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The holiday season brings with it a sense of togetherness and shared moments with family, but it can also pose challenges, particularly when presented with difficult family situations. In addition to planning for celebrations and connection, it's valuable to acknowledge potential stressors and challenges that may arise. If you are finding some family situations hard to manage, it's important to explore setting healthy boundaries, coping strategies for regulating mood and behavior, as well as effective strategies for maintaining your well-being during family gatherings. Striking a balance between fostering the joy of the holidays and preserving your own well-being is key. 
 Coping Tools for Dealing with Difficult Family Members Navigating difficult family dynamics requires coping tools. Practicing mindfulness and developing emotional resilience can help you manage challenging interactions. Some tips I like to provide my clients with during this time of year are the following:  Come up with comfortable boundaries (I will go into this more shortly) Identify your support system, whether that is someone in the house with you or someone you can reach out to to express feelings as needed. Check in with your emotions and mood regularly and take breaks from conversations if and when it becomes overwhelming.  Avoid controversial topics  Pro tip: Picture a gray rock (It is simple, boring, and uninteresting). Use this style of conversation when interacting with someone you do not wish to become engaged with.  Excuse yourself when you need to. There's nothing wrong with stepping out for some air. Pro tip: Explore a code word or phrase that can be used to notify someone else that you are feeling elevated and would like them to exit with you for a brief period of time. Set realistic expectations to avoid frustration or disappointment  Adjust your mindset and only focus on what is presently in your control-  not  what you believe can or may happen. Use grounding techniques and deep breathing to redirect yourself away from unhelpful thinking.  Avoid remaining present in stressful or triggering situations Listen: give off what you desire to receive in return and just maybe your efforts will be met in kind. 
 Ideas for Healthy Boundaries with Family Members Setting healthy boundaries and limits in interactions with family members is vital for maintaining positive relationships and ensuring your well-being. Remind yourself when exploring possibilities that boundaries are not a set of rules you impose on others, but rather the standard to which you hold yourself. You might consider the following ideas to establish clear and respectful boundaries: 
 Clear Communication: Clearly express your needs and expectations about personal boundaries. You may even want to plan out what you will calmly and kindly communicate if someone crosses a boundary.
 Limit Invasive Questioning: Set limits on personal questions or topics that make you uncomfortable, steering conversations toward more neutral subjects (picture that gray rock).
 Balanced Time Together: Find a balance between spending time together and carving out personal time, time for your usual routine, and healthy breaks. Establishing clear time frames for family activities can help manage expectations.
 Define Personal Space: Clearly communicate the need for personal space, both physically and emotionally. This includes respecting privacy and individual decision-making.
 Consider What you Plan to Agree to: Don't let guilt drive your decisions- Before you say “yes” to an ask or obligation, consider your motivation for doing so. Will it make you genuinely happy, or do you think it will make you look good?
 Establish Gift-Giving Guidelines: Discuss and agree upon guidelines for gift-giving to manage expectations and avoid unnecessary stress. Consider setting a budget or opting for meaningful experiences over material gifts.
 Communicate Expectations for Holiday Traditions: Share your expectations regarding holiday traditions, gatherings, and celebrations. Clearly outline what activities are important to you and discuss compromises if needed. Remember, healthy boundaries are a two-way street. Encourage open communication within your family and be receptive to the boundaries set by others. This approach fosters mutual respect and contributes to a more positive and enjoyable family dynamic. 
 Setting Boundaries for Self-Care Amidst the joy and festivities of the holiday season, it's crucial to prioritize your mental and emotional well-being as this time can also be fast-paced and demanding for many. Setting boundaries for self-care not only ensures that you have the space to recharge but also allows for better emotional regulation and contributes to a healthier and more enjoyable family experience. Here are some ways to establish boundaries for self-care:
 Create a Self-Care Plan: Develop a self-care plan that includes specific activities and strategies to manage stress. Plan to engage in self-care before, during, or after gatherings, as needed. Define Personal Retreat Spaces: Designate a specific area where you can retreat when you need a moment alone. Establish Alone Time: Clearly communicate your need for alone time to recharge. Set realistic expectations regarding when you will take breaks. Communicate Emotional Needs: Express your emotional needs openly and honestly. Encourage family members to be understanding and supportive of each other's emotional well-being. Prioritize Self-Care Activities: Identify self-care activities that bring you comfort and relaxation. Schedule time for these activities, whether it's reading a book, taking a walk, or practicing mindfulness. Delegate Responsibilities: Share responsibilities during family gatherings to prevent feeling overwhelmed. Delegate tasks and encourage a collaborative approach to reduce individual stress levels. Set Technology Boundaries: Establish boundaries around your use of technology to promote in-person connections. Designate specific times for checking emails or messages to avoid constant digital interruptions. Respect Your Energy Levels: Acknowledge your energy levels and communicate when you need to take breaks. Be honest about your capacity to engage in certain activities and avoid overcommitting.
 Remember that setting boundaries for self-care is not selfish; it's an essential aspect of maintaining your overall well-being. Communicate your needs openly and encourage a supportive environment where everyone's self-care is respected and prioritized. 
 What to Do If Family Members Do Not Respect Boundaries Many healthy people understand the importance of setting personal boundaries and the positive effects of doing so. Often, the people who get upset about you setting boundaries are those who do not set them themselves, or the ones who were benefiting from you not having any. In situations where family members do not respect your boundaries, reaffirm them calmly and respectfully. Seek support from other family members or a friend who can validate the importance of your needs. If repeated boundary violations continue to happen despite reinforcing the importance of mutual respect, consider the outcome of walking away versus defending or asserting yourself, and seek to take care of yourself either way. 
 Conclusion In fostering healthy boundaries with family, open communication and mutual understanding are most important. As you navigate the holiday season with your loved ones, may these strategies contribute to a harmonious and fulfilling experience for all. 
 If you are struggling to cope with family members who are not respecting your boundaries and want to speak with a mental health professional, reach out to Heritage Counseling at 214-363-2345 to set up an appointment. Our team of talented clinicians can help you establish healthy boundaries, walk through coping tools, and provide insight into difficult family interactions in an unbiased way.  

