Herpes and Mental Health: Part 1

I have been working with individuals diagnosed with genital herpes for over 20 years in different capacities. Most of the people I work with do not develop serious clinical depression but many of them do struggle with a period of sadness and shame. They feel scared, angry, and hurt. They can have feelings of hopelessness, lowered self-esteem, and may feel alone, either believing they can’t tell others or that others can’t understand, even if those people respond in caring ways.

Most of this sadness is associated with the stigma. Usually it is the meaning associated with herpes that is the hardest part of the diagnosis. The emotional pain and shame are primarily centered around the fear that no one will accept you if they find out, particularly romantic or sexual partners.

Feelings of Uncertainty and Loss

In the beginning, it can feel hard to imagine how you will wrap your head around the diagnosis. You might feel the loss of dreams you had about your future. You might wonder how your life will turn out. You may worry about future symptoms and what they’ll be like.

These feelings are often temporary and the first stage of adjustment. Although you might have feelings of hopelessness, reading an article like this shows that you do want to feel better and that you do in fact have some hope that you can feel better. And you can. You can have a good life with a herpes diagnosis.

Resilience

Resilience is a characteristic that gives us what we need as humans to get through difficult times. You may not feel very resilient in this moment and that is ok. It is normal to need time to adjust to something that feels life changing. It’s normal to feel grief about change and what you feel you’ve lost. And people grieve in different ways and for varying amounts of time depending on the circumstances. And this grief often is part of a process of problem solving, an attempt to understand new circumstances and figure out what you will do about them.

Hope

There are very good reasons to have hope. A genital herpes diagnosis often does not turn out to mean what a person initially thinks it will mean. And most of my patients do adjust. They do find hope again. They do feel happiness again. Their courage grows. They learn how to talk about herpes with new partners. They date, find love, have families, and even have casual sex if they choose. People with herpes can do all the things everyone else is doing. The main change is that my patients start making an effort to talk about sexual health before having sex with someone new. This may not sound very fun and may feel embarrassing at first, but people find ways to do it that feel authentic for them. And they often find partners who appreciate this and who respond in sincere and caring ways.

Of course rejection can happen. That is part of being human. But truly, after all these years of working with patients diagnosed with herpes, and witnessing the many, many partners who have accepted people with this diagnosis, I don’t believe that herpes has to get in the way of any of your life dreams or desire to connect with others in whatever way you long for. (Here’s one of my posts on rejection.)

Don’t give up hope. And don’t give up on finding a way to move forward.

In-Person Counseling in NYC

If you are in New York and would like in-person counseling or to participate in my therapy group for women diagnosed with herpes, please contact me. I’m located in the Murray Hill neighborhood of Manhattan. I would be happy to speak with you about whether counseling or the group might be helpful to you and whether working with me might be a good fit.

Other Posts on Herpes

If you’d like to read more, here are my other posts about herpes.

**This information is not intended to replace medical advice or psychotherapy and is not intended to address all the caveats of a diagnosis.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Contact me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

Feeling Lonelier Since COVID?

I have noticed an increase in feelings of loneliness among patients lately. It’s not that surprising I suppose. Culture has changed so much since COVID. So many events happen virtually now. Classes and activities you used to do in person are now conveniently online. If your work can be done at home, you probably aren’t required to go into your office everyday. You might even feel resentful if your company makes you come in at all. If you do go into an office, you might be surprised to see your colleagues taking meetings virtually from their desk despite being able to see each other from across the room.

While this change in culture has certainly created more convenience, it has also increased feelings of isolation and disconnection. Despite feeling isolated and lonely, you may have difficulty getting motivated to leave home, even if you know it would make you feel better. You might even feel out of practice and more unsure of yourself in social situations than you did before. Or maybe you’ve become depressed, which adds to the difficulty of getting out to socialize or do something fun.

Less Opportunities To Connect

If you don’t have family close by or a core group of people who get together regularly, it can feel like a lot of effort to stay connected to others. Just 5 years ago, even if you found it hard to socialize, you would have some social experience just by showing up at work. You may have even had a built in after-work activity a couple times a week that you participated in before going home. If you live in NYC, commuting was shared with many others and offered opportunities for casual social interaction, even if brief. Being out and about could make you feel part of the world.

Of course the good news is that many more people who would not have access to certain activities, due to location or time constraints, can now participate. But with that comes the loss of those small but important opportunities to interact with people when waiting for an event to start or exchanging reactions at the end. Without this, you are less likely to identify those people you feel at ease with or want to see again. We miss opportunities for touch, even if just a handshake or an embracing greeting. We miss opportunities to be seen, for someone to notice how we might be feeling and to witness our lives. These are important experiences that can help us feel connected.

Making New Friends

If you have a built in network of friends or a close family who regularly get together, you may not notice these losses as much. But if you are single and living at a distance from those you love, or you’ve grown apart from old friends due to people moving, getting married, or having children, you may feel alone more than you’d like. Many people discover that it is much harder to make close friends as an adult.

No matter how you came to feel isolated or lonely, whether this is a new experience or something you have struggled with at times over many years, it will likely take more intentional effort to change it now. Finding opportunities will require more thought. And I know this can feel much harder if you are depressed or low on self-esteem. But I want you to know that there are others out there who are also lonely and longing for connection.

A Practical Place to Start

It can be helpful to begin thinking about what you naturally find pleasure in or are curious about.

What did you used to enjoy doing that you no longer do?

What would you like to learn?

What is something that interests you that you could also do with others?

I strongly recommend that people who are feeling isolated or lonely try to identify an activity that occurs weekly where many of the same people attend regularly. This could be a class, amateur sports league, art sketching group, faith based community, volunteer organization, book club, or even a support group. By finding an activity that meets at the same time each week, it becomes a reliable, consistent event that you can attend. If others also attend regularly, the relationships can develop naturally over time. You may choose to get together with people outside of the group but developing relationships doesn’t have to be reliant on this. You can start by simply being consistent in your attendance.

Something Predictable and Consistent

You may have to try a few groups or activities before committing. And once you find something you like, that you enjoy enough to go weekly, you can start talking with others at the pace that is right for you. This is one of the easiest ways to begin to meaningfully engage with people when you feel isolated, doing something that is a shared interest with others that is predictable and consistent.

Certainly some groups will be more open and friendly than others. And some groups cater more toward group interaction than others. Don’t be discouraged if you don’t find the right group for you at first. Give yourself some time.

This is just one way to build connection in your life if you are feeling lonely. That said, sometimes we become isolated for reasons that are difficult to understand or explain. Sometimes we just can’t shake off sadness, grief, or anxious thoughts. If you are still having trouble getting out or feeling impeded by depression, low self-esteem, or anxiety, individual therapy may be of help.

If you are in the NYC area, I offer weekly in person therapy. Therapy can give you an opportunity to talk through your concerns in an understanding and safe place. It can give you a supportive environment to understand yourself better and to find the strength to make change.

If you are interested in therapy, please don’t hesitate to reach out for a brief, complimentary phone consultation to see if we may be a good fit to work together. You can contact me at 917-689-6530, email at melissa@myheartdances.com or message me securely on Signal.

Resources for Activities in NYC

If you are in NY, below are some resources for group activities to get you started on your search.

ZogSports: https://www.zogsports.com/ny/

Play NYC: https://playnycsports.com/

NYC Trivia League: https://nyctrivialeague.com/ (Contact them via their form to be connected to a team)

New York Cares: https://www.newyorkcares.org

YMCA: https://ymcanyc.org/programs/health-fitness/adult-sports

The New York Society for Ethical Culture: https://ethical.nyc/

Metropolitan Community Church of NY: A Church of LGBTQ People and Allies: https://www.mccny.org/

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

A 2022 Year End Reflection Exercise

What were some of the most important moments for you this year?

Revisiting experiences you’ve had during a period of time, making a point to think of them in the context of a year, can help build stronger memories about your life and help you feel grounded in space and time.

It can be easy to get to the end of the year and wonder where time went, though you likely had many experiences, maybe even themes that occurred during the year. Thinking through how you actually spent your time can help you to remember what mattered, what had an impact on you, what brought you joy, what you never want to do again, ways you spent your time that you wish were different. It can help you to think about how you are living your life and whether you’re ok with how you are in the world or if you want or need something to change. Even remembering loss, though it might hurt, can help you know that something was meaningful.

I hope you are able to recall some experiences that delighted you. It can also be exciting when you pinpoint something you want to change. The end of the year and the new year are a time when there is a lot of cultural momentum to reflect and look forward to something new. It can be fun to take advantage of that wave.

I created a worksheet a few years ago that many of my clients find helpful. It’s a great exercise to do when you have some time off over the holidays or just as the new year begins. I’ve attached the worksheet here. I hope it can be helpful to you too!

It’s lengthy, so plan a time to settle in with a cup of something you enjoy. This is for you, so answer the questions that are important to you and leave the rest.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

Anxious Attachment in Dating and Relationships

Maybe you’re reading this because another new relationship with someone you really liked just ended or perhaps you are worried it is ending. You feel confused as to what went wrong because you thought you had such great chemistry.

Maybe you noticed a shift, not long ago, that alerted you that something was amiss, that this person was pulling away. Maybe they didn’t text as often, plan dates, or seemed distant. Perhaps there was a conflict or you’ve felt some tension between the two of you.

Maybe you told yourself not to be needy or worry, to be confident and to not show your feelings or angst, or maybe you started to call and text more to seek reassurance from them. Maybe they responded by telling you what you wanted to hear but didn’t really change their behavior, or maybe they finally came out and said that they didn’t feel things were working out, they needed space, or perhaps they just pulled further and further away without saying anything.

Whatever has happened, you can’t stop thinking about it.

A Familiar Experience

Perhaps this experience is one that feels familiar to you—the anxious feelings you experience when wanting a relationship to progress that doesn’t seem to be progressing, to feel close when the other person is not as engaged as you wish they would be, or when you fear that an argument or conflict will result in your partner abandoning you. You start to wonder if there is something you could do to keep their attention, to get them to love you, to get them to open up, or to assure them that you are totally fine with them taking space if they would just tell you that they needed some.

Many of my clients have expressed a desire to be the “cool girl” who is easy going and doesn’t need too much. You worry that something is wrong with you or that your needs are too much for anyone to meet, that if a partner or potential partner knew about them, they would be scared away. Perhaps you feel you have already scared someone away.

