Get it Together!

Psychological Survival

When I was in grad school, a professor started a semester with 2 questions: Would you ever have owned a slave? Would you have ever considered being a Nazi?

Of course everyone answered “no”.

Weeks later he stormed into the classroom and was clearly pissed off. He stated that someone in the class had complained that he didn’t give enough tests, so he was administering one today. Two people spoke up to tell him that was unfair and he yelled at them and sent them out of the room. He left the class after passing out the test and I started to hear giggles. I turned over the test and it said: “Behavior modification works.” On the next page, “I can make you do almost anything I want.” And on the last page, “I just proved it to you.”

When asked why we didn’t challenge him, we explained it was because we pay a lot of money for school and want to make good grades. His point was that, if we wouldn’t speak up because of money and grades, what made us think we would have stood up to slavery or the Nazis? Speaking up could have you killed, or your family.

It was a powerful message that I never forgot. It made me think of the show “Walking Dead” and the book “Lord of the Flies”. Both stories are about survival in which common everyday people become the monsters they started out fearing.

Of course, it’s hard to imagine being in situations such as that in our time. A zombie apocalypse isn’t realistic and it’s not every day we get stranded on a desert island. However, there are extremely stressful situations such as combat and natural disasters. Under extreme duress it’s easy to fall into an “anything goes” situation.

How does one maintain psychological survival in those instances? You have to direct your fears, manage your emotions, and keep your ego in check. You have to first decide TO survive. Where there’s a will, there’s a way. If you’re in the mindset that you can do it, then you will. Don’t ever accept the “fact” that it’s a useless, helpless situation.

You also have to value teamwork and accept that there might be others who are better at certain things than you. Make sure to delegate responsibilities and focus on each individual’s strengths rather than weaknesses. It’s important for us all to be aware of our core values and not to panic in stressful situations. When you are feeling overwhelmed, that’s an indication that you need to step back from the situation, assess what’s going on, remember your core values, and act accordingly.

Hope that helps!

Self Medicating

It seems to me that different people have different versions of what it means to self-medicate and when it becomes a problem. When I was younger, my dad used to come home and drink 2 straight vodkas in a highball glass, eat dinner, then watch tv, and go to bed. Every day. I never saw him as an “alcoholic.” He never beat us or slurred his words or fought with my mom or anything like the stories I’ve heard people tell about growing up with alcoholics. I think that having a glass or two of alcohol at the end of the day is not a big deal.

How can you tell if there’s a problem? I have two questions that I ask to determine the answer:

1) Does it affect your day-to-day life?
2) Is it affecting your health?

If the answer is yes, you might want to start thinking about what’s going on (or what’s gone on) in your life that’s causing you to self-medicate. I look at substance misuse as a tip-of-the-iceberg situation in that there’s usually something much bigger under the surface. It might be untreated depression or being bullied as a child or anger over a past relationship.

What do you do about it? I like to assign brainstorming activities. This involves sitting down in a calm space alone and handwriting whatever comes to mind for 30 minutes non-stop. This exercise typically reaches the sub-concious and you can learn better what it is you’re dealing with. Another technique is to make a list of the people who have hurt you most or with whom you’re the angriest. One by one, address those people and situations by either writing about them until you feel somewhat resolved or writing them a letter saying everything you want to. At the end, burn the letter or rip it to pieces. This can be a very cathartic exercise but it can also bring up a lot, so make sure to have something fun planned afterwards.

If these exercises don’t help, you might consider psychotherapy. If you do, remember us. We have 4 therapists here at BHC.

Hope this helps!

Positive Trends in the Trans Community

It’s easy to look at the state of our world/country/state/city and find what’s wrong with it. I quit watching the (bad) news because it often made me feel sad or angry. Especially in the LGBT community, it’s simple to point out the flaws in our system and see how it hurts or discriminates. While that is frustrating, for those of you who know me, know I like to keep it on the optimistic side – especially when it comes, more specifically, to the transgender community.