Nurturing Healthy Boundaries:  A Guide to Harmonious Family Relationships

What is Autism Spectrum Disorder? Autism Spectrum Disorder (ASD) is a developmental disorder that is most commonly identified at an early developmental age, or once social demands become more prominent within a child's life. Given the range of the spectrum from mild to severe, many adults may go through life feeling out of place, wondering if they qualify for a diagnosis.  



 What should I be asking myself to determine if I or someone I know may have Autism? If you're not sure of the symptoms of autism (and I will map them out more in-depth below), you may want to consider the following questions:  
 For  children  considering ASD testing:  Did your child struggle to reach developmental milestones (speech, crawling, walking) at a typical rate? Does your child exhibit atypical social behaviors (avoids eye contact, prefers to play alone, does not respond to their name or facial expression)? Does your child display any repetitive habits, fixations, or unusual routines? Does your child have difficulty coordinating body movements? Does your child display any particular sensory interests or dislikes? For  adults  seeking ASD testing:  Do you often feel you do not fit in with others or feel “different”? Do you struggle in interpersonal relationships? Do you have difficulty appropriately participating in conversations? Do you like things done a specific way or have rigid interests? Do you find that you need specific instructions to understand what others expect of you? 
 
 What are the DSM diagnostic criteria for Autism Spectrum Disorder?  In simple terms, to receive a diagnosis of Autism, a child or adult must display deficits in the following two categories which disrupt social, emotional, and cognitive development:  Persistent deficits in social communication and social interaction across multiple contexts  Restricted, repetitive patterns of behaviors, interests, or activities in at least two instances Diagnosis is broken down into three possible severity levels: Level 1, “Requiring Support”, Level 2, “Requiring Substantial support, and Level 3 "Requiring very substantial support” Full DSM-V diagnostic criteria can be found  here. 


 Do online tests for autism work? If the questions above sound like you, you may have considered taking an online test to assess for Autism Spectrum Disorder. These “screening measures” have become increasingly popular and while online tests can provide insight into behaviors as well as some insight, it is important to recognize that they are self-assessment tools that often consist of questionnaires or checklists that assess common autism-related traits and behaviors and are in  no way   a valid substitute for a professional evaluation and diagnosis!  
 Online tests for autism can provide a preliminary indication or raise awareness about potential symptoms, but they cannot provide a definitive diagnosis. Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that requires a comprehensive evaluation by a qualified healthcare professional, such as a psychologist, or psychiatrist, for an accurate diagnosis. Given the strict criteria and the level of observation and evaluation it takes to support an Autism Spectrum diagnosis, there is  no way  an online tool could be definitive in determining an accurate outcome. 
 So in short, no, online tests are not sufficient indicators for autism in my professional opinion.  