Meeting Reasonable Needs

Often, the clients I work with have very reasonable needs. One of the things we work on is identifying those needs and building a healthy sense of expectation for them to be met. Building some self-esteem around healthy desires and normal needs for closeness and good treatment in a relationship can help people begin to choose partners who are more attentive and caring. However, the harder part can be letting go of people you desire and are attracted to who can’t show up in the way that you need them to.

If you are conflicted about whether your needs are legitimate, this can be much harder to do and can result in over-accommodating your partner and feeling there is a lack of reciprocity and mutuality in the relationship.

I also work with clients to unpack and understand why these types of partners are so desirable or whether there is something else that is happening that is breaking down these relationships. Sometimes the relationships are salvageable when my clients learn how to set healthy boundaries for themselves, accept their needs and address them appropriately, and learn how to communicate effectively. But often there is something else going on that drives them to engage in dynamics where they choose and are attracted to individuals who cannot meet their needs.

The good news is that this kind of pattern can be changed to one that is healthier and more satisfying. It’s not easy and takes time, but it’s worth the work.

What If My Needs Really Are Too Much?

Some people might wonder “What if my needs really are too much?” In my practice, I do also have clients who are seeking things from a partner that another person cannot provide, and it’s quite possible that any partner might feel those needs are too heavy of a burden to bear. Sorting through whether this is the case and how to get these needs met appropriately can help individuals have better relationships. Your needs are legitimate and quite real and deserve to be addressed but may not be able to be addressed in the way you are seeking. However, ignoring them or trying to push them away doesn’t work either and usually creates other problems, such as resentment.

Feelings and needs rise up from inside of us, and they are there for a reason. Often, we can feel lost as to how to interpret them or address them. But they should be addressed. There is no shame in having needs.

Counseling can really help with this. But if you aren’t able to do counseling, I recommend doing activities that help you engage in curiosity and understanding about what is going on for you and that help you connect with your body (where we often feel needs first). Journaling can be a great exercise, both journaling about what is wrong but also what is going well. I also recommend the Headspace app for mindfulness. Headspace has created a really accessible way to do mindfulness exercises that can help you quiet down your mind and connect with your internal experience.

I haven’t read it, but many of my clients have also found the book Attached very helpful.

Individual Therapy

If you are in NYC and interested in in-person therapy, I am happy to help. Counseling can provide some relief for anxiety, unpack and resolve patterns that aren’t working, build greater self-awareness, and offer new skills specific to your needs and circumstances. If you have any questions about working with me or would like a phone consultation, I would be happy to speak with you. You can email me or call me at 917-689-6530.

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If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

Anxiety Can Feel Crippling--More on Coping

Anxiety can feel crippling. It can interfere with sleep, your ability to focus at work, or doing things you enjoy because your mind is worrying. Anxiety can make everything on the inside feel so confusing. You might find it difficult to figure out how to create steps to address the problem or decide where to put your focus so you can move forward. You might feel “all over the place” mentally or you can’t think about anything else because of how worried you are about something you may have no control over.

You may have just one specific thing that you’re anxious about and all you really need is more information, some tools to manage your thoughts and feelings, a plan of action, and some courage to execute it. Or you may have anxiety that really impacts your life in multiple areas and you find it very difficult to get control over your thoughts, even if you believe those thoughts are not rational. And sometimes there are problems that could have really significant consequences if something goes wrong or if you make the wrong choice (even if it’s impossible to know which choice is the right one), and the anxiety that is experienced in response makes it hard to think clearly.

What Doesn’t Work

If you have ongoing difficulty with anxiety, it is usually not helpful when people around you say, “Don’t worry,” or “You worry too much.” This can feel dismissive and limit the opportunity for you to explore your thoughts and feelings and understand why you are this way or why an issue is bothering you so much. Sometimes friends or family try to jump in and solve the problem for you or tell you what to do. This can feel frustrating as it can minimize how difficult the problem really is or can presume you haven’t thought of these things already. At other times, you might feel relief when someone takes over the problem and unburdens you. But the latter usually doesn’t help when this is something you face repeatedly. Sometimes we need another person’s assistance to carry the burden for us or with us, but often, when there are ongoing struggles with anxiety, the need is centered on learning how to effectively solve problems, how to take reasonable risks, developing a sense of trust in yourself (to make the right choice or to be able to handle it if things do go wrong), learning how to tolerate uncertainty, and building confidence to move forward. It also means recognizing that none of us make the “right” choices all the time, even when we’re very diligent and careful. Not only are we all imperfect, but often it’s impossible to know which choice will result in the best outcome because life often presents dilemmas without clear answers. It can be really disappointing to realize that there might be no perfect way forward, but I hope it offers some comfort to know that you are not alone in these kinds of circumstances.

Counseling/Therapy

If you struggle with ongoing anxiety, therapy can be helpful. Different types of therapy can be helpful for different people. If therapy hasn’t helped you in the past, it may not have been the right fit of therapist or the right type of therapy for you, or you may not have been ready for change at that time. If you are looking for a therapist, Psychology Today offers a directory where you can filter by your location and what kind of therapist you are looking for.

Cognitive Behavioral Skills

While most of my work focuses on helping clients understand why they are the way they are, building an internal sense of confidence and trust in oneself, and feeling more effective in relationships, I do integrate cognitive behavioral therapy (CBT) where it can be helpful. Some of my clients with anxiety respond really well to CBT and have really liked the book Feeling Good by David Burns, which provides information about the exercises and activities that can help create change. It’s an older book but a classic. You can see by the many positive reviews!

Other clients of mine do not feel engaged by CBT and want a space to talk through what is going on for them and to feel heard and supported. They want to understand why they feel the way they do and to sort through things that have gone on in their lives that have impacted them. They want to do this with another person or people because being seen and heard feels important, as does hearing feedback from the other person. Another person can sometimes see something that is being missed or recognize a pattern that is not helpful.

Journaling

Another tool that can help with anxiety is journaling. Clients of mine who sustain a practice of this frequently report back how much it helps them. There are different ways of journaling. You can just “freewrite” whatever comes to mind and get all of your thoughts out on paper. Alternatively, you can identify what the problems are that you are facing, write about possible solutions, write about the pros and cons of each solution and the possible outcomes, and then decide on a plan of action; or if it is an unsolvable problem, you can write how you feel and ways you can cope.

There is also a form of journaling called “Positive Affect Journaling.” This type of journaling helps you to attend to what is working well in your life and research has shown that it does in fact help with anxiety and depression. You write about things like “What is working well?” “What went well today?” “What strengths am I using?” You can view prompts used in a study about positive affect journaling here. Sometimes we focus so much on what is not working, that we miss what is working and what is good, meaningful events that we need to be reminded of. In the study referenced, people journaled 15-minutes a day, 3 days a week. I also find that people gain more benefit from writing by hand than by typing, though typing is better than not doing it at all.

Medication for Anxiety

There is medication for anxiety as well. Medication is not necessary for everyone, but some people find that it really helps them make progress and implement the changes they are trying to make. If someone wants to try medication, I recommend finding a psychiatrist if possible because they are specialists in this area, and in my experience, are often better able to fine tune and attend to what is working and what is not than primary care providers. Primary care providers tend to be more accessible, but psychiatrists tend to be better at monitoring what is going on and have the experience of working with mental health and appropriate medications all day long in their practices.

Individual and Group Therapy

If you are in NYC and interested in in-person therapy, I am happy to help. Counseling can provide some relief for anxiety, unpack and resolve patterns that aren’t working, build greater self-awareness, and offer new skills specific to your needs and circumstances. In addition to individual therapy, I also host an ongoing women’s therapy group for women who would like the support and feedback of their peers in addition to a therapist. If you have any questions about working with me or would like a phone consultation, I would be happy to speak with you. You can email me or call me at 917-689-6530.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

How In-Person Therapy Makes a Difference

If you’ve been wondering if virtual or in-person therapy would be right for you, I have some thoughts for you to consider. I almost exclusively offer in-person therapy, with only some exceptions.

Here’s why.

It is very exciting that therapy has become more available via video calls. I’m grateful that an increasing number of people are able to access therapy as a result. Some people do very well with virtual therapy and research shows that it is effective. And it can be the only way for some people to get therapy due to their circumstances. But others really benefit from an in person approach, and some people make more significant progress when they do therapy in person.

A Safe, Dedicated Space to Focus on You

When you come to therapy in person, the room, the space around you, the weekly appointment time, the ritual of going to and from the office, all act as a “container” for addressing your concerns. A container like this offers some separation from your personal environment as well as the distractions or issues that might occur at home, and it gives you a place to focus on you. When everything happens at home, other obligations can easily be booked too close to the therapy appointment and it can be harder to transition into and out of an emotionally vulnerable self-reflective state than if you had to block out time and “head space” to change environments. In addition, if you live with others, you might be worried about privacy, which may affect how you express yourself in your sessions.

Obviously, you can be very intentional to take care of any potential distractions in advance and it would be good to do so. But there is something important that happens when you go into a separate space that is private, comfortable, and maintained by someone else, someone who is caring for you. There is something valuable that occurs when you are able to go into that space each week to focus on yourself, without distraction, and address your needs. Even the commute can offer an opportunity to prepare mentally and then to digest what you worked on when you leave. Commuting can offer a break between two spaces to allow for transition. Changes in environment matter and they offer cues to your brain about what to expect from yourself and from others.

Body Language and Therapy

In addition to this, there is a lot that goes on in therapy that is unspoken and much more apparent when in person than on video. I pick up much more body language, facial expressions, and eye movements when I work with someone in person. The way you carry yourself into my office, situate yourself on the couch, and how you hold your body throughout the session are all important pieces of information that help me to understand you and care for you. We communicate all sorts of things in the energy we carry around that can often be missed on video. For patients of mine who I met for the first time on video during the height of the pandemic and then met in person later, when it was safer to return to the office, I gathered a lot more information about them through their physical presence that was new and influenced my thinking about their concerns.

