scores excellently on various tests that measure her outcome. She is cured.

However, Yalom considers this treatment a 'misencounter' and 'an instance of missed therapeutic opportunities.' The main reason why is that this woman - with the help of support systems available to her - has worked 'around' her problem and not 'through' it. She did not address the underlying causes of her anxiety, but rather sought to soothe the anxiety though various forms of distraction. The end result is that she leads a satisfied, but a equally numb and static life.

On the other hand, Yalom describes a patient he treated with almost identical circumstances where the patient worked 'through' her issues - 'In the treatment of this patient, I attempted to nurse [the anxiety] rather than anesthetize it... her anxiety lead to important areas. It was true that she had problems of self-esteem, she did suffer from 'empty nest' syndrome, and she was also deeply troubled... It was true enough that she could find ways to fill her time, but what was the meaning of the fear of the empty nest? She had always desired freedom but now, having achieved it, was terrified of it. Why?'Yalom then goes on to describe how answering these questions allowed the patient to become an 'authentic being: she wondered not at the way that things are but that things are.'

Yalom's final comment on these two patients is very telling 'Anxiety is part of existence, and no individual who continues to grow and to create will ever be free of it.' In other words, we can learn to work 'though' our anxiety to master it, or we can work 'around' our anxiety and let it control us - even if we are, for the most part, able to feel as if we have a nice life. The choice is yours, and I would love to hear comments...

Psychotherapy is perfectly suited to help individuals handle divorce for one main reason - it can get you in touch very quickly with your true motivations as you are going through divorce and thus give you an infinitely better, and more authentic picture of your situation. The deeper issues I often see and work with in divorce are the following:

Mourning A Dream Marriage often full of dreams for the future. Though throughout a marriage, there may be many signals that such dreams are over or may not come true, the finality of a divorce presents a very chilling reminder of such. Therapy is very well-suited to working through issues of loss and 'saying goodbye' to a dream. In many cases, emotions such as self-recminiation or 'feeling stupid' for saving stayed in a bad marriage for so long often cover-up the the inevitability that one's dreams are truly lost.

Concerns About Starting Anew I think that one of the things I get to see as a therapist is people's authentic reactions to things very quickly. While on the outside, people may put-on a very brave face, inside they remain very nervous about their new life. This anxiety is often inter-mixed with excitement and the pursuit of new activities and interests. In therapy, excitement and anxiety are simply viewed as opposite sides of the same coin - so the goal in therapy is to examine the anxiety as a road to possible growth.

Intense Feelings The feelings involved in divorce get very intense. From hatred, to anger, to fear, to joy, to relief - all the emotions and feelings involved could in many cases 'go to 11' (if you get the Spinal Tap Reference). The goal in therapy is to encourage a full exploration of feelings instead of having the feelings be 'reactionary' to some part of the divorce process. In examining feelings in this way, one becomes more at peace with the process instead of fighting against the emotions that come-up. It is not possible to tell someone to act rationally towards a situation when they have not worked-through all the intense feelings that keep bubbling-up and interfering with the process.

Attachments & Process As mentioned above, divorce is often about saying goodbye to a dream. However, much of that dream comes in very material form, and may even involve children, custody and access. It should be worthwhile for you to know that the therapeutic process does not alter your view, position or passion towards anything that you wish to keep from your divorce. The goal, however, is to allow you to deal with the demands that are placed on you during the divorce process, so that you are in a better position to take actions that are appropriate - and not based on the intense feelings discussed above.

If I asked you what you, as someone living in 2011 thinks 'human potential' means, you are more than likely to tell me it means things like 'anyone can do anything', 'everyone is so great and full of wisdom and love', 'we can live our dreams' and 'everyone has the potential to change the world'. If you feel this way, I cannot disagree with you, as I believe that this is what 'human potential' has 'BECOME' in 2011, I do not believe it is what was meant by those who founded it, and moreover, I believe, as a psychotherapist, these definitions of human potential do us much more harm than good.

I am a student of Gestalt Psychotherapy. Though anyone can argue with this, there are anecdotes that it started the 'human potential' movement of the late 50's and 60's. I have also heard rumblings that anyone who was a real part of the 60's had a copy of Fritz Perl's 'Gestalt Therapy - Excitement And Growth In The Human Personality' on their bookshelf the way we have Dr. Phil books on ours. All I am saying is that I believe I have some perspective on what was actually going on at that time, and given that perspective, I cannot help feeling that 'human potential 2011' has done a disservice to 'human potential 1961'.

One of the basic tenets of Gestalt Therapy is that the act of simply encountering, confronting or contacting the unconscious is bound to lead to growth. That is human potential 50 years ago meant that once people were exposed authentically to themselves, they would have the ability to change on their own. There was no need to intervene in the process - the human him/herself would be able to fully see him/herself and make whatever changes they wanted on their own. Thus the actual 'potential' in 'human potential' was a trust that a human being, under the right circumstances, would be able to improve himself. The by-product of all of these self-improved individuals was indeed greatness, hope, happiness and a certain esprit de corps that I don't think has been culturally seen since the 1960's.

