Please tune in NYE (adjust for time zone) for another installment of "Subservient Chris" http://ping.fm/jkHuK

I'm so glad I topped off my partying with a 1/2 can of Diet Coke! Happy B-day Dr. D, http://ping.fm/g355v

Doing what I love today: helping people, writing, and getting ready to celebrate friends. How do you ring in the New Year?

Start the partying countdown to NYE. Wishing Dr. D a Happy B-day today, plan on filming Space Needle fireworks from West Seattle's Alki.

Just in time for the holidays - pay-per-session eTherapy from home

After accompanying a friend to the doctor's office, it dawned on me that the more people have control of their own health care, and the more well-timed that care is delivered, the healthier the person and the more likely he or she can make decisions to prevent illness and promote wellness.

Quick Question Consult (that's me!) is going to keep taking quick questions for free, to help you in a pinch. But I'm also adding the convenience of a pay-per-session eTherapy option: you can choose from 90 minutes, 60 minutes, or 30 minutes of therapy for a specific issue that needs the attention of a professional, without having to leave your house. I'll conduct your visit by phone, Skype, email, chat, or a combination of all of these to help answer your question.

I hope this addresses the needs I'm seeing out there: winter blues, holiday stress, relationship stress, compulsive decision-making, and mild depression and anxiety that can be addressed without medications or long-term therapy.

By clicking on the Paypal button and selecting the amount of time you wish to purchase, I can deliver professional eTherapy in a timely manner. This is not new: eTherapy (a.k.a. tele-shrinking) has been around for almost a decade now. What I think you will enjoy is being able to get your issues addressed when it means the most to you. No more long waits, no inconvenient commuting. I have been doing Skype and phone sessions with clients over the past years, and all of them attest that it works.

The difference in price per session is $10, which would be all the paperwork and progress notes, filing fee and processing that occurs in my physical office.

Like it? Know someone who can use this service? Please share this post with others, post it on your social media websites, and help me get the word out. Remember, eTherapy can be conducted across state lines. You can also purchase time for friends and family members who wish to have someone to discuss a confidential issue. A listening ear makes a wonderful gift.

I had a dream with my Grandma in it

Quick Question: I had a dream w/my grandma in it & she was worried about something I had told her. Does she not want me to do it or is it my own doubts? It was about something I have felt guilty about doing but haven't done yet.

Quick Question Lady Answers: First of all, apologies for getting back to you so late. I have been on vacation (yep, even counselors need to unplug, have a change in scenery, etc). I hope to bring more perspective and freshness to all the things on my plate.

Dreams are really interesting to consider, and there are so many ways to interpret them. The style I like is to ask you a series of questions, rather than for me to peer into your dream and try to map it to a list of symbols. I don't know you like you know yourself, and so you are the key to the interpretation of your own dream.

Who is your grandmother to you, besides being your grandmother? Is she a lot like you? Do you admire her? Do you wish to be like her? Is there a part of her in the dream that is also you (Jungian theory on dreams seems to suggest that we are every character in the dream).

Where is the guilt coming from? Have you talked over whatever this action is, objectively, with someone you trust? Is the action worthy of guilt? If so, what do you want to do about it?

What does it mean to have your grandmother know about either your actions or your thoughts? She is another set of eyes, but does it have a deeper meaning (i.e. shame, self-doubt, lack or validation, fear, etc)?

Lastly, as the Dreamer, what does the dream seem to be saying to you? There may be the obvious implications. Are there some less obvious ones that have come out since you had the dream?

As a follow up, you may feel that there was more to the dream you'd like to explore. Before sleeping, try giving yourself permission to go back to the dream and explore what else might be there. It is possible to finish the dream or encourage it play out a bit further.

Good luck!

Quick Question Consult Lady

What do you do when you wake up everyday hating life?

Quick Question:

What do you do when you wake up everyday hating life? Nothing seems to work out in my favor ever. I wake up sad and down and just miserable. I cry every single day. What do I do? Is this something that I might need extra help with? Meaning anti-depressants. I just feel so lost - dazed - confused - lonely.

