When someone says, “She (or he) is just a friend,” this generally means the relationship is not romantic, not sexual and not too intimate. It is also understood to mean, “You need not take this too seriously.”

On the other hand we sometimes hear someone say in a reverent way about a spouse, or a partner, “He (or she) is my best friend.” This is saying, “Yes, lots of people are married, lots of people have sex and live together, but what we share is a special trust, support and a rich love.”

What does it take to have this rich enviable friendship? For a start it takes risking being open about one’s feelings, being gently honest about what one thinks and does, being able to deal with disagreements in a relatively calm manner and being able to negotiate differences.

Unfortunately these skills are rarely taught in childhood. Instead many of us learned not to trust because we found caregivers not safe, not trustworthy and it was not smart to trust. Suspicion and fear are often survival skills in childhood but as an adult they can impede love. To learn how to be a true friend and how to choose someone trustworthy may take relearning in a safe environment.

In effective relationship therapy you may learn techniques, like how to let another person know that you heard what they said by repeating what you think you heard back to them and checking to see if you are correct. You may learn certain "no-no's" like telling someone they "should" do or be a different way. That is a sure way to create distance in a relationship very quickly, almost as fast as by telling someone they are stupid. These things certainly do not gain intimacy.

But most effective may be observing the therapist's style and emotional tone. Or you may notice that the therapist may see things very differently from the way you have seen them and wonder what he sees that you don't. You may explore why your partner's comments are so upsetting to you. What does it remind you of in your history? It can be very helpful to have a wise and experienced guide to do this and feel safe.

Gil Shepard is a licensed Marriage and Family Therapist in Walnut Creek, California

How much do your personal feelings about animals affect the way in which you are authentically able to be with someone grieving the loss of their pet? How does your past inform your present? Whether it be a sibling's allergies, cultural beliefs, or perhaps fond memories of your own childhood pet, they all help to inform our view today. 

As therapists, we have a rare opportunity to learn from our clients, as our clients learn from us. Over the course of nearly three decades, I continue to bear witness to clients' pain, whether it be buried, projected, internalized, or stuck! However, one thing remains the same: when it comes to the loss of one's pet, there is nothing stuck about the deep and expressed/experienced pain! Quite often, it is this pain that brings someone into therapy. If we, as therapists, dismiss the pain experienced by our client, they will leave feeling empty, misunderstood, and could possibly experience a sense of shame! 

Pet loss has become an important topic, even more so during natural disasters and a down economy. Most people will tell you how sorry they are, some may even send a card, but there does remain a discomfort or stigma around grieving too long or too deeply (i.e., "it was only a cat", or "she should be over it by now").

Therapy can truly be a place to grive and heal in a helpful and healthy environment. 

As a client, whether you are seeking help from a new therapist or are already working with someone, you need to feel comfortable expressing your pain over the loss of your pet. Working collaboratively with a therapist, you are entitled to feel understood, respected, and supported through this tremendously painful time. 

The following are some suggestions for clients to work collaboratively with a therapist and feel empowered in the process: 

1. Be clear and direct around what you need, how you are feeling, and how your therapist might help you in regard to your loss.
2. Pay close attention to how you feel. Does it feel like a safe space? Are you given the time to share, grieve, and process without there being a different agenda or the topic being changed? 
3. Does your therapist respond in a kind, caring, and empathic way? Do you feel heard and understood by him/her? 
4. One way to include your therapist in your grieving process is to bring in photos and memorabilia, as well as share stories about your pet. 

There is no time limit to grief and grieving. Take the time you need! Hopefully your therapist will ask a lot of questions, remain engaged, and empathize with your pain. 

The darkest hours of a client's pain around the death of their pet can also help to create a new and healthy beginning of a relationship! For some people, the loss of their pet is as important and painful as anyone's loss of a family member, friend, or partner/spouse. 

Grieving the loss of your animal is both extremely personal and profound. It is an experience that far too many people dismiss or can't understand. It is my hope that we all can find that safe place and person to help us grieve, heal, and bond/love again. 

