Friday, September 29, 2017

Practice what I preach...

Glossophobia or speech anxiety is the fear of public speaking or of speaking in general. So many people have it. The idea of presenting in front of a group and being the center of attention can be overwhelming, especially for people prone to anxiety. I have had symptoms of anxiety my entire life and yet speaking in front of a group is something that I find exciting and motivating.  I worked for years in a training role for a major pharmaceutical company and currently I teach classes and workshops on mental health, optimism, and resiliency as part of my clinical social work practice. Although I get a bit nervous just before a presentation, within seconds I begin to feel the positive energy of the group and find my flow.  I pride myself on the ability to handle negative and challenging audiences and can keep calm even when things go horribly wrong.  

So, if all of that is true, why did one workshop throw me into a panic last month?

It all began after finishing up a three-week class I teach several times a year for the local adult school. It is called: Get Happy: The Science Behind the Smile. The next session starts October 2017 (here’s link if you would like to join me).  Two women from the last class contacted me to see if I would put together a program with the information we covered in class, specifically to reinforce resiliency and a positive mindset in their teenage daughters. They thought that the information presented would be best received coming from an expert instead of from mom. Excited by the idea, I agreed.

Having a 13-year-old daughter, I had a pretty good idea how to create a version of my course that would be appealing to young teenagers. I could easily re-package the information with relatable stories to create an hour-long program that would fit the needs of the parents and keep the kids engaged. After creating the content and going back and forth on dates and times, we settled on a date for me to come to the home of one of the women. The plan was for her to host a party of 8th graders after school where I could present my information and lead a discussion style workshop.

After I agreed to do it and was all ready to go, I panicked. What the heck? Why was I feeling so anxious about this? My internal voice kept reminding me that I am better with adults than I am with kids. I began my career as a therapist working with children and families but after taking a 13 year detour into a corporate job, my current my current clinical therapy practice is much more focused on working with older teens and adults, especially around work/life balance stressors and triggers.  All of a sudden I felt completely unprepared for what I had signed up to do.  My negative self-talk had me feeling overwhelmed and insecure about doing something that really should be a no brainer for me.

So what did I do? I am not proud to admit it, but I tried to get out of it. I was not exactly sure why I was so fearful of doing this workshop, I just knew I wanted to bail. The mom hosting the workshop emailed to say that her daughter told her that this was going to be the lamest party ever. That was all I needed to hear, I was convinced that it was a bad idea. My 13-year-old daughter reminds me on a daily basis just how “uncool” I really am. I thought, “How could I possibly think I could do this?”

I tried to remind myself that teachers do this every single day, but that did not really help. Teachers have special gift and type of patience I don’t believe I have. As much as I love to teach, adult learning is where I thrive.

Nothing worked. I couldn’t find a way out. So there I was, sitting in someone else’s home with a room full of young teenagers whose parents paid money to have them come learn from me how to be more resilient and optimistic, when I myself was feeling overwhelmed and pessimistic. Before getting started one boy said to me, “I don’t think I want to stay, I don’t really like psychology type stuff.”  Ugh, I just kept thinking, “This is going to be a complete shit-show.”

So, I just took a deep breath and started anyway.  A few minutes in and I was shocked to see that I held their attention. Most of the teens were engaged and were began participating in the discussion. Hmmm, I thought “Maybe this would not be so bad after all.”

As I went through the material it hit me. The key points I was trying to teach these kids were the very messages I needed to tell myself at that very moment. I was not practicing what I preach. I was doing, in my own mind, exactly what I was trying to teach these kids not to do.  My panic, fear and insecurity around doing that program were in my mind, not reflective of situation.  I believed my irrational thoughts, personalization, pervasiveness, and perfectionism that had driven me into a panic. All of these were topics of this workshop.

When the obvious light bulb went off and I gained insight into the unhelpful thoughts I was having, I was able to use more adaptive thinking strategies, reframe my thoughts and adjust my perspective to allow my fear to dissipate. As I listened to the kids sharing examples of growth mindset thinking it clicked how much I was operating from a fixed mindset and sabotaging myself over irrational and unhealthy assumptions. I was stuck believing my thoughts that “I just don’t work well with kids” or “I can’t really relate to a room full of 13-year-olds.” Those beliefs weren’t based in facts or evidence but in my own maladaptive thoughts. I had to remind myself that just because I think it, does not make it true. Something I say to other people several times a day.

During the hour together, the kids shared stories of social comparisons and how those emotions have had negative affects on their self-worth.  We identified examples of situations where emotions were triggered by unhelpful and unrealistic negative thinking, labeled and reframed those negative thoughts. The kids showed insight and eagerness to understand their own triggers and even the kid who said he didn’t want to stay, shared with the group a challenging time when negative thoughts led to feeling depressed and hopeless.  