On the other side, patients gather much more information from me therapeutically as well. My physical presence is part of the treatment as my movements can help someone to feel welcome and nurtured or safe. A patient may pick up on reactions I have that they would not otherwise notice on video, reactions that may feel validating or give them a sense that I am concerned about them and what they are sharing. Patients have told me that meeting in person makes them feel much more connected as they pick up on all of these non-verbal cues. The shared environment also matters. If you are at home with a pile of laundry behind your computer screen that you are worried about finding the time to do, it may be unconsciously impacting how you are coming across on the video, but I cannot see that laundry and would have no clue it was there unless you told me so. How might this impact both of us in different ways? When we’re in the same room, if you look over at something, I can look over at that thing too, and that shared experience can matter.

The Needs and People I Work WIth

Many of the patients I work with struggle with feelings of shame, low self-esteem, loneliness, relationship difficulties, stigma, depression, and anxiety. These feelings and experiences all benefit from human contact and coming to therapy in person, especially in a time when there are increasing feelings of isolation, can be healing and help people to feel a greater sense of connectedness, of being in the world, of being seen and accepted, and it can help them to break out of their comfort zone in ways that increase satisfaction in their lives.

I do provide virtual therapy when needed, such as if someone wakes up feeling unwell or if they are traveling for work and wouldn’t be able to make it in person. The consistency of meeting becomes more important in these situations. But I am passionate about in-person therapy and encourage those who work with me to commit to working in person. Most people welcome it and have said it helps them a great deal.

On that note, I have colleagues who I respect who exclusively provide virtual therapy. I’m grateful there are lots of options for people in need to find the right fit. If you are looking for virtual therapy, I am happy to refer you to a therapist who does this well. In addition, I am licensed in California and Florida and do provide virtual therapy to individuals there when they are seeking support in my specialty areas and have been unable to find someone else who is a good fit.

If you are in the NYC area and would like help, I am here for you. You are welcome to contact me at melissa@myheartdances.com or 917-689-6530 to schedule a brief phone consultation to discuss your needs and see if we are a good fit.

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If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

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4 Ways to Change Your Relationship with Anxiety

Some people are so good at avoiding their anxiety that it doesn’t appear they are anxious at all. Others show signs of being panicky. Some people are anxious about a very specific thing (such as a health issue) and others are anxious about their place in the world, how they are doing in life, the security of their relationships, or when the next disaster is going to happen and how they will cope. Some people are able to function well despite their anxiety and others feel frequently distracted, distressed, and can’t sleep well. Some repeatedly seek reassurance from friends and family while others become more introverted and avoidant.

Anxiety is definitely not one size fits all.

There are many techniques and approaches to address anxiety and different things work for different people. Some people really benefit from using counseling or psychotherapy to explore and process why they are anxious and to gain insight into the underlying factors that keep them feeling this way. Others benefit from tools and exercises that teach them to manage their anxious thoughts and feelings in a new way. I’ve found that many people need both of these approaches.

Some tools my clients have found helpful in managing anxiety are:

1) An Appointment for Anxiety

Schedule a regular time for worrying. With this tool, you find 15 or 30 minutes (or even an hour depending on how significant the issues are) and you schedule that time daily for worrying, just like any other appointment you might schedule. For example, everyday at 5:30pm for 30 minutes. Once you’ve set this schedule, every time you catch yourself worrying, you tell yourself you must wait until 5:30 to think about this concern any further. You can keep a list of your worries throughout the day if you feel you will need to reference it at 5:30. When 5:30 comes, you focus on your worries for 30 minutes (or whatever time frame you set), no matter what. A journal can be helpful if you’d like to write them out. You commit to this schedule every day until you begin to feel you don’t need it anymore (a sign that you don’t need it anymore may be forgetting more frequently about the worry or becoming bored with the worry and more relaxed about the concern). This creates a container for your worries so that they bleed less into the rest of your day. For many people it provides some comfort to know they have a time and place to worry and don’t have to resist their worries entirely. You may find this is a helpful way to manage concerns as a permanent, fixed part of your regular schedule or if it is an isolated worry, you may find that it begins to pass after some time and you no longer need to think about it.

2) “What Else Would I Be Worried About?”

If you are focused on one particular worry that is difficult to get over and it is a worry that you can’t do much about, it can be helpful to begin asking yourself “What would I be worried about if I was not worried about this?” You might find that your anxiety is a defense mechanism to avoid something else that is actually a problem that needs addressing. For example, if you are obsessed over a body part and feel it is not good enough, you might ask yourself: “If I wasn’t worried about my thighs/stomach/nose/fill in the blank, what would I be worried about?” It may be that you’re worried about failure in some other capacity, if you’re going to lose an important relationship, or if you’ll always be lonely. These are deeper questions that could be pursued and worked on in a more meaningful way, because fixing the body part is probably not going to solve these problems. Anytime you notice your thoughts ruminating on the issue, ask yourself this question.

3) The Self-Compassionate Approach

Sometimes it can be helpful to get more at ease with the anxiety itself. For instance, if you tend to be an anxious person, when you recognize that you are engaging in anxious thinking or behavior, say to yourself in an easy going, kind manner, “Of course, you’re anxious about this. That’s what you do.” The hope is that by accepting your anxiety, changing your relationship to it (rather than resisting it or punishing yourself for it), it allows you to be more comfortable with it, and your anxiety may diminish as a result. You can say, “Ok, so you’re anxious about this. It’s ok. You’re just trying to keep yourself safe.” This is an inner-compassionate approach to your anxiety.

4) Anxiety is Valuable Information

Anxiety is not a wrong feeling. It is information. Many people learned over time to deny or resist certain feelings or they never learned to understand what their feelings or instincts were trying to tell them or how to care for and respond to these feelings. For instance, if you feel angry at someone, but learned as a child that you weren’t allowed to be angry or were never taught how to respond effectively to your anger, your psyche may have compensated by becoming anxious instead. One example is: if I’m angry at you but I’m scared of confrontation or don’t know how to get my needs met by you, I might become more passive and my attempt to control these feelings might lead me to become anxious (about our relationship, about myself and my worth, or about something unrelated because that will distract me). This can become so automatic that you never identify the underlying feeling (in this example, anger) because you have learned to immediately feel anxiety instead, which, despite the distress it causes, may feel better than grappling with a more foreign, unfamiliar, scary feeling. So, remind yourself that the anxiety your feeling is information and see if you can figure out what legitimate information the feeling is trying to give you. You can then ask yourself whether the anxiety is out of proportion to the actual problem (maybe your anxiety has become louder over the years because you haven’t been able to respond to this information effectively). Journaling can be very helpful in trying to understand the feeling/information and to respond accordingly.

A Resource: Feeling Good

If you are interested in cognitive behavior therapy, which offers a lot of tools for managing anxious thoughts and feelings, many of my patients have found the book Feeling Good very helpful.

It’s an oldie but a goodie! You’ll see from the many positive reviews!

Counseling for Anxiety in New York CIty

Therapy can be really helpful with anxiety. It can provide a space to talk it through as well as some direction on what tools might be helpful for you. A pattern of anxious experience is usually not solved overnight, but learning more about yourself, gaining insight into the underlying factors that contribute to your anxiety, nurturing unmet needs, and gaining new tools to address the problems and manage the anxiety can help you make meaningful progress.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

The Truth about False Positive Herpes Test Results

Over the years, many people with no history of herpes symptoms have called me to begin counseling or group therapy after receiving a herpes diagnosis from a blood test screening alone. It is true that you can have herpes and not be aware of symptoms. However, if someone tells me they have never recognized any symptoms, I think it’s worth exploring a little further to make sure the diagnosis is accurate. I suggest that they obtain a copy of their results and look at whether they had an IgG or IgM based test (the CDC says IgM based tests should not be used to diagnose herpes). Once they confirm that it was an IgG based test, I ask them to look for the index value of their result. About 50% of people who test positive for HSV-2 on an IgG based test with an index value between 1.1 and 3.5 do not have herpes (the lower the value, the higher chance of a false positive, the higher the value the more likely it’s an accurate result). The CDC recommends that anyone who tests positive on an IgG based test with an index value that falls between a 1.1 and 3.0 should get confirmatory testing (experts say the Western Blot is the best confirmatory test). Research shows that there can even be false positives above this range in some people.

(**A positive swab test of a lesion in someone with symptoms can be a confirmation. Blood tests are helpful when a swab test can’t be obtained or to help sort out other matters.)

Getting Help with Confirmatory Testing

I've found that an important part of mental health for patients with herpes is to feel a sense of understanding and agency around their diagnosis and test results and to learn information that can help them make a decision about whether they want to pursue confirmatory testing or not. I often refer patients with low positive results to consult with a medical expert if they have additional questions. The healthcare provider I trust the most with these types of questions is Terri Warren, NP, who has been an excellent resource for many of my patients. There may be other healthcare providers who can navigate appropriate confirmatory testing, but many providers have not learned how to do this. If you are questioning your diagnosis and want to learn more about confirmatory testing, you can do so here. If you need help coping with the diagnosis or with awaiting results, therapy or a support group can often help.

Low Positive Result with Symptoms

On rare occasion, I have seen people with symptoms that are assumed to be herpes, even recurring symptoms, who have not obtained a positive culture and who have a negative or low positive result on the IgG, even after an adequate amount of time has passed to have a higher value. Other conditions can cause rashes on genitals, such as eczema and even Lyme disease (yes, I have actually seen this happen). While a case like this can certainly be a true positive for herpes, if something is just not adding up in your mind, it may make sense to explore it further with your healthcare provider or perhaps seek confirmatory testing (either via a swab or Western Blot for instance).

A Little Something About HSV-1

HSV-1 can also have low index values that are false positive. If there is no history of symptoms and it is a true positive, it is impossible to know if an HSV-1 infection is oral or genital (unless the individual has never had contact that could expose the genital area). More than 50% of adults in the U.S. will test positive for HSV-1.

Take that number in…

Most HSV-1 infections are oral and plenty of people don’t recall ever having a cold sore or symptoms that would explain their HSV-1 diagnosis. That said, there are also many people who contract it genitally, often from someone who has the infection orally and performs oral sex (with or without active symptoms).

Coping with Results

Finding out your result is not a false positive or simply having to wait for confirmation of a result can be really difficult. If your result is a true positive, please know that you are not alone! I know this is not something you probably ever thought you would have to deal with. It can take time to adjust, but you absolutely can still date, have sex, have relationships, and feel good about yourself again. You may not be able to imagine it right now, but it’s true.

