Question: Hi Mr. LaPierre, This morning, my husband, daughters and I went to see the therapist we started seeing a few weeks ago. I shared with her that I am struggling with Secondary Trauma surrounding school shootings. These are the most frightening thing for me to consider, yet they have been happening around the country with frightening regularity. Within the past month, there were two threats - one at each of our daughters' schools - that have caused me to experience horrid anxiety and often left me in tears. The idea that I am sending our sweet girls to public school and that there could be someone there who feels angry and violent enough where he would commit this kind of act just shakes me to my core. Of course, when news stories have occurred covering one of these events across the country, I put myself in the same place as the families themselves. It is as if I am experiencing their unimaginable tragedy also. Wednesday, an email was sent by our 12-year old's middle school to say there had been some sort of "terroristic threat" by one of its students. All I could do was beg my husband - through tears and sobs - to allow our daughters to stay home this past Friday. He allowed this, but not without a ton of conflict between him and I about allowing this. He feels that we have to live our lives and by keeping our daughters at home, we are really not doing so. I know I cannot keep them locked inside their home, but honestly, if I could convince them, I would love to live in a "safe house". We'd drive each other bonkers, but at least no one would shoot us. Today, our family therapist talked to me about spirituality. I feel a tremendous amount of mistrust towards conventional religion and therefore turn my nose up towards anything "God" and "Jesus". She spoke to me about developing a relationship with my "higher power" instead. After reading what you wrote on your site, I was quite taken with what you said. Do you know of any books that are available to help me develop my relationship with my higher power? Years ago, I read "Codependent No More" and thought a great deal about Melody Beattie. I don't know if you are familiar with her or not. Thanks for reading this long email! Elizabeth G,

Jim LaPierre Says...:

Elizabeth,

Thank you for your question and my heart goes out to you and your family.

My children were in middle school when 9/11 occurred and I will never forget how terrifying it was to know that there was a broad, developing threat and not understanding whether I could keep my children safe.

School shootings have become too common and your fear is justified. I also understand your husband's point of view. I would say that you're both correct.

I think the central theme is powerlessness and I believe it's one of the most difficult lessons a person encounters in their lifetime. Powerlessness is not hopelessness or helplessness. It is simply not having control. Everything about fear makes us crave greater amounts of control. I have found that as much as I dislike powerlessness, I dislike everything I do when I don't accept it more. I agonize and stress and seek comfort in illusions. This of course does not help my loved ones and it makes me stressed and unhealthy. I recommend the Serenity Prayer and I recommend it to people who are devout atheists. It does a wonderful job of naturally separating what I have control over and what I don't.

The things I don't have control over, I surrender to a Higher Power. That was a very hard lesson for me to learn, but I reconciled that whether I trust the Universe or not. I still can't do a thing about it - so I quite literally have nothing to lose.

Religion doesn't work for me either - but as a clinician, I have seen far too many miracles not to believe that there is something more powerful than myself and I choose to believe that It wants good for me.

So, I talk to it - and in the worst of all worlds, I'm just talking to myself which is still healthy. I ask my Higher Power for absolutely everything. It's not that I think of the Universe as Santa Claus - far from it.

It is that I do not believe me asking changes what the Universe will do.

Instead, I believe it makes me more mindful and aware - which leads to recognizing blessings placed in my path.

I would say the connection you have to your children is spiritual - it's about connection. The fear of losing them is intolerable - I concur. How you cope with that fear will determine the lion's share of what is possible in your life.

I also urge you to consider that you are teaching your children by your example.

Books on the topic:

• Everything Anne Lammot has ever written, but especially Plan B: Further Thoughts on Faith
• the Tao Te Ching
• The Big Book of Alcoholics Anonymous
• Narcotics Anonymous - all of their literature

I hope you find what speaks to your soul and I pray your children are safe.

If I can be of further help please email me

counseling@roadrunner.com

Very best,

Jim

Question: I am in burnout mode. I need your opinion. Should I seek medication, marijuana, or work with a counselor?