 I think I or my child may have symptoms of Autism. Should I consider getting an Autism Evaluation through a school or receiving an evaluation from a doctor? The evaluation process for autism can vary depending on whether it is conducted by a school or a private clinician. It's important to note that while school evaluations can provide valuable information within an educational context, they are not always sufficient for a comprehensive diagnosis or to provide a detailed understanding of an individual's strengths and challenges. Private evaluations, conducted by qualified professionals, offer a more in-depth assessment and can provide a broader perspective on the individual's needs.  Here are some key differences: Diagnosis Vs. Eligibility School evaluations:  Evaluations primarily focus on determining eligibility for special education services and developing an Individualized Education Program (IEP) or a 504 plan. The goal is to identify educational needs and develop appropriate interventions within the school setting. The Individuals with Disabilities Education Act  (IDEA) has defined  14 eligibility categories for IEPs , one of which is Autism. Schools cannot give your child a diagnosis of autism; they do not have the authority to do so. Instead, they evaluate children to determine if they fit the eligibility criteria for any of the specific categories. Private evaluations:  Provide a broader, more comprehensive diagnosis and understanding of autism for various purposes, including accessing therapies, seeking medical interventions, or obtaining accommodations both inside and outside of the school setting. These more detail-oriented evaluations will assess multiple domains, including social communication, sensory processing, cognitive abilities, and adaptive functioning, to provide a comprehensive picture of the individual's strengths and challenges. The Team School evaluations:  School evaluations typically involve a multidisciplinary team within the educational system, which may include school psychologists, special education teachers, speech-language pathologists, and other relevant professionals.  Private evaluations:  Often conducted by clinicians specializing in neurodevelopmental disorders, such as psychologists or psychiatrists, who have expertise in diagnosing and assessing autism. Evaluation Tools School evaluations:  Use standardized assessment tools that are specifically designed for educational purposes, focusing on identifying academic and functional needs.  Private evaluations:  Utilize a wider range of assessment tools, including standardized measures, clinical interviews, observations, and parent or caregiver input, to gather information about the individual's developmental history, social interactions, communication skills, and other relevant areas. 



 How is autism tested for adults and children?  At Heritage Counseling a typical Autism Evaluation for children or adults consists of: 4-5 sessions, each 3-5 hours in nature.  Each appointment consists of 30 minutes of observation to start, one or two independently, one with each parent or guardian, one with a stranger, and at times one with a sibling. Utilization of two in-depth ASD evaluations: ADI-R: A diagnostic interview that seeks to develop an understanding of developmental, health, social, communication, and play, both past and present. ADOS: An observation schedule that consists of multiple structured presses which challenge the individual being tested in multiple scenarios and is later coded.  Intelligence (IQ) testing, achievement testing, behavioral testing, adaptive functioning, language, visual, gross motor, and fine motor all included in the evaluation.  These additional tests serve two functions, 1. further support an autism diagnosis and provide valuable insight into additional strengths and weaknesses as well as ways to best support the client moving forward, and 2. If an autism diagnosis is not supported, provide further answers into social, emotional, and developmental functioning to a client who is clearly struggling in one of those areas given the need for an evaluation.  



 Once receiving a diagnosis of Autism Spectrum Disorder, what will treatment look like? The treatment plans for individuals who are diagnosed with autism, whether adults or children are typically individualized and tailored to the specific needs and challenges of the person. The treatment approach may involve a combination of various interventions and therapies. Ongoing monitoring, evaluation, and adjustment to the treatment plan are typically necessary to address changing needs over time. The following are commonly used approaches to treatment plans for individuals diagnosed with Autism Spectrum Disorder: 
 Cognitive Behavioral Therapy (CBT):  Addresses specific challenges related to cognitive processes, emotions, and behaviors through multiple approaches.  Cognitive restructuring:  Helps individuals reframe thoughts and develop more adaptive thinking styles regarding social interactions, sensory experiences, and self-perception. Emotional regulation:  Individuals with autism face challenges with understanding and regulating emotions. CBT will assist in recognizing and labeling emotions, developing strategies to manage intense emotions, and promoting appropriate self-regulation. Problem-Solving Skills:  CBT uses proving solving skills to develop strategies to address everyday challenges. This may include breaking down complex tasks into manageable pieces, developing alternative solutions and displaying cognitive flexibility, and evaluating outcomes of different strategies. Social Skills Training:  Focuses on teaching specific social behaviors, understanding social cues, and improving social interactions overall. It may involve role-playing, modeling, and providing feedback. Anxiety and Stress Management:  Many individuals with autism experience anxiety or high levels of stress in certain situations. CBT can help identify triggers for anxiety or stress, develop relaxation techniques and learn coping skills to manage big feelings effectively.  Generalization of skills:  CBT aims to facilitate the generalization of skills learned in therapy to real-life situations across the lifespan. This involves practicing and applying the strategies and techniques learned in therapy sessions to various contexts and settings. 
 Behavioral Therapies:  Applied Behavioral Analysis (ABA) is a widely recognized and evidence-based therapy for autism. It focuses on increasing desired behaviors and reducing challenging behaviors through systematic reinforcement and shaping techniques. ABA is often provided at home, or at a private facility.  
 Speech and language therapy:  Many individuals with autism experience difficulties in communication. Speech and language therapy aims to improve communication skills, including language development, speech clarity, social communication, and pragmatic language skills.  
 Occupational Therapy:  Occupational therapy addresses challenges related to sensory processing, motor skills, and daily living activities. It helps individuals develop skills necessary for independent functioning and enhances their ability to participate in daily activities.  
 Educational Support:  For children , special education services and individualized Educational programs (IEPs) can provide tailored support within the school setting.  For adults , continuing education and vocational training programs may be beneficial in developing skills for employment and independent living. 
 Medication:  In some cases, mediation may be prescribed to manage specific symptoms associated with autism, such as anxiety, attention difficulties, or aggression. Medication decisions should be made in consultation with a qualified healthcare professional. 


