Economic Stress and Skipping Therapy …. Therapists Need to be More Responsive.

     With rising inflation and economic uncertainty, unfortunately, some couples are skipping therapy to save money. There is a good article in the Wall Street Journal discussing this difficult situation. My bottom line is that therapists need to work with clients that are having a difficult economic time. Economic stress merely compounds so many other issues. Here are a few major points made by this article. 

  • U.S. inflation has been rising at the fastest rate in four decades. Many are putting off therapy sessions or forgoing them altogether. 
  • Nearly a third of American adults in therapy say they have had to cancel a session because they couldn’t afford it and nearly half say they would have to quit if their out-of-pocket costs increased. 
  • Healthcare spending was down 7% in July from September of the year prior. 
  • People are experiencing more stress, there’s an exacerbation of chronic illness, they are having sleeplessness, they’re using more substances. 
  • Many therapy providers say they are largely unaffected by inflation-driven dropouts thanks to wait lists that have amassed throughout the pandemic. 

“Some Americans Skip Therapy to Save Money.” Wall Street Journal (8.25.22).

In Praise of Anxiety — ‘Anxiety May Lead to Excellence.’

A recent article in the Wall Street Journal describes recent research that discusses the benefits of anxiety in the workplace. That it can lead to really good performance and in fact excellence. Here are a few excerpts.

  • Over the past decade, research has also shown something that many scientists didn’t expect: higher levels of dopamine, the “feel good” hormone, when we’re anxious. 
  • Individuals who learned to reframe their anxiety as an advantage, compared with those who didn’t, performed better under pressure, were more confident and showed biological signs—steadier heart rates, lower blood pressure—of being focused and engaged. The study showed that when we believe anxiety is a benefit rather than a burden, our bodies follow suit and better prepare us to meet the challenges ahead.
  • A sense of purpose doesn’t mean some grand vision or a burning life mission. Purpose refers to the values and priorities that make us who we are and give our life meaning. 
  • That’s why it’s crucial to channel the benefits of anxiety, like persistence and hope, toward purpose. 
  • People who tended to pursue excellence over perfection in these exercises made mistakes, but they came up with more—and more original—answers.

“In Praise of Anxiety.” Wall Street Journal (May 7, 2022).

When Depression Drugs Stop Working — Why and What to Do.


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The problem of antidepressants when they stop working is a significant issue. A recent article discusses this critical situation. The following are excerpts from that article Depression Drugs Often Suddenly Fail to Work” that appeared in the Wall Street Journal recently (February 17, 2022).

  • You’ve been on the same antidepressants for years. Then suddenly, the medication seems to stop working. The problem can hit people even when a drug has worked well for a decade or more. Symptoms such as persistent sadness and a loss of interest in favorite activities resurge. Identifying the right solution can be difficult and largely trial-and-error: Some patients may need a higher dose of the same medication, while others may need to try a new drug or a new combination of drugs, doctors say. 
  • There are no statistics on how frequently antidepressants seem to suddenly fail in people who had been doing well on them. But psychiatrists say they see it fairly regularly. 
  • Scientists aren’t certain exactly why psychiatric drugs appear to lose effectiveness for some patients. There’s some evidence that long-term antidepressant treatment may reduce the number of serotonin receptors in the brain, says Dr. Nemeroff. Serotonin is a neurotransmitter, a chemical that transmits messages between neurons, that is important for mood.    
  • People who have lingering symptoms of depression while undergoing treatment, such as continuing sleep problems, are also more likely to experience a relapse or what may seem like a failure of their antidepressants.
  • Alcohol and drugs can destabilize mood and bring on symptoms, as can a change in sleep schedule. Other medications can interfere with antidepressants’ efficacy. And sometimes what a patient thinks is the medication failing is actually a side effect that can occur with long-term antidepressant use: emotional numbing or apathy.
  • The easiest move is to raise the dose of the drug the patient is currently on, says Maurizio Fava, psychiatrist-in-chief at Massachusetts General Hospital. 
  • Some psychiatrists prefer switching patients to a different class of medication. The most common switch is between an SSRI and a serotonin and norepinephrine reuptake inhibitor (or SNRI) like Effexor. SNRIs affect the action of serotonin and the chemical norepinephrine, which is involved in alertness and arousal. Dr. Schwartz says there is some evidence that SNRIs may be more effective at treating depression symptoms.
  • There are potential pitfalls to switching. Besides the possibility of new side effects, people may have withdrawal symptoms from their current medication. It can take several weeks before patients feel the beneficial effects of the new drugs. The biggest danger is that the patient won’t respond to the new medication—and that the old drug was actually helping more than perceived. Patients should work closely with their doctors and monitor their symptoms to continue making adjustments to their treatment until they improve.  

Couples Change — Often Hard to Adjust — But Often Possible.


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 There’s a good article in today’s New York Times discussing how all couples change. Here are a few of its observations that I believe are very helpful — especially during the current pandemic.