Now flash forward to 2011, and what we mean by self-improvement is completely different. Today we simply seek greatness, hope and happiness that was a by-product of the 1960's self-improvement movement. Today, we want happiness and greatness without having to look inside ourselves for it first. What is perhaps even more nefarious is the fact that most self-improvement today is designed to make us 'believe' that we want greatness, excellence and success as part of who we are. Many coaches often equate authenticity to greatness or authenticity to success and results. While these may be some of the by-products of authenticity, they are not authenticity themselves and that is where our biggest mistake in 2011 is.

It is very hard today to tell someone that 'authentically' they may not want it all or 'authentically' they may be someone who really just wants to get by, because there is so much pressure on us to do exactly the opposite of such. However, being able to realize such may just what is needed to live a life of peace - and to my understanding, that was a big thing in the human potential movement too.

Similar to other conditions, treatment for OCD often includes exposure therapy, where clients are slowly exposed to their fears by a therapist who is able to help the individual process the experiences and fears that they are having. The goal of most therapies, however, is not to 'push' towards stopping the compulsive behaviour per se, but to allow the client to experience and feel everything that is happening in the moments that the exposure is occurring. In other words the treatment involves a certain amount of mindfulness and awareness building around the experience of the compulsion or the obsession.

I remember the very first taste of psychotherapy I had. It was in a group session lead by the late Dr. Julie Righter in Toronto. I was discussing a relative and this person's behaviour. Julie cut me off about 2/3 of the way through what I wanted to say and asked me 'How do you feel now'? I said quite naturally and simply 'I feel angry'. She replied 'Where do you feel your anger?' I noticed I had clenched my right hand into a fist, and I said 'Oh, look it's there in my hand.' She said 'take a moment to feel your anger.' What happened next was incredible. In silence, I clenched my fist as tightly as I could, and it seemed like I held it there forever, when I knew it could not have been longer than 20 seconds. I saw the group members staring at me, and normally I would not want to take up anyone's time, but I felt as if they were giving me permission to be angry, as opposed to wanting me to stop. All of the sudden, I felt a wonderful release of energy, and I let go of my fist. I turned to Julie in complete amazement, and I said 'It's gone'. Not only that, but the issue about which I was complaining with my relative had completely vanished. I developed complete sympathy for my relative. All of this within 20 seconds.

I think this experience of anger is highly indicative of people who face anger management issues - they just don't know how to experience their anger, and instead (and you don't need to be a psychologist for this) to know that the anger gets bottled up, displaced, projected, etc... However, unlike my fortunate experience, therapy for those with chronic anger problems is much more involved. Asking individuals who face anger management issues to 'feel their anger' in the therapy room brings up issues such as shame and other defences that need to be managed and treated very carefully in the therapeutic situation. In the end, those wishing to control their anger need to engage in a therapy that validates their all their feelings, and the situations into which their misguided anger puts them. When this trust is developed, the anger in the client will begin to subside and the therapist and client can go on to explore other key issues such as awareness of anger, and the mechanics involved in managing it. Discussing these with someone whom the client really, really trusts will help resolve many anger management issues.

Now, however, there are lots of consequences to ADHD which are not so pleasant. Primarily, psychotherapy does not treat the ADHD itself or its symptoms. Rather it focuses on the effects that ADHD has individuals. People with ADHD are prone to anxiety and addiction issues as well as depression and possibly bipolar disorders. They are often prone to having financial issues or concerns as well. Psychotherapy primarily works on these symptoms of ADHD.

Finally, one of the more interesting areas of ADHD and psychotherapy is the fact that therapy often explores the 'adaptations' that individuals with ADHD have to make in order to fit in. ADHD is something that most adults probably developed as they were children. As children go to school, which is a fairly regimented activity, those with ADHD develop coping mechanisms to both 'fit-in' to the school setting and to ensure that they are able to study and complete assignments. These adaptations can sometimes be very useful for managing ADHD in later life, but they could also be equally confining, and could have resulted from some issues in childhood that may need to be explored in therapy.

For those of you with adult ADHD in the Toronto area, I strongly recommend www.totalladd.com

In humanistic terms PTSD can be very debilitating for a number of reasons. Besides the fear and anxiety involved, an individual's world-view could change entirely, and those with PTSD often find themselves out-of-step with those around them. Those with PTSD react more sensitively and severely to everyday situations and this leads to increased alienation and misunderstanding. Many suffering from PTSD get very concerned when others tell them to 'get over it', because implementing such advice is very difficult. Ultimately living in the here and now proves to be very difficult and elusive.

Current treatment involves Cognitive Behavioural Therapy, where a client is taught to become aware of the thought patterns and make appropriate changes so that re-experiencing the trauma is not so severe. Also, where possible, exposure therapy is used. As a Gestalt Therapist, I somewhat combine the two approaches - while you will not physically go back to the trauma, you will discuss it, focus on it, and possibly re-enact some of it within the therapy room - noting that re-enactment is something that need to be done exceptionally carefully and tenderly, as does any discussion of the trauma itself. Gestalt therapy, however, will always focus on how you feel in the 'Here and Now' of the therapy situation, and thus those thoughts and feelings are used as an entry-way into any changes in cognition that may occur on the road to self-improvement. Group therapy is also an option for those working through PTSD issues.

