| The Therapy Room

Being thankful and grateful

Posted on 21 November 2019 by LeslieM

It’s November and that means many of us will celebrate the Thanksgiving holiday. Many folks will gather with family members and enjoy a Thanksgiving feast. For others, it means the onset of “holiday blues” or feelings of sadness and depression.

Being thankful or grateful are ways we express feelings of appreciation. The difference between thankful and grateful is that thankful is an inward expression and grateful is an outward one.

Major benefits of being thankful and grateful:

Makes one happy

Opens door to more relationships

Improves physical and mental health

Strengthens one’s self esteem

Sleeping habits improve

Makes one optimistic

Enhances empathy

Two topic related patient stories follow, and, after reading them, I ask that you reflect upon what you are thankful and grateful for in your life.

Mary’s story

Mary is a psychotherapy patient of mine that initially contacted me because she found out that she was unable to become pregnant. She and her husband had numerous medical tests to diagnose her inability to conceive. After this news, Mary quickly became withdrawn from her husband and believed that she was depressed.

Mary told me that she always dreamed of getting married and having lots of children. With the current news, she was convinced that her husband would leave her in order to find a new partner who could conceive and give him children.

After a few months of therapy sessions, the couple acknowledged the reality, the sadness and the potential possibilities of their situation. Mary and her husband are currently investigating adoption programs in order to have the large family they want. Mary and her husband are thankfulthat they have the option to consider adopting children and they are grateful that psychotherapy allows them to have the space to express their feelings about each other, adopting children and parenting.

Tim’s story

Tim was a 17 year-old senior at a local Boca Raton High School. He was accepted to a prestigious college along with a tennis scholarship. Tim has a great family, was a stellar high school student, an athlete, enjoyed his social life and had a healthy approach to eating food, and was physically active.

Tim was also complaining of right knee pain and had an examination with his primary care physician. Tim was diagnosed with Juvenile Idiopathic Arthritis (JIP). He had severe inflammation and joint damage in his right knee.

Tim took this news poorly and became depressed. Tim’s parents asked him to meet with me for his depression. He agreed, and the first thing he said to me when we met at my office was “My life is over! I am disappointing so many people because I have a damaged knee.”

Tim and I discussed many facets of his life during therapy sessions. We defined the new limits of his right knee and discussed acceptance of JIP, swimming as an alternative to playing tennis, his family and personal relationships, managing depression and his overall connection to his thoughts, feelings and behaviors.

Fast forward: Tim graduated from college and is now in medical school. He teaches tennis lessons to children and speaks regularly for the Arthritis Foundation on JIP. Tim is thankfulthat knowledgeable, supportive, caring and loving people helped him through his diagnosis of JIP and grateful for having a better understanding that life is a wonderful journey worth living that includes unexpected experiences. Tim demonstrates that change is possible.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Her website is www.drjuliabreur.com. For more information, e-mail info@drjuliabreur.com or call 561-512-8545.

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Family Secrets

Posted on 16 October 2019 by LeslieM

Fifty-five years ago, the mother of a loving family gave birth to a baby girl with Down’s syndrome. The child was sent to an institution and never mentioned in the family again … A middle aged daughter sits with her aging mother, who survived Auschwitz and learns that her father had been married before and had two daughters. She also learns that her father’s first wife and two daughters were murdered in Poland by the Nazis … A husband and wife celebrate their 25th wedding anniversary and the husband, recovering from a heart attack, tells his wife that he has fallen in love with his cardiologist — his male cardiologist … These are a few examples of secrets families carry. More often than not, they carry shame along with the secrets. “We are as sick as our secrets” is a slogan said at 12 Step programs, along with encouragement to share those secrets with a higher power and another human being in order to remove the power the secrets holds.

Keeping certain things in our lives to ourselves can certainly be a normal aspect of privacy; but, when such secrets have an impact on the family’s well-being, they can cause hurt and disrupt familial bonds.

As a licensed psychotherapist, I hear details of family secrets during many of my family therapy sessions.

Some of the family secrets disclosed include physical abuse, substance abuse, sexual abuse and hidden political opinions. (Families say they can finally open up about sexual abuse due to the “Me Too” movement and others say they hide their political opinions due to the current U.S. political climate.)

