Justin K Hughes LPC

My Election Choice

 

Almost there.  End of Election Day 2016.  In seriously considering how to be a good citizen in this election, I came across a sure fire one.  It’s research based, and all respected professionals agree with this one.

Communication in love = improved relationships.  

Yeah, that’s right.  I suckered you into reading this.  But why stop now?  This is good stuff!  

I’ve seen a lot of head-shaking and apathy this election season.  As a mental health specialist, I have been watching the behavioral and relational patterns of interactions, whether from leaders at a podium or the lay person on the street.  I actually DO see some really good communication patterns in some people who exhibit characteristics that follow.  But as I wrote about in a blog post entitled “Effective Communication” a few years back (right before the last election), the examples many of us see reflect abysmal communication styles.  Well, at least if we want to be respectful.  IF you’re attempting to minimize, disrespect, and emotionally distance, fair WARNING: do not read and apply the following.    

PAA

Passive, Aggressive, and Assertive Communication styles have very clear results in various settings (in case you are wondering, passive-aggression can often be placed as a subtype under aggressive).  Assertive communication is based on mutual respect, regardless of how much you disagree with the other person.  Abusive language or behavior are out of the question.  Assertiveness always involves respect.  You may strongly state a point or quietly listen, but finding an assertive sweet spot is key- speaking the truth in love, and sometimes learning to just close the mouth.  

Check out the Mayo Clinic’s thoughts on this one, or for organizational settings, look at Daniel Ames’ research at Columbia Business School.  

Turning Towards

The famous marriage researcher, Dr. John Gottman, found that turning towards a partner (which is not passive/casual agreement, but a positive stance of staying invested in one’s spouse), is significantly correlated with couples who stay together versus divorce.  This means that in every “bid” that’s made for attention or connection, the masters of marriage turn towards the other person most of the time.  I think there’s a lot to learn by studying successful couples’ interactions- after all, these are the people who are able to somehow stick with the same person for YEARS!!

Distress/Uncertainty Tolerance

Distress Tolerance is the ability to manage high levels of upset (distress), while staying grounded.  Intolerance of uncertainty (IU), seen especially in OCD and anxiety disorders, can be successfully redirected by developing Tolerance for Uncertainty.  Maybe the most common misconception with these are similar to misunderstanding forgiveness: to forgive doesn’t mean to just smile and approve.  These all involve character-building at a deep level of maturity where a person can still hold to what is true, while at the same time having peace when the world around seems (or is) out of control.  

Understanding

Back to Gottman.  He joined up with Anatol Rapoport to form an amazing Conflict Blueprint.  It involves working hard to really “get” what the other person is saying, and it recognizes underlying longings- and respects them- in the other person.  READ: NOT the same as adopting their perspective.  Furthermore, Softened Startup entails bringing something of significance and/or pain to another’s awareness, while staying gentle and guarding against criticism, blame, and shame.  

These things are actually really simple.  But they take discipline and deeper metamorphosis to bring about in daily life.  What can you do when all around you people communicate with disrespect and contempt?  Be a difference maker by communicating in love.  

That’s my election choice.  What’s yours?

Sincerely,

Justin K. Hughes

What A Year Off From Social Media Taught Me

This post has been updated and moved to my professional website.  You can find it here: www.justinkhughes.com.

Heart Attacks and Resolutions

If your heart condition were so bad that you had to undergo expensive ($100,000) coronary bypass surgery to improve it, would you change your lifestyle after the surgery?  Nope.  Not likely, at least according to a surprising study by Dr. Edward Miller at Johns Hopkins.  Miller found that 2 years after patients had a coronary bypass surgery, 90% did not change their lifestyle significantly (diet, exercise, stress, substance use).  90%!  Wouldn’t such an adverse event motivate change for the better?  Not necessarily so.

Being at the end of January as I send this out, many New Year’s resolutions have been made.  Fewer have been kept.  It is common sense that the resolutions we make mean very little without proper follow-through- whether at the gym, with eating habits, or in even more complicated areas, such as relationships.

