Month: January 2016

Unloading Stress Before it Explodes

 

Reader’s Question

I have a very stressful job in IT. I love my job — it’s probably the best job I’ve had. But I let the stress build up like a bag of garbage and I carry it around for months. Then, I usually let the bag explode on the people I love. It is usually when something is said at home. The last time I blew up I said a lot of things and did a lot of things I don’t remember. I just remember this boiling feeling rise up inside of me. My wife told me about what I said and did, but I don’t remember it. I need something that will keep me from carrying around this garbage and letting it explode.

Psychologist’s Reply

What a great way to describe how stress and frustration can build and burst when we don’t have ways to manage it or prevent ourselves from releasing it as it comes. Many people experience stress and other difficulties in the way you’ve described — they just ignore it or hope it will go away until it then takes over in a very uncontrollable way. Thankfully, there are strategies that can help anyone to pay better attention to the stresses as they come and find constructive ways to manage them rather than having them manage you.

The first step is to begin to notice and pay attention to stress itself. Do you notice it, but push it aside? Or, do you only notice the stress when it’s too late? Begin to pay attention to stress itself — especially in your body. Some people feel stress in their neck/shoulders, some feel tightness in their head, chest, or stomach. Where is your stress?

The next step is to begin to notice the events that happen before you feel the stress. Is it something someone says? Is it a work deadline you receive? Is it interpersonal tension at the office? What are the situations that seem to influence the stress?

Once you’ve noticed how the stress feels and the events that happen before the stress comes, you can begin to think more about the stressful situations — particularly the thoughts that come to you about the situations. For example, after being given a deadline, some automatic thoughts might be: “Are they crazy? That’s too soon!” or “I’ll never meet this deadline.” Notice what other thoughts snowball afterward — perhaps thoughts such as “How will I get my other work finished?” or “How will I have time to go to my kid’s game this weekend?” or “I’ll never get any down time this week,” etc.

Some people have found help in the research supported Mindfulness-Based Stress Reduction (MBSR) to help them better explore and release the stressful thoughts that can build. The program has been adapted into several workbooks that are very easy to use. The overall goal of MBSR is to build your mindfulness “muscle” through short daily practice, so that when stress comes you can manage it easily instead of letting it build, carrying it around with you, then having it explode when you least expect it.

For anyone who finds themselves in a similar situation, I like to recommend the workbook by Bob Stahl, PhD and Elisha Goldstein, PhD, A Mindfulness-Based Stress Reduction Workbook [Amazon-US | Amazon-UK]. It might be worth trying instead of carrying such a heavy load with you all the time.

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Hating Your Body After Pregnancy

 

Reader’s Question

My husband and I had a child about 10 months ago. Due to complications during delivery I had to have a c-section. Next month will mark 1 year since my husband and I had intercourse. It’s not from a lack of trying on his end. I only weigh about 10lbs more than my pre-pregnancy weight, but I can’t even stand the thought of being naked, which completely deters me from wanting to have intercourse — and don’t get me started on my scar from the cesarean section. I am afraid of getting pregnant again even though I am on the depo shot due to getting pregnant while on the pill. I wouldn’t change anything because my son was born healthy and safe. Is this normal? And is there anything that I can do to help this?

Psychologist’s Reply

After pregnancy, it is incredibly common to have negative feelings towards one’s body. These feelings can often translate into diminished desire for intercourse. It is usually not the specific type of scar or exact amount of weight gain that impacts one’s self-esteem and body image. More so, it is how you felt about your body prior to pregnancy and how you cope with all these changes that matters. For anyone in this position, try this: pause for a second and absorb that for 40 weeks (10 months) you had no real control over how your body changed. As you think about this, what feelings or emotions came up? The first step is to give yourself permission to process those feelings by talking them through with your spouse, friends or a professional counselor.

