General Issues

• Self-Development/Existential Questions

• Perfectionism

• Cultural Issues

• Grief and Loss

SELF-DEVELOPMENT/SELF-ESTEEM/SELF-UNDERSTANDING 

What to call it exactly?  Some people come into therapy, not because of specific problems or specific disorders, but because they are seeking to understand themselves better, perhaps so that they can lead a more meaningful life, build healthier relationships, feel better about themselves, or make better choices in their future. 

For some clients, they start therapy for specific problems or specific disorders, but once those issues are manageable and since we've already developed a therapeutic relationship, we agree to shift the focus of therapy to more global issues such as self-development, self-esteem, self-understanding, self-identity, self-improvement....call it what you will. 

Treatment strategies: Therapy often reflects more of psychodynamic and insight-oriented approach and entails a more thorough understanding of family dynamics past and present, family patterns and beliefs passed on through generations, childhood experiences, the impact of cultural values that are imposed on us, clarification of goals and values, or prioritizing commitments to create a more meaningful life. 

Some of the questions addressed are fundamental existential themes:

• Who am I?

• What are my emotional needs?

• What has been my temperament and personality?

• What are qualities about myself that I value and what are qualities about myself that I have a hard time accepting?

• How have these qualities about myself led to difficulties in the past?

• What are the relevant aspects of my identity, such as my race, ethnicity, age, gender, sexual orientation, disability status? How do they interact with experiences of oppression and privilege?

• What experiences have influenced who I am today?

• What cultural values and beliefs have shaped my own beliefs?

• What is important to me in terms of my family, romantic, and friendship relationships?

• What are my priority values and goals? How can I live in alignment with my values and goals? What gets in the way?

• What gives my life meaning and purpose?

• What are my beliefs about death and how does that shape how I live my life?

The process and goals for therapy are mutually determined by both client and therapist.

PERFECTIONISM

Perfectionism refers to having excessively, unreasonably high standards that, when not met, lead to harsh self-criticism and feelings of failure. Those suffering from perfectionism find that their perfectionistic standards lead to significant distress leading to stress, anxiety, physical symptoms (ulcers, headaches, aches and pains, etc.), or depression.

In addition, perfectionistic standards tend to be debilitating, discouraging, or counterproductive. Perfectionism is markedly different from having healthy high standards. With healthy high standards, an individual does not feel distress but rather feels a sense of challenge or excitement because reasonable standards are set and the probability of meeting those standards are pretty good.

Furthermore, with healthy high standards, an individual feels motivated to achieve their best rather than debilitated by the pressure to be perfect.

How does perfectionism develop?

Perfectionism is not necessarily bad, but rather, it is a strategy often developed early in life that was once effective but eventually begins to cause too much distress and impairment. Some theorists believe that perfectionistic standards are developed via harsh and critical standards set by parents that are then internalized by the children.

Perfectionistic behaviors may also be modeled by parents and picked up by children. In addition, our society rewards those who strive for perfection while criticizing those who feel that good enough is good enough.

Perfectionistic behaviors are maintained because sometimes it can lead to powerful rewards such as the admiration of others, high scores on exams, landing a business contract, or more money.

The problem is that perfectionism may begin to interfere with life happiness, social relationships, educational attainment, or job performance. With perfectionism, people inevitably hit a wall where their perfectionistic standards become more debilitating than facilitating.

A common phenomenon associated with perfectionism is procrastination. The pressure to be perfect generates so much anxiety that people often choose to avoid the situation rather than confront the possibility of failure. At this point, people begin to recognize that their healthy high standards have somewhere along the way turned into debilitating or distressing perfectionism.

Treatment strategies:

Perfectionism can be seen as a habit. In therapy, we can begin to generate an understanding of how this habit developed and how it can be both helpful and harmful and decide which components to keep and which to change. In addition, cognitive therapy techniques have been found to be helpful in shifting perfectionistic attitudes.  This entails monitoring perfectionistic thoughts and then developing alternative perspectives.

For example, a typical perfectionistic thought might be, "I have to get this proposal right before I present it at the meeting tomorrow," which is followed by the behavior of writing and re-writing the proposal over and over again throughout the night.

A strategy may be to develop an alternative thought such as, "I've been working on this proposal in some form over the last week. I'm sure I've done a pretty good job. If there's any mistake, I'm there is unlikely to be serious consequences. I've done proposals like this before, and they were well received."  

