Dry January… and Beyond?

Did you participate in Dry January? For those that are not familiar, Dry January is choosing not to drink alcohol during the month of January. This has been primarily practiced in the UK, but has gained traction in the US in recent years. The idea behind Dry January is to help your body “reset” after the indulgences of the holidays and to kick start a New Years commitment to health. Whether you participated, continued with your usual habits, or have never heard of it, everyone can benefit from taking a look at their drinking habits and relationship with alcohol.

What is “problem” drinking exactly?

I often hear statements like “I don’t drink alone, so I must not have a problem” or “I don’t drink in the morning, so I am certainly not an alcoholic.” However, problem drinking is more complex and multifaceted than that. Rather than solely focusing on how often and how much you drink, we instead identify the ways in which alcohol may be having a negative impact on your life.

Some questions you can ask yourself to determine if drinking may be a problem for you are:

  • When I drink, do I have more drinks than I planned to? Am I drinking more often than I want to?
  • Have I tried to cut down but haven’t been able to?
  • Am I spending a lot of time drinking, or a lot of time recovering from a hangover?
  • Am I having cravings or urges to drink?
  • Am I neglecting responsibilities at work, home, or school because of drinking?
  • Is drinking contributing to problems in my relationships?
  • Have I given up hobbies, interests, or friendships because of drinking?
  • Have I put myself in dangerous situations when I’m drinking (i.e., driving a car).
  • Do I have physical health problems that are made worse by drinking?
  • Does drinking alcohol negatively impact my mood, anxiety, or other aspects of my mental health?

If you answered yes to 2 or more of these questions, you may want to consider changing your drinking habits. However, change does not necessarily have to mean never drinking again or attending AA meetings (though both are great choices for many!). Below I will discuss some other options.

Sampling Sobriety

This is essentially what Dry January is. Committing to a set amount of time alcohol free (e.g., 2 days per week, 1 week, 1 month), gives you the opportunity to directly experience what life is like without alcohol in it. For those wanting to sample sobriety, I encourage them to track their mood, sleep, and other changes they notice, so that after the sampling period is over they can make an informed decision about their drinking going forward. What if you try to sample sobriety and aren’t able to do it? That may be a sign drinking is a problem for you and it is time to reach out for help.

Harm Reduction

The harm reduction approach involves changing your drinking habits so that they have less of a negative impact on your life. This can be accomplished in a number of different ways, but it almost always involves reducing how much and/or how often you drink. Two strategies that help with this are measuring and counting drinks – often times what you think is 1 drink is more like 2 or 3 because of the quantity of liquor in it or the size of the pour. Also, it is important to make a conscious effort to cultivate activities and hobbies that do not center around drinking. Commit to a morning run when you otherwise may have stayed in bed, meet friends for coffee rather than drinks, or take that hike you haven’t made time for yet because an afternoon at the brewery has sounded more appealing.

If after reading this you are questioning your drinking habits, psychotherapy can provide you a space to explore the pros and cons of change. And, if you decide to move forward with reducing or stopping drinking, it can offer you the support, accountability, and tools to increase your likelihood of success. If you live in the Austin area, I would love to speak with you about your situation and see if I may be able to help. I can be reached by email at laura@drlaurawahlstrom.com or by phone at 512-521-1531.

New Year, New Me

Happy New Year! Around Thanksgiving, I wrote a blog about how the holidays are difficult for many people. However, most folks I work with tend to feel increasingly optimistic as the calendar rolls over to a new year. Even though there is nothing objectively different between December 31 and January 1, the new year represents a fresh start. Many people also identify areas they want to change and things they want to accomplish, aka “resolutions.”

If you want to change something in your life, not having goals is like setting out on a road trip without a map (or smartphone!). It’s a lot of aimless driving, confusion, frustration, and ultimately not ending up where you want to. When I have used this analogy in the past, some folks have told me “that sounds really fun!” However, the analogy is meant to illustrate that without goals, we are less likely to succeed at making positive changes and moving toward living the life we want to live.

Have you ever heard of SMART goals? SMART is an acronym (more on that in a minute) that outlines criteria for setting effective goals. Adhering to these criteria when setting your goals ensures that you are clear on what you want to achieve, when you will accomplish it by, and how you will make it happen. In other words, it sets you up for a greater likelihood of success! So, let’s walk through what each of the letters stands for and look at an example:

Specific

Your goal should be simple and clearly define what you want to do.

Measurable

Your goal should be able to be objectively measured, so it is crystal clear if you accomplished it or not.

Achievable

Your goal should be a stretch, but not so challenging that it is not realistic to accomplish.

Relevant

Your goal should be related to what you actually want to accomplish.

Time-bound

Set a date by when you will accomplish your goal. Be as specific as possible.

