Shoshana Shira Twersky

I can understand your confusion and concern about the child’s change in behavior regarding eating lunch at daycare. It’s not uncommon for children at her age to go through changes in eating habits and it could be related to many factors such as developmental, environmental, personal/social etc. It won’t be possible for me to offer anything concrete without assessing the child directly and/or speaking with the parents and caregivers at her school. I suggest you start with asking the child in a non-threatening, curious and open fashion. We don’t want her to feel like she is doing something bad that she needs to defend or for her to worry that the grownups are disappointed, upset, frustrated and that it’s her fault. Perhaps something like: “Hey sweetie, let’s spend some time together coloring, how does that sound?” And while engaged in the activity… “How’s school?… Who are your friends?… What do you like to do together?… Do you sit with your friends during lunch time?… What kinds of lunches do your friends bring?… Do they eat anything that looks yummy?… Is lunch time long or very quick?… Do you like lunchtime…?
As you can see, the goal is to get her talking about what’s happening without asking directly. She may not have the language/vocabulary to articulate her feelings (yet) but if we listen to her closely, we can help provide that language to her by using complex reflections, which means, not simply reflecting back her words, but adding what we imagine her experience must feel like based on what she’s describing. So, for example, if she says: “Lunchtime is very fast” a complex reflection might be: “That sounds like it can be frustrating if you feel you would need to eat faster than your tummy wants to. I wonder if it feels better or safer to just not eat at all if lunchtime is too fast?”
Hope this helps as a starting point.

Autism is pretty common and there are many people who have this diagnosis and are high functioning successful individuals! It is important to remember that your daughter’s diagnosis doesn’t change anything about her as a person, other than the fact that the neurotransmitters in her brain fire in a way that has a consistent pattern associated with her diagnosis. Your daughter is still a beautiful girl with many roles in life that have zero to do with a mental health diagnosis. She is, I imagine, a friend, perhaps a sister, a student, a skilled individual with her unique contributions to her family and friends that only she can provide because of who she is. She will probably miss social cues that are “obvious” to someone without her diagnosis, and she may exhibit some rigid inflexible behaviors. She’ll probably need some skills training to help her navigate the complexities of relationships. She might need some extra help with school and you might notice some sensory sensitivities. None of us (people) get a free ride on earth without dealing with “something”. Not her doctor, teacher, neighbor, or best friend’s cousin’s uncle. We’ve all got challenges to manage! This is part of her “something” and it doesn’t define her. I suggest you talk with her doctor or whoever diagnosed her and get a recommendation. She may need a therapist, and/or a behavior intervention specialist or a speech specialist, depending on what her symptoms are. Autism isn’t cured, it’s a neurological disorder. The goal is to manage it and help her learn the skills/tools she needs to be a successful best version of herself.

The evidence-based treatment for OCD is ERP (exposure response prevention) which is best done with a licensed therapist who has had extensive training in Cognitive Behavioral Therapies.

It depends. Your friend will establish treatment goals with their therapist and depending on progress and other factors, the therapy may be short (a few months) or longer. Sometimes, a client comes to therapy to work on, for example, managing symptoms of ADHD, and then in the course of the therapy work other areas that need attention begin to surface.

It is important to work with a professional, qualified, licensed therapist who is trained to treat depression. A qualified therapist will be familiar with the evidence-based treatments for depression. This is the best way for you to get help. If you were to say that you suffer from migraine headaches and inquire whether “medication” can harm you, it depends! If you take the wrong medication or too much of the right medication, or a medication that doesn’t work well with your body in particular, then yes, of course it can harm you. But if you work with a licensed doctor trained to treat migraines, you’re probably in good hands.

A licensed psychologist and probably a psychiatrist too. There are psychiatrists that will do the therapy as well, but typically you would see both. I would start with a psychologist (this is the doctor who will do the talk therapy) and then get a recommendation for a psychiatrist (this doctor will do the evaluation and prescribing/monitoring or medication). There are many people with similar diagnoses who lead normal productive lives. A diagnosis doesn’t define you! These doctors will help you get to a place of feeling and living as serene and grounded a life as possible.

