Question: IS it possible to increase the quality of the sleep I get rather than increase the quantity? If I have x hours to sleep and x hours aren’t really enough I want to make sure that I get as much sleepy goodness juju as possible out of those x house. My bedroom is already dark.

Cynthia Klatte Says...:

Dear Anonymous,

Sleep difficulty is both a common and a complex problem. And sleep quality has been extensively studied and they have identified many things that can interfere with sleep quality and several interventions you can undertake to improve your sleep. And it does appear that you can get better sleep quality without necessarily increasing quantity, to a certain degree.

Sleep quality can be broken down into a few dimensions: sleep latency (how long it takes to fall asleep), sleep duration (total time asleep), sleep efficiency (sleep duration as a percentage of total time in bed), sleep disturbance (number of arousals), and daytime dysfunction (daytime sleepiness and impaired cognitive performance).

Sleep can be broken down into stages. Two main stages are non-REM sleep and REM (Rapid Eye Movement) sleep. Non-REM sleep can further be divided into Light Sleep and Deep Sleep. REM sleep is the stage where dreaming occurs. For good quality of sleep, what is important is the depth of sleep or time spent in each stage of sleep. Deep sleep is a time when the body repairs itself and builds up energy for the next day. It is a time where muscles and tissues are repaired and your body's natural immune system does its work. In order to wake up feeling refreshed, you must get adequate deep sleep. During REM sleep, the brain reviews the information taken in during the day, consolidates it and mood related neurotransmitters are produced (http://www.helpguide.org/life/sleeping.htm).

So how do you do that?

1. Keep a regular sleep schedule. People who work different shifts and go to sleep at various times have poorer quality of sleep.

2. Minimize noise to reduce arousals. Fragmented sleep decreases time spent in deep sleep.

3. Avoid working night shifts. It is harder to get quality sleep in the day due to more noise and sunlight.

4. Avoid alcohol and nicotine in the evening. They disrupt sleep. Caffeine also should be avoided.

Some new technology available to help your circadian rhythm run effectively is a dawn simulator. It is a light that slowly increases in intensity, simulating the rise of the sun and it also mimics the setting of the sun. It helps trigger the brain's natural sleep cycles.

There are many other ways to improve your sleep. Consult with your primary care doctor.

Question: I get very upset when people enter into my personal space. I also don’t like to be touched at all. The problem is my sense of personal space seems to be larger than what other people consider normal so I am very often feeling u comfortable and I will often get out of situations either by basically running away to get out of the situation or if I stay I often get irritable and make the other person give me more space. This is such a stupid thing but it causes me a lot of social problems. I try to ignore it when someone gets too close but I can’t change how I feel.

Cynthia Klatte Says...:

Dear Anonymous,

Individuals certainly can vary in terms of the size of their own personal space, or how much space they need between them and another individual to feel comfortable. Anthropologist Edward T. Hall studied social distance and found that the distance tended to vary depending on the relationship with the other person. On average, 6 to 18 inches was the level of physical distance for people that you closest to, a loved one or someone you are in a romantic relationship with, called the “intimate distance” zone. 1.5 to 4 feet was the typical distance for family members and close friends. 4 to 12 feet was the “social distance” zone for acquaintances. 12 to 25 feet was the zone for the public, such as when doing public speaking. So you can see there is quite a bit of variability from person to person. Studies have looked at variability by gender, by cultural background, by height, etc. It can vary due to context, such as being in an elevator vs. walking on a street. Some individuals might not fit the norm in terms of their comfort zone for a variety of reasons, such as a medical condition, autism, having experienced a traumatic event in the past, etc. For some, physical touch may be unwelcome or problematic. For those individuals, it is important that they communicate their need for space with those they are close with, asking that they provide them with the level of distance that makes them comfortable. Honor that within yourself and ask those around you to honor that as well. If someone is distressed by their difficulty tolerating touch or closeness and wants to learn how to accommodate it better, consulting with a therapist could be very helpful.

Cynthia Klatte, LCSW, ACSW

Question: My husband cheated on me. He is trying to patch things up and he wants me to agree to go to couples counseling with him. I feel like if I agree to do this with him it means I have agreed to forgive him and it is all about how we will get to reconciliation together. The thing is I am not sure if I want to or am able to forgive him. Should I go to this therapy before I even know what I want?

Cynthia Klatte Says...:

Dear Anonymous,

This must be a very difficult time for you. I can understand your hesitancy in making a commitment to counseling, when your husband has not kept his commitment to fidelity to the marriage. First of all, a commitment to counseling is not necessarily a commitment to staying in the marriage. It is agreeing to the process of attending and participating in the sessions to sort out your feelings about the marriage and whether or not both parties can "work it out". If you're unsure what you want or need to do, then counseling can help you achieve that. I think the bigger question right now might be, would that be best achieved in couples or in individual counseling, or maybe a combination of both? I'd suggest scheduling an appointment with a therapist individually to start to sort out your feelings and then make a decision about whether or not couples counseling makes sense for you. If you have an employer, find out if your benefits include an EAP (Employee Assistance Program), as often that includes a few sessions at no cost. If not, then call your insurance company for a referral, or if uninsured, your local social service agency. I wish you well.

