Is it even possible to have a healthy relationship? For most people, relationships aren’t easy. Too often they’re ruled by unconscious patterns and fraught with drama, disappointment, and distress. 

Sometimes we move on from one partner only to find yourself embroiled in hauntingly familiar styles of dysfunctional interaction yet again with the next partner. Maybe you even carry the same patterns into everyday interactions with family, friends, and colleagues.

Let’s look at one classic explanation of what goes wrong in relationships and how to counteract it. The “drama triangle” refers to  a model of social interaction and conflict developed by Dr. Steven Karpman in 1968.  It identifies three roles commonly and often unconsciously played out in relationships: Victim, Rescuer, and Persecutor. 

Let’s take a peek at the characteristics of each role, and the suffering that occurs in these stressful interactions. Then we’ll check out the “empowerment dynamic,” the way out of the Drama Triangle.

The characteristics of a victim attitude include:

• Hopelessness
• Powerfulessness
• A belief he or she is unable to care for themselves
• Feels broke and unfixable
• Feels stuck or persecuted
• Lacks accountability for their circumstances
• Doesn’t question his or her own responses to life 
• Wants to be saved or rescued by someone else
• Wants others to treat them gently or carefully
• Finds it difficult to make decisions

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A Victim says things like:

• “Life is against me”
• “This always happens to me”
• “Nothing can help me”
• “Poor me”
• “It’s not my fault”
• “Yes, but…”
  
  

The characteristics of a rescuer include:

• Wants to solve other peoples’ problems, instead of looking at their own issues and challenges
• Neglects their own needs
• Keeps the victim dependent 
• Overly protective
• Needs to be needed
• Feels guilty or worthless if they are unable to help
• Often burdened, overworked, and may be at the edge of exhaustion
• The martyr, enabler, co-dependent

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A rescuer says things like:

• “Let me help you”
• “I can do it for you”
• “If they just listened to me, they’d feel better”
• “I would love to help”

The characteristics of a persecutor include:

• Blames others
• Frustrated
• Self righteous
• Critical
• Controlling
• Authoritative
• Angry
• Manipulative
• Over-powering

A persecutor says things like: 

• “It’s all you’re fault”
• “You’re wrong, I’m right”
• “I know best”

Obviously, these three roles need each other. If you function in one of these roles, you’ll try to draw someone into a corresponding role on the Drama Triangle. Or if you’re not in one of these roles, you may find someone else is trying to pull you into one of them.

Most people operate from one primary or habitual role when they’re involved in a Drama Triangle. They typically embrace this role as their identity in life.

But we also move between roles. For example, a victim can become a persecutor or a rescuer can move into the victim role. You might even move between roles in a single conversation. 
When you interact from a position on the Drama Triangle, you reenact and reinforce painful beliefs and patterns that keep you from living a conscious, authentic, and fulfilled life.  
So how do you move out of the Drama Triangle?  Let’s take a look at the Empowerment Dynamic.

The Empowerment Dynamic was developed by David Emerald to help people move out of the Drama Triangle.  It identifies three empowered roles: Creator, Coach, and Challenger. 
Below are some of the actions you can take to move from a dysfunctional role in the Drama Triangle into an empowered one. You’ll have to take these actions again and again to create new modes of healthy interaction.

To move from victim to creator take these steps:

• Take responsibility for your thoughts, feelings, and actions.
  
• Think like a problem solver and use your creative imagination.
  
• Take actions that will achieve your desires outcomes.
  
• Instead of looking for someone to save you, learn to take care of yourself.
  
• Focus on what you want instead of what you don’t want. 
  
• Ask empowering questions like: “What do I want?” and “What steps can I take to get what I want?” 
  
• Look at what’s going right in your life.  You can do this by practicing gratitude each day, reviewing your accomplishments often, and appreciating the goodness in life.
  

To move from rescuer to coach, take these steps:

• Be helpful and supportive by acting like a teacher or a coach instead of a rescuer or a fixer.
  
• Help people learn to solve their own problems instead of solving problems for them.
  
• Encourage self-responsibility rather than dependency.
  
• Set boundaries on the amount of time you’ll listen and provide support.
  
• Ask empowering questions like:  “What would you like to see happen in this situation?” or “What can you do to change this?”
  
• Trust that the other person can solve their own problems.
  

To move from persecutor to challenger, take these steps:

• Challenge people but don’t blame, criticize, or oppress them.
• Be firm but fair in your interactions.
• Ask for what you want, be clear but not punishing.
• Address the consequences of their actions and set boundaries.
• Ask questions like, “What do you think you react so strongly in this situation?” or “What would happen if you challenged the belief you can’t take care of yourself?”

Another empowered model, the Winner’s Triangle, was developed by Acey Choy in 1990.  It recommends alternative ways of being to counteract the roles on the Drama Triangle: vulnerable and outcome oriented instead of victim, caring instead of rescuer, and assertive instead of persecutor.

Acting out a role in the Drama Triangle only leads to pain, suffering, anger, and resentment for everyone involved. While you might get your needs meet on the short term or feel gratified temporarily, triangle dynamics never bring lasting happiness.

No matter how embedded you are in a particular role, you can learn to act in more empowered ways through self-awareness and making alternative choices.

It’s not necessarily easy because we’ve practice and reinforced these patterns so many times.  You need to give it your all. Take time to study the Drama Triangle and the Empowerment Dynamic. Journal about your reactions and and the role you see yourself playing. Make your own program to practice the skills for your corresponding role in the Empowerment Dynamic, one at a time.

Chances are, you’ll return to and play out your former role in the Drama Triangle again and again.  But every time you act from an empowered place, you build your capacity to interact in healthier and happier ways.  Gradually, your relationships will feel more satisfying, you won’t feel so powerless, and you’ll be able to avoid toxic relationships that would only draw you back into the Drama Triangle.

Your Turn: Which role on the Drama Triangle feels most familiar to you? What emotions come up when you see this? How do you notice when you’re in a self-defeating role and how do you get out of it? I would love to hear from you in the comments.

A while back I wrote a brief post about the benefits of abstaining from the use of your health insurance when seeking mental health treatment. I decided that it'd be a good idea to go into a little more depth on the topic of why you shouldn't use your insurance for counseling and therapy. It never fails that I receive inquiries multiple times a week from folks asking if I take their insurance. The simple answer is "no" I do not and I do my very best to educate them about why in the short window of time that I have them on the phone.

When a potential client is willing to have a short chat about the pros and cons of using insurance for mental health treatment, those individuals tend to recognize the benefits of not using their insurance and proceed with scheduling an appointment with me.  However, those who are only looking to use their insurance often decline and let me know that they will call other clinicians to try to use their insurance. These same individuals often call back, though this usually occurs weeks later after they realize that most providers who take insurance are booked out for months. This can be very frustrating for individuals who have finally made the courageous decision to seek professional help as there is usually a notable amount of immediacy to get in for an appointment (because of this, I make it a priority to keep several new client appointment slots open in my weekly schedule).

Before utilizing your benefits, I encourage you to investigate all options and arrive at an informed decision regarding your health care. You can always decide to use your benefits, but you can’t reverse many of the negative consequences after using them.  Considering the frequency that people contact me about this, I want to share some insight as to why you should not use your medical insurance for mental health treatment.