 Next Steps  If you suspect that you or someone you know may have autism, it is important to consult with a healthcare professional who specializes in diagnosing and treating autism. They will conduct a thorough assessment, which may include interviews, observations, and other standardized tests, to make an accurate diagnosis. Heritage Counseling & Consulting is currently offering a 30-Minute free consultation to discuss what  Autism Spectrum Disorder testing  includes and will determine if the client is a good candidate for testing moving forward. Please call 214-363-2345 to schedule. 
 Resources: https://www.autismspeaks.org/autism-diagnosis-criteria-dsm-5 https://www.verywellhealth.com/online-tests-for-autism-5198481   https://www.medicalnewstoday.com/articles/autism-online-test   https://www.elemy.com/studio/autism-diagnosis/online-vs-in-person/   https://adayinourshoes.com/autism-whats-the-difference-between-medical-and-educational-diagnoses/ 

Autism Testing: Your questions answered by Dr. Casey Ferri, Psy.D., M.S.

What is OCD? Obsessive Compulsive Disorder is a common mental health disorder in which people have unwanted, reoccurring thoughts, fears, worries, ideas, sensations, or urges (obsessions) that lead them to engage in repetitive thoughts or behaviors. The resulting behaviors will temporarily relieve the anxiety an individual feels, however, the obsessions and anxiety quickly return, reactivating the cycle. These frequent thoughts can be disturbing to individuals experiencing OCD, and are different for everyone. To be diagnosed with OCD, someone needs to be experiencing both obsessive thoughts and compulsions. (1,2) 




 Common Symptoms of OCD Obsessions : recurring thoughts, urges, or mental images that feel intrusive, unwanted, and distressing. People with OCD will often try to ignore or suppress obsessions and avoid triggers, or they may take action to neutralize them. (2,3) Examples of obsessions commonly center around themes such as fear of contamination, the need for objects to be arranged specifically or orderly, unwanted, aggressive thoughts about losing control and harming yourself or others, sexual or religious acts and images, morality concerns, fears of acting inappropriately in public and much more.  Emotions: The obsession then causes a feeling of intense anxiety or stress which the person looks to alleviate Compulsions  are repetitive behaviors or mental acts that someone with OCD feels driven to perform. Someone with OCD engages in compulsion as a way to alleviate distress or prevent something negative they believe will occur. Sometimes, compulsions might happen according to a set of self-imposed rules. (3)  Examples of compulsions may include themes such as washing, checking, counting, orderliness, rigid routine, repetition, the need to confess, reassurance seeking from others, repeating prayers or phrases, etc. Additional OCD spectrum disorders include a presentation with concerns related to body preoccupation, hypochondriasis, skin picking, hair pulling, and impulse control challenges. (​​4)  
 OCD symptoms will usually present in childhood or early adolescence and are most commonly first experienced before age 25. Symptoms usually begin gradually and adapt or vary throughout life. It is common for a person with OCD to have good insight and understanding that their behaviors are unreasonable or extreme, yet think they are unable to stop. (5) 

 Thought Action Fusion Thought action fusion is a main characteristic of OCD. This is the belief that thoughts are equivalent to actions. For example, if someone with OCD has obsessive thoughts about harming someone else, this is equally as bad and distressing to them as if they had actually engaged in that behavior. The person’s anxiety in this situation is so intense it prevents them from making informed, rational decisions and judgments about the risk of the situation, and to remain on the safe side they will often avoid or create compulsive rituals to prevent any possibility of harm to themselves or others regarding the feared outcome. (6) 



 What if I Suppress My OCD Thoughts? Often individuals with OCD tend to engage in thought suppression by trying to ignore or control distressing intrusive thoughts. Although doing so may feel adequate at the moment, pushing away intrusive thoughts will actually worsen and strengthen the obsessions. Without an understanding of how to adequately manage obsessions and thoughts, continuing to engage in thought suppression will continue to worsen obsessions and contribute to the OCD cycle. (7) How & Why does it get worse?-  Trying to suppress an intrusive, unwanted thought can cause it to rebound, or reoccur. While the initial thought likely happened automatically and without mental effort, suppressing that thought is a controlled, purposeful action. The suppression is a conscious effort that requires your mental resources and brings the thought to the forefront of your brain even more. In addition, in doing so you lower mental resources, and the ability to cope,  which may already be depleted if you are feeling stressed, tired, or overwhelmed. How do I stop engaging in thought suppression?-  A mental health professional can increase your ability to notice when intrusive thoughts are occurring, manage feelings of anxiety and challenge the thoughts without acting on compulsions.  