Next, let’s try to understand why these feelings may occur. During pregnancy, many expectant mothers feel they have lost control over their bodies. This loss of control often results in feeling distant and/or wanting to control their bodily needs post pregnancy. During the first year of motherhood, women are also learning how to respond to their babies’ needs and often overlook their own. Complaints about not having time to shower, sleep, use the restroom or eat a full meal are commonplace. As such, on a daily basis, they are constantly ignoring and distancing themselves from their bodily needs in efforts to raise a child. The body that they knew for 20-40 years prior to pregnancy can feel very different from their current one. And many women weren’t happy with their bodies prior to pregnancy. During periods of change and stress, pre-existing negative feelings can intensify.

A good starting point to address these feelings is to critically examine your emotions and current lifestyle. Ask yourself the following questions:

  • How did you feel about your body before pregnancy?
  • What areas of your life do you feel you have control over?
  • Has your schedule drastically changed?
  • Do you have any time for just you, without your child or spouse?
  • Can you spend any time getting to know your new body through meditation/yoga/exercise?

Try to start cultivating love for the body you currently have. In your specific case — and I appreciate this is more easily said than done — consider reframing how you see that c-section scar and weight change. These changes can symbolize the miracle of life…the proof that you brought a child into the world.

It is especially important to pay attention to the negative thoughts and/or critical statements you may say to yourself or to others about your body. Common negative self-talk statements include terms such as always, never, should, and could. When you hear yourself saying them, try to ask yourself: Is this really true? Are there any exceptions? Would I say this about someone else? This process is part of a set of cognitive behavioral techniques used to reduce negative self-talk. Increasing awareness of how often you engage in negative self-talk and countering it with more positive statements can be helpful.

In terms of the worry about becoming pregnant again, some women find it helpful to return to their OB/GYN for reassurance about pregnancy rates of the specific birth control method being used. Others also chart their ovulation to assist with ensuring they are not having intercourse during fertile periods. When you find yourself getting worried about becoming pregnant, you can try reminding yourself of these facts to help manage the anxiety. For example, “I know I am scared of getting pregnant, but the doctor mentioned that research shows X people get pregnant while on Depo. Also, I am not ovulating during this time period so the chance of pregnancy is less than Y.” Creating an inner dialogue to help counter your anxiety is often helpful.

Some couples find it helpful to rekindle their intimacy by beginning with non-sexual touch and gradually increasing their levels of physical touch. Many new parents find it useful to seek individual or couples counseling to gain assistance in navigating the multiple transitions with parenthood.

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Quick to Anger

 

Reader’s Question

I’m a 22-year-old girl and I’m a medical student. My problem is that I get angry SO FAST! I don’t know how to control my anger and I feel really bad when I keep my rage inside!

Psychologist’s Reply

Anger is one of those common emotional states that historically brings on behaviors that we can regret and that cause us and those around us discomfort and pain. Many of those I work with who struggle with their anger relate, like you, that it often comes on fast and strong. There are many sources that can bring on anger and rage. For many, common contributors to anger include stress and depression. Being a medical student, I’m sure you can identify with the stress aspect, but depression can often be a source as well. Often we think depression keeps us sad and lethargic, far from anger. However, anger and depression can be closely associated.

With depression often comes two very important collaborating emotions — fear and pain. Anger is often a secondary emotion to a response we are already having. Fear can arouse anger when we are in our fight or flight response to some stressor. Pain can be a bit more complex. Often under our anger are feelings of hurt and emotional pain. This emotional state is quite — well, painful. Sometimes I think to avoid or escape this emotional state we jump up to anger to search for relief. Most of my clients will tell me it is easier to feel angry than feel sad, depressed, and hurt. Unfortunately, a lot of us will take the anger and then turn it back in on ourselves because expressing our anger feels guilty or we are forced to stuff it down because others or environments around us prohibit us from expressing it. Turning our anger back inward creates more depression, more depression leads to more anger, and so on. Dealing directly with our sources of pain negates the need to escape into anger.

