I am excited to announce that I will be moving my practice to the Cherry Street Professional Offices building on the corner of  Humboldt and Cherry streets in historic downtown Santa Rosa.  The office is located at 659 Cherry Street and is less than half a block away from my current practice.  This of course means minimum disruption for my clients:  directions to the office and parking remain the same (two hours of free street parking).  The office is beautiful, inviting, and offers an environment that is both professional and conducive to healing.  For me, atmosphere means so much and this is exactly the kind of space I have been looking for in order to offer and expand Mayesh Counseling Services.

I will be at the new location starting August 1, 2011.  My telephone number and email address will remain the same. 

659 Cherry Street, Suite 108
Santa Rosa, CA  95404
707-527-9822

How do we accept what feels completely unacceptable in our lives such as the loss of a loved one by suicide?  Starting in September, I will be offering a 6-week grief counseling group specifically addressing this issue.  Open this pdf flyer for more details if you or someone you know might benefit from attending such a group:  Accepting the Unacceptable 

For the last five years, I have focused on grief with an emphasis on catastrophic losses due to suicide, homocide, sudden illness, accidents, or multiple deaths.  I am most experienced in the area of suicide loss because of my own personal experience (my mother took her own life) and because I volunteered as a grief counselor at the Marin Suicide Prevention and Community Counseling Center before becoming a licensed therapist.

Group counseling can be very effective in healing from grief.  It is helpful to share your experience with others who can identify and relate to what you are going through, especially with suicide loss which still carries some stigma.

I also address grief and loss in individual therapy.  Please call me at 707-527-9822 to learn more about the group or to schedule an individual session.

I only learned about the death of Phoebe Prince a few weeks ago when nine of her classmates were arrested on related charges ranging from harassment to statutory rape of the Massachusetts teenager (see Boston Herald article for more info).  The charges allege that their relentless bullying led directly to her suicide in mid-January.

And I just can’t stop thinking about it.

The details are pretty horrific.  A fifteen year-old girl was unrelentingly tormented by nine other teens who in concert threatened, assaulted, insulted, and humiliated her publicly and in private — at school, online, and via cell phone — for over three months.  Then after a particularly bad day of abuse, she went home and quietly hung herself. 

As a civil society, we are left to wonder how something so terrible and seemingly preventable was allowed to happen.  Where were the adults whose job it is to protect children from physical and mental abuse?  And why did the school staff not adequately respond to her cries for help as well as to the complaints of her mother? 

Equally as important, why did no adults step in to protect those bullying teens from themselves and their very worst instincts?  (Yes, I mean protect.  These are still young people susceptible to influence). No one called them to account or pointed out that their actions were not only cruel, but shameful — and reflect very poorly on them and their environment, as their families and school have since learned.

Only now that they are facing serious legal consequences might some of those teens experience anything close to remorse.  I find it deeply disturbing that they did not have such feelings at the time they learned of their victim’s death.  Quite the opposite it seems.  Even after her suicide, the harassment continued on Facebook.  According to one news account, one of them actually posted “accomplished” on her memorial page.

The death of a young person is a particularly tragic event and we as mental health professionals, parents, and teachers, need to do all that we can to understand and prevent teen suicide.  Depression or other underlying mental illness is almost always a factor, but depression can be caused and exacerbated by painful circumstances such as bullying, humiliation, physical and sexual abuse, and loss.  That is why it is essential to address both the feelings of the depressed individual and any related causes.  Had this been done, this vibrant young girl might still be alive today.

You often hear people use the phrase, “That’s the story of my life,” usually said with humor, sometimes with resignation or a combination of both.  According to the Cambridge Online Dictionary, it is said “when something bad happens to you that has happened many times before.” It is helpful to remember that how we digest and relate to the events of our lives, i.e. the stories we tell about them, are what make them defining.

Our stories, good and bad, can be powerful indicators of how we feel about ourselves and our lives, but if you pay attention, you will notice that they shift with time.  There may be different emphases, new information, or new interpretations with each telling.  Or an important story suddenly isn’t anymore and we no longer relate to it in the same way.  This shows us that even though events belong to the past, our stories remain dynamic and can define who we consider ourselves to be in the present. 

Our stories, based in fact and subjective memory, though powerful, can be limiting.  The  gift, however, is that we always have the ability to re-examine, learn from, and relate to our past in more constructive ways.  Psychotherapy is one means of doing just this:  examining the stories that are active in our lives and shifting our perspective to allow for greater and more positive possibilities.

Depression is a common complaint among clients seeking counseling and is experienced by far too many who do not seek help in spite of their symptoms.  If the depression has been long-standing, some do not even recognize they are depressed or assume that their feelings are part of their personality or a natural reaction to their circumstances. 

The good news about depression is that it is very responsive to treatment and can be well managed even if recurrent.  Studies have shown that people get the best results when treatment is multi-faceted and includes some combination of psychotherapy, behaviorial changes, and when warranted, antidepressant medication. 