Sharyn Rose is a Psychotherapist and Clinical Hypnotherapist in Davis Square, Somerville, MA. To learn more, visit her websites at: www.sharynrosetherapy.com and www.srosehypnotherapy.com

Therapy is a special place. A relationship is created in order to help you feel better, or at least that's the hope. When you start therapy you have all these feelings swirling around that control your life and you want the therapist to fix it. That is understandable. However, it is a false expectation. First of all, a therapist has no magic wand to make all the pain go away in an instant. We would if we could. It is a process of small changes and insights that build to create a better, calmer, more fulfilling life. 

As you build the relationship with the therapist and start trusting (oooh bad word) them, you start revealing deeper more painful things. These things often seem scary, embarrassing, and they can hurt. The irony is the more you hold onto these feelings and negative thoughts (that are hurting you) the more you are scared to face them. When you start revealing those tender, inner parts to a trusted professional, it does seem to hurt a little more for a while. However, you find out you are strong and courageous by facing those inner struggles and the emotions start to decrease. You win. You become more confident and able to make choices that benefit you and help you reach your full potential. 

Therapy is a place to be vulnerable and take risks. Speak up. Say what you need to say. Trust yourself. You will be better off in the end for finding your voice. What a precious gift to have a place to share the depths of who you are with someone you know cares for you no matter what.

Shelley Quinones is a Licensed Therapist in San Dimas, California. She has been in the field in various roles for over 20 years. She is trained in EMDR which helps process minor daily traumas that accumulate, or major traumas that influence daily choices, or even allows for performance enhancement. She is a Christian and believes faith plays an important part in healing. Her website is www.shelleyqmft.com.

I had been working with Annie for 3 months. Her symptoms of anxiety, insomnia, and frequent bouts of crying had improved, but not to the extent either of us would have liked. Annie began to wonder whether difficulties in her marriage were implicated in her symptoms, and she decided to invite her husband Matt to join her in therapy. Matt agreed, but reluctantly. After the introduction he said, "I'm here, but I don't believe in psychotherapy". 

As I said to Matt that evening, I don't believe in psychotherapy either. Psychotherapy involves a knowledge base, a skill set, and a relationship, and hence is not something to "believe in". It requires knowledge of human behavior, interpersonal and family dynamics, emotional wellness and illness, and an awareness of the impact of culture and economic systems on people. It requires communication skills, along with a capacity for insight, intuitive understanding, the ability to suspend judgment, and a knack for making connections between seemingly unrelated events, behaviors, and feelings. The knowledge and the skills needed for the practice of psychotherapy qualify it as a science. 

As a relationship, psychotherapy is also an art. While certain principles underlie therapy as a particular kind of professional relationship, like boundaries, ethics, and non-reciprocity, it can't be learned from a book or even by imitating other therapists. Relationships must be experienced and felt, and too many rules or road maps diminish them. 

When I sit down with Annie and Matt, I can't forget what I've learned or the skills I've developed. Paradoxically, however, I have to bracket them time and again to e receptive to these unique human beings, and to open myself to a brand new relationship. Empathy, which is the ability to walk a bit in someone else's shoes, so that they might possibly walk farther or more easily, involves both a  commitment and an aptitude. 

I suggested Annie and Matt think of therapy like a house, a house being important, even essential, but not something to believe in. The foundation, the framing, the siding, and the roof make up the science of psychotherapy. Everything else is art. 

Susan Donnelly has been a practicing psychotherapist for over 30 years, and presently maintains a private practice in Ridgewood, NJ. she has held clinical and administrative positions in public and private agencies and has recently completed a term as Chair of the Bergen Country Mental Health Board. You can visit her website and blog at www.ridgewoodtherapy.com. 

After receiving a diagnosis of schizophrenia, bipolar disorder, or a personality disorder, one can become overwhelmed with the seemingly disastrous news. Fear and anxiety may creep in and take over, but it is important to gain knowledge and learn how best to cope with the news. By learning about these disorders, one can come to terms with the diagnosis and move toward seeking appropriate treatment. 

