Untreated Psychiatric Disorders Can Affect Couples Counseling

We all come to couples counseling for a variety of reasons. As a couples therapist, I often hear similar complaints from clients, “he just doesn’t listen to me,” or, “we fight all the time.” Also on the list, “we’ve stopped having sex,” or “can you just change her?” While couples counseling can be the perfect venue to give you tools and tips on how to communicate better, resolve conflict differently, liven up your sex life, and make important relational changes, there are a few things that will stop the process right in its tracks.

Untreated psychiatric disorders will make couples counseling incredibly difficult. If you’re struggling with depression, anxiety, ADHD or any other psychiatric disorder, it is imperative that you get individualized treatment, first. Treatment typically includes a thorough assessment by a specialized professional, either a psychiatrist or a therapist in that particular field of study. If you don’t get individualized treatment first, your couples therapist will give you tools and tips that either you’re unable to utilize (yet). Your therapy sessions will be met with either failed attempts or frustration. All things that you want to avoid as you venture down the vulnerable journey of couples therapy.

While it is the hopes of many clients to change their relationship, such as wanting better sex, more aliveness, stronger communication, less fighting, and so on – the very first step is to take a look at yourself. If you are struggling independently, your treatment comes first , before couples therapy.

One example to illustrate this point is the classic case of someone struggling with undiagnosed adult ADHD. One partner complains that the other is late, lacks of organization, has the inability to prioritize and is unaccountable. It is easy for the other to potentially pin this on characterological factors, saying things like, “he’s just like this,” or “he’s selfish and doesn’t think of me.” However, what if your partner has undiagnosed ADHD? Your partner could be struggling with something outside of their control.

Another excellent example to display the importance is that of undiagnosed depression. A partner may complain that their spouse “never gets out of bed,” is “irritable,” often is “tired and lacks motivation.” Again, these are all signs that could point to a diagnosis of depression – but what if your spouse is convinced that it is because “you just don’t care,” or “you’re lazy.” Your spouse will end up persecuting you on behaviors that may have be out of your control.

Clients struggling with reoccurring symptoms that seem out of the ordinary may need individualized treatment. Through a thorough assessment, skills and coaching, the client has the ability to make individual changes that will impact their relationship. Once the psychiatric disorder is stabilized, couples counseling can be extremely beneficial. Skills such as communication, conflict stabilization, sex, and intimacy issues can be addressed – the very ingredients that help couples and relationships have stronger and more intimate connections.


For more articles and information from Erika Boissiere, MFT – Founder of the Relationship Institute of San Francisco, please visit www.trisf.com or  call 415-519-6446.

Negative Thoughts Lead to Negative Performance

Negative thoughts can zap your performance. We have all experienced negative self-talk about our abilities, self-worth, future success, etc. This negative self-talk almost uniformly has a negative effect on performance. When we are engaged in goal focused activities we need adequate levels of the neurotransmitter dopamine in order to reach our goals or desired outcomes. When we are in a positive space and feeling confident, we have a higher likelihood that our brains will have adequate levels of dopamine present. When we are in a negative space and not feeling confident, we tend to have less of this very important chemical present. For adults with ADHD this phenomenon can be even worse. The reason it can be so much worse, is that people with ADHD already have a diminished amount of dopamine, so any reduction makes things far worse.

So how to do we create the patterns of thinking that lead to optimal performance?

The first step is to increase awareness. Awareness is absolutely critical to creating any change in thinking. We often take our thoughts as they come, never naming them or trying to change them. When we are not fully aware of our thoughts and feelings, we are prone to fall victim to unchecked negative thinking.

The next step is to start replacing negative thoughts with more adaptive an positive thoughts. For example, “I’m going to fail.” could be replaced with “I’m going to succeed.” or “I’m prepared and will do my best.” This obviously takes practice and for the best results it helps to work with a therapist who uses Cognitive Behavioral Therapy (CBT). The changes that result from CBT can be profound and last a lifetime. This is especially true for adults with ADHD as they tend to have a long list of negative experiences that drive an ocean of negative thoughts. In the video series Learn to Thrive with Adult ADHD, there is an entire module on CBT that has been shown to be very effective for all people wanting to change their thoughts, not just those with adult ADHD.