When I’m humble enough to admit my own strengths and limitations (my human-ness), there are many things I cannot do on my own, many areas of life I CANNOT control.  But for those things I CAN change and affect, I ask myself:  Do I need additional support?  Help?  Growth?  Acceptance?  Is what I’m doing sufficient enough to bring the change I want?  Do I have the “horsepower” to do what I need?  In counseling, there are rarely quick fixes.  My job is mostly helping clients identify the how of change, not simply the what (i.e., how do I eat healthier versus simply identifying a need to eat healthier).  I regularly ask myself the following question that I also pose to clients: “Am I pursuing what is needed to bring about growth and health in my life?”

If you’re having trouble changing something, first of all, that’s okay.  Deep breath.  You will be less likely to change something if you get overwhelmed and caught up in helplessness.  If you ask all of the above questions and determine you need a little bit more than “pulling yourself up by your bootstraps” (which is self-contradictory, by the way), passivity will lead to the same result- not even a heart attack can change that.  If it’s time for something different, only you can decide.  And if you hire me, we’ll get down to business.

Yours truly,
Justin

Myth Busters: Psych Meds Edition

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It is sad to see the person looking for a chemical fix to all their problems.  Equally discouraging is seeing marriages torn apart, lost dreams, and lives ended early- when psychiatric medication might have made a difference in the big picture.  Not “pro-meds” or “anti-meds,” as a mental health clinician I am “what is your situation, and could psychiatric medications possibly be a better option to what you are facing?”

Is it better if you don’t have to take medications?  Of course!  Why add anything to your body that’s not needed?!  But the question really is, do the possible benefits outweigh the likely risks I run in not taking medications?  Does the likely negative impact on myself and/or others suggest I would want to consider medications? Suicidal thoughts can lead to suicide, manic episodes can lead to marital unfaithfulness, addiction can lead to prison, anxiety can lead to ruined relationships, and ADHD can lead to job loss.

My paradigm on taking psychiatric medications comes from a framework that sees it as more of a philosophical and psychological decision in nature than it is about finding the “right scientific argument.”  There’s no perfection in science, and even the medical treatments we know and love involve a lot of guesswork and uncertainty.  We can’t know all possible interactions, side effects, and possibilities for every person.  What it often comes down to is risk and trust.  Taking Advil for a headache is a fairly low risk, with fairly certain outcomes- for some people.  Taking Abilify for Bipolar is less certain.  But if it works, is it worth the risks?

I submit to you that deciding to take medications really comes down to two questions: 1) Is what you are facing worth considering the cost/benefit of medication? 2) Are you willing to try something different? 

 

Top Myths On Taking Psychiatric Medications

If I take medication, it means I am crazy.

First of all, what is meant by crazy?  Most folks I talk with say ‘crazy’ is something along the lines of becoming “controlled” and losing their choice.   With psychiatric medications, this is a phenomenon mostly relegated to the movies.  Seeking a trained professional to affect biological changes in order to help a person with outcomes they desire isn’t crazy; it might be wise.

Also, the opposite of this myth may actually mean a person is in WORSE shape.  It is usually those who seek help who are healthiest; those who leave their problems to chance are most likely to be overcome by them.

I will become a drooling vegetable.

This is a movie concept, not a real world reality of Psychiatry (unless if there are illegal, wholesale abuses/uses occurring).

Psychotropic meds need to be taken if you are depressed.

This is the opposite, yet equally erroneous view that medications are always beneficial.  Sometimes they are not.

We really don’t know exactly how psychiatric medications work.

True.  This is absolutely true.  However, if we are to get honest about the process of research (and for that matter, science), we don’t know a lot about a lot of things.  Even in cardiovascular science and treatment, there are many unknowns.  Even in the treatment of heart disease, that formidable foe of American health, there are many treatments that have uncertainties as to how/if they will work on the individual.  But remember, the business we are talking about is saving lives.  And so it is with Psychiatric medication.  Saving and/or improving lives is the question.  If you know with certainty that taking medications will do neither, then there is no reason to take them!

