People with mental disorders more vulnerable to domestic violence

People with mental health disorders, across all diagnoses, are more likely to have experienced domestic violence than the general population.
This is according to new research from King’s College London’s Institute of Psychiatry, in collaboration with the University of

Bristol.

Previous studies into the link between domestic violence and mental health problems have mainly focused on depression, but this is the first study to look at a wide range of mental health problems in both male and female victims.

In this study, researchers reviewed data from 41 studies worldwide. Compared to women without mental health problems, women with depressive disorders were around 2 and a ½ times more likely to have experienced domestic violence over their adult lifetime; women with anxiety disorders were over 3 and a ½ times more likely; and women with post-traumatic stress disorder (PTSD) were around 7 times more likely.

Women with other disorders including obsessive compulsive disorder (OCD), eating disorders, common mental health problems, schizophrenia and bipolar disorder were also at an increased risk of domestic violence compared to women without mental health problems. Men with all types of mental disorders were also at an increased risk of domestic violence. However, prevalence estimates for men were lower than those for women, indicating that it is less common for men to be victims of repeated severe domestic violence.

“In this study, we found that both men and women with mental health problems are at an increased risk of domestic violence. The evidence suggests that there are two things happening: domestic violence can often lead to victims developing mental health problems, and people with mental health problems are more likely to experience domestic violence,” said Professor Louise Howard, senior author of the study from King’s Institute of Psychiatry.

This study is part of PROVIDE, a 5-year research programme on domestic violence funded by NIHR.

The finding has been published in PLOS ONE.

Intense Dreams May Lead to Heightened OCD Symptoms

Some people believe that dreams can predict the future. In the case of people suffering from obsessive compulsive disorder, that may be true – with a caveat. More intense dreams can predict exacerbated compulsions the next day.

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A study conducted by researchers at Hong Kong Shue Yan University examined the relationship between dreams and the reality of 594 individuals with obsessive compulsive disorder. The researchers found that certain types of dreams exacerbated symptoms and compulsions the following day, particularly dreams charged with feelings of anger, guilt, and shame. Researchers also found that dreams characterized by magical thinking, or thoughts of having a superpower or being able to control the behavior of others, also increased the symptoms of OCD.

According to Calvin Kai-Ching Yu, one of the study authors, unhappy dreams can cause the person to attempt to purify himself or herself when he or she wakes up the next morning. Feeling angry, ashamed, or guilty may prompt an individual to remove the negative feelings when they are awake. Because the anxiety may be exacerbated by these intensely negative dreams, it can cause an increased amount of compulsions.

This finding may also explain why many obsessions and compulsions begin during childhood. During adolescence, magical thinking is generally the strongest, usually because children’s level of imagination is so high. Unfortunately, Yu said in a statement, people with OCD grow up and become unable to distinguish between magical thinking and reality, prompting feelings of paranoia and other heightened anxiety.

Obsessive-compulsive disorder is a type of anxiety disorder marked by unwanted or repeated thoughts, feelings, ideas, and behaviors, which are also known as compulsions. Often the person has compulsions that he or she needs to act out in order to relieve the anxiety, but the tension relief is generally temporary. However, not acting out the compulsions can lead to great anxiety.


Published by Medicaldaily.com

Fudging the Facts, for Peace of Mind

Zadie.Courtesy of Harley A. Rotbart, M.D. Zadie.

Lou, my beloved grandfather, lived almost 101 years and obsessively worried every single day of his adult life — probably because his adult life began before it should have. As a child in Russia, he watched helplessly as his mother and sister were killed during a vicious pogrom in their village.

Lou (I called him Zadie) made his way to America, and immediately began imagining the worst about his fate, and his family’s fate, in his new country. I believe Zadie lived as long as he did because he was afraid of what would happen to his children, grandchildren, and great-grandchildren if he wasn’t here to protect them.

When I was a third-year medical student in New York City, he called from Denver very early one morning, waking me and my roommates. He had been listening to his transistor radio on one of his many sleepless nights of worry, and had heard that a Staten Island Ferry boat had crashed, injuring numerous passengers.

There were more than seven million people in the city, and Zadie called at 4 a.m. to make sure I wasn’t one of those injured. It was from him we learned the importance of telling white lies and omitting certain truths with our elderly parents and grandparents.

