It Takes a Village

“In the beginning, a lot of us thought we could do this alone. But as recovery programs such as AA, NA and CA prove; we just can’t. A great way people jump-start their recovery is through inpatient and outpatient treatments. These facilities (that can be independent or hospital run) are armed with people to help and guide you through a smooth and successful recovery. Offering therapies and skills that will offer you the chance to lead a happier life. I went to rehab at Gateway for a month and followed up with an intensive outpatient program. Now I have graduated that with over 65 days sober and seeing a therapist regularly (and of course finishing the 90 in 90!). It has been a long journey so far, but everyday I am reminded of my strength and perseverance. I will never give up on my sobriety because that means I would be giving up on myself. Something I never want to do again…” -Thank you, Robyn

Types of Recovery Programs

Not all recovery programs involve a inpatient stays. Some programs involve daily attendance and participation in group programs such as Narcotics Anonymous. Some types of treatments that might be available in your area are outlined below.

• Residential programs involve living in the treatment facility and attending groups, individual counseling and other activities. Long-term or extended programs usually last 90 days, and shorter programs require stays of 28 or 30 days.
• Outpatient rehab programs offer a number of options, often treating individuals for several hours a day over the course of a few weeks.
• Group support or therapy sessions can meet daily, weekly or at other intervals. This type of recovery program is offered by accredited facilities, volunteer organizations, churches and community centers.
• Individual therapy with a Board Certified Substance Abuse Counselor can be the appropriate treatment for some patients and may also be part of an aftercare program following a stay in a residential rehab program.
• Some addictions may require medical intervention, especially during the early days when physical withdrawal symptoms can be dangerous for the person attempting to become sober.

Who Should Consider a Rehab Program?

No simple formula exists for providers or patients to determine who should attend what type of drug treatment program. Drug addiction is not a simple issue, so you should ask for assistance from experienced medical or behavioral health professionals to design a treatment plan that is right for your situation. Trying drugs just once does not necessarily indicate an addiction. On the other hand, being unable to say no to substances, taking extreme actions to obtain drugs or finding yourself frequently taking drugs may indicate a need for treatment for drug and alcohol recovery.

Important Information for Effective Treatment

Research over the past 40 years has consistently identified some key information that has helped build effective treatment programs. It is important to understand the following drug recovery information.

• Addiction impacts the function of your brain, which can alter your behavior. Guilt associated with drug-related behavior often keeps people from successful addiction recovery, but you need to be able to separate how you act on drugs from how you want to act.
• Successful treatment programs provide for all aspects of a person’s life, not just a specific addiction. Learning new skills and sharing emotional troubles may help with recovery.
• It is essential that you remain in treatment and comply with follow-up care. Drug addiction is a chronic disorder; some doctors have even compared addiction with asthma or hypertension. You would not stop taking your asthma medicine if it was helping to control symptoms.
• Drug addiction is often closely related to mental illness. A rehab program that can deal with adual diagnosis is essential in these cases.
• Treatment plans should be reevaluated and altered on an ongoing basis to seek continuous improvement. In most cases, the individual struggling with addiction should have the opportunity to provide some feedback.

When you are looking for a drug recovery treatment center, keep the above information in mind. You may also want to ask for a referral or request information about outpatient and residential rehabilitation programs from a counselor, social worker, doctor or psychiatrist.

Aftercare is Essential for Success

One thing that causes people to fall off the wagon after completing a recovery program is noncompliance with aftercare. Some people believe that drug addiction can be treated similarly to a traumatic injury such as a broken arm. The arm is set and it heals, the cast is removed, physical therapy is scheduled and life eventually returns to normal. In most cases, drug addiction cannot be approached in such a manner. Someone struggling with an addiction can appear to heal, only to relapse months or years later because of the chronic nature of the problem. Because of this, following aftercare recommendations, including involvement in group or individual counseling, is essential.