In order to answer this question, it’s important to understand what is “addiction” and where does it come from. As with any behavioral or thinking problem, typically it’s acquire from part biological and part environmental. Using your example, your friend might be predisposed to an alcohol addiction if this disorder runs in their family (this would be the biological component) and even if this is the case, that doesn’t necessarily mean your friend will struggle with alcoholism. If, however, your friend already has this biological predisposition and begins to drink excessively whether socially or as a coping tool, there is an increased chance it may lead to alcohol addiction. That said, the “addiction” is truly about the “relationship” the person has with the thing, whatever the thing is. Sometimes people quit one vice only to transfer their maladaptive relationship to another (gambling, food, shopping, etc.). Alcohol is not necessarily the problem, rather the quantity, frequency, impact it has on the person’s life is what can become problematic. Alcohol is also an interesting vice, so to speak, because it is both a depressant and also tends to be negatively reinforcing. What that means is as follows:
Let’s say your friend drinks to reduce stress. The drinking begins… the stress is decreased (because the person starts feeling the effects of the alcohol), so that’s reinforcing! Next time there’s stress, guess what’s going to happen? The person will do the thing they did that decreased stress (drinking). Now, remember I said alcohol is a depressant? After the euphoria comes the crash. The person starts feeling down in the dumps (depressed). It doesn’t solve the issue, obviously.
Another thing to understand about addiction, is there’s something that gets classically conditioned (meaning “connected) so that the person’s system will recall that alcohol = stress relief, fun, social disinhibition, whatever it is that leads them to drink… so it will become habitual (meaning addictive behavior) to use the thing, alcohol in this case, to achieve desired outcome. I would suggest your friend speak with a professional (licensed therapist) to discuss this if it’s a concern.

I imagine this feels tricky because, as you mentioned, the person you’re speaking about is a friend. I assume you want to maintain a level of friendship that feels good for you. Sometimes we can deal with these types of situations using effective communication skills. Other times we may realize that despite our best efforts, the other person is remaining the same, and that’s when we work towards acceptance, shifting our expectations, and perhaps boundaries for ourselves which is the part we have control over. In other situations we may ultimately realize that the friendship had run its course. I imagine the latter could feel sad. Not all relationships/friendships are meant to last forever. I wish you the best in the course of action you choose!

Cognitive behavior therapy (CBT) targets a lot of symptoms experienced when feeling depressed. Sometimes medication can complement the therapy process as well. There are important considerations to explore that will be helpful in deciding the best treatment for you including age, history, other diagnoses that may be present, the severity of your symptoms etc. I suggest that you reach out to a therapist with expertise working with depression to give you more guidance about what would best serve your needs.

There are different humanistic therapies though in general they share some common characteristics. For example, to understand a person, it is vital to understand that person’s subjective experience. The focus with humanistic therapy is on current behaviors (less so processing the past and figuring out where things started in your history). A believe that people have an innate desire to be well. The therapy stresses the importance of the alliance between the therapist and client to be authentic and collaborative. Finally, there isn’t a focus on traditional assessment techniques or a diagnostic label.
There is a lot of focus on personal choice rather than difficult upbringings or problems with how the neurotransmitters are firing in our brain.
I’ll give you an example with depression. William Glasser’s Reality Therapy (one of the humanistic therapies) talks about people having 5 basic innate needs: survival, love and belonging, power, freedom, and fun. He says that the love and belonging are most important because without them you don’t have the others. He believes most forms of mental health are a result from when we are unable to fulfill these needs in responsible ways or we infringe upon others to get our needs met. So from this perspective, a person is depressed because they have “chosen” to depress themself. So the goal of therapy here is to help the client identify responsible and effective ways to get their needs met and this is done through the use of asking open ended questions, encouragement, and other strategies that are designed to help the client explore and evaluate their behaviors, develop and commit to a realistic plan that will ultimately decrease the depressive symptoms and increase the clients level of feeling empowered and in control.

Of course, yes. The anxiety is a “feeling” that comes from the way you think about things and the way you behave (or don’t behave). Your anxiety is not what needs to be worked on. If you work with a good cognitive behavior therapist (CBT) you’ll be able to learn how your thoughts and behaviors (those are in your control) directly impact how you feel. I would imagine you might have some patterns of thinking that increase your level of anxiety on a regular basis. Whether it’s all-or-nothing rigid black/white thinking, catastrophizing, personalizing, having unrealistic expectations, generalizing, thoughts that lead to anticipatory anxiety… The good news is this is very treatable. Remember that the anxiety is a *feeling* and feelings can’t hurt us, they don’t have power, they at times FEEL big and dangerous but they are not.

The short answer is yes. The *things* that get talked about will be important to your treatment and recovery. There are specific skills and techniques that aim at reducing anxiety and challenging the thoughts that brought on the anxiety in the first place such as a Though Record, challenging and/or reframing automatic thoughts, identifying and challenging cognitive distortions, mindfulness-based skills, engaging in exposure response prevention exercises, etc. I highly recommend that you work with a therapist well trained in Cognitive Behavior Therapy (CBT).

