Author: Maria Lopez

The term “mental health” is used everywhere—from workplace wellness campaigns to TikTok therapy trends. But its ubiquity doesn’t mean it’s well understood. Mental health isn’t simply the absence of illness, nor is it a synonym for feeling good all the time. It’s a complex, dynamic system involving emotional resilience, self-awareness, behavioral regulation, and the capacity to function in a variety of social and internal roles. So what does it really mean to be mentally healthy—and who gets to decide?

Mental Health Is Not Binary

Mental health exists on a continuum. People often think of it in binary terms—either you’re “mentally ill” or you’re “mentally healthy.” But most of us move between different points on this spectrum throughout our lives. You can experience symptoms of anxiety or depression and still be high-functioning. You can have no clinical diagnosis and still be emotionally dysregulated, unfulfilled, or in crisis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) provides a framework for identifying mental illness, but it doesn’t define mental health. That’s because mental health encompasses a broader range of human experience than any manual can capture (American Psychiatric Association, 2022).

The Components of Mental Health

The World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to their community” (WHO, 2018). This definition includes several core components:

• Emotional well-being: The ability to regulate emotions and manage stress
• Psychological flexibility: Being able to adapt to changing situations and recover from setbacks
• Cognitive functioning: Clear thinking, decision-making, and problem-solving
• Social health: Maintaining satisfying interpersonal relationships
• Purpose and meaning: A sense of direction or fulfillment in life

It’s possible to struggle in one area while thriving in another. Mental health is not static—it’s a set of capacities that can strengthen or erode based on environment, life events, neurobiology, and systemic factors.

What Mental Health Is Not

Understanding what mental health is also requires clarifying what it isn’t. Mental health is not about always being happy. It’s not about being free from stress, never experiencing conflict, or always feeling “fine.” In fact, suppressing difficult emotions or maintaining an inauthentic sense of calm can indicate emotional avoidance—not resilience. Mental health is also not a luxury reserved for those who have the time, money, or cultural permission to seek it. Unfortunately, social narratives often frame therapy and emotional wellness as optional or indulgent. This erases the reality that mental health is as foundational as physical health—and equally deserving of care and attention.

The Role of Culture and Identity

Mental health cannot be separated from context. What’s considered mentally healthy in one culture or subculture may be viewed differently in another. For example, independence and assertiveness are often valued in Western mental health frameworks, but collectivist cultures may emphasize harmony, duty, and interdependence. Similarly, gender, race, and class shape how mental health is understood and accessed. Black, Indigenous, and people of color (BIPOC) communities often face barriers to care and are more likely to be misdiagnosed or underserved in mental health systems (Snowden, 2001). Queer and trans individuals may avoid seeking care due to past discrimination or lack of affirming providers. What we internalize as “normal” or “healthy” is often filtered through systems of power. That means developing a healthy sense of self may require unlearning societal messages—not just resolving individual symptoms.

Mental Health Is Relational

While many self-help approaches emphasize internal mindset shifts, mental health is deeply relational. Your emotional regulation, self-worth, and ability to cope are shaped by early attachment, ongoing relationships, and the feedback loops of your environment. People raised in invalidating or emotionally inconsistent households may struggle to trust their feelings or regulate their nervous systems. Adults who spend years in toxic workplaces or abusive partnerships often experience a slow erosion of mental health—not because they’re weak, but because sustained relational trauma rewires your sense of safety and identity (Herman, 2015). Healing doesn’t just happen in isolation—it often happens in safe relationships, including therapeutic ones.

When Mental Health Looks “Fine” But Isn’t

One of the most overlooked aspects of mental health is the experience of people who appear functional on the outside but are emotionally struggling beneath the surface. High-achieving individuals—especially women, neurodivergent adults, and people socialized to mask distress—often internalize the belief that mental health means productivity, emotional control, or being easy to be around. This can lead to a chronic state of internal dysregulation, emotional suppression, and burnout that never gets addressed because it doesn’t look like “typical” illness. True mental health includes the capacity to be real, not just the capacity to perform wellness.

Mental Health and the Nervous System

A growing body of research connects mental health to nervous system regulation. Chronic stress, trauma, and emotional neglect don’t just impact mood—they dysregulate the autonomic nervous system, leading to symptoms like hypervigilance, emotional shutdown, irritability, and fatigue (Porges, 2011). Mental health, in this context, means having access to a regulated range—the ability to shift flexibly between states of activation and rest. This is why nervous-system-informed therapy, somatic practices, and mind-body approaches have become more central to contemporary mental health care. It’s not just about fixing thoughts—it’s about restoring balance to the body.

The Medical Model vs. a Holistic Model

Traditional mental health care has often leaned heavily on the medical model, which focuses on diagnosis, symptom reduction, and pathology. While this approach is valid and necessary for many, it can also pathologize normal responses to abnormal environments. Feeling anxious in an unsafe world or depressed in a lonely culture isn’t necessarily a disorder—it may be a signal. A more holistic model recognizes that mental health is also impacted by community, purpose, creative expression, physical wellness, and access to resources. Therapy within this model isn’t just about “fixing” the individual—it’s about exploring how to live more authentically within a complex world.

Why Mental Health Matters

Good mental health is foundational for everything else: relationships, work, creativity, physical health, and decision-making. When our mental health is supported, we can tolerate discomfort, take emotional risks, and engage in growth. When it’s neglected, even the simplest tasks can feel insurmountable. Prioritizing your mental health doesn’t mean you’re broken. It means you’re human. Therapy, self-inquiry, community support, and intentional rest aren’t luxury items—they’re tools for long-term sustainability.

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR).

Herman, J. L. (2015). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

Snowden, L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3(4), 181–187. https://doi.org/10.1023/A:1013172913880

World Health Organization. (2018). Mental health: Strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

Much of what we believe about ourselves doesn’t come from conscious thought. It’s shaped in layers—through experiences, family dynamics, culture, media, religion, and social expectations. Over time, these messages become internalized beliefs: invisible narratives we absorb as truth. Some are adaptive, helping us navigate the world. Others become distorted, rigid, or self-defeating—and quietly drive everything from anxiety to burnout. This article explores how internalized beliefs form, how they influence mental health, and what therapy can do to help you identify and unlearn them.

What Are Internalized Beliefs?

Internalized beliefs are deeply embedded thoughts and assumptions you hold about yourself, others, and the world. They’re not surface-level ideas you consciously repeat. They’re core frameworks your brain uses to make meaning. For example, someone raised in a perfectionist household may internalize the belief: “If I make a mistake, I’m a failure.” This belief might never be said out loud, but it becomes the lens through which they interpret feedback, relationships, and even their own worth. These beliefs are often learned before we had the capacity to question them. That’s what makes them powerful—and sometimes dangerous.