  • We don’t marry one person as much as we marry one version of a person, a snapshot of who we (and our partner) are individually and to one another at the moment when we say “I do.” Who we are five, 10 or 40 years later is anybody’s guess.
  • People change. As a result, relationships change, too.
  • Not only do relationships change with time, but people change, which can affect the relationship dynamics as well.
  • Personalities are more malleable than we may think. Most of us change, though often gradually.
  • But the pandemic and the disruption it brought have resulted in a period of far more rapid, intense and often negative change for many people the world over.
  • Communication has and will always be the key to mitigate negative feelings around change in your relationship,
  • Sometimes change is precisely what the love doctor ordered in order for two people to realize they are right for one another.
  • Accepting changes that you can live with not only leads to more self-fulfillment but can also lead to a stronger relationship. Change brings back some of that ‘newness’ and can add new passion and interest to the relationship. 

          “Watching a Partner Change is Hard.” New York Times (January 10, 2022).


Couples & the Pandemic — Many Thriving, Three Suggestions.

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     Many relationships have thrived during the pandemic, surprisingly.

     According to recent research 74% of married couples surveyed felt the pandemic strengthened their marriages, and 82% said it made them feel more committed.  Here are three recommendations from this recent research as discussed in the recent article “How Some Relationships Flourish in a Tough time.” (January 4, 2022):


  • Give Space — Perhaps unsurprisingly after nearly two years of being cooped up together, time apart is crucial to relationship health.


  • Assume Positive Intent — Often we’re quick to assume the worst about a situation or a person’s intentions, a tendency that has worsened as pandemic stress wears us down. Assuming a positive attitude can be very beneficial.


  • Make Time to Be Positive — Block out a specific time of day to be positive together, then stick with it no matter what.

     My initial observation is that the three above items do contribute to a better relationship between couples. Both emotionally and physically. Of course, other factors are also very relevant. But these three suggestions are a start.

“Languishing” and What to Do.


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     A good piece recently appeared in the New York Times discussing “languishing.” As it turns out it was the mostly widely read article in the paper for 2021. From my observation languishing has become a really significant issue during the last two years. This is true for individuals and couples. Simply put the article discusses the notion of “languishing” as a mental health issue.  Which has rarely been done before. It then makes a few suggestions. Here are the main points: 

  • Languishing is a sense of stagnation and emptiness. It feels as if you’re muddling through your days, looking at your life through a foggy windshield. And it might be the dominant emotion of 2021.
  • Languishing is the neglected middle child of mental health. It’s the void between depression and flourishing — the absence of well-being. You don’t have symptoms of mental illness, but you’re not the picture of mental health. Part of the danger is that when you’re languishing, you might not notice the dulling of delight or the dwindling of drive. You don’t catch yourself slipping slowly into solitude; you’re indifferent to your indifference.
  • While finding new challenges, enjoyable experiences and meaningful work are all possible remedies to languishing, it’s hard to find flow when you can’t focus.
  • Give yourself some uninterrupted time. I don’t think there’s anything magical about Tuesday, Thursday and Friday before noon. The lesson of this simple idea is to treat uninterrupted blocks of time as treasures to guard. It clears out constant distractions and gives us the freedom to focus. We can find solace in experiences that capture our full attention.
  • Focus on a small goal. That means carving out daily time to focus on a challenge that matters to you — an interesting project, a worthwhile goal, a meaningful conversation. Sometimes it’s a small step toward rediscovering some of the energy and enthusiasm that you’ve missed during all these months.

“There’s a Name for the Blah You’re Feeling: It’s Called Languishing.” New York Times (Updated December 3, 2021).


Mental Health and Universities — More Needs to Be Done, Now.

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Mental health services for students on campuses have always been underfunded. As a former board member of the Virginia Board of Counseling  and a therapist in private practice in McLean, Virginia, this has been very apparent to me. Federal law requires universities to be more responsive and proactive. This problem has only skyrocketed during the pandemic. If universities claim to be responsible institutions they have the legal and moral responsibility to do better. Here a a few comments from a recent piece in the Washington Post:

