Boundaries With Others – How To Set Them

When you’re trying to create boundaries with people they will be tested. It’s like when cows enter a new pasture, they will knock their shoulder against the perimeter a few times to check out where their boundaries are and how strong they are. Cows are strong enough to take down barbed wire if they really wanted to, but they aren’t really testing if they can get out, they are testing if they are safe from the external world. Once they know that the boundaries are consistent and stable they feel safe and they graze in the middle. If the cows don’t have that consistent boundary they will rely on the cowboy to tell them when they have gone too far. The cowboy, however, doesn’t have consistent boundaries, they will only correct the cow when they notice the cow has gone too far, which doesn’t create a feeling of safety. People are the same when they have never experienced consistent boundaries, or they are experiencing new boundaries. People will test boundaries, not enough to break them but enough to trust that they are there to stay and to trust that they are there to keep them safe.

A lot of young adults who never experienced boundaries, because their parents wanted to be their friend. They have a great relationship with their parents, but they will tell me that they feel like they grew up as an orphan because they don’t have a secure home base. but they will tell me that they are afraid to explore and take risks as an adult because they can’t trust that they have parents who are watching out for them, to make sure they don’t make a mistake big enough to ruin their entire life.

It’s important that people are given the space to grow and find their own solutions within appropriate limits. When your setting limits the goal is not to get a specific outcome, rather the goal is to prevent a specific outcome. It is quite spectacular what people can come up with when their possibilities aren’t limited, but just the same we don’t want anyone hurting themselves or others in the process. Limits are set to prevent irreversible and/or irreplaceable damage, while still allowing people to learn how to cope with and improve from mistakes.

When cattle are being herded they have the instinct to turn around when they feel blocked, which can be disruptive to the flow and requires more work to redirect them back into the flow. To redirect a cow, you want them to feel pressure on their shoulder. If you are in front of them when you apply this pressure they feel blocked, if you are beside them when you apply this pressure they will simply turn a bit from where they shouldn’t be. People are the same, when they are told to stop doing what they are doing (and they don’t continue trampling over you) they will do a complete turnaround, even if this wasn’t your intention. If you’re only wanting a slight redirection from a no-go zone you want to adjust your approach to let them know that you understand that they want to move forward, and you want that too, but you want them going forward in a slightly different direction.

Written by Madison Price, MA, LAMFT – therapist at the Holladay Center for Couples and Families

 

Medication Management and Mental Health

In my career in healthcare, I have seen far too many patients who have been prescribed medication and continue to take that medication faithfully; Yet after a time, they are not really sure why they are taking that specific medication or if it is even helping with the diagnosed issue.  

 What is missing for these patients? Medication management 

Medication management is the process of following up with the healthcare provider on a regular basis to assess the effectiveness of the prescribed medication therapy, discuss any side effects that may go along with the medication, and make adjustments in order to achieve proper dosing. In some cases, the follow-up may be to change the prescribed medication therapy, if it is not providing the desired outcomes. Medication management should be an ongoing process. It should include open dialogue between the patient and provider about the effects of the medication combined with any other therapies or treatments that may be in place. This is to ensure useful data is being collected, so decisions can be made based on the whole picture; not just the medication piece. 

When it comes to psychiatric and mental health services, the importance of quality medication management cannot be overemphasized. Not all people who seek psychiatric help will require medication. In some cases, amino acid therapy may be appropriate or continued therapy and counseling with regular psychiatric follow-up is warranted. If medication is prescribed, the patient should plan to see the psychiatric provider within 2 weeks (in most cases) for the first medication management visit.  Continued follow-up visits should be scheduled monthly, or as needed depending on the individual case. 

During these visits, the patient should plan on communicating openly with the psychiatric provider about their use of the medication, any side effects that they may be noticing, and any changes they are feeling in relation to their mental health diagnosis. At times, genetic testing can be used to pinpoint what medications are more likely to work for each individual patient. This testing can be used not only for patients who are just beginning psychiatric treatment but also for patients who have been prescribed medication therapies that aren’t working. The patient should also plan to consult with the psychiatric provider before taking any other medications. They should inform the provider of other mental health therapies being used or medical complications that may arise during treatment. The patient should expect the provider to ask questions that will direct and lead the conversation, so time is well spent and modifications can be made with confidence. 