Before accusing me of infantilizing and patronizing my older family members, hear me out. Anxiety disorders can be debilitating for the elderly. A comprehensive review of the subject found 10 to14 percent of those 65 and older meet the criteria for these diagnoses, a significantly higher figure than for the more widely recognized depression syndromes in the same demographic.

Indeed, depression and anxiety disorders often occur together. Anxiety disorders are underdiagnosed in the elderly, largely because the symptoms are often assumed to be just another manifestation of aging. Additionally, the clinical assessment of the elderly for anxiety is more complicated than for younger patients because the signs may differ from those classically described in the diagnostic manuals.

A large national study showed an increased incidence of general anxiety disorder beginning after age 55, and the National Alliance on Mental Illness notes that, like depression, obsessive-compulsive disorder tends to worsen in old age. Factors contributing to the prevalence and severity of anxiety disorders in the elderly include a host of concomitant medical problems that interact with anxiety in a complicated way.

From the review article cited earlier:

The co-morbidity between medical illness and anxiety disorders poses difficulties for…diagnosis and detection of anxiety. Researchers have suggested that older adults may be more likely to attribute physical symptoms related to anxiety to medical issues… In turn, many physical conditions, such as cardiovascular disease, respiratory disease, hyperthyroidism, and pulmonary and vestibular difficulties, can mimic the symptoms of anxiety…making it difficult to establish the underlying cause…

Furthermore, the symptoms that result from medical illnesses may produce fearful bodily sensations that may result in the subsequent development of anxiety disorders.

As an example, more than 40 percent of patients with Parkinson’s disease meet the criteria for an anxiety disorder. Dementia is also associated with anxiety in a bidirectional way — anxiety can accelerate cognitive decline, which in turn can increase symptoms of anxiety. Added to this morass are the side effects, which can include anxiety, of many medications taken by older patients.

The elderly clearly are an at-risk population for anxiety disorders. Which brings us back to white lies. Zadie’s well-earned anxieties, obsessions and worries accelerated greatly as he got older, and we realized they could largely be prevented if we simply didn’t share the complete truth with him all the time. This became known in our family as the Zadie Filter.

When we took our children to the mountains, we told him we were headed to Colorado Springs; he’d been to Colorado Springs many times and knew it was a flat highway drive from Denver. No high mountain passes or narrow roads without guardrails.

When he begged my sons to become doctors so they would serve behind the front lines in the event they were drafted (this was long after the military draft ended, which was still not reassuring enough for Zadie), they so promised. When our daughter started driving, Zadie warned her it wasn’t safe for a girl to drive alone in case she had car trouble; she promised she would always have company in the car.

Zadie died when his great-grandchildren were still teenagers, and so he never had to know that the boys didn’t go into medicine and that his great-granddaughter drives alone.

My mother, Zadie’s daughter, inherited his anxieties, and as she has entered her mid-80s her symptoms have also markedly increased. On the other side of the family, my mother-in-law’s issues with anxiety began with her Parkinson’s disease and have worsened as her neurological condition has progressed.

With our mothers, we also rely on the Zadie Filter. Our white lies and omissions reduce their worries — which is not to say we can protect them from all triggers (they still read the newspaper and watch the nightly news), but even a bit of relief for them is relief for us as well.

Our parents live for the most part on fixed incomes, so when we’re able to cover some of their expenses without their knowing, we do so, and they worry a little less about their bills. All it takes is a little white lie: “The apartment manager waived your heating bill this month because you’ve been such a good long-term tenant,” or, “Of course I used your credit card when I paid for your medicines.”

My mother accidentally found out that our son broke his finger (playing flag football during finals week!) when a well-intentioned friend asked her how her grandson was doing after his injury. She was upset we hadn’t told her — but only for a few moments, until we explained that it had happened a week before, that he was all splinted up and was in no pain. All of which was 100 percent true, and she didn’t lose a minute of sleep worrying about it.

Last week, after pressing our law student son (he of the broken finger) about a school transcript issue I’ve been worried about for him, he assured me it had been taken care of. Our daughter in grad school goes into bars only when she’s with a large group of friends, and our college son is the designated driver for all of his fraternity functions.