Schizophrenia, bipolar disorder (previously known as Manic-Depressive Illness), and the personality disorders are all treatable conditions. While they each have distinct characteristics, they can also have overlapping symptoms, making proper diagnosis challenging. 

Schizophrenia and bipolar disorder are two major mental illnesses. Schizophrenia is primarily a thinking disorder. Bipolar disorder is primarily a modd disorder. Both conditions can cause the person to lose touch with reality. 

Personality disorders refer to enduring patterns of being, which are maladaptive, and interfere with an individual's attainment of contentment, stability, safety, and integration into society. A personality disorder often supports symptoms that trouble the individual such as anxiety, depression, eating disorders, and substance abuse. 

The most talked about personality disorder is borderline personality disorder, distinguished as the personality disorder that may require specialized treatment for its behavioral aspects. One one personality disorder, antisocial personality disorder, is not considered to be treatable with medication or psychotherapy techniques currently available. 

Schizophrenia

Schizophrenia commonly starts in late adolescence. The young person with an emerging schizophrenia may suffer from unrealistic, compelling ideas (called "delusions"), perceptual disturbances such as hearing voices, social withdrawal, and difficulty putting thoughts together. 

Early intervention with psychotropic medications is always indicated in stabilizing the individual before symptoms become flagrant and disruptive to the person's life. Sometimes hospitalization is needed to accomplish this goal. Psychotherapy and group therapy centers are important adjuncts of the treatment for this illness in many cases. 

Social workers play an important role in providing psycho-education for patients and families, and making appropriate referrals for services specially designed for helping people with this illness. Clinical social workers directly deliver psychotherapy for the conditions of mental illnesses. People with schizophrenia often lack the consistency of judgment to cope alone in the world, can show deterioration over time, and may need lifelong help in sustaining themselves in the world.

Bipolar Disorder

Bipolar disorder is expressed in people who have episodes of serious depression (characterized by symptoms such as lack of appetite, withdrawal, pessimism, lack of energy and disinterest in normal activities), coupled with episodes of mania or elation (characterized by such symptoms as sleeplessness, high energy, distractibility, irritability and excessiveness of sexuality, spending, talking, and self-importance. 

As with schizophrenia, medication is essential to stabilize mood. In the case of bipolar disorder, psychotherapy is also essential for the person's overall understanding of, and coping with, their condition over their lifetime. Sometimes people resist believing they have a mental problem. Disbelief can lead to repeated involuntary hospitalizations for the safety of the person and others. Therapists who are social workers can be especially well equipped to look for and be sensitive to cultural attitudes which may impede the acquiring of appropriate mental health services.

Personality Disorders 

Personality disorders provide fertile soil for the maintenance of uncomfortable and sometimes behavioral symptoms. While medications may temporarily help with symptoms that are supported by the particular disorder (depression, anxiety, insomnia), the ultimate help comes with the psychotherapy that treats the underlying personality disorder. 

Psychotherapy for personality disorders often requires a commitment to meeting with an experienced therapist frequently and regularly over a long period of time to obtain a significant result. Those people whose condition includes seriously self-destructive behaviors do best with DBT (Dialectical Behavioral Therapy), a therapy which specifically focuses on curtailing these behaviors. As with major mental illnesses, hospitalization can be required at times. 

After Diagnosis

Post-diagnosis can be a confusing time and with a clinical social worker specializing in mental health issues can clarify the path to begin the process of obtaining help. An expert can help wade through the numerous types and modalities of therapies offered and find the best treatment available. 

Joan E. Shapiro LCSW, BCD is a Lecturer in Social Work for the North Shore University Hospital's Department of Psychiatry. She is in full time private practice on Long Island, N.Y. Ms. Shapiro earned her MSW from Smith College School for Social Work in Northampton, MA and attended the Institute for Psychoanalytic Training and Research in New York City. Ms. Shapiro has trained at New York Hospital Westchester Division, Bronx Municipal Hospital Center, and The Clifford Beers Guidance Clinic in New Haven. She was a staff social worker at North Shore University Hospital Department of Psychiatry's Out Patient Department for twenty five years.

*Photo Credit - Williamsburg Hedge Maze