The rule is that insurance companies only pay for services that are considered “medically necessary” (more on this below). This means that in order to utilize your medical insurance for mental health treatment, you must be diagnosed with a mental illness or disorder.  Additionally, the clinician has to prove that your mental health condition is affecting your health and overall functioning on a daily basis.

The problem is that many of life’s difficulties, and the reasons why people seek mental health treatment, are not mental illness disorders and are not diagnosable. When this is the case, your medical insurance is not going to cover the treatment. Insurance will not cover “I am having a hard time” or “I am grieving a loss.” Many of the patients that I see do not have a diagnosable disorder, so any intentions they had of ever using their medical insurance (in-network or not) to cover treatment becomes irrelevant.

You may be thinking, “so just diagnose me,” but equally important is that any ethical therapist will not simply diagnose you for the sake of using your insurance for treatment. While you may initially disregard the importance of this, this is a very good thing.

(Note: Any therapist who will falsely diagnose you for the sake of using insurance is committing fraud, is unethical, and you should turn around and walk out the door. These are indications that the clinician is not concerned about the integrity of their practice and the quality of care provided, which will become more clear in terms of your interactions and the effectiveness of treatment if you were to continue seeing them.)

Couples Therapy
Couples therapy is an excellent example of where this often becomes an issue. Some insurance companies claim to provide coverage for couples therapy, however there is much more that goes into this. Insurance is billed using two pieces of information: the type and length of the session (e.g., individual therapy 30/45/60 minutes) and the mental illness diagnosis (the basis of medical necessity).  The problem is that there is no procedural code explicitly for couples or marital therapy. In fact, the exact code is listed as “Family Psychotherapy with patient present.”  This means the identified patient is the person whose insurance is being billed, has a diagnosed mental illness, and the understanding is that your partner is present as a support to you in treatment.

There is a "V-code," listed as “Counseling for Marital and Partner Problems,” however, this is a code that is typically rejected by insurance companies for not being medically necessary. The equivalent would be trying to get your medical insurance to cover a face-lift or botox for anti-aging. It’s just not going to happen. As far as insurance companies are concerned, couples therapy may be great, but just like a face lift, it is not medically necessary.
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So when an insurance company says they cover couples therapy, what they really mean is that, you, the identified patient who has a diagnosed mental illness disorder, is permitted to have your partner present in the room while you receive treatment for a diagnosed mental illness.  And the therapy is supposed to be addressing the disorder. The problem again lies in that many couples seeking therapy do not meet criteria for a diagnosable mental illness. To further that, it is insignificant if your partner does in fact meet criteria for mental illness unless they use their own health insurance and are the identified patient.

This is the term used by medical insurance to describe procedures or treatments they believe must occur, or if not, the person may suffer insurmountable consequences. A large goal of the insurance company is to contain costs, and one big way of doing this is by only providing coverage for services that fit into their matrix and which they deem “necessary.” Medical necessity is extremely important to insurance companies as they will only pay for services they agree must occur, and they will stop paying as soon as possible.
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As described above, the first component of medical necessity is having a diagnosable mental illness. Without a reimbursable diagnosis, insurance companies already view the therapy as unnecessary, and will not provide coverage. This rules out a large portion of insured patients who are looking to work on coping, managing stressors, relationship problems, grieving, or life coaching. Second, the illness must be causing significant functional impairment. Without these factors present, it is likely the insurance company will deny your claim.

Any documented mental health treatment that is filed through your insurance will go on your permanent medical record. This can have a significant impact on your future ability to secure any health insurance coverage at all; if you are able to obtain insurance with this on your record, your insurance premium, deductible, and co-pays are likely to be much higher. Given the current state of affairs in the United States with regard to health insurance coverage, this concern is applicable to every person who possesses health insurance and is thinking of using their health insurance for mental health treatment.

One of the biggest concerns about using insurance for mental health treatment is the possibility of losing confidentiality. When your insurance is billed, not only do they require a diagnosis, but they gather information about the type of treatment you are receiving and whether you have improved or not (this is important to them because their goal is stop paying as quickly as possible). The insurer can also audit your records at any time they wish, which means they have full access to any details your therapist has, including information the therapist intentionally did not include in the claim submitted to the insurance company. Any and all information, including progress notes, which can include details about what occurred during the therapy session, is technically open to the claims specialist.

The average insurance claim passes through 14 people while it is being processed. These people are able to view information about your treatment including your diagnosis, treatment plans, progress notes, as well as any other information pertinent to them approving your claim. These details should be private, but are open to anyone with access when you use your health insurance. Confidentiality is also often lost when your information is being faxed to anyone in the health care industry who ever requires access to it, which often occurs while claims are being processed.
While you may not care about this, if you a hold a high security clearance for a job, are seeking a military or federal job, a political position, an aviation position or any other job that requires health-care checks (many institutions are now screening out employees who may be unstable or cost too much money in mental health treatment and lost work days) or have other reasons you want your information to remain confidential, this is important to know. Additionally, children often have an even more difficult time when given a diagnosis, as their diagnosis follows them for much longer and can impact school, college, and be a barrier to pursuing certain careers. If your child’s condition warrants a diagnosis, you may want to have some say over how that diagnosis functions in their life – you may want to keep all treatment private.

If you are a new patient using a in-network provider through your insurance, it is very likely you will have to wait a significant period of time before getting in for your first session. Clients, as well as my colleagues and other professionals in the mental health industry, have told me they were told anywhere from two to four months before being able to get in for a first appointment. This is totally unacceptable.

If you have ever sought therapy before, or are currently seeking it now, you know what a big decision this can be. Typically, you have already tried to manage the problem in some way on your own – be it an external situation or an internal psychological issue. Maybe you have read some self-help articles, sought advice from friends and family, tried to ride it out and allow “time to heal,” but finally realized you needed something more. To then hear that you must wait another two to four months before you can attend an intake session is both disappointing and potentially harmful.

​Though in some particular situations (such as relationship break-ups) it is true that time is one of the biggest components for healing, in many others (particularly with traumatic events) time only leads to more severe symptoms and internal psychological distress. As with anything else, the best results and less difficult path to healing comes when problems are caught and treated early.

When a clinician accepts insurance, they by nature of their contract with the insurance company cannot specialize. The clinician can note the areas where they prefer to practice, and likewise advertise this to insured consumers, but they cannot turn away a potential client simply based on the person not being their ideal client so long as they have an opening and take that individual’s insurance.
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For example, I specialize in treating relationship concerns in couples, betrayal trauma, and issues that artists and creative, highly sensitive people face. If I were contracted with insurance companies to provide services, I would be able to advertise that I have a focus on these areas, but that is the extent of my being able to specialize. I would be required to see any and all patients who contacted me, so long as I accepted their insurance and had an opening. I could not turn down patients on the basis of them seeking treatment in an area outside my “specialities.” If that were the case, then by nature I would not be able to specialize as I would be required to see every type of person and problem who walked through my door.