 How is OCD Treated? If you or someone you know is struggling with OCD, it may be helpful to consult with a mental health professional in psychotherapy to learn effective strategies to deal with intrusive thoughts and obsessions. In some cases, medication will be recommended in combination with therapy.  Cognitive Behavioral Therapy (CBT) is an effective form of therapy in reducing OCD which encourages you to notice your thought patterns so you can understand the effect that they have on your life (8). This form of therapy for OCD will often focus on learning to accept and challenge thoughts, rather than suppress or avoid them. CBT does so by challenging negative automatic thoughts, addressing cognitive distortions, and changing “unhelpful” thoughts to more rational ones. It also focuses on exposing yourself to situations that may trigger obsessions in a controlled manner, to learn to manage feelings of anxiety and response. Due to CBT being such a broad approach to therapy, it will often help with building skills to manage other areas in life OCD may have impacted through awareness, social support, positive reinforcement, challenging thoughts, and relaxation.  Exposure and Response Prevention (ERP)  is the most effective form of CBT used to treat OCD (9). This modality focuses on discouraging avoidance through exposure. A CBT therapist will first help you identify and understand your triggers, then work to safely confront them. Ideally, ERP helps an individual learn new ways to respond to triggers and cope with emotions. While engaging in ERP, with the support of the therapist, you will be exposed to a fearful stimulus, experience anxiety/discomfort, and work to refrain from engaging in compulsions which would typically be used to cope with the uncomfortable feelings. By not engaging in the compulsive ritual, you weaken the relationship between needing the ritual to feel better. This can be difficult, but is thoughtfully introduced in a hierarchical way and is effective in reducing symptoms of OCD and stopping the cycle long-term. 
 Exposure therapy focuses on three main areas, In Vivo (staying in the presence of a feared object or situation that evokes anxiety and distress), Imaginal (mentally visualizing oneself in the feared situations or visualizing the consequences of the feared situations), and Ritual Prevention (refraining from engaging in compulsive behavior) (10). By purposely becoming anxious when doing exposure practice and resisting the urges to ritualize, you will learn that the anxiety and discomfort will dissipate on their own. In turn, the urges to ritualize will decrease. Exposure must be done repeatedly and be paired with relaxation to really help with OCD. Where a person may have initially felt that they could not handle the anxiety or perceived consequences of a particular situation, they will find out with ERP that they can. After exposure practice, such situations will no longer make them feel as uncomfortable as they once did. This process is called  habituation . (11) Acceptance and Commitment Therapy (ACT)  is an empowering form of CBT that has become popular in working with OCD through its role of building flexibility in thinking (acceptance) rather than engaging in avoidance. ACT emphasizes the ability to control our actions and strive toward what matters most, while not attempting to control or waste resources on internal experience, obsessions, or compulsions. According to ACT, difficult thoughts and feelings are not to be perceived as problematic, but rather as part of life's unique experience.  ACT proposes that frequent attempts to control our thoughts to avoid discomfort may help in the short term, however, it gets us stuck in our internal experiences and removes us from the present. In the case of an intrusive thought, that would mean accepting the presence of the thought without making an effort to suppress it or change it in any way. ACT teaches psychological flexibility, or approaching discomfort with self-compassion and curiosity, rather than responding in a rigid way. It emphasizes the freedom to choose how to respond at the moment. This form of therapy uses a variety of mindfulness techniques and perspective-enhancing exercises and has been shown to be helpful for people with OCD.(12) Mindfulness  may help with mental clarity and distance from thought-action fusion. This practice encourages you to notice your thoughts and emotions while maintaining a non-judgmental point of view. For example, when an intrusive thought arises, instead of suppressing it or reacting to it, you would acknowledge the thought non-judgmentally and remind yourself that it doesn't control you. For people with OCD, learning to accept thoughts without judging them may make intrusive thoughts happen less often and feel less distressing. (13) 