Now, as I mentioned, this guy comes from Westpoint, and all he is doing is reflecting his training in how he approaches self-improvement. When I look at the U.S. Military, I definitely want them to live and breathe by the motto that 'Failure Is Not An Option'. If they fail, then my way of life, if not my life itself, is at stake. Similarly, for them, results are the key deliverable of what they do. They keep the enemy away from me (note that I do not wish you to infer that I am endorsing the techniques, validity or definition of 'enemies' involved in the current US war).

However, I really have to ask whether or not we can use military training and ethics to help us with our own self-improvement. Is it right to have the foundation of our own self-improvement based on the 'win at all cost' and 'failure is not an option' of the U.S. military? I have no doubt that this guy produces results in his clients. He moves them to where they want to be, and I don't think there's much wrong with that.

I am, however, very concerned with the messages that underlie his methods. In my life, 'Failure is not an option - it's a certainty.' I have failed, I am failing and I will fail. Unlike the US Military, it's not that I have the option of failure, but rather I have the luxury of it. I can recover from most any circumstance - unlike them. If they fail, we may not survive. To that end, I strongly disagree with the messages he was giving to people at his seminar. He equates self-improvement with less failure, whereas I equate self-improvement with the ability to handle failure better - and if I am able to fail better, I will live with less regret and emotional distress, and that may make me succeed more.

In my opinion one of the dirty little secrets of many quick 'self-improvement' methods is that participants often come-out feeling very good about themselves, and are often filled with wonderful expectations. Attendees indeed may have changed, and may have had very real self-improvement during such courses. However, what is often not said or accounted for is the very basic fact that the rest of the world has not changed along with you. In this regard, it can be said that real change can only occur in someone who can accept the relatively disappointing fact that the world has not changed along with them.

To me, this is one of the biggest issues with the self-improvement industry today. They inspire, motivate, move and provide techniques that allow you to play a 'bigger game' - yet they never teach acceptance. Acceptance of yourself, your situation and the way things are. Self-improvement today is sold on the premise that you can 'change the world', yet it completes forgets to change the self along the way. In doing this, I suspect that there are many, many, many, many self-improvement attendees who come home only to find their spouse is still a lout, the kitchen needs to be cleaned, their bank balance still sucks, their boss won't listen to them and their kids still wake them up at 3:00am needing a feeding and diaper change. Too bad the course told them that they could change the world - perhaps it simply needed to focus on how to change ourselves and how we react to everyday situations.

This past weekend, a TV station in Canada had a Mary Tyler Moore-A-Thon. I caught the following clip of Lou Grant 'counselling' Mary Richards (played by Mary Tyler Moore) about a personnel decision in the newsroom, and I thought what a perfect, if very comic, example of existential psychotherapy. Watch the clip, and then I'll discuss further...

Notice the laughter of the audience as Lou Grant discusses death, meaninglessness and the fact that a person's life can be summed-up on the back of a post-card from Disneyland. They're laughing because they know that everything Lou is saying is in fact true, and I cannot help but think that the audience is very nervous at the same time. Ultimately what Lou Grant is saying is both comforting and uncomfortable. Also, notice the extreme irony in Mary Richards saying 'I feel so much better' as she leaves the office. Though brilliantly funny, the real commentary here is that accepting existential concerns can put us at ease, but we'll only get there through the difficult process of recognizing them to begin with. It is clear that our poor Mary is just beginning to recognize them. In fact, I cannot help but find it ironic that Lou Grant starts off by saying 'Mary, let me tell you about life' when he is, in fact, about to have a conversation about death.

On a more serious note though, existential themes in psychotherapy are not meant to be used the way they are in this clip. That is, a therapist will not say what Lou Grant said, which is basically 'your problems don't amount to a hill of beans because we're all going to die anyhow, and even the greatest of us is barely a footnote in the lives of other people.'

Instead, as a therapist discusses any kind of issue with a client, they must be attuned to existential issues faced by their clients. I recently had a client who incurred a fairly negative, significant and traumatic event in his life. As we were discussing the incident, at one point, he said the worst part of it was that he could not discuss the situation with his mentor and business partner, who has passed away two years earlier. That concern, at least from my point of view, came out of nowhere, as he had never discussed anything in our sessions to do with the passing of his partner, except during the intake process, which occurred six months earlier. What that incident and this video show is just how close to the surface existential issues truly are in our lives and how confronting them during times of crisis can help us gain further perspective about ourselves - even if it seems like an odd way of doing so, as our poor Mary Richards just discovered.

However, as we hit our 30's, and become really world-wise and mature, many people begin to realize that their self-esteem compensations are not working as well for them as they thought. Specifically, our relationships change. Whether we have normal or impaired self-esteem, we want more from ourselves and we want more from our relationships. In fact, not only do we want more - we want more authenticity from ourselves and from those with whom we are intimately involved. Those with healthy self-esteem know how to be authentic and how to sniff-out authentic partners, and if the authenticity is not there, they are completely OK with leaving the relationship. In other words, they are not 'stuck' to anything.