How Internalized Beliefs Are Formed

Internalized beliefs are shaped through repetition and emotional intensity. When you repeatedly hear a message (e.g., “You’re too sensitive”) or have emotionally charged experiences (e.g., being punished for expressing feelings), your brain begins to encode those messages as truths. The earlier these experiences happen, the more ingrained the beliefs become (Beck, 1976). Children do not have the cognitive ability to evaluate the fairness or accuracy of adult behavior. They adapt by building internal stories: “If they’re angry, it must be my fault.” These stories can later calcify into rigid beliefs, such as “I am responsible for everyone’s feelings” or “My needs are a burden.”

Reflection Prompt:
What’s one belief you carry about yourself that feels like a truth but may have started as someone else’s opinion?

Common Internalized Beliefs That Harm Mental Health

Some internalized beliefs are so normalized we barely notice them. Yet they show up in chronic stress, people-pleasing, burnout, and relationship conflict. Here are a few examples that often emerge in therapy:

• “I must always be productive to be valuable.”
• “If I set a boundary, I’m being selfish.”
• “I have to fix everything to feel safe.”
• “My emotions are too much for other people.”
• “Asking for help means I’m weak.”
• “If someone criticizes me, it means I’ve failed.”

These beliefs are not just thoughts—they are emotional reflexes. They shape how we interpret events, how we treat ourselves, and what we believe is possible in life.

How Beliefs Influence Emotions and Behavior

Cognitive models of mental health, such as Aaron Beck’s Cognitive Theory of Depression, suggest that internalized beliefs shape how we feel and behave in automatic ways (Beck, 1967). If you believe, “People will leave me if I express my needs,” you may avoid confrontation—even when it hurts you. If you believe, “Rest is lazy,” you may feel guilty for taking a break, which keeps your nervous system in a constant state of overactivation. Over time, these thought-emotion-behavior loops become habitual. You don’t just think the belief—you live it. The result can be anxiety, depression, shame, or burnout.

The Role of Schema Activation

In therapy, internalized beliefs are often addressed through the lens of schemas—enduring themes that begin in childhood and influence how we perceive ourselves and others. For example, someone with a Defectiveness/Shame schema may believe, “If people really knew me, they’d leave.” This belief might lead to avoidance of intimacy or overcompensating through perfectionism (Young et al., 2003). Schema activation can be triggered in adult relationships, workplaces, or social situations that mimic early dynamics. The reaction might feel irrational, but it’s actually your brain replaying an old pattern.

Reflection Prompt:
What situation in your current life triggers an outsized emotional response? What belief might be getting activated?

Internalized Oppression and Identity-Based Beliefs

Internalized beliefs are not only shaped by families—they’re shaped by culture and systems of power. Internalized oppression refers to the unconscious adoption of negative societal messages about one’s identity (David, 2014). This includes:

• Internalized racism: Believing you are less worthy due to your racial identity
• Internalized ableism: Believing your neurodivergence or disability is a flaw
• Internalized sexism: Believing your voice, anger, or ambition is inappropriate
• Internalized capitalism: Believing your value is tied to productivity or output

These beliefs can lead to chronic self-doubt, shame, overwork, and a sense of emotional invisibility. Therapy must account for these systemic layers—not just individual psychology.

How Internalized Beliefs Block Healing

Many clients begin therapy hoping to feel better. But internalized beliefs often stand in the way. For example:

• If you believe “Other people have it worse,” you may minimize your pain and avoid asking for help.
• If you believe “Feeling sad is weakness,” you may shut down emotionally or intellectualize your way through therapy.
• If you believe “I have to prove I’m worth loving,” you may seek validation from emotionally unavailable partners.

These beliefs don’t just affect mood—they affect whether you let yourself heal. Part of therapy is creating enough emotional safety to question these patterns.

What Therapy Can Do

Unlearning internalized beliefs is not about positive thinking or self-affirmations. It’s about building new internal frameworks that reflect who you are—not who you had to be. Effective therapy helps by:

• Identifying the origin and function of your beliefs
• Validating why you developed them in the first place
• Introducing more flexible, accurate alternatives
• Practicing new beliefs in safe, real-world situations
• Teaching you how to tolerate the discomfort of change

For example, someone who believes “I can’t ask for help” may be encouraged to name one small need in session and notice what happens next. These micro-corrections, repeated over time, begin to create new neural pathways.

Why Insight Alone Isn’t Enough

Understanding your beliefs intellectually is helpful—but it’s not enough. Beliefs live in the body as well as the mind. You may know that you’re not responsible for other people’s happiness—but still feel panicked when someone is upset. This is why therapy that includes somatic or experiential elements can be more effective. Techniques like EMDR, schema therapy, or psychodynamic work help integrate insight with emotional release and behavioral change (Wampold, 2015). You don’t just learn a new belief—you start to embody it.

Reflection Prompt:
What belief have you intellectually outgrown but still feel emotionally stuck in?

Letting Go Without Losing Yourself

One of the fears people have about unlearning beliefs is: “Who will I be without this?” If your entire sense of self has been built around being useful, strong, compliant, or successful, letting go of those identities can feel terrifying. That’s normal. But beneath the fear is the possibility of a self that is not performance-based. A self that can rest, say no, feel deeply, and exist outside of utility. Therapy doesn’t erase who you are—it helps you reclaim parts of yourself that have been silenced by survival.

Final Reflection Prompt:
What belief are you ready to unlearn—not because it’s wrong, but because it no longer serves you?

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. Harper & Row.

Beck, J. S. (1976). Cognitive therapy and the emotional disorders. Penguin.

David, E. J. R. (2014). Internalized oppression: The psychology of marginalized groups. Springer Publishing Company.

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Starting therapy can feel like stepping into the unknown. Whether you’re seeking support for anxiety, trauma, relationship issues, or just trying to understand yourself better, the first month of therapy—also known as the intake period—is not about solving everything. It’s about building the foundation. Many new clients expect immediate emotional relief or breakthroughs, but what often happens instead is paperwork, assessment, and a slow unraveling of patterns. This isn’t a delay—it’s part of the process. The first month sets the tone for how the work will unfold.