The problem with this is comparable to going to a family practitioner when you really need to see a neurologist. Sure, the family practitioner has medical training and can probably identify from a more general standpoint what may be going on, and they may be able to provide general treatments, but they do not have advanced training or experience in treating your precise problem. This is akin to seeing specialists for mental health treatment. This is also precisely the saying “jack of all trades, but master of none.” Just like you would seek a specialist to get the best care and outcomes for a physical medical concern, it is equally as important to seek a specialist for psychological concerns.

So, you ask, what about scope of practice? This is an ethical concept!, and has nothing to do with the contract signed between the therapist and the insurance company. Insurance companies are not concerned with specialities or scope of practice, and that is because their stance is a licensed mental health professional is qualified to see mental health concerns (which, in fact, they are, but this does not mean the clinician is specialized in a particular area). To the insurance company, if a provider is a licensed mental health professional, they should be able to manage common mental health concerns just as a family medical practitioner should be able to manage common physical health concerns (but, as we know, sometimes you need more than managing; you need a specialist for advanced techniques and treatments and that is the key difference here). As such, insurance companies are focused on the legalities contained within the signed agreement between the clinician and the insurance company, which typically state they cannot turn a client away so long as there is an opening. No one forces a clinician to sign a contract with an insurance company, so when a clinician makes the decision to do so, they (legally) must comply with the requirements of the contract, which again, means they must take clients if there is an opening, which means they cannot truly specialize.

This goes against what we tend to think of, as most medical providers are seen through your medical insurance. However, simply put, mental health treatment is very different. In the mental health field, most experienced and seasoned therapists simply do not take insurance. This is because they don’t have to (and don’t want to, but this blog is focused on the consumer side, so we will not go into specific reasons why providers don’t prefer to take insurance). Logically speaking, experienced and seasoned therapists are specialized and have enough of a following and community reputation that they do not need to acquire patients from insurance mills. New patients are referred to these experienced clinicians by other patients, other medical providers, attorneys, etc. This is not to say that all providers who take insurance are unexperienced, but this is often the case.

When you see an in-network provider through your insurance, neither you nor the clinician get to decide how you spend your time in treatment. Insurance companies require that a treatment plan be submitted in order to approve the number of sessions and ultimately, they use this to determine how your time in therapy is spent. The number of sessions is determined ahead of time by the claims specialist (a non-mental health professional who you have never met and does not know your plight) and is not based on need.

Attempting to extend the number of covered sessions often proves futile, as the insurance company has a matrix for determining what they believe are the number of sessions needed to correct the problem. The huge difficulty with this is that therapy is not at all predictable, so treatment may very well take longer. Further, their version of correcting the problem often means getting you out of crisis or back to a very minimal level of functioning. Truly effective and thorough therapy requires time, and insurance companies NEVER cover this type of treatment.
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Rather than giving you the care that best meets your needs (which in therapy sometimes means deviating from the treatment plan and discussing the terrible interaction you had with your boss yesterday), the therapist is responsible to the insurance company for “completing” your treatment within the pre-determined number of sessions. Bottom line, an in-network therapist works for the insurance company, not for you. This is because of the contract with the insurance company that the therapist is required to uphold. Another common issue is that it can take months for your therapist to get reimbursement, if at all. These delays can interrupt treatment until your therapist is paid by the insurance company (or you) for services rendered.

While many patients come to therapy and do not have a diagnosable mental illness, just as many come to therapy because they do have a diagnosable mental health condition (e.g., major depression, generalized anxiety, bipolar disorder, etc.). For these patients, it comes as no surprise that the therapist would notate their diagnosis in the record, primarily to know what they are treating and then provide effective treatments based on the presenting issues. There is a huge difference, however, between filing insurance claims with this information versus not using your insurance.

Simply put, when you don’t use your insurance, this information remains private. When you use your insurance, your mental illness diagnosis, as well as your treatment, becomes part of your permanent medical record. You don’t get to take this information out once treatment is over, or ever.

This can make applying for new health insurance, life insurance, or a new job incredibly difficult as they can require an authorization to release information to view your entire medical record. With the likely changes coming to healthcare as a result of the new administration likely overturning ACA, it is possible that people may once again be denied coverage based on a preexisting condition which includes mental health diagnoses. If you do secure coverage, companies can charge significantly higher premiums because of having ever been treated for a mental illness diagnosis. If you are someone who might ever be unemployed, self-employed, or need to purchase your own benefits, a mental health diagnosis can make the difference between preferred coverage or none at all.
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This is often one of the more significant reasons that resonates with patients, and why many who are insured often choose to not use their medical insurance for mental health treatment.

Insurance companies will warn you, “A quote for benefits does not guarantee payment…” This means that despite being told verbally (over the phone) that something is covered and possibly even being given an authorization number, you can still be denied once they review the diagnosis. If you attend therapy sessions under the belief you are using health insurance to cover your visit, and the therapist receives a denial of the claim, you are still responsible for the full payment to your therapist. You can attempt to appeal the claim with your insurance company, but be prepared to go through several levels of appeals, which can take weeks to months – all while your treatment is likely interrupted.
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Additionally, you may have a deductible that needs to be met or a particularly high copay. For example, depending on your deductible, you may have to pay $500 or even $5,000 out-of-pocket before your insurance company will begin making payments on claims.

Unfortunately, medical insurance often becomes a hindrance to obtaining timely and effective mental health treatment. The biggest, and most sincere, suggestion I can offer is to simply pay out-of-pocket. You are putting the power back in your own hands in terms of finding the right therapist, choosing one who specializes in your particular problem area, and one who is likely very experienced. You are also in full control of the length of treatment and how often you attend therapy sessions. And, your record remains private.

Another possible solution is to use pre-tax dollars, such as by using your Health Savings or Flexible Spending Accounts to pay for therapy. These accounts typically come in the form of a credit card with major credit logos.
Also, unbeknownst to many, visits to your psychologist or psychiatrist can be tax deductible when paying out-of-pocket (however, this same rule does not apply to mental health counselor or social worker visits unless you are receiving psychoanalysis). This link to the IRS shows all available tax deductible medical expenses.

You can also work with an out-of-network provider, which is something I often do with my patients. This means you pay the therapist directly but submit a statement to your insurance for direct reimbursement. However, the statement you submit (called a superbill) still must contain a mental illness diagnosis and the type and length of session attended. This option does not resolve issues concerning confidentiality and your medical record, but allows you to maintain more control of your treatment than when using an in-network provider. You will want to call your insurance company ahead of time to confirm they will reimburse you.

We all experience pain in life. Heartache, loss, disappointment. Suffering is a part of the human condition.

When you're in the depths of pain, it can be hard to see how you will ever recover from the experience. The idea that you will one day be grateful for your disappointment and hurt seems unimaginable.

Yet, we always have a choice. Even in our pain we have a choice to make. We get to decide whether we will take the opportunity and grow, or whether we will let it consume us.
The intention of saying that we only need to make a choice is not an attempt to to oversimplify; in fact it may be the hardest thing you will ever do.

But your pain may also be the thing that pushes you towards your greatest personal breakthroughs.