And so it begins.


Dr. Harley A. Rotbart is professor and vice chairman of pediatrics at the University of Colorado School of Medicine and the author of “No Regrets Parenting.”

Shame and Anger Are Common Dream Themes for Obsessive Compulsive

December 14th, 2012

 
 
 
 

01-Therapy-News-Banner-03Research on obsessive-compulsive (OCD) tendencies has suggested that anxiety is prevalent in most cases. Anxiety-related stress is at the root of the majority of compulsions, and individuals with OCD engage in ritualistic behaviors in an effort to alleviate feelings of anxiety derived from obsessive thoughts, visions, or emotions. Additionally, anger, shame, and magical ideations propel anxious emotions and drive compulsive behaviors in OCD. Although magical ideas are markers for schizotypal issues and not OCD, they may still play a significant role in the manifestation of symptoms.

Calvin Kai-Ching Yu of the Department of Counseling and Psychology at Hong Kong Shue Yan University recently led a study that explored how these factors influenced OCD in a sample of 594 individuals. He also looked at dream experiences and how emotional valence during dream states affected waking behaviors and symptoms of OCD. “The overall findings substantiate the notion that individuals with high obsessive-compulsive distress tend to dream certain themes more frequently,” Yu said. In fact, he found that the individuals who experienced dreams that had strong emotional messages, those that were charged with feelings of guilt, shame, and anger, had increased waking compulsive behavior. Additionally, magical thinking, believing that one had super powers or could control other people or things, also elevated OCD symptoms. Yu believes that dreams that are filled with malevolent content can prompt people to try to purify themselves during waking hours. Individuals who feel especially guilty, angry, or shameful about imaginary things may become obsessed with finding ways to remove their negative feelings while they are awake. The conscious level of anxiety they feel during the day, caused by obsessive magical thoughts and negatively toned dreams, can lead to increased compulsions.

Yu theorizes that most of these obsessions are first developed in childhood, when imagination knows no limits. As individuals with OCD mature, they are unable to distinguish between magical thinking and reality when it comes to emotions and behaviors. Feelings of paranoia and other heightened states of anxiety resulting from magical thoughts and unrealistic dreams consume these individuals during their waking hours, making the sole mission of their lives to achieve a state of harmony, absent of anxiety, guilt, anger, or fear. Yu hopes that these most recent findings draw more attention to the way dreams, especially those of anger, affect anxious feelings in individuals with OCD.

Reference:
Kai-Ching Yu, C. (2012). Obsessive-compulsive distress and its dynamic associations with schizotypy, borderline personality, and dreaming. Dreaming. Advance online publication. doi: 10.1037/a0030791

© Copyright 2012 by www.GoodTherapy.org Concord Bureau – All Rights Reserved.

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The agony of OCD

Alarmingly, left to its own devices, OCD can escalate to the point where sufferers think that the most minor thought, action or act of negligence may cause mayhem to themselves or others. This, in turn, induces ritualistic behaviour. “One person I treated was getting up at two in the morning to do all the cleaning rituals before packing up his car with his TV, iron, microwave – anything that plugged in – so he knew it wasn’t left on at home, then driving to work several times in order to finally get there around 9am,” says Simon.

Living with Generalised anxiety disorder: ‘My mind whirrs continually …

Generalised Anxiety Disorde 300x225 Living with Generalised anxiety disorder: My mind whirrs continually   negative thoughts compete for space

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“Nothing is to be feared but fear [itself].” Sir Francis Bacon knows nothing of the importance of his words to my life – this year alone, I’ve stated iterations of his quote (to myself) more than I’ve used any other words in the dictionary.

My problems began in summer 2011. After three months of blood tests, scans and invasive procedures, I was diagnosed with a rare, incurable cancer. The summer passed in a blur of shock, denial and fear. It quickly became apparent that I had two major problems to tackle – the cancer with accompanying treatments and the severe anxiety that would run alongside it, eventually becoming the more malicious of the two evils.