Those with impaired self-esteem do seem stuck - stuck in the same relationship, stuck with the same patterns of relationships, stuck with not getting what they want from relationships, stuck with the same insecurities about themselves and relationships. Moreover, people in their 30's who are stuck concerning relationships realize that their self-esteem issues only perpetuate their problems. Every bad relationship only goes to reinforce their outmoded beliefs, and at the same time they do not know how to get out of their bad relationship habits. It's like being aware that you're drowning and being paralyzed such that you can't swim to save yourself.

When people come into my office, they are often very distressed about their relationships. That is not a bad thing, as the distress is often a sign that something needs to change. The people who walk through my doors are taking an action that previously would have been difficult for them to do and that too is a challenge, because this is the first time they realize they have to address a problem they thought did not exist. When people come into my office they want 'better' - specifically they want better relationships and they are demanding better of themselves.

Working on improving self-esteem issues is NOT - I REPEAT - NOT EASY. I emphasize that because many self-improvement coaches and lifestyle experts make it seem easy, and unfortunately, many people who are dating and in their 30's eagerly listen to this advice. In fact, one of the reasons people start getting distressed about relationship is because they know that what they have tried before, and the advice they are hearing now is not helping them at all.

It is not that difficult to understand why this is the case. Coaching advice lifts up and supports a person with low self-esteem when it comes to relationships. Everyone can find their soul-mate. Love is worth it. You can date anyone you want with a little bit of confidence. My view is that people who are serious about their self-improvement realize that such external support is not what they need, as they have tried these things already and they have not worked. They need to find a solution that lifts themselves - and not their circumstances.

The goal of psychotherapy in treating relationships and self-esteem issues lies in answering a deceptively simple question 'How can you get what you want, given what you've got already?' The goal is to recognize everything that has happened to a person - both the highs and the lows and the 'wisdom gained from experience'. This begins building self-acceptance and self-esteem. In fact acceptance becomes absolutely vital in treating anyone going through self-esteem issues who is in a relationship. When one is able to accept themselves - warts and all - they are able love of others. And this is really when self-esteem improves.

To give a concrete example, I saw a thirty something female for six sessions who came-in with short-term acute moderate depression about her relationship. She knew she had to leave it. The reason she was stuck for so long was because she felt that given all the other problems that people have with their relationships, like abuse, infidelity, distrust, arguments, etc... that she had it quite good, and should not be complaining about it, even though the guy she was with was a jerk. She also felt that she had to date a certain type of guy, given her looks, background and education, even though such guys rarely proved satisfactory to her. In the fourth session, she was very distressed about her situation and displaying exceptional anxiety. I offered this observation - 'What I see is someone who takes herself and her situation very seriously and who is taking the steps to make the right choice for herself. I see someone who is strong and articulate making some very important decisions, because this is a very important situation.' With that she sobbed, and when I asked her about her tears she simply said 'I can't take in what you just said.' Within two sessions, we terminated, with my client saying that just having her struggle validated was enough for her to take action. She was in the process of moving on from the relationship and joining various dating services.

The goal in this therapy was not to validate the person, which is what many people try to do. Instead, the struggle itself was examined and validated. In this way, my client is in a much better position to exercise and recalibrate her self-esteem on her own. I did not provide a single piece of advice about how she should go through and approach her next dating challenge, but I have no doubt that she will do it with more authenticity and self-esteem than ever before.

Much of the theory surrounding psychotherapy is based on the causes and treatment of anxiety - it is something that underlies many other conditions. When I say that anxiety is 'fear', there are many theories as to what causes the fear in us. Existential psychotherapy, which forms a strong base of my theoretical bent, says that we fear existence and everyday living. Things like ultimate responsibility, meaninglessness and fear of death are posited to cause Generalized Anxiety Disorder. However, quite often people come in to discuss other symptoms and other things that make them anxious.

Gestalt Psychotherapy, which addresses living in the 'Here And Now' says that our anxiety is caused by fear of the present situation and by the fact that dealing with the present requires us to be responsible, authentic and vulnerable, and it is these attributes that we fear. In fact, regardless of the theoretical source of the fear underlying the anxiety, it can be said that any anxiety is always caused by the present situatiuon. In this way, Gestalt Therapy therapy addresses how we live in the present to begin to cure generalized anxiety disorder.

Specifically, Fritz Perls, the founder of Gestalt Therapy said that one is cured through the 'safe emergency of the therapeutic situation'. In other words, for the person facing anxiety disorder, the therapist works at getting the client to live in the present - even if just for a second - in the therapy session. This contact with the present will invariably cause anxiety to arise in the session, at which point the therapist and client can begin to address it - and in many cases addressing it is done using a Cognitive Behavioural Therapy approach. In fact the entire exercise is much like Exposure Therapy that grounds many of the current treatments for anxiety and Obsessive Compulsive Disorders. Gestalt works well when the anxiety is Generalized and displaced in various non-specific situations, as this generally indicates an issue with living in the 'Here and Now'.