 When to Seek Help for OCD OCD goes beyond the idea of being a perfectionist. If you or someone you know has symptoms of OCD that are becoming unmanageable or disruptive, understand that anyone with OCD can benefit from therapy and should seek treatment. It may be beneficial to ask the following questions:  Are symptoms causing distress? Is excessive time being spent preoccupied with symptoms? (i.e., intrusive thoughts, engaging in behaviors) Do symptoms disrupt the course of the day or interfere with activities/relationships/work? OCD treatment looks different for everyone, however intervening as early as possible with the general techniques previously mentioned is known to be effective. The right therapist can provide valuable techniques and help you regain control of your life as soon as possible.  If OCD is negatively affecting the quality of life, it's time to seek additional help. Heritage Counseling has experienced therapists trained to treat a broad range of OCD spectrum disorders and design a treatment plan specific to a client's individual needs. Please reach out to Heritage Counseling & Consulting at 214-363-2345 for more information. 
 
 
 
 
 
 
 Sources: The National Institute of Mental Health Information Resource Center.  Obsessive-Compulsive Disorder (OCD) . National Institute of Mental Health (NIMH). International OCD Foundation.  What Is OCD? ) American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders . Fifth Edition. American Psychiatric Association; 2013. doi:10.1176/appi.books.9780890425596;  Allen A, King A, Hollander E. Obsessive-compulsive spectrum disorders. Dialogues Clin Neurosci. 2003 Sep;5(3):259-71. doi: 10.31887/dcns.2003.5.3/aallen. PMID: 22033547; PMCID: PMC3181632  Gruner P, Pittenger C.  Cognitive inflexibility in obsessive-compulsive disorder .  Neuroscience . 2017;345:243-255. doi:10.1016/j.neuroscience.2016.07.030 https://www.verywellmind.com/thought-suppression-and-ocd-2510480#:~:text=2-,Impact%20of%20Thought%20Suppression,process%20that%20requires%20mental%20resources   Lambert AE, Hu Y, Magee JC, Beadel JR, Teachman BA.  Thought suppression across time: Change in frequency and duration of thought recurrence .  J Obsessive Compuls Relat Disord . 2014;3(1):21-28. doi:10.1016/j.jocrd.2013.11.004 Olatunji BO, Davis ML, Powers MB, Smits JAJ.  Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators .  J Psychiatr Res . 2013;47(1):33-41. doi:10.1016/j.jpsychires.2012.08.020 Hezel DM, Simpson HB.  Exposure and response prevention for obsessive-compulsive disorder: A review and new directions .  Indian J Psychiatry . 2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18 https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/treatments-for-ocd   https://www.med.upenn.edu/ctsa/forms_ocd_cbt.htm l   Ost L-G.  The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis .  Behav Res Ther . 2014;61:105-121. doi:10.1016/j.brat.2014.07.018     https://www.verywellmind.com/thought-suppression-and-ocd-2510480#:~:text=2-,Impact%20of%20Thought%20Suppression,process%20that%20requires%20mental%20resources 