  • College students nationwide are more stressed — with the  pandemic adding loneliness, worry about illness, economic distress, relentless uncertainty and churn to a time of life that is already challenging for many. Demand for mental health services had already been high, but a recent study of college students found increased levels of anxiety and isolation during the pandemic.
  • Last year, the Centers for Disease Control and Prevention reported that more than 10 percent of adults surveyed in June 2020 had seriously considered suicide within the past month. Two years earlier, the share stood at about 4 percent. The issue is particularly acute for young adults. Among 18-to-24-year-olds surveyed in 2020, the CDC said, about 25 percent had seriously considered suicide.
  • Campuses are a microcosm of the larger societal problem of worsening mental health during the pandemic, said Samantha Meltzer-Brody, chair of the department of psychiatry at UNC, who will be leading a university summit on mental health this month. “The needs are massive.”
  • Mental health has historically been underfunded nationally, Meltzer-Brody said, “and the data is very clear that our kids and adolescents are struggling.” That will require more money and more commitment to reach students in a variety of ways, to create connections to combat the pervasive isolation of the pandemic.
  • Schools across the country have taken steps to address the need, from Virginia State University and others adding days set aside for students to decompress, to Dartmouth College, one of hundreds of schools partnering with a suicide prevention nonprofit to study its mental health policies and plan changes.
  • Federal officials say schools are obligated under civil rights law to address the needs of students with mental health disabilities. On Wednesday, the Education Department sent educators a letter urging steps to prevent students from harming themselves. Suicide is a perennial concern on campuses. Now officials say the pandemic has cast a new spotlight on the stress and fear students endure.
  • Without doubt, students have suffered. They were shut out of campuses abruptly in March 2020. Then they endured long stretches of isolation during the last school year, whether they took remote classes from home or lived on or near campus under tight public health restrictions. And this fall is hardly back to normal.
  • The data did not show any significant uptick in suicidal ideation in fall 2020 compared to fall 2019. But it did show increases in stress, social isolation and general anxiety. “These data indicate that colleges and universities should be preparing to specifically support the mental health needs of students during COVID-19, especially in the areas of academic distress, family, eating concerns, trauma, and anxiety, among others,” the center reported in February.
  • At many colleges, the pandemic accelerated a trend toward providing counseling online. That continued even after campuses reopened. “Most of our service right now is still telehealth,” said Jennifer Hung, assistant director of counseling and psychological services for the University of California at Riverside.
  • Now, Hung said, the university is seeking to help students through a new challenge: reentry anxiety. Coming back to campus isn’t as easy as it might seem. “How do we navigate this new normal?” Hung said. Some students need help plugging back in. “We really tailor our workshops to managing stress, managing this transition.”

          “Students Mental Health and Colleges.” Washington Post (October 15, 2021).

ANXIETY AND JOURNALING — “Guided Notebooks” and the Pandemic.

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A good article appeared today in the New York Times on journaling, anxiety and the newer use of ‘guided notebooks.’ “Feeling Anxious and Journaling.”  This is a growing trend and is very important in dealing with anxiety.  Here are some highlights concerning ‘guided notebooks’ as a newer development in treating anxiety during the pandemic:

Over many centuries, journals have served as tools for recording history, as emotional outlets and as creative stimulants. In the current age of self-care and self-optimization — not to mention digital overload — logbooks are resurging, this time as a means of supporting one’s mental health.

The Anti-Anxiety Notebook, a tidy blue-and-white volume, is one example. It takes a page, or several, from cognitive-behavioral therapy, featuring work sheets that aim to challenge cognitive distortions — the thought patterns that can make anxiety worse, such as catastrophizing (assuming the most disastrous possibility will play out) or self-blaming (“believing that you are entirely responsible for a negative situation,” as the book’s appendix puts it).

The potential value of mental health care has not escaped businesses. Venture capital firms invested $852 million in mental health tools in the first quarter of 2021, an increase of 73 percent since the same period last year. –

And there’s a documented demand for such tools. “Individuals are seeking out treatment at levels we’ve never seen before,” said Dr. Vaile Wright, the senior director of health care innovation at the American Psychological Association.


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A good piece appeared in the New York Times today (Sept. 28, 2021)  discussing social anxiety and teens. This has increased as the pandemic has continued. Here are some highlights.

  • About 9 to 10 percent of young adults and adolescents in the United States have the disorder, defined as an intense fear of being watched and judged by others, according to the National Institute of Mental Health. Now many have felt their extreme self-consciousness grow more severe, psychologists say.
  • As the country continues its gradual re-emergence from lockdowns, some young people are grappling anew with the disorder’s symptoms, encountering newfound insecurities, a fear of public spaces and a reluctance to hang out with friends. The result, experts said, has been a harmful weakening of their socializing muscles, underscoring the pandemic’s potential long-lasting effects on the mental health of a generation.
  • Intertwined with these feelings, many young people say, is a pressure to enjoy their youth while knowing the pandemic and their social anxiety have prevented them from taking even the simplest steps of early adulthood, like meeting new co-workers in person, going on dates or simply having fun with friends on a night out.
  • As we start to socialize more, we’re going to probably see greater rates of social anxiety than there were before the pandemic.
  • Several studies and psychologists across the country expect the disorder to become more prevalent in the coming months, leading to greater rates of depression, which already affects about 13 percent of adults ages 18 to 25.

“Pandemic and Social Anxiety.” New York Times (Sept. 28, 2021).

Reconnecting After Covid With Grandchildren.

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I noticed a change in my relationship with my seven year old grandson after covid distancing — wearing masks and keeping away.


I tried hard to reconnect after being vaccinated but felt my efforts were falling flat.  Then I figured out how to meet him where he was and connect in a way he would welcome my interest in his new passion.


I took Pokémon tutorials, ordered online starter sets, which led to our first Pokémon battle. He won.


But now my grandson can’t wait until our next card battle. I am still a bit confused but I’m learning the game.


My suggestion – determine your grandchild’s interest and then connect.