Abuse is any behavior that is used to control or quash another human being with fear, humiliation, manipulation, intimidation, guilt, criticism etc. Emotional abuse employs verbal and psychological tactics rather than physical ones. Sometimes it can be blatant while other times it can be quite subtle and hard to detect. Chronic devaluing and shaming gradually tugs away at the victim’s psyche leaving long-lasting, sometimes lifelong scars. The abused feels worthless and deserving of this torment. Usually the victim’s greatest fears are being lonely and unloved.

At sixteen years of age, Jenny did not understand why her father called her a “whore”, “slut”, and “tramp.” Her virginity was intact. Sometimes she flirted with boys like the other girls, but never did anything beyond kissing them. She wondered if sleeping with a boy would make her a bad person.

Her father also exhibited dramatic mood swings that left Jenny terrorized and uncertain about what would happen next. He sometimes displayed great affection towards her, but at other times, became enraged and rejected her.  Jenny’s frustration over her father’s name-calling and mood swings grew over time. She felt violated, yet was afraid to speak back to him and communicate her insecurity. Jenny hated herself for not standing up to him. Her mother also feared the father’s abuse and neglected to defend her daughter. Jenny a once bouncy, effervescent little girl, began feeling hopeless and expressed learned helplessness in her teenage years. She was losing her life force. Over time she developed an eating disorder, which became her cry for help.

Some common forms of emotional abuse:

• neglect
• rejection
• isolation
• demands/criticism
• being ignored
• threatened
• domination
• verbal assaults
• unpredictable behaviors

Because emotional abuse can so easily occur behind closed doors, it is often difficult to identify. If children are consistently exposed to emotional abuse at home, they may think the behavior is normal. An emotionally abused child has not necessarily witnessed the way a healthy home environment operates.

Some signs and symptoms of emotional abuse with children and adults:

• anxiety
• difficulty with intimate relationships
• constantly seeking approval and affirmation
• feeling different from others
• judging themselves harshly
• lying without apparent reason
• depression
• low self-esteem
• guilty feelings
• isolation
• sense of shame
• feeling unlovable
• mood shifts
• substance abuse
• self-abuse
• extreme neediness
• suicidal ideation or attempts

The cycle of emotional abuse: tension and anger increases, there is some explosive incident, followed by a reconciliation and finally a period of calm.

How do you think someone you care about can break the cycle of abuse?

Please stay tuned for Part 3 about some ways to break the cycle of abuse.

Maggie, a single thirty-six year old teacher, began each school year feeling energized and optimistic. Once daylight savings time arrived, her mood spiraled downward. Invariably in the weeks following the winter break Maggie’s energy dragged. It became harder for her to get out of bed in the morning and her enthusiasm for work subsided.

Maggie told me she hibernated in the winter. By each February her level of fatigue felt deep and relentless. Her social life suffered to the point that she did not attend social activities because getting together with friends required too much effort. She essentially isolated herself during the darkest months yet felt deep pangs of loneliness.

After work, Maggie routinely flopped on the couch, turned on the tube, ate crackers or another starchy food, and then usually ended up sleeping for several hours. Most days she managed to get herself off the couch and into bed, sleeping until the next morning, when the cycle repeated.

Seasonal Affective Disorder

All the signs pointed to Maggie suffering from seasonal affective disorder (SAD), which is a form of depression that occurs and reoccurs along with shorter periods of daylight during the fall and winter. SAD is a biochemical imbalance triggered by the brain’s response to diminished exposure to natural daylight.

It is believed sunlight might play an important role in the brain’s production of melatonin and serotonin, which help regulate sleep, mood and energy levels. Most SAD sufferers are women and the age of onset is usually between 18-30. The severity of SAD depends on a person’s particular sensitivities combined with their geographical location.

SAD Symptoms

Symptoms include feelings of hopelessness, fatigue, anxiety, social isolation, irritability, oversleep, loss of interest in activities usually found to be pleasurable, weight fluctuations, carbohydrate cravings and difficulty concentrating and processing information. These symptoms can be mild or can run serious interference in one’s sense of well-being. In the most extreme cases SAD can be associated with suicidal ideation.

Treatment for SAD

Regular exposure to natural light is one of the best ways to treat SAD. I suggested to Maggie that whenever the sun is shining to make a point of getting outside and walking. When driving in the car crank up the heat if necessary and open the sunroof. Whatever natural sunlight can be had on any particular day will help.

There are also ‘light boxes’ that provide phototherapy or light therapy. These light boxes can be bought on-line and are about 25 times stronger than the typical light found at home. The problem for most people is that they need to sit under these light boxes for about 30-90 minutes daily and compliance to follow through with this regimen is often a challenge.

Of course relocating to a part of the country that is sunnier could also help considerably, but this is not always a viable option. Vacationing someplace sunny helps, but once returning home the symptoms quickly return and sometimes with a vengeance.

Anti-depression medication is also used to help alleviate this debilitating form of depression. However, it is important to keep in mind that medication alone is not considered to be a complete treatment modality for SAD. When one is taking anti-depression medication it is always best to combine this treatment with a ‘talking therapy.’

Maggie Manages Her SAD

Maggie came to therapy to talk about her feelings and managing her stress level more productively. She also took a low dosage of medication. Motivating herself to come to therapy once a week was helpful in a number of ways – connecting instead of isolating herself and not succumbing to her couch habit at least one day a week.

After a few weeks of working together Maggie also agreed to institute a walking program on the sunnier days. Taking her outdoor activity to another level, I instructed her on mindful walking. She also kept a gym bag packed in her car so she had the option of exercising after work. Maggie immediately felt that short walks in the sun positively affected her mood and energy level, as did her workouts.