This has been very rudimentary overview of how thoughts can help or hurt your performance. If you want to understand things more, I recommend contacting a trained therapist  in CBT. I utilize CBT methods with both my ADHD clients and those who just want to find optimal mental performance. After all, the Silicon Valley is performance pressure cooker, so any mental techniques to gain an edge are important.

10 Signs You Need Couples Counseling

Written by Erika Boissiere, MFT of The Relationship Institute of San Francisco.


Is it time for us to consider couples counseling?

Everyone has his or her own way of determining when it is time to seek couples counseling. Wherever you are in your relationship, here are the Top 10 Signs that it might be time to seek professional help.

You’re unhappy in your relationship.

Plain and simple – you are unhappy. You have no interest in talking to your partner, consistency tune them out, or hide at work to avoid returning home and seeing them. The weekends together seem long and there are a lot of moments where you wonder how you got to this place.

You are no longer attracted to your partner nor do you have interest in sex with them.

No matter how much we convince ourselves that sex is not important, the truth is, sex is an essential part of a healthy committed relationship. Through sex we connect at an intimate level and share an experience that fosters closeness and human intimacy. Without sexual intimacy, you and your partner are best friends who share a household together. If that is okay with both of you, then perhaps counseling isn’t needed. However, if one partner wants to have sex and the other doesn’t, it might be time to discuss the situation with a professional.

You fundamentally don’t trust your partner.

You may have experienced infidelity or other events that have caused you to lose trust in your partner. If you are checking their phone, reading their email, or constantly asking, “Who were you with?” – then you have trust issues and counseling can help.

You are considering a divorce.

If you are considering separating from or divorcing your partner, now may be the time to give counseling a try. In some cases, the only reason that a couple ultimately chooses to stay together is because they sought counseling for help. Often those who leave one relationship to enter another without working through the underlying issues through counseling will again encounter similar issues from partner to partner. Consider working on the current relationship before calling this one quits.

You have disdain for your partner.

You dislike your partner, have contempt for them, and often find yourself rolling your eyes at them. You didn’t always have these feelings towards your partner, but something along the way has gone awry. Couples counseling can help identify what is creating this situation and if there is an opportunity to make it right.

Every disagreement turns into an argument.

Your fighting marathon continues day after day and you are completely exhausted. If you are fighting over trivial matters, but are not able to get to the resolution phase, it might be time to seek a couples therapist. Disagreements are normal, however, constant fighting is not.

You are having an affair.

Infidelity can be a relationship killer. If you are having an affair, and want to either end the affair or tell your partner about it, one approach is to consider consulting with a couples’ therapist. There are many reasons why people have affairs. Couples counseling can help discover what is really going on in your relationship and help things to change.

You have very different life dreams

You want a baby; your wife doesn’t. You want to move out of the city, but your partner doesn’t. You want to sail around the world, and your partner is a workaholic. Could your life dreams and aspirations be more different?  If you want to continue in this relationship, it is critical to address – either in therapy or between yourselves, how you will navigate major life decisions. If you do not find a way to bridge this gap, the difference in your visions will likely cause resentment as one partner may feel as if their dreams do not matter.

Family trouble.

Do you despise your mother-in-law, father-in-law, or in-laws in general?  Do you dread spending time with them or think they should just mind their own business? If you and your partner are fighting consistency about your in-laws, it’s time to consider sorting things out, once and for all.

Relationship tune-up.

You love your partner, but things just feel off. Your sex life has dwindled, your responsibilities have increased, or maybe you are just not the same person you were five years ago. Something is fundamentally different, and you feel stuck. Couples therapy can provide a safe place to address what is going on within you and your relationship and get things back on track.

Overcoming Adult ADHD with Positive Visualization

One very important technique for overcoming adult ADHD is Positive Visualization. For adults with ADHD years of negative outcomes and self-defeating thoughts build up to become giant roadblocks that lead to procrastination. When people with ADHD are confronted with negative or overwhelming thoughts about a project or task, it causes all other stimulus in the environment to become very distracting and even enticing. Often, people will find themselves doing things that they like even less than the task they need to be doing. For example, doing dishes or cleaning the bathroom, rather than sending a quick email to their boss.