When someone comes to see me for the first time, often I’m the first person they’re coming out to. Even if that’s not the case, when someone’s seeking an HRT (Hormone Replacement Therapy) referral, they’re often very nervous. One of my favorite things about my job is delivering the good news to them: It’s going to be a lot easier than you think.

We have a Readiness to Transition Survey in which I read out statements and the client rates them on how much they agree or disagree. I still get goose bumps when 2 of these in particular are answered with “non-applicable”. One of these is: “I don’t get frustrated with others’ negative reactions, nor am I disturbed by their intrusive questions”. The other is: “I have made peace with those who have decided not to accept me”. More and more, people are finding they don’t have such issues during transition.

I often look at what’s on TV to measure how common or mainstream something has become. In comparing the trans thing to the gay thing, 3 years ago when I started here, I would have said we’re in the “Three’s Company” stage. For those of you too young to remember, this was a show in which one of the characters had to pretend he was gay when the landlord came around. Then the AIDS epidemic happened and everyone on the forefront of that movement went WAY back into the closet. That was in the mid 80’s. I don’t remember any other TV shows dealing with gay issues until Ellen came out with her sitcom when I was in college, then “Will and Grace” in the late 90’s or so. Now it’s everywhere.

Today, however, I would say the transgender community is in the “Will and Grace” stage where it’s about to take off. There are so many shows with positive transgender characters such as “Orange is the New Black”, “Transparent”, “Glee”, and “It’s Always Sunny in Philadelphia”, just to name a few. This is a very good indication that people are being more open and visible in dealing with trans issues – which is a good thing!

Hope this helps!

Sociopaths Among Us

They’re everywhere. You’ve worked with them, talked to them on the plane ride home, and perhaps even dated them. That’s right. I dated one for 3 years before I realized it.

A sociopath is someone who has no conscious. Much like babies and kids grow up learning the language being spoken around them, sociopaths grow up learning how to react to situations to “fit in.” For example, when a co-worker comes into the office and is crying about her 16 year old dog she just had to put down, the sociopath feels nothing. He knows, however, that he’s supposed to care so he reacts with feigned empathy.

When I say the word sociopath, it might conjure up images of Charles Manson, Ted Bundy, and Dr. Hannibal Lecter from Silence of the Lambs, and you would be accurate. Those folks are all indeed sociopaths. But you might be surprised to learn that CEO’s typically have the same psychological make-up as those infamous serial killers. (Well, Charles Manson not so much, but you know what I mean.)

How can you tell if someone’s a sociopath?

1) Sociopaths are very charming. You might find yourself waiting in anticipation to see what the person is going to do next. They are able to act as though they’re very interested in you but are usually assessing the person and situation to see what they can get out of it.

2) Grandiose stories are another tell-tale sign. Charles Manson would invent wild stories about being the modern day Jesus and leading his “family” into an underground cave where they would hide until it was time to rise up and take over the world. Sound crazy? He had a group of about 20 sane, otherwise average, people believing it for a long period of time.

3) Sociopaths are always going to want to have the last word. They’ll always win. And they’ll be unapologetic about their actions and what it took to get there. They figure that everyone’s the same as them and, therefore, it’s a fair game. They’re great at justifying bad behaviors. They typically like to “one-up” others and get agitated or angry if someone tries to prove them wrong. This makes me think of the business card scene in American Psycho. If you’ve never seen it, you can check it out on YouTube.

There are no known effective treatment methods for a sociopath. If you realize that you’re dealing with one, you have to assess the situation to adjust how to deal with it. As I mentioned earlier, being one doesn’t mean the person is violent or evil. Just be weary and move forward with caution.

Hope that helps!


A few months back, Dr. Dave told me about an article he read about anxiety. It was a very interesting theory of how we’ve evolved into the over-anxious society that we are today.

The theory goes like this: Back in the caveman days, we had to build our own shelter, hunt and forage for our food, and run from wild animals. I liken it to the Zombie Apocalypse. Under such circumstances, you would be in a constant state of survival. Your brain is constantly looking out for threats and danger. Often, your brain would find said danger and have to assess accordingly with a strategy plan.

