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Licensed Psychologist

Two Powerful Techniques to Lower Anxiety

Originally published at Psychology Today Anxiety is miserable. And most people reach for a pill or push it away to reduce it. But if we think of anxiety as a signal or as the tip of an iceberg, we can take steps to more permanently ease it. Anxiety tells us deep biological programs called core emotions have been triggered out of conscious awareness. These core emotions are designed by evolution to be felt and expressed. When we push them away, we feel anxiety. Learning about core emotions and how they work in the mind and body is the most important thing we can do to change anxiety. Tools like the Change Triangle guide us to name our core emotions. Emotional conflicts can be more effectively dealt with when we can identify and work with the underlying divergent emotional experiences. What follows is an explanation of two techniques I teach my psychotherapy clients and participants in the Emotions Education 101 class I teach:

Technique #1: Identify both sides of your conflict and speak them in your mind with an "and" instead of a "but." For examples:

I love you AND right now I’m so angry at you that I feel like I hate you. I feel sad AND happy. I am depressed and I know I am lucky in many ways. I am lonely AND I prefer to be alone. Summary: Name and validate when you have anxiety, look for any underlying conflicts, validate each side of the conflict with an "and" instead of a "but." Notice how that feels. Click here to read the full article

Growing a Healthy and Loving Relationship

Re-posted from an article by Jeannie Ingram, LPC-MHSP Valentine's Day just passed and love is in the air. Not for everyone, unfortunately. As a therapist, I'm often needed when love is no longer in the air. A heart has been broken, and love has turned cruel. Or the pain of loneliness has become unbearable. Only occasionally do people seek therapy when love is blooming like the daffodils. But take heart. Like the words in so many songs, love is indeed the answer; it always has been, and always will be. It's the question that needs examining, that question being, "who do you love"?

Love Yourself First

People often give their love to another before they've ever truly explored what it means to love themselves, and this can be a setup for problems in the relationship. Why? Because until you truly deem yourself worthy of love, you may sabotage the love of another, finding it difficult to trust. It's like building a mansion on quicksand. It may be beautiful at first, but after a short time, it will likely disappear. To experience a sustained, loving relationship with another, you must have a sustained, loving relationship with yourself to receive love with an open and undefended heart. I am not talking about narcissism, which is an ego-inflated sense of self-importance. I'm referring to a healthy and loving understanding of self and truly knowing that your value is at least that of others. All of us have equal value. Believe it or not, many people struggle with this. For some, it's due to leftover childhood shame or negative messages that program us into thinking something is wrong with us or that we're not worthy of love. Again, if we didn't get it as children, it's hard to trust when it tries to come into our adult life.

Love is a Verb

Love is about action. Love is about caring behaviors. Many people believe love is a feeling, and it certainly can be. Still, that feeling is ultimately the result of how we demonstrate our love in both giving and receiving. To expect the feeling of love without actively nurturing it through everyday actions is like expecting fruit from a non-existent tree. If we want to grow the fruit of love, we must first take the action steps of planting and nurturing the tree. Then we can expect the fruit or the feeling of love to blossom.

Tips to Grow the Love Tree

  • Find ways to express your love, and don't be confused by advertising messages. 
  • Spending money to show your love is unnecessary. 
  • Showing love through your language, thoughtful, caring behaviors, and realistic expectations. 
  • Replacing demands with requests and appreciations allow the flow of love.
  • Refrain from language that criticizes, condemns, disparages, and shames. It will create misery, not love. Instead, reframe into expressions of desire, encouragement, and gratitude.
  • Try seeing mistakes as opportunities for redemption and forgiveness rather than punishment.
  • Try seeing yourself as a human being who, like everyone else, is searching and worthy. 
  • Practice random acts of kindness toward yourself, as well as toward strangers.
This is the way we should all be treated, and no one, not even you — should be an exception. Because, like being in love, it sets you up for inner peace, success, and joy in life. Who doesn't want that?  When you have love and peace toward yourself, you're much more likely to attract and maintain genuine love with another person. So this Valentine's Day, may I suggest that you give yourself the gift of loveBegin by looking in the mirror and seeing the person who most deserves it. And love that person with your whole heart and your actions. Love is, after all, the answer.