Jim LaPierre Says...:

Hi and thanks for your question - Ive always viewed burn out as a product not of what we do, but of what we do not do. As the expression goes, "You cannot pour from an empty cup." I have found that the cost of not accepting my limitations is that I gradually become depleted and burn out is not only exhausting, it's emotionally devastating. I am biased, but I recommend getting a counselor because it affords you an objective perspective on where you're at and input on how your life might change for the better. Invest in you! I don't judge marijuana or medication but in my experience, neither prevent burn out. Really great self care and connection to good people does. Best of luck to you!

Question: I am a caregiver to my dad who has Alzheimer’s. I got totally burnout around Easter and I basically broke down and had a nervous breakdown and my sister had to come and stay with us for a while to take care of dad while I went away on vacation and got myself back together. She has left now and we made a lot of changes to try to make sure that I won’t get so overwhelmed again, like we have a caregiver helper that comes in 5 days a week now in the mornings so I can go out and run errands. Therefore things are much better, however there is one thing that is really troubling me. One of the main symptoms of burnout is losing your empathy and compassion. That definitely happened to me. But even now that things are way better and I am not burnout any more, I still don’t feel much empathy or compassion for my dad, like I used to. Like a normal human being should. And this makes me feel really upset. What is going on with me?

Dr. Mark Abrahams Says...:

The title is a standard expression among therapists to individuals who get down on themselves, often for no good reason. Since I don't know you from Adam, you'll forgive me if I don't believe that you've lost your empathy and compassion. For all I know, you've been 'bending over backwards' as the expression goes, and have become co-dependent to your dad. When we develop co-dependence, a number of things go awry. Perhaps the most noticeable thing that happens when we step back, take a holiday, and create some necessary and healthy distance, is that we feel badly when we take care of ourselves for a change. We feel guilty and selfish, and perhaps we wrongly believe we've lost our empathy and compassion, but what has really happened is that we begin to treat ourselves with needed empathy and compassion! When we become co-dependent, we put our own needs on the 'back burners,' and attend almost solely to whomever we have assumed responsibility for. 

Co-dependency is a form of dysfunction because we have lost all perspective and live 'as if' the needs of another, even a parent who has given us much, are more important than our needs are. Even thinking such a thought registers guilt feelings, which are not a result of real guilt, due to mistreatment of our charge, but of neurotic, unfounded guilt feelings. It is not selfish if we take care of ourselves with the same measure of empathy and compassion that we care for others. Not to do so weakens us as care-givers, which is illogical, but it also reveals a form of pathology, a martyr syndrome, or perhaps a form of masochism in which we derive pleasure or satisfaction from real suffering. 

Admit to yourself that caring for a parent with Alzheimer's is very difficult, and that it does wear a person down. I would suggest that you find a support group, if only for a few meetings, just to give yourself a frame of reference as to just how difficult it is, but also to draw strength from others who are experiencing the same thing. Learn to be patient with yourself. We all have limits. Professional caregivers often need to find 'space' in which to get centered before continuing with a task that requires patience, empathy, and compassion, I know that I do. Lastly, and with all due respect to you and the task at hand, this too shall pass. So be as 'Present' to your dad as you possibly can, and retreat when you need to get centered again. Best regards.

Question: Is feeling tired and irritable all the time a symptoms of burnout. I am a sandwiched caregiver of two teenaged children and my elderly dad. This summer I am so tired all the time and it’s bad timing since my dad had another stroke this spring and the caregiving is a lot more physical and tiring than it used to be. I think I am getting burnout.

Jennifer Liles Says...:

Absolutely irritability and fatigue can be signs of burnout. Caretaker self care is both one of the hardest and most essential parts of taking care of loved ones.It sounds like you are caught between a rock and a hard place. 

It might be a very good idea to reach out for help from someone, at the very least to get respite from helping your father. If you have another adult in the household or a close friend, that is a good resource. You might call local senior centers to see if they know of any resources in your area for respite. 

You say you have two teenage children that you care for in addition to your father. One thing that might help tremendously for your self care is to give those two teenagers some of the responsibility you're shouldering, particularly the heavy lifting. It does teenagers no harm and generally a lot of good to assist with caretaking, and could help ease your burden. 