Sincerely,

Cynthia Klatte, LCSW, ACSW

Question: Can a person get addicted to the feeling of being in love? I think I can never stick it through with a relationship because I so want to feel that new love feeling all the time and it never lasts like that no matter how good the person is I am with at the time.

Cynthia Klatte Says...:

Unfortunately, yes. Human beings can become psychologically addicted to anything that brings us pleasure- alcohol, tobacco, shopping, gambling, running, etc. And few things are more pleasurable than being in love! While there is no physiological dependency, like with alcohol, there is a rush of "feel good" chemicals that get released when we feel that euphoria during that early romantic phase. These chemicals are associated with feelings of arousal, pleasure and satiation. We can become dependent on these “feel good” chemicals to self medicate whatever is ailing us. Some people can addicted to the sex in the love relationship, some may become codependent with the partner. Others may be dependent on the boost in self esteem that comes from another being attracted to them and being in love with them. They may have difficulty feeling good about themselves outside of a relationship. It can manifest in many forms and serve different purposes. So there are different types of love addiction. How do you know if you're addicted to love? There is a self assessment questionnaire that may helpful that is published online by Love Addicts Anonymous, a self-help group, at http://www.itsallaboutlove.com/love_addiction.htm. In general, when it comes to any type of addiction, some red flags would be unsuccessful attempts at stopping the problem behavior (which could be exploring new potential partners, ending relationships early out of boredom, etc), spending a lot of time engaging in the problem behavior or thinking about the problem behavior, other people expressing concern about it, hiding it or lying about it, and experiencing negative consequences as a result of it and still continuing to engage in the behavior. Another useful site is http://www.slaafws.org/ which is the home page for Sex and Love Addicts Anonymous. Another resource is http://www.recoverynation.com/main/la.htm which talks about relationship addiction and recovery. There are many ways to work on these issues, from getting into individual therapy, attending a self-help group, or doing some reading, research and introspection. Good luck to you.

Question: How much is a fair price to pay for a life coach?

Cynthia Klatte Says...:

The fee for a session with a life coach will vary, depending upon geographic location and it can vary depending on the experience level of the coach. Life coaches who are certified are likely to charge more, though there is no one standard certification for life coaching and none is required for the practice. According to LifeCoach.com, they “charge about $200 to $1,000 per month for a 30 to 60 minutes call 3 or 4 times a month. Executive coaches charge more and some clients work with a coach for an hour or two a week. It all works about to about $100 to $300 per hour. Obviously, corporate coaching is more, and can cost $1,000 to $10,000 per month and usually starts at $500 an hour.” Some coaches offer group coaching to make it more affordable. How coaches bill will vary. It could be by the minute, by the hour, by the month, or they may offer a package deal, such as a certain number of sessions or services. Sessions can be 30-60 minutes and other services can include in-between session contact by email or phone. Sessions can be in person or online via video conference. It is important that you discuss fee setting and what services to expect with the life coach before scheduling a session.

Question: I am very worried about my niece. She was always a little bit shy in high school but she always had friends and she was a really funny person to anyone who got to know her. She was OK looking, kind of pretty even, but she always had acne. I just recently moved back home after 3 years out of the country. I had not seen my niece for probably 6 or 7 years. Now she is in her 20s and stays with my mom and gets paid a little bit to act as a live-in caretaker. She barely leaves the house anymore and she didn’t even want to see me when I came over the first time, I almost had to force my way into her room and she didn’t want me to look at her and she would hide her face with her hair all the time. I saw her face and there is nothing wrong. A little acne, but nothing really but if you hear her describe herself it’s like she is horribly grotesque. She won’t look at herself and she barely leaves the house so no one else will have to see her. If she does go out she tries to go out at night and she always wears this big hooded sweatshirt. It’s really crazy. She still tries to hide her face from me all the time. She has even covered up the mirrors in the hallway. Her parents are both dead and I am the closest family she has. I feel so bad that I haven’t been around to see what was going on with her. I had been told about it but I did not understand the extent of her reclusivity and I guess I was just grateful that she was willing to take care of my mom so I didn’t have to put her in a nursing home and all I had to do was send over a check every month. She obviously needs some help, but I do not know what she needs. What is wrong with her and how can she get better? She has been on her own for too long with this and I want to do right by her now – hopefully it is better late than never.