Compiled by Recovery.org

Film Pick: Drug Abuse, Mental Illness and Co-Occuring Disorder

“This is a a great old video that offers a lot of information regarding substance abuse and mental illness. It brings up questions like, “Which came first?” This is a common topic many people struggling with co-occurring disorders ask. The speakers and stories shared in this film explore topics like those and many more. Go ahead, get educated and take an hour to learn something new!” – Robyn

Panelists:
Patricia Ordorica, MD – Associate Chief of Staff, Mental Health & Behavioral Sciences Central, James A. Haley Veterans Administration Hospital; Associate Professor Dept. of Psychiatry & Behavioral Sciences, University of South Florida College of Medicine; Director Addictive Disorders Department of Psychiatry & Behavioral Sciences, Univ. of South Florida College of Medicine. Deirdre Forbes – Intake Coordinator for Madison East, part of Mount Sinai Hospital in New York. Ms. Forbes is in recovery from a co-occurring disorder.
Hosted by:
Mary E. Larson, Vice President of Communications and Membership for CADCA

Your Recovery Checklist

“I will be using this great checklist I found from addictionandrecovery.org to inspire the rest of this weeks post. Checkout how far you’ve gotten in your recovery and how much further you can take it down the road.” -Shanti, Robyn

A list of important goals for the first year of your recovery. Use it as a reminder and to help you stay on track in the days and months ahead.

🔹Accept that you have an addiction
🔹Practice honesty in your life
🔹Learn to avoid high-risk situations
🔹Ask for help
🔹Practice calling friends before you have cravings
🔹Become actively involved in self-help recovery groups
🔹Go to discussion meetings and begin to share
🔹Get a sponsor and do step work
🔹Get rid of using friends
🔹Make time for you and your recovery
🔹Celebrate your small victories.
🔹Recovery is about progress not perfection.
🔹Practice saying no
🔹Take better care of yourself
🔹Develop healthy eating and sleeping habits
🔹Learn to relax and let go of stress
🔹Discover how to have fun clean and sober
🔹Make new recovery friends and bring them into your life.
🔹“Play the tape forward” to deal with cravings
🔹Find ways to distract yourself when you have cravings
🔹Deal with post-acute withdrawal symptoms
🔹Develop a strategy for social settings where drinking is involved
🔹Thank the supportive people in your life.
🔹Develop tolerance and compassion for yourself and others
🔹Say goodbye to your addiction
🔹See yourself as a non-user

What a Wonderful World by Louis Armstrong

Who doesn’t love this song? Its a fabulous song for anyone, in and out of recovery. Just remind yourself of all the beauty in the world by giving this song a listen. Lyrics are on the video, enjoy!

How To Break Any Bad Habit

“I just read and fell in love with this article from Mind Body Green and had to post it for you all! Enjoy!” -Love, Robyn

Learning to understand the self is a lot like stirring water in a glass. If we don’t stir, sentiments stay at the bottom of the glass and our water stays polluted.

Take a simple goal: Eat better.

For me, eating always starts with a craving. It’s rarely because I’m hungry. Usually I eat out of boredom. Or, on a deeper level, maybe loneliness.

First, the feeling. Then filling that feeling with food.

I imagine what I’m craving. Pizza. I see it. Feel it. I taste the crust and the cheese, and I know exactly where I’d go to get it. I see myself driving there and sitting in the booth eating it. (I am an extremely visual person. In this case, it’s not to my advantage.)

Then I become obsessed with this image. Inner conflict begins. Desire vs discipline, Want vs need. I start to reason with myself.  I work out hard. I deserve this. It’s not a big deal. What’s a slice? I need to get out of the house anyway.

Reasoning turns into deals. Okay, one slice but I’ll get a salad.

It’s on. The fantasy becomes a reality. I’m now actually sitting at the pizza place. And of course, I always break the deal I made with myself. Three slices and no salad. I eat until I’m stuffed. The Addict, The Liar, the Pseudo Self wins again.

On the way home, I feel guilty about myself and the pizza is never as good as I imagined it.

If I take this process and apply it to other areas of my life, is it the same? Dating? Relationships? If so, are the consequences and feelings the same?

Study patterns in your thoughts and behavior around fitness and nutrition. Chances are, they’re the same patterns you apply to other areas of your life. Maybe you maneuver in extremes: Win or lose. If so, do you apply that to work, love, etc.?  Do you use food or exercise to reward and punish yourself? If so, do you use work and relationships to reward or punish yourself?

Filtering your cloudy water means breaking patterns you believe are unhealthy. The more you are able to break unhealthy patterns, the cleaner your water will be.

Now, if you’re able to get stronger at rewiring your thoughts and behavior with food cravings and exercise habits, including all the fears you hit while working out, can you apply those new muscles to breaking patterns in other areas of your life?