This summer, we are pondering how pain in our journey can lead to growth and strength in our lives. Lean in. Plant down. Grow up., the new exhibition at Emerge Wellness, curated by TJ Walsh discovers how we can explore, learn and change our situations so that we can become stronger through our pain. It is our hurt that can crack us open and let the light in. It is our pain that can help move us towards living a more deeply fulfilling life.
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There is a psychological concept known as Post-Traumatic Growth. Most people are familiar with its cousin, post-traumatic stress. Post-traumatic growth isn't discussed as frequently, but it is the concept that explains how many of us take our pain and use it as the energy to grow psychologically.

"Post-traumatic growth is not about returning to the same life as it was previously experienced before a period of traumatic suffering; but rather it is about undergoing significant 'life-changing' psychological shifts in thinking and relating to the world, that contribute to a personal process of change, that is deeply meaningful" (Tedeshi & Calhoun, 2004).

Here are 3 things you can do to help you channel your deep pain into an opportunity for your greatest growth:

Explore Your Feelings (Lean in.) 
Get in touch with your emotions, and be willing to feel them. To understand why you hurt, you have to dip deep into where the pain is stemming from. You may choose journaling, therapy or coaching - but you need to find some way to really explore and understand your feelings.It is easy to say you are hurt because of heartbreak, but the question is, what part of the heartbreak is really causing you the pain? Is it that you feel like a failure? That you are grieving for a future that no longer exists? Or that you don't feel worthy of love? Express your emotions and work through them until you can find their root cause. Self-reflection and personal understanding is a prerequisite to deeper psychological growth.

Look for the Lesson (Plant down.)
In order to grow from a painful experience, you need to focus your mind on looking for the lesson. This is one way of choosing to have a growth-mindset.
No matter what the situation, you will be able to uncover a lesson if you look hard enough. If you have been faced with an illness, perhaps it can teach you what you need to prioritize in life. If you are recovering from heartbreak, perhaps it can highlight your need to respect yourself more, so that you are not prone to letting other people disrespect you.
Looking for the lesson is about taking your power back. You can't wallow indefinitely in the pain if you are to step up and grow. Once you've identified the root cause of your hurt, you have the power to look for what you can learn from the situation.

Resolve to Change (Grow up.)
Once you can acknowledge what your current situation might have to teach you, you need to resolve to change. Real positive growth must be followed by action. You have to do things differently. This is where your pain can truly turn into your greatest power.
It may be that you reprioritize how you live your life, so that the things that really matter to you play a bigger part. Or you may resolve to focus on truly deep-down loving yourself before you begin to look for another romantic partner. Your actions will always be so personal to you.
Real growth comes from a willingness to change. You need to do things differently and use your pain as the thing that leads you on your path to growth.

It may be useful to have a therapist help you work through these stages. We can accelerate our growth when we work with skilled professionals who can help guide us. 

You can turn your pain into power. If you are willing to lean in, plant down and grow up, you will come through the suffering a brighter and stronger person.

According to the American Psychological Association (APA), millennials experience more stress and are less able to manage it than any other generation. In fact, more than half of millennials report that they have laid awake at night over the past month due to stress.

It's not surprising that millennials are more stressed than older Americans. The APA reports that 12% of millennials have a diagnosed anxiety disorder — almost twice the percentage of their boomer counterparts. Non-clinically, the BDA Morneau Shepell white paper found that 30% of working millennials have general anxiety, while a 2014 American College Health Association (ACHA) realized that 60% of college students live with anxiety.

Not only does anxiety harm our wellbeing, but it affects our productivity. The ACHA assessment found that the top two tolls on students' academic performance were stress and anxiety. Two-thirds of millennials interviewed by BDA report that declining work performance to be related to anxiety.

Sources of millennial anxiety may include a difficult job market and student debt as well as psychological causes, such as ambition addiction, career crisis and choice-overload. Even our day-to-day behaviors can create anxiety. Here are eight common habits that cause stress and compromise our potential.

Bad Sleep Habits
Poor sleep may be the most prevalent contributor to anxiety. A study by UC Berkeley found that lack of sleep "may play a key role in ramping up the brain regions that contribute to excessive worrying." Common causes of poor sleep include going to bed at inconsistent times, not making sleep a priority, and spending time on the phone or laptop right before bed.

Mental health professionals suggest that you form a long, boring nighttime routine that is technology free, and that you keep a journal by your bed to write down thoughts that keep you awake. Exercise during the day is also helpful to tire your body.

Skipping Meals
Eating regularly not only regulates your metabolism and insulin levels but also our mental stability. “Waiting too long to eat or missing out on breakfast may lead to unsteady blood sugar levels, which can cause anxiety-like sensations, including shakiness, dizziness, confusion, and difficulty speaking. Dehydration has a similar effect. Because food and water are biological needs, anxiety naturally follows hunger and thirst.

It's important to eat meals regularly. Try to keep things like granola bars or nuts in your desk drawer. Bring a water bottle to work and sip it throughout the day. Have a glass of water right upon waking and right before you go to bed.

Drinking Coffee
Drinking coffee makes us more alert and, in many cases, helps us perform better on short-term tasks. However, it can also make people jittery, irritable and nervous, especially if they’re already predisposed to anxiety. Sensitivity to caffeine is, in fact, heightened in people with panic disorder and social phobia, and caffeine can provoke panic attacks in some individuals. Caffeine is also diuretic, which can cause dehydration—an anxiety trigger established above. 

Try to wean off coffee by switching to just one cup a day, decaf or black tea. If you feel more calm and in control after a couple weeks without it, commit to quitting it altogether.

Sitting
America’s surge of anxiety symptoms parallels our increasingly sedentary lifestyles. But, until a recent review by BMC Public Health, it wasn't clear whether the two were actually linked. After lengthy process, researchers found that the risk of anxiety risk increases as sedentary behavior increases—and, specifically, sitting time spikes one’s likelihood of experiencing anxiety. 

If you work at a desk all day, you’re not doomed. Get up and walk around every ninety minutes. Offset your sitting time with regular exercise, which halves your risk of anxiety and depression.

Your Phone
A 2014 study by Baylor University found that American students spend an average of nine hours a day on their phone. Of course, technology vastly improves our lives in so many ways. But too much of it makes us anxious. Screen-based entertainment increases central nervous system arousal, which can amplify anxiety. Social media is similarly associated with low moods and depression. 

Next time you’re waiting or have nothing to do, leave your phone in your pocket or purse. Stop utilizing it as a means of alleviating boredom and instead use it consciously as needed for its useful functions.

Always being "on the clock"
According to data from FORBES’ @Work State of Mind Project, millennials become anxious and irritated when work intrudes on their personal lives. But our bad work-life balance is our own choosing. BDA’s assessment explains, “Millennials do not believe that productivity should be measured by the number of hours worked at the office, but by the output of the work performed. They view work as a ‘thing’ and not a ‘place.’” Even after we leave the office, we’re still at work. 

We can still be ambitious, work long hours and impress our bosses without sacrificing psychological health and personal boundaries. Schedule a defined, consistent time at night to stop working. When time’s up, mark that task complete and go take care of yourself.

Netflix and Chill
You may think snuggling up on the couch and watching a movie will help you unwind, but research disproves this trend. In one study, participants felt more depressed and anxious after watching just two hours of TV than those who didn’t. Another study found that those with anxiety and depression spend significantly more time on the computer and watching television. While resting reduces anxiety short-term, research reveals that its effect is short lived, particularly compared with exercise. 