There are various severities of depression, and I work with all kinds. Generally, I find that depressed individuals are often 'split' inside three ways. There's a 'Doer', 'Done To' and an 'Innocent 3rd Party'. In those who have mild to slightly moderate depression, what I often hear is 'I just can't get myself to do what I want/need to do'. We can clearly see the three parts here. The 'Doer' wants a task done. The 'Done To' cannot do it, and the 'Innocent 3rd party' just suffers with the inaction. The goal of therapy then is to get these parts of the personality back in line with each other and functioning well together. This is done by examining beliefs about what 'should' be done, and factors that cause the inaction. The real goal, however, is for the client to be able to: 1) Identify thought patterns that cause depression; 2) Understand them; 3) Accept them; 4) Change the thoughts or circumstances as necessary.

When the depression falls into the moderate to severe categories, the same structure as identified above is still critical to treatment. However the 'Innocent 3rd party' needs to be given more consideration. Specifically, in moderate to severe cases of depression, people may begin to experience strong feelings of worthlessness, or concerns about their value to themselves and others. Moreover, in moderate to severe depression, our ability to function becomes impaired - things like waking-up, eating well, going to work, taking care of ourselves begin to slip away from us. While the goal of treating moderate to severe depression remains largely the same as it does with mild depression, more initial emphasis is put on the impaired functioning and feelings that come-up.

I'm not prone to giving much heed to 'flavour of the day' self-improvement experts, but the quote above is very, very true and very, very succinct. However, it is really worthwhile to examine why 'awareness' is so hard to achieve, and how becoming aware improves change.

Regardless of which particular modality of psychotherapy one subscribes to, virtually all modes agree that humans have the ability to 'obliterate' various parts of themselves or their environment, and this function is largely based on the 'Pleasure Principle' outlined by Freud. In plain English - we are attracted to things we like that make us feel good, and when we encounter things we don't like, we generally wish to either assume they don't exist or we work to ignore or even destroy them.

Awareness fits into this in two very important ways. First, this cycle of attraction/obliteration is largely reflexive and done unaware on the part of the individual - and that is often why it is so hard to become aware of things - we do them so automatically. As such, becoming aware of what we do in this cycle is exceptionally valuable when we have to change. I am not saying that we 'love everyone' or 'love everything', as that is simply not possible. What I am saying is that by becoming aware of this very visceral unconscious process, we learn a lot about ourselves. Most importantly, not only do we become aware of why we may accept/obliterate something, we become aware HOW we do it.

Becoming aware of HOW we accept/obliterate leads to the second aspect of how awareness leads to change. Specifically, we become aware of HOW we accept/obliterate parts of ourselves. Just as we like and accept things from our environment, we like and accept certain aspects about ourselves. Also, however, just as we dislike and wish to obliterate things from our environment, we dislike and wish to obliterate certain parts of ourselves. In fact one could make the argument that the main job of a psychotherapist is to simply make a client aware of how an individual obliterates a part of themselves, and that by accepting that part, a person is better able to work as an integrated whole.

To give an actual example, I had a client who appeared very gruff and tough on the outside, and came-in wondering how he stayed so long in a job in which he was taken-advantage of by an abusive boss. The answer was readily obvious within two sessions of therapy - the client had a soft side that was vulnerable to such exploitation, but he never acknowledged that he had it (though unaware to him, he did show it a fair bit).

Answering the client's question of how he got into the situation was thus fairly straight-forward. The client simply needed to become aware of his 'soft side'. It did not mean that he needed to yield to his soft side, but rather to simply use his soft side as a barometer. In a situation where he felt his soft-side being pushed into a situation that he did not want to be in, he needed to use that feeling as a 'red alert' so to speak, and re-evaluate the situation. Of course, when one is not aware of a part of themselves, and when one is not aware of how they suppress that part, change is not possible. However, awareness and acceptance of the whole part of a person makes for a better functioning person, and that leads to change.

Finally, I do have to say that if I was not clear, that we did not work on my client becoming 'nicer' or showing a 'softer side' more often. Therapeutically, all I wanted to do was make him aware that he had a soft side that he was unaware of. Once he became aware of it, he understood himself how he could use it as an early warning sign of trouble in a relationship. His relatively gruff behaviour, he felt, ensured that he would not be taken advantage of, and he was simply unaware of how to use his nice side in employer relationships.

However, within the healer-client relationship (n.b. I use the term healer here, because I refer to both coaches and therapists), inspiration is quite a different thing. In this kind of setting inspiration is like a medicine - or better yet - a drug that is dispensed to clients. In fact it is one of the most important tools that a healer has in his or her toolkit, and in my opinion, it needs to be treated as such.

What strongly concerns me about the coaching movement is that many are too quick to dole-out way too much inspiration to their clients. That is, many coaches simply bombard their clients with messages of inspiration without any regard for the consequences. Now, the last sentence may raise a number of eyebrows - specifically - what kind of consequences could there be to someone receiving TOO MUCH INSPIRATION? Well, in my view, inspiration is like a narcotic and receiving too much of it has the exact same effect as an overdose.