Without knowing your specific situation, I don't know how much preparation you would need to get your teenagers into helping mode. Perhaps they are already helpful kids, or perhaps they are currently enmeshed in fairly normal teenage selfishness and you're struggling to get any help from them. 

Sitting them down, one on one or both together, whichever works best, and outlining your expectations with regard to their help with household chores, their grades at school, or any other issues that are compounding your caregiving efforts, and then following through to ensure that they do what you ask them to do will be a great investment. 

In the short term, getting your teens on track toward helping you, either by picking up some of your other responsibilities or through directly helping you with care giving duties, will probably add to your exhaustion and irritability. It'll be work to get them to change patterns of letting you do stuff for them. But within weeks or a month or two, where you had three care giving burdens you may find that you now have one care giving burden and two (semi) reliable helpers. 

Again, I don't know your particular situation. If one or both of your teens has disabilities of their own that require care giving, clearly this doesn't apply. However, underestimating a child's ability and willingness to pitch in to help the family is very common, and you may find yourself surprised at just how much your teen is able and willing to help, when given the opportunity. 

This requires balance. Make sure you're not passing your burnout to others, including your teens, but do set limits on what you are able and willing to do yourself. If you need more specific answers, feel free to follow up with more detail.

Question: Do vitamins like stress tabs and other stress formulations actually work to help reduce the effects of stress or are these just marketing?

Rebecca Ashton Says...:

Thank you for your question. I'm not sure what you mean by stress vitamins; whether you mean specific herbal remedies (things like Rescue Remedy or Kalms) or straightforward supplements, such as Valerian or St John's wort.

Either way, it is possible for herbal remedies to relieve stress, but the effects are short term (for example, the effects of lemon balm can help you to feel calmer for up to six hours, or a cup of Valerian tea can help you get a good nights sleep) and there is little evidence that suggests that they are effective over long term use.

However, just because something is herbal, does not mean that it is safe and it should be used with caution. Herbal remedies should not be used with other sedative medication or alcohol .

It is always advisable to consult your doctor before considering trying medication whether it is natural or chemical and to rule out the possibility of a more serious health problem. It is also worth remembering that it would be better in the long run to look at the underlying cause(s) of the anxiety or stress before trying supplements or medication.

Question: I have a lot of debilitating headaches. My doctor has done a lot of tests and there is no obvious physical cause. I am under a lot of stress and anxiety so that seems to be the most likely culprit. There is little chance that I can reduce my workload (new business plus new child…not exactly perfect timing) or stress since I’ve got all my money and my families money tied up in my new restaurant. I need to get better fast. I know medications might work but I have an addiction history so I am scared to get into something like Xanax. What’s the best way for me to get rid of the headaches quickly, considering I cant stop 16 hour days for the conceivable future?

Jim LaPierre Says...:

Wow - I can so relate to where you're at. When I started my own business it was exactly as you describe. You're right - stress is inevitable (for all of us but especially in your current situation). Anxiety is optional - anxiety occurs when we do not cope with negative emotions and stress in healthy ways. There are elements of self talk that do not take time. Pay attention to your self talk - notice when you're beating you up and then stop. It doesn't take time to treat yourself the way you treat your employees. All it takes is that you pay attention, notice things, and make them healthy.

Other short cuts - massage once a week, loud music on your way home, yelling (do it in the walk in cooler), prayer, breaking things (hurl glass stuff into the dumpster), vent to loved ones, call people who care during your commute, have sex and/or masturbate no matter how tired you are.

In my opinion - stay the hell away from benzoes - Xanax is terrible stuff as is Ativan and Klonopin and Valium.

Best of luck to you!

