I'm a clean freak married to an inveterate slob, my husband. Sometimes murderous rage arises, divorce comes to mind or separate domiciles...but then lonliness would be an issue. Then it all dissolves with other concerns until the next time arises. What should I do?

Talk with your husband, preferably when you're in a calm state of mind, about how you need more help with housecleaning (rather than telling him he has to help you) and enlist his help in coming up with a solution that addresses your need.

Negotiate. Perhaps there are things you do that drive him crazy and he'd be willing to make changes if you would too.

Consider the responsibilities your husband does take on (hopefully there are some and if not perhaps this needs to be explored) and let him know you appreciate his efforts.

Hire someone to come in regularly to clean and tidy up the house. If you can afford to do this you can turn your attention to other matters and take some negative energy off the relationship.

From a more psychological standpoint what are the thoughts that are running through your mind during and leading up to the murderous rage feelings? How are you interpreting the fact that he hasn't kept things neat and clean? Is he sending you a message, and if so, what? Who was responsible for keeping the house clean and organized in your family of origin and what kind of impact did this have on you? The answers to these questions may reveal deeper issues for you to reflect on personally and/or to begin a more intimate conversation with your husband.

Consider what having the house clean and neat does for you. For instance, for some people a neat, clean and calm environment is a way to manage anxiety. Others are unconcerned and unaffected.

It's always good to think about how important this issue is when considered in the context of your whole relationship. What if your partner is not going to change in this respect? If you value your partner and your relationship is good in many ways is it wise to continue to be invested in his changing? Or would it be better to work toward acceptance of your differences and finding ways to dissipate your anger and any arguments that arise from it?

Is therapy really right for me?

Some seek psychotherapy as a means to clarify and crystallize their thoughts and values when contemplating a change or out of a desire for personal growth and development.

People seek psychotherapy when their relationships are fraught with discord or disappointment or even when the relationship is good and they wish to further explore and clarify lingering concerns before making a deeper commitment (as a couple might wish to do in premarital counseling).

Often people consider entering psychotherapy because they are suffering in some way. Their suffering may be related to a current crisis or trauma in their personal or professional lives or may be the result of long-standing patterns of thinking, feeling or behaving, perhaps connected to unexplored aspects of their family dynamics, which have for a long time sabotaged the creation of a happy and rewarding life. It may be that the experience of childhood abuse or neglect has cast a shadow on their adult lives. They may be grieving or struggling with self-esteem issues or experiencing symptoms of depression, anxiety, panic, or posttraumatic stress.

How do I know if I my symptoms warrant talking to a therapist?

Rather than continue to question yourself about the seriousness of your problems and whether they merit your seeking help, why not acknowledge that something is troubling you and that you deserve to seek the help you need. Schedule a session, pay attention to the way it feels to talk with your therapist, decide whether the session seemed helpful and then discuss with your therapist whether psychotherapy can provide you with the help you need.

Psychotherapy has the potential to help with many symptoms, some of which are listed below.

Some symptoms of depression are:

• depressed mood
  
• loss of interest or pleasure
  
• sadness and tearfulness
  
• significant increase or decrease in appetite and/or weight
  
• insomnia or hypersomnia
  
• fatigue or loss of energy
  
• loss of motivation
  
• indecisiveness
  
• compromised ability to think or concentrate
  

Symptoms of generalized anxiety:

Excessive anxiety and worry that is difficult to control and includes three of the following six symptoms:

• restlessness or feeling keyed up or on edge
  
• being easily fatigued
  
• difficulty concentrating or mind going blank
  
• irritability
  
• muscle tension
  
• sleep disturbance

The focus of anxiety and worry is not confined to another psychological problem and causes significant distress or impairment in functioning.

Some symptoms of panic attacks:

A discrete period of intense fear or discomfort in which four or more of the following symptoms developed abruptly and reached a peak within 10 minutes:

• palpitations, pounding heart, or accelerated heart rate
  
• sweating
  
• trembling or shaking
  
• sensations of shortness of breath or smothering
  
• feeling of choking
  
• chest pain or discomfort
  
• nausea or abdominal distress
  
• feeling dizzy, unsteady, lightheaded, or faint
  
• feelings or unreality or being detached from oneself
  
• fear of losing control or going crazy
  
• fear of dying
  
• numbness or tingling sensations, chills or hot flushes
  

For some, panic attacks may be followed by anxiety about being in places or situations where a panic attack might occur and from which escape might be difficult or embarrassing.

Syptoms of posttraumatic stress:

Experiencing, witnessing or being confronted with a traumatic event(s) involving actual or threatened death or serious injury or threat to the physical integrity of oneself or others and responding with intense fear, helplessness, or horror.

The traumatic event is persistently reexperienced in various ways:

• recurrent and intrusive distressing images, dreams, thoughts, perceptions
  
• a sense of reliving the experience
  
• intense psychological distress and/or physiological reactivity when exposed to cues that symbolize or resemble an aspect of the trauma
  

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness:

• efforts to avoid thoughts, feelings or conversations associated with the trauma
  
• efforts to avoid activities, places or people that arouse recollections of the trauma
  
• inability to recall an important aspect of the trauma
  
• diminished interest in activities
  
• feelings of detachment or estrangement from others
  
• restricted range of feelings
  
• sense of a foreshortened future
  

Persistent symptoms of increased arousal:

• difficulty falling or staying asleep
  
• irritability or outbursts of anger
  
• difficulty concentrating
  
• hypervigilance
  
• exaggerated startle response
  

Do you continue to educate yourself in research findings and other aspects of your field?