To understand this, one must understand the main reason why someone seeks personal self-improvement. The main reason why they do so is because they cannot find their own support, solutions or inspiration and they need help finding such. However, the solution is not for the healer to simply fill-in the missing support and provide it as needed with an excess of inspiration. The key reason why is that the client winds-up relying on the healer to provide inspiration and thus does not develop the self-support to do it internally. In fact over inspiration from external sources often leads to counter-productive behaviour and further neurosis. Specifically, if one is inspired to do great things, but does not accomplish as such, one is left holding an empty bag wondering what is wrong with them.

The goal of any healing is to allow the client to develop the means to create self-support. However, simply giving the client an overdose of support is not what is needed. There's a famous axiom that a rising tide raises all ships, and when the tide goes away, the ships sink. The goal of the therapist is not to do the heavy lifting for the client, but to have the client do it themselves. And when you understand this aspect of therapy, you can begin to realize that being careful with how inspiration is given-out is indeed an act of inspiration unto itself.

'All human wisdom is summed up in two words - wait and hope' - Alexander Dumas

'Patience is the ability to idle your motor when you feel like stripping your gears.' - Barbara Johnson

And many, many more great quotes here -http://thinkexist.com/quotations/patience/

I've got a new website up and I'm in the process of expanding my practice. However, at times like this I always start thinking things that lead me towards depression. I think the main reason why is that I believe marketing and getting new clients should never be as difficult as it is. Moreover, I always believe that I will fail at the endeavour.

So, I decided based on this to write a blog post on patience. Now sure, the wise quote should be 'patience is a virtue' or 'good things come to those who wait.' However, I've never liked those quotes. The reason why is that I am often described as a very patient person, yet many times I'm not patient at all. I have just developed a good way of hiding my emotions as well as my real wants and needs.

So off I trudged to Google to look at quotes about wisdom, and I was completely floored by what I found (click here to see) The reason why I was so impressed is the fact that most of the quotes keep telling me to trudge forward and that waiting patiently is not necessarily a virtue. Waiting without doing nothing can be a very foolish thing, these quotes tell me. And as a therapist I know the converse is equally evil - doing lots to avoid doing nothing is equally foolish.

What these quotes above did was they put me smack in the middle of my dilemma. As it stands right now, my life is about climbing a ladder, striving to get get one or two more Twitter followers a day, spending more and more money on marketing that may or may not work, getting in front of audiences and doing speaking engagements that abut my true sense of values as a therapist. This situation sucks for me - and it is the same situation I find myself in time after time. The bottom line is this, I'm not sure whether I can accept having to market or not, but at least the quotes above give me the sense that I am not patiently waiting alone for something to happen, and that patience itself is not a virtue. Patience only gets turned into wisdom by some sort of action or growth - and in my case, that may mean acceptance of my situation.

Awareness Questions

1) If you had to sit for 5 minutes being patient, what would you be thinking about yourself? What would you want to really be doing?

2) When you were growing-up in your life, around whom did you have to be patient and why? How much of the demand placed on you to be patient was 'their issue' versus your own issues?

3) How has 'being patient' or learning the concept of patience impacted your life?

If you've never considered it before, it is kind of weird to think about a real mind-body connection. How can what goes on in our mind affect our body, and vice versa? However, therapy and general psychological literature is full of mind-body links and connections.

I chose the quote above because it is of personal interest to me. I am prone to severe chonic back pain. I do not question whether or not my back pain can be reduced if I change my attitude or outlook on life. The fact is, I have a steel rod in my back that I get checked-out every few years. I remember one orthopedic surgeon who said quite forcefully 'Of course you're going to have back pain. Look at your X-rays, you've got a steel rod there!' It's factual and it's true, and no amount of 'positive mind shifting' mumbo-jumbo is going to change the biology of my situation.

However, is the quote above true - that those who cannot handle what is on their mind create an antidote to their mind by making their body suffer. Am I doing this to myself? To be honest, I suspect that I am. Again, the literature is chock-full of examples, the most compelling of which is a quote about self-harm by Fritz Perls which says 'The person who does not know how to express their anger takes it out on the most convenient, easy and innocent victim, the body.'

In my most serious back-pain episode, as I experienced pain so severe I had to shout at the top of my lungs, I asked myself what if any messages were happening in my mind. I realized very quickly that my cry of anguish really said 'your life should not be like this', and it was then I knew the mind-body connection. My life, my back ARE like this. I may not be able to change any part of it. Getting over the pain does not mean my mind over coming the physicality of a stainless steel rod in my back - it simply means letting go of the fact that it, along with the pain is there. In other words, I may not be able to stop the pain in my back, but I can stop the war that is going on there - and that may be all that I need.

Awareness Questions

1) This is going to be a weird one - draw your pain. Get a piece of paper and crayons and draw your pain. Notice how you are drawing it. How do you feel when you are drawing it? What does this say about you?

2) What would your life be like without pain? How would it be better? Even with the pain, can you still take steps towards how you envision your life without pain?

3) Who do you want to blame your pain on?