Anger coming on so quickly is often the problem. Before we know it, we’ve said or done something that we regret. One of the first things to do to break the anger cycle is a very simple strategy that is actually tough to master. STOP. Stop what you’re doing, stop what you’re thinking, stop everything. Anger is like a shallow but powerful river we are caught up in. We have to be able to stand up and face the current and not allow ourselves to be swept downstream. I’m not saying stop the anger; we don’t just turn it off. I’m saying stop everything else. Stop and just focus on breathing. Breath. Just focus on that to give yourself an opportunity to break free of the current and avoid getting swept over the anger falls ahead. Once you do that, you’ve given yourself a few seconds to take advantage of other ways to cope — beathing, relaxing, leaving, changing your perspective, counting to 10, etc. From studies of physiology and anger, we know that it takes our body about 20 minutes before it really begins to calm down. Take advantage of that time before you come back to the person or situation that has triggered you.

Here are some more tips:

Rant.
Many people feel that they are out of control with their anger. Giving yourself permission to rant is in a way staying in control. Venting how you feel can also let you discharge this uncomfortable emotion.
You don’t have to explode.
Some people have learned that fighting and violence, and extreme reactions to anger, are normal and acceptable. Perhaps they grew up with examples of extreme anger and others who were out of control with their feelings. It’s important to know that these extreme reactions are not the norm.
Explore and find thinking that triggers your anger to help with future anger events.
Often it is our own thoughts that encourage our anger. Look for words like “should” and “must;” “always” and “never” are also common ones. If you can identify thoughts in your head that use those words, you can likely find irrational thoughts that have triggered you. Examples can be “He should have known better!” or “They are always like that to me.”

Overall, if you can teach yourself to stop and manage what you feel under your anger you’re doing well. There are plenty of books and writing on anger management out there. Find the ones that fit and work for you. Many with anger issues can manage it with support and practice. If you still struggle, seeing a therapist can be a more effective way to do so.

Please read our Important Disclaimer.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. Last reviewed or updated by Dr Greg Mulhauser, Managing Editor on.

All copyrights for this article are reserved to ask a therapist

Why Being Alone with Depression Makes it Tougher

 

Reader’s Question

I’m turning 22 in a few days. I have been depressed for almost four months now. I tried to kill myself once. If it weren’t because of my housemates, I could’ve been dead by now. My family doesn’t know I tried to kill myself. They have no clue that I have been depressed for months. What can I do? We’re not exactly the kind of family that shares everything. We’re not the kind of family that tries to comfort the other when he or she needs it. We’re more like strangers living under the same roof. I’m the total opposite of what I was before. I was the life of the party but now I’m mostly by myself. I’ll just hide in my room and do my own thing. They say I don’t talk much now. The internet is kind of my world now. Online, people may see me as this lively, happy and talkative person. But deep inside I feel empty and worthless, like I have no purpose and all. Nobody really knows me, not even my own family. I am so lost. I hope I can find help.

Psychologist’s Reply

One of the most serious effects of depression is the sense of being alone and isolated with the way you feel. From your description alone, it seems like you feel disconnected and like no one else truly understands. In working with my depressed clients, I can tell you this is very common. Many of them talk about the isolation that accompanies depression, feeling like they put on a good face to cover it up, and that if they told others about how they feel they would be judged or misunderstood. In my experience, being isolated with the way you feel just seems to intensify depression.

People isolate with their depression for many reasons. Like you, they may feel like they don’t have a supportive family or feel closer to their friends instead. Depression seems to take away our motivation to be social if we feel like we have to “fake it” around everyone else. Not having enough social support, having few friends or family can increase the risk of depression for both men and women, especially for example in women who are at home alone with young children and in those who describe themselves as isolated. Having fewer social networks and close connections are variables often associated with the onset of depression. Recent research has also identified college students with minimal social support as being at high risk for suicidal thoughts. Overall, a lack of social support — described as feeling unappreciated, unloved and uninvolved with family and friends — emerged as one of the most powerful predictors of persistent suicidal thoughts, even in the absence of other risk factors.

We need to think about depression as a captor. Depression does a great job at convincing you that you are alone, like no one misses you or that you are the only one who feels this bad. It makes you believe that no one would understand or that others would judge you if you spoke up. Listening to this we can find ourselves in both physical and emotional isolation. It is important to understand that social support is an extremely important part of recovery from depression. People are meant to be social and together. Thousands of years ago we all huddled around fires in caves and stayed in groups for protection and support. Over the generations, this need to be a part of the larger group has actually become ingrained in our DNA. I personally believe that we were not meant to handle everything on our own and that seeking connection and support is actually a strong survival skill and not a sign of weakness as commonly thought. Social connection can even help you find solutions and resources you didn’t even know were out there.