I offer individual therapy for men and women and group therapy for women in NYC who are diagnosed with herpes. It can be a relief to have space to talk about how you are feeling and how you will move forward with someone like me who is knowledgeable about herpes and familiar with the questions and worries people newly diagnosed with herpes often have.

I have been working with men and women with herpes for over 20 years and have watched many, many people get through this and go on to enjoy dating, sex, and relationships again. If you would like the support of therapy, I would love to help!

More Posts About Herpes

I hope the resources in this blog can further assist you. Read other posts about herpes here.

In-Person Counseling in New York

If you are in New York and would like in-person counseling or to participate in my therapy group for women diagnosed with herpes, please reach out. I’m happy to speak with you about whether counseling or the group would be a good fit.

**This information is not intended to replace medical advice or psychotherapy and is not intended to address all the caveats of a diagnosis. I am not a medical provider and simply provide this information as a resource for learning.

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If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Contact me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

Finding Joy in Depression and Anxiety

If you’re feeling depressed or anxious, it can be hard to find the energy to do things that are rewarding or that bring you joy. Even some people who would not identify as anxious or depressed are finding themselves feeling a bit lost as they transition out of the pandemic and back into a semi-normal life. If this is you, you might have forgotten how good certain things you used to enjoy can feel.

The thing about these experiences—depression, anxiety, trauma, change—is that a rhythm of doing things that tend to fill your soul can be lost. New beliefs can creep in that these things don’t matter or won’t make a difference or distressing thoughts can be so pre-occupying that it becomes hard to find the space to relax and enjoy something that takes any effort.

But it’s important to do these things anyway.

Finding a way to keep rewarding activities in your life or restart them will help you to stay grounded and will nourish you so that you have more energy to tackle the challenges life presents. Doing things that make you feel like you can also help you to problem solve or make decisions. The thing is, you often have to just decide to do the activity rather than wait for the feeling of desire to motivate you. If you keep doing the activities, the desire and good feelings will often return.

If what you usually like to do just feels too overwhelming right now, you can start small.

• Watch a movie or series that you love, one that always made you laugh

• Take a bath

• Buy a fun color and paint your nails

• Use some lotion that has a scent that you love

When you’re ready, start to do the bigger things you enjoy. Maybe it’s a run in the park, time with friends, honing a skill that you used to find interesting. Try to do it at the time of day when you’re most likely to follow through. Some people find it easiest to do the activity as soon as they get out of bed, before they have a chance to talk themselves out of it. Others find it easiest to do it right after work. And some people find that signing up for a class or activity they have to attend every week at the same time (which also has the benefit of meeting people you can see regularly) is what helps them.

If you try these things and are still struggling, please seek support, whether from friends, a support group, or a therapist. Fortunately, there is a lot of online counseling available these days, so therapy can be more easily accessible. But I am also finding that many of my own clients feel better when they come to counseling in person. If you don’t have a counselor and aren’t sure where to start, you can google for counselors and psychotherapists in your zip code or call your health insurance for a referral. If you are in NYC, you can also get a referral through NYC Well.

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Get Updates about New Blog Posts

If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

You Were Just Diagnosed with Genital Herpes: Now What?

Maybe it’s hard to believe right now, but it’s going to be ok. I have been working with people diagnosed with genital herpes for a lot of years, so I am not saying this from some naive belief. It comes from my experience with my patients. Life really can go on after a herpes diagnosis. Many of my clients say that herpes actually forced them to deal with issues that were present before their diagnosis, such as with self-esteem or how they engaged with relationships, and that they ended up better than they were before their diagnosis.

So here’s what I suggest:

1. Breathe.

It’s probably going to take a second for you to wrap your mind around this. That’s ok. In the meantime, I want you to know a few things.

• The difficulty with herpes is mostly the mental health impact, leading to feelings of shame, loneliness, and sadness related to social stigma. That’s real. And it sucks. There are no overnight answers, but there is something you can do about these things.

• Realize that from a medical perspective, for most people, herpes is minor. I know you might not care since the stigma makes things feel so painful, but I want to at least put your mind at rest about the medical piece. Medical complications from herpes are uncommon.

• Unless you are very current with STI education, much of what you think about herpes probably isn’t true. That’s what stigma does. It leads to a lot of myths and misperceptions. A good place to go for readable and up-to-date facts is the Updated Herpes Handbook by Terri Warren who is a medical expert in the field.

• There is usually a period of adjustment but most people I’ve worked with eventually move on with their lives. They date, they have sex, they have relationships, and they have families. Fortunately, you are not a pioneer. Many people have gone before you and figured this out. In the last 10 years, more people (writers, comedians, healthcare providers, etc.) have come out publicly about their diagnosis. I know it might be hard to believe right now, but most of my clients go on to have partners who are negative (to their knowledge)—meaning, lots of potential partners are accepting of this diagnosis.

• Stigma often leaves you feeling that others will believe you made bad choices and will question your worth. The truth is, herpes is common. Most people have some risk. In addition, most people who have herpes don’t know they have it. So it’s actually not that uncommon for it to be transmitted in ways people don’t suspect, such as in monogamous relationships, between two people who know each other well, and even between people who have asked to see each other’s STI test results (doctor’s don’t usually test for it unless you have symptoms). I won’t pretend that people’s ideas aren’t shaped by stigma but people’s ideas are also influenced by hearing the experience of a real person sitting across from them. There are no guarantees that you won’t experience rejection after telling someone about your diagnosis, but I can tell you that many more people out there are understanding and supportive.

2. Don’t Google.

I discourage googling because there is so much outdated and poorly written information about herpes on the web. If you’d like to read more, go to the list on My Favorite Herpes Resources. I strongly discourage visiting online forums, with the exception of Terri Warren’s medical forum because she is the only one who responds and she does so with facts.

3. Do Things That Make You Feel Like You

You may feel a bit “out of body” right now. And initially it might be hard to feel like yourself while doing things you usually like to do. But try to keep doing those things with some regularity. Herpes did not make you into someone different than you were yesterday. It’s important to stay connected with your true self.

4. Support Groups

If you need to talk with someone who gets it, there are many support groups out there. Many are online since COVID and can be attended from anywhere.

If you’re in New York City, I have an in person therapy group for women diagnosed with herpes.

Here are some online support groups some of my clients have recommended.

LA HELP

Love Profound

@HSVintheCity

ASHA Support Groups

If you feel comfortable, friends and family can also be helpful. Many of my clients have found a lot of comfort from telling a friend(s) or family member(s).

5. Get A Copy of Your Results

When you’re ready, get a copy of your results. No need to rush. That said, when you are ready, I think it’s always empowering to have your own copy of your test results and to learn to read them. An important resource I recommend where you can learn more about how to understand your results is The Updated Herpes Handbook by Terri Warren, NP.

6. Counseling Can Offer Relief

If you need someone to talk to, counseling can offer relief. I would love to help. If you are in New York City, I offer in person therapy for individuals who have been diagnosed with herpes or who are worried about having herpes but don’t have a diagnosis yet. I also offer virtual counseling to individuals in California, Florida, and Upstate New York.

Keep Moving Forward

No matter what you do, keep moving forward. Life throws us curve balls that can knock us down for a bit, but you can find your way from this. Many people have. I have heard hundreds of stories, and that is only a small sample of those out there who have emerged out of this!

I hope something from this guide helps you on your way.

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If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

New Year's Reflection Exercise

Wow, this is the first post of 2019! That’s going on my list of things to change in 2020!

I love connecting with you through this blog, so on one hand I am sad that I have not been able to post in 2019, however, as I reflect on the last year, I recall that it was not only a very busy one, but also a year that I took time for self-care and personal activities that nourish me and bring me joy, something I am often working to help clients do. As therapists, we call these “reward-seeking activities.”

People often stop doing “reward-seeking activities” when they become depressed or are struggling with other issues that affect their mental health. Making effort to do activities that ultimately reward you with joy or deeper fulfillment is an important therapeutic tool and can help prevent things like low mood and depression.

It may seem a bit cliché, but I love to close each year with a reflection about what was good and what I want to change. It’s a time of year that I often challenge clients to think about these things, and this year I provided a worksheet that received a positive response from many of those I work with. Clients said it was helpful and some of them reflected at length on the questions.

I thought I’d share this worksheet with you as you bring 2019 to a close and think about what you’d like to do differently in 2020. I hope the exercise is helpful to you in both noting what worked well in 2019 and in making small (or big) changes to improve the quality of your life in 2020. Reflecting on whether you made an effort to pursue reward-seeking activities and how you will do so in 2020 is one of the questions.

You can download the worksheet here as a PDF or simply review the questions below.

Reflecting on 2019

Take a few moments to reflect on who you have become, what you have done and what you experienced or learned.

After you have spent some time freely reflecting, think about the following questions:

What worked well this year?

What are you proud of?

Was there anything unexpected?

Was there anything deeply meaningful or memorable that happened or that you learned this year?

What didn’t work well in 2019?

What would you like to change or improve?

As you continue to reflect, consider what worked and didn’t work in the following categories— feel free to choose only those categories that feel relevant to you at this time:

Professional/Career

Home Environment/Aesthetics

Marriage

Sex/Sexual Health

Dating

Close Relationships/Friendships

Social Life (social activities or activities involving those who may be less close to you) Family

Finances

Spirituality

Health

Fitness/Physical Activity

Reward-Seeking Behavior/Activities that bring you joy, pride, or positive feelings Habits (good habits/bad habits)

As you think about the coming year, 2020, is there anything you want to:

Add:

Reduce:

Do more of:

Do less of:

Change:

Learn about:

Reflect on over the year (such as a theme or quote):

Is there a narrative you tell yourself that needs to change about your past or future?

Are there new habits or disciplines that you’d like to implement (daily, weekly, monthly)?

Thinking further into the future, where would you like to see yourself in. People tend to have the most difficulty with this section. Do what feels relevant and move on. Don’t be afraid to dream. We can’t always predict what will happen and how things will change as the years go by. That’s ok!

1 month

6 months

1 year

2 years

5 years

10 years

Now reflect on this exercise as a whole and choose 2 or 3 of the goals or changes you want to make that stand out most or that are most important. List them below:

For each of them, think through the following questions. Choose the questions that are relevant to this particular goal:

1st goal or change:

How will I achieve this?

