Signs of Depression in Adults

PLEASE NOTE: this list is NOT intended to diagnose or treat you. See a licensed mental health provider or medical professional for proper diagnosis and treatment.

Most people get “the blues” sometimes that last a day or two. However, Major Depressive Disorder is a SERIOUS and often FATAL illness that occurs in approximately 6.7 percent of US adults. Medications can be helpful, but come with side effects that many people cannot tolerate. Medications will NOT cure the mistaken belief system causing the depression.

Without talk therapy to both uncover the root cause of the depression and learn ways to manage it, depression can persist despite medication. Cognitive Behavioral Therapy, or CBT, can help you uncover the beliefs you carry about life without even knowing it. These beliefs often contribute to depression below your level of awareness. Once uncovered, I can help you face and refute the irrational thoughts and replace them with healthy, logical thoughts.

If you are experiencing any of these symptoms on a frequent or daily basis, please contact me for a full professional evaluation:

  1. sadness
  2. pessimism
  3. feeling like a failure
  4. loss of pleasure
  5. guilty feelings
  6. punishment feelings
  7. self-dislike
  8. self-criticalness
  9. suicidal thoughts or a sense of, It would be better if I  weren’t here*
  10. crying, or unable to cry anymore
  11. feeling agitated
  12. no interest
  13. hard to decide things
  14. feeling worthless
  15. no energy
  16. sleep issues
  17. irritable
  18. appetite changes, up or down
  19. can’t concentrate
  20. fatigue
  21. no sexual interest

(Adapted from the Beck Depression Inventory)

Taking that step to call me for an appointment is hard, but can be the best decision you ever make.


Say What You Need to Say: Healthy Communication Tips

Even if your hands are shaking

And your faith is broken

Even if your eyes are closing

Say it with your heart wide open

Say what you need to say.

 (John Mayer)

“Finding your voice” is a wonderful benefit of therapy, as you learn here that you have both a RIGHT to ask for what you want and the WAY to state your needs respectfully.

Some basic tips when you are “saying what you need to say:”

  1. Use “I Need” instead of “you should.”

 It is not OK for you to tell other people how to live their lives. “Saying what you need to say” is NOT a license to judge, criticize or otherwise counsel others!

 It IS OK to require them to treat you with respect, but you must first ask respectfully. This means not yelling your message at them. Not using sarcasm or anger. It means speaking up firmly and courteously about what you will or will not tolerate.

  1. Speak honestly, clearly and directly—don’t hint, manipulate or guilt-trip others.

We get in trouble when we expect others to “just know” or read our minds. This is a common pitfall when dealing with the opposite sex. Women, most guys don’t get all the hints and signals that your girlfriends do. It’s not a sign of any lack of love. “Say what you need to say” without playing games.

3.  After you say what you need to say, take responsibility for what comes next.

You have choices here. Maybe you’ll get what you’ve asked for, maybe you won’t. The next step is to decide what is required in order for you to stay in the relationship or on the job. Do you need to require marital counseling? Do you need a different job where you are respected? Do you need a time apart? Do you need to hire help to get things accomplished which are being neglected?

Then, do what you need to do.

Say what you need to say.

And let me know if I can help in that process.

Simple Ways to De-Stress

It contributes to illness. It’s the major factor in back pain. In fact, it makes ANY pain worse. And it’s not always caused by bad things-it can be related to celebrations, new jobs, holidays, new babies, and many other things we would never wish away.

Yes, I’m talking about stress, or as defined by Webster’s, “a strain or pressure on the body or mind.” It’s almost always presented as a reason people finally get professional help for life issues, and I diagnose and treat it daily.

The body and mind perceive any change as potential danger, and they react with heightened awareness, muscle tension, and increased cortisol production (cortisol is that nasty hormone that can increase blood pressure and blood sugar, and suppress immune response). It is essential to our overall health to learn to reduce stress responses in our body and mind. The following are some ways to do so:


Under constant stress, our breathing becomes shallow and strained. A simple exercise is to sit back in your chair for a minute or two, close your eyes, and just focus on your breath. Breathe in deeply through your nose to the count of four, using the ticking of a clock if you have one. Hold your breath for four counts, and then SLOWLY let the air out for six beats. This deliberate focus and attention will both calm and distract your mind temporarily.

Guided Imagery

This is an article all by itself, but basically guided imagery involves taking time to mentally “visit” your favorite relaxing memory-be it the beach, the woods, whatever brings a smile to your face- and mentally placing yourself there using all five senses. This also works with visualizing a beloved child’s face or your pet. A few minutes of visualization a day can actually increase immune response and is simple to do.