Quick Question Consult Lady Answers:

The fact that you have identified clearly that you feel lost - dazed- confused - lonely -- tells me that you know something is wrong -- that feeling this way for long periods of time, "crying every single day" isn't normative for you. Although life can be have many moments of really tough struggles, tragedies, and mishaps feeling miserable shouldn't be the "norm". I think you know there is something more than this.

In terms of what you can do: if you don't already know this for sure, you should figure out if you have a clinical depression going on, and whether that depression is linked to particular "triggers" (events that caused that pattern of thinking and feeling), or if this is a long-standing depression that seems like it has been with you all your life. Some depressive moods respond to treatments that don't involve psychotropic medications (i.e. anti-depressives). If you are suicidal or have repeating thoughts of harming yourself and you don't want to "give in" to those thoughts, I highly recommend you to call your doctor's office or find a therapist you can talk to, IMMEDIATELY.

If you aren't suicidal and you have a little bit of energy, you can do some things to boost your mood: eating nutritious food, moving your body around, getting a little sunshine (Vitamin D), listening to music you enjoy, engaging in an activity that makes you feel hopeful, taking supplements like Fish Oil, and talking to a good listener who won't judge you negatively for how you feel can all be helpful approaches. Even if you need the excuse of walking your dog (or someone else's dog!) in order to move you around the block outside, use that excuse.

Some things to keep in mind: are your feelings about hating life associated with the end of relationship (partner, friend, job, family, a death, trauma)? If so, is there something there unresolved that can be explored so you can start some healthy grieving and recovering?

In terms of knowing if you might need extra help: a good rule of thumb is this -- if you have tried everything you know, and nothing has worked to change how you feel, AND you find that you aren't functioning well in other aspects of life, you have nothing to lose by changing what you are doing by getting professional help. If you simply continue to do what you have been doing without positive results, it begins to feel even more pointless to try. Having another set of eyes -- and another heart! -- right there with you can be very cathartic, restorative, and hopeful.

If you have private access to a computer and/or phone line, consider giving me a call or an email. All contact info is on my website, www.seattledirectcounseling.com. I may be able to get you resources even if you aren't in my area. My purpose help you get what you need to feel better ... and soon.

Good luck!

Quick Question Consult Lady

What do you think about someone who says he/she wants to change?

Quick Question: When somebody says that they want to change & you do see small steps of that happening. What do you do when they fall off track again & hit rock bottom. Do they want to change when they say it? Or are they just telling you what you want to hear? Do you believe them?

Quick Answer: That's a challenging question. Thanks for posting [insert brow furrow and hands rubbing together in anticipation].

Change is often compared to death. "Change or die" was one of the mottos floating around the hallways of my graduate school. It certainly applies to organizations as much as it does to organisms.

Essentially you are asking about the reasonability of trusting someone after that someone has indicated that sh/e wants to change but has an "opps, I did it again". Without more of the context of your question, it would be too difficult to weigh the factors of that person's intent when sh/e told you sh/e wanted to change. Whether or not you should believe that person is going to be based on a number of factors:

1) your own issues with trust

2) the person's recent "track history"

3) the level of violation involved with this person's "rock bottom" experience.

For example, if a chemically addicted individual tells me in session that she hasn't taken a drink or taken drugs for one year and I see that this is true, I will have a higher level of trust that this person wishes to change in the direction of staying clean and sober than if she had only been clean and sober for one week (track history). I also would assess my own history of trust -- in my case, I have had so many clients not tell the truth because it is so difficult to do so, I often assume that they hide the truth anyways (example of understanding my own issues with trust). If a person has a complex cycle of addiction, compulsion, or shame involved with the "rock bottom" experience, there is a high degree of violation involved that may play into whether or not the person can change without very intentional intervention in the change process.

If the change is more on the relational level or about elements of one's character or personality, change can be slow. It may make more sense to re-evaluate whatever timelines or expectations are involved. A messy person, for example, doesn't usually become a clean person overnight.

The person may be telling you not only what you want to hear, but also what sh/e wants or needs to hear about him or herself. We really do want to believe that we can do good, that we can be good, and that others will be pleased with us. This is a noble and beautiful thing, and the desire to change can be acknowledged. But I would encourage that person to take it one step further and identify the small and large steps that would bring that change to life. Wanting to change and actually changing are two different things.

Best of luck to you! Let me know if this post helped.

