"SMART" goals

Goals can be excellent things for us to have. They can guide us toward our future, toward changes that we want to make, and toward accomplishments we seek to achieve. But goals can also set us up for defeat if they are too lofty. Ideally, goals should be "smart" goals. What do I mean by that?

S = Specific
M = Measurable
A = Achievable
R = Reasonable
T = Time-limited

For example, someone could have a goal such as "I want ten thousand dollars for a house downpayment." Without a reasonable plan, it might seem daunting and frustrating on a daily basis to think about the $10,000 that you want, but not have a good solid plan for obtaining it or demonstrate any progress toward having it.

A "smart" goal might be something like "I plan to place $200 each month into an interest-earning, low-risk account. In 4 years, I should have accumulated the ten thousand dollars for my downpayment on a house." The second goal, of saving $200/month over a period of 4 years, is very specific, is measurable in the number of dollars, might be achievable with the correct budgeting, is reasonable and not too lofty, and has a time-limit, thus making it a "smart" goal.

When you set goals for yourself, use the acronym above to guide you toward setting goals that are SMART, and then have fun achieving those goals!

Play Therapy for Adults

Think for a moment about children at play. In their play states, they are often creative, happy, laughing, less inhibited, more daring. Do we grow out of play as we age? Do we learn to become so overly cautious and self-conscious that we forget how to free ourselves from our adult responsibilities just to have fun? Yet, wouldn't it perhaps lift our spirits to go run in a park, plop down on a swing and soar into the sky, propel on a scooter, or play a lawn game? Whether you be around kids or not, challenge yourself to join in the fun of play, letting your body feel free, your mind be unburdened by responsibilities just for a few moments, your chronological clock to run backwards a few years. Enjoy the moments, play, and seize the day.

What is Recovery?

Recently at a conference in Seattle, there was a very interesting and dynamic discussion about defining recovery in the mental health field. On a simple and tangible level, we look for remission from the primary symptoms being treated. Yet on a more complicated (and in my opinion, meaningful) level, we look for the quality of life to be significantly improved. While achieving a symptom-free life is a significant accomplishment, it does not in and of itself mean that life is enhanced. It does provide a more solid foundation for building a stronger life with greater value and meaning, and that can weather future storms. Keep this in mind when you are working so hard - that each day you are able to be symptom-free you are strengthening your life's foundation.

The Invisible Bear Trap

I went to an outstanding seminar yesterday, "Advances in the Integrated Treatment of Trauma," taught by international expert John Briere, PhD. He shared a wealth of important clinical conceptualizations and treatment paradigm shifts for all in the room.

Dr. Briere highlighted how important it is that when we are around those who have been traumatized (physically, sexually, and emotionally including emotional neglect), we understand how much traumatized people are hurting. He emphasized this point by talking about an invisible bear trap. If you are walking down the street and accidentally step on an invisible bear trap and its jaws snap around your ankle, you are going to be in tremendous pain. You might jump around, scream out loud, wave your arms in the air, try to grab someone walking by to help you, etc. But if this invisible bear trap is in fact invisible, others won't be able to see it. What they may see is a 'crazy' person and try to get away from you, leaving you alone in your suffering. If they can't see the bear trap, they aren't likely to understand your reactions and be able to empathize with you and help you when you're in so much pain. As difficult as it is to talk about painful and traumatic events, doing so helps the pain and suffering become visible and more understandable to others, thus boosting their ability to extend compassion, warmth, and assistance. Which trusted person in your life might need to know more about your invisible bear trap so they can better understand and help you?

Learning to Leap for Joy!

It's rare that I get to blog on leap day - what fun! Let's do something special and unique to celebrate this precious 'extra' day that we get. Let's 'leap for joy' - but what is joy? Here are some quotes that describe others' definitions of joy:

Joy is prayer - joy is strength - joy is love - joy is a net of love by which you can catch souls. - - Mother Theresa

I define joy as a sustained sense of well-being and internal peace - a connection to what matters.
- - Oprah Winfrey

Learning to live in the present moment is part of the path of joy.
- - Sarah Ban Breathnach

There is no greater joy nor greater reward than to make a fundamental difference in someone's life.
- - Sister Mary Rose McGeady

We could never learn to be brave and patient, if there were only joy in the world.
- - Helen Keller

What I glean from the aggregate of these quotes is that joy is palpable because we have known hardship yet is always within us, is felt in our meaningful connections with others, and is enhanced when we positively affect the lives of those around us including the lives of you and of me.

