Tag Archives: anxiety

A Good Read on Self-Doubt in Therapy

21 Mar

My friend Molly shared this article with me today, and I thought it did a nice job of illuminating the anxiety we often feel as beginning therapists and describing one individual’s process of working through it. Check it out here:

A Crash Course in Psychotherapy: Moving Through Anxiety and Self-Doubt – by Charlotte Dailey

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Exercise is Depressingly Awesome

20 Dec

I hate exercising for the sake of exercise. I wouldn’t be able to pass my high school’s Presidential Fitness Test today – I mean, I barely passed it back then, and I only passed because our gym teacher let us all cheat at pull-ups – and the idea of “running for fun” is mystifying and unsettling. The only forms of exercise that truly appeal to me involve large, expensive animals that I cannot currently afford (horseback riding, doing stuff with my future giant dog), swimming leisurely, dancing, or actively accomplishing things (i.e., gardening). I also like the playground game Four Square, but it’s really hard to get a group together to play now that I’ve graduated from middle school, and these days everyone wants to do the online kind of Four Squaring anyway.

So when I finally caught up with my backlog of APA Monitors this week, I was pleased to read this month’s Questionnaire section, in which Dr. Howard Friedman was interviewed about his longevity research. As a person who is always searching for justification to avoid the gym, I especially liked the following quote:

“…our studies suggest that it is a society with more conscientious and goal-oriented citizens, well-integrated into their communities, that is likely to be important to health and long life. These changes involve slow, step-by-step alterations that unfold across many years. But so does health. For example, connecting with and helping others is more important than obsessing over a rigorous exercise program.”

Excellent, I thought, chortling to myself. The Presidential Fitness Test can suck it. But a few pages later, I ran into Kirsten Weir’s “The Exercise Effect,” which briefly and convincingly summarizes some recent research supporting the effectiveness of exercise as an intervention for major depression and anxiety disorders. Weir’s article is the latest in a stream of exercise-related literature that has made its way into my hands in the last couple months, and while the notion that exercise can be helpful for depression and anxiety isn’t new, it seems that interest in the focused use of exercise as a behavioral intervention has been on the rise lately. So much for my plans to connect with and help others solely from a sitting position.

This isn’t to say that I neglect discussion of exercise’s benefits when working with clients who are depressed or anxious. It always shows up somewhere in the  “Here-are-some-things-that-we-know-can-be-effective” speech, and sometimes I help clients develop brief behavioral plans to get them moving. But if clients express little interest in exercising, I focus on other interventions and don’t push the issue – because after all, who am I to push someone else to exercise? Yet the research I’ve been exposed to lately suggests that maybe I should be pushing… and not just pushing clients. Weir quotes Dr. Michael Otto, who claims that “failing to exercise when you feel bad is like explicitly not taking an aspirin when your head hurts.” A physician who refuses to use aspirin because it’s “too hard” or “not interesting” would be ridiculed. Should the same level of ridicule be directed at a psychologist who explicitly refuses to exercise?

I’m admittedly biased, but I don’t think Otto’s analogy is a fair comparison. A physical workout is usually a  sweaty, gaspy, time-consuming set of behaviors that requires organizing on the part of the individual and produces effects that aren’t always immediately apparent. (I have never, ever experienced a runner’s high, and there have been times when I have tried to make exercise a serious part of my life.) Taking an aspirin is a three-second endeavor… maybe six seconds, if you have a hard time with the child-proof cap. We’re not talking about similar behavioral investments. There’s also still a lot we don’t know. Should we all be running six miles a day, or will a brisk 20-minute walk a few times a week do the trick? Does it matter if we exercise alone or with others? Weir notes that “researchers don’t yet have a handle on which types of exercise are most effective, how much is necessary, or even whether exercise works best in conjunction with other therapies.”

Despite the questions that remain, the research I’ve been reading lately has encouraged me to make more of an effort to engage my clients in exercise, and to get myself more engaged too. But if my own hate-hate relationship with exercise has taught me anything, it’s that for most of us, exercise must be rewarding in the moment for it to be truly sustainable. If you legitimately enjoy going to the gym or training for 10Ks, then that’s awesome, and I really wish I had a share of your crazy exercise-loving genes. But I don’t think there’s anything wrong with making exercise a secondary component to some other goal, whether that goal is doing something fun with your dog or doing yardwork or getting to the grocery. For me and the clients who despise the gym as much as I do, it may be worthwhile to create behavioral plans that focus on adding exercise to already-enjoyed or necessary activities rather than instituting a “traditional” exercise plan from scratch. Some examples of what I mean:

  • Primary goal: hang out with friends, family, or your partner. Exercise addition: hang out while swimming, walking, window-shopping, dancing or hiking. Or take a movement-based class with friends through a university or community center.
  • Primary goal: have a phone conversation with a family member. Exercise addition: stretch or walk around building during conversation.
  • Primary goal: make a difference in the community. Exercise addition: choose a volunteer activity that requires movement (e.g., cleaning cages at the humane society, participating in fun runs/walks for charity, helping with a Habitat build, etc.)
  • Primary goal: have a romantic evening with your partner. Exercise addition: sex, duh.
  • Primary goal: make apartment/house more attractive. Exercise addition: incorporate active DIY projects, like painting, landscaping, thorough cleaning, etc.
  • Primary goal: cook dinner. Exercise addition: turn on music that makes you want to dance and bust a move while cooking. Ke$ha and LMFAO, though not exactly highbrow, produce some pretty irresistible dance music.
  • Primary goal: play video games. Exercise addition: play games on a console that requires movement (like the Wii or Playstation Move)
  • Primary goal: keep dog from getting bored and chewing up all your stuff. Exercise addition: go on interesting walks or hikes, play frisbee at the dog park, take an agility training class.
  • Primary goal: make extra money during grad school. Exercise addition: babysit an active child or children.