Ultimately, the key to effective psychiatric medication management is open and continual communication between the patient and provider. At the Center for Couples and Families, our psychiatric providers strive to provide thorough psychiatric assessment, follow-up, and medication management. 

Originally published on http://utvalleywellness.com/

 

Love Loud

When I was in high school, my best friend was gay, and I never knew. When he came out to me years later, I asked him why hadn’t he told me back then, and he answered, “You remember what it was like, right?” Yeah, I remembered. It was the 90’s and it was Utah County. Fear and misunderstanding were the norm, and for many LGBTQ+ youth, day-to-day life could be a terrifying experience. I’d like to think that there have been positive changes since then, but sadly, Utah’s youth suicide rate isn’t one of them.  

Instead of falling, it is climbing steadily, and has been each year, nearly four times faster than the national average. LGBTQ+ youth in unaccepting homes and communities are 8 times more likely to commit suicide and 3 times more likely to engage in risky drug use.  

 But Dan Reynolds, the lead singer of Imagine Dragons, and the LoveLoud Foundation are trying to change that. Last year, Dan started the LoveLoud festival to increase suicide awareness for Utah’s LGBTQ+ youth. We recently sat down to talk with Dan and Tegan Quin from the band Tegan and Sara—artists who are trying to make a meaningful impact in the lives of our youth here in Utah.  

UVHW: What inspired you to start this journey, and LoveLoud, on behalf of the LGBTQ+ community? 

 Dan Reynolds: I watched how difficult it was for friends of mine to feel safe in that space. And then I went on (an LDS) mission, and became good friends with Tyler Glenn of Neon Trees. I watched him go through his process of being Mormon and gay and coming out and how difficult that was for him to feel at odds with God. Then I married a woman who is a badass activist who helped me to find my own inner truth and speak it. It’s been a lot of different things and a lot of different people who have inspired me throughout the years as well as people like Tegan who have been doing things in this realm for a long time. I’m just trying to do my little part with the platform that I’ve been given.  

UVHW: Your film Believer aired on HBO in June. What would you want the Utah Valley audience to know about your film and how to embrace the message that you’re sharing? 

Dan Reynolds:  That it’s a safe film to watch with their children. It’s motivating, it’s emotional, it’s powerful and I truly believe it will create real change in the communities that need it most. We tried really hard to create a documentary that was honest and to convey what’s happening on ground zero with our LGBTQ+ youth within homes of faith. The question is, what can we do to change the statistics, the environment and to create a safe one for LGBTQ+ youth, and that’s what this documentary is looking to do. I hope that everyone would give it a chance to sit down and watch it and see how their heart and mind feels. 

UVHW: How can we create greater safety for our LGBTQ+ youth and as well as adults; what can we do as a community? Tegan, do you want to answer that? 

Tegan Quin: It’s so profoundly moving to watch the documentary and that’s why Sara and I and our foundation got involved with it. We want to bring the community together, not to talk about how we don’t agree, but instead to create an amazing space to come together—to have the LGBTQ+ community speaking their truth, but also have Mormons in the community who want to learn and want to be better allies or want to understand what’s going on. The community is the space to do that, and to use music to bring people together. That’s a really wonderful way to start the conversation. As queer artists, our number one job is to bring people together to a space that feels inclusive and feels warm, and I think that music is really wonderful—a great equalizer. It transcends all of our differences and brings us all together. Encouraging people to watch the documentary or come to LoveLoud is a great way to start that conversation. 

UVHW: I brought my kids to LoveLoud last year, and that really opened up the door to talk about what they heard, and what they saw, and how they felt about it. It was such a cool experience, and was such a great success. What are your hopes for year two of LoveLoud? 

Dan Reynolds:  For me, it’s that dialogue that takes place beforehand and after the concert at home, at the dinner table, at school or at church. I think that change really comes about on people’s own timelines and nobody ever changes in a deep way on matters that are this ingrained in some people’s hearts, by just having someone talk at them. I think the change comes about with time, with patience and with open dialogue and thoughtfulness. What’s the most important thing is the child sitting down with mom and dad and saying, “Hey, this is what I felt at LoveLoud. What’d you guys think?” And then the parents expressing their thoughts and then the child their thoughts and then going to school and talking to their friends about it. And that to me is how you de-stigmatize an issue and that’s how you create a safe place for LGBTQ+ youth where this isn’t even a conversation that needs to be had anymore. But hopefully there’ll be a day where LoveLoud isn’t necessary any longer. Maybe it will just take on a different life of just being a celebration of love. 