It is funny how sometimes the things we fear can become valuable lessons. In preparing to teach other people how to be more resilient and operate from a growth mindset, I really reminded myself to practice what I preach.

Thank you to the families who trusted me to teach their children, and for the opportunity to step outside my comfort zone and continue to grow.


If you are interested in attending an upcoming workshop or setting one up, please reach out any time, you can contact me through my website Maximize Wellness or via cfmaksimow@maximize-wellness.com

Thursday, August 31, 2017

Price of Perfection

This summer I had an opportunity to put a small dent in my never-ending pile of books I want to read. One in particular that motivated me to write this blog is, “What Made Maddy Run, the Secret Struggles and TragicDeath of an All-American Teen” by Kate Fagan. This particular book popped up on my Facebook feed from a friend connected to the Author and I immediately was drawn to the story as both a parent and as a therapist. I wanted to better understand Madison Holleran's story, having remembered hearing about her suicide on the local NJ news a few years ago. At the time it was shocking and hard to image what could be going on with such a talented, beautiful and seemingly "perfect" young girl.

Thinking about what could have been going on in her life through my experiences as a therapist, I can see how warning signs can be missed and how depression can look different then we expect it to look. However, as a mom of two highly driven kids, her story triggered my fears about just how much I really know about the pressures my children are facing, as compared to pressures I may have faced a kid. Just as I started to read this book an acquaintance lost her 12-year-old daughter, Mallory, to suicide as a result of relentless middle school bullying. It is impossible for me to fully comprehend the pain Mallory, Maddy and their families have, and still are, experiencing. This book, “What Made Maddy Run” helped to remind me the importance of talking about this subject with my children and better understand life from their perspectives.

Maddy's situation wasn't about external bullying or social media however social media did play a part in her story. The author, Kate, talks about Maddy's carefully crafted social media profiles and the contrast between that image she put out into the world with the internal pain and conflict she experienced. Kate Fagan also bravely shares about her own experiences with the pressure to be "perfect" on the outside while having doubts on the inside. It reminds me of the term “imposter syndrome” which I see almost every day in my work as a therapist. Highly accomplished people report feel as if they have been fooling everyone and that someone will find out they don't really belong. Those feelings come from distorted thinking and self-doubt with very little truth behind them. I have struggled at varying times in my life with challenges related to self-esteem, self-doubt, and perfectionism and it is easy to understand how negative thoughts like “I am not good enough” and “someone will see I don’t really know what I am doing” can increase fear and anxiety and feed unrealistic expectations. Much of my personal struggles were before social media. I had no Instagram or Facebook to compare myself to others and I could shut off social comparisons when I needed to. That is not the case today.

In this book, Kate describes how social media leads people to believe they connected and that they know about other's lives when really they only know the very carefully constructed ideal image they want others to see. That magnifies the feeling of “I’m not good enough” for so many people. Although on some level people are aware that others' reality is far different from the Instagram or social media persona, it is still very difficult to not compare and ultimately feel less than.

For athletes, that contrast can be even more pronounced. The book describes the pedestal that athletes are placed on and expectations of success that are different from everyone else’s. Kate talked openly about her years as a college athlete and the pressure she felt. She writes

"Our culture celebrates harder, faster, stronger. Vulnerability, it would seem, undermines that pursuit. And within sports culture, continuing to practice of play, no matter what your mind and body says, is romanticized: T-shirts are emblazoned with quotes, inspirational sayings are stenciled on the locker room wall, epic speeches are given At Colorado, a saying above one doorway read "Pain is weakness leaving the body."

Defining athletes by sports performance is not new. My husband and I went to the same high school in the late 1980's, yet our experiences were vastly different.  I was more insecure and awkward and he was confident, popular and well-liked. I was on the swim team, however swimming was not looked at the same way as other sports. My swimming career was mediocre at best and ended with high school. My husband, on the other hand, was a football player and received a full scholarship to play football at Boston University. His experience and “social status” in high school was far different from mine and so much of what people knew about him was defined by his place on the football team. We never would have dated back in high school and only became a couple at our ten year reunion. We joked it was because ten years later, “I got more cool and he got less cool.”