I’ve suffered bouts of ‘normal’ anxiety throughout life – who hasn’t? However, after my cancer diagnosis I began to experience a heightened state of fear almost constantly – it just wouldn’t leave me alone. After an intolerable amount of panic attacks and the realisation that I was becoming a recluse, I began cognitive behavioural therapy. Mid-way through, the psychologist diagnosed me with Generalised anxiety disorder (GAD) with obsessive compulsive tendencies, post-traumatic stress and panic disorder. And I thought the cancer was complicated! Labelling them didn’t matter to me as they all contributed to each other, feeding the anxious beast in my mind.

Perhaps I should have expected this but at the time I was otherwise consumed with all the fun and games of cancer treatment, and it didn’t really occur to me that my feelings were escalating out of control.

Fast forward through many panic stricken days to May 2012 when I was deemed a medical miracle – although not cured of cancer, the doctors hadn’t expected me to respond so well to treatment. My life was to become my own again, allegedly. I should have been euphoric, singing from every rooftop in London. I just felt awful – I may have won a battle but the war was just beginning.

Currently a typical day begins with strong feelings of dread and doom on a spectrum ranging from mild to horrendous, characterised by the feeling that ‘today is my last’. I’ll spend (a lot) of time wondering whether I’ll choke on my breakfast; trip over the cat and break my neck; whether my partner will be hit by a car and other such niceties.

The physical symptoms are always there – the crushing feeling in my chest, the difficulty swallowing, the hyperventilation and the dizziness. My mind whirrs continually – negative thoughts compete for space in the dusty loft of my memory lobe. Panic releases adrenaline into my body – I’m always in ‘fight’ mode. Unfortunately when the fight is against an antagonist that is unseen to all and extremely unpredictable, it’s very difficult to win even one round.

GAD is a difficult thing to explain rationally, especially when you’ve been a fully functioning member of society. I try to keep my sense of humour when explaining to loved ones that I am sometimes controlled by a ‘beast’ and that, yes, weirdly, I have degrees of both agoraphobia and claustrophobia.

I fear most forms of transport, being alone in my house, being outside in a crowd, choking to death/drowning/being murdered and the impact of this leads me to feel there is no purpose to my life. GAD is an illness of peaks and troughs – one day I can feel fabulous, the next dreadful. The continual not knowing is a very difficult thing to accept and however hopeful I am one day, GAD quickly slams me back down to earth the next.

I would be so very grateful to wake up without the doom-filled prophecies, leave my house with a jaunty whistle, hop on the train, go to work, sit in a meeting with my colleagues without feeling like the walls are collapsing in on me, walk down the street without clinging to a person/fence/bollard, have lunch without wine to calm the nerves, not jump out of my skin when I hear any loud noises. All the things I used to do without even thinking.

I’ve tried various anti-anxiety drugs and alternative therapies with some degree of success. Positive mantras used to be an alien subject to me but are now a daily habit. Music rates highly on my list of things to make me feel better. Crying is unfortunately a regular occurrence but it’s a good way to release tension. I’m currently undergoing treatment called Eye Movement Desensitisation and Reprocessing which I am hoping will make a difference in the long term.

It’s interesting that although one in 20 people have GAD, I’ve yet to meet anyone (outside of anxiety forums) who really talks about it – I think anxiety is still a taboo subject. I am really appreciative that Anxiety UK is trying to rectify this by raising awareness with this video (below). I hope it helps people talk about anxiety a bit more, so that we can try to beat this malevolent enemy.

For more information about anxiety visit www.anxietyuk.org.uk

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Is autism a link to violence





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Investigators are still working to learn more about the Connecticut killer, 20-year-old Adam Lanza.

According to a mediator who worked with Lanza’s parents during their divorce, the young man had an autism-related disorder called “Aspergers.”

Mental health experts say there is no connection between the disorder and violence.

Aspergers is a mild form of autism often characterized by social awkwardness.

According to Julie Miller, an autism specialist, people with autism do have a higher rate of aggressive behavior, outbursts, shoving or pushing or angry shouting.
However Miller says it’s not the type of planned and intentional violence we saw in Newtown.

“There’s something else that happened that caused such an unspeakable act, ” says Julie Miller, Director of the Autism Center in San Luis Obispo. “But typically individuals on the autism spectrum are the victims of crimes, they don’t perpetrate crimes.”

She added that people with autism are all unique and cannot be lumped into a single category.