Managing Loneliness During the Holidays and beyond

Originally posted at Beacon Lens The holidays are upon us, and the irony they bring is the potential for isolation and loneliness. Holidays’ essential identity is getting together with loved ones, but some people do not feel as connected as they would like or expect. In 2020, add COVID-19 and its quarantining dictates, and the potential for such feelings can strengthen. The holidays, therefore, present an excellent time to discuss how we can reinforce connections during a time that requires us to be apart to protect our physical health, a requirement that paradoxically can have a damaging effect on our mental health. We can, however, take charge of improving our mental health.

Loneliness and isolation and our health

What is the difference between loneliness and isolation? “Loneliness is the feeling of being alone, regardless of the amount of social contact,” according to the Centers for Disease Control and Prevention (CDC). Social isolation, on the other hand, is a lack of social connections. Put differently, one can have many social connections but still feel lonely. The physical and mental health risks of loneliness and isolation are significant. They include but are not limited to:
  • Social isolation increases the risk of premature death by 29 percent, rivalling smoking, obesity and physical inactivity.
  • Social isolation is associated with increasing the risk for dementia by approximately 50 percent.
  • Loneliness is connected to higher rates of depression, anxiety and suicide.
A 2020 report by the National Academies of Science, Engineering and Medicine (NASEM) states that more than one-third of adults 45 and older feel lonely, and approximately one-fourth 65 and older are socially isolated. Add the holidays and COVID-19 to an already preexisting condition, and the time is ripe for all of us to take action to protect our mental health.

Simple steps for better mental health during the holidays

Specific to the season and the times, there are common-sense tips that we all can practice to help manage loneliness. For example:
  • Talk to someone about your sense of loneliness and isolation. There’s stigma around loneliness so it can be hard to do. However, you may well find that you’re not alone in those feelings, and sharing them can help lessen their effect.
  • Manage your holiday/COVID-19 expectations. The holidays can fall short of expectations, but this year it may be worse. Understand that the pandemic won’t last forever, and that we’re all in this together. Indeed, many people’s holiday gatherings will likely be different this year.
  • Remember to take care of yourself, now more than ever. Sleep, exercise and good nutrition — with the proper amount of holiday indulgence — go a long way in addressing mental health.
  • Avoid social media, such as Facebook or Instagram, especially during the holidays. It’s easy to negatively compare one’s life to the “perfect” lives posted on social media, forgetting that people mostly post only the positive.

Loneliness and isolation as its own pandemic

The holidays don’t last forever, and we will get through the COVID-19 pandemic. However, loneliness and social isolation may persist, which presents a challenge for behavioral health providers. The recent NASEM report explores interventions that the healthcare system can take to address loneliness as a societal condition, such as engagement in support groups, cognitive behavioral therapy and mindfulness, social determinants of health, social prescribing and more. Social prescribing is arguably one of the more interesting interventions in that it puts a clinical lens on non-clinical solutions. While there is no hard-fast definition of social prescribing, it is generally accepted as a way to connect people to non-clinical sources of support, according to the NASEM. Specifically, it is a “non-medical referral, or linking service, to help people identify their social needs and develop wellbeing action plans to promote, establish or reestablish integration and support in their communities, with the aim of improving personal wellbeing.” Examples of secondary services that improve social concerns affecting health include housing and food insecurity services. While known to varying community-based organizations, social prescribing is not common among practitioners, but it’s a common-sense solution. An analysis of one pilot program from the NASEM report — albeit a small one — found that social prescribing reduced inpatient admissions by as much as 21 percent and emergency room visits by 20 percent. A modern world — without COVID-19 — is more connected than ever due to social media and other technology. However, studies have shown we are more lonely now than in any other time in recent history. It’s time to think out of the box as we realize more and more how non-physiological conditions — such as issues ranging from a public health emergency to social media — can affect our health.