I believe you can.

Here’s how.

1. Know what’s triggering your behavior.

Usually it’s from a feeling.

For me, it was boredom and loneliness.

Pizza was a way of coping or numbing that feeling.

Being aware is the first step.

2. Force yourself to change that behavior.  

There will be an internal fight and it will be difficult. But this is where the road can fork. Give yourself other options. I could go on a walk. See a movie. Write. Any behavior that’s different, even if it’s only slightly more healthy. The goal is just to break it. You may not succeed in the beginning. It takes lots of practice. But eventually, if you keep at it, you’ll get stronger.

Next time I have a feeling that triggers me, I’ll walk around the block and maybe reward myself with fruit, juice, or even a protein bar instead of stuffing my face at a pizza joint.

Now, in relationships, something will trigger the same feeling. You may get into a fight and feel unheard, angry, lonely, etc. Think about your bad habit (your “pizza”) in relationships…  Is it to shut down or explode? Well, you can apply the process above to change that behavior, too .

3. Identify the feeling that triggers your behavior. 

What’s the feeling? Feeling hurt, unheard, lonely?

4. Focus on addressing that feeling. 

 

Maybe you talk to a friend. Go for a walk. Stay and talk it out. Journal. Call your brother. Exercise? Whatever. Just make sure it’s more healthy. Know that you can do this because you did it with the eating and it will work the same.  Remember the results you got from breaking the bad eating behavior and trust that process.

If you’re afraid to do something in the box or at the gym, but you overcome that fear and by doing so, see results, that revelation – that you can overcome a fear and see results can now be applied to confronting your boyfriend, boss, or parents.  You may believe one has nothing to do with the other.  On the surface, true.  But fear is fear.  And no matter what door you go in or how you tackle it, the more you conquer it, the more you will be able to conquer it in other areas of your life.

Once you prove to yourself that you can do something you were afraid of, that PROOF – belief – will spill into other areas of thinking.

Imagine fear as the black and white image in a coloring book. The more you color, the more the fear disappears. It doesn’t matter where you start or how you do it, all that matters is that you keep coloring. And the more you color, the more that page will come to life.

So it doesn’t matter if we’re talking about eating better or facing workouts you never thought you could do. Keep stirring to get that water cloudy so that you can then break patterns – filter that water clean in all areas of your life.

Take Five

Sure enough(she really should’ve known) when it came to going up, she would come down. This rapid cycling has been going on for about two weeks now. Today she spent the whole day laying in her bed crying. Going over all the insanity she had experienced six months prior when she was in India. Every time she managed to stop, she burst end out in tears again. She decided to make some calls. After several failed attempts she finally reached a girl she had met in rehab.

Amy had been a good friend from the start. At the age of 19, with it being her first time in rehab, she had more in common than most of the other girls. They spoke about their dreams of travel and made up a master scheme to backpack around the US with all the money they would save in sobriety. But those dreams were about to be shattered… 

The moment she picked up her words formed in an endless stream, overwhelming Amy on the other line, “Hi! How are you!? I’m terrible, I don’t know what’s going on I’ve been crying non-stop and I just don’t know why I think its a bipolar flare up or something I know you don’t have bipolar but I just thought I’d see how you were doing I just need to talk to someone! How are you?! What are you doing?!” 

It didn’t take long for Amy to come out with her guilty truths. She had relapsed and judging on her tone and lack of inspiration, she wasn’t coming back just yet. She explained how she had ODed… 

Amy listened as she began to cry for her. “Oh! No! I feel like I want to relapse now! How could you? What’s going on? What made you relapse?!” 

Amy immediately replied, “No! Don’t relapse too, be strong! It’s just tough for me, so many things have been going on, I just can’t control…”

Ahh, but there lies the problem. Amy thought she had to control this. But that’s not it. Give it to your higher power. That’s what I’ve learned in NA and AA. It took her another phone call to a member of NA, Ryan, before she realized this. After that call she had prayed so hard she though God would get annoyed.

Ultimately it took her a long walk, a couple more calls before she was able to calm herself down. One girl, Tay, told her firmly that everything passes. Tay may not struggle with bipolar disorder but if there is anything she knows how to do, its lift people up when their down. When she hung up with her she felt empowered enough to get out of the house and keep her mind busy. Though that was another faulty idea, as her sister, Jacquelyn, pointed out. 