Mental health professionals also say those with autism and related disorders are sometimes diagnosed with other mental health conditions such as depression, anxiety, or obsessive compulsive disorder.

Leading many to believe what happened in Connecticut may have more to do with other mental health issues Adam Lanza was experiencing.

According to the Centers for Disease Control and Prevention, autism now effects one in 88 American children every year.

7NEWS – Experts: No link between Asperger’s, violence – News Story

NEW YORK – While an official has said that the 20-year-old gunman in the Connecticut school shooting had Asperger’s syndrome, experts say there is no connection between the disorder and violence.

Asperger’s is a mild form of autism often characterized by social awkwardness.

“There really is no clear association between Asperger’s and violent behavior,” said psychologist Elizabeth Laugeson, an assistant clinical professor at the University of California, Los Angeles.

Little is known about Adam Lanza, identified by police as the shooter in the Friday massacre at a Newtown, Conn., elementary school. He fatally shot his mother before going to the school and killing 20 young children, six adults and himself, authorities said.

A law enforcement official, speaking on condition of anonymity because the person was not authorized to discuss the unfolding investigation, said Lanza had been diagnosed with Asperger’s.

High school classmates and others have described him as bright but painfully shy, anxious and a loner. Those kinds of symptoms are consistent with Asperger’s, said psychologist Eric Butter of Nationwide Children’s Hospital in Columbus, Ohio, who treats autism, including Asperger’s, but has no knowledge of Lanza’s case.

Research suggests people with autism do have a higher rate of aggressive behavior — outbursts, shoving or pushing or angry shouting — than the general population, he said.

“But we are not talking about the kind of planned and intentional type of violence we have seen at Newtown,” he said in an email.

“These types of tragedies have occurred at the hands of individuals with many different types of personalities and psychological profiles,” he added.

Autism is a developmental disorder that can range from mild to severe. Asperger’s generally is thought of as a mild form. Both autism and Asperger’s can be characterized by poor social skills, repetitive behavior or interests and problems communicating. Unlike classic autism, Asperger’s does not typically involve delays in mental development or speech.

Experts say those with autism and related disorders are sometimes diagnosed with other mental health problems, such as depression, anxiety, bipolar disorder or obsessive-compulsive disorder.

“I think it’s far more likely that what happened may have more to do with some other kind of mental health condition like depression or anxiety rather than Asperger’s,” Laugeson said.

She said those with Asperger’s tend to focus on rules and be very law-abiding.

“There’s something more to this,” she said. “We just don’t know what that is yet.”

After much debate, the term Asperger’s is being dropped from the diagnostic manual used by the nation’s psychiatrists. In changes approved earlier this month, Asperger’s will be incorporated under the umbrella term “autism spectrum disorder” for all the ranges of autism.

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AP Writer Matt Apuzzo contributed to this report.

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Online:

Asperger’s information: http://1.usa.gov/3tGSp5

Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Experts: No link between Asperger’s, violence

What is obsessive compulsive disorder?

Anyone who’s seen As Good As It Gets has a basic idea about what an Obsessive Compulsive Disorder is, broadly.

“My son keeps on and on washing his hands in the bathroom,” said a confused father to Dr Kersi Chavda at the P. D. Hinduja Hospital MRC, Mumbai. The father came to consult the doctor for his 12 year-old-son. “He has to wash in a particular way, and has to count the number of times he soaps himself. He refuses to open doors holding door handles, unless he has a tissue in his hand, he thinks the handle is always dirty. Again, after locking the doors at night, he locks and unlocks them seven times, and then comes and repeats the entire process to his mother verbally; the parents were literally going crazy.” Dr Kersi’s diagnosis confirms the problem to be Obsessive Compulsive disorder.

Obsessive Compulsive Disorder (OCD) is the second most common psychological disorder nowadays. Part of the spectrum of anxiety disorders, it can drive people to anger and despair, wreck marriages, and be a source of sadness to the care-giver as well.