The message that success is linear and defined by accomplishment is ingrained in our kids from a very young age. For athletes, like Maddy and Kate, it meant winning, being strong, and working through any pain or doubt without letting anyone see imperfections. For academics it means getting the best grades and achieving the most prestigious college acceptances. Society praises and rewards good grades instead of praising the journey and learning experience overall. Is an A in a class where very little effort was put into it better than the C that took time and perseverance to earn? For me it is not, but most people says it’s the “A” that matters. That’s how we are judged, by the outcome and not the effort.

As a parent I try to be more mindful. Being a self-proclaimed “recovering perfectionist” I am careful of the messages I send my children. Both of my children play team sports and I remind them that it is about having fun and not just about the win. I tell them that success is defined by being better today than they were yesterday and not about being the best or better than anyone else. I believe accomplishments are important in the sense that they reflect effort, motivation, and drive, however those accomplishments do not define us, they are a part of a much more complex and full sense of self. My daughter has said to me that I am the only mom who doesn't care about grades. I reply by telling her I care about her happiness first and foremost, grades are a byproduct of learning. 

Another message I have tried to convey is that mental health and physical health are not much different despite the stigma associated with mental health or emotional health. My children both know relatives and friends who have struggled with depression and anxiety and I am open about things I do to manage my own anxiety levels. They understand diseases affecting mental health can be treated just like other medical issues such as a broken leg, diabetes, or strep throat. Mental health struggles are not personality flaws, personal weakness or something to hide or be ashamed of.

Even though I try my best, sometimes things slip through the cracks. For example recently I had an eye opening conversation with my 10-year-old son. He had been really busy with travel sports and summer camps and increasingly irritable and angry at home and I wondered if maybe he wanted to talk to someone other than his mom. He sometimes will meditate with me and uses some cognitive skills I have taught him but I thought it was important to ask if he needed more support.  I asked him if he wanted to talk with a counselor or as we call it “feelings teacher.” To my surprise he immediately became angry. He said, “I’m not stupid, why would you say that!” 

What? What did he mean, “stupid?” Is that really what he thinks? I was completely blindsided by his reaction. I approached him with curiosity and tried to understand what he was feeling. He expressed being embarrassment at a sports camp that was new to him and he wasn’t performing well and falling behind his friends. He had internalized his performance from a negative and fixed mindset instead of seeing potential to learn and grow and enjoy the opportunity take on a new challenge.

The take away I want to share today is for all of us to be aware of the messages we send our kids, whether consciously or not. Take time to understand how they are feeling and show them they are valued for who they are and not just what they accomplish. Recognize that pressures today are increased with social media and many of us just can’t fully appreciate what it is like for kids today compared to how it was for us when we were that age.  Not only should we tell them they don’t need to be perfect, but show them by modeling our own self-care, acceptance, and self-compassion.

Maddy’s story is heartbreaking and my hope is that by sharing it in her book, Kate has opened up dialogue for others who are struggling and can make progress toward reducing the stigma that contributed to Maddy’s death.


If you or a loved one are in need of help, please reach out to the Suicide Prevention Lifeline at: http://www.suicidepreventionlifeline.org/ or call 1800-273-8255.

Friday, July 21, 2017

Why a mental health day is so important...