Example: Let’s say you want to get healthier. Health is something that is aspirational in nature (i.e., there is no definitive way to know we have accomplished it, but instead we continue to work toward), but you will likely set several SMART goals to help you achieve better health. One goal may be to lose weight. If we set our goal for that consistent with SMART criteria, we would say “I want to lose 15 pounds by June 1.” Or, another goal may be to get better sleep. A SMART goal would be “I am going to meditate using Headspace for 15 minutes each night before bed.”

Here are some other tips for successful goal setting and achieving those goals:

Consider setting “mini goals.”

If you want to quit smoking, maybe your goal is to completely quit by August. In addition to that “end” goal, each month you set a “mini” goal to reduce the number of cigarettes you have per day by 2. This provides you with more frequent, tangible evidence of your progress, and reinforces your efforts!

Don’t set too many goals.

You may be entering the new year with lots of things you want to change. And, that’s great! However, trying to change too much sets you up for failure (again, the A in SMART is for achievable!). You’re much more likely to succeed if you pick 1 or 2 things you want to accomplish, and also use my previous tip to set mini goals along the way.

Be kind to yourself.

Change is hard. Really hard. And, most of the time when we are working toward something, we experience setbacks. It is easy when these setbacks happen to start to believe we are back at square one, so continue to remind yourself that they are normal and part of the process. Something that helps with this is to journal or write down your progress as you go so you can review it when this happens.

Enlist help.

As I said above, change is hard. And, with anything that is hard, support helps. See if a friend or family member wants to make the change with you. Or, if they have another goal, you can check in with each other on how it is going. Technology is also a great resource – there is an app for just about anything these days. Lastly, consider finding a therapist to help you with the process.

If you are in the Austin area and would benefit from extra support in identifying and sticking with goals for 2019 (and beyond!), I’d love to talk with you and see if I am a good fit. Please contact me at laura@drlaurawahlstrom.com or 512-521-1531.

Common Misconceptions of Cognitive-Behavioral Therapy

In this previous post I provided an overview of cognitive-behavioral therapy (CBT), a therapeutic approach based on the idea that our thoughts (i.e., running commentary in our heads), feelings (i.e., emotions), and behaviors (i.e., things we “do”) are all related to and influence each other. To follow up, I thought it would be useful to address some of the common misconceptions people have about CBT. Given how popular it is, there is plenty of information about CBT on the web, not all of it good or accurate.

CBT teaches you to think positively.

Because CBT theory emphasizes the interaction of thoughts and emotions, a major component of therapy is challenging unhelpful patterns of thinking (i.e., cognitive distortions), such as all-or-nothing thinking (“My girlfriend recently broke up with me, I’ll never find anyone to love me”) or catastrophizing (“Since I got a bad grade on this test, I’ll likely fail this class and won’t graduate”). Because the vast majority of these distortions are negative, many people assume that one goal of CBT is to replace negative thoughts with positive thoughts. However, that is not quite correct. The key is the word “distortion” – the goal of therapy is to challenge thoughts that are not rational, helpful, or based on evidence, and replace them with more adaptive thinking. See this video from the Beck Institute for a great explanation of this issue.

CBT is rigid and manual-based.

A common misconception of CBT is that it is a rigid, one-size-fits-all therapy based on manuals. I believe this belief is popular because there are a variety of CBT manuals for therapists attempting to learn the technique and for use in clinical trials evaluating the effectiveness of the therapy. However, well-trained therapists are skilled in tailoring the approach to the needs of individual clients, and most will also incorporate techniques from other therapy approaches as needed (see my example below of how to use motivational interviewing and CBT together!).

CBT only works with motivated clients.

Because it often includes exercises (homework!) done outside the therapy session, it’s commonly assumed that CBT is only effective with very motivated clients. There are a few reasons why this is not true. First, any therapist, regardless of their orientation, should be trained in how to engage clients through the careful use of language, matching their interpersonal style to that of the client, or by leveraging the rapport built in the therapeutic relationship.

Second, many therapists are trained in a range of therapeutic approaches and can combine approaches as necessary to meet the needs of their client. One approach I’ve found effective is blending techniques from Motivational Interviewing with CBT. It’s a relatively common approach (common enough for an entire book to be written about it!). The thing I like most about motivational interviewing is that it is a “meet your client where they are at” approach that is supportive, gentle, and non-judgmental.

Lastly, one nice feature of CBT is the notion that the therapist and client work on small, approachable goals throughout therapy. A client is not asked to take on more than feels manageable or reasonable, and they get to quickly see tangible results of their efforts. This is reinforcing and often strengthens motivation.

CBT is only supported for use with anxiety and depression.

Cognitive behavioral therapy was developed by Dr. Aaron Beck, who originally applied his theory to the treatment of depression. Since then, it has also become recognized as the gold standard for the treatment of anxiety. However, CBT is recognized as an effective therapy for a wide range of psychological disorders including schizophrenia, ADHD, and eating disorders. See this analysis by the American Psychological Association evaluating the evidence supporting the use of CBT for a variety of disorders.