Tegan Quin: I think there’s so much negativity in the media and there’s just a lot going on in the world. It can be extremely overwhelming, and maybe a young person is experiencing anxiety or depression. Another wonderful positive about LoveLoud and the documentary is that it’s celebration, it’s positivity–it’s starting the conversation and it’s exploring a different side of the conversation. Just this morning, I was speaking to a grade four teacher who told me that they had taken their students to an event where there had been positive LGBTQ+ representation there and they had been talking about pronouns and a kid who had been really depressed and who had expressed thoughts of suicide at 10 years old, which is just devastating to hear, had come back after the field trip and said, “I now know more about myself.” This kid had been feeling like maybe he was LGBTQ+. And sometimes it’s just giving LGBTQ+ kids something to look forward to, something positive to get them through these things. You know, that’s why I think LoveLoud is important. It’s positive and we need that right now in the community. 

UVHW: Yes, we do. What are your plans or thoughts about doing LoveLoud on a national level?  

 Dan Reynolds:  My focus is really on Utah, because that’s got one of the highest suicide rates in the nation. When someone has a LoveLoud necklace on or a t-shirt, then our LGBTQ+ youth can go up to that person, and find a safe zone there. But I would like it to be an organization that represents safety to all LGBTQ+ youth, not just in the nation, but around the world, and I think it starts here. We hope to continue to do as much as we possibly can to create a real impact. 

Sources:  

https://loveloudfest.com 

https://www.sltrib.com/news/health/2017/11/30/utahs-youth-suicide-rates-growing-at-alarming-pace-new-federal-report-says/ 

 

Originally published on Utah Valley Health and Wellness Magazine 

 

Coming Out – Part 2 Parental Self-Care

When he told me he only had crushes on boys and thats why he never dated, I started crying. 

My son told me not to tell his father that he really feels like a girl. Did I let him play with girls too much? 

I asked my daughter why her best friend identifies as lesbian, and she told me she thinks she may be one too. Im sure she is not. 

When teens come out, the world shifts. Some parents respond with denial, wanting to diminish the news. Others feel anger and want to find out who is responsible. Some parents feel sadness, anticipating a loss of shared values, a loss of future. Denial, anger and sadness are all important aspects of grief processing, and for many parents, responding to a child’s coming out is a grief experience. 

Most children talk with their parents only after years of trying to figure out what is really happening inside, and when they finally tell parents, those years are condensed into a moment that – to a parent – may feel like a dropped bomb. 

After listening to hundreds of stories of parents responding to their children’s expressions of attraction and identity, I’ve seen how important it is for parents to take care of their own emotional health afterward.*  

Here are some valuable principles to keep in mind: 

  1. Take a break to figure yourself out. Denial, anger, and grief are expected. However, if your child feels overwhelmed by your denial, anger, and grief, then healthy connecting may be more difficult. Many children “take on” their parents’ reactions and become more isolated. You may want to find another place and time to express and explore your genuine reactions. One mother told her child she loved him and needed some time to figure out her own feelings, and then she spent the afternoon at her sister’s home. Another father immediately called a counselor, reassuring his son that the counseling was intended to help the father provide healthy support for his son.  
  2. Remind yourself, “This is not a crisis.” One mother described feeling completely numb. Because Christmas was only a few days away, she felt both the pressure of the family’s expectation and the heaviness of the news. She found that repeating aloud the words, “This is not a crisis” reminded her that their family would still survive despite the new information.
  3. It’s normal to feel more upset, even though your child may seem happier. While children often feel relief after sharing feelings with parents, your feelings may begin to resemble a roller-coaster. It may seem unfair that your child has just given you the burden to carry. Breathe through these feelings and recognize that this is normal.  
  4. Find safe people to share what you are feeling. Your child may insist that you tell no one. And although it’s important to honor your child’s sense of privacy, it’s OK to let your child know that you need to talk with someone. Perhaps you and your child can agree on a trusted family member, friend, or counselor. 
  5. Limit your contact with others who are uninformed. Sometimes well-meaning friends and family have advice that is not helpful, or that undermines your confidence in yourself and your child. It’s OK to limit your contact with these people for a period of time. Plan what you will say. “We are working hard to support each other right now and I need to focus on that,” may be helpful to repeat.
  6. And finally, when you ask “Why me?” try switching to the question, “Why not me?” and see what strengths you find in yourself. Chances are you are being called to a deeper way of loving your child and yourself. 