Tense/Relax (Progressive Muscle Relaxation)

Starting at the top of your head, tense and relax the muscles of your face, neck, hands, shoulders, etc, all the way to your toes. Hold the tension to a count of four, and then let it go, moving on to the next muscle group. This puts a focus on muscles that may have been tight without your awareness.


The benefit of scribbling down thoughts and feelings is well researched. You don’t need to watch spelling, grammar or anything else, as no one will see it. You don’t even have to “keep” a journal-just the act of writing in itself is beneficial, even if you shred it immediately after! Try completing these sentences to start:

It really bugged me today when….

If I could wave a magic wand I would change…

Then just keep writing without thought or censure.

Doing Nothing

A totally foreign concept to our goal oriented society, isn’t it? But sitting completely still in silence for a few minutes a day is a wonderful way to de-stress. As we let the mind daydream, rest and wander, we often find new solutions to our stressors. This concept is summarized by the beautiful quote: “Sitting quietly, doing nothing, spring comes, and the grass grows by itself” (Zen saying).

If these simple measures don’t ease your stress symptoms, the next step is to seek help from a licensed therapist who can help you resolve underlying issues contributing to the problem. Best of all, these simple steps to de-stress can’t hurt!

Untreated depression is indeed dangerous

Depression wreaks havoc on the entire body by throwing the stress response system out of whack. The risk of heart disease, osteoporosis, diabetes and cancer are all raised as normal immune function is disturbed by anxiety, stress and /or depression. Difficult relationships, parenting and work issues all contribute to this situation.

This post contains my  “prescription” for becoming (and staying) healthy. Basically, here’s what we should all be doing for a healthy, happy lifestyle:

  • Get a yearly physical exam.  Depression and anxiety can be related to thyroid and other issues
  • Exercise: it relieves stress, raises endorphin levels. It’s even better if you get outside in natural light to exercise!
  • Journaling: research shows it increases hopefulness,releases stress, and calms the brain.
  • Regular Sleep: essential to mood stability and a healthy immune system.
  • A good social or family support system increases longevity and raises immune system function
  • Professional Therapy: coming for a session BEFORE symptoms are out of hand with regular checkups

Now maybe you are thinking, well, if I could MAKE myself do all of these things, I’d be fine! What you may not realize is that a mental health provider is trained, licensed and qualified to be a resource to help you do these things. A therapist can be your encourager, your supporter, and your guide in prioritizing and planning your best, healthiest life.

Therapy helps uncover the roadblocks to your success that exist outside of your awareness. These roadblocks include childhood messages, both told to you and modeled by your parents, and negative experiences that impact your habits to this day. Together we can gently uncover and examine these self-defeating beliefs without shame or judgment. When “the truth sets you free,” you are then able to move forward and possibly see new levels of well being.

What Therapy Stage Are You In?


Virtually all counseling clients start at this level. You are in crisis, at a low point, depressed or anxious. My focus here is an immediate and practical prescription for helping you regain hope and basic functioning. This most often includes health issues such as exercise and rest, as well as releasing pain out of the body by relaxation and journaling.


At this stage you move on to the relationships around you as a focus for change. You are ready to see how you help create the painful patterns in your own life, and you go out into the world as a scientist, observing your patterns with others. You begin to see how you contribute to your own problems by the thinking habits you’ve formed.


Too many clients leave therapy at this stage. The pain is eased—why go deeper? The problem with stopping here is that the fundamental issues and reactions have not been changed yet. It’s like stopping an antibiotic on the second day because you feel better—the basic “infection” has not been eradicated, and will resurface in time.


A client who “stays the course” to this stage begins to reap the deeply satisfying rewards of enjoyment and contentment in life. Persistent body aches, migraines, rashes and recurring illnesses often ease or disappear entirely as the client ceases to be at war within and therefore has the energy to heal.


Once the bothersome thinking patterns are uncovered and corrected, the client has found peace in their personal boundaries and dealings with others. The “coaching” side of my work now begins. I help the client explore what they want their legacy to be in life, how to live with integrity regardless of circumstance, and dream for the future by exploring goals.

Ten Signs You May Need Professional Therapy

We all go through challenging times in our lives, but some experiences are worse than others. There is NO problem that can’t be eased—a little or a lot—by seeking professional counseling.

