|
|
Most individuals suffer from anxiety at some point in their lives. For many of these people, anxiety may become chronic or escalate to an unmanageable state.
Anxiety disorders include Generalized Anxiety Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and Phobias. The first part of treatment of these disorders is an anxiety assessment in which Dr. Dye and the client work together to identify sources of anxiety, symptoms of anxiety, and situations most likely to evoke anxiety. Based on the results of this assessment, treatment goals are established.
Some individuals are reacting to situations in their lives, including job stress, school difficulties, family problems, or other common stressors. These individuals may benefit from cognitive and solution-focused therapy to gain control over their symptoms. Discussion of stressors is also important to identify actions the client can take to address sources of anxiety in their lives.
Treatment for other anxiety disorders, especially Obsessive-Compulsive Disorder and Phobias, must include behavioral interventions, such as placing oneself in the stressful situation to develop mastery over symptoms. Medication may also be an important part of treatment, which can be stressful.
Some individuals may need to understand the roots of anxiety in their lives. They may need to work on building self-esteem and recognizing the strengths and resources they have that can be utilized in overcoming anxiety. Discussion of past negative experiences is important for the development of self-understanding.
Depression can be a short-term reaction to difficult life circumstances, such as divorce, loss, and problems at work or school. A cognitive-behavioral or solution-focused approach is often effective for individuals struggling with these issues.
Depression can also be a more serious long-term condition resulting from a combination of personal history, current stresses, and biological factors. Individuals with severe depression require more active long-term intervention. This may include a combination of psychodynamic and cognitive-behavior therapy, potentially including work with family members. Medication can also be an important component of treatment. Dr. Dye works with each client to develop a mood management program to insure that they learn to manage their depression and maintain a stable mood both during and after completion of treatment.
Depression in children and teens is often overlooked by parents, teachers, and even mental health providers. Kids with depression do not always present with classic symptoms of depression, such as sadness, lack of energy, and a poor appetite. Because depressed kids often have periods when they appear happy, they can be misperceived as being lazy and unmotivated or as having behavior problems. For example, it is important to rule out depression before treating kids for behavior disorders, Attention-Deficit Hyperactivity Disorder (ADHD), family problems, and substance abuse. If an underlying depression is overlooked, treatment for other problems may not be effective.
For children and teens, it is essential that family members participate in treatment. All members of the family must be educated about depression and how to interact with individuals who are depressed. With Dr. Dye, parents work on coping skills and receive emotional support in addition to learning effective methods of helping and interacting with their children. Although teens and some children may prefer to meet with Dr. Dye individually, parent or family sessions are scheduled as needed. Treatment can also include coordination with schools, including attending school meetings.
Depressed mood
Lack of energy
Inability to concentrate
Lack of motivation
Loss of interest in things previously enjoyed
Feelings of boredom and hopelessness
Changes in appetite
Sleep disturbance
Irritability
Social withdrawal
A sense that life is meaningless
Thoughts of death or suicide
Individuals with depression exhibit many but not all of the symptoms above. Additional symptoms may include inappropriate anger, self-injury, and substance abuse. Adults often express a general dissatisfaction with their lives, including jobs and marriages. Children and teens sometimes exhibit oppositional behavior, such as tantrums, school problems, or rebellion against family rules.
Individuals with Bipolar Disorder suffer from biologically based wide fluctuations of mood. Most individuals struggle with both depression and mania. Information about depression is included under the DEPRESSION tab on this website.
Most individuals with Bipolar Disorder suffer from severe depression alternating with periods of mania. Depression or mania can occur for an extended period of time. Bipolar individuals presenting primarily with depression are difficult to diagnose, as they may not show mania for many months or years. Some people suffer from "rapid cycling" in which mania and depression alternate frequently within the same day. Others have "mixed states," during which aspects of both depression and mania are present.
Medication is essential for the treatment of Bipolar Disorder. As with depression, clients must develop insight into the disorder and an ability to identify when they are at risk of mood swings. Coping strategies such as taking a "time out," obtaining emotional support, exercise, and distraction are essential to control moods. With Dr. Dye, each client develops a list of coping strategies that can be helpful when he or she is having difficulty with mood regulation.
Elated mood
Grandiosity
Impulsivity
Pressured speech
An unusual level of energy
Reduced need for sleep
Irritability and rage
Children and teens may experience any or all of the symptoms above. However, at times they present with behavior problems.
Oppositional and argumentative behavior
Rages and "meltdowns" when frustrated or when things "don't go their way"
Violence toward property and people
Verbal abuse
Hyperactivity and agitation
Disruptive behavior in school
Children and teens often have difficulty identifying changes in their moods and in using their coping strategies. Parents and other adults in their lives must be educated in how to help children and teens best utilize their coping strategies.