Why am I not losing weight?

Quick Question: I am a woman in my mid-thirties, and I have struggled with my weight pretty much as long as I can remember. I am about 60 pounds overweight for my height. About eight months ago, my fitness trainer put me on a strict diet that restricts my starchy carbs as well as over-all calories from fat and sugar. My intake is close to 1200 calories a day. After exercising four times a week and being on the most boring diet ever, not only am I hungry all the time, but I've lost less than 10 pounds. Why am I not losing weight?

Quick Answer: First of all, I commend you for your attempt to use diet and exercise first for a lifestyle change that normally should encourage weight loss. Weight loss is a more complicated field than most of us imagine. We can't simply abstain from food like one can from alcohol or cigarettes. We need food, and we need it regularly, in order to function efficiently and effectively.

From the get go, the diet you have been placed on sounds not only too restrictive, but unsustainable. Even if you were to achieve your weight loss goal, you would not be able to sustain this level of eating. Normally, you must actually eat more calories - and the right ones (fiber, protein, and good fats) -- to lose weight up to 3 - 5 pounds a week on average. Since you have lost less than ten pounds in eight months, I would hazard a guess that you have a problem with your metabolism. Find a doctor you trust, and run a battery of tests for everything from thyroid problems to Metabolic Syndrome. I am 99% sure that if you followed that restrictive diet for that length of time with little weight loss, something will come up in these tests to show you WHY. From there, a nutritionist will help you create a more sustainable diet. You may find your workouts to be more comfortable, and you may sleep better as well.

On the mental health side: there is a lot that goes on inside about food, eating, and appearance. My background is rooted in working with people with Eating Disorders and Eating Issues. I would recommend talking to a therapist with this kind of experience to help you determine what a healthy relationship with food and a realistic body size would be for you, if you haven't done that already.

Best of luck to you!

Quick Question Consult Lady

How do I get rid of feelings that I may never be good enough for somebody else?

Quick Question: I lost my boyfriend to a suicide almost 1 year ago & I'm now seeing sombody else. I know my boyfriend loved me but can't help to think & feel that I was not enough to make him happy enough to stay in this world and so now I can't help but feel that I will never make anybody happy and/or be good enough for somebody else. How do I get rid of those feelings?

Quick Answer: First of all, my condolences to you for your loss. I can only imagine that you still miss him and grieve his death. At the same time, his death must also affect your new relationship in profound ways.

My standard answer is to seek professional help, teasing through all the pieces of insecurity that are intensified after a suicide. Likely, you have your insecurities about your ability to love or to be "good enough" that all of us have, but on top of that you have to deal with feelings that if you had just been good enough, or if you had just been loving enough, your boyfriend would have chosen not to take his life.

A good therapist will keep reminding you to consider that this last part is a myth. A suicidal person who does not seek professional intervention will likely make a suicide attempt because of his own sense of hopelessness and despair. He can only borrow the function of another person for so long. You could of -- and very likely are - been absolutely loving and nurturing, and yet he still could have - and did - taken his own life. Therapy can also involve your new boyfriend, and the sessions can help him become a part of working through your feelings without him needing to solve them.

Part of what will help is to evaluate benchmarks: that is, go back in your history with various people (family, friends, and boyfriends) and name the times you have demonstrated love. Recall also how that love was positively received. I bet you can think of times when you know you are a loving human being. Do the same thing towards benchmarks of being good, and how that was received by yourself and others. Benchmarks will help you have a more realistic view of your abilities, so when the feelings come up, you can sort through them with a sense of reality.

Feelings are like ocean waves. They peak and trough, but you notice that they aren't going to swamp you. When you have these feelings, look for validation for what may be really true -- that you are worried about your present relationship and all the thrills and fears that come with it, especially if you are feeling happy with the relationship.

Finally, talk to your boyfriend about these feelings, asking that he just listen and not have to soothe your feelings for you. If he's in the right space to do this, he can reflect your feelings back to you and give you feedback on how he perceives your ability to love and to be good enough.

Good luck.

Quick Question Lady

I struggle with depression, but I don't like anti-depressant medication.

Hi Folks, thanks for checking in on my blog, Quick Question Consult. I've been away and then dropped into a ton of things that begged for my attention, but here's a post for you!