When I am in session with clients, I don’t seek to win this (or really any) arguments by sheer data.  Most often, it comes down to our a) belief in what makes change possible and b) our willingness to change.  These choices we make are based on values, goals, perceived risk, and the beliefs we hold.  And each of us must decide for ourselves.

If I go to a Psychiatrist, they are just going to give me a pill.

To be fair, this does happen a fair amount.  But also to be fair, Psychiatrists have to gather a reasonable clinical rationale to prescribe, and there are many who do not recommend medications in every situation.  You have choice whether or not to follow the suggestions given and/or to get a second and third opinion.  To increase confidence in the process, bring up your concerns and ask around for the best Psychiatrists.

Medications will change who I am.

At their best, medications help address what is dysfunctional, not the enduring qualities of a person.  The prescribing doctor can track your symptom profile to determine- with you- whether or not a prescription leads to positive or negative changes.    Please remember that ANY medication used in medicine can cause unwanted effects- this is why it must be tracked and monitored, especially initially.

I will go crazy if I take medication.

Psychotropic medications are meant to help correct problems.  The higher risk of problems is when a person doesn’t take medications when they could help prevent or intervene with major issues.  If you are concerned about having a very negative reaction to a medication (whether due to Drug Allergies, past experience, or fear), consider setting up some supports such as regular follow-up with your psychiatrist, blood tests, and having friends/family monitor how you are doing when first starting on a medication.

There will be nasty side-effects.

Due to regulations, drugs used by Psychiatrists in the U.S. are highly researched to ensure that they do not create public health concerns.  That being said, there are certainly bad experiences and side effects that can occur.  In the end, it’s not a perfect science, and it comes back to those two questions of whether 1) what you are facing is worth considering the cost/benefit of medication, and 2) having willingness to try something different

I will become addicted.

If this is a concern, please raise it with your doctor, especially if you have a history of addiction.  There are MANY meds prescribed that are non-addictive.  However, it is true that benzodiazepines, sedatives, etc., have addiction risks.  Many patients can use these medications without becoming addicted, with a substantial improvement in their quality of life even short-term (e.g., through better sleep or less anxiety).

Psychiatrists force medication on their patients.

A respectable doctor will not force medication on you.  Unique, individual focus is made by seasoned professionals, including your involvement with the process.  The concept of against-your-will medication is mostly made up for entertainment/story purposes and rarely exists in the realm of actuality (even in the EXTREME situations where medication is forced, it is to guard a person from being a threat to human life, but this is not the usual we are discussing here).

Medications are a quick fix.

Some medications are only indicated for short-term use and all but do away with presenting symptoms when they are taken (e.g., panic).  However, medications do not change the environmental and personal factors that interact with your overall well-being, so those areas must be addressed for holistic improvement.  However, sometimes meds can help to get a person to a better spot as a co-treatment so other areas of life can also be improved.  Therefore, involving medications, personal work and change, spiritual growth, environmental adaptations, and so forth, a person will usually secure a greater likelihood of improvement.

I’ll have to take medication forever. 

Many medications are meant to be taken only for a time.  However, just like with other medical treatments, some clients will find that maintenance on medication really is the best approach.  This is usually only recommended when the cost of not taking the medication consistently is too high or risky because of the condition or problem being faced.

If certain prescriptions work for my friend, they’ll work for me. 

CONVERSELY: If prescriptions didn’t work for my friend, they won’t work for me. 

Each person is incredibly unique.  Whether through diet or exercise or blood pressure, people have to have different approaches and combinations to make their health the best.  Patience in the process is called for.

Caveats and Disclaimer:

Some of my readers are inevitably asking, “What about the wholesale problems with Big Pharma?”  “What about all the abuses with medications?”  That is another topic for another day; I do not deny there are some MAJOR issues and concerns to be addressed related to greed, regulations, and abuses.  But consider this article as a thought-provoker and encourager in the realm of appropriately administered and utilized psychiatric medications.

I am not an MD, nor do I give medical advice.  I offer feedback based on counseling experience and research.  Medical questions are to be handled by a medical provider.