What Do Women Want

Originally written by Deborah Fox, MSW What do women want?" is an age-old question that rolls off the tongue of many men with alarming regularity. The nods of other men confirm the mystery. Women will be happy to tell you if you ask. And men have. What keeps the mystery going is that the answers are so different from how men think and operate that they're too often tossed out simply because the answers don't seem to make sense. Knowing what makes women tick is discoverable, but you need to suspend your beliefs about what you think she wants and be prepared to be impacted.

A woman wants to be understood for who she is, how she thinks, what's important to her, how she feels, and why she feels what she feels.

Tip #1 - Listening

Understanding can't happen without listening, really listening means being fully attentive. It means putting aside your frame of reference. It means checking your assumptions at the door. It means not interrupting. It means saying, "Help me understand why you felt dismissed?" If you ask, "Do you think you could've done...?," she'll feel abandoned. She'll let you know if she wants your help to problem-solve. Shaking your head, glancing at your phone, looking away lets her know that you're not listening to what she has to say. She gets the message you're judging her, disagreeing with her, and just waiting until she's done talking so you can tell her so. You may think you're not helpful by just listening because this isn't what men want or do. Women tend to find their way to a solution by sharing their stories. And she will ask for help if she trusts you to help her brainstorm and not take over by telling her what she should do. When my six-year-old daughter recounted the playground drama of the day at dinner one night, my husband asked her if she wanted to call her friend Susie to say something about what had transpired that day. My daughter and I looked at him as if he'd suddenly grown three horns. She and I understood that what she wanted was simply to share the story and be heard. The woman in your life needs you to tune into her emotions, not merely the facts of a situation. Men tend to be very uncomfortable when their partner is distressed. They feel their job is to make their partner feel better, so they rush into righting the wrong. This skips over what women need most, which is for their feelings to be acknowledged and understood. Period. It's highly unlikely that you woke up that morning and said to yourself, "Hmm . . .how can I hurt Stacy today?" Of course not. But you did, unintentionally, by not listening.

Tip #2 - Trustworthiness

A woman wants you to be trustworthy. Say what you mean. Mean what you say. Do what you say you're going to do. She needs to feel secure with you. Be a safe person for her to be vulnerable. Don't judge or placate. She wants you to have her back. Stand up for her if there's a potential for her to be embarrassed. Be protective. A woman steps out into the world with an eye out for danger and lives with a heightened degree of vulnerability that is her "normal."

Tip #3 - Sexuality

Women do want to be desired sexually by their chosen partner. This can be a complicated one for men. You might be understandably confused about how to find a balance between being considerate and being passionate. It can be confusing when you hear women want a sensitive man and capable of talking about his feelings. It's not such a leap for you to assume this means she wants a gentle lover---and this might be true. Women can seem to be a walking contradiction because this same woman may want to be ravished or desired passionately by her partner. The answer to this mystery is good communication. Talking about sex is uncomfortable for many people, but the alternative is literally and figuratively groping in the dark. In Dr. Emily Nagoski's book, Come As You Are, she writes that stress, mood, fatigue, trust, and body image are central to the sexuality of a majority of women, not just peripheral factors. For these women, understanding that openness to sex is context-dependent and that everyday life affects that context is vital. The source of sexual desire is often relational for women. They don't tend to be frequently struck with desire walking down the street on a given day. However, a shared activity, a conversation, flirtatious banter, an affectionate note are door openers for her to feel desire. You might have to enlarge your definition of what it means to be a good lover. Men tend to make assumptions about what is satisfying to a woman, which she often finds oppressive. Again, ask her.

Tip #4 - Being Your Priority

She needs to feel she's a priority to you. Let her know she matters to you. When you have some good news, please share it with her first. When you have a problem, go to her first. Ask her what makes her feel loved. You may think that doing household chores shows your love, but perhaps what makes her feel loved is spending quality time with you or hearing what you appreciate about her. If she's distressed, assume it's something for the two of you to resolve together. Put your relationship at the top of your "to-do" list, not something you attend to after...everything else. We learn what we observe in our families as children and adopt tons of mythology from our peers and the media. With the growth in understanding of yourself and your partner, your relationship can become secure and satisfying.