Just last night, we were watching Walking Dead (don’t worry, no spoiler alerts) and discovered that the main characters had Post Traumatic Stress Disorder and had trouble functioning in society because of it. PTSD causes the brain to be hyper-aware of surroundings and imagine threats that are not really there. There’s a lot more to PTSD but that aspect of it is like anxiety. It’s your brain being hyper-aware of its surroundings and exaggerating the potential threats.

So now that we no longer have to build our own shelter, hunt and forage for our food, and run from wild animals, what dangers actually exist for us? Instead of your arrow missing the deer that was going to feed your family through a good part of the winter, you’re now afraid of grocery stores. Instead of running from a wild bear, you’re now afraid of public speaking.

That being said, when your brain is constantly assessing the situation and looking for danger, when it finds nothing but being afraid of crowds or feeling really uncomfortable in social settings, you’re actually safer than you’ve ever been. The brain is looking, but it’s got nothing. It creates a heightened sense of danger. So the anxiety itself is actually a really good indication that there are no real threats to you whatsoever.

Knowing that has substantially curbed my own anxiety because, when I remind myself of this theory, I feel better about the situation that’s making me anxious. When it starts to come on, I can feel relieved that the “threat” or the “danger” I’m feeling is totally created by my brain out of sheer boredom.

For more tips on what helps with anxiety, read my other blogs at You can learn all about anchoring, sitting with anxiety, and using 54321 as coping mechanisms.

Hope that helps!

The Victim/Martyr Complex

One trend I have been noticing lately is the Victim/Martyr Complex. I had known of each of these separately but was surprised to see that folks can have both. Many years ago, I had a session with a mom of a 5 year old boy with autism. I had not been trained in this realm and knew nothing of it. When he broke out in a rage, the mother began to fluctuate between wanting me to feel sorry for her and being indignant at the fact that I didn’t know what to do. “See?” She asked. “See what I have to deal with? No one seems to want to help me or know how.”

When someone suffers from a Victim Complex, it’s all about shifting the blame. They feel as though they are never in control and the world happens TO them. If this person is late to work, it’s because of traffic. If s/he gets into arguments frequently, it’s because the other people in her/his life are mean and unmanageable. Nothing is ever the victim’s fault and the world tends to mercilessly beat them up.

A Martyr is someone who chooses to be in situations of extreme suffering and/or persecution. S/he tends to take on these situations and then want attention, acknowledgement, and sympathy from others for doing so. Having this type of recognition provides feelings of worth and meaning.

How do you know if you are dealing with someone with a Victim/Martyr mentality? Ask yourself the following questions: Is the suffering something that could be avoided? Is the person in an abusive relationship (or several abusive relationships)? Does the person typically complain about others not noticing or appreciating the sacrifices he/she makes? Do they have an exaggerated idea of their importance and how nothing and no one can function without them? Is their goal co-dependency?

If you are dealing with someone who suffers from this (a mother-in-law, a boss, a partner, etc…), what do you do? Manage expectations, don’t take it personally, and understand that the person most likely does not see what’s going on and, therefore, doesn’t want “help”. Depending on how well you know the person, you might gently suggest therapy. If you do not know her/him well, you will want to disengage helps in potential arguments and manage your feelings and thoughts about the situation.

Hope this helps!


Highly Sensitive People

A while back I reached out to see what mental health topics people would like to read and got an overwhelming response for “highly sensitive people” (or HSP). I have to admit, I didn’t know much about this topic so I had to do some research. I learned that I meet many of the determining factors to consider myself to be highly sensitive. So what does it mean?

Well, for starters, HSP make great friends because they’re compassionate, empathetic, and hyper-vigilant in regards to others’ feelings. They demonstrate superb manners, going out of their way to make sure they’re not inconveniencing anyone. They feel things more deeply than others and have a true appreciation for music and art. They are also really good at being able to comfort others and notice when and where this is needed.