Are there any obstacles I need to plan for or be prepared for?

What resources do I have to help me?

What do I have control over?

What do I not have control over?

What time frame will you commit to before giving up or re-evaluating? (i.e. 30 days, 60 days)

2nd Goal or Change

How will I achieve this?

Are there any obstacles I need to plan for or be prepared for? What resources do I have to help me?

What parts do I have control over?

What parts do I not have control over?

What time frame will you commit to before giving up or re-evaluating? (i.e. 30 days, 60 days)

3rd Goal or Change

How will I achieve this?

Are there any obstacles I need to plan for or be prepared for?

What resources do I have to help me?

What parts do I have control over?

What parts do I not have control over?

What time frame will you commit to before giving up or re-evaluating? (i.e. 30 days, 60 days)

Healing Unhealthy Relationship Patterns Can Improve Depression and Anxiety

Not always, but often, I find that many of the struggles that lead people to therapy, such as depression or anxiety, are associated with not getting needs met in relationships. This is most often apparent in romantic experiences or family dynamics but can also be seen in friendships and in problems with professional relationships. For this post, I will use romantic relationships as the primary example to highlight how relationship patterns work.

Patterns in our Relationships

If we look across your dating experiences or your patterns of romantic attraction, we can often find a pattern. Perhaps you are strong and independent and have deprioritized relationships despite having a longing for one. Perhaps you have had a pattern of being attracted to unavailable partners. Or maybe when you are in a relationship, you find yourself frequently feeling insecure and seeking reassurance or constant contact with a partner who becomes frustrated by your needs.

Some questions to ask as you reflect on your patterns are

1) What has been similar about my experiences of attraction?

2) What has been similar about the types of people I’m attracted to?

3) What has been similar about the way those I’m attracted to respond to me?

4) What is similar about my experiences of people who are attracted to me? (*for some, the people they are attracted to are not always the same as the people who are attracted to them).

If the problem seems to be more with friendships, you can ask similar questions to see if you can find a pattern.

Common Patterns (Styles)

There are a few different general styles of relating (patterns) that will often pop up, one style will tend to be associated with anxiety, a tendency to seek or need a lot of reassurance from the partner that they care for you, perhaps you initiate contact and attempts at closeness more than the other person does, or frequently worry about the security of the relationship, sometimes feeling like you need to do a lot to make sure the other person doesn’t go away or that they are satisfied with the relationship. You also may tend to be more preoccupied with what others are thinking and feeling than attuned to yourself. (Anxious style)

Another style tends to be highly independent and self-sufficient, feeling less of a need for relationships. You may be very good at focusing on other aspects of your life, such as your profession, but not as good at being open about your emotions, perhaps not even identifying that you have feelings or needs for closeness at all. If relationship problems occur, you may be more likely to withdraw or express yourself less rather than to move closer or seek comfort or reassurance. (Avoidant style)

And finally, there is a style that is called “disorganized,” which tends to be a combination of the two other styles, often using interpersonal strategies for getting your needs met that conflict with each other. Desiring safety and security but frequently feeling fearful in relationships is a characteristic of this style. These individuals often have the most difficult time getting their emotional/relational needs met. (Disorganized style)

Insecure Attachment

The styles above are called “attachment patterns” and are generally referred to respectively as

1) preoccupied anxious,

2) dismissive avoidant, and

3) disorganized (sometimes called fearful/avoidant).

These three fall into a category called “insecure attachment” which is a separate category from the healthier alternative, “secure attachment.”

Secure Attachment

Those who have a secure attachment style often seem to have an easier time engaging in relationships. They experience a sense of confidence and relationship security, trusting their partners, and feeling comfortable when together and apart. They tend to choose partners who are caring, attentive, and want to spend time with them. These couples are supportive of each others interests outside of the relationship, and both partners enjoy coming back together when not involved in these other activities.

Each of these patterns have a lot of depth to them, far more than can be said in a blog post. I am just giving a few common characteristics to help you discover whether you may fall into one of these categories. We all tend to be on a spectrum with some being more anxious or avoidant than others. Even those who are secure can be shaken and feel insecure in relationships at times.

One thing that can be challenging about our attachment styles is that we tend to choose partners who trigger the challenges associated with our attachment style. For instance, a person who needs more reassurance may find themselves choosing partners who are less available (or even avoidant) and perhaps even feeling repelled by partners who are too available.

Addressing Attachment Patterns

Relationship patterns are something I have a lot of interest in and really enjoy helping people with. It takes work and time, but I think it’s worth it. Often, addressing this problem helps to resolve other issues that you are experiencing, like depression. Relationships are important. We need meaningful human contact, to be noticed, cared for, and loved. When we learn how to get our needs met more effectively, it can help us to resolve other mental health related concerns.

So, what does a healthy secure attachment style look like?

In addition to what I wrote above, having a secure style often means having the experience of believing your needs will be met in your relationships, believing that you are loved and cared for by your partner and those in your life, trusting that when you ask for your needs to be met, your partner will do their best to meet them if they are able to, feeling safe to open up about your deepest concerns and needs, and knowing that your partner finds joy in you. You also find joy in them. There is a healthy sense of interdependence and you both maintain activities outside of the relationship. Those with a secure attachment style usually choose partners who are caring and attentive and secure themselves and tend to quickly lose interest in partners who are not.

Perhaps this sounds a little too perfect or even impossible to obtain. It is important to clarify that those who have a secure style still experience relationship conflict. Long-term relationships are hard and take work regardless of your level of security. However, having a fundamental belief that you are loved and safe in a relationship can make all the difference when it comes to working through problems, expressing your needs effectively and getting them met, and deciding which relationships to be in in the first place.

How do we move toward feeling more secure?

1) Therapy is a really important component to addressing insecure attachment. I highly recommend seeking therapy to anyone who struggles with relationships in these ways. Getting feedback and having regular weekly support can help with beginning to get your emotional needs met and to become aware of the ineffective ways in which you are relating. There are specific treatments that help with attachment and it often involves ways the therapist responds to the needs and behaviors you express over the course of therapy. It can also include specific exercises done in the therapy sessions and at home.

2) Begin a practice of mindfulness. Headspace is one popular app that makes this easier. Many of my clients really enjoy using Headspace. Mindfulness is helpful because it guides us to center and helps us to get in touch with what we’re really feeling. It helps us to learn to sit with difficult (or even exciting) emotions rather than avoid them or just react to them (by anxiously doing something in response, for instance). For those who are preoccupied with other people’s feelings, it can help you to re-attune to yourself and your needs and focus less on people pleasing or worrying about what others think of you.

3) Reflect on what the other person might be experiencing when you’ve had an interpersonal interaction, particularly in situations that are confusing or distressing. Taking some moments to journal about this can help you slow down and really give this some thought. *This exercise is not the same as being preoccupied with the other person’s feelings as a reaction to your needing reassurance or security in the relationship.

4) Pay attention to the balance of initiating contact with those you are interested in or care for. Do you initiate contact more than they do? Do they initiate contact more than you do? Begin to pay attention to how this really feels. If you are putting in more of the effort, it can be helpful to pull back and initiate only as much contact as they initiate and then sit with the feelings that arise as a result. (Mindfulness is helpful here). If you are someone who experiences others as putting in most of the effort, notice what that is like for you. What would it be like to experiment with increasing your effort to initiate contact with those you care for? How does that feel? (I don’t recommend increasing contact with someone who is abusive or toxic in your life. Focus on those you are interested in or care for and enjoy.)

5) Learn more about attachment. A lot has been written that can be found online and there is a popular book called Attached that I have not read personally, but some of my clients have found helpful. The book is not a complete picture, but it seems to be a very helpful introduction.

This is not an exhaustive explanation of attachment, but I hope it gives you a few insights to explore further and some exercises you can try to begin working on in this area of your life.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

Finding Love When The People You Love Never Seem to Love You Back

Photo by Bruno Nascimento on Unsplash

Longing for a relationship but having a pattern in which you are always attracted to partners who are wrong for you or partners who aren't interested in a relationship with you can be really painful.

This is especially true when you meet someone you really like. Maybe you've had some deep, satisfying talks with them and really fun times together. It feels like there is so much potential! You can't get them out of your head and find yourself anxiously waiting in anticipation for a text from them or hoping that they will soon make plans to get together with you. But they always seem out of reach, leaving you longing. Ultimately, you learn they don't feel the same or they don't want a relationship. This really hurts and can make you feel like something is wrong with you, like something keeps you from being good enough for someone like this to love you back.

We've been talking about attraction a lot in my women's therapy groups, and I hope it gives you some comfort to know that you are not the only one who goes through this experience. There is research and theory on attraction that can help us understand these patterns and what compels us to repeat them over and over again. The good news is that you can correct the patterns. It's not easy work and doesn't happen overnight, but there is a pathway to healing.

Everyone is unique and there are a variety of components (attraction, boundaries, self-acceptance, vulnerability) that play a role in allowing us to have healthier and more satisfying relationship experiences. But if you find yourself in the pattern described above, I recommend taking some time to listen to an excellent podcast episode that came out last week. The show is hosted by clinical psychologist Dr. Nazanin Moali and her guest does a wonderful job of breaking down the principles of attraction and what drives our desire for individuals who never give us what we long for and who leave us in pain.

As a supplement, another resource I point my clients to for understanding their attraction patterns is the theory of attachment (which you can simply google). The book Attached is based on this theory and has been helpful to many people. I know the book looks a little gimmicky but it is actually based on good science!

Finally, one of my clients found this terrific article in the NYTimes last week which is a playoff of the above patterns....one where you find yourself in a quick whirlwind relationship that feels like the most amazing thing ever and then it crashes not long after it begins: How to Stop Rushing Into Love

Love can be complicated. But if you're reading this and confused by your patterns this Valentines Day I hope you will have some self-compassion and know that, like Ken Page says in the podcast I've linked to, seeking love is not weakness but it is wise. Love is meaningful. We are social beings and working on this part of your life is valid and important.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

Why Doctors Don't Test for Herpes

Many people diagnosed with herpes feel betrayed by the medical system when they learn they had never previously been tested for herpes and their partner likely was not either. If you didn't know before now, herpes is generally not included in a standard STD panel. That means all those screens that you so diligently obtained since becoming sexually active and the one you may have asked your partner to get as well, probably did not include herpes. 