SIDEBAR MATERIAL — Find a Parent Support Group in Utah County 

Find a parent support group. Meeting with other parents in similar situations has been a positive emotional turning point for many. Here are a few in Utah Valley: 

  1. PFLAG (Parents and Friends of Lesbians and Gays) meets weekly at St. Mary’s Episcopal Church in downtown Provo (provopflag@gmail.com) 
  2. Encircle Parents’ Meeting (Third Sunday of each month at Encircle in Provo) https://encircletogether.org/supportgroups 
  3. Northstar Parents’ Meeting (Quarterly meeting at a parent’s home in Lehi) 

https://www.lds.org/blog/navigating-family-differences-with-love-and-trust?lang=eng  

 Next time:  Coming Out Part 3 – What do we do now? 

 

Coming Out – Part 1 When your teen opens up

“I wish I could take it back and do it over!” parents say about the moment their teens told them they were gay, lesbian, transgender, or that the teens were worried about their sexual orientation, attractions, or gender identity. “Nothing prepared me for this!” they say. Other parents remember, “My first thought was that what I was hearing was somehow my fault, that I’d been a bad parent, and I just fell apart.” Even parents who managed to say to their teen, “I still love you, it doesn’t change anything,” still sometimes have regrets and wish they could press the re-start button.

As a therapist who has listened to hundreds of family “coming out” stories, I’ve noticed that what happens during these conversations has a strong impact on feelings within the family. This first interaction between parent and teen (and each conversation that follows) either creates stronger bonds or difficult memories that parents and teens have to work through later.

What most parents want is to keep a strong relationship with their teen, to remain a positive influence for good mental, physical and spiritual health. Yet, sometimes, conversations with teens create distance rather than connection.

Why should I think about this?

Chances are you will have a teen in your family, your extended family, your neighborhood, or church community who will eventually come out to you. How you respond to this teen may make the difference in his or her decision to live a healthy life, or even to keep on living. Research suggests that teens who identify as LGBTQ (lesbian, gay, bisexual, transgender or queer/questioning) feel the greatest positive or negative effects from their family’s reaction to them. Negative reactions from family are associated with teens’ increased risk for depression, alcohol use, substance abuse, and other dangerous behaviors including suicide attempts. Your preparing now for a possible family member’s coming out may be one of the most powerful chances you have to be a positive influence in a young person’s life.

What can I say?

Some parents feel authentic simply saying, “Oh, OK, tell me more about it when you feel like it,” and moving on. If you’re reading this, chances are that’s not you. A young person’s coming out may make you feel as if the axis of the world has shifted and you are supposed to set it right somehow. One of the least helpful ways to respond is to assume that the teen has made a choice that rejects your values.

Most teens share their feelings about attractions and identity only after they have wrestled alone with issues for weeks, months, and often years. Most are keenly afraid that their parents will feel that family values have been rejected. Even if you are the wisest person you know, it is unlikely that you will know more about the challenges of what they have been experiencing than they do. It is also unlikely that you will learn what they are experiencing without a lot of listening. The most helpful thing a parent can do may be to set the stage for future conversations.

The statements below encourage further sharing without assuming the teen wants to reject family values. These statements also make it more likely a parent will learn more about what a teen is experiencing:

I’m so glad you’re sharing this with me.

Thank you for telling me this. I’ve been wondering how I could help you.

What you are telling me is important. Most important, however, is that I love you, and this doesn’t change my love for you.

I hope you will keep talking to me about this.

This changes things for me too, and it will give me a lot to think about, but it doesn’t change how I feel about you. I still love and cherish you. We’ll work through this together.