Exercise doesn’t have to involve weights or running shorts to count as exercise, and even small “doses” of exercise seem to produce measurable mental health benefits (see Weir’s article). And if we conceptualize exercise in a simple, essence-based way – as sustained, purposeful movement, separate from the very specific types of movement promoted by Fitness Magazine spreads and Nike commercials  – then maybe I don’t hate exercise at all. It’s the word itself that’s the problem for me, and its connotations of in-the-moment pointlessness and endless striving toward weight- or muscle-based goals that my genes never meant for me to achieve. But dancing while cooking dinner? I can do that. I can like that. And I think some of my clients could too.

Does anyone else have ideas for making exercise a natural addition to primary goals?

Internship Blues

29 Nov

In the grand scheme of the universe, there are many things that I should probably be more worried about than the APPIC internship application process, including but not limited to climate change, international strife, global food shortages, the terrifying implications of the Singularity should it ever come to pass, what Diet Coke is doing to my body, etc. But like most 4th or 5th-year doctoral students in counseling/clinical psych programs, lately I’ve been directing the full power of my anxiety toward the question of whether or not I’ll get an internship.

For those reading who aren’t familiar with the internship process, APPIC stands for the Association of Psychology Postdoctoral and Internship Centers. Doctoral students in clinical or counseling psychology programs who have finished their coursework and comps are required to complete a 1-year predoctoral internship approved by the American Psychological Association in order to receive their doctorates. All approved internship sites are registered with APPIC, which facilitates the application and match process. Eligible students labor feverishly over applications and submit them to internship sites of interest (usually around 15 sites) during October, November, and early December. APPIC encourages sites to inform candidates whether or not they qualify for interviews by December 15, but every site operates on a slightly different timeline. Some students may hear back about interviews before Thanksgiving (causing dark fears to bloom in the minds of their cohort members, who will spend the next two weeks wondering why no one wants to interview them and asking themselves, Did I actually hit the send button on my applications? What if I didn’t hit the send button on my applications?). Other sites may not notify candidates about their interview status until after December 15, a date that will by that point have cemented itself in students’ minds as the Absolute Deadline for Hope and what if I hit the send button on some of my applications but not all of my applications? Interviews take place in December and January, and students rank the sites at which they interviewed in order of preference. Sites also create ranked lists of candidates, and students are informed on Match Day in late February whether or not they’ve been matched with a site. Those who aren’t matched go through a sort of clearinghouse process called Phase 2, which I don’t know much about because it makes me unhappy to think about it. There is no guarantee you’ll be matched during Phase 2.

There is currently a shortage of APA-accredited internships. Last year, almost a fourth of applicants were not matched with a site, and not matching has major implications for students. It means another year between you and your degree, another year between you and your career, and potentially nasty financial consequences (many programs, mine included, do not guarantee funding for students who stay beyond their fourth year). I guess that it’s little wonder that the message boards and listservs frequented by internship applicants exude all the cheer and calm of a fire evacuation. Dr. Greg Keilin, the psychologist and training director who sacrificially agreed to coordinate the Match and its listservs, sent out a message on the APPIC Intern Network last night that had a certain tone of parental exasperation:

“Everyone,

Before everyone on this list has a heart attack because one person has reported hearing back from a site, let me state categorically that it is VERY EARLY FOR ANYONE TO BE HEARING BACK ON THEIR APPLICATIONS OR GETTING OFFERS FOR INTERVIEWS!  Some application deadlines haven’t even passed yet, much less have sites had the opportunity to review materials and contact applicants to set up interviews.

So, if you haven’t received any notification yet, all that means is that you are one of 4,000 other applicants who also have not yet received any communication from sites and who feel like they are the only one in North America who hasn’t heard anything… If you want to make yourself really anxious for no good reason, you can:  (a) wonder how each site notifies applicants (alphabetically?  by date the application was received?  by astrological sign?, etc.) and how you will fit in that process, (b) start worrying two weeks before the “interview notification date” in the Directory about why you haven’t heard anything and then assume it must be bad news, and (c) assume that if a classmate hears from a site before you do, it means you’re toast.  All of these are tried and true methods of generating gobs of anxiety while waiting to hear from sites.

Seriously, go by the dates in the Directory, and assume you’ll hear at 11:59pm on those dates and not a moment earlier.  Will some notify you days earlier?  Yes, but some won’t.  One year, I sent out my notifications the evening of my interview notification date, and I was surprised how many applicants told me that they had assumed they weren’t getting an interview because they hadn’t heard anything from me.

In the relatively infrequent event that you don’t hear from a site by the end of that ‘interview notification date,’ you should call or e-mail the site the next morning to inquire about your status.”

Unfortunately, graduate students are very talented in the area of making themselves really anxious for no good reason. I’ve found that the best way to address my anxiety is to develop excellent backup plans in the event that I don’t get an internship. Current frontrunners include starting an adorable pie shop like Keri Russel in Waitress or becoming a “dog enrichment coordinator” at a doggie daycare, which is apparently a real job.

I might change up the uniform a little.

I applied to 15 internship sites in North Carolina, Texas, Georgia, and Virginia. My husband Ted and I would like to move back in a southeasterly direction to be closer to family and college friends, and for some reason, Ted requested that we move somewhere where he could enjoy continued employment. I’ve gotten an invitation for one interview in Texas (instant elation!) and a regretful email from a site in North Carolina (instant desolation). Guess I’ll twiddle my thumbs, contemplate how my astrological sign might affect the manner in which I’m notified about interviews, and hope for the best.

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