Changing perfectionistic attitudes may also require changing one's priority, for example, prioritizing your physical health and happiness over a perfect proposal.

This all may sound easy enough, but if you suffer from perfectionism, you probably already can tell that change will take much effort and time. Therapy may not offer you anything magical or new, but it may offer you support, motivation, and a systematic program for change. 

CULTURAL ISSUES

One of the most wonderful aspects of living in Southern California is the cultural diversity. Many people from countries around the world immigrate and settle in the area so that by now some ethnic communities have been firmly established in California for several generations.

Many people from ethnic minority groups, at some time or another, go through a process of ethnic identity development. This process is characterized by thoughts, feelings, and behaviors related to the question, "Who am I?"  For individuals from ethnic minority groups, this question often involves how they feel about their own ethnic identity. 

There are many different reasons why one might start thinking about their ethnic identity. Perhaps it was a racial comment another person made, perhaps it is a gradual understanding that ethnicity and how you look may at times impact how others react to you (whether positive or negative or neutral), or perhaps it is triggered by life changes such as separating from parents, starting a family, or moving to a community with a different ethnic composition than one you're used to. 

Ethnic identity development does not necessarily have to be a confusing or torturous process and there is no one right way of feeling about your ethnic identity. Instead, it is a process of understanding more fully who you are and what that means to you. 

Cross-cultural issues do not necessarily have to be the focus of one's thinking but can still impact one's life decisions and psychological functioning. For example, general life issues (transitioning to college, changing jobs, getting married, raising children, etc.) may be influenced by cultural factors such as cultural values, parental values and expectations, experiences with racism, expectations of the ethnic community, balancing your needs and values with the family's needs and values. 

Treatment strategies:

Therapy can help you develop a better understanding of yourself, the influences in your life, and how that impacts your future choices. Therapy can also help you through experiences related to racism and discrimination by providing a place of support and by also helping you to develop strategies to be able to make decisions and attain life goals without feeling constrained.    

For some individuals, value conflicts contribute to distress around life decisions. Parents may have been raised with different cultural values, they may want their children to follow their values, and the children may be torn because a part of them wants to follow the cultural values of their traditional ethnic group and another part of them wants to follow the cultural values they developed as Americans or American residents.

Therapy can help clarify these issues so that these individuals feel they are making more informed decisions about your life.

Even if cultural issues are not the focus of therapy, it will be important to have a counselor with cultural sensitivity. Cultural sensitivity has been identified as an important component of effective psychotherapy.

According to the U.S. Department of Education, a culturally sensitive individual is one who understands each individual has unique value system based on upbringing and culture, values diversity (in ethnicity, sexual orientation, religions, etc.), is aware of her own cultural biases, can work effectively in different cultural contexts, and does not assign values (better or worse/right or wrong) to cultural differences.

For ethnic minority or international clients, these qualities can be quite important.

GRIEF and LOSS

Grief is the natural reaction associated with the pain of loss. Normal emotions associated with grief and loss are often shock, anger, guilt, and profound sadness, and normal disruptions to one's physical health and emotional functioning are also common. Most people associate grief and loss with losing a loved one, and though this can be one of the most challenging losses to a person, grief and loss can also relate to:

• Relationship breakups

• Loss or changes in health, physical functioning, or physical appearances

• Loss of job or loss of financial stability

• Death of a pet

• Loss of a dream or of an important expectation in life

• Loss of feelings of safety following a traumatic experience

• Loss of the relationship one never had and possibly may never have with a significant person

• Life transitions that involve moving homes, moving away from family and friends, loss of stability, loss of certain freedoms, new career or academic roles

Every person grieves in their own way and can be influenced by various factors such as the significance of the loss, personality and coping styles, faith, and life experiences. The process of healing takes time though the amount of time can differ from person to person. What is important is that each individual allows the time and emotional space to allow the grief to unfold.  

The process of grieving can be supported by: 

• Acknowledging and validating the pain and loss along with any other emotions

• Creating space for the wide range of emotions that are a part of grief

• Seeking support from caring people and organizations 

• Taking care of oneself emotionally, physically, socially, and spiritually

• Recognizing when grief is shifting into more serious depression

More information on grief and approaches or strategies that may help: https://positivepsychology.com/grief-counseling/