Maggie is now armed with some strategies for managing this disorder. She understands the cyclical nature of SAD and can prepare for the next round well in advance. Maggie also makes sure to connect with others now whether she is in the mood or not, for invariably her friendships buoy her sense of control, balance and happiness.

Have you noticed your moods changing with the seasons and what have done to help yourself feel better?

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How do you let go of the hurt that another person has inflicted on you?

Robin grew up with an older brother that sexually abused her for years, when their parents were sleeping or not home for the evening. Erik, 15 at the time of the first episode, was left to care for his 12 year old sister. He warned her that he would call her a liar or worse if she ever told. For almost three years, until Erik left home, Robin endured his abuse. No one ever found out until she came to therapy.

Almost three months into our work together Robin hinted about something terrible that happened to her as a teenager. She began to trust our relationship and finally one day shared this painful story. Robin told me she had kept this secret for almost 20 years and felt like it was running interference with having a healthy relationship with men.

Robin desperately needed to tell her story and learn some tools for dealing with these complicated feelings. She had difficulty sleeping and sometimes concentrating, although she performed extremely well at work.

Her story took months to unfold. Along the way I taught her skills in abdominal breathing and meditation to help diminish her anxiety level.

She still saw her brother occasionally over holidays, which was always painful. Her parents never learned the truth. Robin was adamant about never sharing her story with anyone else. She felt too much shame and humiliation and wanted her story to remain private.

Over time we began to talk about forgiveness. Robin insisted she could never forgive her brother for ruining her life.

I explained to her that forgiveness is about letting go of anger, hurt and resentment. When you are deeply injured you can never fully heal until you forgive. “Forgiveness is not about forgetting, reconciling, ignoring an injustice or removing consequences.” I told her.

“Forgiveness is not something we do for other people. We do it for ourselves to get well and move on with our lives.”

Some of the benefits of forgiveness include:

• Lowers blood pressure and heart rate
• Reduces stress and chronic pain
• Diminishes anger and feelings of hostility
• Lowers risk of alcohol or substance abuse
• Lessens anxiety and depression symptoms
• Improves relationships
• Heightens sense of well-being
• Improves psychological health

Learning to forgive

We continue to meet weekly. In additions to our conversation, Robin now uses affirmations daily, keeps a gratitude journal and practices exercises for strengthening her capacity to forgive.

One of these forgiveness exercises is the following:

• Pay attention to your anger
• Observe and reflect carefully on the situation
• Keep your thoughts flexible and compassionate
• Practice abdominal breathing when the pain or anger arises
• Choose to forgive – remember this is where the healing occurs
• Commit to forgive and letting go
• Repeat

Robin continued to share her story with me and opened her heart up to the idea of letting go of her long standing anger. She understood she was doing this for herself in order to lead a more balanced and happier life.

What can you do to forgive someone who has hurt you or let you down?

“How do I choose the right therapist for me and get the support I need?” When you or someone you know is hurting inside or needs additional support, there are people and resources that can help. The questions I would like to address here are: how do you find the best mental health assistance during a difficult time? What criteria do you look for in choosing a therapist?

The truth is a good therapist is not necessarily measured by her or his training, degree, license, orientation or official listing. While all of these factors do matter, the ultimate test for who is the best match for you depends primarily on the connection felt during the initial meeting. A good therapist should have trained listening skills, be nonjudgmental, be patient and have an accepting attitude. It is important that you feel a sense of comfort and trust. Your gut reaction is probably the truest barometer for knowing if a fit with a particular therapist is a good one.

A recommendation from someone trusted who knows you is the best way to go, and, even better if that person is a professional in the medical or mental health field. The next step is deciding what type of therapy you wish to engage in. There are varied approaches such as – cognitive, behavioral, psychoanalytic and Gestalt. I encourage setting up the initial appointment on the phone rather than by email, since even a brief conversation provides important information.

Asking the therapist what type of therapy they practice is a good and fair question. They might offer one or a combination of methodologies. After you have gleaned the insight you need ask yourself, “Do I feel that this person can help me?”

Another factor to consider, of course, is your insurance coverage. Most insurance companies today require that you work with a therapist within their own network. The therapist working with insurance companies generally have a contractual agreement with that particular company and agree to a substantially reduced rate.

More established therapists are often unwilling to participate in these insurance networks because they can generally charge more. That said, there are still good therapists within the networks, but you may need to do more research. This means asking your insurance company for a list of mental health providers in your area and interviewing those available until you make a good connection. Ultimately you need to be your own advocate for finding the best practitioner for you. You might even need to stand up to the insurance company if there is a particular therapist outside of its network that is a good match for you. Sometimes the insurance companies will make exceptions and give you coverage if you have a good rationale for needing to see a certain therapist.

The Internet can also serve as a resource and streamline your search for a therapist. You can learn much about a therapist this way, but again ultimately it is how you feel with this person that should be the deciding factor. Some directories include:

1. About.com’s UCompare HealthCare
2. 4therapy.com
3. findatherapistnow.com
4. find-a-therapist.com
5. PsychologyToday.com
6. Psychology.com

In the case of an emergency it is best to call 911 or go to your nearest hospital emergency room. Your health and safety always come first. The ER is the fastest way to obtain immediate attention when necessary. Ideally you don’t want to wait until there is a crisis to schedule an appointment with a therapist. It is best to connect with someone before one’s emotional world is so compromised.

After you have successfully done the work needed to feel better, my recommendation is that you keep your therapist on board as a resource. It is always good to know that you have a support system in place when and if the time arises again. I think of a therapist as one would a good physician – you go for treatment as needed throughout the life cycle.

Who do you turn to in times of emotional need?