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Treating Anxiety, Fear and Depression

(This article is a reprint from a "Dear Ginger" mental health column in the La Jolla Light.)

Dear Ginger:

I suffer from anxiety and fear of having a heart attack and/or dying. Every now and then my heart will "flutter," and I think that's it. I was checked out thoroughly by a cardiologist.

Do you experience many people with these same fears and anxieties?

Thank You, AP

Thank you for your question and concern about your situation. You are ahead of the game in just knowing that your condition is caused by: anxiety and fear. Most people who have physical symptoms such as the ones you're describing don't know or can't believe they are caused by anxiety and fear; they often think they are having a heart attack.

So, first off, congratulations for pursuing a medical workup and acknowledging that you have anxiety and fear. The first step to change is awareness. Without it, we can do nothing to change or improve our circumstances.

Yes, I do work with people who have similar fears and symptoms and with people who have a different constellation of symptoms. Everyone is unique in configuration and symptomology.
Anxiety, fear and panic are very common in our society and in mental health practices. You are not alone and have nothing to be ashamed of.

Anxiety, fear and depression are very treatable conditions with a variety of different treatment approaches that are effective in resolving symptoms. You can learn to live effectively without feelings of impending doom.

The most common treatment is called cognitive/behavioral, which teaches you that your thoughts cause your feelings, which in turn affect your behavior. This usually involves negative thinking that is out of your consciousness and quickly turns into "what if" worries, anticipating fearful or negative consequences and can include panic.

This thinking is so automatic and deeply buried that your mind acts like a most powerful computer automatically spiraling downward until these thoughts take over and begin ruling your feelings and behavior. This usually involves avoidance of uncomfortable and/or fearful activities and begins to constrict your life.

I use a self-help program called "Attacking Anxiety and Depression" that you work on at home, supplemented by individual counseling/coaching sessions. I find that most people need the support and accountability in initially learning how to overcome these ingrained behaviors. I also can then monitor your symptoms and make other recommendations as necessary.

The Internet, bookstores and telephone directories have many listings and information on anxiety, depression and phobia treatment options.

The main thing is to find professionals who specialize in this area. You need to feel comfortable with the treatment they recommend, feel comfortable with them and their treatment style.

The sooner you get help, the better. As I mentioned before, these symptoms and behaviors can easily build up and really affect the quality of your life, including peace of mind, and your normal activities.


The Art and Nature of Personal Responsibility

I find that most people don’t know the term or concept of taking personal responsibility. We like to look to others to point our fingers at or blame for our unhappiness. “You did such and such, they did such and such” is a common complaint I hear, and often that is accurate, someone has done something to upset us.

The nature of taking personal responsibility is to look at ourselves and the situation as objectively as possible. To acknowledge and own up to ourselves (honestly) what we might have done to provoke the situation or person to respond as they did.

You do that by standing back in your mind observing, watching, and replaying the incident to see what you might have contributed to things going awry. “What did you contribute?” is the basic question and concept.

The art of taking personal responsibility is just that. How we acknowledge and share our “contribution”. There are three parts to the art of taking personal responsibility.

First we start with describing the situation as factual and non- blaming, using “I” statements. For example, “When we made plans to go out for the day, you wanted to go _____ and I wanted to go _____, and we ended up doing what you wanted to do, which I said was fine.”

Second, we acknowledge our part or contribution. “Then I realized I wasn’t happy doing _____ and I started acting mean instead of telling you directly that I wasn’t happy.”

Third, we problem solve to find a better solution, such as, “Next time I will try to tell you beforehand I wouldn’t be happy doing _____ and we can come up with some other options.”

For every conflict we are involved in, it would serve us and humanity better if we could acknowledge our contribution without blame, take personal responsibility for our part, and find a better solution. Wouldn’t you appreciate it if someone offered you this nice treatment?


How Do You Say Goodbye? 