So be courageous on this special day and seek out some joy. Be still in your soul and true to yourself and your health. Find that warm, valuable, mattering spot in your heart and identify one way that you could bring joy to your life. See what happens when you act on it!

Parents Making a Difference

In my discussions with parents, I hear the distress in their voice, wondering if they are making a difference in the life of their son or daughter. They ask questions like how to help their kids handle teasing, avoid substance use, feel confident and build solid self-esteem. While the answers to these complex questions may take time to implement, one thing remains true - parents can make a difference. As we found in a 2006 study, adolescents who perceive that their parents (mother and/or father) care about them, feel as though they can talk to them, and value their opinions (even if they don't heed the advice!) are adolescents who have stronger mental health. These are the adolescents who are less likely to experience depression and low self-esteem. They are also less likely to use substances, engage in unhealthy weight control behaviors, and attempt suicide. Parents can make significant strides toward helping their kids feel valued by taking time on a regular basis to listen with full attention, making eye contact during conversations, and refraining from quick judgment or providing solutions to the problem. Focus instead on holding a discussion in which pros and cons of many solutions to a problem are discussed, and seek to help the young person make an appropriate decision on his or her own.

The Ultimate Private Practice Goal

Over a decade ago, when I was establishing my private practice, my father asked me what my goal was for it. I don't know what answer he expected. Perhaps it was about growth in appointments or income, or about professional activities outside of the private practice. I never asked what he had in mind, but I do know that he was more than a little surprised by my answer! I told him that my ultimate goal for private practice was to go out of business!! And the reason I want to go out of business is because the need for the type of services I provide is gone - for people to feel amazing all the time, take great care of themselves, and not hurt others. If that happened, psychotherapy as a profession might just disappear. Wouldn't that be amazing? Perhaps it's a lofty goal (I may be a dreamer), but will you help me achieve it?

Great Expectations

It's important to be cautious yet realistic about what we expect from others. Evaluate what you think a person can provide, and tailor your expectations to those observations. Just because a person isn't able to provide one thing doesn't mean that they aren't highly valuable for another need. You don't go to a dry well for water, but you may go there to sit and rest, partake in the shade. When we correctly determine which valuable people can meet our expectations for one need versus another, we are more likely to be satisfied with our relationships.

No Tense for the Future

I just came back from a really interesting and exciting vacation exploring three main parts of Chile... but I have to tell you about one of the highlights - Easter Island. Easter Island (Isla de Pascua) is a teeny island in the Pacific Ocean, very remotely located far, far from other lands. The native inhabitants are known as the Rapa Nui people. At dinner one night, I was so fortunate to have the amazing opportunity to sit next to a native Rapa Nui woman whose name is Tina Maria. She told me many fascinating stories about her people, and one that I found highly interesting is that the Rapa Nui language has no future tense. They don't plan in advance. They can't talk about what lies ahead. They have no language for worrying about what will happen tomorrow. They can only address what is happening now and what has happened in the past. As I wondered what that would be like, I also remembered that optimal mental health encourages us to focus on the present. This may be more challenging in a culture that does focus on the future but perhaps we can challenge ourselves to live in the moment.

Check-Up from the Neck Up

Many of us are pretty good at basic maintenance. We have the oil changed in our cars when it's due, we have our teeth cleaned every 6 months, and perhaps we even change the air filter in the furnace and replace the batteries in the smoke detectors once a year. All of these tasks are designed to keep things running smoothly and prevent problems. Yet it's not so clear to us what practices might improve our mental health. We're not born with engine lights that tell us when some part of us is overheated or broken, nor calendars that tell us when our next vacation is due (but wouldn't that be nice?!). Instead, we can benefit from a "check-up from the neck up" - checking in with ourselves to evaluate how we are doing and feeling. Try these questions:

• How regularly are you sleeping? How many hours each night? Do you sleep soundly or not?
• Are you eating enough, or eating too little? Open your cupboards and refrigerator - do the contents look like you want them to?
• Is there time for exercise, reflection, meditation in your life?
• How would you rate your connections with others? Frequent enough, too often or just right? Superficial or deep?
• Are your finances and chores up to date? Or are things slipping behind you?
• Do you engage enough in activities that make you feel good - such as whimsy, hobbies, volunteering, spiritual activities, visiting with special persons?