This is hard for me, but I’m willing to do hard things as your parent. I want to be here for you to help you.

 

Next time:  Coming Out Part 2 – What now? Parent self-Care.

By Lisa Tensmeyer Hansen, MS, LMFT

Feeling Anxiety? by Garret Roundy, LMFT, MS

Anxiety in response to feared situations or experiences plays a part in everyone’s lives, but for some, calming the anxiety requires a bit more help. Let’s take a look at a few ways to invite more calm into our daily lives.

Stressed BusinesswomanNeuroscientists have identified what they call fear extinguishing circuits in the brain (Herry et al., 2008). These circuits interrupt the basic fear response, so that previously feared stimuli do not activate the physiological and behavioral sequence that you feel as fear or anxiety. In other words, activating the fear extinguishing brain in response to fears keeps you feeling calm and engaged with life. Because anxiety is a response to a perceived threat, anxiety can be calmed if the threat is addressed.
So, what experiences can activate the fear extinguishing circuits? Glenn Veenstra (2013) succinctly cites four: security, safety, tolerance, and mastery.

1. Security is our most basic, inherited form of achieving calm after encountering a fear-inducing threat. We obtain a feeling of security through connection and proximity to other people who can protect us. Sometimes, just knowing we are not alone in a trial changes how we feel about it.

MP9003854012. Safety is achieved when the probability of danger is low. If I am afraid of lightning, safety is attained when I see a blue sky and my brain senses the threat of being struck by lightning is minimal to none. Oftentimes, much of our anxiety is needlessly produced by an overestimation of the probability of danger. Furthermore, this overestimation continues because of anxiety’s chief accomplice, avoidance. As long as the feared situation is avoided, a true evaluation of the danger cannot be made. Having someone help us along (#1, security) in facing our fears can make a big difference in discovering our overestimated threats and attaining a sense of safety.

3. Tolerance of the feared outcome can activate fear extinguishing circuits because the evaluation of “threat” is changed. If I can tolerate the pain of a paper cut and know that I can take care of it properly until it heals, then my mind isn’t threatened by the outcome and will not feel anxiety about reading the newspaper. That’s fine for a paper cut, but what about really big threats, like death? When death itself is a feared outcome that can be tolerated (or accepted!), then its power over us can be transformed into calm purpose in living; we can then live life without anxiously running from an inevitable transition.
For many who carry burdens from trauma, the continual pain caused by that danger in previous experiences remains clear evidence that the danger is not tolerable. The damage, much more than a paper cut, remains a wound that warns them to avoid certain threats because the cost of the danger is too high. Extinguishing this fear through tolerance will not happen until we experience healing and know that we can handle the pain and are stronger than the injury. After healing, the danger is tolerable. That is the earned peace of many people who have reached out to qualified help and received treatment for emotional and spiritual wounds.

?????????????????????4. Mastery is achieved through knowing we have the skill to master the danger. For example, anxiety about meeting new people because of feared negative social outcomes may be extinguished by mastering the skills of social interaction in such situations. A man, we’ll call Jim, avoided social situations with new people because they provoked intense anxiety. His perceived threat was that everyone (#2 overestimation of danger) would think he was strange or awkward and reject or not like him. Jim combined #3 (tolerance) with #4 (mastery) to find calm in this once feared situation. After feeling that he would be okay if some (#2, not everyone) people did think those things about him (#3), he reversed his pattern of avoidance and set the goal of meeting someone new every day. Instead of focusing on his defects or anxiety, he began observing and experimenting in these daily experiences, noticing what he and other people did and tried out different ways of interacting. I caught up with him after he had met over 1,000 new people. With time and practice, and certainly some tolerably awkward introductions, he developed the skills needed to master the danger inherent in social introductions and ultimately became very skilled and comfortable talking with people from all walks of life about everything!

balanceWhen the bottom line answer to our questions is “I’ll be okay because I am resilient and connected with others who can help me when needed,” then calm can quiet our fears and we can enjoy the energy of being fully present in our lives (Siegel, 2012). If you wonder about this possibility in your life, I invite you to hope and choose the path of courage, because greater peace is awaiting you.