Week 1: The Paperwork Is Part of the Work

Your first session likely begins with logistics: completing intake forms, reviewing confidentiality policies, and discussing informed consent. While this can feel bureaucratic, it’s actually your first experience of the therapist’s boundaries and ethics. These documents cover your privacy rights under HIPAA, any limits to confidentiality (like safety concerns), and details about fees, cancellations, and communication outside of session. Don’t overlook these sections—they tell you how your therapist thinks about structure, which is crucial for building trust. You may also complete standardized assessments during this session, like the PHQ-9 (for depression) or GAD-7 (for anxiety), which help establish a clinical baseline. These are not diagnostic tools in isolation but part of a broader evaluation. If you’re neurodivergent or managing chronic stress, you may want to ask whether your therapist uses additional screening tools or tailors their approach accordingly.

Week 2: The Therapist Is Listening for Themes

The second session usually begins what’s known as a clinical interview. You’ll be asked about your current stressors, mental health history, medical background, family dynamics, and what brings you to therapy now. While it may feel like you’re just sharing your story, your therapist is actively gathering diagnostic impressions, risk factors, and potential treatment directions. They’re listening for emotional tone, relational patterns, coping mechanisms, and belief systems. This isn’t about labeling you—it’s about understanding how your nervous system has adapted to stress over time. During this week, you might feel disoriented or even emotionally hungover afterward. That’s normal. Speaking your history out loud, often for the first time, can bring old feelings to the surface.

Reflection Prompt:
What was your emotional response after your first session? What do you think that feeling might be telling you?

Week 3: Naming the Patterns Behind the Problem

By week three, you and your therapist are beginning to move beyond surface-level concerns. This is when many people feel the urge to ask, “So what kind of therapy is this?” or “How are we going to fix this?” You’re not wrong to want answers. But therapy doesn’t always offer quick clarity. During this phase, your therapist may begin to suggest formulations—a working hypothesis of how your presenting concerns developed and what keeps them going. They may also begin discussing therapeutic models (like psychodynamic therapy, CBT, or schema therapy) or explain what kind of work may be helpful. For example, if you struggle with people-pleasing, they may begin to explore your early experiences of conditional acceptance or past environments where your safety depended on keeping others happy. You’re not expected to resolve anything yet—this is the phase where you name it before you change it.

Week 4: Defining Goals and Establishing the Frame

By the end of the first month, your therapist will likely begin to introduce the therapeutic frame: the structure and expectations that define how therapy will proceed. This includes how often you’ll meet, what kind of goals you’re working toward, and what roles you and your therapist will each play. For some clients, this is the first time they’re asked to reflect on what success looks like. That question can feel overwhelming—especially if your only goal was “not feeling like this anymore.” Good therapists will help break this down into smaller, more concrete outcomes. Maybe success means responding to stress with less panic. Maybe it means becoming more assertive, sleeping better, or reducing emotional reactivity in relationships. You don’t need a perfect answer, but being curious about what you want out of therapy helps shape the work ahead.

Common Misconceptions About the First Month of Therapy

Many people enter therapy expecting to feel better right away. But the intake period can feel messier, not easier. You may experience:

• Emotional discomfort from naming old wounds
• Frustration that the therapist isn’t “doing” more
• Fear that your story is too much, or not enough
• Doubts about whether therapy is “working”

These responses are not signs that therapy is failing—they’re signs that your internal defenses are reacting to something new. Therapy is a relational process, and the therapeutic alliance (the bond between client and therapist) is the strongest predictor of positive outcomes (Flückiger et al., 2018). It takes time to build.

Reflection Prompt:
What are your expectations of therapy? Which ones came from TV, social media, or others—and which ones feel true for you?

What the Therapist Is Watching For

During the intake period, therapists are quietly assessing a number of things:

• Your emotional range and how you describe feelings
• Whether you intellectualize, dissociate, or deflect under stress
• What coping strategies you rely on—healthy or otherwise
• Your relational style (avoidant, anxious, controlling, compliant)
• Any risks related to safety, trauma, or substance use

You may not hear all of this reflected back right away. That doesn’t mean your therapist isn’t noticing—it means they’re pacing the work. Rushing too quickly into trauma, grief, or identity exploration without first building safety can cause harm. The intake month is about observing before intervening.

How to Know If It’s the Right Fit

The first month is also when you begin to get a feel for your therapist’s style. Do they interrupt or let you talk? Are they validating or more confrontational? Do they seem attuned to your nervous system—or are they focused only on surface symptoms? You don’t need to feel instant emotional intimacy. But you should feel safe enough to begin being honest. If you consistently feel judged, misunderstood, or minimized, it’s okay to bring that up—or even explore other options. Finding the right fit can take time, and many clients don’t hit their stride until the second or third therapist. That’s not failure—it’s discernment.

Red Flags in the Intake Period

While discomfort is normal, some signs indicate a poor clinical match or unethical practice:

• The therapist discloses too much about their own life
• They seem distracted, rushed, or disorganized
• They don’t explain their approach or ask what you want
• They pathologize you without consent or context
• They ignore racial, cultural, or neurodivergent context

If something feels off, you can name it, ask questions, or move on. The first month of therapy is just as much about you interviewing them as it is about them evaluating you.

Why the Intake Period Matters So Much

Intake is not a throwaway month—it is the blueprint. Rushing through it to “get to the work” is like trying to build a house without a foundation. Every question your therapist asks during this time is designed to understand your psychological architecture—where it holds, where it cracks, and where you’ve patched it up with coping mechanisms that no longer serve you. This is also the phase where you begin to feel into the relational dynamics that mirror your other relationships. Do you minimize your needs? Apologize for taking up space? Look for cues of approval or rejection? These behaviors often show up early in the therapy room and are essential data for the work ahead.

Reflection Prompt:
What part of yourself showed up in therapy that surprised you? What do you think it reveals about how you relate to others?

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172

Kleiman, E. M., Turner, B. J., Fedor, S., Beale, E. E., Huffman, J. C., & Nock, M. K. (2017). Examination of real-time fluctuations in suicidal ideation and its risk factors: Results from two ecological momentary assessment studies. Journal of Abnormal Psychology, 126(6), 726–738. https://doi.org/10.1037/abn0000273

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Parenting is often portrayed as the ultimate act of selflessness—constantly giving, staying strong, and putting your child’s needs first. But what happens when the parent is running on empty? When anxiety, depression, trauma, or burnout aren’t just occasional challenges, but part of your daily reality?

In a culture that idolizes parental sacrifice, it’s rarely talked about: parenting while managing your mental health can feel isolating, exhausting, and loaded with guilt. Yet it’s far more common than most people realize. Studies estimate that at least 1 in 5 adults will experience a mental health disorder in any given year (National Institute of Mental Health, 2022)—and many of them are parents.