Try to do anything but watch TV when you’re done with work. Go on a walk, grab drinks, knit, work, draw, write, sit in your room and look at the wall, call your mom, actually cook dinner, build something, play a sport.

Hanging Out with Anxious People
Maybe you feel like you’ve found someone you can vent to who understands you, but studies show that ruminating on anxiety often makes it worse. Furthermore, participating in “intergroup anxiety” increases one’s anxious behaviors. 

Try to seek out people who level your mood. After you hang out with someone, check in with yourself and ask if you feel stable and well—or if you're hyped up and on edge. It’s easy to spend less time with certain people once you’ve decided they’re not great for your health.

If the annoyance, pain and performance impairment of day-to-day anxiety isn’t enough to quit these bad habits, maybe this is: According to Harvard Medical School, anxiety is implicated in heart disease, migraines, chronic respiratory disorders and gastrointestinal conditions.

Despite your youth, chronic anxiety is not sustainable. By switching out these daily practices, you can improve your mood and your life one habit at a time.

In my practice, when I meet with someone in their 20s it’s rare that they won't mention “anxiety” as the reason that they're coming in to see me. The topic of "anxiety" is normal, every day conversation for these young people — which is scary, but it's the reality of our current culture. With social media breeding comparison on overdrive, being overloaded with information, and attempting to keep up with the Jones', it’s no wonder we’re all feeling a bit… anxious.

From sleep issues to stresses about jobs, anxiety is an unpleasant thing to deal with, but the good news is that there are absolutely things that can help. Continue reading for the major causes of millennial anxiety and ways around each type.

FOMO
FOMO, meaning "Fear of Missing Out," began as some fun lingo but it is increasingly becoming associated with some serious anxiety that can be anything but fun.

Simply opening your Facebook and Instagram feed can immediately cause feelings of FOMO to rise to the surface. Whether you're wishing that you are on that fancy trip your friends are on or bummed that you missed a party that you weren't invited to, FOMO is real.

How to deal with FOMO:
Try to get to the root of your FOMO. Categorize the times when you feel it the hardest. If it surrounds travel, set goals and start saving for your next trip or book a weekend get away. Do you experience FOMO because you believe that you don't have many friends? Become proactive and sign up for a community sports league or volunteer with an organization whose mission you align with.

It's important to take note of what your FOMO is telling you and make changes around whatever area you're missing out on. It's also a good idea to log off of social media for a bit.

​Not Prioritizing Sleep
Even though more senior generations like to assume that the millennial generation is lazy, it's actually true that the younger set is, on the whole, very hard working. Young adults have lived a life that is 24/7. This often means staying up until 1 a.m. to hit a deadline or texting every person back before being able to put the phone down.

The constant priority for everything that is happening in life takes a toll on sleep. This is not good.

How to prioritize sleep
If you notice that you're not getting seven to nine hours of sleep per night, it's important to make a change. Start to say no to events or working late if it's getting in the way of rest.

Creating a nighttime routine is a great idea to help you wind down. Put your phone on airplane mode, take a warm bath, drink herbal tea and get into bed with an analog book at least nine hours before your alarm goes off.

Being the next Big Boss
Career anxiety may be the biggest source of anxiety for people in their 20s. While pushing to be the next break out star is great, it also leaves you feeling less than if we're not successful at starting our own business or rising to the top immediately. And of course there's the anxiety that presents itself when you don't know what you want to do with your life. Individuals in their 20s were born into a constant rat race that pushes people to be the best or more inventive than the rest. The internal and external pressure to have things figured out right out of college is exhausting.

How to deal
If you're feeling a lull in motivation but like your job, it's probably time that you take a break. Use your vacation (or sick...) days and take a break from the cubical for a few days. Even if all it means is that you get to catch up on your doctor's appointments and chores around the apartment. The time away from the desk will reboot your energy.

If you're anxious about what to pursue, take some time to attend a workshop or conference that you're interested in. Put yourself around inspiring people to gain more information and get things brewing.

Grab a cup of coffee with someone you respect and pick their brain. The act of talking to friends who feel this pressure can also help because you will realize that you're not alone.

Not knowing how to relax
We’re so anxious, the thought of relaxation even stresses us out. But this is really about how we’re relaxing, and that’s usually through binge watching, which research shows actually can have the opposite effect. Watching TV and spending hours scrolling through social feeds might be to blame.

How to relax
Force yourself to truly take a break - even if that means you become a little bored. Think back to the times when you've felt the most relaxed and go back to that place.

Find the practices that truly leave you feeling relaxed and renewed and incorporate them into your weekly routine. Maybe you'll even take the step to turn off your phone for one day a week and block out any new information from clouding your head. It's uncomfortable at the start, but you'll feel your anxiety decrease within a few hours

Hitting Milestones by a Certain Age
Many 20-somethings need to feel like they've reached a certain level of success by a certain age. If that age is reached and our careers or personal life still seems “mediocre,” cue the anxiety.

This is likely due to the fact that while times are changing and people are doing things later in life, millenials were brought up by a generation much different. The parents of 20-somethings got married young and they didn’t go back to school, and that’s likely weighing in on where you're *supposed* to be — or where you thought you'd be by age 30 as a kid.

How to deal
Instead of setting up your life to reach specific milestones by certain ages, let life take the course it was meant to take on its own. That idea is way easier said than done, but be careful to settle for a job or a partner all because you're turning 30 next year and you have to have those things before then. Set goals for things you can control, but really try not to attach an age to the goal. Do what feels right for you—no matter what your friends or parents have done.

Most importantly, take care of yourself! No matter the type of anxiety, there's usually one thing in common: we all need to step away from our phones and tune into ourselves instead. Move slower, create real human communication, take breaks, journal, meditate, go to therapy. Do what you need to do to feel good personally.

For a while now, science has shown that anxious people tend to to be more intelligent. Now we are finding that there is a link between anxiety and being more creative. In my work with artists, I find that many of them feel anxiety even if the symptoms vary from one person to another. It's not uncommon to learn that creative people, like artists, musicians, dancers, and writers live with mental health challenges like anxiety.

Painter Vincent van Gogh suffered throughout his life, as he explained in a letter to his brother: “I am unable to describe exactly what is the matter with me. Now and then there are horrible fits of anxiety, apparently without cause, or otherwise a feeling of emptiness and fatigue in the head … at times I have attacks of melancholy and of atrocious remorse.”

Artist Edvard Munch, painter of the famous painting "The Scream" suffered from anxiety and hallucinations throughout his life. In fact, that painting came to him as a vision while he was trembling with anxiety. He wrote in his diary: “My fear of life is necessary to me, as is my illness. They are indistinguishable from me, and their destruction would destroy my art.”

Grateful Dead’s Jerry Garcia said that music is “something that escapes between frenzies, between anxiety attacks.” It's known that some artist capitalize on their neurotic view of the world to fuel their creative ambitions. I imagine you know some people in your own life who fit the description of an anxious artist. Or maybe you're channeling your own anxiety into artwork.