Therapy helps clients identify the issues that are contributing to the depression as well as finding tools to counter the distorted and negative thoughts that characterize depressive thinking.  Behavior changes can include just about anything that improves functioning, but some good examples are:  reducing (or eliminating) drugs and alcohol, getting regular exercise, eating well, and developing a mindfulness practice (like tai chi or meditation).

Anti-depressant medication has high efficacy rates and can be very helpful.  Depression is often caused or at least exacerbated by a biochemical imbalance, frequently a deficiency in the neurotransmitter serotonin. 

Of course, the bad news about depression is that it can be dangerous, even deadly when it is severe.  The nature of the disorder is to impose a negative and hopeless view that a person suffering from it mistakenly accepts as the truth.  Common symptoms may include sleep disturbance, over or under-eating, negative thinking, guilt, irritability, lack of interests or pleasure, suicidal thoughts, frequent crying, or emotional numbness.

If the depession has lasted more than a few weeks or is getting worse, then I encourage treatment.   Often, therapy is enough to provide immediate relief, but as stated above, the most effective treatments involve a more holistic approach. 

For a list of books I recommend about depression, visit my page Resources: Recommended Reading.

I treat many clients who are self-critical and especially hard on themselves when they make a mistake or their performance is less than perfect.  I know it sounds incredibly simplistic, but I will often interrupt a self-directed diatribe with this simple question, “If a good friend was in a similar circumstance, what would you say to him/her?”

First, there is silence and usually my client smiles with recognition.  She (or he) knows exactly what I’m getting at.  When the answer comes, we are both taken by the clarity and kindness of the advice offered.  “You deserve better,” she might add, or “Don’t take it so hard.  We all make mistakes.” 

It is so common for us to view a situation with compassion when it isn’t our own.  We reserve the greatest understanding for others, perhaps even more for those who aren’t our relatives or very close associates.  That’s why the example of a “good friend” can be so helpful.  But even so, my clients will share with sadness that it is “different”  for them.  Somehow, they “have to be better” and this is rich territory for us to explore. 

However, as my clients learn to listen to and strengthen this understanding and kind self, they are better equipped to counter the self-critical inner voices that fuel depression and anxiety.  Cultivating positive “self-talk”  in this way is more than saying affirmations.  It really is a means of tapping into an inner wisdom.

In addition to my practice as a Marriage and Family Therapist, I work at a facility where I provide counseling and education to families who have a loved one with Alzheimer’s Disease or other type of dementia. In addition to facilitating support groups for caregivers, I frequently make public presentations on the topics of memory preservation, memory care, and other related issues. 

In my teaching, I emphasize taking practical steps to promote mental fitness and mental health as we age.  In fact, this is relevant at any point in our lives.  The earlier we start, the better.  Scientific studies have shown that physical exercise, mental challenge, emotional well-being, good nutrition, and social engagement are all factors in having and maintaining a healthy brain.

I recently wrote an article about the Brain Gym I helped create with my colleagues at Primrose.  For those who are interested in learning more about the brain fitness field and options that are locally available, I invite you to read this article in the 2010 Winter Issue of Sonoma Medicine, the magazine of the Sonoma County Medical Association.

Today is the Winter Solstice, the shortest day and the longest night of the year.  It is the first day of winter in the Northern Hemisphere and marks “the return of the light” in many traditions and celebrations. 

An analogy can be made to the human psyche.  Even in moments of darkness: of uncertainty, sorrow, fear and despair, there are glimmers of light, all that has sustained us to this moment and the promise of brighter days to come.  And still, sometimes it can be so hard to remember that we are loved, worthy, and capable, and that things can — and will get better.

In these frozen moments, it can seem that this is all there is or will ever be.  It is a good time to remember that, like the seasons, hard times and difficult emotions will pass.  They are a part of the human experience, not the entirety of it.  Sometimes our pain leads the way to greater knowing and deeper resolve. 

The darkness of night is also a  positive force, a necessary time of rest, withdrawal, and rejuvenation.  Time to reflect and to dream.  This portion of Michael Sheffield’s poem, “Winter Solstice” reminds us of the truth of this:

All creatures sleep and wake and sleep
Enjoying rest from daylight’s busyness.
Relax, renew your tired self.
Restore your soul.

And this remember all the year
The mountain needs the valley
To appear
So high.

(From:  Sheffield, Michael. “WINTER SOLSTICE.” 17. ReVision Publishing, 2008. Psychology and Behavioral Sciences Collection. EBSCO. Web. 21 Dec. 2009.)

On Monday of this week, I was very pleased to read in the North Bay Business Journal that there is a plan to bring acute psychiatric care back to Sonoma County. The article reported that a Southern California-based mental health provider purchased the Santa Rosa campus at Fulton Road and plans to open a psychiatric hospital in early 2011. This is good news for our community. Of course, I wish that services would be available sooner, but this is far better than the current situation.