Herry, C., et al. (2008). Switching on and off fear by distinct neuronal circuits. Nature, 454, 600-606.
Siegel, D. J. (2012). The developing mind: Toward a neurobiology of interpersonal experience. New York: Guilford Press.
Veenstra, G. J. (2013). Neuroscience advances for improving anxiety therapies. Anxiety disorders and Depression Conference, La Jolla, CA.

Garret Roundy2About the Author: Garret Roundy is a licensed Associate Marriage and Family Therapist in the state of Utah. He earned an M.S. from Brigham Young University and is currently completing his PhD in Marriage and Family Therapy. Garret has developed a specialization in the treatment of anxiety and trauma-related disorders through studying scientific research and completing advanced clinical trainings. He has also presented on these topics in professional and community settings. Garret is a therapist at the Provo Center for Couples and Families.

Can Facebook Harm Your Marriage? by Dr. Mark White Ph.D, MFT

Mature couple with laptop.Can Facebook harm your Marriage?  Although we’ve been hearing since 2009 that Facebook may be playing a role in divorce, a recent study published in the journal Computers in Human Behavior1, appears to be the first to scientifically examine divorce rates, marital quality, and the use of social networking sites (SNS) like Facebook.

The researchers examined two kinds of data. For each US state, they collected recent divorce rates and the proportion of persons in each state with a Facebook account. The second was an online survey of almost 1200 individuals specifically examining marital well-being and SNS use.

Across the 50 states, they found that as the proportion of Facebook users increased, there was a slight elevation in the divorce rate. While this finding is interesting, it doesn’t tell us anything about what’s going on for the individuals in that state. That’s where the individual-level data comes to play.

Attractive couple portrait.The researchers were able to control several variables in these analyses, such as income, education, race, age, and religious attendance. After removing the contribution of such factors, increased SNS use was shown to play a small role in predicting lower marital quality, less perceived happiness in the current marriage, more perceived troubles in the current marriage, and thoughts in the last year about leaving spouse.

Unfortunately, the design of this study did allow the re searchers to identify which is the cause and which is the effect (the perennial chicken and egg problem). Does SNS involvement cause marital problems, or do people in unhappy marriages spend more time on SNS? Although these data cannot answer that question, common sense would suggest that both occur.
For some, SNS detracts from the marriage and also provide an avenue for various forms of infidelity (such as wondering what your high school girlfriend is up to these days). Others seek support and contact with others to cope with an unhappy marriage.

Young Woman Sitting Looking at Laptop ScreenSo how can you prevent Facebook from harming your marriage? Here are 10 common sense suggestions:
1. Don’t hide anything on Facebook from your partner and don’t have anything to hide.
2. Have a shared understanding about how you each will use SNS. Some couples have a shared Facebook site (BradndSusan), others share the password to each other’s account, while others frequently look at Facebook together. There’s no right solution here—I just recommend you reach an agreement about the use of these sites.
3. Do not friend, or promptly unfriend, any person that makes your partner uncomfortable.
4. Analyze how you spend your time—are you spending more time with your virtual friends or your real-life partner?
5. If you discover that you’d rather post another kitten meme or play Candy Crush Saga than be intimate with your partner, it’s time to seek help.
6. Be willing to ask yourself some hard questions if you find yourself tempted to spend time perusing the pages of your ex, old flames, or people you find attractive (either on or offline). What’s going on in your life or your marriage that makes such behaviors appealing?
7. If you are unhappy about some aspect of your marriage, address your concerns with your partner rather than seeking support online.
8. If you both enjoy SNS, use them to flirt and communicate with each other. Message each other and post on each other’s page regularly. Make sure your status updates and photo albums convey that you are happily married.
9. Do not engage in any activity on an SNS (posting pictures, sending messages, etc.) that you would not participate in if your partner were sitting next to you, viewing the same screen.
10. Remember Rule #1.

1 Valenzula, S., Halpern, D., & Katz, J. E. (2014). Social network sites, marriage well-being and divorce: Survey and state-level evidence from the United States. Computers in Human Behavior, 36, 94-101.

markAbout the Author: Dr. Mark B. White is the Marriage and Family Therapy Doctoral Program Director at Northcentral University. He is a licensed marriage and family therapist and AAMFT Approved Supervisor and provides therapy at the Vernal Center for Couples & Families