“You need to face your thoughts, not just dismiss them and burry them in your heart. You can’t escape from yourself or you disorder. You have to learn to live with it. It may not be who you are but it will always be apart of you.” Jacquelyn told her.

She found all of these people so gracious and understanding. She knew again– because she needed reminding– that she was loved and not alone. 

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P.T.S.D. And Childhood Trauma Linked to Addiction

“This is a wonderful article that focus’ on P.T.S.D that can develop from childhood trauma and how it is linked to Addiction. I may not have experienced much trauma due to my up-bringing but I can fully understand the diagnosis of P.T.S.D after I was faced with the traumatic experience of an extreme manic outbreak while I was living abroad in India. Its hard not to think of something so dramatic everyday and live in extreme regret and torture from the memories. I hope your able to find as much appreciation for this problem and its connections to addiction recovery as much as I have.” -Love, Robyn

by Kevin VaLeu

We live in an addictive age. In the last five years of my life I have come across and counseled more people struggling with cocaine, marijuana, alcohol, anorexia, sex, and a whole host of other addictions then I did in the previous five years.

Are people becoming more immoral? Or is there something else causing people to turn to substances and sex. Perhaps these next statistics will shed light into what I believe is the underlying causation of our culture’s craziness.

1) The turn of our century (2000) marked the first time in American history that the majority of our children (over 50%) were raised without both biological mother and father in the same home.

2) Even if both mother and father are in the home it doesn’t mean they are in any better shape if they are being abused or neglected. 61% of all children experience some form of neglect.

3) Greater than 1 out of 3 girls will be sexually molested during their childhood or teenage years.

What does this mean? We live in a day and age where children are experiencing trauma at unprecedented levels from molestations, abuse, abandonment, neglect, and dysfunctional or fragmented homes. When traumatized children slip under the radar of effective treatment they will find illegitimate, illicit and unhealthy coping mechanisms to medicate the long unforgotten pain.

Link Between Trauma and Addictions

Research shows that 50-60% of women and 20% of men in chemical dependency programs report a history of childhood sexual abuse. When you include people that have experienced P.T.S.D. (Post-Traumatic Stress Disorder) or childhood trauma the number can climb as high as 99% of them having substance abuse problems.

How Trauma Affects the Brain

In order to understand how trauma makes one more susceptible to addictions, we need to understand two types of memories at work in the brain: 1) Explicit Memory–this is a memory that we can deliberately call up or put away at any time. We have a sense of control over it and we know it is just a memory; 2) Implicit Memory–these memories have coded in them not only a picture of a past event but the resulting feelings, sensations, and emotional response that went with it. These memories happen outside our control.

These memories are adaptive or automatic, which means they can “pop up” or shoot into our minds involuntarily upon some stimuli or current event that reminds us of a past trauma (called association). This is why a current event can trigger a flood of negative emotions that are identical to the emotions we felt at the time of the trauma. In fact, this is why people with PTSD are continually being tortured from their memories because when something “triggers” their past they are actually reliving the painful past trauma over again. Its no longer just a memory they recall, its all the emotions, feelings, and sensations engraved upon that memory card they recall and relive in the present.

This is why many Vietnam veterans with PTSD experience such painful flashbacks. They aren’t just remembering the past, they are actually reliving it. The bomb they see coming at them in their memory is a real bomb coming at them right now.

In addition, as we grew up, all of our basic assumptions about people (e.g. can they be trusted), ways of relating, and behaving towards people are formed on these implicit memory cards. This explains why you get tense or tighten up at the bank whenever you run into a particular man that reminds you of your cruel step-father.

In order to successfully treat a person with PTSD they have to be guided to convert their implicit memories into explicit ones.

Trauma is Recorded in the Limbic System which sits on the Vegus Nerve.

An interesting physiological discovery is that our traumatic memories are housed in our limbic system. This might not mean much if it weren’t for that fact our limbic system is on top of our Vegus Nerve. When the vagus nerve is stimulated by pain, fear, other distresses, and at an extreme, fainting may occur since such stimulation of the nerve affects the pace of the heart. Such stimulation also causes nausea and cool, clammy skin.

Its now easy to see how memories not only affect our emotions but also our physical bodies.