What should you expect from Couples Therapy?

Tip #1 - Better Communication.

You should learn new skills to help you communicate more effectively and navigate the relationship road's inevitable bumps. In Imago, we use the "Intentional Dialogue" as our primary tool. This method has been used and refined for over 25 years, and has been the standard by which many other approaches have followed. You will learn to listen deeply to your partner and manage your reactivity in ways that allow both of you to feel safe, heard, and understood. This is an essential skill that leads to relationship success.

Tip #2 - Truly Understand the Core Issues

You should gain an understanding of your "core issues."  In my experience, every relationship has just 2 or 3 core issues that come up over and over again. These issues can turn what is essentially a great relationship into a nightmare! When these issues get triggered, we can become so hurt and angry that we forget all of what is good in the relationship. Some common issues include:
  • Feeling criticized
  • Feeling under-appreciated
  • Feeling disconnected to our partner
  • Feeling smothered by our partner
  • Feeling controlled by our partner
  • Losing our sense of independence or sense of "Self" and so on.
Couples therapy will help you identify what the core issues are that are operating in your relationship. It will also help you understand why those issues are there and how you can not only end the pain but also get your needs met in ways that you may have never experienced before in your life!

Tip #3 - Relationship Growth.

You should learn how to grow in your relationship. We believe that relationship is both our greatest source of satisfaction and our greatest source of challenge. Intimate relationships often force us out of our comfort zone. They require us to see the world through our partner's eyes and to "stretch" into parts of ourselves that may be undeveloped. For example, if your partner is the more "emotional" one in the relationship, they may be calling you to stretch into awareness of your own feelings and emotions. If your partner is the more logical/rational one in the relationship, you may be called on to learn to contain your emotional reactions and to develop your rational side further. When we stretch to meet our partner's needs, we "grow ourselves up." But first, we have to…

Tip #4 - Learn to be a more generous, loving, and giving partner.

Marriage or couples counseling is not just about solving problems or resolving conflict. It will also help you enhance the positives deepening your connection, and your ability to give and receive love more fully. We can all learn to be more loving, generous, patient, accepting, and so on. I hope these four tips help you and your partner get more connected and grow your relationship.  Every couple is different, and effective therapy will address your particular needs as a couple. It is more flexible now than ever with online therapy for couples as well. I am hopeful these general principles that I have found to apply for most couples and most couples therapy are helpful.

10 Ways to Take Better Care of Yourself This Winter

Winter can be a difficult time.  Here are some ways that you can care for yourself:

Self-care is always important

Self-care includes all the things we do to maintain or improve our wellbeing. We all know how important basic self-care activities such as adequate sleep, exercise, healthy eating, hobbies, and spending time with friends are. And we know that when we don’t prioritize self-care, we feel lousy. Our health suffers. We get sick. We’re irritable, lonely, sluggish, and unfulfilled.

Self-care for the winter

As the seasons change, we often need to change our self-care routines to accommodate the weather, amount of daylight, our schedule, and so forth. The winter months can be particularly tough on us both physically and mentally. We’re more prone to colds and flu. some of us suffer from seasonal depression (the winter blues or Seasonal Affective Disorder (SAD) because of the lack of sunlight. And it’s hard to get out and be active. So, we need some self-care activities to meet the specific needs we have in the darker, colder months. Below, you’ll find 10 of my favorite self-care activities that are well-suited to winter.

1. Write in a Journal

It’s the beginning of a new year and a perfect time to start writing in a journal. Journaling is great for your mental health. It provides a place to dump your feelings, process and reflect, and clear your head. Even if you’ve already got a journal, you may want to consider starting a new one. I hear from many avid journalers that there’s something uplifting about the fresh, clean-start feeling of a new journal.