I hope that you have found this blog post helpful today. If you are in the Austin area and contemplating starting psychotherapy, I am happy to speak with you on the phone to answer any questions you may have, including those about CBT. Please reach out to me at laura@drlaurawahlstrom.com or 512-521-1531.

The Importance of the Therapeutic Relationship

As humans, we not only desire relationships with others, but need them. Research indicates that social support increases our odds of survival by 50%. So, if we need supportive relationships to survive, it makes sense that we also need a strong relationship with our therapist for treatment to be effective. My blog post today will focus on aspects of the client-therapist relationship that contribute to better outcomes in psychotherapy.

The therapist-client relationship (often referred to as “therapeutic alliance”) has been studied extensively, with data indicating it is a consistent predictor of therapy outcomes. Individuals who have a strong relationship with their therapist are more likely to comply with therapy, experience greater symptom relief, and report a greater satisfaction with the therapy process.

What are some of the therapist characteristics that promote a strong therapeutic alliance?

  • A collaborative approach to therapy, as opposed to an authoritative or direct approach.
  • An ongoing communication of hope regarding the outcomes of therapy.
  • A warm, genuine, and friendly demeanor.
  • Objectivity and honesty (even if sometimes you don’t like it!).
  • The use of plain, straightforward language as opposed to jargon.
  • A flexible treatment plan.

Not all of these qualities are immediately evident when first meeting someone, so what should you be looking for when deciding on a therapist? First, you should look for a therapist who specialize in approaches that fit with your personality and preferences (e.g., does a cognitive-based approach resonate with you, or do you feel a humanistic approach is more your style?). Second, take some time to talk with a potential therapist and ask questions before scheduling a session. While relationships take time to develop, research also suggests our initial impressions of kindness, trust, and compassion are pretty accurate. Don’t be afraid to trust your gut!

Given the importance of the therapeutic relationship, I offer a free 15-minute phone consultation prior to scheduling my first session with any Austin-area client. This gives us an opportunity to learn more about each other, and you a chance to decide if I seem like a good fit for you. If we determine that we aren’t a good fit to work together, I’m always more than happy to help you find someone else in the area better aligned to your personality and therapy goals.

Please reach out to me at 512-521-1531 or laura@drlaurawahlstrom.com if you would like to discuss your situation and see if I may be able to help you!

What IS a Psychologist?

Finding and reaching out for help can be overwhelming. You may already be struggling with low energy, little motivation, and difficulties making decisions, which makes that process feel like you are embarking on a drive from South Austin to Round Rock, on I-35, during rush hour. Then, once you start looking for help, how do you figure out what type of mental health provider to reach out to? My blog post today will explain the education and qualifications required to be deemed a ‘psychologist,’ and the specific ways in which a psychologist’s training sets them apart from other types of mental health providers.

A psychologist has a doctoral degree (PsyD or PhD) in either clinical, counseling, or school psychology. Graduate training is typically between 5-7 years, and includes rigorous coursework in a variety of areas of psychology, research (though less of an emphasis for PsyD), training in assessment and treatment of psychological disorders, and completion of a year-long, full-time clinical internship. Following completion of the doctoral degree, post-doctoral supervised experience is required (typically 1-year) prior to becoming licensed to practice independently.

The licensure process differs by state, but Texas requires an individual possess the necessary degree, training, and clinical hours, as well as pass the Examination for Practice in Professional Psychology (EPPP) and a Jurisprudence exam (a test of state laws and rules psychologists must follow). They also previously required an oral exam, but did away with this requirement in 2017. After licensure, psychologists are required to complete a certain number of continuing education hours each year to help them stay current on issues related to treatment, ethics, and cultural diversity in the field.

Does this sound like a long process? Well, that’s because it is! While the type and quality of training a psychologist receives can vary greatly, there are a few things that you can expect when working with a psychologist.

First, the primary thing that sets a psychologist apart from other types of mental health practitioners is training in assessment. This includes intelligence, cognitive, and personality testing, that is often used along with a clinical interview and self-report measures to establish diagnoses and make recommendations.

Second, psychologists are trained to diagnose psychiatric disorders. During graduate school, they take courses on the diagnostic criteria and interviewing skills. These areas are then put into practice during their practicum, where they see clients under the supervision of a licensed psychologist.

Lastly, psychologists are trained in psychotherapy. This includes ways to connect with clients and develop a strong relationship, as well as specific treatment approaches for different problems.

I’ve provided a link below that further explains the different types of mental health professionals. If the type of training a psychologist has sounds like a good fit for your needs and you live in the Austin area, please give me a call at 512-521-1531 or email me at laura@drlaurawahlstrom.com to discuss your situation and see if I may be able to help you.

Types of Mental Health Professionals