Throughout history, social scientists have supposed that there may be a link between anxiety and creativity. For a long time this hypothesis was based upon anecdotal evidence alone, but today there is a growing body of research that suggests there actually is a link between creativity and mental illness.

What the science tells us

One of the first key studies, which found that creative people had an unusually high number of mood disorders, reviewed individuals in creative fields such as literature and the arts. Researchers in Sweden’s Karolinska Institute followed more than one million Swedes and their relatives using a registry of psychiatric patients. The patients demonstrated conditions such as anxiety, depression, or schizophrenia. The study revealed that people working in creative fields, including dancers, photographers and authors, were eight percent more likely to live with bipolar disorder. Writers alone were 121 percent more likely to suffer from the condition. Researchers also found that people in creative positions were more likely to have relatives with schizophrenia or bipolar disorder, which shows that there may be a genetic trigger for both creativity and mental illness.

In 1987, Dr. Nancy Andreason from the University of Iowa found that a sample of creative writers had significantly higher levels of bipolar disorder than a control group. Andreason also noted that a writers' first-degree relatives, meaning their parents, siblings, or child, were more likely to suffer from mental illness. In 1994 a study looked at 60 female writers' mental health. The results of that study revealed that writers had a significantly higher rate of depression, mania, panic attacks, or generalized anxiety as compared to the study's control group. A 2004 survey by psychologist Erika Lauronen found that of 13 published studies, all but one supported a connection between mental illness and creativity.

More recently, in 2015, a study that was published in the journal of Natural Neuroscience found that genetic factors that raise the risk of bipolar disorder and schizophrenia are found more often amongst people who are in creative professions. Creative people were, on average, 25 percent more likely to carry the gene than less creative professionals like farmers, manual laborers, and salespeople. The scientists point out that to be creative, people need to think differently, and this may be genetic.

Imagination

Imagination is the main reason for the connection between anxiety and creativity is imagination. The difference lies in the fact that the same brain that conjures up inventive artwork can also get stuck in repetitive thoughts and unpleasant worries. These individuals use their imagination to visualize something before it happens, whether it's their artwork or an issue (real or otherwise) that scares them and causes them concern and panic. People with both traits tend to overthink and over-analyze nearly everything, this can increase anxiety. However, dwelling on one's fears may be the root of creativity and problem solving. A double-edged sword, right?

There are still some people who question the direct link between anxiety and creativity. The research does tend to be limited because it is difficult to define what "creativity" is and replicate it for study. People will argue that while a correlation may exist between these two traits, one does not necessarily cause the other. For sure, there are plenty of people who are creative who don't battle anxiety or other mental health issues.

What does this mean for you, a creative person?

So, what should you do if you're an anxious creative type? Of course it's always a good idea to get professional help from a therapist who can work with you to evaluate what is actually going on and formulate a plan of action...and then walk with you through that plan. Once we learn what is actually going on, we can begin to gain tools and start using the imagination in a helpful way to minimize anxiety. It turns out that some artists are able to channel their anxiety in the right places to their benefit. Creativity comes from expression, and some of the most powerful forms of expression result from our struggle.

​Here are some ways to transform anxiety into creativity.

1. Identify what you are feeling.
Name the feelings: You’re scared. You’re anxious. You have creative anxiety. Ask yourself what is behind the feelings: You’re afraid of failing. You’re afraid of succeeding. You’re afraid of producing terrible work. Then, make a list of all the things that might be standing in your way, creating the feelings. When you name your feelings and what is holding you back, they become easier to face. Getting them outside of your head and onto paper makes them tangible. When they are outside of you it is possible to see how you might deal with them and how they are not as big as the internal feeling makes them out to be.

2. Consider why you're doing this (creating) in the first place.
My guess is that you didn't start creating things because you felt that you should. People do lots of things because they feel like they should, but they don't become writers, painters, sculptors, and dancers because they should. That doesn't happen because there is a lot of risk involved in creating. There's not much security in being an artist, so no wonder why it scares you. No wonder you experience anxiety. You're going to make something no one's ever made before. A brand new thing. That's inherently risky. And what's more, it's something that goes straight to the core of who you are. Creating art reveals your deepest self and it's going to be reaching out to the deepest self of others. That's also risky. But isn't that why you do it? The things that scare you are precisely the things that compel you to make art in the first place. They scare you because you need them, they are a big deal, and there's no certainty that you will be successful. But that is what makes the whole process valuable. You don't have to make art. You're not doing it because you should. You're doing it because you want to. Keep that in mind the next time you are afraid to get to work. You started this because you want to.

3. Lower your expectations of yourself.
Stop being so hard on yourself. Creators want so much to make something good, useful, and beautiful. Artists have grand visions and they want to make those visions come to life. They strive for it to come to fruition and wonder why what they produce never matches up to the dream in their head. There is often a disconnect between what you want to be able to do and what you can do. You have to become okay with your limits. It's also important to become comfortable with failure. We learn through failure, so it's okay to produce crap sometimes. The only thing that matters is the making.

4. Remember what it felt like to make art as a kid.
Remember when you drew monsters with crayons as a little kid? Wasn't that great? Wasn't it the best feeling in the world? Hold on to that feeling. Call upon it every time you sit down to work. Be a kid artist.

5. Calm yourself before beginning.
If you don't already have a daily mindfulness practice, I suggest developing one. Yoga, breathing exercises, and body scans can be helpful to help you remain grounded and focused as you begin your work.

As both an artist and therapist I know the importance of sacred spaces. Both my studio and my consultation room are spaces that are worthy of respect, devotion and reverence. The process of painting and therapy for me is a time to develop personal intimacy and depth, to find myself and learn about who I am and was created to be.

It was when I first experienced painting in a sacred context that I was completely shocked by how much energy I had to express and how good it felt to not know what was going to move through me. I had people in my life who saw this in me and encouraged me to keep painting. I kept painting.

This year, as I continue to develop my offerings as a therapist and artist, I will be hosting intuitive painting workshops. These workshops will be a way to introduce participants to creating a sacred space, to find freedom and to begin the process of learning who they are through the use of our hearts, minds, hand and materials.

Here is some of what you can expect when you participate in one of these workshops:

•  We gather in a sacred circle, candle lit, and begin the morning with a few minutes of quiet time. You will be guided in each painting session with a short meditation and some body movement to help you begin with ease.

• You will never hear that someone likes or doesn’t like your painting in the experience. This is my cardinal rule. No one will come up to you in the middle of your painting and begin a conversation or tell you how much they like what you are doing or how good it is. Nothing shuts down safe space more than hearing positive or negative judgment concerning your painting process.

• No two people paint alike. Some people will paint images, some will paint color and texture, and some will paint words… I invite in a range of painting experiences from healing/therapeutic process paintings to spontaneous creative expressions without “meaning”.

• You will have anonymity in that we agree at the beginning of the day not to identify anyone individually when sharing experiences of the workshop once it’s finished.

• The materials are very non-technical. We use liquid acrylic paints, paper plates as pallets, and industrial paper as our canvas. Crude and simple, these materials will help you feel free to experiment and explore. No white canvas “Oh my god! How do I start?” moments.

• Inspired poetry and background music help fuel your creative fire and focus your spontaneous play.