Therapy and support groups can provide us with something very critical to recovery — a sense of “universality.” Universality is the sense that you are not alone, that others understand and have felt similarly to the way you have even though their stories may be different from your own. Simply having this sense of universality has been found to be one of the most productive and healing factors in coping with depression. Research has shown too that isolation can affect an enzyme in our brain that regulates a hormone related to anxiety, aggression and memory impairment. So you see, we are literally made to be around others and connected during times of difficulty.

Disorders like depression can steal our desire to connect and often pull us to suffer alone. It can be difficult to fight this inclination to be alone when hurt and depressed. However, doing so is critical to recovery and feeling better. Many of my clients who manage to do so relate that although they did not want to socialize, once they did they felt some relief. If regular social situations like eating and movies are too much, consider interventions like individual therapy and a depression support group. Given time, these connections with others can be valuable. Connecting with the right social support is just as important as connecting itself. Peers who are supportive and accepting are obviously going to be the way to go. Research has shown that others tend to be somewhat more supportive and helpful than what depressed people give them credit for. Our initial perceptions of others’ reactions when we are depressed tends to more negative than what they should be.

Many are finding online support as well. Numerous online support groups (preferably ones monitored by mental health professionals) can be of help. New studies are even suggesting that adolescents and younger adults are more likely to text a suicide crisis line than talk to someone on the phone.

The bottom line for anyone in this or a similar situation is this: being alone with the way you feel sucks. Even though you may not have solutions to everything you are facing, you don’t have to face it alone. You weren’t built for it. You just need to push yourself to begin to build that connection. The relationships you make and support you build might just even outlast what difficulties you are going through.

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When Trust Is a Problem

 

Reader’s Question

I am a 31-year-old male. I can’t trust anyone. Due to many experiences through my life I don’t see how anyone can be trusted. People get what they need from others and throw them aside once their usefulness is over. Like the rest of humanity I will always have the desire to want to be close to someone, but with not being able to trust anyone I don’t see how that will ever be possible. How can one learn to trust without going through the hurt all over again?

Psychologist’s Reply

Trust can be one of the most important parts of a relationship; the lack of trust can be the most damaging as well. Nonetheless, your difficulty in trusting others is not all that uncommon. This difficulty in trusting others may develop for many reasons. The most common reasons for this include previous negative experiences in relationships that have either aided the individual in developing fears of being hurt or simply just reinforced fears that were already there or learned. We know that trust starts very early for all of us when we are infants and dependent upon our caretakers to feed us, protect us, and comfort us. Sometimes, we over attach to the same sex parent and never develop the trusting bond with others of the opposite sex. When those around us fail to caretake, it can impact our trust of others later in life. Failing to learn to trust can lead to emotional distance in close relationships. The good news is that even if we do not experience trust early in life, we can learn to do so again.

The first step in learning to trust again is to understand that it is innate in all of us to trust and attach to other people. Despite being hurt in relationships previously, I believe this need stays around. However, it puts us in that place of wanting to trust people but feeling afraid to make it happen. We want to be close and intimate, distant from our loneliness, but are scared to do anything about it. Recognizing we need to trust others brings up uncomfortable feelings of vulnerability. Being vulnerable is a very difficult place for us to be. Some of us would rather stay safe than feel vulnerable. I see many people settle for safe and alone, sacrificing being happy and attached.

I think we have to be willing to put ourselves at risk to move forward. A difficult reality to face is that we might get hurt again. However, sometimes, that is the consequence of attachment. For many of us, we have to learn that, although the pain is great when we are hurt, it won’t kill us. It will be difficult, but we won’t die. We really have to believe we will survive a relationship ending and come out OK in the end. This can take time, and one certainly has to grieve and begin to move through the loss before doing so. Once you achieve this, you’re ready to go on to the next step.