Major medical associations regularly publish guidelines for how doctors should practice. When it comes to STD screening, the general consensus and recommendation is to not test individuals for herpes unless they have symptoms.

Most people with herpes have no idea they’re infected. While some people have classic symptoms easily identified as herpes, most people have no recognizable signs or no indications that concern them enough to head to the doctor.  

Nonetheless, asymptomatic individuals can still pass herpes on, and you could be one of them, even if you obtain regular STD testing.

Many doctors also don't inform patients that the test is not included, so when people do have symptoms and receive a diagnosis, there can be feelings of confusion and worry about whether a partner was dishonest or cheated, when their partner simply may not have known about the infection. In fact, by the time some people are diagnosed, it can be very difficult to determine how long they've had the infection. This means they may not have contracted it from their current partner.

So why is this test not included? Doesn’t the medical community care about preventing transmission?

Although it may not feel this way, the doctors and researchers who established these guidelines have been quite thoughtful about them. If you read the documents, you can see that the researchers sensitively consider their decision from many different angles. In fact, you can learn a ton about the research on genital herpes and transmission by reading the U.S. Preventive Service Task Force documents where they discuss the reasoning for their decision.

The biggest contributing factor to the guidelines is that 1) standard herpes blood tests are not totally reliable and 2) receiving a herpes diagnosis can have a significant impact on mental health while being virtually non-threatening to your physical health.

The blood tests do have a lot of value, but here are the biggest issues:

1. About 50% of the population has type 1 herpes. Type 1 can be genital or oral. If you have never had symptoms (no cold sores or genital symptoms) and obtain an IgG based type-specific blood test (the standard test for herpes simplex), and the test comes back positive for type 1, we have no way of knowing whether you are infected orally, genitally, or both. The only way we can know which location is infected is by symptoms. (Type 2 is almost always a genital infection.)

2. About 30% of negative results for HSV 1 are false negatives. This means if you test negative, you might still have HSV 1. (There is about an 8% chance of false negative with HSV 2.)

3. If you are positive for type 2 and fall within a positive range of 1.1 - 3.5, there’s a decent chance this is a false positive. About 50% of positives that fall in this range are in error, with the closer you get to 3.5 the more likely you are positive and the closer to 1.1 the less likely you are positive. There can be false positives above 3.5 as well but they’re less likely. If you do test positive within this low range, the CDC recommends confirmatory testing (update: CDC now encourages confirmation between a 1.1 and 3.0, but some experts still say below 3.5). The most accurate confirmatory blood test is the Western Blot. The Western Blot is more complicated to obtain (though not impossible) and your insurance may not cover it. In addition, many doctors do not know about the high false positive rate within this range so they incorrectly diagnose their patients without getting confirmation. I have worked with a number of patients diagnosed within this range who I encouraged to follow up with the Western Blot and they discovered they were negative. (You should not do confirmatory testing with the same blood test that gave you the positive result; and to be confident in your results, you should wait 16 weeks from the last possible exposure to be tested.)

4. Blood tests given too early after possible exposure can be false negative.

What about mental health?

We also know that due to the stigma, learning that you are positive for herpes can impact your mental health. Research shows that people diagnosed with herpes are more likely to become depressed, withdraw socially, and experience reduced self-esteem. The shame associated with contracting herpes can make a big impact on a person’s quality of life. This is despite the fact that it’s a common virus that affects people of all walks of life, all social circles, and all socioeconomic classes. It not only affects people who have casual sex partners (as is often assumed) but also people who limit their sexual behavior to monogamous relationships. It can even affect people who have only had one partner.

I can almost guarantee you know multiple people who have genital herpes even if no one has ever told you. Also, many cases of genital herpes occur as a result of oral sex from someone who has a history of cold sores (there is no need for a cold sore to be present at the time of oral sex because herpes, which causes cold sores, can shed virus when no symptoms are seen or felt). 

Medical experts pretty much agree that from a physical health perspective, outside of the rare case, herpes is by and large no big deal. Most other STDs (gonorrhea, chlamydia, syphilis, HIV, and some strains of HPV) can have a significant impact on your health if left untreated. This is not the case with herpes. If you have no symptoms but test positive for herpes, there is nothing to do differently when it comes to your personal health. So the experts who publish these guidelines feel that the risks of knowing you have herpes based on tests that might not be accurate and still leave a lot of questions will have a potentially worse impact on your mental health than it’s worth.

And perhaps they are right, however...

Research suggests that the psychological impact on people who are asymptomatic but test positive tends to get better with time. If asymptomatic people were informed of their infection, maybe they would do something to reduce the risk of transmitting the virus. In fact, one study showed that people aware of having HSV-2 were 50% less likely to transmit the infection in new relationships than people who are unaware of their infection.

As a mental health provider who sees the impact on people who contract symptomatic herpes from partners who didn't know they were infected, I think we as healthcare providers owe these individuals a bit more.

The few patients with knowledge of their infection shouldn't have to bear the full burden of herpes stigma while most people with herpes are able to go on with their lives, transmitting unknowingly.

My call is for more informative conversation about herpes between practitioners and patients who are seeking sexual health services.

At the very least, I believe providers should inform patients if herpes is not included in their test. Providers should take this opportunity to educate patients on how common herpes is, dispel some myths, inform them that most providers don’t test and therefore the patient and their partners are unlikely to know if they have herpes unless they exhibit symptoms.

STDs are a public health concern, so STD testing should come with education, which hopefully will help reduce stigma. If we all heard about herpes every time we were tested for STDs (regardless of whether we are tested for herpes), learning that we could have the virus and not know it, that genital herpes can be contracted via oral sex by someone with oral herpes even when no symptoms are present, that all types of people have herpes and contracting it doesn't mean you're "dirty"--then this might do a lot for reducing the mental health impact for people who do receive a diagnosis.

I can't say that everyone should be tested. But I can say that patients should be informed about what is not included in their test, especially since they are likely to assume herpes will be a part of it. Doctors (or their nurses) should take the opportunity to inform patients and reduce stigma, hopefully mitigating some of the mental health impact should a patient be diagnosed in the future or learn that someone they care about has herpes.

A few notes and resources:

**If you have tested low positive for herpes (between 1.1 and 3.5) via a herpes IgG blood test and want information about obtaining confirmatory testing via the Western Blot, you can find that information at The University of Washington's website or contact Terri Warren, NP who is an expert in herpes and can help guide you through the process of obtaining the Western Blot and interpreting your results. If you've had a positive swab for herpes from a genital lesion, this can act as confirmation.

**People with herpes simplex who have a partner with the same type of herpes simplex are very unlikely to "re-infect" or transmit herpes to their partner since their partner already has antibodies for the same virus. For instance if both partners have HSV-1 (even if one has it orally and the other genitally). Check out The Updated Herpes Handbook or The Good New About The Bad News for a thorough discussion on transmission.

**Pregnant women who are negative for herpes simplex should avoid activities that could put them at risk for contracting genital herpes during the 3rd trimester, as becoming infected at this time carries the highest risk for neonatal herpes.

**Women who have a genital herpes diagnosis prior to becoming pregnant are at a very low risk for transmitting to their infants during birth, however it's still important to inform your doctor as you will likely be prescribed antivirals at the end of your pregnancy to reduce the chances of an outbreak at delivery. Most women in this situation are able to give birth vaginally and do not need a cesarean section.

**You can read my other posts on genital herpes here.

Counseling in NYC to Help Cope with a Diagnosis

You do not have to go through the experience of being diagnosed with herpes or awaiting a diagnosis alone. I have been working with women and men with herpes for over 20 years. While I know that awaiting a possible diagnosis or receiving a diagnosis can be a very difficult emotional experience, I have so much hope for you. I have watched many people work through these difficult feelings and come out stronger on the other side, finding confidence to enjoy dating, sex, and relationships again. If you are in NYC and interested in whether therapy might be helpful, please contact me for a complimentary phone consultation. I also am able to offer virtual counseling to individuals in California, Florida, and Upstate New York.

Disclaimer

My hope is to keep you informed, but this is a blog post and not meant to be exhaustive. I am not a medical doctor and it’s possible information written here does not apply to your unique circumstances. Also, I do my best to stay up-to-date on the best information regarding herpes, however, a blog post can become out-of-date without my realizing it, so I always encourage patients to do their own research. Information on this website is not intended to substitute professional medical or psychotherapeutic advice.

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About Melissa King, LMHC

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about on this blog.

Get Updates about New Blog Posts

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Packing Your Emotional First-Aid Kit

Walking around New York City, I often see emergency preparedness signs, the ones that tell you to make sure you have a plan and working supplies, such as flashlights, batteries, water, etc. 

I especially love the poster of one family's strategy, where under each family member's photo there is text describing what that individual will do. Under the dog, it says, "Grab the cat."

Emergency preparedness is important. But what about being prepared for emotional "emergencies"? Discouragement, loss, let-downs, and grief are no fun. So why not do something in advance to help make those times easier for yourself when they happen?

What would you put in your emotional first-aid kit?

Here are some ideas:

Items for your Emotional First-Aid Kit

* a playlist of uplifting and empowering music 

* selected poems and/or prayers to read 

* a journal to process your feelings

* a cash stash to spend on something nurturing: a yoga class, movie, or other activity

* a scented candle or essential oils that you love

* a list of films you can watch that make you laugh or feel strong

* colored pens/pencils or other art supplies

* pictures that make you feel good (could be art, places you've been, people who love you)

* lotion or bubble bath 

* a list of things to do

* a list of people to call

Find a fun box or if you're artsy, use a shoe box and turn its appearance into something that cheers you up.

Of everything on this list, my favorite is having a playlist prepared because music is so powerful and you can take it with you anywhere. I checked in with some colleagues to see what they would include in their "first-aid" playlist. Here are our picks!