Some problems are like a sore throat—we go to the doctor, get a short round of treatment, and feel better. But others, such as death of a loved one, relationship issues, parenting problems, moving to a new city, living with the after effects of abuse from childhood, dealing with an elderly parent, health or weight issues—are more like a cancer. The problem only grows without professional intervention.

So what are you experiencing?

1) I have low energy, “blahs”

2) Someone in my life puts me down or threatens me

3) I can’t relax

4) I have the same fights over and over

5) People keep disappointing me

6) My sleep is disturbed

7) I can’t keep a job and/or a relationship

8) My temper gets out of hand

9) I wouldn’t mind if I weren’t here anymore

10) I feel guilty all the time

I have extensively studied how to help these and many other issues common to all people. Let’s get started making your life better! We will gently examine the things that are troubling you and I will guide you toward new ways of thinking and dealing with people to lead you toward freedom. Homework is an essential part of this process, as you take the suggestions I give you and try them out between sessions. Are YOU ready to change?

Do I Need Counseling?

Every day millions of people search online for help with their problems, wondering if it’s finally time to reach out for direction and support to handle sadness, depression, anxiety, stress, fights with their partner or spouse, and family issues, among others. Here are some of the questions and mistaken beliefs we encounter as therapists every day.

Can’t I just talk to my friends about my problems?

Talking to a friend about mental health or personal issues may bring you temporary relief, but will make the problem more deep seated in the long run because you become more identified with the issue the longer you complain without intervention. Remember, you get what you pay for, and zero-cost advice is pretty much worth zero!

Nobody can change my situation, so why pay to see a professional about it?

There is a saying that “your world changes when YOU change.”  A professional, licensed therapist is trained in ways to help you respond to your world differently. We have at least two college degrees and extensive supervised training thereafter. There are thinking patterns, usually formed in childhood, of which you are completely unaware. I can show you how you are holding yourself back and perhaps help you find insight and freedom. It’s often a cage of your own making!

I’ve felt this way so long…

If you had a persistent fever, would you just say “oh well” and live with it? Or would you go to a health care specialist who could evaluate, diagnose, and treat it? The average person doesn’t realize how common mood and relationship problems are to the human condition, and that they can be (and are) identified and studied. Whole systems of therapy are developed for common issues, much as drugs are developed for physical ailments.

What will people think?

The people intelligent and mature enough to seek therapy realize that it doesn’t matter what people think! It matters how you live every day of your limited, precious life, and whether you can enjoy that to a higher degree and love more fully. Besides, you would be surprised how many of those “imaginary people” you think are judging you are actually patients themselves.

Is it time for YOU to feel better? It’s time!

Keys for Less Stressful Communication

What might you imagine is one of the biggest stressors that convince people to seek counseling? Is it fear of death, disease, or unemployment?

Actually, it’s a fear of being seen as selfish and therefore, being disapproved of. It’s the conflict between knowing in your deepest self that someone is taking advantage of you, treating you disrespectfully, or otherwise ignoring your needs, and your fear of speaking and acting differently in order to address that person. (NOTE: A physically abusive situation is dangerous and is not intended to be addressed here.)

Sometimes we don’t speak up because we don’t know how to do so in an appropriate way. After all, where do we learn how to communicate, how to be an adult? From watching our parents—and who taught them? The end result is that most people find themselves communicating either passively or aggressively—and neither will bring the desired results. Stress and tension only build in your life when these are used.

The Sighs Say it All…

Passive (also called passive-aggressive) communication is:

  • hinting, sighing
  • glaring, eye rolling
  • sarcasm
  • “forgetting” to do what we say we will do
  • “Swallowing” our words with alcohol, overeating or smoking

We feel we are somehow responsible for the other person’s misbehavior (“what did I do to make them act that way?”) instead of remembering that EACH of us is responsible for our own actions.

Sayings like “if you can’t say anything nice, don’t say anything at all” feed the passive style. A belief that feeling angry is wrong makes many people so frightened of this emotion that they suppress it rather than express it in healthy ways.

Look Out! Here Comes The Unloading…

The aggressive style is often dangerous. This person might:

  • yell or call names
  •  hit or throw things
  •  put you down or threaten to leave you
  •  control your money and activities
  •  check up on you constantly

 They tend to unload their anger at the world directly onto you. If you bring up any frustrations or needs of your own, they quickly launch an offensive attack, telling you that you are “wrong” to feel that way. You are told that “you’re just too sensitive” often enough that you finally begin to believe them and tune out the voice of reason inside you.