To help along the way, here are some tips:

Take your time.
Like really take your time. After being hurt and going through a loss we need time to psychologically recover. We need distance and time to heal, get things in perspective, and grieve. Often we are hit suddenly with feelings of loneliness and the temptation to jump right back into a relationship with that person or someone new can be overwhelming. We need time to be single, with ourselves, and alone. This is often a substantial period of time when we grow tremendously. Allow yourself the privilege of that growth.
Be safe.
I don’t want this to sound contradictory to what I previously said about being safe. What I am talking about here is more the idea of making healthier choices about who you choose to be vulnerable with. Simply traumatizing yourself in bad relationship after bad relationship will only make it more difficult for you in the long run. You can’t put yourself back into a situation or a new situation and rebuild trust unless you feel safe with the other person. We need to really reflect on the situations we place ourselves in and decide if these were the best situations for us to be in or go back to. For many couples I work with in which one person has cheated, the couple often needs space to heal and then to feel safe with the other person before they can even begin to talk about rebuilding trust. If you can’t go back to a situation that can provide you with feeling safe, then I often recommend not going back.
Be open.
Finally, when in a new relationship, be willing to talk about your reservations and fears. Be open about your expectations and put your thoughts out on the table to give both of you a chance to try and work through them. Here’s where you get to practice being vulnerable, with the right person. Believe it or not, trust can actually develop from sharing and being vulnerable with others.

Please read our Important Disclaimer.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. Last reviewed or updated by Dr Greg Mulhauser, Managing Editor on.

All copyrights for this article are reserved to ask a therapist

Self-Esteem: When You Are Your Own Worst Enemy

 

Reader’s Question

I have no self-esteem at all. I am such a burden to everyone around me because I’ve been struggling for so long with my divorce and low self-esteem issues. My sister finally told me that I am “heavy” with all my problems. I understand that in order to feel better I have to get out of the house and still see people, but when I was told that I am a burden, how can I even want to surround myself with people? So then I stay alone, I try not to talk about my stuff to make sure I don’t bother people, then I go home and feel like a failure because I can’t even be myself, because my true self is “heavy” for people. These negative thoughts about me turned out to be real and not just something I make up because of my low self-esteem. I am truly a burden. It’s not in my head. I don’t see how I can love myself one day knowing that the most important people to me don’t even enjoy my company.

Psychologist’s Reply

Problems with self-esteem have been said to have reached epidemic proportions. In my work as a psychologist, I have seen low self-esteem permeate just about every problem my clients can present with. It has its hands in depression, anxiety, relationships, and even career issues. Psychologists often look at self-esteem problems from a cognitive perspective, that is looking at those negative and core beliefs we hold about ourselves and how they impact how we feel and act. However, it is more than just this. Self-esteem is about the relationship you have with yourself. Often my clients talk about the relationship problems they have with their partners, co-workers, family and peers, but opening themselves up to talking about how one relates to the self is a door few walk through. I talk often with my clients about the therapeutic relationship we have, but it’s just as important to talk about the relationship with the self.

The relationship we have with ourselves is often dictated by events early in life or other longstanding and recurring events that happen to us along the way. One of the important things to know here is that self-esteem is created and constructed by these events. I think sometimes we actively and/or passively participate in that process. Bottom line is this -– you are not born with self-esteem. We are born, for the most part, tabula rasa (a blank slate). Self-esteem is something you learn along the way. We are taught by others, events, and eventually ourselves how to see ourselves. These early, core beliefs we develop later dictate what we are willing or unwilling to notice and see about ourselves. Right, wrong, accurate or inaccurate, we are taught to see simply what we are taught to see.

Now things get tricky from there on out. Here is something I have come to understand about the people we call humans. People prefer to be right rather than happy. We need and seek confirmation of our self-concept, regardless of whether it is positive or negative. Then we seek relationships and events that confirm or support what we believe, even if what we believe is that we suck. This is why some of us can’t take a compliment. It never makes it past our negative self-concept that we were taught to believe in. To make matters even worse, we tend to remember those negative events or things people say more because they confirm what we already believe about ourselves. We construct ourselves out of rotten wood and timber and build monuments of self-esteem that could never remain upright when the wind blows. This is why when working with a client that I have genuine good feelings towards they might out of the blue say something like “You hate me don’t you?”