Treating OCD in Therapy 

You may be familiar with the phrase, “You need to love yourself before you can love another.”  This is an important phrase to consider when applying resilience in relationships. Resilience is all about being able to recover quickly and face challenges and adversity head-on without losing who you are along the way. Building relationships is also an important component of resilience. Knowing ourselves and being the best version of ourselves also means being able to be at our best for the people we care about.  Similarly, have you ever stopped to wonder why flight attendants always make sure to mention “ Please secure your own oxygen mask before helping others ” which is in contrast to being told to always help other people first? This is so important because until we are stable and secure with our own situation, we can't effectively help others! The same holds true in our personal lives. We want others around us to feel supported, confident, and loved, but it's difficult to do that if we are unable to appreciate and love ourselves! How do we show others we are forgiving and non-judgmental if we are unable to overcome these challenges within ourselves?  Overall, if you run out of oxygen yourself, you won't be much help to others. Therefore, if you want to have the most long-lasting, tightly bonded, resilient relationships, this requires you first look inward. 
 Resilient selves = Resilient relationships! Why is this? When we are working on becoming the best version of ourselves, we are more likely to make healthy choices for ourselves, which carries over into healthy relationships with others. But, the reality is, that we do not always “love” ourselves and everything we do, and sometimes we make choices that we wish we hadn’t. However, this does not make us less resilient, or less worthy of healthy relationships! 
 The relationship we have with ourselves is very similar to relationships with other people. They include ups and downs, sometimes need work, and are far from perfect. It is important to value resilience and act in ways that promote self-love in both areas (with yourself and with others). We also must value the importance of building positive relationships just as much as increasing our own well-being.  What do resilient relationships look like? There are many ways to take care of yourself and others around you. Let’s start with a few simple ways to build a resilient relationship with yourself and with others. 
 Set boundaries Boundaries can be tough but are also essential in maintaining positive mental health as well as benefiting your relationships. When we say “yes” to too much and we don’t actually want to do something or feel we are spread too thin, this can lead to resentment towards others. Learning to say no is an important skill to learn, in order to make sure you're not overextending yourself and can be the best version of yourself. Learn more about boundaries  here. Taking time for yourself  Spending time with yourself is just as important as spending time with the important individuals in your life. We need our own space in order to help relationships thrive.  Still having a life outside of your relationship  and enjoying things with other people is a sign of a healthy relationship! Quality time Just as having a life outside of your relationship is important - how you spend your time with the important people in your life also matters. Try to engage in activities you both enjoy, and limit outside distractions (such as technology) to really connect when you have time to yourselves!  Expressing gratitude  Gratitude allows us to experience positive emotions and get more joy out of the good things in life. Try to “count your blessings” each day, noticing the good things you do, and appreciating the things your partner does. Being grateful benefits both the giver and receiver, resulting in shared positive feelings, love, and bond. Expressing and respecting needs Seeing ourselves and seeing who other people are requires us to be honest, open, and curious. It allows us to pause judgment and explore ideas, values, and beliefs and grow as individuals. Seeing other people doesn't require us to drop our boundaries or give up our beliefs if we don't agree. It actually invites a stronger relationship involving trust, respect, and vulnerability as it honors the humanity of being an individual. Overall, healthfully supporting yourself is a prerequisite to being the best you can be for others. Resilience in relationships asks you to remain strong and secure enough for yourself and those around you while having the ability to bounce back from challenges quickly. Knowing who we are (our values, boundaries, needs) lets us identify the qualities we appreciate in others and that we enjoy being around. In turn, building resilient relationships makes our connections stronger and provides us with supportive benefits from others, making challenges easier to cope with. This skillful approach to building relationships allows us to surround ourselves with healthy connections that fill us with joy and gratitude!  Resilient people tap into their strengths and support systems to overcome challenges and work through problems. At Heritage Counseling, our therapists use Cognitive and Behavioral techniques to help you maximize your lifestyle through promoting optimism and incorporating personalized positive behaviors and healthy coping mechanisms into your routine. Please give us a call at 214-363-2345 if you are interested in exploring options that may help you increase resilience overall and in your relationships. 


 Sources:  https://positivepsychology.com/great-self-care-setting-healthy-boundaries/ https://www.psychologytoday.com/us/blog/brave-talk/202107/5-things-resilient-couples-do 