Divorce is always a difficult experience. However, divorce does not have to be excessively expensive or contentious. Research has shown that litigated divorce has negative effects on all parties involved, especially on children. When couples are randomly assigned to either lawyers or mediators, children of the couples who go through mediation are doing significantly better after ten years.
Dr. Dye provides psychotherapy for couples and children undergoing divorce. Goals may include supporting couples going through divorce mediation, education about how to effectively manage the emotions involved in divorce, and working together to make sure children are minimally hurt by divorce.
Children and teens have many different feelings about divorce. In contentious divorces, children suffer from being caught in the middle between two divorcing parents. Even when divorce is relatively amicable, kids feel sad about divorce and worry about what the divorce will mean to them and to their parents. It is often difficult to adjust to having two homes and to visitation schedules. At times, it is difficult for children to feel good about both parents. When parents begin to date, kids often have strong feelings about the fact that they are dating and about potential partners parents bring home.
Most kids benefit from short-term therapy during a divorce. It is good for them to have a neutral party to speak with so that they can talk about feelings without the fear of offending either parent. They also benefit from asking questions to a professional experienced in working with families of divorce. The therapist can be used as needed after and initial period of introduction, and weekly sessions are not always necessary.
Some kids need ongoing therapy throughout the divorce process. These kids may feel depressed, anxious, and alienated from one or both parents during the divorce. While many children and teens eventually adjust well to divorce, others are more sensitive and are unable to adjust without help. Therapy may be particularly important during a litigated divorce.
Even after a divorce, parents may continue to struggle with effective communication and cooperation. Therapy can be helpful to provide a safe forum for discussion and to receive advice on how best to manage conflicts. Coparenting sessions do not need to be weekly but can be scheduled periodically when conflict arises.
Most divorced individuals eventually wish to pursue new relationships. This can be complicated after the pain, sense of failure, and feelings of rejection common after divorce. People are often afraid they will repeat the mistakes they made during marriage with a new partner. They often express fears of selecting the "wrong" person and having another bad relationships. Adults in the Washington, D.C. area have difficulty meeting potential partners unless they actively put themselves in situations where others also want to date. It is important to think about appropriate venues to meet people.
Dr. Dye helps clients to explore their readiness to date, the apprehensions they have about forming new relationships, and to identify and appropriate strategy for dating. She also works with clients to develop a more sophisticated ability to identify the strengths and weaknesses of potential partners. Dating is often stressful because it involves making oneself vulnerable and withstanding the inevitable rejections that occur during the process. It is essential that clients learn not to personalize the ups and downs of dating and to work toward optimism and resilience.
Dating is especially difficult when children are involved. Questions may include:
"When is it ok to start dating?"
"What information is appropriate to share with my children?"
"How soon should I introduce children to the person I am dating?"
"How much time should I spend with my children and new partner together?"
"When and what should I tell my ex about a person I am dating?"
"Is it appropriate for a new partner to spend the night at my house?"
"What should I tell the kids if I decide to get remarried?"
There are no right answers to the questions above, and people often differ in their approach and on what they think is appropriate. Nonetheless, it is helpful to obtain professional advice and to establish goals and guidelines that will be effective for a given family situation. For example, family issues for parents of young children usually differ significantly from those faced by parents of teens.
Dr. Dye works with couples on a variety of issues, including premarital counseling, improving marital satisfaction, sexual issues, and divorce prevention. She takes a structured approach to working with couples and works to prevent arguments and bringing up an excessive number of problems from the past. Although the past must be understood as a part of therapy, sessions are goal-oriented with a focus on changes to improve the future. Ground rules for effective communication are often reinforced during sessions.
Most people are ill-prepared for the task of parenting. Even when parents educate themselves and implement skills such as effective communication and "time out," children often fail to conform to the plans outlined in books and lectures on parenting. Most parents have had different experiences in their own families of origin and may not agree on strategies based on their own backgrounds. This can be particularly problematic when children have special needs.
During parenting sessions, Dr. Dye reviews what parents have tried already with their children and how effective these strategies have been. She then works with parents to learn new skills and to creatively modify existing skills to make them more effective. Children and teens may be included in sessions to give their views on their conflicts with parents or to participate in the development of behavior contracts. It is essential that parents work together, something that is often difficult with challenging children. If children have special needs, such as ADHD, learning disabilities, and Bipolar Disorder, parents often need education on reasonable expectations for these children and on strategies that are most effective.