Songs that Empower and Uplift

Roar by Katy Perry

Shake it Off by Taylor Swift

True Colors by Cyndi Lauper

the first 3 are a few of my playlist picks

I Will Survive by Gloria Gaynor

submitted by Tiffany Spilove, eating disorder and trauma specialist in the Philadelphia area

Bad Reputation by Joan Jet

submitted by Ella Dawson, sex writer who has contributed significantly to positive media and education on herpes

Believe in Love by The Dazz Band

submitted by Darryl Aiken-Afam, fitness, movement, healing and martial artist

Wildflowers by Tom Petty

submitted by psychologist, Julie Groveman, PsyD

Rio by Duran Duran

submitted by Lori Fauquier, Nurse Practitioner, telemedicine for women

The Largo Movement from Winter in the Four Seasons by Vivaldi

submitted by Edgard Danielson, PhD, Psychoanalyst

Fight Song by Rachel Platten

submitted by Janelle Marie Davis, founder of The STD Project

Fast Car by Tracy Chapman

also submitted by Janelle Marie Davis, founder of The STD Project

What songs (or other items) would you add?

Don't put this off. You will thank yourself later!

Melissa

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About Melissa King, LMHC

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

 

Get Updates about New Blog Posts

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Life After Herpes

I recently connected with Lori Fauquier, a nurse practitioner who used to practice at Callen-Lorde, here in New York City. She now has a tele-medicine practice focusing on women's health issues. I've found Lori to be a knowledgeable and passionate provider who is also comfortable talking about sex and sexual health. She is very generous with providing education through her blog and a regular Facebook Live show, both of which I've been so excited to participate in this month.

My Guest Post - Life After Herpes

I wrote a guest blog at Lori's site, Women's Health on the Go, for patients recently diagnosed with herpes: Life After Herpes

The Emotional Impact of Herpes - Facebook Live Interview

Lori will also be interviewing me this Friday at noon for her weekly Facebook Live educational show. We'll be talking about the emotional impact of herpes. It will be recorded and posted after the show in case you miss us!

Melissa

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About Melissa King, LMHC

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

Get Updates about New Blog Posts

If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

DISCLAIMER

Please remember that we are continuously learning new things about herpes. I will try to keep this website updated but remember that research may come out today that changes what we currently know about herpes. Information on this website is not intended to substitute professional medical or psychotherapeutic advice.

How Childhood Bullying Impacts Us As Adults

Were you bullied as a kid?

Do you know what it's like to go to school and be picked on, to always be worried about what the next insult will be and when it will be thrown at you?

to sometimes be unsure if people are being nice or trying to trick you? 

to not be included and to know that you are purposefully not being included?

to wish you belonged?

Do you remember those experiences as if they were yesterday?

Many adults do. 

Their memories aren't vague but very clear. And research shows that we feel the reverberations of bullying experiences on self-esteem and in relationships well into adulthood, perhaps for a lifetime.

Bullying isn't just physical intimidation. Teasing, being picked on, name-calling, sexual harassment, purposeful group exclusion, and spreading rumors are all behaviors that encompass bullying.

Maybe you experienced it just a few times or maybe you experienced it everyday. Either way, being bullied is painful and it shapes self-concept, relationships, decision-making, and aspirations during years of significant personal development.

When your brain is growing and you have to go to a place everyday where you must constantly be on guard, where you are fearful of what might happen next, and while, at the same time, you are learning something about who you are, this is going to have an influence on the wiring of your brain and emotions. It will affect how you will react to the world later in life.

Many adults who were bullied as kids say they have trouble trusting or getting close to others, feeling secure in relationships with friends and/or romantic partners, or feeling confident--whether it be at work, in socializing, trying new things, or participating in activities. Some adults become perfectionists or people pleasers, going out of their way to make sure no one can find or point out a flaw.

Others just give up trying and struggle to live up to their potential.

If you were bullied, you might have escaped those kids but not the memories and not the way it left you feeling about yourself and others.

Bullying is a significant problem in America. It’s a public health issue. Kids who are bullied are more likely to struggle with mental health problems like depression and anxiety as a result. Too often, bullying is passed off by adults as “kids just being kids.” Sadly, in many circumstances, the victim is the one blamed, assumed to be doing something to cause it.

This can feel devastatingly lonely for a kid who is already being shunned by peers.

We all need a sense of belonging, especially during our developmental years.

We need to know that we are valued by our peers and that we have something to offer the world. These are developmental needs, human needs. Being teased and ridiculed or excluded can be traumatizing.

Elena deLara is a researcher who has extensively studied the effects of childhood bullying on adulthood. She discovered common symptoms and struggles such as low self-esteem; shame; problems trusting others; problems in relationships; a tendency to people please; food or substance abuse/misuse; emotional problems; feelings of anger, rage, and desire for revenge; and poor body image. She discovered that the trauma can be so consequential that symptoms can parallel PTSD. Maltreatment at school can have just as much impact on mental health as that of kids who experience maltreatment at home.

If you’ve gotten this far in this post, bullying has probably had an important impact on you. Despite the pain, I wonder if you have also identified something positive that came out of those experiences.

Were there ways in which bullying made you a better person today?

Perhaps you felt it propelled you to excel, to prove those kids were wrong about you. You might feel it made you more empathetic and considerate of others. Perhaps it compelled you to be an activist in some way.

Finding the positives is important.

But even with the positives, you might still feel angry at times, wishing you could shake off those mean words and the rejection, wishing that it did not have such an effect on you. 

Maybe you still wonder if something really is wrong with you.

I want you to know that the pain you experienced matters. It’s important. Your life matters. 

Processing those experiences with others can really help you heal, gain insight, and help to repair the ways in which those experiences might have changed you.

Here are some things you can do.

1. Join a Group

I'm starting an 8-week group this summer for adults who want a chance to process these bullying experiences and explore how those experiences still impact the way they seem themselves and those around them. You can find more details here. Send me a message if you'd like to talk with me about whether this group might be a good fit for you. 

You can process the experience of bullying in therapy groups that aren't specifically focused on bullying as well. Therapy groups are excellent for understanding and improving relationship experiences. You can search for one by zip code here.

2. Write Your Story

Write out your story. How do you tell the story of your experiences of bullying as a kid? How did those experiences shape your childhood? 

Afterwards, answer the following: If it happened a lot, what were the exceptions? Was there a kid who was kind? Did you have some friends at school or elsewhere? Did anyone listen to you or support you? Did someone ever stick up for you? Were there good times? What would you tell your kid-self now that you didn't know then?

Don’t deny the painful experience, but try to integrate the good stuff (whether it was something positive then or something strengthening that you now know as an adult). Include the positives as part of your story. So often we focus on what went wrong and lose the good parts as a result. Even if they were few, it’s important to remember what helped you along.

3. Self-Criticism vs. Self-Compassion

Many adults who experienced bullying struggle with being highly self-critical. Learning self-compassion is a significant step to breaking free from the messages you received about yourself as a kid. I recommend this exercise by Kristen Neff as a start. You can also view her TedX talk on self-compassion.

4. Online Support

There are a number of supports and articles online. Google “adult survivors of bullying” and you’ll find many.

Here is one: https://www.facebook.com/PeerAbuse/

5. Read Ellen deLara's book, Bullying Scars

Ellen deLara’s book Bullying Scars, The Impact on Adult Life and Relationships is an academic type of read, but good if you are interested in her research and the research of others on this topic. She includes many touching quotes from "survivors" she interviewed.

6. Learn About Anti-Bullying Projects

Below are some anti-bullying programs. Perhaps you will want to be involved or help a school near you. Sometimes we find healing in helping to make a difference for others.

Olweus Bullying Prevention Program

StopBullying.gov

7. Don't Stop Growing

Whatever you do, keep growing. Self-criticism can be like bullying yourself. Identify your strengths. Be kind to yourself. Treat yourself the way you always wanted to be treated. 

And if you feel disconnected, fight to find connection. Look for people who really think you're great. Building relationships as an adult is harder but not impossible. You deserve it and it matters!

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Get Updates about New Blog Posts

If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

About Melissa King, LMHC

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

5 Ways We Stay Stuck in Cycles of Anxiety and Depression

Some experiences of anxious or depressed feelings are normal. You notice the feeling but have a sense of being in control of it; it doesn’t interfere with your ability to take action, handle your responsibilities, or participate in activities you enjoy--at least not for long. You might even see the sadness or nervousness as a natural part of the circumstances, of healing, moving forward, or being challenged. You cry it out or give yourself a pep talk and then find yourself moving on.

But sometimes anxiety and depression can become more significant, either in intensity, frequency, or duration.

Both can leave you feeling stuck and uncertain about the way out. Sometimes it’s hard to know where the dip or hurdle began or why it seems to be sticking around.

Most people struggling with feelings associated with depression and anxiety want to understand why it is occurring and want to gain some control over these feelings rather than feeling controlled by them.

Below are 5 areas that could be keeping you stuck in a cycle of depression or anxiety. Often depression and anxiety are complex. Solving one issue doesn’t always solve the whole problem. But if you identify with one or more of these, you may be able to start unraveling the tangles.

Procrastination

Procrastination can really make you feel heavy. It’s like carrying a bag on your shoulder and never taking it off or unpacking it to lighten your load. You know you have to do something, whether it’s complete a project, make a decision, or confront someone. You know that completing the task will offer some relief but something is holding you back. Perhaps addressing the matter makes you uncomfortable or maybe you’re afraid of not doing a good job.

If this is you, ask yourself

What is standing in the way?

Is there an additional problem to be solved or do I need more information?

What action do I need to take today?

Sometimes we have really good reasons to procrastinate, but being aware of and conscious about what you are doing is valuable for ultimately moving forward.

Avoidance

Avoidance is similar to procrastination except that with procrastination there is something you know you need to do, but you perpetually put it off for later. You can avoid without procrastinating because you may not have any intention of facing the issue. 

Avoidance is when you go out of your way to evade something uncomfortable. Maybe you’re avoiding someone you feel intimidated by, someone who has hurt you, something that scares you, or the possibility that you might fail or won't live up to others’ expectations.

Addressing avoidance begins with acknowledging what you are avoiding. It can be really helpful to face the circumstance you're avoiding in your mind. Ask yourself about the worst case scenario and how you might survive it.

You can also avoid thoughts. For instance, you might worry that someone doesn’t like you, so you try to think of ways to get them to like you or reassure yourself rather than truly accepting the possibility that they might not like you.

If it's thoughts you are avoiding, you can ask yourself

What if this were true? 

What would it mean?

How might I cope with that?

Exploring the thought doesn't make it true, it just helps you to face the thought and make some peace with it if it is true.

It’s easy to spend a lot of time avoiding uncomfortable feelings, but uncomfortable feelings are a normal human experience. Learning to tolerate those feelings and understand what they are trying to communicate is a valuable life tool.