2. Enjoy Nature’s Beauty

Yes, winter can be cold and dreary. But it can also be beautiful – fresh snow on the trees, icicles hanging from the roof, red cardinals at your birdfeeder, a full moon. When we’re mindful and take the time to look, there’s a lot to take pleasure in.

3. Go to Therapy

Have you been thinking about starting therapy? It can be daunting to find a therapist you feel comfortable with, get yourself there consistently, and pay for it – but most people find the results are well worth the effort. And since we’re already inside so much during the winter, it seems like a good time to start or resume therapy. And if the weather or transportation are significant barriers, there are more and more options for online therapy, as well.

4. Get More (Sun)Light

Exposure to light (sunlight or artificial light) improves your mood and energy. So, if you’re living in the Northern Hemisphere during the winter, you’ll probably feel better if you spend an extra 20-30 minutes outside when it’s sunny. Even opening the curtains and turning on the lights in your office or home can help.

5. Relax and Get Cozy

On a cold winter’s day, there’s nothing better than staying home in your pajamas, cuddling up with a good book (or your significant other or your cat!), sitting in front of a fire, or binge-watching your favorite show. Occasionally, give yourself permission to stay home and just relax.

6. Connect with Friends

We all need to socialize, connect with others, and feel like we belong. And yet, spending quality time with friends or your spouse may end up at the bottom of your to-do list. How about meeting this self-care need by planning a game night, potluck dinner, or hosting a party to watch the Oscars with your friends? Not only is spending time with friends good for our mood, doing so may encourage us to relax, laugh, do something active, or try something new. And again, if it’s hard to get out and do things in person, have a virtual coffee date on FaceTime or Skype, or schedule a time for an old-fashioned phone call.

7. Enjoy a Hot Drink

A hot drink on a cold day is so comforting – a true simple pleasure. I’m a big coffee drinker, but I can easily overdo it. So, I try to mix things up with a collection of herbal teas and homemade sugar-free hot cocoa (just warm milk and a little cocoa powder and your favorite sweetener).  Maximize this self-care practice by slowing down. Instead of gulping it down in the car, take a few minutes to sit and relax and savor your drink. This is a quick, easy, and inexpensive way to pamper yourself.

8. Get a Flu Shot

Getting a flu shot isn’t necessarily enjoyable, but that’s true of a lot of self-care. It’s something you do for your health. And it’s not too late in the season to get one. So, speak to your doctor or pharmacist about whether a flu shot is a good choice for you.

9. Exercise

Many of us need to change our exercise routine or physical activities to accommodate winter weather. If you don’t have a regular exercise plan for the winter months, consider adding some winter sports (skiing, ice skating, snowshoeing, winter hiking) to your routine. Alternatively, there are lots of indoor exercise options such as yoga or dance classes, exercise equipment at a gym or home, or using exercise videos on YouTube or television. Don’t let winter weather be an excuse – you know you’ll feel better if you get a little movement into every day.

10. Encourage Your Creative Side

If you’re stuck inside, tap into your creativity. Did you know that arts and crafts are good for your mental health? Benefits such as reduced stress, depression, and anxiety, a sense of accomplishment, increased confidence and self-esteem have been reported. Crafts are nice because they can be done alone or in a group. And there’s something for everyone – everything from painting, scrapbooking, knitting, quilting, woodworking, jewelry making, and more. Pull out an old favorite or try something new this winter!

Put self-care on your calendar

Now that you’ve got a few ideas for your winter self-care, it’s time to put it on your calendar. Self-care (like most things) is much more likely to happen if you create a plan for when and what you will do to take care of yourself. Where will you begin? Perhaps, just add one new self-care activity to your schedule this week.

How Do I Know If I Need Therapy?