Quick Question: I struggle with chronic depression, but I don't like anti-depressants. I'm not even convinced that they work beyond the placebo effect. What are effective alternatives?

Quick Answer: I haven't had a single client in 10 years who hasn't wanted to either stop taking their anti-depressant medication, or hasn't had major reservations about trying them. In my experience, the selection and dosing of psychotropic medications can appear to be more of an art than a science. Check out this article that a friend recently sent me:

http://articles.mercola.com/sites/articles/archive/2008/09/30/best-kept-secret-for-treating-depression.aspx

In the article, this doctor reiterates what I've been telling my clients for years: exercise is one of the most effective ways to treat depression. Along with other elements of treatment (psychotherapy, Omega 3 fatty acids, vitamins like Vitamin D and sunlight exposure, good nutrition and adequate rest), exercise is a vital component of what I advocate for those who are depressed.

The problem is, most depressed people complain that they can't find the energy to get up and go to the gym. So I make it simple. "Can you turn on the radio or your favorite vigorous and upbeat CD, and dance around your room while you dress, make your breakfast, or get ready for work?" Even 10 minutes of movement to happy music can make you feel better by increasing seratonin production and uptake, elevating mood with a flood of endorphins, and increasing your respirations so you are oxygenating properly (in the yoga world, we refer to this as pranyama).

My favorite way to beat the blues is to dance to a beat. If you can't find the energy or the will, let the music find it for you. Put the CD on and let the music lend you the will to move around.

Of course, it's always sensible to check in with your doctor before engaging in any exercise program. Music and dance is just one of those things that is accessible to everyone, and you'll find you have less excuses if you give yourself permission to engage in kitchen and living room dancing.

Good luck!

Quick Question Lady

Wanna get hired? First, talk to a therapist...

Quick Question: I want to get hired for a job but there is a lot of competition. What can I do to give myself an advantage and "stand out" in a crowd?

Just a little PA on getting hired... check this article out. 

http://www.facebook.com/ext/share.php?sid=112359425688&h=zLpaK&u=VBquC&ref=mf

It is completely legitimate for corporations to ask prospective employees to take tests given by psychologists. It is also your choice to seek a therapist for brief therapy to give you the upper hand before you meet with an interviewer or take those tests and measurements. 

In the age of technology, it is entirely possible to conduct a few Brief Counseling (insight oriented, goal oriented, and time-limited) therapy sessions to help focus you as to what you bring to the table at your interview -- AND to do this over the phone or through emails (provided you sign paperwork explaining to you the risks and benefits of using technology as it relates to confidentiality). 

A therapist can give you feedback as to how you come across to another person, even if the content of the interview and the job specifications are unfamiliar. We are, of course, in the business of reading and observing emotions, behaviors, and unspoken communication, as well as verbal communication and facial expressions. These days, businesses are not only hiring people who can do the work; there are plenty of people available for the amount of openings. They are also looking for people they can get along with and that they perceive their other employees and/or customers will be able to relate to. 

If you can't afford this option, there are many books on the subject of preparing you for an interview, and these can be checked out of your local library. Here's just two:

http://www.amazon.com/Complete-Q-Job-Interview-Book/dp/0471651257

http://www.amazon.com/Interview-Rehearsal-Book-Deb-Gottesman/dp/0425166864

At a minimum, you should sit with a friend who has hired employees for his/her job, and do a couple of practice run throughs, including what to wear (i.e. first impressions), body language, handshake (firm grip, don't pump), eye contact, exuding confidence without arrogance, and knowing how and when to ask questions. A lot of preparation is spent on convincing employers that you are technically and academically qualified for the job, so if you've gotten an interview lined up, you can know that everyone else who is being interviewed is also qualified. What they will also be looking for is your EQ or Emotional Quotient: that is, how "intelligent" are you on an emotional or relational scale? Also referred to as the "soft side" of management, this is a two-way street where both employer and employee are checking each other out for the more gratifying aspects of the work environment, such as friendliness, open-mindedness, ease of being, relationship skills, and work-life balance qualities that cause most of us to "connect" or "synch" with others. 