Emotional Disregulation & Tension-Reduction Behaviors (Addiction):

When an implicit memory is jarred the body automatically releases the hormones of cortisol and adrenaline to give it power or enable it to go into the “flight” or “fight” (emergency) mode. However, for a person that has experienced emotional trauma, there response mechanism is a bit different. When a person with PTSD has their “flight” or “fight” system alerted they experience the current stress at a visceral or guttural level (soul depth) and have to shut down the hippocampus. Similar to a computer that is slowed down by too many programs running in the background, the mind shuts down certain parts (in this case the hippocampus) because it is too difficult to run it while in emergency mode. Implicit memories can cause one to live in a constant state of being overwhelmed. Past traumas that induce implicit memories also damage mood regulation. It is easy to see how the extra strain on a brain from trauma would affect our ability to stay an even keel.

When the mind tries to remember what has happened during a traumatic moment a person experiences emotional disregulation. There are three coping strategies a person may employ in dealing with emotional disregulation:

1) Avoidance: A person doesn’t want to talk about the trauma, think about the trauma, or be around anybody or anything that reminds them of the trauma.

2) Dissociate: They disconnect from reality which, without realizing, turns off the integrative links connecting the pre-frontal cortex to the limbic system. This means one disconnects from their experiences, which on the one hand helps them escape from the painful anxiety that would normally come, but on the other hand is detrimental from an emotional stand point. You lose the ability to feel anything through this numbing process; even the ability to empathize for others. This is damaging to the psyche.

3) Tension-Reduction Behaviors (leads to Addictions): When trauma occurs the brain fires up, becomes overactive and makes a person feel they cannot deal with it without the aid of some type of pleasure to “settle things down.” This is the point where a person may turn to drugs, alcohol, sex, gambling, etc. It is here, at this stage of the process, that lends itself toward addictions.

The Missing by Deerhunter

I absolutely love Deerhunter, they have been my favourite band for years and it wasn’t until I heard this song in recovery that I was able to get a different perspective on it. Lately I’ve really been really having to give up my control over problems to my higher power, letting them go so I can move on with my day in acceptance and serenity. This song reminds me that my higher power has the answers and everything will pass with time. Concerns of my thoughts that race and drag me down on tough days don’t have to rule my life if I don’t let them. I can ask my Higher Power to show me the meaning to the mess of life I have created and show me “the missing.” Check it out!

Lyrics:

Open up my thoughts
tell me if you see
some meaning.
Take me all apart.
So that I can see
the pieces.

And I could walk for miles.
And on every street
is the same scene.
Follow the telephone wires
until i feel this air beneath me.

Oh and if you don’t mind,
would you show to me
the missing?
With my weak eyes
I would only see
the missing.

Open up my thoughts
Tell me if you see some meaning.
Take me all apart,
So that i can see the bleeding.

Oh if you don’t mind,
could you show to me
the missing?
With my weak eyes
I would only see
the missing.
The missing.
The missing.
The missing.
The missing.
The missing.

And I would understand
(I could understand)
if you show to me
the missing.

And I could understand
(I could understand)
if you showed to me
the missing.

And I would understand
(I could understand)
if you show to me
the missing.

Take Four

Yes. It may be two in the morning and she may be up right now. But she simply can’t sleep. She tried and succeeded for a couple of hours only to arise completely awake. She had taken more melatonin and yawned a couple times, but still no luck. She has tried watching a bit of television, having a snack and painting for a while… Nothing. Her thoughts are racing, her eyes are shifting and she cant stop rocking. What does all this mean? I’ve been taking my meds, eating, working out and sleeping for long hours. I haven’t done anything to promote this, Im done with that childish fantasy of mania as I expressed before. She did have coffee earlier but she couldn’t imagine that the caffeine from then would have lasted this long. That must have been over twelve hours ago. None of this made any sense. She reviewed her day. It was productive. Up until she took her PM meds ,which made her feel groggily and irritated, she had had a very good day. No pressures of her addiction from outside sources, just a light and easy day spent walking around town and lounging in the coffee shop. Nothing to offset any sort of manic state! She took a drag from one of her moms cigarettes. There was nothing to do now but wait for some sort of signal from her brain that told her it was time to sleep.