Dr Kersi explains Obsessive Compulsive Disorder: “An obsession is a recurrent thought, idea or image which causes anxiety, for example ‘My hands are dirty’, this anxiety causes the person to do whatever he can to alleviate the feeling and often in the process of reducing his anxiety, he finds that he has done a particular recurrent action which has helped. This recurrent action then becomes the “compulsion”, and almost invariably is ritualistic, i.e. it has to be performed in a particular manner. Thus ‘I have to wash my finger tips, then the palms, then up to the wrist and then my arms’ becomes a compulsion every time the patient head to the tap. One would continue the action until he/she is convinced that they have done it their way.”

The commonest Obsessive Compulsive Disorder involves cleanliness, checking or counting and religion and often the tenor of these images themselves can be very frightening to the person concerned. “No one enjoys having this problem. Often one is aware that the thoughts and actions do not make sense, but there is still tremendous resistance to change and control of the ritualistic actions,” adds Dr Kersi.

Obsessive Compulsive Disorder Treatment includes relaxation techniques, delayed gratification, supportive therapy and the use of specific medication which break the Obsessive Compulsive Disorder cycle. In severe intractable cases, psycho-surgery is performed.

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Tara Fass: Why Is Therapy Like a Toxic Dump?

What is therapy? As a therapist in Los Angeles, I’m asked this a lot. One patient likened therapy to “emotional vomiting.” Another likened it to cleaning out her “junk drawer,” another to “connecting the dots” on his life and yet another to a “dress rehearsal.”

Kidding aside, may I also suggest that therapy is a place to unload a “toxic dump” in the office and, by doing so, clear your path in the real world? Therapy is not to be confused with mere complaining. What you can more safely experience in the office (that which feels broken and unsafe outside) and leave it between us, therapy then becomes a safe place and a bridge to new ways about thinking and feeling, instead of just reacting.

Whatever rift was created in your relationships must be repaired through tolerable interactions with another human too, in this case your therapist. That’s why in-person therapy is by far the best mode of contact, though other modes of communication such as the telephone, texts, email, etc. are also handy. There is a quality of being “all in” by meeting in person for therapy sessions, which is not to be underestimated.

Weeping, breaking down and muddling through your complaints in the presence of a third-party trained to help you pull it together again can be highly rejuvenating and refreshing. Yet finding the right one can be challenging. When reaching out to therapists you may want to work with keep in mind a few practical considerations in addition to their theoretical perspective and training: Do you want to commence therapy with a man or a woman? What age range do you want your therapist to be?

You may have some rather unconscious criteria too that may sound outlandish stated out loud, such as: Are you afraid of or looking to feel you’re with an idealized version of your mother or father? Is there a desire, perhaps, to fall in love with your therapist? Does a therapist’s voice or photo repulse, thrill or scare you? These are emotions and questions that might come up in you to pay attention to.

Maybe you want to choose a therapist who might be tempting in these or other ways. In any case, to keep it interesting (and if your therapist doesn’t pick up on it first and address it) see to it that you bring all of this into the treatment room as soon as possible. The experience of therapy will be compromised if what feels forbidden or poisonous is avoided and suppressed. Remember, thinking and talking about what is awful is okay in a way that acting out in shameful ways is unacceptable.

How fast should a therapist call back after you make the initial call? It’s simple: the sooner probably the better, even with a second call-back in round two of telephone tag. You want a therapist who is flexible and responsive, and one who also holds strong boundaries.

Think about how the professional makes you feel personally. Rarely does anyone reach out to a therapist expecting a day at the country club. You are likely up to your armpits in deep suffering. Previous attempts at figuring out your issues have not been working, even though you may be meditating, going to yoga, reading all sorts of self-help books, and talking endlessly with close friends and family. You’re still a hot, melting-down mess, longing for resolution and somewhere safe to unload a toxic dump.

Is there a real person — a therapist — who you can make a connection with and who is trained to help you squeeze through what feels like a dark and narrow passage? Though this entire blog post may sound like advice, good therapists strive to steer clear of giving advice. They help you sit with discomfort and contain your symptoms long enough — whether it is anxiety, depression or obsessions and compulsions — to make it possible to feel and think rationally so that you can sort out what is going on, heal and self-correct.

The benefits of therapy are nice “work” if you can get it. The effort to figure out your conflicts and motivations on a comfortable couch in a nicely-decorated office with one other person, rather than unloading on your loved ones and friends, may be well worth the effort.

For more by Tara Fass, click here.

For more on mental health, click here.