• You are off the hook for making a painting! Process is queen. You can have an incredibly fulfilling workshop experience without liking your painting.

• You have dedicated painting time to paint with or without individual conversations with me. Some people flourish on their own, in silence, while others need time and/or a conversation with me to help them get unstuck or expand in some way.

There are so many ways to paint, write, dance. But over the years I have learned that sacred space is essential to all my work as an artist and therapist. If you'd like to explore yourself in a different way, I invite you to give one of these workshops a try. It might just be what your creative spirit has been waiting for.

Fill out the form below to receive information about when and where these workshops will take place. 

Both the fear of failure and the enormity of what’s possible can cause creative anxiety.

I have been a professional artist for more than a decade and have been creating art for longer than that, but there are still times when I want to run screaming from my studio at top speed — as if my paintings are standing there with pitch forks waiting to come after me.
Sometimes the simple action of entering my space and staring at my materials is enough to cause my stomach to jump with anxiety. This experience is a strange mix of excitement and immense fear.

Whether “bad” or “good,” creative anxiety triggers stalling, procrastinating, pizza gnawing and Ben and Jerry diving...and oh yeah, binge watching whatever series is being talked about on social.

Over many years of teaching, coaching and counseling university art students and professional artists individually, I have gathered a great deal of experience working through this creative anxiety and want to help more people do the same. This year, I am developing some seminars and workshops dedicated to the pursuit of pushing through creative blocks and anxiety, turning the symptoms into strengths.

Anxiety can be broken down into 'good' and 'bad' anxiety.

Because I prefer to end on a good note, let's take a look at the bad first. Here's some bad news: the brain is wired for negativity. Crap. This means that about 60% of the time, we see the glass as half-empty and look for confirmation that we suck. When we are in this mindset we don’t focus on the evidence that we are, in fact, fundamentally okay and super capable of changing the world.

Because I'm a therapist I like to turn words into acronyms and ideas into images so that we can remember them more easily when we're overwhelmed. An acronym that I like for the word 'fear' is "False Evidence Appearing Real." Fear follows me into the studio and harasses me with questions like:

What if I can’t come up with any good ideas?
What if I waste these expensive materials on something that goes nowhere?
What if I spend hours and hours on this thing and nobody wants to show or buy it?
What if I’m just being ridiculous thinking I’m going to sell this piece for thousands of dollars? Like, real dollars?  
How can I outdo myself this time?
Why did I buy so many shades of white paint, anyway?

Even now, fear is right behind him, demanding my attention. It is relentless with its criticism and disapproval. That's the job of fear. The negative voice of fear is a part of the brain—hidden deep in back of our skull...literally (the amygdala) that's wired for survival, the part that senses danger and tells us to fight, flee or freeze. But at the end of the day, is a blank canvas really as dangerous as a charging animal? Definitely not.

So how do we get our nervous system to know the difference between bad fear and good fear?

​When I start to feel creative fear, I become overwhelmed and want to run. But then I remember that this is MY art! The thing that I love to do, the thing that's kept me up at all hours of the night...so why don't I want to start creating?

As a therapist, I can assure you that this is normal. I tell my clients that this on a regular basis. Creative Anxiety is the whole deal. It's your life energy, showing you what is possible. 

I get that my amygdala is my brain’s mechanism for signaling danger and that there is a vast difference between a charging tiger and a blank canvas. So, why does a pile of acrylics scare me out of the room and into the comforting arms of my couch ...especially when I enjoy the creative process so much?

Here are some strategies I’ve developed to deal with the kind of creative anxiety that stops you. When your fear starts pushing in, I suggest the following:

​Greet your fear like an old friend.
It's normal to feel fear and apprehension when you're staring a blank canvas or page and hoping for magic to happen. Resisting anxiety takes more energy than accepting and working with it.

It may sound stupid, but give your fear a name. Let's say it's name is Henry. Tell Henry: "I hear you. Come on in, but sit over there and bet quiet. I have work to do and if it doesn't come out right the first time, I'll fix it later."

Procrastinate with purpose.
Procrastination is just anxiety with a bad reputation. We procrastinate to create space between decisions. When you feel the need to run away, give yourself permission to run. But put a time limit on your procrastination so that you don't fall into a deep hole of web surfing...or as I like to call it: "researching."

Two minutes of sitting down and deep breathing can really help your productivity. All of my favorite art books are in my studio so I can turn procrastination breaks in to inspiration breaks. Sometimes opening the books can be a breath of fresh air, but keep it to a minimum so that you don't become stuck.

Spend only 20 minutes on deciding your next step.
It's easy to make excuses for not moving ahead. Practicing this rule helps work out your "creative risk muscle" and makes taking risks easier over time.

Work on multiple projects at once.
I find that working on many pieces in a kind of round-robin style accomplishes a few things. It keeps me productive when I get stuck on a piece or want to postpone a decision (20-minute rule), and it focuses me on the process rather than the product.

Working on multiple things at once alleviates any one thing of all the responsibility to be "good."

It's a commonly held belief that fear keeps us from taking risks.
Fear of rejection, fear of failing, mediocrity, disappointment keeps us in a holding pattern. But there's another fear that is at play. It is a silent, hidden fear that you may have never recognized in yourself. The next time you feel fear pushing you away from your creative work, think about this: you are running from your own potential and success. I know that it sounds nuts, but we are more afraid of our own success than of our failure.

Infidelity is the most common type of betrayal that our society focuses on, but really, it's the subtle, unnoticed betrayals that truly ruin relationships. Check this out -When partners do not choose each other day after day, trust and commitment erode away.

Partners might be aware of this disloyalty to each other, but dismiss it because it’s “not as bad as an affair.” This kind of thinking is false. Anything that violates a committed relationship’s contract of mutual trust, respect, and protection can be cataclysmal.

Betrayals are founded on two building blocks: deception (not revealing your true needs to avoid conflict) and a yearning for emotional connection from outside the relationship.

Below, I've listed three betrayals that ruin relationships. It's only by purposefully confronting and taking responsibility for them that couples are able to reestablish their trust in each other.

Emotional Cheating
It’s very easy for platonic friends to bond in the trenches of work, day after day. Sometimes we call this person a “work wife” or “work husband.” Even friendships made at the gym or local coffee shop can threaten the bond at home. These nonsexual relationships can lead to both parties sharing intimate details about each other’s lives. That sharing within a friendship doesn’t make it a betrayal. What makes it a betrayal is this: if your partner would be upset by the things you’ve shared or would be uncomfortable watching the interaction.

Joe first learns of his wife’s sexless affair when they hosted a Christmas party. Kate has never mentioned Chris, the new manager of her department. At the party, Chris seems to know about Emily’s entire life. He even brought their son Jake a the newest version of his favorite game.

Joe looks at Kate with a shocked expression. Her uncomfortable look sinks his heart. When he approaches her after the party, Kate argues about her friendship with Chris. She tells Joe it’s “nothing” because they are “just friends.” Kate then turns against Joe and defends Chris. She accuses her husband of being irrational and jealous and tells him it’s those reasons that  he didn’t know about Chris in the first place. Joe feels there is nothing irrational about his jealousy. Whether he admits it or not, his wife is cheating. The evidence lies in her secrecy.