This article explores what it means to raise a child while also navigating your own psychological well-being, what internal narratives make it harder, and what actually helps.

You Are Not a Broken Parent

Let’s start with a reframe: struggling doesn’t mean you’re failing. In fact, the ability to acknowledge your limits, seek support, and reflect on your inner experience is a sign of psychological maturity.

Children do not need perfect parents. They need present, emotionally responsive ones—and emotional responsiveness is only possible when your own nervous system isn’t maxed out.

The myth of the ever-stable, always-available parent harms both adults and children. Kids who never see their parents take breaks, set boundaries, or say “I’m having a hard day” don’t learn what emotional regulation looks like in real life. Modeling honesty—age-appropriately—about your own needs shows your children that emotional maintenance is part of life, not a sign of failure.

Common Emotional Struggles Parents Don’t Talk About

Many parents managing mental health issues live with chronic internalized shame. You may fear that your child deserves someone “better” or worry that your symptoms will harm their development.

These are painful fears—but they often stem from perfectionistic or distorted beliefs rooted in trauma, societal pressure, or cultural expectations.

Some common patterns include:

• Feeling guilty for needing time away from your child, even when overwhelmed
  
• Comparing yourself to other parents who seem more patient, cheerful, or involved
  
• Believing your child is better off with a co-parent or other caregiver
  
• Avoiding honest conversations about your needs because of fear they’ll feel unsafe or unloved
  

These beliefs are often based on schemas—deep, unconscious mental patterns developed early in life (Young et al., 2003). If you were raised to prioritize others, to fear abandonment, or to suppress your own feelings, parenting can trigger those same unresolved wounds.

Reflection Prompt:

What do you believe makes a “good parent”? Where did those beliefs come from? Which ones are helping you—and which ones are hurting you?

How Your Mental Health Impacts Parenting—And Vice Versa

The relationship between parenting and mental health is bidirectional. Your mental state affects how you respond to your child, and your child’s behavior (or sleep schedule, or developmental needs) affects your mental state.

When you’re anxious, you may become overprotective. When you’re depressed, you may feel emotionally numb. When you’re burned out, even simple tasks may feel monumental.

These shifts don’t make you a bad parent—they make you human. However, unaddressed symptoms can reduce emotional availability and increase reactivity, which may affect a child’s emotional development (Goodman et al., 2011).

Conversely, managing your mental health—through therapy, medication, routines, or rest—can lead to more attuned parenting. Taking care of your mind isn’t selfish. It’s part of the job.

When Your Child Is Also Struggling

Many parents managing mental health challenges are also raising children with emotional, behavioral, or neurodevelopmental differences. If your child has ADHD, autism, anxiety, or sensory processing difficulties, the demands can be even more intense.

This double load can leave you with less energy for self-care and increase the risk of compassion fatigue. It’s important to acknowledge the emotional toll of caregiving without judgment.

You are allowed to grieve, feel angry, or want space—these feelings don’t mean you love your child any less. They mean you are a full person with needs of your own. Seeking your own support is not optional—it’s protective for everyone in your household.

Microboundaries That Make a Big Difference

You may not be able to take a vacation or redesign your life right now. But mental health isn’t built on grand gestures—it’s built on microboundaries: small decisions that protect your capacity.

Try experimenting with:

• Setting a visual cue (like a light or sign) that tells your child when you’re taking a five-minute reset
  
• Not answering questions immediately when you’re overstimulated—”I’ll respond in five minutes” is okay
  
• Keeping one small part of the house or day sacred for adult needs, even if it’s five minutes with a cup of coffee
  
• Using earplugs, noise-canceling headphones, or sunglass filters to reduce sensory load
  
• Having one phrase ready for hard moments—e.g., “I’m doing my best, and I’ll try again in five minutes”
  

These strategies are not about avoidance. They’re about regulating before you react. Every moment you model nervous system recovery teaches your child that big feelings are manageable—not dangerous.

Therapy Isn’t Just for the Crisis Point

Therapy is not only a place to “fix” something. For parents, it can be a space to explore:

• How your upbringing shaped your current parenting style
  
• Which emotions you suppress—and how that affects your relationships
  
• How to reparent yourself while raising a child
  
• How to name and reduce guilt, resentment, or shame
  
• How to stop performing perfection and start living authentically
  

Therapy doesn’t make you a better parent because it gives you tricks. It makes you a better parent because it helps you return to yourself. And from that place, your child learns to return to themselves, too.

Reflection Prompt:

If you could parent from a place of calm, self-trust, and enoughness, what would change in your household? What would you stop doing? What would you do more of?

You Are Allowed to Be a Work in Progress

Perhaps the hardest truth for parents managing mental health is this: your child will see you struggle. But that’s not the problem. The problem is when they see you struggling and pretending everything’s fine.

Children are incredibly perceptive. What matters is not that you’re always okay—but that you show them what it looks like to name your needs, recover from hard days, and stay connected through it.

You don’t need to perform strength. You just need to show up—honestly, consistently, and with a little grace for yourself.

Parenting while managing your mental health is not a detour from being a “real parent.” It’s the full, raw, human version—and it’s enough.

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14(1), 1–27. https://doi.org/10.1007/s10567-010-0080-1

National Institute of Mental Health. (2022). Mental illness. https://www.nimh.nih.gov/health/statistics/mental-illness

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Entrepreneurship is often framed as freedom—freedom from corporate structure, from limitations, from the 9-to-5. But what doesn’t get talked about nearly enough is what replaces those structures: emotional pressure, decision fatigue, financial risk, and a mental load so relentless it becomes a way of life. From the outside, entrepreneurship looks like hustle and innovation. But internally, it often feels like a quiet war between your vision and your nervous system.

This article unpacks the psychological costs of being a founder, freelancer, or small business owner. It’s written for the high-functioning entrepreneur who appears fine, meets deadlines, and gets results—but who secretly wonders if they’re one crisis away from collapse. If you’ve ever said “I can’t afford to burn out” while already being burned out, this is for you.

The Entrepreneurial Mindset: Ambition Meets Anxiety

Many entrepreneurs don’t just stumble into business ownership—they are driven by a deep need to prove something, create something, or control something. While these motivations can be adaptive, they’re often rooted in early psychological patterns. Unresolved trauma, attachment injuries, or a childhood of emotional parentification can shape the need to be independent, exceptional, or untouchable (Schimelpfening, 2023).