Photo by Tim Gouw on Unsplash
A few weeks ago a 26 year old web developer’s twitter post about taking sick time for mental health reasons went viral. Her message to her boss was:
"I'm taking today and tomorrow to focus on my mental health. Hopefully I'll be back next week refreshed and back to 100%,"
The company CEO, Ben Congleton, read her note, he sent the following a supportive reply back.
"Hey Madalyn, I just wanted to personally thank you for sending emails like this. Every time you do, I use it as a reminder of the importance of using sick days for mental health – I can't believe this is not standard practice at all organizations. You are an example to us all, and help cut through the stigma so we can all bring our whole selves to work,"
As a therapist, I see a huge significance in that response. The stigma around mental health and behavioral health continues to be a barrier toward effective treatment and proper self-care. Taking the viewpoint that mental health and physical health are equally important can go a long way to more effective prevention and increasing health and well-being.
When we are sick we stay home from work for three main reasons:
1.    Working while sick with a cold, cough, fever, stomach virus or any other medical condition can exacerbate symptoms and ultimately make us sicker. For those of us who go to our jobs despite feeling sick because we don’t want to get behind in our work, we can wind up getting even sicker and missing more days than if we just rested when our symptoms started.
2.    Productivity goes down when we are feeling sick. Being tired, in pain or suffering through illness can interfere with our ability to do our job effectively. It’s tougher to concentrate, more difficult communicating and slows down our productivity.
3.    We can get other people sick. Coming into the office or workplace while sneezing, coughing or with other contagious symptoms can affect those around us. Whether it’s our coworkers or clients, it creates a larger problem for the office.
Let’s look at the same three reasons and apply them to taking a mental health day and as you can see, they still apply:
1.    Coming to work and ignoring warning signs of stress, depression or anxiety can increase symptoms. Knowing yourself and how to reduce emotional reactivity and/or unhealthy responses to stress by taking appropriate breaks can go a long way to maintaining healthy mental and emotional wellness.
2.    Productivity is also negatively affected. When we are overly stressed out, depressed, or anxious it can be very challenging to stay on task, stay focused or communicate effectively with others.
3.    You may think that getting other people sick in traditional terms may not apply, but that's not exactly true. We as human beings are affected by the mood, attitude and emotions of those around us. Going to work when feeling depressed, negative, or with poor emotional regulation absolutely affects the mood and productivity of those around us. Have you ever found yourself feeling down after spending time or working with someone who was in a bad place emotionally? What about smiling when you see someone smiling? New research in the area of “mirror neurons” is starting to explain why we sometimes experience emotions as contagious. Here’s a great video with more details: https://youtu.be/HTFdMwCXpMw   
Taking care of our physical health has now become mainstream and part of our daily routine. We all know how healthy foods, exercise, drinking more water, using sunscreen, getting sleep (whether we do them or not) can positively affect our physical health. These things also have an impact on our mental and emotional health as well as other practices that are slowly getting attention. Having a healthier work/life balance, increasing time with loved ones, as well as practices such as mindful meditation, are all becoming more important as we better understand a more integrative and holistic approach to health and wellness. 
That being said, taking a sick day for emotional or mental health reasons is as important as taking one for physical illness.  
It is all part of a effective self-care for better health and wellness.  Thank you to Madalyn and her boss Ben for getting the conversation going!  


Wednesday, June 28, 2017

Make Failure Your Friend!

How many of us have a fear of failure? 

Could you see your failure in a positive light?  

Fear of failure can have a huge negative impact on how we live our lives. It can stop us from taking risks or trying new things. For perfectionists, this fear can be even more debilitating.

As Brene Brown said in her book, The Gifts of Imperfection
“Perfectionism is self-destructive and addictive belief system that fuels this primary thought: If I look perfect, live perfectly, and do everything perfectly, I can avoid or minimize the painful feelings of shame, judgment, and blame.”
Failure is seen as unimaginable. Most of us want to avoid negative feelings like shame, judgment, and blame, which go hand in hand with failure.

This week Gatorade released a new commercial that turns that idea that failure is all bad upside-down. In the ad “Make Defeat Your Fuel” sports stars, Michael Jordan, Peyton and Eli Manning, and Serena Williams reveal their greatest failures which ultimately motivated them toward their greatest victories. The ad then highlights Atlanta Falcons quarterback Matt Ryan at the end of February’s Super Bowl where the Falcons blew a 28-3 lead to the New England Patriots. Click here to take a look.

We have a choice - either let failure be what stops us, or use it to motivate us toward success. 


This speaks to the idea of Mindset by Psychologist and Author, Carol Dweck, Ph.D. In her book she describes the new psychology of success with what she calls a growth mindset. When we have a growth mindset it means we have a strong desire to learn, we embrace challenges, persist in the face of obstacles, learn from criticism, and find lessons and inspiration in the success of others. 

In other words, with a growth mindset we don’t fear failures, instead we use them to create better opportunities. 


For those of us who have an overwhelming fear of failure, we are operating from a fixed mindset, which means we avoid challenges, give up easily, often see effort as fruitless, ignore negative feedback, and can feel threatened by the success of other people.

With a fixed mindset, we stay stuck; with a growth mindset, failure can be our friend.


One of my new favorite books is Option B by Sheryl Sandberg and Adam Grant. Sheryl is the author of the book “Lean In” from 2013. Option B Was co-written by Adam Grant, author and psychology professor at Wharton School at University of Pennsylvania. 
Together they wrote Option B following the tragic and sudden death of Sheryl's husband in 2015. She shares heart-wrenching and inspiring personal stories about facing adversity, building resilience, and finding joy with the help of positive psychology (PP)and cognitive behavioral therapy (CBT). In Chapter 9 of her book she talks candidly about "failing at work." Sheryl returned to work as a widow, single mother, and mourning her husband. Through this "new normal" she learned the importance of a growth mindset.

In Option B she talks about how important it is for all of us to learn from our mistakes. She points out how initial failure can be more effective for creating future innovation than success. Having a culture where people feel safe talking about mistakes can create opportunities for new discoveries and creative ideas that can lead to more overall success. 

As a small business owner and clinical therapist I keep a picture of "famous failures" above my office desk as a simple reminder to keep my perfectionism in check.