One way to begin overcoming this, is to integrate Positive Visualization at the beginning or at the scheduled time to work on a given task or project. Positive Visualization involves thinking about the rewards that will come from completing the task. These may be things like material success, praise from others, or even intrinsic factors like the feeling of accomplishment. By doing this, it tends to excite the brain and bolster the production of dopamine,  making it more likely that you will engage and complete the task.

This is just a brief overview of a very powerful tool for managing procrastination. There are more complex techniques to practice with this and bring about real change in your life. However, by starting with this very simple application, you will likely start to find some success.

3 Easy Steps to Declutter Your Life

Clutter tends to plague people in ways they are not even aware of. If you are interested in 3 easy steps to declutter your life then please read on. If you are under the belief that clutter is your friend, then definitely READ ON!

If a cluttered desk is a sign of a cluttered mind, of what, then, is an empty desk a sign? -Albert Einstein

Many creative types, adults with ADHD, and eccentrics alike, tend to take pride in having a cluttered, messy, or a seemingly disorganized space. Unfortunately, the science behind clutter shows that it actually hinders the ability to focus and process information due to competing stimulus in the visual field.  This means that the 3 foot high pile of art books, science articles, bills, and magazine clippings strewn about, are actually dragging you down. In fairness, I am an artist, a writer, therapist, and researcher who dabbles in clutter. However, by following these three steps I have been able to slay the clutter dragon and increase performance.

1. Give it a home and expect it to live there. When we make a clear effort to assign a place for things to be kept we are more likely to keep them their when not in use. This step is also the back bone of the next 2 steps. This will also help adults with ADHD avoid heated arguments with family and roommates.

2. Don’t shove! If you are opening your desk drawer to put your notebook away and find that it doesn’t fit easily and with mindful placement, then pause and decide what can be thrown away, donated, or recycled to make room. Do it right then. Use this acronym to help you do it then and there: Only Handle It Once (O.H.I.O.)

3. Put one thing away a day. Although your Type-A parter may nearly have a coronary thinking about “chipping away” at things, or having to look at your piles for one more minute, it will help. One of the reasons that things don’t ever get put away and contribute to the massive piles on your desk, is that the act of cleaning up or putting things away seems daunting. Well, make it small and before you know it, you will be free of clutter.

Unleash your true mental performance by breaking the chains of clutter for good.

Done is better than perfect! -Phil Boissiere, MFT


Success and Focus for Entrepreneurs with ADHD

What makes an adult with ADHD like Richard Branson so successful? Why do some adults with ADHD struggle to succeed in their career? There are many factors to this complex question. However, there is one overriding principal that allows entrepreneurs with ADHD to find success, and it is called focus. Focus is a big word for adults battling ADHD. The good news is that focus can be greatly improved through treatments like Cognitive Behavioral Therapy (CBT), skills coaching, exercise, and medication management.

CBT specifically, is focused on treating ADHD by teaching skills that improve executive functioning, decrease anxiety, and help provide direction. For many entrepreneurs it can mean the difference between an office full of half finished projects and a handful of very successful ventures. The process and techniques work to activate the brain in a way that helps boost an individuals ability to focus and execute their innovative ideas. San Francisco and the Silicon Valley are full of incredible people doing amazing things. Unfortunately, there are many standing on sidelines struggling to break through due to their Adult ADHD. With the right help, most of these people can make the changes they need to treat their ADHD and find the success they deserve. If this article resonates with you, then reach out, find support, and take control of your Adult ADHD and your career.


5 Steps to Manage Your Diet

Tired of being a slave to your cravings? Tired of using food to manage your stress? Want to tune up your physique and mental health? Follow these 5 steps to manage your diet (with your MDs permission of course):

1. Understand your brain: The best way to understand why your brain is pushes you to eat things you want to is to look at at adults with ADHD. People with ADHD have an underproduction of dopamine in their brains, making it hard to control impulses. Food, especially carbohydrates, provide a rush of dopamine making binging immediately gratifying. You may not have ADHD, but when you are stressed, tired, or down,  your brain is craving dopamine and a slough of other neurotransmitters.