Question: Hello, I have had some problems with impulse control since growing up as in when I didn't get my way at home, I slammed doors, I am 39 now and in rage have run away from home 3 times in the last yr only to return feeling confused about my own behaviour; now before you say I should be living on my own at almost 40, I have, a couple of times, but after a breakup of an engagment (I impusively would lose it on him but I knew he wasn't the one and probably impulsively got into the relationship, though I did want marriage, I impulsivly picked him based on a comment of someone saying ok it's time, just do it); I want to be a 100% responsbile for my reactions/and respond to situations, not react, as it has cost me jobs, relationships, and almost turning 40 now, I had a breakdown when I ran from home on one occasion where my mother's comment that I wasn't listening to her when I was just trying to cook something to feel better after being laid off from my job and also after breakup of a relationship, had left me low; I felt so insulted by her comment that I am almost 40 and don't listen, that I insulted her, ran to my room and was throwing a chair at my bed and screaming and swearing; thankfully no one but the workers working on renos I don't know heard, however, since then my confidence/self-esteem has recovered somewhat but a deep sadness is still there, as I don't know how I can trust myself in any situation, if I have to be worried about my own reactions; something that has also been reflected to me in relatinships with men, who have said they don't know even after they find me amazing and loving and a great catch, they don't know if they can talk to me without me intterupting, breaking up with them over and over (out of fear of being hurt is probably y I do it,but i realize this is not fair and hurts them, even if justified, it can be done in a rational thought out manner); Please help I want to get a handle on this. I am generally very loving, caring and emotional, into art and admired by people; but when life failures or big events that are negative happen and I feel repeated disappointed wt a job or relationship is when I lose it, or when I am afraid in a relationship with a man mainly. Other than that, I am completely calm, meditate daily and am more than fine, now with mediations, things like my impulsive speeding when driving and my impulsive dating one man after another (without getting too close physically, though emotionally still draining as I have tried hard to be engaged/married again but feel stuck), dating and driving much better with meditation; since I was a teenager they put me on mild antidepressants/anti anxiety but no offense they did nothing to help me permanently; the mediation is what helps in a real way, but still the temper loss I had with throwing a chair at my bed and hitting my bed scared me. Please let me know what are healthy ways to express anger/redirect the energy so when major negative events happen, easier to deal with. for example I had such a positive attitude after being laid off as I hated my job and although I was shocked for 10 minutes, I was singing on the way home, feeling free, but I didn't tell anyone I told evone I quit. then the breakup happened with someone I thought I might marry and my mother's reaction which was not that bad but treating me like a 2 year old made me lose it bad. I want to trust myself again, I want to know that I will never have impulsive issues; as even impulsive comments online, once got me into big trouble a few years back, and now on facebook, affected my relationship with my sister in a very unnecessary -ve way, just because i didn't feel good that day and was stressed and posted something stupidly.

Mark Hughes Says...:

Thanks for giving me such a clear and detailed picture of how your angry reaction is affecting you and making relationships so hard for you, both in your family and with men. I hink you've done well to recognise this, find something that helps (meditation), and are asking for help here.

I'm not sure if I would be the best person to help you, but I would like to suggest that you consider working with a counsellor or therapist. You might also find some kind of group which works with anger, or if you have some sense of the origins of your difficulty - something related to that. Clearly you are sensitive, which just means that small things can hurt you so much and so deeply, that you react without time to consider yourself or what's happening. So I wonder if there's something underlying this from your past.

There are different ways a counsellor or therapist could help you with this. One is to help you slow things down to the point you can identify what it is that causes the reaction, and what in you is being triggered. Another would be to work more directly with the cause, if you think you know what that might be.

I offer counselling online, so might be able to help, but you should consider whether that would work for you, or if you would do better to see someone in person. I can't say one is better or worse for you, so you could try and see how it goes.

You can also look for information online. Your biggest resource is in yourself, so trust that in you which has got you through so far, and keep up with the meditation so long as it helps. But also see if you can find someone to work with, who will both support you, guide you and help you work with this, and ultimately help you support yourself.

I hope this helps. Good luck, and thanks for asking for help. I think it is both brave, and a beautiful gift that you give.

Mark

Question: How long do you have to meditate for every day to get a lasting stress beating effect? I am very stressed out and I am willing to try meditation since everyone tells me how well it works. I do not really relish the thought of sitting and doing nothing so I would like to do it for as little time each day as possible. I am having trouble getting reliable information on how much is enough?