There are some standard questions that are always asked about your experience and your perspective, and you should practice being watched as you answer these questions, especially as they pertain to your former place of work. If you cannot get with someone right away to practice and observe you, you should get in your best lit bathroom and practice in front of a mirror, noting any nervous behavior and figuring out how to keep yourself calm and friendly. If you have a digital camcorder, film yourself for 10 minutes, no notes, just cue cards with questions that you believe will be asked during the interview. 

I hate to say it, but one truth is that the good-looking and the friendly people tend to get hired over the workaholics who are not easy to work with. It will be easier if an interview can see you smile, answer intelligently, and have a sense of appropriate humor. 

Quick Question Lady

What are some healthy ways to move on after a breakup?

Quick Question: What are some healthy ways to move on and let go after a breakup?

Especially if you're having trouble (after over 6 months) moving on
and letting go.

Quick Question Lady Answers:  First of all, let me say that I think breakups are really really tough. Almost all of our problems can be traced to some kind of relational break, and feelings of abandonment, loneliness, and insecurity about our ability to love and be loved can cause us to shake down to the bone. For whatever your circumstances, my heart goes out to you.

Since you asked for some healthy ways to move on and let go after a breakup, I'm going to put my "coaching" hat on and give you some tips from my toolbox for after the break up, plus a time line to see if it's time for something a little more "ramped up" in your "moving on" phase.

1. Revisit. Try listing the good qualities of the relationship that ended 6 months or more ago. Moving on requires "moving through", which is an invitation not to forget, but to remember well. 

2. Reframe. After you've revisited both pleasant and painful (because it's absence) memories about the relationship, it's time to see if you can reframe some of those memories. For example, if one of the things you loved about this relationship was having someone to share things with, you could reframe that to say that sharing things with yourself first could also be positive. How many times are we so busy, we forget to sit back and truly enjoy something with our full presence?  Or, if another thing you loved was cuddling up at night, try reframing it to say you know you're a person who enjoys being cuddled and giving a cuddle. These are important benchmarks for you to be able to take with you as you move from one status (with the person) to another (without). 

3. Recreate. Often what happens after a break up is a period of time where life just feels like a bitch: you can't even go to your favorite coffee shop without getting misty-eyed about the last time you were with that person, laughing over some stupid thing. It helps to name the kinds of activities that have dropped out of your life and to begin inserting them back in, with new people and old friends, new life and a different perspective. After a break up, consider either reviving an old hobby you love, or getting into a new one. See if you can't get back in touch with parts of you that may have been kicked to the curb because of the relationship itself or the period just after it ended. 

Recreate also means recreation, as in move your body around.  I will often tell my clients after a break up to try to get a bit more active by bicycling, taking walks, dancing, running, swimming, or taking a fitness class. The endorphins help with mood elevation, and the activity gives you a different perspective -- literally, you are MOVING, and thus moving through the break up. 

4. I don't have another R for this one, except maybe Rest. Specifically, rest from the dating world. The longer the length of the relationship, the longer I advocate a rest from dating and more importantly, from starting any serious romantic relationships. Otherwise, you'll simply tend to bring your unresolved issues to another relationship. I know what people say: "jump on the bandwagon" or "get out there again". But there's something to be said for taking some time out, clearing your headspace and heartspace, and doing whatever you need to do to feel good about yourself and to make room in your life for another person...when it's the right time for you. Free yourself from the pressure to jump into another relationship too quickly. I would count sexual encounters too. Usually, they are never much a good reaction to a break up, although I'm sure we all fantasize about it. :)

5. To let go: Redeem. Redemption in a non-moral category is purchasing back something of value. Letting go could look like taking prized momentos, pictures, gifts, cards etc and placing them in a gift box. Say good-bye, and silently thank the person for the good moments. If there is a lot of anger, acknowledge that too. Close and tape up the box, and put somewhere you can't get into easily (attic, storage, etc). When 6 more months or more go by, you can choose to either keep the box as it is, unopened, open it again if you need to, or toss the box if that's what needs to happen. Visit places you used to go to with the person, and say thank you and good-bye for now. If you were not given an opportunity to say anything to the person in response to the break up, write a response in an email and DO NOT SEND IT. Or, let a friend read and keep it for you. Sometimes, just the effect of writing the letter is catharsis enough. If the person is no longer living, you can do what is called "The Empty Chair" exercise, where you imagine the person is in a chair sitting in a room, and you talk to the person as if they are there. Again, catharsis like this helps you let go of that person and the sadness or anger that you feel. 