However, HSP are sometimes misunderstood and feel uncomfortable in social situations. It is common to be overwhelmed by intense stimuli such as loud music, lots of people, bright lights, and high activity. This could be a concert, bar, farmer’s market, or sporting event. They often get told not to take things so seriously or personally. HSP are often perfectionists and, therefore, take a long time to make a decision and then beat themselves up over having made the wrong decision. They might be seen as “overly emotional” because they cry more and can have intense reactions to criticism.

Here are some tips on how to cope with some of these aspects:

1. Know your triggers and plan accordingly. If crowds bother you, consider going to events at the beginning or end when there aren’t as many people around. For loud noises, try some earplugs or listening to some soothing music. Smartphones now have apps that provide sleep-friendly noises such as rain, white noise, or storm.

2. Manage emotions. Rate your fear on a scale of 1-10 to see how realistic it is. (1 is “I got nothing” and 10 is “I can take it into court and win the trial with it”.) This trains our brains to think more rationally so we can put things into perspective. Walk yourself through the worst case scenario (knowing that 9 out of 10 times that never plays out) and develop a plan on what you would do if that transpired.

3. Become very familiar with calming techniques. Try a meditation in which you envision yourself in a canoe on a beautiful river. When a worrying thought comes, place it on a leaf coming toward you in the river. Pick it up, read the worry, then put it back in the water and watch it float away. Try a 54321 (written about in a previous blog) or “alphabets on the leg”, in which you write out the alphabet on your knee with your finger. The key is distraction. You want to get your mind off what’s worrying you and put it on something more constructive.

Hope this helps!

If You Really Want It, Why Aren’t You Doing It?

I hear it all the time: “I know what I want to do, and I know how to do it…So why am I not just doing it already?” When you find you are procrastinating, feeling stuck, or avoiding making those changes you need to get what you want, here are some tips about what might actually be going on and how to turn it around.

FEAR OF FAILURE: Plain and simple, a lot of us don’t want to set a goal because we don’t want to fail. Losing weight, for example, is a common goal in therapy. We all know that losing weight requires a change in our diet and exercise.
To eat healthy, a lot of people go on a “diet”. That’s like putting a band-aid on a major wound. I suggest learning more about eating healthy, following suit, and considering it your “lifestyle” (permanent, or long-term) instead of a “diet” (temporary, or short-term).

A lot of us fail at exercise because we start our goals too high and then get disappointed when we don’t meet them or we do exercises we don’t like and lose our motivation. All too often we start out saying we’ll go to the gym 5 days a week. If you weren’t exercising at all before this, that’s an unrealistic goal. Start out at two times a week and see how that goes and build up from there. Make sure exercise is something you enjoy (playing volleyball, riding a bike, going for a walk, etc.). Add an exercise partner to increase motivation and accountability.

FEAR OF SUCCESS: This might sound crazy to you at first, but think about it. With success comes a lot of responsibility. Getting that promotion is going to create more work. Having a relationship demands compromises. Any success you can obtain is going to be work. And most of us want to find the easy button when it comes to responsibilities.

What you can do to overcome this obstacle is change the way you’re looking at the success. Instead of viewing it as creating more work, look at it as an opportunity to grow and become stronger. Enjoy the process and envision the end result.

FEAR OF CHANGE: The two most stressful changes a person can experience in a lifetime are marriage and having children. Most of the time (I would hope) folks are making these changes willingly. And still it’s stressful. Being successful in making big life changes takes planning.

Once you have a plan put together, you can make lists with deadlines and schedule the things you need to do in your calendar. Break tasks up so you don’t look at a list of 100 things to do and get overwhelmed. A little organization is all you need to feel more confident about the changes you want to make.

In addition to organization, you need the HOPE and the BELIEF that you can make the change. Correct yourself every time you hear yourself saying “I can’t” or giving excuses as to why it won’t happen. You have to think positive and convince yourself that you can, and will, do it.

Change Your Attitude, Change Your Life

Your “reality” is really nothing more than what you notice about it and what you choose to focus on. Think about it.