It’s very easy to convince yourself you are a burden to others, that you don’t deserve to be loved, that you are not worthy, stupid, and don’t deserve to be treated well. These are all very threatening thoughts that bring on emotions we hate to feel, so we try to protect ourselves from that by trying to be perfect, never allowing ourselves to make mistakes, always having to do the right thing, and believing that we have to win love in order to be loved, sacrifice ourselves in order to gain approval etc.

A lot of this comes down to a very simple idea. Just because you were taught to see yourself a certain way does not make it truth. I’ll say that again, because some of you may have just only bolstered your defenses and gone “But you don’t know me!” or “I know it’s true, because I feel it so strongly!” Just because you were taught to see yourself a certain way does not make it truth. In the end, only one person gets to decide how you will see yourself. You. You just have to make that choice, actively putting down previous lessons that have only skewed how you see yourself. When you make that choice, you are ready for the next step: change.

For anyone struggling with self-esteem, I would say recognize, and be mindful, of the negative (and even positive) bias you have about yourself. Think about the way you were taught to see yourself. Then decide if it is a way you want to keep. Don’t ask if it’s accurate or not. Ask yourself if it has served you well or made you feel like crap. Then just stay mindful of this as you go through the next few days. See where it pops up, when it is triggered, when it impacts your mood and behavior. Make a conscious effort after a while to react differently. Make a choice about how you want to think and feel, and act on it. Often, writing it down can help you keep track of it all and help identify patterns to your thinking you never knew were there.

Put yourself around others who support these better ideas about yourself. You have a choice most of the time who you let into your life. Make a conscious effort to let in those who tend to make you feel better about yourself and begin to spend less time with those who don’t. Changing your social environment can really help change self-esteem.

Let go of the previous, old, biased self-concept and begin to develop a current one. Allow yourself to start clean and fresh by purposely going out of your way to do something that you know will make your see yourself in a new and better light. Start to do things today that will make you feel better about yourself next week, next year, next decade. Rebuild your foundation with more solid wood.

Learn to accept and forgive. Rebuilding our self-image brings us in view of some things that we are not proud of, and that we may not actually like about ourselves. Nobody is all good or all bad. Just don’t allow only those things to define how you choose to see yourself. Recognize there is more. Recognize that your future will provide you with more opportunities to positively define yourself.

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Resolving a Career Crisis

 

Reader’s Question

I’m a 23-year-old woman going through a career depression. I worked for a big company for over a year, and it gave me financial security. I got along well with everyone except for my own team; people told me it was because they felt threatened, but in the end we buried the hatchet. However, an old school friend offered me a job which suited my college major. Since I thought it would be good to pursue and it’s something I’d enjoy doing, I took the job. I did my research, talked to my family and friends, and they supported me in the decision. I moved out of my old apartment to a location nearer my new office. But it turned out my old friend had lied to me about the contract, the job, basically everything. In the end, I ended up working more hours even on public holidays without getting another day off or even being paid. It severely affected my health and personal life. I resigned before it got even worse. So, I received unemployment compensation for a few months and also ended up digging through my savings.

My former manager offered me a job someplace else that he thought would be good for me. I wasn’t sure at first since I really wanted to go back to my original company. But in order to get out of the unemployment and pay the bills, I took it. I’ve been trying really hard to move on, to stay positive, and not let the slightest things get to me. I know I can learn a lot in this new job, but what causes my depression is the fact that it’s a long commute, and the job itself is not really something I can do well or enjoy doing. I’m stepping out of my comfort zone since it’s a big opportunity to learn and work in a new environment, but once again I feel like I’m buying into the ol’ BS of the initial job offer. I’m so scared of failing again, I can’t cope with unemployment, and it feels like my life is falling apart. I was an honor student and suddenly I became this corporate victim. I understand the corporate world is a real jungle, and I don’t want to waste my time doing this unwise pursuit — but it seems like quitting yet again. I’ve been reading lots of spiritual books, self-help books, and some of them made me feel better but they don’t give a real solution. I feel so lost right now.