As a therapist I welcome and “graduate” many people. I do short and long term treatment, initial assessments and referrals. I also lead groups that teach people how to develop good relationship and marriage skills.

One thing I have noticed over the years is a universal “discomfort” that people have with endings and goodbyes. Most people want to avoid them, sugar coat them, or make someone wrong in the process. It seems hard to be honest and forthcoming about our true feelings and why a change or goodbye might be necessary.

Because of this, I have a policy that if someone wants to end/change treatment that they do it in person; not on the telephone or voice mail. That way, we can talk about the reasons why, put a plan together, and feel good/respectful of the need for change and the process of getting there. Finishing one’s “business” with integrity and mutual respect makes it a lot easier when the next change opportunity arises, and it makes it a lot “easier” to come back together if that’s what’s needed in the future as well.


Why Does Love and Marriage Seem So Elusive?

Most of us grow up with the myth that our Prince Charming or our Cinderella will just one day appear in our lives, that we will fall madly in love, get married and live happily ever after.
What a terrible thing to find many years later that our dream has not come true.

 Unfortunately, this can happen for a number of reasons. So breaking down the myth, let’s take each step one at a time.

What if your Prince Charming/Cinderella just doesn’t appear? Do you know how to appropriately go looking for them, while making your life full and fun in the process?
What if you do meet your Prince Charming/ Cinderella and fall madly in love? Have you really gotten to know them and built a solid foundation before getting married? Or is “love” going to carry you through? What happens if it doesn’t last?

Most of us who get married think it will be “happily ever after.” What we don’t know or aren’t told is how much work it is to have a healthy, loving relationship. There are so many complicating factors in building and living a happy and fulfilling life.

Love and marriage can flourish or break down at any given point along the way. Why it seems so elusive is that it is hard; and we often don’t have the knowledge, tools, or effort to make it happen and be wonderful.


La Jollan Offers Step-by-Step Guide to Relationships

Article written in the La Jolla Light Newspaper

Dana Minney

La Jollan Ginger Lipman Wishner is giving San Diego's singles some pointers. She offers dating classes to anyone who's romantically challenged, that is, single and searching. By taking her eight-session course, people get a step-by-step guide on how to meet members of the opposite sex, date and develop healthy relationships that lead to marriage. When Wishner discovered some years ago that she wasn't the only one struggling to find her ideal mate, she got the idea to start a group. “I read a book called Searching for Courtship. It gives how-to advice on dating. I followed the steps and eventually found my husband,” Wishner said. “Friends told me I should teach others how to do what I did. So I started ‘Ready for Love and Marriage.” She explained that most people lack a practical approach to romance. “People make decisions with their emotions instead of their logic. This can lead to relationships that aren't good for you.”

Wishner, a happily married therapist and coach, admitted some of the concepts she teaches in her classes are unconventional. “Dating is really a numbers game. On average women might date at least 125 men before they find their mate.” Another premise of the book is that people should view looking for a mate like they do buying a house or finding a job. “Men and women need to do their research and weigh the costs and benefits of each option,” she said. No word on how many dates Wishner had to go on before she met her husband, but she did say marriage has changed her. “Since I've gotten married my life has changed ten-fold. Marriage is about growth. You've got to be willing to grow with the other person.” Her own relationship notwithstanding, Wishner has additional proof that her methods work. A lot of her graduates stay in touch with her. “They send me wedding pictures and pictures of their kids as well,” she said.

For more information, call (858) 454-8993 or go to www.howtoimproveyourlife.com. •By Dana Minney


Marriage Equals Growth

I distinctly remember the day I told my clinical supervisor that I had gotten engaged. “Oh how wonderful,” she said, “Marriage is such a growth process.” I was shocked and stunned. That was not exactly the response I was expecting, nor had I ever heard marriage described that way. I was “in love and blissfully happy” imagining our wedding and life together. Growth was not part of the equation, fantasy was.