At times, family secrets are maintained due to the desire to protect someone. Parents try to protect their children from information and past situations they believe if known would be painful. Sometimes, this desire to protect does the opposite. One example is a parent not telling their child they are adopted. Another example is a caretaker who is known to the child as their mother tells the child that another relative is their actual birth mother. In these situations, honesty is best. Honesty will decrease the long held belief of protection and shame associated with family secrets.

Keeping a secret sometimes is the better choice and not unhealthy. If a patient tells me they wish to keep their past sexual escapades from their spouse or even their voting record a secret, I help them see that privacy is an active choice that they can be content with.

Many issues that were stigmatized in the past such as adoption, divorce, sexual orientation and gender identity have become more accepted today. Discussing these issues with openness helps affirm to a family that their situations are not shameful. They have become normalized and cared about.

My work as a psychotherapist is to cultivate honesty within the family system and to encourage dealing with family issues in a healthy manner. Family secrets can be worked through and families can realize that “change is possible.”

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Her website is www.drjuliabreur.com. For more information, e-mail info@drjuliabreur.com or call 561-512-8545.

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Couples, Aging and Retirement

Posted on 18 September 2019 by LeslieM

Aging can be a very difficult topic for couples to discuss. The first aging sign most couples realize is a reduction in their energy levels.

A couple I currently see in therapy, both age 65, spoke to me about them physically slowing down and their lack of energy throughout the day. The husband said it was a sign of aging and not a very good one. The wife said they were simply learning to finally pace themselves.

I told this couple that everyone feels tired at times. In fact, according to a recent study by the Journal of the American Geriatrics Society, nearly a third of those aged 51 and up experience fatigue.

Four areas of fatigue to explore:

Medical

Illnesses such as rheumatoid arthritis, heart disease and Cancer cause fatigue. Medications such as antidepressants and treatments such as chemotherapy and radiation can also cause significant fatigue.

Sleeping

Apnea causes sleeping problems, and an overactive bladder and enlarged prostate can cause people waking up multiple times at night to use the bathroom which disrupts sleep.

Mental Health

Anxiety and depression can cause fatigue. I recommend an individual seek therapy for relief. To search for a psychotherapist that fits your needs go to the website: psychologytoday.com/us/therapists or find a therapist at association sites as the American Association for Marriage and Family Therapy: aamft.org

Lifestyle

Energy can be drained by what you eat and drink. The energy zappers include fried foods, sugar-laden snacks, caffeine, soda and alcohol.

Addressing retirement

It is not uncommon for a 50-something aged couple to sit down with their accountant or financial planner to discuss retirement only to discover that each has their own vision. When it comes to talking about retirement, couples can be plagued by the same obstacles that keep many people from talking about finances throughout their married life. Couples either do not get around to it, or it is a subject that is too difficult to address.

One couple I worked with in therapy had different ideas about where they would live once they retired from their corporate jobs. One partner wanted to move to Arizona while the other wanted to stay in Boca Raton in order to be close to their children and grandchildren. Within a few therapy sessions a compromise was met. The couple agreed to continue to be home based in Florida, but also own a reasonably priced condominium in Flagstaff, AZ to enjoy as they choose with their family members throughout the year.

I recommend that couples do not focus on the concerns of aging alone. Researchers are finding that if we think about getting older and retiring primarily in terms of decline or disability, our health will likely suffer. If we tend to view aging in terms of opportunity and growth, our bodies and minds will respond kindly. I highly recommend that couples practice forgiveness along with having a sense of humor at times about getting older. Change is always possible!

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, call 561-512-8545, visit www.drjuliabreur.com or e-mail info@drjuliabreur.com

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Therapeutic Tattoos

Posted on 15 August 2019 by LeslieM

Tattoos have exploded in popularity over the past decade and have become an artistic way for people to express themselves. What do tattoos mean? Before we address the meaning of various tattoos, let’s take a brief look at the history of tattoos.

We can go back almost 12,000 years where tools for tattooing were found in France, Portugal and Scandinavia. The oldest surviving tattoos were found on a mummy in the Otzi Valley in the Alps from the fifth to fourth millennium BC. Ancient Egypt and India used tattoos as methods of religious worship and healing. Ancient Romans, Greeks and Chinese tattooed their slaves and criminals to be able to identify them if they escaped.

