There are many people suffering from the distress of anxiety such as fear of public places, worry, fear of public speaking, panic disorder, etc. Similarly many others suffering from depression, viz, sleep disorder, low energy, hopelessness, depressed mood, social withdrawal. Cognitive-behavioral therapy developed by Aaron Beck and others is a powerful tool to resolve problems with depression and anxiety. Thoughts cause feelings. When we become anxious or depressed our thinking becomes distorted (cognitive distortion). Examples of cognitive distortion of thinking errors are such things as catastrophic thinking, such as “I’ll NEVER get better,” “no one will EVER want me,” “things will keep getting worse.” Cognitive-behavioral therapy or CBT assists patients with reprogramming their thoughts. It is like a reset on our cell phones or our computers. There are many great books with exercises in this area for patients. Examples are “The Anxiety and Phobia Workbook” by Bourne and cognitive-behavioral therapy workbooks. An approach combining therapy with homework assignments gives patients a major role i outcome of their therapy. This is as opposed to "talk therapy" with no concrete assignments. This process can go on interminably. The approach suggested in this article assists patients in becoming an important part of treatment outcome.

The issue of children raised without fathers or faced with the loss of a father in one’s life is huge. Donald Dutton, a domestic violence expert in the OJ trial points to research that shows that one of the most significant factors in young men becoming abusive towards women is the absence of the father in their lives. This author consistently observes that young males without their father in their lives are depressed, deprived of affirmation and self-confidence and experience an inner void of emptiness and pain. Aaron Hernandez’s life began to change subsequent to the untimely death of his father who, in good health, died from a medical error. He checked himself into a local hospital for a routine hernia operation. Something happened on the operating table and he died. Aaron as many young men in this situation began not to care anymore and his life went sideways. Parental alienation destroys a young male’s relationship with his father. Recent research in this area reveals that young boys grow up and are not gainfully employed or academically successful. The effects are devastating. They have no self-concept nor sense of who they are!

Patients presenting symptoms of anxiety and depression are faced with the decision of medication. What are the factors going in to the decision to take medications? One needs to assess whether one can function in activities of daily living (academic, vocational, career, social, communication, etc.). If one is not suffering from severe impairment from functioning, then one may choose to defer on the issue of medicines. Any decision needs to be made with one’s physician or psychiatrist. One needs to rule out danger to self and others. There are great protocols on e.g. structuring one’s day and activities (in the case of bipolar disorder). These can be quite helpful.

ADHD can be misdiagnosed when the actual problem is domestic violence or severe familial discord. Research literature notes that children from homes with domestic violence may indeed have symptoms mimicking domestic violence. All too often, children who are hyperactive and/or inattentive are misdiagnosed with ADHD with no consideration to a differential diagnosis. Children from homes with high familial conflict may exhibit hyperactivity and /or disorders of attention. Frequently psychological testing is neither done nor requested; therefore, there is a lack of objective data. Parents would be wise to insist on objective psychological testing and assessment. Diagnoses OTHER than ADHD, out of necessity, must be considered. Moreover, there are methods other than stimulant medicines to approach this problem, viz, assistance with organization, family counseling, non-medication approaches to problems with memory and attention. One also needs to consider that children have developing frontal lobes predisposing them to problems with impulse control, attention, and organization. ADHD symptomatologies untreated can lead to substantial problems on adulthood, viz, problems with impulse control,organization and substance abuse.

Patients who are presented with sleep disorders are usually approached with sleep medicines. However, this can readily lead to a slippery slope of dependency and abuse. A much more fruitful approach is polysomnography or sleep study. The sleep environment is assessed prior to any intervention with medicines. Multiple sleep latency studies assess daytime drowsiness. Then, one can pursue relaxation, guided imagery, hypnosis–a far safer and long lasting approach. The patient is then placed in a position of self determination rather than passive dependence on medicines.

I have seen many patients presented to me with symptoms of panic disorder, e.g. fear of driving. Frequently, the focus of treatment is the anxiety treated with relaxation. Is that the correct focus? Relaxation is helpful but not always the correct way to address the problem. Patients are angry and suppress their feelings. Others are struggling with bitterness and vindictiveness. When one suppresses feelings, they accumulate producing tremulousness and thus, anxiety. This can often be misconstrued as panic disorder. This writer has found that a psychodynamic approach, assisting patients with expressing suppressed feelings, often diminishing anxiety, and then great coping begins, e.g. patients can drive again, thus fears dissipate. Treatment of the WHOLE person in their entirety often brings about a great outcome that is long lasting and aids in general coping with life stressors.

Is it wise to weigh the sexual aspects of a relationship as a deal breaker? All too often one sees a cycle of conflict, fighting, and abuse followed by sexual intercourse. This is a temporary penance soon to be repeated in the cycle of conflict. Individuals are the product of their families. In our busy society with parents struggling to meet economic demands, the children are given Iphones and video games. This leaves the children developing with a lack of fulfillment of affectionate needs. The children grow into adults not knowing how to behave in intimate relationships. This points to the need for the couple working on conflict management, communication, forgiveness, humility and mutual respect. These building blocks ensure longevity and increase the quality in a relationship!

What do Aaron Hernandez, Michael Jackson and Bill Clinton have in common? They all were very accomplished individuals in their professions but succumbed to self-destructive behaviors which could also happen to any of us. Some self-destructive behaviors are the result of unconscious anger against the self. Other such behaviors are the result of risky behaviors. In some cases, individuals are stimulation seeking (such as Evil Knievel), which could result in horrific consequences. There are unfair accusations hurled at celebrities such as Michael Jackson. This author was interviewed on the Howard Gluss show about Mike. He suffered from depression and was a very lonely individual who had difficulty crying out for help. Despite his pain from being burned in the past, he continued to perform under a very demanding schedule. Unfortunately, he was being administered Propofol by Dr. Conrad Murray who did not appear to be an anesthesiologist. Moreover, why such a powerful drug usually given in the OR in this case where Mike was in his bedroom. This was such a tragic loss of a great entertainer. Doctors should have said no to more drugs and confronted Michael about the need to get treatment. Michael succumbed to self-destructive behavior, not addressing treatment for his pain, psychic pain, and depression. Instead, he chose to medicate himself with drugs. He really was a dual-diagnosis patient…substance abuse with a concurring psychiatric disorder. In the case of Bill Clinton, one sees the tendency of individuals to recreate past traumatic situations. As Freud termed it, the repetition compulsion was the tendency to repeat the trauma of the past. In the autobiography, “My Life,” there is mention of Clinton entertaining the idea of an encounter with another woman in his home while there was a party in the backyard. Moreover,his stepfather reportedly chased him around the house with a shotgun, thus he was a product of trauma. He placed himself in extremely precarious situations such as that with Monica Lewinski.

When individuals go for marital counseling, psychological testing can be of great benefit to uncovering the core elements of conflict. Parents who are threatened with the loss of child-custody can have a bonding study to asses whether it would be detrimental to split custodial arrangements. Parents of teens with suspected ADHD can obtain neuropsychological and cognitive testing. Students who are unsure of college majors or career choices can obtain career and vocational testing. Far too often, therapists have new patients come in and converse with them without objective data to assess the problems and solutions. This is such a waste of time and money. Patients should insist on an assessment that will focus on the problems and solutions.