Thoughts and Beliefs

There are a lot of messages in our society to “think positive,” but sometimes the issues we worry about are realistic. Bad things do happen.

“I’M A FAILURE”

”I’M UNLOVABLE”

But often there are beliefs and thoughts present in anxiety and depression that aren’t exactly accurate. Thoughts like, “I’m a failure,” or “I’m unlovable.” These thoughts and beliefs can make us miserable despite often having some evidence to the contrary. Anxiety and depression can also lead you to falsely predict negative outcomes for situations that are truly unpredictable—and even cause you to self-sabotage in order to make the prediction come true. 

Surprisingly, despite causing pain, we can be really committed to these beliefs and thoughts. They are often a way we try to protect ourselves from being vulnerable to what we think might be greater pain.

Take a moment and reflect on the thoughts that lead to your negative beliefs. Ask yourself if you can really say that each of these thoughts are factually true. Are there any exceptions that prove your belief/thought wrong? Are there realistic possible outcomes besides the negative one you are presuming?

If you find that something really has some evidence to support your concerns, then you can ask,

What can I do about this?

What are some ways I can get through this if my fear is true?

Is there something I can change or improve?

Is there someone who I can talk with about how I’m feeling?

Fear of Conflict

Ugh! That feeling in the pit of your stomach when you know you need to address something with someone but you are sure the outcome is not going to be good (which, by the way, may not be an accurate belief).

So you keep stuffing it.

You don’t say how you really feel and you don’t ask for what you need. Leaving things unsettled and accepting less than what we deserve can create a heavy emotional burden. It can also lead us to stay in all kinds of relationships that aren’t great for us. Learning some skills for addressing conflict can make a big difference. Garnering up support and a pep talk from a friend or family member before addressing the conflict can also be helpful. In addition, it also takes some self-esteem and self-compassion—believing that your thoughts, feelings, and needs deserve to be voiced and heard. 

Conflict is uncomfortable, so being willing to accept and tolerate the discomfort can be helpful.

If you fear for your safety when it comes to conflict, pay attention to that signal and don’t move forward without talking it over with a professional who has experience with relationships that can feel threatening at times.

Fear of Loss

This is a big one. It’s really easy to get stuck in a depressive or anxious pattern because we are afraid of facing a loss.

Fear of loss can be paralyzing.

You might be afraid of losing the admiration or affection of someone. You might fear someone finding out you aren’t perfect after all and rejecting you. You might fear facing the loss of a dream or losing your health. Identifying what you are really afraid of is really important.

Acknowledging sadness about the loss or potential loss is important, while also identifying how you will get back on your feet despite it being tough.

Fear of loss calls for a lot of self-compassion. It also calls for you to give yourself some credit. Most people are more resilient than they think. If you are reading this, that shows you have some resourcefulness in you. Embrace that belief in yourself.

Be Kind to Yourself

You might notice that all 5 of these have a thread of avoidance running through them. Sometimes we avoid things because we need extra support, new skills, or we just have too much on our plate.

Try not to judge yourself. 

Avoidance just describes a behavior. It can be an effective coping tool for a period of time. But at some point it usually needs to be addressed. I hope that this post helped you identify some areas where you can get brave and take some action.

If you just can't get going or feel overwhelmed by the challenges you need to solve, you don’t have to do it all alone. Even if you are not widely connected, there are places to go for support, whether it be a church, community group, or online support group.

If you'd like to talk with someone in a safe, confidential, and therapeutic space, I am here for you. Individual and group therapy are a great resource for navigating anxiety and depression. 

Most importantly, know that you are not alone. Life is challenging to navigate. But keep going! Be brave!

Melissa

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

Losing Control: Autoimmune, Migraines, and other Chronic Health Conditions

I’ve recently had an increase of clients and loved ones in my life with autoimmune conditions, like Fybromyalgia, Hashimoto’s disease (which causes hypothyroid), or other chronic pain conditions like migraine. These are all individuals who are young, mostly in their 30s, and in the prime of their lives. 

Emotionally, these individuals are finding it difficult to witness the loss of control of their body and their health. Taking care of these conditions often requires a change in diet, increased rest, and reduced ability to engage in social activities. Even with a dedication to self-care, there is still a struggle with energy levels, weight control, and sometimes pain. Friends and family often don’t get it and sometimes it’s hard to find a knowledgable doctor, too.

It’s difficult to face health issues at any age, but when you are young, it can really feel like something you were supposed to have is being stolen from you. You expect to be thriving in your 30s, working hard, achieving goals, having fun, finding or enjoying a partner or family--not managing an illness. Before developing the disorder, if you got sick or gained a few pounds, it was nothing to get back on track with a little self-nurturing and healthy eating. Now, you can do everything “right,” make healthy, balanced choices, and still find your body resisting and rebelling.

Losing control of something we previously had control over or coming to a realization that we can’t control everything, that we won’t always be able to prevent painful things from happening to us, even when we do everything “right” is one of the hardest things to face as humans. Watching our health suffer and, for the first time, being unable to fix it easily with a few good nights of sleep is discouraging and emotionally painful. You might even feel like you don’t recognize yourself. You may have always thought of yourself as energetic, social, and hard-working but now find yourself unable to accomplish all that you used to.

When there is loss like this, it is real. Letting yourself grieve is important, so that you can eventually rise out of it into acceptance and a new kind of strength. Finding people who get it and who can be present with your pain and loss is so important.

Having people around who know and believe in the strong person that you are behind the illness is also important.

Often, friends and family try to give unsolicited advice on how to solve your problem, but this can be so exhausting. You probably already know more about your experience and condition than most people around you. As a society, we often don’t recognize the value of just sitting with someone in the pain they are experiencing and not leaving them alone there. We need our pain to be seen by those we love. 

I find that these kinds of conditions force us to challenge cultural values around weight, appearance, independence, accomplishment, and being a go-getter. To find some kind of peace with our new reality, we have to start to believe that we are more than our bodies, more than our appearance, more than all the things we can do. If we don’t, the battle with our bodies and minds will be much more difficult.

From a spiritual perspective, I think this gives us an opportunity to connect more deeply with ourselves and others, to enter into real relationships in which our imperfections are welcome—and we are loved for who we are.

If you are experiencing an autoimmune disease or a chronic pain condition, a support group can be tremendously helpful. I recommend searching meetup.com for autoimmune or the specific name of your condition. If you want more professional support and structure, therapy groups of all types can be a great resource. You can find many on Psychology Today by searching your zip code or town. I facilitate one for women here in Murray Hill (Manhattan) on Monday nights. 

The important thing is to connect with others and to know you can count on regular support.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

5 Little Known Strengths in Those Who Are Insecure

If you live with insecurity, you are well aware of how bad it feels to always be unsure of yourself in relationships, to always be second guessing yourself, and even judging yourself for feeling insecure.

Insecurity often develops out of early relationship experiences in childhood and sometimes traumatic events or major stressors that occur in your family.

Even when you come from a great family, parents and caregivers have a huge job to do in detecting and meeting your emotional and physical needs. They don't always guess your needs correctly or have the skills to meet them adequately. 

Sometimes difficult and uncontrollable events occur in good families that leave a child’s needs for security and emotional attunement unmet. These very early experiences, even those we don't remember, have an influence on our developing brain and can contribute to characteristics of being unsure of ourselves when relating to the world and others later in life.

You might see insecurity as a deficit but there are also a lot of strengths that are commonly present in those who struggle with insecurity.

As children, when our needs aren’t getting met, we develop other “muscles” to protect ourselves emotionally and to find ways to make the best of our circumstances. These strengths are often highly developed and when honed, can offer so much value to your relationships and your community.

What are they?

5 common strengths in people who often feel insecure

1. Sensitive to others’ needs.

2. Perceptive of the emotional nuances others are experiencing. You may pick up on facial cues easily and quickly.

3. Considerate and polite.

4. Loyal and supportive of friends.

5. Introspective and work hard on personal growth.

Now, here is the caveat.

I suspect some of you are thinking that it is the above traits that tend to get you into trouble in relationships and in life, to leave you feeling hurt and misundertood.

It is true that the above strengths can leave those who feel insecure vulnerable in relationships as adults. The thing about strengths is that if there is an imbalance in another area, the strength is not always able to function at its highest potential. If you only worked out one of your legs and not the other, one leg would be super-powerful, but you might limp or you might not be able to stand well on the weak leg in order to kick with the powerful leg.

The weak leg in this analogy usually represents the part of yourself that doesn't recognize, believe in, or care for your own thoughts and feelings. It's the part of you who puts so much effort into others that you leave yourself behind, the part that values others over yourself to the point of hurting yourself.

But weak legs can get strong.

It just takes acquiring some new skills, gaining insight (which insecure people tend to be good at), and practice. Self-confidence and developing healthy, secure ways of relating are characteristics that can be learned.

Here are five new behaviors you can begin thinking about to move in the right direction.

5 behaviors you can develop in order to make the most of your strengths:

1. Set limits so that you don’t give too much too quickly to people who haven’t yet earned it.

2. Allow others the space to take care of themselves even when you know or feel something is wrong.

3. Learn to take care of yourself even when others have needs.

4. Don't be too quick to blame yourself for others feelings and experiences.

5. Recognize and believe that you can and should have requirements of others in relationship with you (attention, support, honesty, reliability etc.).

Some of these ideas might seem abstract right now. It can take some time and some guidance to move into a new way of being. But you can begin reflecting on these ideas and see whether any make sense in a particular area of your life today. 

Making change isn’t easy. It involves taking some risks and learning new skills. Sometimes the help of a therapist, mentor, support group, or good friend is needed as you learn to detect your needs and to become more effective at getting them met. 

An individual who struggles with insecurity often has a large capacity for introspection and self-growth. That ability can help you rise out of insecurity and develop a strong sense of genuine self-assurance with others.

For further exploration:

What Are Personal Boundaries? How Do I Get Some? by Darlene Lance, JD, MFT

Kristen Neff's famous Tedx talk on Self-Compassion. Self-Compassion is a pillar to healing insecurity.

Some exercises from Kristen Neff on developing self-compassion

Codependency No More--a classic book on how to start taking care of yourself and stop finding your security in pleasing others.

 

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If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

 

About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.