Originally Published by the American Psychological Association Most of us face struggles at some point in our lives. These struggles may include stress at work, difficulty with a romantic partner, or problems with a family member. Alternatively, struggles may include emotional symptoms such as depression or anxiety, behavioral problems such as having difficulty throwing useless items away or drinking alcohol too often, and cognitive symptoms such as repetitive upsetting thoughts or uncontrolled worry. Sometimes, life's struggles can be eased by taking better care of yourself and perhaps talking about the issues with a supportive friend or family member. But there may be times when these steps don't resolve the issue. When this happens, it makes sense to consider seeking the help of a qualified licensed psychologist. How do you know if therapy is needed? Two general guidelines can be helpful when considering whether you or someone you love could benefit from therapy. First, is the problem distressing? And second, is it interfering with some aspect of life? When thinking about distress, here are some issues to consider:
  • Do you or someone close to you spend some amount of time every week thinking about the problem?
  • Is the problem embarrassing, to the point that you want to hide from others?
  • Over the past few months, has the problem reduced your quality of life?
When thinking about interference, some other issues may deserve consideration:
  • Does the problem take up considerable time (e.g., more than an hour per day)?
  • Have you curtailed your work or educational ambitions because of the problem?
  • Are you re-arranging your lifestyle to accommodate the problem?
A ‘yes’ response to any of these questions suggests that you might wish to consider seeking professional help. Remember that sometimes a problem might be less upsetting to you than it is to the people around you. This does not automatically mean that you are in the know and your friends or family are over-reacting to you. Rather, this situation suggests that you may wish to think about why the people who care about you are upset. Clearly, the decision to enter into therapy is a very personal one. Numerous advances have been made in the treatment of psychological disorders in the past decade and many therapies have been shown scientifically to be helpful. As you think about whether therapy might be helpful to you, remember that many psychological problems have been shown to be treatable using short-term therapy approaches. Learning more about different approaches to therapy might also help you to discern if one of them sounds like a good fit with your personality and approach to life. Given the range of therapeutic options that are available, you don‘t need to continue to struggle with a problem that is upsetting and/or getting in the way of other parts of your life. Help is available.

Containment in Relationships

While the vicissitudes of ordinary discourse in relationships may be easy for many of us, this is by no means the case for everyone. What can we make of the times when words are not treated as simply the best tools we’ve come up with for communicating our private experiences to others, but instead serve as triggers in relationships- triggers that can lead one to feel quite threatened or to feel the need to marshal whatever defenses may be available in one’s arsenal? What can we do when seemingly ordinary attempts at communication lead to feelings of humiliation, woundedness, or unbidden vulnerability? Unfortunate circumstances such as a history of trauma in relationships, bullying, or chronic humiliation are only a few of the things that can lead a person to feel a sense of danger about making contact with another person’s point of view. Rather than experiencing another’s perspective as food for thought, an opportunity for meaningful reflection or increased intimacy, or helpful feedback about one’s interaction with the external world- those of us wounded by past traumas may at times experience others’ ideas as weapons of destruction that can lead to painful and concrete outcomes such as disruptions in the ability to think, the visceral experience of being slapped in the face, a rush of adrenaline or “out of control” emotion, or even physiological distress/illness. And since meaningful relationships typically require a level of communication that involves a regular open exchange between oneself and others, relationships can be a minefield for those who experience the other person’s mind as a potential source of danger and distress. This is, of course, not only difficult for the one who feels so raw to the other’s impact, but is also difficult for the partner or loved one in relationship with such a person. It is certainly not easy to speak freely of one’s impressions, needs, or observations- only to have this easy conversational flow be treated as an act of aggression or a threat. It is also not easy to be on the receiving end of defenses such as rage, counter-attack, or distance and withdrawal. And so, the fate of a conversation between two partners very much depends on each person’s ability (not just willingness!) to hear and take in the other’s communications without feeling unduly threatened, as well as each partner’s ability to accommodate to the other’s capacities (or lack of capacity) to do the same. One partner may need to learn how to tone down a sense of reactivity to the other’s communications; the other may need to figure out how to speak in a way that will expand his loved one’s tenuous ability to hear and to be aware. Whether it’s feedback about oneself that is felt to be painful; awareness of the other’s needs, separateness, or vulnerability; or even perhaps just the unknown of what we may come to feel, know, or remember when talking with another, finding ways to help the people we love most be able to stretch their capacities to listen and to know, is often a task left to the one who is perhaps a little less wounded- or vulnerable- in the moment. (And of course the one who finds himself positioned in the more vulnerable position can shift from one minute to the next!) So, how do we take some of the sting out of talking, thinking, and listening? One of my favorite techniques is the simple one of “asking permission”. By the simple act of asking another’s permission before we offer our thoughts, we avoid catching the person off-guard; we give the other a sense of healthy control; and we create a sense of receptivity which can open up space for our words can to enter willingly and gently, rather than by force. We can also communicate in ways that allow the other to “save face”, whether it’s during a shared parallel activity (like cooking together in the kitchen) or while sitting side by side (in the car, for example), easing the pressure often demanded by direct face to face communication. We might use metaphor, stories about our own selves, or open-ended comments that reduce the sense of threat that the other may experience from a more direct communication. Perhaps the best gift we can give another is to simply hold stuff inside ourselves until the other is truly ready for us to share it. Processing and containing our own thoughts, feelings, and perspective until the time seems right to “put it out there”, can give those we love the much needed space they may need in order to heal from past assaults and impingements to their own sense of self and integrity of being…allowing them slowly to trust that inviting in another may actually be a rewarding experience rather than a threatening one. Is this a gift you can give to those who need it most? Originally posted on Goldstein Therapy- Clifton, NJ