Psychologist’s Reply

What you’re experiencing isn’t unusual among high-achieving young adults who land lucrative and ambitious jobs after college. It sounds like it has been a very difficult and unexpected road for you, especially given the success you experienced in college. While family and friends can be supportive and mean well, sometimes they encourage us to make choices that seem to be good for us on the surface — but when we reflect on the experience, we recognize that the environment or work just isn’t a good fit. Because you have started the process of reflecting on your own experiences, you’re on the right track to making a change that helps you find a much better person-environment fit.

Many people, especially people just starting out in their careers, are surprised to learn that people change careers an average of seven times within their lives. Like you, many people see a certain path for themselves, but their needs as well as their interests shift as they go along. When I work with individuals like you with career conflict, we explore three areas: abilities, interests, and values. For example:

Abilities
  • You are college educated and probably have skills such as critical thinking, analysis, effective writing/communication and others that may fit within your major field of study. It sounds like number-crunching is not a skill you feel most comfortable with.
  • You have already held two jobs and likely have interpersonal conflict resolution skills, teamwork skills, and other job-specific skills that you acquired.
Interests
  • Ask yourself what you enjoyed as a teenager or during college (including extracurricular activities) as well as what job you would love to do if money weren’t a concern.
  • What led you to choose your college major? Did others influence the decision?
  • How did you choose to work in a corporate environment? What interested you about the first job you held?
Values
This seems like the area with the greatest amount of conflict for you right now and might require the most exploration. There are many questions in this area to begin to ask yourself — for example:

  • How do you want your personal/work life balance to look? Would you work part time if you could?
  • How much do you want to earn or need to earn? What are the tradeoffs to earning less money but working fewer hours?
  • How important is retirement and healthcare, and what are you willing to give up to obtain those benefits? Do you thrive in a high-stress environment?
  • Do you prefer to work alone or on teams?
  • Do you want to be in an office all day, or would you prefer to be outside or going to other sites?
  • How long do you want to commute to work?

I would encourage you or anyone in this situation to find a professional to help explore these and other questions. Many colleges offer their alumni free or discounted access to career services, which might be worth looking into. In addition to career counseling, your university might be able to connect you with a mentor who can help you navigate issues like new job contract negotiation, and networking outside your group of friends and family. Otherwise, finding a licensed psychologist who is trained in vocational/career assessment and counseling could be a great investment — especially if you’re noticing other areas in your life that you’d like to feel better. In addition to helping you sort through what you want in your personal life, a psychologist would ask similar questions and offer interest inventories that can help predict what careers would be more satisfying for you. Giving yourself the space to explore these areas with a professional may help you feel like you have found your internal compass again.

Please read our Important Disclaimer.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. Last reviewed or updated by Dr Greg Mulhauser, Managing Editor on.

All copyrights for this article are reserved to ask a therapist

Staying Connected to Attention-Seeking Sister

Reader’s Question

Over the years I have suspected my sister has Narcissistic Personality Disorder. Now in her late forties, her need for sexual attention is becoming more of a problem; her firm belief in her eternal sexual appeal is causing more inter-personal problems for family and friends. Knowing that any attempt to approach the problem will provoke an outburst of anger and abuse, I try to respond to her excessive behavior as I would with a child who is throwing tantrums if she doesn’t get what she wants — by largely ignoring it. However, I am beginning to realize that as she gets older, and has now been single for over six years, the same behaviors of the past seem more delusional.

Every conversation centers on her past pain, her stress, or her fear that she won’t succeed. She drinks excessively and spends beyond her means.

She has always been competitive with myself and my two brothers. She seems to want to follow career paths we choose and then becomes bored and changes direction. Recently she met my partner of three years for the first time, as we live in different parts of the country. She flirted with him openly, and now texts him constantly, imagining there is a soulmate bond — she has no idea how obvious it is, and how very embarrassing for me and my partner.