If you notice that you are moving into a more deep depression or sense of "stuckness", I would highly recommend talking to a professional and delving into a more specific plan about how to get yourself unstuck. 

Best of luck to you, and come back and post and let us know (anonymously) how you're doing. 

Quick Question Lady

Support groups for families of depressive people

Quick Question: Is there such a thing as a support group for people with severely depressed people in their families? Kind of like Alanon for mental illness? 

Question Question Lady Answer:  Yes! Just a sample you can find through the Web by searching "depression support groups for families"

http://www.familyaware.org/resources/supportgroups.php

http://www.healthcentral.com/depression/support-groups.html

Each has a link to where you can find a local or a web-based support group. 

I would also check the website of your local hospital. Many of them have on-going support groups or facilitated therapy groups on a variety of topics, including depression, grief and bereavement, and transitions.

Additionally, your community center, church or synagogue may also have local support groups for families with a depressed individual. 

Let me know if you find what you're looking for.

Quick Question Lady

How do I post to this blog?

Well... duh, I didn't quite explain how this works.

If you would like to post to this blog, send an email to 

imeis_sdc@yahoo.com  (please do NOT use your real name in your email)

and you can type your question. I simply take the question and paste it into the next blog entry, along with my answer. Your name or any identifying information will be removed from the email before it is posted. 

If you want to do this anonymously, you can use a different screen name. Again, DO NOT use your real name unless you want the world to know it's you.  I will later try to add a separate page where you can post directly and anonymously, but for now, I wish to moderate the questions so you get some diversity of subjects.

And remember, your question needs to be 100 words or less. Don't give me lots of detailed background. It's a quick question, and a quick answer.

The Quick Question Lady

How do I know if someone is depressed?

Quick Question: How do I know if someone is depressed?

Last night I spent a good hour on the phone for a online newspaper interview on the subject of suicide and job loss. Crisis line calls have been up 20% in February 2009, and suicide rates traditionally rise as unemployment rises. 

Among other things, I talked about how not everyone who experiences a job loss is at risk for suicide. One of the most important factors to assess in someone is the degree of depression or depressed mood s/he is experiencing, whether their mood is related to a job loss or anything else. 

So I don't have to reinvent the wheel, here's a quick link to Dr. Oz (think Oprah's celebrity doctor) on the five prominent symptoms of clinical depression: 

http://www.oprah.com/article/oprahshow/20090305-tows-oz-depression-signs

I'm adding my two cents on the other "red flag" factors that co-workers, friends, and family can look for when someone appears to be depressed and may be at risk for suicide.

1) Sending you a message. These are obvious, such as giving away possessions, and making jokes like, "You'll miss me when I'm gone." There also may be some erratic attempts to connect with people to help them overcome their ambivalence and either further their depression OR give them hope to keep living. 

2) Having a plan to carry out a suicide. You must ask the person, even if their message is followed by, "I'm just kidding", whether or not they have thought of a plan to take their own life. Don't be afraid to ask upfront about this, and be careful not to joke about this. 

3) Ambivalence towards living or dying. A suicidal person is struggling with thoughts of deep despair against thoughts of the struggle they would need to face to survive whatever painful situations they face. If ambivalence is overcome, the risk for suicide is very high.

4) Support. Is the person talking to anyone, i.e. a friend, professional, clergy, partner, etc? Is s/he withdrawing from social activities?

5) What is the level of shame this person is feeling? The higher the experience of shame, the more likely a person will seek more desperate means of reducing that shame, including suicide or homicide.

6) Sudden euphoria. When a person who is depressed experiences sudden euphoria, this could be a sign that the person has made a decision to end his/her life, and the relief of that thought gets translated as almost a giddiness and lightness of being as s/he throws herself into planning the end of pain.

If you or someone you know is experiencing this kind of depression, do yourself a favor. Seek professional help early, and don't wait to see if this will blow over. With professional help, many people can stave off a serious bout of depression, recover, and build new skills to weather difficult times. 

www.seattledirectcounseling.com