Since that “jolt” with my supervisor it’s funny to me how right on her comment was, and how important it is to choose a partner who is willing to grow, change, and work at having a good relationship.

On television, movies and the novels we read, the fantasy of being in love is “sold” to us. Not the reality of living day to day, how to communicate effectively, how to work through conflict and adversity, how to be real partners, and how to have a fulfilling sexual life.
Most of us struggle with the fantasy we are overexposed to and the reality we are living being so different than the fantasy.

Growing together and working together is the crux of a good and healthy marriage. Unfortunately, most of us want to live in the fantasy or don’t know how to effectively grow and live happily ever after together. I believe my supervisor was right.


Clues for the Holiday Blues

After more than 25 years in practice, I have heard many different reasons why one could love the holidays or dread them. What is abundantly clear is that the holidays are usually tinged with apprehension for most people. The common sources of holiday blues are:

• Who to spend the holidays with or without
• Where or how to spend them
• Not having enough money to spend or    overspending
• Previous negative holiday experiences
• Not having enough time to get everything    done

The bottom line seems to be pressure. What I have found that works, is to help people discern what is important to them this year and how they might consider trying something different than they may have done before. For example, pick names and only buy for that person(s), try dinner at someone else’s home or facility. Make your gifts, or take a trip somewhere and celebrate there. Try to find some way to lessen the burden of pressure with a creative twist.

It’s amazing what you can come up with if you are willing to be open to new possibilities. Holiday blues can be holiday dreams, if we remember the reason for the season and try to find new ways to enjoy them.


Self Esteem and Dealing with the Herpes/HPV Viruses

Featured in the San Diego City Help Newsletter

SELF ESTEEM could be the mental health buzzword of our time, although that wasn’t always so. I remember being asked to present a workshop on the subject in the early 1980’s when self esteem was hard to define because it was hardly a coined term. Today just about everyone uses it with a wide range of definitions.

Self Esteem is often generated by the power vested in another’s esteem of us. Unfortunately too many of us use other people’s judgment and opinion to dictate how we feel about our own personal self worth (and esteem).

One faction of people especially hard hit by “other esteem” are people who have a chronic, recurring, sexually transmitted disease such as herpes or the HPV virus. Over the years I have worked with many clients who have been diagnosed and are trying to come to terms with having these viruses. Almost everyone feels their self esteem is affected by dealing with how another’s opinion will impact them, i.e. they are “other esteem worried” and abandoning their own self esteem.

Having any chronic recurring illness is hard to adjust to. Having a chronic illness/virus that involves sexuality and another person lends itself to “other esteem” and how they are going to be accepted or rejected for having it. Also at issue is when is the right time to tell another that they have this condition and the anticipation of possible criticism or rejection.

Self esteem, self love and self acceptance is everyone’s goal. People are challenged in varying ways on how to achieve positive self esteem. Some helpful suggestions to put you on the road to healthier self esteem are:

  1. Develop a positive internal dialogue/voice within yourself, “everyone has something about themselves they wish they didn’t have”. “If I am rejected for having this virus they aren’t someone I would want in my life anyway.”
  2. Make a list of all the things and positive attributes that make you a unique and distinct person.
  3. Find a nurturing support group.
  4. Take small steps to build a solid foundation of self esteem.
  5. Set small weekly goals to overcome the things you think you can’t do.
  6. Be accountable to someone, tell them what you are working toward and what you plan to accomplish each week.
  7. Always acknowledge and appreciate yourself and your accomplishments.
  8. Remember that you are human and that overcoming disappointment or adversity is a process.

Self acceptance can only come when we stop feeling victimized or punished and see gaining self esteem as an attainable process. If you learn to love and accept yourself, you may begin to see your human fallibility as a threshold to personal peace, freedom and personal growth.

Feel free to call me if you are stuck in any negative thinking while regaining or improving your own self esteem, or with any other questions you may have.

Ginger Wishner, LMFT 858.454. 8993




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