The Jewish world has a longstanding aversion to tattoos. The taboo against body ink remains powerful among largely secular Jews. The objection relates to Leviticus 19.28 “You shall not make gashes in your flesh for the dead, or incise any marks on yourself.” Some liberal Jews have taken a fresh look at tattoos, but many still overwhelmingly see tattoos as inconsistent with the teachings of Jewish tradition.

Most people get tattoos to tell a story, to highlight pain, triumph and obstacles they have faced in their lives. Tattoos can also be therapeutic to some. Below are a few types of therapeutic tattoos:

Mastectomy Tattoo Movement: Following Breast Cancer treatment, some women opt to get artistic tattoos to cover mastectomy scars and to reclaim their bodies. An organization P.ink (Personal ink) refers Breast Cancer survivors to tattoo artists with mastectomy tattoo experience.

Recovery from Addiction Tattoo: It takes amazing strength to address and recover from addiction. It helps to have motivational reminders to stay on track, and a tattoo can inspire and celebrate recovery. A patient of mine has “one day at a time” tattooed on the inside of her wrist. If she feels anxious, she reads her tattoo and that reminds her to slow down, breath, realize she can make it through today sober and contact her sponsor for support.

Memorializing a Loss Tattoo: Sarah, a former psychotherapy patient of mine lost her father to suicide. Sarah had a tattoo behind her left ear — a semicolon. She explained that she searched for a tattoo that would honor her father and increase awareness of mental health problems. She stumbled upon “Project Semicolon.” This organization is dedicated to preventing suicide. Sarah has taken a positive step in her healing process and told me she likes to talk to others who have experienced devastating loss in their lives and wants to promote positive ways to discuss mental health issues.

A 60-year-old female patient told me that for years she thought anyone getting a tattoo did not realize the consequences, such as not liking it after a few years, and the time and pain involved to have it removed. Then, she pointed out a hummingbird tattoo on her right shoulder. She decided to get this tattoo because it represented her daughter who had died of Brain Cancer. This tattoo brought her peace. Here was a woman who was anti-tattoos for years and, at the age of 60, decided there was a very good reason, the memory of her daughter, to get a tattoo. Yes, change is possible!

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, call 561-512-8545, e-mail info@drjuliabreur.com or visit www.drjuliabreur.com.

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THE THERAPY ROOM: Summertime Blues

Posted on 18 July 2019 by LeslieM

Do you find yourself depressed during the summer months? Is it difficult for you to manage children being home from school, family visiting or planning your own summer vacation? You are not alone. Many people experience Summertime Blues or Summertime Depression due to Seasonal Affective Disorder (SAD).

SAD is a psychological mood disorder in which people who have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year. SAD has gained notoriety during the winter months due to the decrease in daylight, but SAD also exists during the summer months and is linked to two factors:

• the light-dark cycle

• temperature and humidity

The following are some triggers that ignite Summertime Blues/SAD:

Sleeping Disorders: Staying up later due to summer days being longer naturally exposes you to more light. This can cause you to not sleep well, or not sleep at all.

Body Image: If you have a negative body image you might avoid going to the beach or engaging in any outdoor activity. Most people feel this from time to time, but those with Summertime Blues/SAD feel it acutely which propels their summertime depression even more.

Daily Routine Disruptions: I explain to many of my psychotherapy patients who suffer from SAD that having a consistent and reliable routine is key to managing and reducing symptoms. It is very important to try to maintain a consistent sleeping, eating and exercise routine during the summer months.

Financial Stress: Vacations, family gatherings, socializing with friends, summer camps, etc. can create an exhaustive list of costs. This can be challenging for those with SAD and trying to follow a budget can be stressful.

Tips to help you better cope with Summertime Blues/SAD:

Sleep: Make sure you rest and get enough sleep during the summer months. Contact your physician to discuss ways to help stabilize your melatonin levels.

Time Management: It is important to try to set a consistent routine during the summer months. Do not aim for creating a perfect schedule — just one that you can follow and adjust as needed. This will make you feel in control of what is happening around you.

Delegate: One of my psychotherapy patients expressed to me that she was overwhelmed with a heavy workload as a corporate accountant and was cleaning her house and cooking more for her family during the summer months. We worked towards her delegating more chores at home to her older children who were on summer break and asking her manager for help with some of her accounting tasks. It is important to ask for help when it is needed to prevent being overwhelmed or depressed.