Research shows that entrepreneurs score higher than average on traits like persistence, risk-taking, and creativity—but they also show elevated rates of anxiety, depression, and ADHD symptoms (Freeman et al., 2015). The very qualities that help you succeed can also put you at risk.

Reflection Prompt:

• What unmet need or unresolved story originally fueled your decision to become an entrepreneur?

Isolation in Leadership: The Myth of Being the Strong One

Entrepreneurs often find themselves in emotionally isolating roles. You’re the person your team looks to for guidance. Your clients rely on your consistency. Your friends assume you’re thriving because your business appears successful.

But the reality is that many founders can’t confide in anyone. Sharing self-doubt might rattle investors. Admitting burnout might undermine credibility. Even among other entrepreneurs, there’s often an unspoken competition to “look” like you have it together.

This emotional isolation—what psychologists call role entrapment—can significantly increase stress-related health issues (Kahn et al., 1964). When your public identity is built on being capable, resilient, or visionary, asking for help feels like a betrayal of your brand.

Common Coping Strategies That Backfire

When emotional overwhelm becomes chronic, entrepreneurs often fall into compensatory coping strategies that temporarily soothe but ultimately exhaust the nervous system. These include:

• Overworking to avoid emotional discomfort
• Numbing with screens, caffeine, or alcohol
• Hyper-controlling tasks and people to manage anxiety
• Seeking dopamine from constant productivity instead of rest

These behaviors are often mislabeled as “just being driven,” but they are actually symptoms of dysregulation. Operating from survival mode can keep the business running—but only at the cost of your long-term mental health.

Reflection Prompt:

• What behaviors in your routine look like discipline from the outside but are actually forms of avoidance or anxiety management?

What Therapy Often Misses About Entrepreneurs

Traditional therapy models tend to focus on internal change: exploring childhood, identifying core beliefs, building emotional insight. While valuable, many entrepreneurs struggle to relate to these slower-paced approaches. Their stress is not only emotional but strategic and structural.

What many therapists miss is that entrepreneurs need their therapy to reflect the systems they’ve built around themselves. Their stress is often tied to business mechanics—difficult hires, cash flow uncertainty, client boundaries—and requires psychologically informed, business-literate support.

Effective therapy for entrepreneurs should include:

• Boundary work that maps onto client and team dynamics
• Emotional processing for leadership fatigue and ethical stress
• Rewiring beliefs about rest, failure, and worth
• Tools for self-regulation without losing ambition

Therapy that ignores the context of business stress risks pathologizing the client instead of supporting them.

The Burnout That Doesn’t Look Like Burnout

Many entrepreneurs burn out without realizing it. That’s because burnout in high performers doesn’t always look like collapse—it often looks like detachment, irritability, or feeling emotionally flat even when things are “going well.”

You might notice:

• Dreading small decisions you used to make easily
• Feeling resentful of your own success
• Watching your creativity disappear
• Waking up already exhausted
• Needing caffeine or pressure to function at all

This is not a personality flaw. It’s a nervous system in chronic overdrive. You’ve built an engine that only runs at 100 mph, and now it doesn’t know how to idle.

Reflection Prompt:

• What signs of burnout have you rationalized as “just being busy”? What would it take for you to believe they’re real?

Decision Fatigue and Emotional Exhaustion

Entrepreneurs make thousands of micro-decisions per week. This constant choice-making leads to decision fatigue, a form of cognitive depletion where your ability to weigh options or feel confident in your decisions erodes over time (Baumeister et al., 1998).

Decision fatigue increases anxiety, fuels perfectionism, and makes impulsive or avoidant behavior more likely. You might find yourself avoiding your inbox, redoing work to feel in control, or spiraling into indecision about hiring, marketing, or pricing.

This is not because you’re bad at business. It’s because your emotional bandwidth is maxed out.

The Psychology of Financial Risk and Identity

Unlike salaried professionals, entrepreneurs often tie their sense of self-worth to their revenue. When your income depends on your visibility, leadership, or personal brand, every dip in sales can feel like a personal failure.

The link between financial instability and mental health is well-documented (Richardson et al., 2013). But for entrepreneurs, financial stress also activates deep psychological triggers around identity: “Am I still valuable if I’m not making money?” or “What happens to me if this fails?”

These existential questions are rarely acknowledged in startup culture, yet they often drive chronic anxiety and shame.

Reflection Prompt:

• What financial outcomes have you wrongly internalized as reflections of your worth?

Entrepreneurial Trauma: What Nobody Names

Not all trauma comes from childhood. Many entrepreneurs experience trauma in their business. This can include:

• Being betrayed by a partner, employee, or contractor
  
• Losing your livelihood suddenly due to external circumstances
  
• Enduring public criticism or legal threats
  
• Navigating discrimination, bias, or systemic obstacles in your industry

These experiences can create PTSD-like symptoms—hypervigilance, difficulty trusting others, emotional reactivity—and often go unacknowledged because they don’t fit traditional definitions of trauma.

Yet business-related trauma changes how you lead, hire, delegate, and relate to your work. It deserves therapeutic attention.

Creating a Mental Health Infrastructure

Entrepreneurs need more than mindset work—they need infrastructure. That means building systems that support your mental health even when you’re not actively focused on it.

Start with:

• Clear delegation systems that reduce decision fatigue
  
• “Minimum viable rest” practices embedded into your week
  
• Regular therapy or coaching that includes business fluency
  
• A trauma-informed lens on your leadership style and team dynamics
  
• Scheduled check-ins with yourself that don’t revolve around goals

Mental health for entrepreneurs isn’t about adding more self-care—it’s about building work in a way that your nervous system can survive.

Reflection Prompt:

• What would it look like to build a business that sustains you, not just your clients or your revenue?

Rewriting the Internal Narrative

Entrepreneurs are often held hostage by invisible narratives: “I’m the only one who can do this,” “Success means never slowing down,” “If I drop a ball, everything will fall apart.” These stories are rarely questioned, even though they quietly dictate every decision you make.

Rewriting these beliefs doesn’t mean becoming passive or less ambitious. It means shifting from a fear-driven business to a sustainable one—where resilience doesn’t come from denial, but from integration.

In therapy, this might sound like:

• “My worth isn’t measured by urgency.”
• “Structure can protect my energy, not limit my creativity.”
• “I can rest without losing momentum.”

Your nervous system can become your ally—not your enemy—when your internal story no longer demands constant survival mode.

Final Reflection Prompt:

If your nervous system could design your business model, what would it look like?