Thanks for reading!

Yours truly,

Justin K. Hughes

Sex Sells (And How I Survived The Ebola Scare Of Dallas)

doctorWhile purchasing my Kung Pao Chicken with steamed rice yesterday, the young lady at the counter put on gloves to handle money (she normally doesn’t).  Though I always appreciate an extra measure of hygiene, she stated she was nervous about Ebola.  This week, the nation discovered that the first U.S. case of naturally occurring Ebola showed up in a patient at a hospital in Dallas.  Panic for some has ensued concerning Ebola- much more than other riskier conditions.  But why?

Let’s look at the numbers.  Tens of thousands of people die every flu-season from influenza in the U.S.  This number has peaked at 49,000 people per year, according to the CDC.  0 have died in the US from Ebola so far (as of October 3rd, 2014).  Zero.  Just over 3,300 people have died from Ebola- over the span of 50 years!  Don’t get me wrong, Ebola poses a significant threat and is not the same as the flu, but does it deserve some of the extreme responses it’s getting?  Is it reasonable for parts of Dallas to become a zoo?  Unfortunately, some media outlets are using fear to make a buck.  And people all over social media are blowing up posts of doom and gloom.  We all know the saying, “Sex Sells.”  But what does that have to do with Ebola?  A lot, I assure you.

I work regularly with disorders such as Panic, PTSD, OCD, Addiction, and Phobias.  The reasons a person experiences these problems is multi-faceted.  However, one of the commonalities of each is that they are “disorders of the limbic system.”

Neuroscience has offered some great insights into brain functioning in recent years.  Our Limbic System is a section of the lower rear brain where much of our protective instincts, sexual drive, and hunger drive is thought to originate.  This is different from the Prefrontal Cortex, which is where our “executive” functioning comes in- using self-control, deciding how to approach situations- rational thought.  Of course both are important (these are simplistic definitions).  If something triggers our fight/flight/freeze response, it is mostly originating in the limbic system.  These responses can help us gear-up for survival and protection (think: Bear Grylls).  Many problems that occur in life are ones born out of managing our limbic system: fear, anger, difficulty controlling desires, and an inability to regulate emotions.

A case in point, with panic disorder, a client will feel overwhelming physical and/or mental duress, and their anxiety will shoot through the roof for a short period of time- all in the absence of a threat to their immediate well-being.  In counseling, my job is to help clients find hope and experience freedom in the midst of this.  And this goes contrary to being controlled by the limbic system.

Back to Ebola.  How do we handle a threat such as this?  We face it for what it is.  One of the most important things in mental health is to tell ourselves the truth.  If we face reality for what it is- good, bad, and ugly- we will respond soberly.  And this gives us a better ability to confront threats for what they are: to make smart decisions about health and contamination, research options available and new possibilities, accept what can’t be changed, and find peace in the midst of suffering.  Then we can evaluate what is or is not a threat- realistically.  This is a powerful counter for limbic system disorders.

But wait, that doesn’t sell.  It doesn’t grab people’s attention.  To stay rational and at peace, we usually have to go counter-cultural to messages around us.  Many people get rich every day playing off of people’s limbic system reactions (remember, sex sells).  If we can market to the brain’s “pleasure center,” people will crave more.  If we can rouse fear, attention will be won.  If we can play off of a sense of not being good enough without the newest gadget, any product can be sold.

Messages swirl around us at all times, including mixed messages about Ebola.  How will you handle it?  How will you respond?  Sex sells.  Fear sells.  But you get to choose what you buy.

Yours Truly,

Justin

Ways to Be Miserable In Your Marriage

No relationship is the same.  People are extremely complex- a marriage multiplies that intricacy.  How can a marriage work?  Amazingly, we really know a lot about what makes marriages function on all cylinders.  But there is a gap between knowing and doing, and this is in large part what I work with in counseling.

Instead of recreating the wheel, I am reproducing word-for-word here the “Ten Commandments for a Miserable Marriage.”  With wit, wisdom, and brevity, Harville and Helen LaKelly Hendrix offer a tongue-in-cheek way to keep a marriage strong.  I want to express my thanks to them for the incredible contribution they have made to marriage counseling.