Psychotherapy can also work wonders for those dealing with Summertime Blues and even help to reverse SAD. Remember that change is always possible!

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, call 561-512-8545, e-mail info@drjuliabreur.com or visit www.drjuliabreur.com.

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THE THERAPY ROOM: Shopping addiction

Posted on 20 June 2019 by LeslieM

Shopping addiction, shopaholic and oniomania are terms used to define and describe someone who has a Compulsive Buying Disorder or CBD.

CBD is the frequent preoccupation with buying or impulses to buy that are experienced as irresistible, intrusive and senseless. The buying behavior causes marked distress, and interferes with social functioning, relationships and often results in financial problems.

CBD has three general stages:

  • Preoccupation with shopping
  • Pre-purchase tension or anxiety
  • Sense of relief following purchase

A psychotherapy patient of mine, we will call Renee for confidentiality purposes, came to see me and told me that she is a recovering alcoholic. Renee attends Alcoholic Anonymous (AA) Meetings locally and online. She told me that she lost close to 30 lbs. since she stopped drinking alcohol and was now eating healthier foods, drinking more water and exercising regularly.

Renee has changed many things in her life for the better, but she told me she is in debt and that, over the past six months, she acquired two credit cards and she specifically uses these credit cards to shop online and to buy clothes.

Renee likes the way her body has changed and improved since she lost weight and feels she is addicted to buying clothes online in order to show off her new physical appearance. She likes the attention she receives and cried while telling me that she never received positive attention from anyone in the past.

I spoke with Renee about the amount of money she spends while shopping. She told me she is spending thousands of dollars shopping online, and said that one credit card she uses has notified her that they are suspending her charging privilege. I recommended that Renee attend Debtors Anonymous meetings to help her understand the reality of her spending habit and the financial damage it was creating.

We also discussed the amount of time Renee spends while shopping. She told me she is spending at least three to eight hours a day searching various online shopping sites. She would sometimes be online through the night and not get the proper rest needed.

Here are steps discussed to help Renee reduce and better manage her CBD:

  • Attend Debtors Anonymous meetings
  • Contact the credit card companies to be pro-active and discuss payment options
  • Consider returning or re-selling purchased items
  • Remove mobile phone and other devices from her bedroom to avoid any evening online shopping temptation and in order to help her get the rest she needs
  • Explore new activities, such as reading books of interest, to lessen and alleviate the urge to shop online
  • Explore her thoughts, feelings and behaviors around being sober, being healthy, her body image and define what shopping and clothes represent

Step by step, Renee is successfully exploring her thoughts and actions relating to her Compulsive Shopping Disorder. Her accomplishments only emphasize my belief that “Change is possible!”

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, call 561-512-8545, email info@drjuliabreur.com or visit www.drjuliabreur.com

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THERAPY ROOM: Journaling

Posted on 16 May 2019 by LeslieM

What is Journaling?

Journaling is a record of experiences, ideas or reflections kept on a regular basis. Journaling is no longer the old-fashioned exercise of keeping a diary. It is something we all can commit to practicing as well as encourage others to experience. Journaling does more than just help record memories or develop self-expression. It is actually good for your mental and physical well-being.

Whether writing thoughts in a booklet or using an online application, journaling helps acknowledge and memorialize feelings, it brings attention to specific moments of a day, helps build a history and, ultimately, can help one achieve progress.

Benefits of Journaling

Journaling and Stress Reduction: Journaling is an excellent stress management tool and, when it becomes a habit, it can lessen the impact of life’s stressors. Recently, one of my psychotherapy patients decided to start journaling after the unexpected death of her father. She made it a habit to journal every night before going to bed. She told me rather than crying everyday she would try her best to express her feelings of grief in words by journaling and that helped reduce the painful feeling of losing her father.

Journaling to help Manage Depression: Another psychotherapy patient diagnosed with depression told me that if he did not journal he would not be able to retain and describe certain thoughts and feelings he had between his weekly therapy sessions. Journaling provides him with a way to recount and recall his thoughts throughout a week and allows him to speak to his depression by using journal entries that help him develop depression coping strategies.