This is a very interesting idea. If someone is always nice to me, but rude to others, what should I truly think of them? More importantly, what if I discover that I'm nice to some people, but not nice to others - what does that make me? We are exceptionally conflicted about niceness - both in ourselves and others. There are probably many times that we are nice, and wish that we didn't have to be. Many of us get into difficult situations or do not ask for what we want out of niceness. In fact, one of my fellow therapists runs a well-received seminar called 'Toxic Niceness.'

What, however, would be the issue in not acting nicely, or admitting to ourselves that we are not nice? Now I'm not advocating anti-social behaviour at all; rather, I am simply posing a question and asking about what the harm is in admitting that we are not nice. Now, I'm not suggesting that by answering this negatively that we must infer that we are chronically mean or cruel. Rather, I mean that we begin to take full ownership of the actions we take that put our own needs first over the needs of others. I also mean accepting the fact that we definitely feel, and thus may act out of anger, impatience or even rage once in a while. It thus becomes interesting to observe what we think of ourselves in situations when we are not nice. Note that I'm not advocating that we be 'proud' of our angry behaviour - I am simply suggesting that we explore how we feel about ourselves and others when we are not nice.

By Dave Barry's definition, I know I'm not nice - BUT - I also know I'm not a bad person. I remember my own therapist coming late into her treatment room saying 'I just got through writing a nasty letter to the bugger that parked in my reserved spot.' My therapist... a nasty letter? It didn't make sense at the time, but it does now. We are human - and that means we are flexible, fallible and adaptive. There are going to be times where the stars align so that I will be nice, and there are times when they will align so that I will not be nice. Similarly, there will be times when others will not be nice to me. There will be times when I have to deliver an unkind message, and I may be able to do it with compassion, or I may not. However, if we understand that we can't be nice all the time, we may be able to develop the sympathy for ourselves and others when niceness is simply not possible - and that just may be the nice thing to do.

Awareness Questions

1) How do you feel about yourself when you are not nice? If you think about a situation when you were not nice, what could you have done differently? Realistically though, could you have acted any differently? At this point in time - right now - do you care that you could have acted differently?

2) Think about a time when someone was unkind to you. How do you feel about yourself in this situation? What is it like to feel this way?

3) Why should you be nice? As you think of those reasons, how many are truly authentic to you?

BUT

'Money Makes The World Go Round' - Joel Grey in Cabaret

There are more times in my life than not where I do think that money is the root of all evil. Forget about the Gordon Gekko's, Wall Street Traders, Enrons, Bernie Madoff's and Philip Bradley's who swindle people out of money. Let's talk about money in relation to you and me. How many of us would seriously work at our day jobs if it weren't for money? Some of the most heartbreaking moments I have with my son come when he says 'You don't have to go to work... don't go to work Daddy.' How many of us get caught-up in the idea of spending and managing money over the pursuit of other activities?

The most wealthy person I ever met told a very cautionary tale. He said 'whatever problems you had before you had money will just become bigger and more expensive with money.' In fact, in our North American society I don't necessarily feel that money is the root of all evil, but that 'money is the root of all neurosis.' I believe that if you are a worrier in general, then you will definitely worry over money. If you are naturally greedy, you will be greedy with money. If you are generous, then you will be generous with money. If you are ever hopeful, then you will pray that you'll stumble into a big stack of money.

However, try as we might, we can't just get rid of money - in other words it does make the world go around. To this extent, money is exactly like every other issue that we face in that we simply cannot obliterate the issue from the face of the earth. Just like there will always be bad weather when we don't want or a 'black fly in your chardonnay', we will have bills to pay and we will need to make money. If money is stressful to you, the only way you can mitigate these circumstances is to re-orient ourselves and change how you view money because there is no way that it is ever going to go away. It is with this in mind that I believe our attitudes towards money reveal a lot about ourselves, and answering the below awareness questions about money will reveal more about your life in general.

Awareness Questions

1) Beyond your actual circumstances like employment, what causes your issues with money?

2) If you had to walk into a room filled with all your friends and tell them exactly how much money you made, how would they react? What does picturing this situation make you feel like? Why does it make you feel this way?

3) If you became wealthy beyond your wildest dreams which 'bad' parts of you would just get worse?

4) What, if anything, is wrong about hoping you'll one day have lots of money?

I remember the first time I heard the song 'Boulevard of Broken Dreams' by Tony Bennett(not the Green Day song of the same name). The first thing that struck me was how inspirational and confident the singer's voice is as he describes walking down a truly miserable street. It immediately occurred to me that the song was about the journey, and not about the road on which one walks. In other words, it is entirely possible to sound confident and dare I say happy in even the most miserable of circumstances.

There are probably two thoughts of relevance going on out there. There are some of you that are strongly agreeing with my view, and there are some of you that are passing it off as positive-psychology BS. In either case you're right, and that's where the Eleanor Roosevelt quote comes in. Happiness as a concept - and logically speaking - cannot possibly work as an end goal unto itself. I can run a mile in 5 minutes. That is a goal. I can work towards it. I can measure it. I can achieve it. I can adjust it and I can improve upon it.