The time to sleep would never come. Instead she would paint until the sun would shine, then she would step outside and take a brisk walk around her favourite place in her hometown.
There was a park located two blocks from her house where a black paved path directed her to a wooden bridge over a quite creek. She would place herself directly in front the creek as it encircled a lonely island. Today was unlike any other day she had visited this place. Today there were countless geese. Maybe thirty, maybe less, maybe more. It really didn’t matter. She glares up at the sky and sees a blanket of grey clouds floating quickly to reveal a clear blue hue. She smiles. Today is going to be a great day.

So far it had been a good day. After looking up the closing times to all the local coffee shops she came to the conclusion that she had to settle with Starbucks. Still not having bought anything she sits on the bare side of the room staring at her reflection on the crayon-streaked window. Only this time she doesn’t care how they got there. Instead of the usual dabbling of her mind, she is at ease. She feels drowsy having just taken her medication and slightly restless; wanting-to-roll-around-on-the-floor kind of feeling. Her eye lids dripped down her cheeks trailing the dark circles that had formed. Her eyes were dilated and her head was spinning. She wanted to take a moment to gather her thoughts. All she could think was this is crap. It’s all a load of crap. There’s no reason to be writing now, there is nothing to write about! But of course there is something to write about. But she simply was not excited about anything that happened today, even though quite a lot of exciting things did happen.
Her giddy humour brought her dancing through the Target store with one of her friends from NA. She remembers walking through the toy section and seeing a jesting display of miniature houses– she couldn’t help but touch it. The moment she did, BAM! The entire case lit up in an array of colours from pink to blue. She jumped up and laughed so loud that another man in the aisle couldn’t help but join her. OH MY GOD, it spins! She blurted out as she began to fiddle with the contraption that made each house go around to reveal the masterpiece in all of its angles. Her friend pulled her away, speaking softly to calm down. She breathed deep. The rest of the adventure was spent pointing out different items; unique or not, they all enthused her.
She then spent several hours visiting her dad, putting a smile on her face and admitting to her current state. But I feel fine. But that’s just the problem isn’t it? A normal person wouldn’t feel so fine after no sleep.

DBT in Recovery

Dialectical behavior therapy (DBT) is a relatively new treatment method that has shown promise for treating both substance abuse and even the most difficult mental health concerns. Targeted dialectical behavior therapy programs work especially for those who:

• Suffer from trauma, life-threatening experiences, abuse or loss
• Try traditional therapy with limited success
• Struggle with co-occurring addiction and mental health concerns
• Struggle with bipolar disorder, an eating disorder, PTSD or borderline personality disorder
• Struggle with self-injury, self-harm or low self-esteem
• Are an adult child of an alcoholic or suffered abuse or trauma as a young person
• Have difficulties coping with emotions or feel that your emotions are overwhelming

How Is Dialectical Behavior Therapy Different?

Dialectical behavior therapy was developed by Dr. Marsha Linehan, a renowned psychologist at the University of Washington. Dr. Linehan specializes in hard-to-treat patients. She found that traditional methods of therapy were not effective, and as a result she developed DBT.

DBT is different, as it does a few things that traditional therapy does not. DBT helps you deal with complicated emotions without putting you “on the spot.” DBT has two types of sessions that include a classroom/group environment and individual therapy sessions. These two types of treatment sessions work together to help you feel more comfortable about the treatment process. DBT provides real-life skills to help you recover from addiction and identify and help yourself get through difficult life moments. Dialectical behavior therapy is different from traditional Cognitive Behavioral Therapy in the following ways:

• DBT works like a class, as you learn more about yourself and how you relate to others
• DBT accepts you as you are and does not pressure you to become someone you are not
• DBT works to help you accept hardships and handle trauma and conflict more effectively
• DBT helps you regulate and control your own emotions
• DBT gives you the skills to release anxiety and live a life you want to live

What Are the Goals of Dialectical Behavior Therapy?

Dialectical behavior therapy helps you become more present, mindful and at peace with the world. By combining Buddhist principles with traditional psychotherapy and life skills, DBT works to help patients in the following four core areas:

• Emotion regulation: Helping patients learn how to manage mood changes and impulsive decisions naturally
• Distress tolerance: Teaching patients how to cope with trauma, distressing feelings and reactions
• Mindfulness: Learning how to observe the situation and accept yourself and others as they are, and learning how to enjoy life just as it is and not how you would like it to be
• Interpersonal effectiveness: Helping patients cope with difficult situations and difficult people to create healthy boundaries and build happier relationships