The aggressive style is powerful and we often allow aggressive people to get what they want, simply because it seems to take too much energy to “rock the boat”, or we don’t believe we have a right to do so.

Honest and Direct = ASSERTIVE Communication

 So how do we need to communicate to keep the stress levels down in our lives? By stating our needs:

  • In a calm voice
  • Directly and respectfully
  • Using “I need, I want, I would like, I am going to” instead of “YOU should, YOU need to”
  • Repeating ourselves if we are not understood, as necessary
  • Asking for clarification if you don’t understand
  • Physically leaving the room if the communication becomes aggressive or abusive (taking a “time out”), with a promise to try again later
  • Taking deep breaths when we are upset
  • Following up with actions that back up our words

Although the people around you will have to adjust to your new communication style, the end result will be less stress and more respect– both self-respect and from others.

Ways We Avoid Healing

“If I journal, then I have to THINK about my husband having an affair,” stated my client flatly. “Why would I want to do that?”

That may sound a bit silly to you, but as human beings we are always finding distractions from our issues that need attention or problem solving. How many of these do YOU do?

  • Work: feeling centered only when working or accomplishing
  • Sex: hiding from uncomfortable feelings through compulsive sexual behavior
  • Television: avoiding discomfort by watching TV for hours on end, every day
  • Drugs/Alcohol: “I need it to relax” translates “I don’t have to think about changing or feel the pain that would push me to do so”
  • Tobacco: using nicotine and the act of smoking to calm yourself
  • Tasks: volunteer or otherwise: needing to stay compulsively active with endless tasks or conversations
  • Rage: only feeling OK after venting anxiety and anger inappropriately
  • Exercise: using exercise compulsively to seek control or avoid emotions
  • Adrenaline: using risky behavior as a form of mood altering
  • Food: eating compulsively for comfort or reward
  • Hoarding: collecting and saving items endlessly
  • Shopping: purchasing an item based on the idea that it will bring comfort, or seeking comfort in the act of buying
  • Cleaning: cleaning endlessly in order to avoid stillness, which might bring attention to anxiety or other uncomfortable emotions. It’s also a way to seek control when feeling your life doesn’t have any
  • Spirituality: becoming absorbed and/or obsessed in spiritual or religious ideas as a way of hiding from uncomfortable emotions*

The problem is that when we resist an emotion, trying not to feel what we are feeling, we tighten muscles around the areas in our bodies where we feel the emotion. This keeps it trapped there instead of letting it flow through naturally.

Are you ready to stop and pay attention to your life? I am your best guide to do so. Let’s get started!

*Adapted from Present Moment Awareness by S. Duncan

Treating Depression, Anxiety, Bipolar Disorder, and Couples Issues

Have you ever wondered about all of the types of counseling or therapy providers out there? All of the issues in this title can be treated by several different kinds of licensed professionals. The key word to look for is “Licensed,” because it means a certain level of accountability to a governing body and a minimum Master’s level of education. Here’s an overview of some of the types of licensed therapists out there:

Master’s Level Therapists include:

Licensed Professional Counselors (LPC)

Licensed Marriage and Family Therapists (LMFT)

Licensed Clinical Counselors (LCC)

Licensed Mental Health Counselors (LMHC)

Licensed Professional Clinical Counselor (LPCC)

Licensed Clinical Social Worker (LCSW)

These are just some of the types throughout the United States, and there are Interns in each profession as well who are licensed and supervised in practice. There are also Supervisor levels for each license, which indicates more experience and training.

Counseling or therapy (the words are used interchangeably) is also conducted by Doctoral level (PhD or PsyD) therapists called Psychologists. Psychologists are licensed to do levels of testing that a Master’s level therapist cannot.

 Mental Health Providers who can legally prescribe medication are generally a Psychiatrist or a PMHNP (Psychiatric Mental Health Nurse Practitioner).  Psychiatrists have an MD level degree, as they are medical doctors who have completed additional training in psychiatry. Most psychiatrists don’t do “talk” therapy, preferring to focus on medication and prescribing instead. The same is generally true for PMHNP providers. Of course, the medical profession itself can prescribe but they don’t do talk therapy.

The most important factor for you is how comfortable you feel with the licensed provider you have chosen. Personalities between client and therapist must mesh for the therapy to be effective. If there’s something your therapist can do differently, ask! Communication is key.

If you have any questions about any of this information, don’t hesitate to contact me.

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