Yes.  All psychotherapists licensed as marriage and family counselors are mandated to complete at least 36 hours of continuing education every two years.

What if I need medication?

If I believed you might benefit from taking medication I would discuss the issue with you and if you were open I would refer you to a psychiatrist for a medication evaluation.  A psychiatrist is a medical doctor with a specialty in psychiatry and an in depth knowledge of the medications used to aid in the treatment of disorders such as depression, anxiety, panic disorder, bipolar disorder, ADD, and obsessive compulsive disorder.  Medication can only be prescribed by medical doctors.  The psychiatrist would spend an hour or so talking with you in order to determine whether you were a candidate for medication and which meds would likely work best for your symptoms.  The psychiatrist would answer questions and give you his/her recommendations and a prescription if you decided you wanted to try the medication.  The psychiatrist would monitor you closely in the weeks ahead in order to establish how you were responding to the meds. During the course of therapy you and I would also be talking about your experience of the medication and I would confer with your psychiatrist (with your permission) whenever I thought it was necessary.

My husband and I talk about having counseling but I am frightened that it will uncover some personal secrets I have about our marriage.

It’s not uncommon for personal secrets to be uncovered during the course of couples counseling but you have the right to allow your own secrets to come out in the open or not and to decide if and when the timing is right for you.

It might benefit you to talk with a therapist on your own about what your concerns are regarding the secrets being revealed. Your therapist can help you consider the implications of revealing or not revealing, help you develop self-care strategies, and can facilitate your having more clarity about whether or not to pursue couples counseling.

I am currently in therapy but feel that my therapist is not taking me seriously. Is it ethical to start with someone new?

It’s important to work with a therapist you feel comfortable with and one who takes what you say seriously. If you wish to extricate yourself from therapy you can tell the therapist in person that you are leaving or leave a phone message.

From the standpoint of getting the greatest benefit from your treatment (whether or not you choose to move on to another therapist) in most cases it would be best to speak to your therapist about whatever dissatisfaction you are experiencing regarding your therapy. Your therapist should take your complaint seriously and invite you to explore the issue with her in a way that fosters awareness and personal growth. Generally we become stronger by developing the capacity to express our thoughts and feelings and to work through conflicts in our relationships. It’s common for uncomfortable issues to arise between therapist and client as they do in other important relationships, and often these issues mirror the issues you have had with significant others in your family, personal or professional worlds. In therapy you have the opportunity to explore the personal significance of the issue in the safety of the therapeutic environment and hopefully come to new understanding and new ways of being that will serve you in your relationships outside of therapy. For the client this process takes courage, the capacity to experience uncomfortable feelings and a strong desire to learn and grow. The therapist should be knowledgeable, respectful, and in service of the client’s growth and development.

From the standpoint of ethics the therapist is expected to take her clients seriously and treat them with respect. It’s ethical for a therapist to treat a client who has recently left another therapist and good practice to explore with the client what led to the termination of her/his last treatment. The client’s personal ethics come into play regarding the best way to leave relationships that are not serving her needs.

If I tell you about illegal conduct or illegal drug use are you obligated to report it?

No.

How private is my therapy? Do you take notes and who else would have access to them?

Your therapy is private in that your therapist is mandated to keep all that goes on (including notes) confidential with a few exceptions:

• If you are using insurance to pay for your therapy your insurance company is always privy to your diagnosis, dates of treatment and information regarding whether you are being treated individually, as a couple, or in a group. This information must be on every invoice your therapist sends to the insurance company or reimbursement will be denied. Your insurance company can request access to your records in other situations as well, for example, if your therapist is being audited by the insurance company your records may be scrutinized to see if the therapist is in compliance with insurance guidelines.
  
• If your mental health is being called into question in conjunction with a lawsuit you are involved in your records and/or your therapist's testimony may be subpoenaed. Your therapist should notify you if your records are requested.
• If you are a danger to yourself or to other people your therapist is mandated to notify the proper authorities so that you or anyone in danger from you can be kept safe from harm.
• Your therapist is mandated by law to report situations where children or elders are being abused. Your therapist would most often inform you before a report was made and talk to you about the process and possible repercussions.
• Your therapist may be invoved in ongoing consultation with other therapists about the diagnosis and treatment of clients. Identifying information about the client is always kept confidential and the focus of discussion is on how the therapist can continue to provide her clients the best treatment.

How does therapy work and how will I know if I’m getting better?

Psychotherapy is a process in which the therapist and the patient discuss a myriad of issues, events, experiences and memories. This process creates the opportunity for deeper self-awareness and understanding of current problems and paves the way for connecting with and building on existing strengths, developing new self-care strategies, and making choices that lead to feeling good about oneself and creating a more satisfying life.

You will know you’re getting better when the problems that brought you to therapy have been resolved or have lost their hold on you and you are feeling better about yourself. During the course of therapy you should be having an ongoing dialogue with your therapist about your progress.