Conduct a "check-up from the neck up" to evaluate how you are doing. If you find that you are "off" on a number of the answers to the questions above, perhaps it's time to slow down and evaluate your priorities. Can someone help you get re-aligned? What responsibilities can you give to someone else or get rid of altogether? What priorities need to shift in rank? Monitoring our behaviors, thoughts and feelings on a regular basis helps us identify problem areas so we can get a tune-up. Try a "check-up from the neck up" on a weekly basis and see what you find out about yourself!

Effects of Abuse on Binge-Eating and Purging

Collaborations with my colleagues at the University of Minnesota have allowed us to investigate several factors on problems associated with sexual and physical abuse (emotional abuse and neglect are likely associated with the same problems, but weren't included in the survey).

In 2001, we were discouraged when we learned that 18.1% of girls and 11.9% of the boys studied reported being physically and/or sexually abused. Abuse was significantly associated with binge-eating and purging behavior. It was further upsetting to learn that less than a third of abused youth chose to talk with someone about the abuse. Our findings suggested a trend toward those who talked with someone being less likely to engage in binge-eating and purging behavior. Of those who did decide to discuss their abuse, they most often turned to a close friend, a parent, or another trusted adult.

Sexual and physical violence have multiple negative effects, including but certainly not limited to eating disorder behaviors. Talking about the abuse may reduce shame and lessen emotional distress related to the abuse, however it's essential to find safe, trusting, and accessible environments and persons to approach about these difficult issues. If you or someone you know has been abused, please seek help from someone you trust.

Your Mental Health Account

Consider that your mental health is like a bank account. For a higher balance (stronger mental health), make regular deposits (self-care) that are larger than the withdrawals (stressors, demands, genetics, etc.) in order to avoid overdrafts (such as significant depression, anxiety, using unhealthy coping skills like drinking or binge-eating) and to build a buffer zone for times when you may need to make larger withdrawals.

Mental Hygiene

Did you know that in the middle of the 19th century mental health used to be called mental hygiene? Hygiene is defined as conditions or practices conducive to maintaining health and preventing disease. I think it communicates that active participation on our parts can help us have better psychological health.

If you didn't brush your teeth or floss for a year (ick!), would you expect that your teeth would be fine? Of course not. Nor should we expect that if we are regularly stressed, overcommitted, sleep-deprived, and overwhelmed that we'll be fine.

What would your mental hygiene comprise? What would you need to have or practice on a daily or weekly basis in order to be at your best psychologically? Go ahead and try it out - see if it makes a difference if you develop regular practices for optimal mental health....

Adolescent Dating Violence: Study Findings

Because of my clinical work in eating disorders, which predominantly affect younger individuals, I have had the joy of working with many adolescents. Yet I have been alarmed in hearing of numerous unhealthy dating experiences, either their own or those of their friends. Subsequently, one of my primary areas of focus has been on adverse dating experiences among adolescents.

• In 2002, we published the largest study to date on adolescent dating violence. In a survey of over 81,247 Minnesota youth, we found that a worrisome 9% of girls and 6% of boys had experienced either physical or sexual violence by a dating partner. Of further concern, dating violence was found to be associated with higher rates of disordered eating behaviors (such as binge-eating, fasting or skipping meals, taking diet pills, self-induced vomiting, and taking laxatives) and suicidal thoughts and attempts, and lower scores on measures of emotional well-being and self-esteem. Visit the American Psychological Association's press release for this article.
• In 2003, we published a follow-up study of over 3,000 youth who completed the Commonwealth Fund Survey of the Health of Adolescent Boys and Girls. With this nationally representative population-based sample, and using a different definition of physical or sexual violence by a dating partner, our findings showed that an alarmingly high 17% of girls and 9% of boys reported adolescent dating violence. Dating violence was found to be associated with a broad range of behavioral and mental health risks, including dieting, binge-eating and purging behaviors, cigarette smoking, alcohol consumption, drug use, suicidal thoughts, depression, and poorer self-esteem for both girls and boys. Of particular concern was our finding that approximately 50% of girls and boys who had experienced physical and sexual dating violence also reported staying in relationships out of fear of physical harm.