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Baumeister, R. F., Bratslavsky, E., Muraven, M., & Tice, D. M. (1998). Ego depletion: Is the active self a limited resource? Journal of Personality and Social Psychology, 74(5), 1252–1265. https://doi.org/10.1037/0022-3514.74.5.1252

Freeman, M. A., Staudenmaier, P. J., Zisser, M. R., & Andresen, L. A. (2015). The prevalence and co-occurrence of psychiatric conditions among entrepreneurs and their families. Small Business Economics, 45(3), 431–452. https://doi.org/10.1007/s11187-015-9650-6

Kahn, R. L., Wolfe, D. M., Quinn, R. P., Snoek, J. D., & Rosenthal, R. A. (1964). Organizational stress: Studies in role conflict and ambiguity. John Wiley.

Richardson, T., Elliott, P., & Roberts, R. (2013). The relationship between personal unsecured debt and mental and physical health: A systematic review and meta-analysis. Clinical Psychology Review, 33(8), 1148–1162. https://doi.org/10.1016/j.cpr.2013.08.009

Schimelpfening, N. (2023). How childhood trauma affects adult entrepreneurs. Verywell Mind. https://www.verywellmind.com/trauma-in-entrepreneurs-7498674

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Social media is everywhere—woven into how we communicate, work, entertain ourselves, and shape our identities. In theory, it’s a tool to enhance connection. In practice, many of us log off feeling drained, anxious, inadequate, or overstimulated. We know we’re supposed to take breaks, but doing so feels like falling behind—or worse, disappearing. This contradiction is part of what makes social media psychologically complex. It meets real needs—belonging, expression, information—but often in ways that come with emotional side effects. And while it’s easy to blame the technology, the real issue lies in how these platforms intersect with human psychology, identity, and mental health. This article goes beyond the generic advice to “use social media less.” Instead, it explores the underlying psychological mechanisms of digital engagement, how they interact with mental health vulnerabilities, and what actually works to protect your well-being without unplugging from modern life.

The Psychology Behind Social Media’s Emotional Grip
Social media platforms are built on behaviorist principles. Likes, follows, comments, and endless feeds are part of a variable reward system—the same one that makes gambling addictive. You don’t know which post will go viral, which story will hit a nerve, or what notification will boost your mood. So your brain keeps checking, hoping the next scroll gives you a dopamine hit. But social media doesn’t just stimulate. It also regulates. Many people—especially those managing anxiety, depression, or trauma—use social media as a form of mood management. It’s a break from internal discomfort, or from the unpredictability of real life. It gives you control: swipe when you want, exit when you want, curate what you want. This is what makes it so tricky. Social media can soothe and stimulate the nervous system—but often in a way that bypasses genuine emotional processing. Over time, this can make your baseline anxiety worse, not better.

Who Is Most Vulnerable to Social Media Fatigue?
Not everyone is affected by social media in the same way. Certain groups are more prone to its emotional downsides due to pre-existing vulnerabilities: People with perfectionistic tendencies—especially those who measure self-worth through productivity or external validation. Social media feeds into performance anxiety and comparison. Neurodivergent individuals—those with ADHD, autism, or sensory sensitivity may experience heightened emotional reactivity or difficulty disengaging due to platform design (Hughes et al., 2020). Trauma survivors—social media can trigger emotional flashbacks, hypervigilance, or dissociation—especially when exposed to news cycles or emotionally charged content. Teenagers and young adults—due to ongoing identity development and social sensitivity, this group is particularly impacted by digital feedback loops (Twenge et al., 2018). Professionals in helping or high-visibility roles—therapists, doctors, educators, or influencers may experience content fatigue from constantly managing emotional and informational input online. These populations may not only be more affected by content—but also more likely to internalize it.

How Social Media Disrupts Emotional Regulation
Social media can feel like a break—but it often prevents the brain from actually resting. Here’s how it undermines emotional well-being beneath the surface: Chronic Comparison: Even when we intellectually know a post is curated, our emotional brain responds to the image. Seeing a peer’s vacation, someone else’s engagement, or a competitor’s success can trigger feelings of inferiority or self-doubt. This is explained by social comparison theory (Festinger, 1954), which shows that humans instinctively evaluate themselves relative to others. Information Overload: Endless feeds and infinite content create a state of low-grade cognitive fatigue. Your brain is absorbing far more stimuli than it’s designed to process, often without meaningful rest in between. This makes focus harder and contributes to emotional reactivity. Nervous System Overactivation: Exposure to constant crises—mass shootings, climate disasters, political upheaval—can leave users in a state of fight-or-flight, even when scrolling from a couch. This is particularly destabilizing for trauma survivors or people with anxiety. Disconnection from the Present: When you’re scrolling, you’re not with your body. You’re somewhere else—mentally tracking, comparing, or reacting to people you may not even know. This disconnect can fuel derealization and emotional numbness, especially when done for long periods. Delayed Emotional Processing: Instead of journaling, meditating, or calling someone, many people turn to social media to escape uncomfortable feelings. This can create a bottleneck of unprocessed emotion that eventually explodes—or turns into chronic stress.

When Social Media Use Signals Emotional Burnout
It’s easy to miss the signs that your relationship with social media has become unsustainable—especially when your use is habitual, professional, or culturally normalized. Common signs include: Feeling agitated, heavy, or empty after scrolling. Noticing more frequent self-comparison or critical self-talk. Difficulty focusing on tasks or staying present in conversations. Obsessively checking metrics, notifications, or follower counts. Sleep disruption tied to nighttime screen use. Emotional flattening or numbness throughout the day. A spike in anxiety or irritability after consuming content. If you’re experiencing several of these symptoms consistently, your nervous system may be signaling that it’s overwhelmed—and that your digital input is a major contributor.

Why “Just Delete the App” Isn’t the Solution
It’s tempting to think that going offline will solve the problem. And for some people, especially those in acute distress, it might help. But for most of us, the relationship with social media is not just about the platform—it’s about what it represents: A source of connection. A way to feel relevant or productive. A buffer against loneliness or boredom. A substitute for intimacy. A place to express identity. Unless those underlying needs are acknowledged and met elsewhere, quitting cold turkey may only increase distress.