The Ten Commandments for a Miserable Marriage

by Dr. Harville and Helen LaKelly Hendrix

1. Be as critical as you can! All criticism, including constructive
criticism, is an ideal way to keep your partner’s
defences on high alert. Being judgmental will ensure that
you don’t get what you really want from your partner.
And disparaging words when angry or frustrated will
stimulate their fight or flight response. If you ritually
play the “blame and shame game,” your marriage will be
safe from the anxiety of being happy.

2. Expect your partner to be just like you. You and your
partner should have the same needs, wants, likes, and
dislikes. You should have the same perceptions, feelings,
and experiences. When your partner wants something
different from you, be swift to show them how being like
you is the only way to be. Absolute compatibility is the
key to a boring marriage, and insisting on it will bring
you unbearable despair.

3. Avoid intimacy as much as possible by engaging in
exits. Engage in activities that help you escape from the
day-to-day intimacy of your relationship. Engage in any
activity, thought, or feeling that decreases or avoids
emotional or physical involvement with your partner.
Increase functional exits (car-pooling, work, taking care
of kids), motivated behaviors (watching TV, reading,
sports, hobbies), and/or catastrophic actions (emotional
or physical affairs, addictions, threats of divorce). This
will help magnify the distance between you and your
partner.

4. When upset, use “You” language as much as possible.
Avoid saying “I feel” and express instead what your partner
is doing that frustrates you. Engage in language such
as, “You always…” and “You never…” to insure that your
partner remains defensive and reciprocates with rolling
eyes, deep sighs, and reciprocal speech. Remember: your
goal is to keep the power struggle active and your intimacy
level comfortably low!

5. Give conditionally and receive cautiously. Bargaining
is the process to ensure minimal growth in your relationship
and keeping score will help maximize your
frustration level. Make sure you only do things for your
partner if s/he will promise to give in exchange. But be
wary when your partner comes through with a gift—
follow the string and see where it leads. Cut the string if
necessary and refuse the gift.

6. Be unintentional about romance. Inevitably, the joy
that came easy in your romantic days disappears. At all
costs, don’t try to make sense of this since you risk moving
through the stage to a deeper experience of love.
Avoid committing to fun activities on a regular basis and
embrace the emptiness as proof you are probably married
to the wrong person.

7. Amplify the negative in your relationship. When you
are away from your partner, think about how s/he has
changed (for the worse) since you first met. Focus on
what is going wrong in your relationship and all the
things your partner is not doing for you. It’s not only the
words you use, but your thoughts, tones and actions that
will help keep you despondent. Live by the motto:
“Negativity breeds contempt.”

8. Avoid learning new communication skills. Basically,
keep doing what you are doing and engage in a one-way
monologue. Talk to your partner as if all s/he has to do is
to listen to you. Make no attempt to listen to your partner.
That will make your partner feel invisible and maintain
the set point of misery you need to regulate your
anxiety about closeness. Insist that the two of you are
ONE and that you are the ONE. There just isn’t room for
two in a dismal marriage.

9. Be sure not tell your partner what you need or want.
After all, s/he should know by now. Never, ever, tell your
partner what you really need or want. Do not drop hints
about things that truly touch your heart. Saying what
you need could tempt your partner to give you what you
actually asked for and then you will have to reject their
offering because you had to tell them. By deflecting as
much love as possible, you can maintain your narrative
of deprivation. Re-read #5 as a review.

10. Expect your relationship to be a fairytale romance.
Live in the illusion that romantic attraction should be
forever. Once the illusion breaks down and your partner
is no longer spiking your highs, demand s/he return to
your dream (and ignore their reciprocal requests). When
s/he fails miserably in sacrificing her/his authentic self
for your insatiable longings, you will realize the dream
has become a nightmare. Congratulations! You have
reached your destination.

 

P.S. For Ten Commandments to a Happy Marriage,
reverse all of the above.