Resilience in Relationships

“Daring to set boundaries is about having the courage to love ourselves even when we risk disappointing others” — Brene Brown 
 What are boundaries? Boundaries are the personal limits we set within our relationships. Healthy boundaries will tell and show others acceptable ways of communicating, interacting, and behaving with us. Setting and maintaining boundaries can be challenging as they are invisible, unique to each individual, and can change over time. 
 Our boundaries will likely vary based on the people we are surrounded by and the setting we are in. For example, it is possible that boundaries loosen up when in the presence of others with whom we are more personally close, rather than professionally. It is important to always remember that all healthy relationships have defined boundaries, and they are there to maintain mutual respect, protection, expectations, and support with the people around us.  The following examples may be applied to any high communication relationships such as with significant others, parents, in-laws, friends, bosses, and co-workers.  
 Why are boundaries beneficial? Communicating personal boundaries with others has significant health and resilience benefits within relationships. Within relationships, boundaries generate a feeling of safety, allowing for mutual trust and understanding.  A person with healthy boundaries has a clear recognition of their own needs and values allowing for a stronger identity, better communication with others, and an increased sense of happiness and autonomy. Ideally, when your wants and needs are respected you are more likely to feel heard, validated, and appreciated. These people are well-liked interpersonally and professionally as they feel content with themselves and have mutual respect for others. Overall, these individuals have experienced better mental health and more positive social relationships as they have the time and space to flourish.  (1,   8 )
 The first step to setting healthy boundaries (or reevaluating them) is looking for areas in which changes need to be made and what your limits are. Identifying  why  these boundaries are important to you can help with finding value in staying true to them.  Identifying relationships which hold discomfort or resentment may be a sign of a lack of healthy boundaries. Putting healthy boundaries in place will help avoid future conflict and resentment  (9) . When setting boundaries, it is critical to be clear with yourself, and others!  
 What are examples of healthy boundaries to set?
 Healthy boundaries reflect your personal values, beliefs, and guidelines. They can be formed within multiple aspects of a person's life. A break in boundaries occurs when another person isn't aware of your needs or chooses to disrespect or ignore them. It may be tough initially, but it is so important to communicate boundaries clearly.  
Basic examples of types of boundaries may include the following:  Healthy  physical  boundaries may refer to setting limits on your level of comfort with others in your personal space such as: Finding independence outside of the relationship, avoiding codependency Creating a space without distraction Communicating things you will not tolerate Right to communicate and have respect for physical needs (bedtime, working out, food) Right to privacy (thoughts/electronics) Healthy  intellectua l boundaries may be set in an instance where others may not be respecting your ideas or beliefs such as: Sharing mutually/not feeling the need to overshare Right to make independent choices Ability to express spirituality 
 Emotionally , healthy boundaries should emphasize respect for your feelings and emotions, as well as how you express and accept the feelings and emotions of others. Some examples include: Saying “no” Ability to communicate your feelings Expecting respectful communication Accepting help Being able to separate from the negative emotions of others Material  boundaries can be healthy as they set limits on sharing possessions such as: Financial: independent funds and accounts  Sharing clothes or electronics with others Time  boundaries set limits on the demands others can place on one's time such as: Staying true to plans and respecting the boundaries of others Ability to manage time respectfully, even when alone Not taking your work home, working off hours
 Within intimate relationships, important boundaries to communicate with your partner may also be set around time spent together, texting, money, sex, honesty, permission, and much more  (2) . Healthy boundaries in relationships are best met when they are reciprocal, so be sure to ask your partner about their needs from you as well! ( 3 )  An imbalance of healthy boundaries in the workplace can make it difficult to maintain a work-life balance and result in feelings of unappreciation, disrespect, and burnout. Moreso with the increase in working from home, the distinction has become more challenging. Setting healthy boundaries at work may look like saying no to working longer hours than needed, limiting unnecessary overtime and prioritizing family time, avoiding taking work home on the weekends and evenings, voicing your opinion, not taking on more than you can handle, and keeping relationships professional. ( 4 ) 
 Are there unhealthy boundaries? It is empowering to set healthy boundaries as they help you maintain self-respect and enjoy healthy relationships. On the other hand, unhealthy boundaries disregard your own and others' values, wants, needs, and limits. This can result in unhealthy relationships, dependency, depression, and anxiety ( 7 ). It is important to note that unhealthy boundaries are typically too rigid or too loose. 
 Rigid boundaries may be self-serving, controlling, or violate another person's boundaries. They can also create walls between ourselves and others, leading to too much separation, loneliness, and personal disappointment. ( 5 ) Loose boundaries simply don't provide enough personal protection or separation, which may leave you feeling like a people pleaser, overinvolved, taken advantage of, and tired. ( 6 ) 
 How does therapy help with boundaries?  Significant barriers can stand in the way of developing healthy boundaries in relationships. Oftentimes clients will stop themselves from implementing boundaries with fears that they are being “too assertive” or “selfish”, as well as fears of guilt, rejection, and conflict. However, it is critical that all healthy individuals maintain some aspect of boundaries with others. 
Therapy can help with  letting go of judgment ,  exploring personal values and desires,  and  discussing where changes may be important . Once goals are developed, together a therapist and client can  identify steps that can be taken towards expressing goals  warmly with others, as well as  set limits.   
Therapy can also help uncover areas in which thought patterns or “schemas” are stopping you from executing boundaries with others or where potential past traumas are interfering with healthy relationship boundaries.  On the other hand, boundary violations are inevitable and when this occurs therapy can help with navigating the challenges that come along with those situations. Oftentimes when a person's boundaries are violated they feel threatened, angry, resentful, or frustrated. These types of feelings can set off physical and emotional reactions which therapists are skilled in working through and improving in session. 
If you are looking for guidance in creating, implementing, or maintaining healthy boundaries in your relationships, please reach out to Heritage Counseling & Consulting. We have a talented team of mental health professionals that can support your goals and help you take actionable steps to create healthy boundaries.  Sources: https://positivepsychology.com/great-self-care-setting-healthy-boundaries/   https://psychcentral.com/blog/why-healthy-relationships-always-have-boundaries-how-to-set-boundaries-in-yours   https://liveboldandbloom.com/05/relationships/healthy-boundaries-in-relationships   https://www.betterup.com/blog/healthy-boundaries-in-relationships   https://www.livewellwithsharonmartin.com/weak-boundaries-rigid-boundaries/   https://www.livewellwithsharonmartin.com/weak-boundaries-rigid-boundaries/   https://psychcentral.com/lib/keeping-good-boundaries-getting-your-needs-met#1   https://www.forbes.com/sites/forbescoachescouncil/2021/07/01/the-importance-of-setting-healthy-boundaries/?sh=7df11e5b56e4   https://www.forbes.com/sites/forbescoachescouncil/2021/07/01/the-importance-of-setting-healthy-boundaries/?sh=7df11e5b56e4 

Casey Ferri

Casey Ferri, Psy.D., L.P.

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