What Actually Helps: A Psychological Approach to Digital Boundaries
Identify Your Emotional Triggers Online: Start tracking what specifically triggers dysregulation. Is it before-and-after body content? Productivity porn? Travel envy? Crisis headlines? Knowing your emotional triggers helps you refine your feed and your boundaries. Establish Content “Buckets”: Think of your digital diet like your nutritional one. A balanced feed should include: accounts that inspire without pressuring, creators who educate in ways that feel grounding, content that makes you laugh or feel wonder, personal connections that feel reciprocal. Limit content that only stimulates comparison, outrage, or guilt. Schedule Reconnection Practices: It’s not enough to disconnect from social media—you also need to reconnect with your body, environment, and values. Try breathwork or nervous system regulation exercises, short walks without your phone, journaling to process what you feel, not just what you see, and in-person connection with someone who knows the unfiltered version of you. Redefine Productivity Without Performance: If you use social media to promote a business or maintain a public identity, your work may depend on being visible. That’s valid. But it’s also important to create offstage time—moments when your value isn’t being measured by likes, reach, or views. Reclaim slowness, imperfection, and invisibility as part of your wellness strategy. Use Therapy to Unpack the Internal Pressure: If social media consistently makes you feel like you’re not doing enough, not thin enough, not successful enough, that’s not a feed problem—it’s a schema problem. Therapy can help explore where those beliefs began, how they’re reinforced by digital culture, and what needs to shift internally for your nervous system to stop bracing every time you open an app.

You’re Not Broken—You’re Overstimulated
Social media often makes people feel like they’re failing at modern life. But in most cases, the problem isn’t your willpower. It’s the cumulative impact of constant digital input on a brain that was never meant to process this much stimulation. You’re allowed to need slowness. You’re allowed to log off. You’re allowed to structure your digital life around your nervous system—not your algorithm.

If you’re ready to explore a more sustainable relationship with your screen, your self-worth, and your emotions, therapy can help you build boundaries that don’t rely on restriction—but on respect for your mental capacity.

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Fardouly, J., Diedrichs, P. C., Vartanian, L. R., & Halliwell, E. (2015). Social comparisons on social media: The impact of Facebook on young women’s body image concerns and mood. Body Image, 13, 38–45. https://doi.org/10.1016/j.bodyim.2014.12.002

Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7(2), 117–140. https://doi.org/10.1177/001872675400700202

Hughes, D. J., Rowe, M., Batey, M., & Lee, A. (2020). A tale of two sites: Twitter vs. Facebook and the personality predictors of social media usage. Computers in Human Behavior, 28(2), 561–569. https://doi.org/10.1016/j.chb.2011.11.001

Levenson, J. C., Shensa, A., Sidani, J. E., Colditz, J. B., & Primack, B. A. (2017). The association between social media use and sleep disturbance among young adults. Preventive Medicine, 85, 36–41. https://doi.org/10.1016/j.ypmed.2016.11.003

Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: Peer-to-peer support and social media. Epidemiology and Psychiatric Sciences, 25(2), 113–122. https://doi.org/10.1017/S2045796015001067

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3–17. https://doi.org/10.1177/2167702617723376

Verduyn, P., Ybarra, O., Résibois, M., Jonides, J., & Kross, E. (2017). Do social network sites enhance or undermine subjective well-being? A critical review. Social Issues and Policy Review, 11(1), 274–302. https://doi.org/10.1111/sipr.12033

You show up to meetings. You hit your deadlines. You manage the group chat, check in on your friends, and remember everyone’s birthdays. On paper, you’re doing just fine.

But inside? You feel exhausted, flat, or anxious. You cry in private, dissociate in public, or spiral at night. And when someone asks how you are, you smile and say, “I’m fine.”

This is the paradox of high-functioning mental health—when your life looks put-together, but your internal world is anything but. It’s not that you’re pretending. It’s that you’ve trained yourself so well to hold everything together that you can’t remember what it feels like to fall apart without shame.

This article explores the psychological cost of constantly being “fine,” why high-functioning distress is often overlooked, and how therapy can help you take off the mask—without unraveling your life.

What Is High-Functioning Mental Health?
The term “high-functioning” is widely used but rarely understood. It typically refers to people who maintain jobs, relationships, and routines despite experiencing anxiety, depression, trauma, or other mental health challenges. These individuals often:

• Struggle in silence while appearing calm and competent
  
• Downplay their emotional needs to avoid burdening others
  
• Overachieve as a form of self-worth maintenance
  
• Delay seeking help because things aren’t “bad enough”

Because their distress is invisible or carefully managed, their pain is often minimized—even by themselves.

Why Saying “I’m Fine” Feels Safer Than the Truth
If you grew up in an environment where vulnerability was dismissed or punished, you likely learned early that being “fine” was the safest emotional posture. Over time, “fine” becomes a reflex, not a feeling.

This tendency is reinforced by social norms that celebrate stoicism, productivity, and emotional independence. When people praise your strength, what they often mean is your ability to suffer silently without making others uncomfortable.

But repressing distress doesn’t make it go away. It buries it—until it leaks out through burnout, panic, insomnia, resentment, or physical symptoms. Studies have shown that emotional suppression is associated with increased physiological stress, lower life satisfaction, and poorer relationships (Gross & John, 2003).

The Hidden Cost of Always Being Okay
Being the “strong one” can feel like a source of pride—but it also creates chronic emotional disconnection. High-functioning individuals often:

• Struggle to name what they’re feeling
  
• Experience guilt when resting or asking for support
  
• Feel chronically misunderstood or emotionally lonely
  
• Fear that dropping the mask will make their life fall apart

Ironically, the very behaviors that make them seem capable—over-preparing, overthinking, over-giving—are often responses to unseen anxiety or shame.

In many cases, these patterns stem from early relational wounds. People who didn’t feel emotionally safe as children may internalize the belief that their feelings are too much—or that expressing them leads to rejection or punishment (Linehan, 1993).

Why It’s Hard to Ask for Help When You Seem “Fine”
Many high-functioning people struggle to seek help because:

• They don’t believe they’re “sick enough”
  
• They feel guilty taking up space from people who seem worse off
  
• They’re afraid vulnerability will destroy their image of competence
  
• They’ve spent so long managing alone that they don’t know how to let go

This is especially true in systems that reward overperformance and dismiss emotional needs—corporate workplaces, healthcare environments, or families built on image management.

But needing help doesn’t mean you’re failing. It means your coping strategies have done their job—and now, they’re ready to evolve.

Therapy Isn’t About Falling Apart—It’s About Reconnecting
Therapy isn’t just for crisis. It’s for the people who look like they have it all together but feel hollow underneath. It’s for the ones who smile on Zoom but dread logging on. The ones who give good advice but don’t feel seen. The ones who keep saying “I’m fine” because they don’t know what else they’re allowed to be.