If I pay attention I can see examples of growth following failure all around me. When my son has a fantastic little league baseball game, hitting his first grand slam,  I realized he had spent extra time focused on batting practice following a game where he struck out every time at bat. 


With a growth mindset, failure can be your friend.


If you are interested in checking out the books mentioned here, you can go to my resources page of my website maximize-wellness.com for these and more helpful resources.
Also, if you want to learn more about counseling with CBT and PP feel free to check out my website or reach out any time for a free consultation! :-) Cara

Wednesday, May 10, 2017

13 Reasons Why: Good, bad or maybe….


There is a Taoist story of an old farmer. One day his horse ran away. Upon hearing the news, his neighbor came to visit. "Such bad luck," they said sympathetically. "Maybe," the farmer replied. The next morning the horse returned, bringing with it three other wild horses. "How wonderful," said his neighbor."Maybe," he replied. The next day, his son tried to ride one of the untamed horses, was thrown, and broke his leg. The neighbor again offered sympathy on his misfortune. "Maybe," answered the farmer. The next day the army came to draft young men, but seeing the son's leg was broken, they passed him by. The neighbor congratulated the farmer. "Maybe," he said.

In this story, every situation the farmer encountered was looked upon as either wonderful, or as bad luck, by the neighbor.  The Farmer, on the other hand, did not rush to judgment; what seemed like opportunities turned into challenges, and challenges turned became blessings.

We are so quick to judge situations, people, and life circumstances as good or bad, black or white. 


Unlike the farmer, we don’t find ourselves living in the space of “maybe” very often. Just take a look at social media posts, have a conversation about politics, or listen to a news story, and you easily see how quickly we can be polarized to one side or the other.  As a therapist I see extreme black and white thinking at the core of many of my clients’ symptoms and suffering.

Recently there has been a lot of heated buzz around a new Netflix show, 13 Reasons Why. Everyone seems to have a very definitive opinion one-way or the other.


As a mom of a 13-year-old girl, I admit I had a very negative initial gut reaction when she told me she was watching it. I read a few articles on how the show glorifies suicide and neglects to address mental health concerns of the main character. I also received a warning letter from our school district which led me to formulate the opinion that this was not a good thing for my 7th grader to be watching.

That being said, I also realize that controlling what she sees is not an easy task, so I decided that the best course of action was to watch the show myself.

After a few episodes I was concerned that this show portrayed Hannah (the main character who commits suicide) as a hero who successfully pulls off what could be considered a “revenge fantasy.” I saw danger in the idea that the show was show was glorifying suicide. I was also uncomfortable with the graphic rape scenes and the step-by-step portrayal of Hannah’s death.

After a few episodes, I found myself invested in the characters and noticed a shift in my perception of the show. I was enjoying the series more than I wanted to admit. I realized this show is so much more than just about suicide. When I looked closer into the complexity of each character I saw an opportunity.  By using the characters in the show I was able to start a dialogue about other topics that my middle-school-aged daughter may or may not be open to discussing otherwise, such as homophobia, self-harm (non suicidal), drinking, and sex. I was able to better understand her opinions, values and experiences around these subjects as well as address the things she, by the seventh grade, has already experienced or witnessed, such as bullying, inappropriate sexualizing, and peer betrayal.  

As a mental health professional and as a mom, I found the lack of awareness of the parents in the show, troubling, although not surprising. Mental health treatment also was pretty much non-existent throughout the series, except for a reference to prior therapy and medication by Clay, another main character.

As I began to see this show as more of an opportunity to get to learn more about my daughter and talk with her about difficult topics, I remembered my early years as a social worker.  Back in 1990’s I worked as a mental health specialist on an adolescent psychiatric inpatient hospital unit. The show My So Called Life was considered a bit controversial and tackled taboo and challenging topics like sex, drinking, drugs, and bullying, not unlike 13 Reasons Why. While working at the hospital we often showed VHS tapes of My So Called Life and then facilitated therapy discussion groups with the teens about the show. By talking about difficult and personal issues from the perspective of characters, we were able to help the teens process situations and challenges they were facing in their lives and do it from a “safer” space.

Just this week news came out that Netflix is not done with the series and will be putting out a season two of 13 Reasons Why. Before deciding if this is good or bad, I choose to look at this as an opportunity to dialogue further with my daughter.

Like most things in life, it’s neither black nor white, but a really strong maybe.


*I urge anyone reading this article who maybe experiencing thoughts of self-harm or suicide to reach out for help. National SuicidePrevention lifeline 1-800-273-8255.