Mark Hughes Says...:

There isn't a set length because everyone is different, so you'll have to try it and see. However, you may be surprised at how even a small amount can help.

What you want to be careful of is setting yourself up for more stress! So take it easy, and trust your own sense of this. Don't try and do too much, because you think more is better and so on. Give yourself very easily achievable goals, and if you miss them, move them down a notch (or by half).

Just sitting and watching your breathing for a few seconds each day, you might start to notice changes in your body. I suggest you don't *try* to relax, but just notice.

Notice mostly how you are in your body, keep coming back to the breath, but noticing and allowing any thoughts, sensations, feelings without trying to change them, and revisiting the breath.

A little and often works best for me, that or something else might work for you. And don't think you have to sit in a particular way. Experiment and find what works for you. These days I don't meditate so much and mainly find mindfulness in
different activities, always though I focus on my sensations, feelings
and letting go of thoughts. Good luck!

Question: My wife is caring for her dad who has dementia and a lot of pain and mobility problems from 2 broken hips. My wife does not work. She has always promised her dad that he could stay with us and she would never put him in a nursing home. Since it was what she wanted and her dad was happy and I liked him a lot and we could afford it I thought it was a good idea and the right thing to do. Her dad is 84 and he has deteriorated quite a lot in the last 2 years and caring for him is now a very physical and demanding job. He was always a stubborn individual but he was also very funny and kind but now his personality has changed and he is angry much of the time and he can't see anymore what a burden he has become. My wife is clearly overwhelmed. She is frazzled and depressed and has gained weight and she is irritable all the time. I try to get her out of the house as often as I can but she feels guilty when she leaves for extended periods. It is time for him to go to a nursing home. To me this is very clear. She is ruining her own health as well as the happiness of our marriage caring for a man who is not appreciative of what she is sacrificing. The problem is she feels trapped by the promise she made that she would never put him in a home and I can't make her see that it is OK and that sometimes you have to go back on your promises when the cost gets too high. I am worried that if this goes on for years we are going to end up divorced. How can make her see that this situation is not good for anyone any more? I don't want it to come down to ultimatums but she won't listen to what I think is reasonable. I think the strain and stress of caregiving has affected her judgement and she can't even think clearly any more. What can I do?

David Shannon Says...:

It is understandable that your wife wants to keep her promise to her dad, no matter the sacrifice.  At least at the present time, she is not likely to be persuaded by the idea that the cost has gotten too high.  She may feel that to go back on her promise would be very costly too, in terms of guilt, reduced sense of integrity, self-worth, and self-esteem.  Placing him in a nursing home would never be a happy choice, but she might be able to see eventually that it is not in his best interests to remain in the present situation.  It would have to seem to her like an improvement for him, in terms of his health and happiness.

I don't know what the type or degree of his dementia, or the long term prognosis, according to his doctors.  But from what you say, his personality has changed, and he is not the same person that he was when she made that promise to him.  I don't think that she will want to consider that as a reason to change her commitment to keeping him at home.  But as it progresses, it might be one of the factors in realizing that he would get better, or at least more specialized, care in another environment.

She is increasingly overwhelmed, depressed, and irritable.  She feels guilty when you do persuade her to get out of the house and do something together.  She might feel less guilty if there was someone else there with him, whom she could trust to give him good care.  It could be worthwhile to investigate the availability of home health care and respite services, so that the entire burden does not fall on her shoulders.  If and when the home service providers say that they are no longer able to provide the care he needs, it would be another powerful piece of evidence that the present situation is not the best for him.

Seeing a therapist for individual counseling might help her come to terms with her own limits, as well as her sense of guilt, as she considers other possible solutions.  This is also causing a great strain in your marriage, to the point it might end in divorce.  Marriage counseling might help you to see each other's perspectives and understand each other's feelings.  It could help you communicate more clearly with each other, in a supportive and less pressurized setting,  Rather than issuing ultimatums, you could both focus on the consequences of continuing as things are.  You could also agree on short term goals, and make their implementation part of your relationship contract for a specified period of time, after which you would talk again about how it is working, and whether other changes need to be made.

Best wishes to both of you in this very difficult situation.