If anyone challenges her, she cuts them out of her life: she divorced her kind and patient husband six years ago because she was in love with a married man whom she considered more her intellectual equal, dismissing her husband as beneath her. She tried to seduce that married man and was rejected; when his marriage later failed due to the entanglement with my sister, my sister decided he had used her, and was no longer interested in the possibility of a relationship. When her closest friend tried to challenge her on her choice in potential partners, my sister cut her out of her life too.

When a younger man smiles at her on the street, she talks it up as proof that she is still attractive to younger men; yet whenever a man her age shows an interest, she laughs at their foolishness in thinking they are “in her league”.

After the chaos she has caused in her own personal life, she has managed to secure a part time job in the media industry, but despite being unable to handle the pressures of a professional job, she is embarking on a new course of study, hoping for a high level senior position once she graduates.

Will ignoring a sibling’s excessive attention seeking behavior just create more problems for our family?

Psychologist’s Reply

It sounds as if this has been a difficult situation for everyone in the family, and that you and your brothers (and now your partner) are at the end of your ropes in trying to manage the uproar that happens in some interactions with your sister. What I’m hearing is that you have tried ignoring her bids for attention but wonder whether that strategy could create more problems. Ignoring is certainly one way to set a boundary, and it may be worth experimenting with if it fits for you. If the ignoring is difficult to do, or isn’t working, however, some other alternatives may be worth exploring.

First, to answer your question about her behavior and a possible diagnosis, it can be helpful to try to determine a loved one’s diagnosis in an effort to help them (and yourself). I hear that you have observed the inflated sense of self, the pattern of elevating and then denigrating someone, and the interpersonal pain as possible indicators that your sister may have Narcissistic Personality Disorder. However, finding a mental health professional to meet with your sister (or with you) to better determine a diagnosis (and rule out alternatives) as well as provide treatment recommendations may be most beneficial for her as well as for your family in learning how to interact more effectively with her.

Some personality disorders share similar features. For example, there are similarities among Narcissistic Personality Disorder, Borderline Personality Disorder and Histrionic Personality Disorder. All three of these disorders are marked by longstanding patterns of interpersonal difficulty and maladaptive ways of managing interpersonal anxiety. What you describe may be more histrionic: attention seeking (particularly sexual in nature) and believing relationships to be closer than they actually are. The grandiosity and inflated sense of self may also fit with personality traits in that same cluster. However, if your sister is also having sleep disturbances along with the hypersexuality, inflated sense of self (grandiosity), substance abuse (excessive drinking) and excessive spending, she may also fit criteria for a mood disorder that is bipolar in nature. If your sister has a mood disorder (such as Cyclothymia or Bipolar II), medications can help her functioning. A licensed mental health professional can help determine a more accurate diagnosis and form a treatment plan.

Second, from what you describe, it sounds as if many friends and family have confronted or challenged your sister, and her response has been to cut them off to manage her own anxiety or pain. When a loved one pushes our boundaries, makes us uncomfortable, and can’t tolerate much confrontation, there are two things that are important to remember to do:

  • Take care of yourself as well as your loved one by setting clear, consistent boundaries, and
  • validate her pain and needs while also expressing your worry, love, and desire to help things get better.

Many individuals who meet criteria for a personality disorder (as well as individuals who experience bipolar disorder) respond much better when other people in their lives set clear and consistent boundaries on their time, energy, and what discussions or behaviors they will tolerate. Some examples of achieving both might go something like this:

I hear how much stress and pain you’re experiencing. I care about you and will support you emotionally in the hopes that things can get better. Sometimes, I don’t know what to say or how to help, though. I wonder if talking to someone else who isn’t a friend or family member who knows how to listen might make things better.

I’m so glad you finally met my partner and are interested in him as a person. Like you, he’s also busy with work, and doesn’t have much time to answer texts. He is glad to have met you, too, and looks forward to visiting with you when we are all together, but not to individual texts.

As you continue to navigate ways to stay connected to your sister and not feel angry with your sister, you (or anyone in a similar situation) may find it helpful to read Harriet Lerner’s Dance of Connection [Amazon-US | Amazon-UK].

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