2. Don’t skip meals: It’s simple, if food provides a release of dopamine, skipping meals will certainly create a deficiency and subsequent craving.

3. Eat multiple small meals: Eating small meals every 3 hours helps regulate blood sugar, neurotransmitters, and stimulates the metabolism.

4. Exercise: Exercise increases the baseline level of dopamine and norepinephrine in the brain. If your baseline production of dopamine is higher, you are less likely to crave the rush of dopamine following a plate of carbs. This is especially important for adults with ADHD.

5. Stay motivated: Staying motivated is a bit more complex. There are many variables that go into the reasons why we start and maintain changes to our diet. For some it is cosmetic, for some it is mental, for some it is physical, whatever the reason, the motivation lies in our thoughts and feelings. By becoming aware of our thoughts and their relation to our feelings, we can ultimately change our behaviors. This is the basis of the powerful therapeutic approach Cognitive Behavioral Therapy (CBT). Sometimes our thoughts don’t serve us well and prevent us from making the changes in our lives we want.

Stress, Your Brain, and Exercise

At the center of the crossroads of stress, your brain, and exercise, lies something very important. What is it? What could it be? In a word, CHOICE. Why choice you ask? Well, every choice we make causes stress. What do I eat for dinner? What business school do I go to? How many ice cubes in my water? Yes, all choices cause stress. Stress is our response to demands and changes and it is inevitable. However, there is also an important choice we make around how we manage or fight stress. Choosing to use exercise to combat stress vs using food or alcohol, may be the difference between living a long life and living a short one. The actual decision to exercise or not can be VERY stressful for many people. The reason it is so stressful, is that people are choosing between a perceived short-cut that they know is bad for them (food, booze, etc.) and the longer road which they know is good for them (exercise). Exercise is natures way of putting our mind and body into repair mode. We need to enter into this repair mode often. Why? Because, stress happens often. It happens daily to varying degrees. Exercise too can vary from day to day, but should never be passed up for drink or a snack. When we are stressed our bodies are flooded with destructive hormones that break down our bodies over time. When we exercise, we not only rid the body of these hormones, we also turn on other processes that rebuild us at a cellular level.

Additionally, the effect of exercise lasts. Think about it, people often go back for a second cookie or second cocktail. You rarely, if ever, see someone going back for a second run or second trip to the gym. This isn’t a coincidence. Exercise puts us on a path of resiliency that builds us up. Short-cuts like food and substances, only mask issue and in fact layer on new stressors to the body.

Don’t put yourself in this anxious trap of decisions. Develop a plan that works for you to get regular exercise and thrive in the face of stress, don’t sink into the cookie isle or the corner store. If you are feeling stuck around developing a plan, try reaching out to a friend or a family member for support. It’s a lot easier to exercise with others than alone. Find the support you need to change your relationship to stress and exercise for better.

3 Reasons Exercise Helps Treat Anxiety

Anxiety by itself is not a disorder, but too much anxiety often is. Here are 3 reasons exercise helps treat anxiety:

1. Exercise boosts anxiety fighting neurotransmitters. Exercise naturally raises levels of serotonin and norepinephrine. This boost happens immediately and lasts over time, making exercise the natural “anti-anxiety prescription.” Additionally, exercise increases GABA which calms the brain making it easier to take advantage of Cognitive Behavioral Therapy (CBT) or other thought changing techniques.

2. Exercise reduces anxiety based tension in the muscles. When we are stressed or anxious our muscles react by holding tension. Exercise reduces that tension in the same way that the popular drug class beta-blockers do.

3. Exercise treats anxiety by breaking the chains or fear. When people are anxious, they typically get stuck in a loop of worry, fear, and apprehension that breeds more and more anxiety. By breaking this cycle with exercise, the brain is freed up to learn new thought patterns that can be strengthened with practices like CBT.

Exercise does not need to be overly strenuous or complex to have these powerful benefits in treating anxiety. Put on  your sneakers, go for a walk, and break the cycle of anxiety.