After Memorial Hospital closed its inpatient psychiatric unit in April 2008, I spent six months working weekend shifts in a local emergency room evaluating patients and arranging psychiatric hospitalization when necessary. I found it disheartening to send our local residents to hospitals outside of the county. I knew how difficult it could be on patients and their families to be hospitalized so far from home. Finding an available bed was not always an easy task, either. Patients sometimes waited days before being transferred to an appropriate facility. I felt that I was working in a broken system, trying to band-aid together the best solution possible.

It was difficult to understand how a county as large as ours could not have inpatient psychiatric care other than the few available beds at Psych Emergency Services. Some of our local leaders tried to place a positive spin on the situation by stressing the expansion of community and peer-based services funded by the Mental Health Services Act at the same time the local psych units were closing. Though I applaud a prevention model of care and community-based services, I do not believe that they alone are sufficient, especially when emergencies arise.

As a Marriage and Family Therapist who has had clients in crisis and who has worked on an inpatient psychiatric unit, I am greatly relieved that a psychiatric hospital will be opening in our community in the near future.

On the heels of the Thanksgiving holiday, I find myself thinking about the power of expressing gratitude. 

Feeling appreciated is a universal human desire and feeling unappreciated is an all too common source of hurt and dissatisfaction in many people’s lives.  Too often, husbands and wives feels unappreciated by their spouses, parents by their children, children by their parents, or employees by their employers, and so on.  Sometimes the lack of appreciation felt is due to a perceived slight or misunderstanding.  But sometimes it is caused by a very real lack of acknowledgement, which can lead to feelings of self-doubt, hurt, and resentment.

In a 2005 study in positive psychology (a young branch of psychology that emphasizes strengths and virtues in individuals and communities),  Mitchel G. Adler and N.S. Fagley of Rutgers University concluded that people who felt appreciation had a greater sense of well-being than those who did not.  “Appreciation was significantly related to life satisfaction and positive affect, even after the effects of optimism, spirituality, and emotional self-awareness had been statistically controlled.” (Adler and Fagley, 2005). 

In short, it appears that having appreciation makes people happier. And it is fair to say that feeling appreciated also contributes to happiness by making people feel valued, which adds to self-worth and purpose. 

Giving thanks is clearly a win-win for all.

Searching for a therapist can be something akin to going on a blind date.   An acquaintance or friend makes a suggestion for someone for you to meet or you get a name from a referral service or directory.  You talk on the telephone and arrange a first meeting if that initial conversation goes well.  For a client seeking help, finding a therapist can be similarly vulnerable, anxiety producing and filled with hopeful anticipation. 

My best advice for clients is to take their time to find a therapist.  As in any relationship, ask yourself about the qualities you are looking for and be prepared with questions when you make that first contact.  For some, a therapist’s theoretical orientation is important or it’s their interactive style, specialization, or life experience. Whatever is essential for you, don’t be shy in asking for what you want. 

 If the chemistry isn’t right, then even the most competent therapist may not be the right therapist for you — or the right one at this time.  Therapy is built on the foundation of a professional and trusting relationship that requires compatibility.

When I meet a client that I believe would be better served by someone else, I will gladly give a referral.  I also give potential clients the opportunity to meet me in person at no cost for a brief “getting to know you” session in order for them to better assess whether or not I am a fit, as well as address any questions or concerns face-to-face.  Not all therapists offer such a meeting, but an in-depth telephone interview can provide much of the same information.

The therapeutic relationship is an important one and the better a client feels from the outset, the more likely the therapy will be successful.

Saturday, November 21st is National Survivors of Suicide Day. It is always the Saturday before Thanksgiving and was created by U.S. Senate resolution in 1999 through the efforts of Sen. Harry Reid of Nevada, whose father committed suicide.

The term Survivors of Suicide (SOS) refers to those who have lost a loved one to suicide. In the last two decades, support groups have formed to address the unique and complicated grief that such a death can cause for the bereaved. It is never easy to lose a loved one, but suicide can create feelings of guilt, anger, and sorrow like no other loss, and if left unaddressed, can lead to anxiety and depression.

As a Marriage and Family Therapist practicing in Sonoma County, I have led Survivors of Suicide support groups and have provided counseling to individuals who recently experienced the suicide of a spouse, child, or close friend. I know first hand, as a client who lost a family member to suicide and as a therapist who counsels the bereaved, that healing from such a tragic loss can be facilitated by sharing with others.

I encourage all survivors of suicide to reach out to others, even if their loss was years ago. This can be done by attending counseling or an SOS group. It can also be very powerful to participate in an SOS event like the Out of the Darkness Walk to raise money for suicide prevention or in a National Survivors of Suicide Day conference sponsored by the American Foundation for Suicide Prevention.  These are all opportunities for survivors to receive support and information, as well empowerment.