Journaling and Recovery: Whatever event, habit or disorder one is experiencing, journaling can help and heal. Those with an eating disorder can experience journaling as a huge source of relief. Journaling can reduce the distancing from issues and help confront problems head on, as well as reduce the obsessive component of the disorder. For those struggling with addiction, journaling can help record struggles and accomplishments. Journaling can also hold one more accountable and help one work through difficult thoughts and emotions in a healthy manner.

A journalist we all know

Billionaire media mogul and philanthropist Oprah Winfrey uses journaling to build mental strength. Oprah has been journaling since she was a teenager and believes journaling helps radiate and generate more goodness because you become aware of all that you do have and less about the have-nots. She emphasizes writing down what you are grateful for and reading it back. She also recommends reflecting on previous journal entries and sharing your journaling gratitude with other people.

As journaling habits are developed the benefits become long term — meaning the journalist becomes more in tune with his/her health by connecting with inner needs and desires. Journaling can assist with the management of adversity and change, and emphasize patterns and growth in life. Journaling fosters growth and reflects what I promote to you every month and that is “change is possible.”

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, call 561-512-8545, e-mail info@drjuliabreur.com or visit www.drjuliabreur.com.

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THE THERAPY ROOM: Stress

Posted on 18 April 2019 by LeslieM

Stress is a very common word and topic discussed with my patients during their psychotherapy sessions. It is expressed so often in therapy that I thought it would be an interesting subject matter to write about for this month’s Therapy Room column.

What is stress?

Stress is a process, not a diagnosis. When the word stress is used clinically, it refers to a situation that causes one to have discomfort and even pain at times. Stress can lead to mental health conditions such as anxiety and depression, and physical illnesses, including cardiovascular and gastrointestinal issues.

Jay Winner, MD, of the Stress Management Program for Sansum Clinic in Santa Barbara, CA, says that “stress can exacerbate just about any health condition you can think of.” Stress can increase the risk of conditions like obesity, diabetes and asthma.

Work, Family and Life Stress

Types of Work Stress:

• Being unhappy with your job

• Working too many long hours

• Unclear expectations of work requirements

• Salary and benefit expectations

• Unsure of advancement opportunities

• Fear of termination

Types of Family and Life Stress:

• Death of family member or a loved one

• Relationship issues to include marital separation and divorce

• Financial obligations and insecurities

• Legal matters

• Home relocation

• Family responsibilities

• Illness

• Health costs

• Aging

• Emotional problems and traumatic events

Coping with Stress

Many individuals use poor coping strategies, including alcohol, drugs and thoughts of suicide to deal with stress. As a psychotherapist, I help many people who realize that drinking alcohol and taking drugs to cope with stress only creates unwanted behavior problems.

Strategies to Manage Stress

To successfully manage or eliminate stress, one must first acknowledge that stress is affecting their quality of life and then one can begin discovering new ways to successfully manage their stressful situations.

Psychotherapy

As a licensed psychotherapist, I confirm that therapy helps individuals address their stress-related thoughts, feelings and behaviors. My work allows me to help individuals alleviate, reduce, manage and eliminate stressful work, family or life situations that cause depression, anxiety, pain, fear, headaches, confusion, illness, etc. I am passionate about my full-time work as a psychotherapist helping so many realize they can live a full, healthy, meaningful and stress-reduced life.

Physical Activities

Exercise, and other physical activities, produces endorphins which are chemicals in the brain that act as natural painkillers. Endorphins also improve sleep and reduces stress. Meditation, acupuncture, massage therapy and deep breathing can produce endorphins and these practices reduce stress.

Rest and Sleep

Sleep is a powerful stress reducer. If you follow a regular sleep routine it will calm and restore the body, regulate mood, improve concentration, and sharpen judgment and decision making. You become a better problem solver and better able to cope with stress when you are well-rested.

In conclusion

Taking time every day to be grateful for the good people and things in your life and realizing that “change is possible” will allow you to successfully address and manage stress.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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THE THERAPY ROOM: Are we destined to become our parents?

Posted on 20 March 2019 by LeslieM

A patient’s story

Nancy, a fictitious name I am using for confidentiality purposes, arrived at her scheduled psychotherapy session emotionally distraught and explained that she just saw her reflection in a mirror and realized that she has the same quirky facial expression that her mother has. Nancy’s uncle recently told her at a family gathering that she looks just like her mother. Prior to the psychotherapy session, Nancy had an argument with her husband and used harsh words, actually the same harsh words that her mother used when she argued with her father. Nancy began to cry and asked me, “Am I insane? Can I be turning into my mother? How do I stop this from happening?”