I suggest that you reach out to do a proper intake assessment with a cognitive behavior therapist (CBT) so you can have more information about what’s going on with you and that will help direct treatment.
I winder whether there was a trigger a month ago when your symptoms dramatically began to worsen. It’s possible that your therapist will help you manage by giving you a short term plan (maybe taking medication at least in the beginning to give yourself some immediate relief and get you back to functional) and then as you begin to work on the actual issue learning how to cope with feelings of anxiety you can decide what makes sense in terms of continuing medication. I am not a psychiatrist so I need to stay in my lane regarding specific medications. What I can tell you though is the idea is to allow the medication to hijack your brain and help your firing neurotransmitters to increase or decrease levels of serotonin, dopamine, epinephrin, neuroepinephrin, GABA, or whatever neurotransmitters are needing some help while you begin to learn the behavioral and cognitive changes you have the power to control to help yourself feel better.

There are literally tens of thousands of tests that test different areas. Depending on what your question is that you want answered, the tests selected are going to be very different. Generally, psychological tests aim to measure different abilities in different areas such as a person’s aptitude in a particular area, intelligence, cognitive functions such as memory and spacial recognition, there are personality tests etc.

Cognitive behavior therapy is effective as well Applied Relaxation. With the latter, first we figure out what situations trigger the panic and then we can start identifying cues to become aware of that happen before the panic happens. The next step would be to learn a technique called progressive muscle relaxation. With practice, the relaxation happens quicker. The last step is to learn how to relax while the panic cues are happening.
It’s not uncommon for people to say that panic attacks happen seemingly “out of the blue” because it seems to be that way until we learn and practice what I’m describing.

Yes, cognitive behavior therapies are the treatment of choice for social anxiety. The basic premise is that our thoughts, feelings and behaviors are inter-related, so if we change just the thought or just the behavior, the others will by default change as well. Cognitive therapy techniques focus on on catastrophic beliefs and thinking patterns that social rejection is likely. The exposure therapies will encourage your daughter to engage with social situations that she fears and try to remain in those situations and she will then see that she is okay because she’s okay, not because she has been avoiding situations. (Look up the concept of “safety behaviors” that are “negatively reinforcing” to better understand this idea.

Anxiety is a feeling, and feelings are created from thoughts. If we work to change the way you think, your anxiety will naturally decrease. These are some of the mechanisms of the cognitive behavioral therapy model (CBT). In a nutshell, imagine a burning building with flames shooting out from all the windows. Your task is to put out that raging fire, and the resource you have is a hose with water trickling out going drip… drip… drip… That’s anxiety. It’s when you perceive your problems to be out of control like the huge fire and you believe that your resources for coping are not sufficient to deal with the problems. The goal here is to work on your perceptions (thoughts) and beliefs in order to reduce the feelings (anxiety). Anxiety also stems from anticipation which is living in the fears of the unknown, struggling with uncertainty. There are valuable mindfulness and grounding strategies to being in the moment that reduce anxiety and increase acceptance and self-care.

I’m sorry to learn you’ve been having so much difficulty finding the help you need in a reasonable timeframe. If you’re in crisis I would suggest that you call 911 to be seen at your local crisis response center. Otherwise, perhaps your primary care physician or even a family member or a friend can help you get in touch with a resource to get you connected with a psychiatrist to get you on the right medications.

It’s similar to a FaceTime or Zoom experience. The difference is that your therapist will hopefully give you a link to his/her HIPPA compliant platform.

There aren’t a “standard” amount of sessions because every person progresses differently in therapy and works at their own pace. Some clients have worked through this in 4-6 months, for others it may take a year or longer. Typically therapy would begin with some psycho education about what happens when the person experiences panic attacks. They are seemingly “out of the blue” but in truth they get triggered by something that happens right before the panic. The trigger may be a thought, a smell, a memory, etc. Your body suddenly goes into a fight or flight response because it thinks there’s an emergency and it’s going to work to protect you from the life/death situation. There’s only one problem; You’re fine! It was a false alarm, but your body know this. Your body feels like you’re going to have a heart attack and die. This is your sympathetic nervous system activated. Then you have your parasympathetic nervous system that’s trying to create homeostasis and get things back to normal. While all this is going on internally, the CBT skills are there to help you learn how to reframe and correctly interpret what’s occurring in your body and help you allow, accept, and not give in to scary thoughts your brain is used to feeding you. It also takes time to explore and potentially rule out other areas of concern influencing the panic that may have to do with trauma which would be a much lengthier therapy process.