Choosing a Therapist: Psychiatrist or Psychologist

The term "psychologist" and "psychiatrist" are often used interchangeably to describe a person who conducts psychotherapy. In fact,these two professions are not interchangeable. There are significant differences between these professional roles. Examining the educational background required for each profession can be helpful in understanding their differences. Psychiatrists go to medical school like other physicians. After three or four years they receive their M.D. degree. They spend the next four years in a residency which generally includes inpatient and outpatient rotations in general medicine, family medicine, pediatrics, neurology, and psychiatry. This residency does not usually include specific training in psychology and psychotherapy. After they complete their residency and pass the state board exam, these physicians can obtain a license to practice. As physicians, they are able to prescribe medicine and admit patients to hospitals. Clinical Psychologists typically spend five to seven years receiving graduate training in psychology in order to obtain a doctoral degree, (most commonly a Ph.D. but may be a Psy.D. or an Ed.D.), in clinical or counseling psychology. Psychology is the study of people: how they think, act, react, and interact. All course work is related to understanding every aspect of human behavior and the thoughts, feelings, and motivation underlying this behavior. Two years of supervised clinical experience follow receipt of the doctorate degree when candidates are trained to diagnose, perform psychotherapy, and help people understand themselves and address their emotional issues. Following these two years of clinical experience, they may take the state licensing exam. Only after they have met the above requirements and passed the state licensing exam are they able to practice clinical psychology and call themselves a "psychologist." Some psychologists and psychiatrists go on to receive further specialized training after attaining their Ph.D. or M.D. Degrees. Advanced programs in child, adolescent, family, marriage and couples therapy, group psychotherapy, psychoanalytic psychotherapy, and behavioral and cognitive therapy may require at least one to three years of additional coursework and supervision. A clinician who has obtained one or more Certificates in advanced training programs is among the most highly trained mental health professionals. Psychotherapy is conducted with individuals, groups, couples, and families. Psychotherapists help people to overcome stress, emotional problems, relationship problems, and troublesome habits. Psychologists treat people by providing psychotherapy focused on helping people understand the root of their problems and what they can do to change destructive behaviors, grow emotionally, and enhance their lives. Most psychiatrists in private practice focus on symptom relief using medicine to correct chemical imbalances that affect their clients. Most psychologists do not prescribe medicine. However, some psychologists who have taken advanced training in psychopharmacology can prescribe medicine as a part of their psychotherapy treatment.
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