Yeah, it’s July in Orlando and there will most likely be a thunderstorm with pouring down rain right as you’re leaving for work. And, yes, you left your umbrella at home. Again. And all that rain isn’t really helping that leak in your roof.

There IS all that.

But what about the upcoming beach trip you have planned with friends at the end of the month? What about that really nice compliment you got from your co-worker this morning?

Your attitude consists of which you focus on more – the negative or the positive. If you notice more of the negative, then your attitude will be negative. And if that’s the case, I can guarantee it’s impacting your life in a negative way.

But, then, we’re not trained to have a positive attitude. No one really teaches us that. So how do you make your attitude more positive?

1) Manage your self-talk. If you catch yourself saying something along the lines of: “That was a really stupid decision” or “I am so fat”– stop doing that. Ask yourself: “Would I have said that to the guy behind me at the checkout line?” If the answer is NO, you shouldn’t be saying it to yourself. (And, think about it, why are you treating the guy behind you in the checkout line better than you’re treating yourself?)

2) Every day, take time to list the things and people for which you are grateful. List at least 10 things before you get out of bed in the morning and 10 things before you go to sleep every night.

3) Don’t let one bad thing ruin your day. For example, if you wake up late, come up with a plan to let people know how late you’ll be and make appropriate arrangements. Don’t let it be the beginning of a series of events that cause you to spiral out of control.

4) When you come across someone or something you don’t like, challenge yourself. Maybe that annoying co-worker is an animal lover like you. Maybe that stupid meeting will be an opportunity to learn something new. It’s all in your perspective.

Once your attitude changes, you’ll see that a lot of other things start to change for the better, too. Instead of seeing the universe as conspiring against you, try imagining it conspiring for you – to give you what you want and need to be happy and to be the very best you can imagine. And, like magic, that’s essentially what starts to happen.

Transgender Awareness

Just over 2 years ago, I got my dream job working at BHC Assessment and Consulting. I added to my repertoire a specialization in transgender issues and, since then, have become somewhat of an expert. I assist clients with coming out to family, friends, work, and school. I can easily recite to you the doctors here in Orlando who provide HRT (Hormone Replacement Therapy) to transgender clients, have been to each of their offices, and have their fax numbers practically memorized. I am more than prepared to assist clients with any aspect of transition.

We, as a whole, take great pride in serving this community with professionalism and integrity. That’s why it totally took me by surprise when I first learned that there are other professionals in the mental health field who have learned enough about the transgender community and their needs to take advantage of them.

When a transition becomes a medical necessity, the client will need a therapist to write referrals for various procedures. Unfortunately, I’ve heard of therapists who charge exorbitant fees for these referrals, and may even require a certain amount of sessions before they will give it consideration.
I was astounded to learn that therapists, of all people, would take advantage of a client in a time of need. I was even more taken aback to realize that, while this is unethical, it is totally legal. To the best of my knowledge, there are no boards or associations to report this behavior.

My purpose here is to make sure that readers are educated and informed before seeking referrals and therapy. Therapists are required, by law, to follow the WPATH (World Professional Association of Transgender Health) Standards of Care, Version 7.

The criteria to begin HRT, as defined by WPATH, are: “1) persistent, well-documented gender dysphoria, 2) capacity to make a fully informed decision and to give consent for treatment, 3) age of majority in a given country (age 18 for the U.S.), and 4) if significant medical or mental concerns are present, they must be reasonably well controlled.”

The criteria for mastectomy and creation of a male chest for female-to-male clients, or breast augmentation for male-to-female clients is the same.

For gender confirming surgery, the criteria are also the same, with the addition of “12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless hormones are not clinically indicated for the goal), and 12 continuous months of living in a gender role that is congruent with their gender identity”.

Any other criterion a client has to meet is up to the discretion of the therapist.

If you, or someone you love, is ready to transition – know your/their rights and be familiar with the WPATH Standards of Care, Version 7. We provide therapy sessions via skype and don’t make people jump through hoops to get referrals, as long as they are ready. If someone is not ready, we help that person come up with a plan. Our services are affordable and our knowledge is invaluable.