Now, let's try and envision happiness as a goal in the same way. The only way I can do that is by asking 'Are you happy now?' and again 'Are you happy now? and again 'Are you happy now?'. The fact is we will be happy some times and not others. So therefore to 'achieve' happiness makes absolutely no sense. To put it another way, as a therapist, I wonder what kind of manipulations you would be doing to yourself - and to others - in order to achieve this goal of happiness. For example, if I was a source of your unhappiness - how would you try and change me? And I say that because more than likely, I would not take too kindly to your changes - thus never making you happy in my presence.

And that is where our real trouble with happiness lies. Making it a goal and something to be manufactured and metered-out cannot do us any good. In seeking to attain happiness, we miss the potential for happiness that could lie in front of us. And that is the point of the quote. Happiness is the by-product of a well-adjusted individual. Someone who recognizes that in both good times and bad, they can be happy - or not. In my view, if you are indeed looking for happiness as some sort of goal, the only way you will find it is when you realize that you can be fully happy when you are unhappy.

Awareness Questions

1) Are you happy now? How do you feel about that?

2) Many therapists encourage their clients to 'let go' of a negative situation in order to be free. Let's try it a bit differently. Can you think of a situation that made you happy beyond belief? How are you holding on to that situation? Can you let go of that situation? What would life be like if you did?

3) Can you think of a situation in which you would be happy but when the circumstances are in fact miserable? What do you think of yourself in such situations?

In 1988, I had a 'class picture' taken of me and about 120 memebers of a youth group I belonged to. Ten years later, in 1998 I showed someone the picture who was about 10 years older than I. I flippantly pointed to people in the photo and said 'This one's bald, that one's fat and this one's divorced - twice!!' He looked me straight in the eye and said 'Wait until you start pointing at that picture and saying 'This one died' and 'That one's dead too'' Unfortunately, about 10 years later in 2009 in what can only be described as some kind of cruelly accurate and ironic piece of timekeeping, that's exactly what happened when I looked at the photo again.

The thought of death makes us sad, angry and anxious - and it should. There is absolutely nothing that would convince me that on balance the process is not painful, tragic, scary, terrifying and lonley. However, is Mark Twain's wisdom true - that a life well-lived spares us from the fear of death? I often wonder about this - when will I KNOWthat I have lived fully and thus know that I am prepared to die? Even as I type this I envision my own death, and I shudder.

I do not necessarily believe that leading a full life reduces the fear of death for everyone, but I do belive living fully strongly helps mitigate death anxiety. We may be obsessed enough by 'living well' that we cannot help but be distracted from our fear of death. This, to me, however, is not 'living well', it is 'living distracted', and I think the difference is obvious.

In my view, the only way to alleviate the fear of death is to accept our death. If there ever was a perfect application for the 12-Step prayer of 'God grant me the serenity to accept the things I cannot change', this would be it. When we begin to become serene about our own death and the invevitably tragic deaths of those around us, I cannot help but belive the opposite of the above quote to be true - 'A man who is prepared to die at any time is a man who will live life fully.'

Awareness Questions

1) How are you not living life fully now? Honestly - does knowing that you are going to die inspire you to live better? Can you describe the conflict you have between what you 'should' do in your life and what you 'want' to do in your life?

2) How do you talk to yourself about your own death? How does even reading this question, or beginning to address this issue make you feel? What blocks you from fully answering this question?

3) If you could talk to someone in your life who died, what would you ask them? How would they answer, and why would they answer that way?

I think this is one of the most powerful phraese about wisdom that has ever been written. I think the question that needs to be asked is whether we can change ourselves. Can we change those deep-seated behaviours and constant thoughts that go through our head that impact our behaviour? Can we change the thoughts that make us anxious, depressed or relive tramua?

I ask these questions in the context of the above quote simply because it gives us absolutely profound wisdom into ourselves. If we agree that we can change ourselves, then according to this, we are asking God for the courage to do so. In other words, change is a courageous act - and acting with courage can often be challenging at the best of times.

So, maybe we should look at this as if we cannot change. If we find that we cannot muster-up the courage to change, then the prayer implores God to give us the serenity to accept the things we cannot change. In other words, we should be peaceful to ourselves if we cannot change. The challenge here, of course is that so many times we 'want' to change - we want to be different or have a better life, so if we cannot change, serenity is often the last thing on our minds. Instead, we continue to try to change and get all tangled-up when we cannot.

The final part of the quote concerns wisdom - the wisdom to know the difference between what we cannot change and what we can. If we know deep down inside what is possible for us in terms of change, does that not lead to acceptance of who we are and whether or not we can change at all? And if so then 'not changing' may not be so bad afterall. In fact, that very sympathy towards not changing may be what leads to change anyhow.

Awareness Questions

1) How do you lack the courage to change? What holds you back from taking even one courageous step? Honestly, do you want to change from where you are, and would you be OK with yourself the way things are now?

2) How do you drive yourself to change? What do you say to yourself? If you had to tell that voice something, what would it be?

3) As you've answered the above two questions, where is your compassion towards yourself? Do you believe that you should be compassionate towards yourself?