It’s partly due to our DNA

I informed Nancy that awareness is the initial step she is beginning to take to determine if she is expressing similar traits to her mother. I explained that we all have two biological parents, so there are going to be physical similarities, but we are not clones of our parents, and it would be ideal if during early childhood we could choose personality traits and physical expressions that do not imitate our parents. Nancy and I needed to focus on the many role models she grew up with, including siblings, other family members, friends, teachers, etc. in order to examine the numerous role model variations that are part of her identity.

Neuropathways

When a person is stressed, it is very difficult to be conscious of the fact that they are reenacting patterns such as using the same harsh words in an argument that a parent used. It is necessary to work on reducing the stress level and, at the same time, realizing that it is not necessary to snap and be nasty to others like a parent demonstrated. Choosing to do things differently than our parents and then repeating our new way of doing things again and again allows our brain to create new pathways and, therefore, we do not repeat parental learned patterns.

Nancy asked me to explain what I meant by saying that the brain creates new pathways. I explained that neuroscience and neuropathways shed light on how we become like our parents and how the brain develops. When we are stressed, we tend to access the neuropathways that were formed when we were a child. We were taught these patterns by our parents. When you create new pathways that reflect who you want to be, even how you want to react to certain situations versus accessing an old pathway or pattern you learned as a child, you will not think or feel like you are your parents.

Benefits of Psychotherapy

Nancy is not destined to be her mother as she fears and is working to recognize and understand the negative parental patterns and behaviors she learned as a child. Nancy also said that she appreciates many positive patterns she learned from her mother and father, and wants to discuss them further in therapy. Nancy is learning more about who she is and who she wants to be. I continue to encourage and support Nancy (and you) by saying, “Change is always possible.”

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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THE THERAPY ROOM: Procrastination

Posted on 21 February 2019 by LeslieM

Procrastination is the practice of carrying out less urgent tasks in preference to more urgent ones. We all procrastinate to some degree. There are only 24 hours in a day to accomplish all we need to and some tasks are more of a burden than others. If you want to manage your life with less stress and more time for the things you want to do, then it is time to get a better handle on procrastination.

I have a patient we will call Sam for confidentiality purposes. Sam is a husband, a father and an accountant who works 60 plus hours a week. He told me that he came to therapy because he cannot stop procrastinating about his need to diet and exercise.

Psychotherapy allowed Sam to face some tough realities. He realized that his top priority was his work and career. This was above spending time with his family and attending to his overall health. Sam said that all that had to change. He also told me he had 30 pounds to lose and avoided facing this fact by procrastinating about it for years.

I am pleased to report, that within a short period of time, Sam began using some of the following therapeutic strategies to address his procrastination (You can too!):

Acknowledge that you are procrastinating:

The initial step involved in any behavioral change is to become aware of behavioral patterns. One must admit they are stalling rather than moving forward on a desired task or action.

Admit reasons for procrastination:

If you are disorganized: Break down tasks into manageable small steps and develop to-do lists and schedules.

If you fear failure: We learn from our mistakes just as much as we do from our successes. Take note of self-sabotaging thoughts and replace with more optimistic and realistic thoughts.

If you think a task or action is unpleasant or undesirable: Use the 10 minute rule. You can do anything for 10 minutes. If you procrastinate about riding a stationary bicycle, do it for 10 minutes and, once you get yourself moving, you will most likely do more minutes.

If you are a perfectionist: Most daily tasks do not require perfection. Learning to accept good enough may take practice, but it is something that can be accomplished.

If you are physically and/or emotionally drained: See your healthcare provider for a thorough check- up. I discuss self-care with patients and recommend various ways for each individual to do things that increase daily relaxation and joy.

If you need to develop better decision-making skills: Focus on asking for more support. Learning how to have more patience as well as being more assertive can help.

Psychotherapy has helped Sam use strategies to reduce his procrastinating behaviors. Use of time management skills allow Sam to plan more quality time with his wife and children. He is making better food choices and has started a weight training and exercise program.

Today, Sam is 20 pounds lighter and determined to lose 10 more pounds to reach his weight loss goal. Procrastination is no longer in Sam’s way. He is moving forward. Change is always possible!

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com .

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