Cynthia Klatte Says...:

Dear Anonymous,

I share your concern. And I'm thankful that your niece has someone looking out for her best interest. From the information you provided, it seems your niece may have developed a distorted belief about her facial appearance, which is interfering with her day to day functioning (i.e. feeling comfortable with oneself, socializing, being in public places, grooming in a mirror). There may be other psychological factors affecting these areas as well. Many of the things you described are common manifestations of body dysmorphic disorder, but they could also be symptoms of depression, anxiety and/or other mental health issues. I strongly recommend your niece obtain an evaluation by a mental health professional to determine the cause of your her difficulties.

Body dysmorphic disorder is characterized by being preoccupied with a flaw in your appearance — a flaw that is either minor or imagined. The person believes the flaw is so severe that they are so ashamed of their appearance they obsess about it and make attempts to hide it or change it. It usually involves the face. Mirrors are often avoided. Often there is extreme self-consciousness and avoidance of social situations. Available treatment for body dysmorphic disorder includes therapy, usually cognitive behavioral therapy, and medications, such as selective serotonin reuptake inhibitors (SSRIs). Often, treatment involves a combination of both. For more information, go to the Mayo Clinic website at http://www.mayoclinic.com/health/body-dysmorphic-disorder/DS00559.

I would strongly recommend expressing your concern for her without directly challenging her belief, as she may not see a problem with the belief itself as to her it is quite real. I would recommend offering to help her locate a counselor and taking her to the appointment as a support person. Be aware that she may resist going out of shame of being face to face with the counselor.

I hope your niece gets the help she needs. We love to hear back from people, so please let us know how "choosing help" assisted your niece.

Cynthia Klatte, LCSW

Question: What do I do if I am having romantic feelings about my therapist? I have seen her now for 6 sessions and I can’t get her out of my head. I am constantly thinking about her, even though I know that there is no possible way for us to get together romantically (my brain may know this but my heart doesn’t seem to be getting the message). I still find her effective but I am a bit distracted away from my focus on myself to a focus on ‘us’. Should I bring up how I am feeling with her? Will I have to find a new therapist most likely? Is this a common occurrence?

Cynthia Klatte Says...:

Dear Anonymous,

Thank you for being brave enough to share your story. Yes, transference in psychotherapy is very common, but my guess is not commonly talked about. Addressing your transference in therapy can be an incredible growth experience, where one can better learn about themselves and patterns in their relationships.

Transference is an unconscious process whereby one’s thoughts and feelings from a past relationship get transferred onto the therapist. When one develops a close, safe and trusting relationship with a therapist, it can trigger familiar feelings related to a previous relationship with others, such as a parent or even a lover. Sometimes that "attraction" isn't really a physical attraction at all, but possibly a desire for some need that was not met in that previous relationship. There are many possible interpretations. Some clients do develop an erotic transference, which is a romantic or sexual attraction, and therapy is the ideal place to work that out as well.

The caveat I give you is that if it becomes obsessive, or if you feel the therapist is in some way encouraging it, or if you don't trust the therapist to have clear boundaries and to be ethical in their practice, then I'd recommend transferring to a new therapist. Otherwise, think of it as an opportunity to resolve a past relationship issue or a way to learn more about yourself.

Question: I have liver cancer and my prognosis is not good. I will likely die before the end of the year. I have 2 girls who are now in their 30s. They do not talk to each other because of a lot of family drama that occurred around the time of their mother’s passing a few years ago. One thinks the other is controlling and manipulative and the other thinks her sister is irresponsible and free loading. I am sorry to say that in my opinion they are both right to some degree, but there is so much more that is good and beautiful about each of them. I do not want to die before seeing them reconcile and become family again. I believe I can force them to sit down together with a therapist at least one time. Is reconciliation therapy at all likely to work though if both parties are forced to participate rather unwillingly?

Cynthia Klatte Says...:

Dear Anonymous,

First, I am deeply sorry for the devastating news you’ve received about your condition. My heart goes out to you and your daughters. Second, I think that your wish is a beautiful one and I empathize with your desire to have the peace of mind that comes with your children being there for one another through a family crisis. Unfortunately, it sounds as if the turbulence during the crisis period when they lost their mother pushed them apart instead of pulling them together. It can go both ways. In response to your question about whether or not forced reconciliation therapy can work, while involuntary therapy is less likely to be effective, there is ALWAYS the possibility that it can work. There is always hope. Growth, healing and forgiveness have occurred in even the bleakest of cases.

The word crisis in Chinese is made from combining the characters for danger and opportunity. A crisis brings with it danger or adversity, but it also creates an opportunity for growth. When things fall apart, sometimes they can be reorganized and rebuilt.

For family therapy to have a chance at success, there does need to be some willingness on both their parts to come to the table to participate in the process. I think you are in a good position to ask your daughters to agree to meet with you and a family therapist with the goal of facilitating family communication during this crisis. Ask them to agree to a “truce”. Perhaps for now, focusing on this coming year and your needs at this time for all to be involved might be more successful than asking for complete reconciliation and forgiveness. And if they experience positive growth now, they may become more willing to consider reconciliation in the future. My thoughts and prayers go out to you and your family.