5 signs your partner’s friendship is not an innocent friendship:

1. Has the friendship been hidden?
2. Are your questions about the friendship responded with “don’t worry” or discouragement?
3. Have you asked it to end, only to have your partner tell you no?
4. Have your boundaries been disrespected?
5. Is the friend the subject of fantasies or comments during troubled times in the relationship?

If you answered “yes” to any of the questions above, the friendship may be too intimate.

Conditional Love
Couples don’t feel supported when one partner walks the fence of the relationship. They don’t feel like their partner has their best interests at heart, that they have their back. When this happens, it’s not uncommon for the betrayed partner to blame a trigger as the real problem, when it’s actually the lack of commitment.

As Camille reflects on her first marriage, she knows she began to feel betrayed when her husband stalled on starting a family. At first she thought he was anxious about becoming a father, but in couples therapy it became clear that he was hesitant to deepen his commitment to her.

Like an anxious lover, she clung onto him with desperation, terrified of losing her marriage until she realized she never really had one to begin with. Sometimes a partner may pressure the other to marry or move in, believing that taking the next logical step will deepen their connection, but it’s difficult for a marriage to succeed if it is built on a vow to create a strong bond rather than the result of one. The shallowness of the bond will eventually leak through the connection.

Steps to create unconditional love: When couples ignore or dismiss talking about difficult issues, they are left with a shallow commitment. By using conflict as a catalyst for closeness, couples can intentionally use problems as an opportunity to discuss their goals, fears, and dreams. Couples that unconditionally love each other live by the motto, "baby, when you hurt, the world stops and I listen."

Emotional Withdrawal
Emotional withdrawal can be something big, like choosing a work meeting over a family funeral, or it can be as small as turning away when your partner needs emotional support.

A committed relationship requires both partners to be there for each other through the earth-shaking traumas and everyday annoyances. That means celebrating joys and successes with your partner, too.

Everybody has different ways of expressing themselves. In a committed relationship, it is the responsibility of both partners to uncover and disclose these preferences to understand what the other requires to feel loved, protected, and supported. Think of The Five Love Languages. In his research lab, Dr. John Gottman discovered that happy couples turned toward each other 86% of the time, while unhappy couples turned towards each other only 33% of the time. That means unhappy couples withdraw 67% of the time! Emotional withdrawal sets in when someone's bids for closeness are ignored.

Solution: To improve your emotional connection, focus on rebuilding and updating your Love Maps, cultivating a culture of admiration and fondness, and turning towards bids more often.

​Do any of the items listed above feel familiar or make you feel uneasy? If so, you may be facing a betrayal. Maybe it’s as serious as finding discomforting text messages between your partner and someone else. This list is not about who is right or wrong. Like sexual affairs, these betrayals can be overcome if you recognize the problem and repair the relationship together.

What feelings were denied you as a child?
Did your parents or caregivers say:

• “I don’t ever want to hear those words again” in response to your anger?
• “I’ll give you something to cry about” when you felt sad?
• “Don’t touch yourself there” when you experienced pleasure?
• “You don’t really feel that, do you?”—denying your experience altogether?

While some feelings may have been allowed, we’ve all experienced the discomfort of others around our more “negative” emotional expressions. This can be especially problematic in romantic relationships. In his book "Getting the Love You Want" Harville Hendrix, PhD explores “forbidden feelings” and the concept of repression. He writes: “Your angry feelings, your sexual feelings, and a host of other ‘antisocial’ thoughts and feelings were pushed deep inside of you and were not allowed to see the light of day.”

Hendrix acknowledges that the rules of emotional expression differ between men and women. Early on, we realize that what’s “allowed” for boys and what’s “allowed” for girls is clear.

Hendrix recognizes that, for boys, emotional expression or the expression of empathy is perceived as weakness or fear. Girls, on the other hand, are encouraged toward these tender exchanges.

Males learn to cut off their own emotional experiences, which, in turn, impacts their ability to express themselves clearly and to develop empathy for their partners. The cutoff that I refer to here often looks like withdrawal, leaving the more emotionally expressive partner to chase after the distant one. These interactions create a negative withdraw-pursue cycle in the relationship.

In my work with both heterosexual and same-sex couples, I have seen these patterns play out repeatedly. Men and women repress their feelings based on a host of unique factors. Factors that influence emotional repression can be traced back to early childhood. These can include influential personalities in the individual's family of origin, cultural and religious background, definitions of masculinity and femininity, trauma, the political climate, and more.

Some of my most meaningful work with a person occurs when they learn how to undo their own emotional repression. Here are some of the steps we take to help them emotionally evolve.

1. Learn Emotional Language
When repressed enough, partners lose their ability to retrieve the language or emotions. Evidence of this may include responses such as “I don’t know” or “I can’t describe it” when a person is asked how they feel. In therapy, we start small, reviewing the six most basic human emotions: anger, sadness, fear, joy, love, and surprise. But knowing the feelings is not always enough to name them  and experience them in the moment.

2. Work from the Outside In
We register our feelings in our bodies. We typically feel our emotions in our throats, behind our eyes, in our torsos (including back and chest), in our bellies, and sometimes in our legs, arms, hands, and feet. When you learn the sensations of the body you are then able to connect your experience to the learned emotional language. Heat in your cheeks might connect to anger, a lump in your throat might indicate sadness, loss of breath may connect to surprise, and butterflies in the belly or ice-cold palms may mean fear. Practice noticing your reactions to conversations and experiences, pay attention to your body, and begin to make the connections for yourself.

3. Verbalize the Feeling
Once you tune into the sensation and connect it to the relevant feeling word, you can verbalize the feeling by sharing with your partner. You can say, for example, “I’m aware that I have butterflies in my stomach and that I feel scared,” or, “I can feel my heart pounding right now; I know I’m angry and I need time to cool off.” Being able to verbalize your feelings gives you and your partner a chance to communicate about what’s fueling them and why they may be uncomfortable.

When you complete all three steps, you've begun to overcome emotional repression. You’re no longer detaching from your feelings. You’re no longer denying yourself the right to speak up about your experience. You’re allowing others to know you more deeply.

Of course, there are other feelings words, such as disappointment, loss, confusion, bewilderment, hope, excitement, and others. But for anyone who has a lifetime of emotional repression, the six most basic human emotions often capture enough to name the feeling adequately. As you become more habitual in sensing, naming, and verbalizing your emotions, consider expanding your emotional language to describe how you feel.

For those of you on the receiving end, check in with yourselves. Make sure you want what is offered. Anger, sadness, and fear are generally harder to receive than love, joy, and surprise. Sometimes, people tell me they want their partners to express themselves more fully, but when they do, the receivers struggle to take in what their partners say.

Healthy emotional communication requires everyone to be both a giver and a receiver. Reciprocation of emotional expression provides the best environment for intimacy between people to grow. If you are struggling with this, either individually or as a couple consider making an appointment with me or another qualified therapist.

Reference:
Hendrix, H. (2008). Getting the love you want: A guide for couples. New York, NY: Holt Paperbacks.

​GoodTherapy.com: How to Overcome Emotional Repression in Your Relationship