Therapy helps you:

• Name emotions without minimizing them
  
• Explore the origins of your high-functioning patterns
  
• Relearn how to rest, ask for help, and connect authentically
  
• Build self-trust that isn’t tied to constant productivity

One of the most powerful moments in therapy is when someone realizes: You don’t have to earn rest. You don’t have to prove pain. You just get to be human.

Letting Go Without Falling Apart
Undoing the need to be “fine” doesn’t mean unraveling your whole life. It means learning how to hold the full truth—not just the parts that are easy to manage. That might look like:

• Saying “I’m not okay” and letting someone stay
  
• Taking a mental health day and resisting the urge to explain
  
• Crying in front of your therapist for the first time
  
• Letting yourself feel anger or sadness without rushing to fix it

These aren’t breakdowns. They’re breakthroughs. Signs that the part of you behind the mask is finally getting a voice.

You Don’t Have to Be “Fine” to Be Functional
High-functioning mental health is still mental health. You don’t need to wait for a crisis, a collapse, or a diagnosis to start healing.

If you’re tired of performing wellness and ready to feel it for real, therapy can help. You don’t have to carry everything alone—or smile while doing it.

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362.

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.

Starting therapy is often portrayed as a relief: you find the right therapist, talk through your struggles, and slowly begin to feel lighter. But for many people, the early stages of therapy feel anything but relieving. Instead, you might find yourself more emotional, more anxious, more irritable—or even questioning whether therapy is “working” at all.

This isn’t failure. It’s actually a well-documented part of the therapeutic process. Therapy often feels worse before it feels better because healing requires you to face the very thoughts, patterns, and emotions you’ve spent years avoiding, minimizing, or managing on your own. When those defenses soften, the pain underneath surfaces.

This article explains why discomfort is a normal part of effective therapy, what it signals, and how to navigate it without quitting prematurely.

Why Therapy Activates Discomfort
Therapy creates space for parts of yourself that daily life encourages you to suppress. You’re asked to slow down, reflect, and engage with thoughts and emotions you usually avoid through work, relationships, perfectionism, or internal numbing.

When those protective strategies are interrupted, your symptoms may temporarily increase. This is known as a therapeutic dip—a common, research-backed phenomenon where clients experience heightened distress before meaningful improvement (Lambert, 2013).

This doesn’t mean therapy is making you worse. It means the things you’ve buried are beginning to surface, which is a sign the process is working.

Healing Requires Accessing What Hurts
Avoidance feels like relief—but only in the short term. Therapy challenges that avoidance by encouraging insight, emotional expression, and vulnerability. That might include:

• Talking about childhood experiences you’ve never named
  
• Confronting shame, fear, or grief
  
• Recognizing patterns in relationships that feel too familiar
  
• Letting go of narratives that once kept you safe

This kind of work activates your emotional system—and your nervous system. It may leave you feeling raw, tired, or more reactive than usual. That’s not a sign of instability. It’s a sign of contact: your internal world is finally being acknowledged instead of bypassed.

The Role of Defense Mechanisms
We all have unconscious defense mechanisms—psychological strategies that protect us from overwhelming emotions. These include intellectualizing, minimizing, avoiding, or projecting. Therapy often disarms these defenses, especially as trust with your therapist grows.
When that happens, it can feel like being flooded with emotions you didn’t know you had. But these reactions are part of a larger emotional recalibration. The work begins when the walls come down.

Emotional Discomfort Signals Movement, Not Danger
It’s important to differentiate between discomfort that leads to growth and harm that requires change. Feeling emotionally stirred, anxious, or even frustrated with your therapist is normal. In fact, a key part of effective therapy is processing those exact reactions—not fleeing from them.

A 2005 study found that clients who discussed and explored ruptures in the therapeutic relationship experienced better long-term outcomes than those who didn’t (Safran et al., 2005). In other words, even tension with your therapist can be useful—if it’s acknowledged, not avoided.

What to Expect in the Early Stages of Therapy
Every person’s process is different, but common early experiences include:

• Emotional fatigue after sessions
  
• New or intensified dreams
  
• Increased irritability or sensitivity
  
• Questioning your sense of self or past decisions
  
• Feeling more aware of painful emotions throughout the week

These experiences aren’t signs of regression—they’re evidence that you’re no longer numbing or compartmentalizing at full capacity. You’re building tolerance for truth.

How to Stay Grounded During the Therapeutic Dip
If you find yourself wanting to quit therapy because it feels too intense, try the following:

• Name it in session. Saying “this feels worse than I expected” can be a powerful entry point.
  
• Track small shifts. Healing isn’t just symptom reduction—it’s increased insight, clarity, and emotional depth.
  
• Build regulation skills. Talk to your therapist about grounding techniques to support you between sessions.
  
• Avoid judging your progress by how you feel. Therapy isn’t about immediate relief—it’s about sustainable change. That often includes discomfort.

Therapy Isn’t a Linear Process
We like to imagine growth as a straight line upward. In reality, it looks more like a spiral: you revisit the same themes from deeper levels of understanding each time. Sometimes you regress before you leap forward. Sometimes you plateau before a major shift.

Therapy that avoids discomfort is often shallow. Therapy that invites discomfort—with support, safety, and pacing—goes deeper. That’s where transformation lives.

Trusting the Process (Even When It’s Messy)
It’s easy to trust therapy when you’re feeling better. But it’s the moments of discomfort, disorientation, and doubt that often contain the greatest potential. Those moments challenge your old narratives and defense systems. They ask you to show up differently—to yourself and to others.

Therapy can feel worse before it feels better because healing isn’t about returning to your old self—it’s about building something stronger from what you’ve avoided.

If you’re ready to do that work, you don’t have to do it alone.
Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Jacob, G. A., & Arntz, A. (2013). Schema therapy for personality disorders—A review. International Journal of Cognitive Therapy, 6(2), 171–185.

Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15(2), 103–111.

Mednick, S., Nakayama, K., & Stickgold, R. (2003). Sleep-dependent learning: A nap is as good as a night. Nature Neuroscience, 6(7), 697–698.

Raichle, M. E. (2015). The brain’s default mode network. Annual Review of Neuroscience, 38, 433–447.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. Guilford Press.

For many high-performing people, rest doesn’t feel restorative—it feels dangerous. You might stop working for a few hours, but your mind races with guilt. You feel behind. You mentally rehearse your to-do list or start troubleshooting things that haven’t even gone wrong yet. You tell yourself you’ll rest “after this next thing”—but the next thing never ends.

This isn’t a productivity issue. It’s the psychological consequence of chronic overfunctioning. And it’s why so many high achievers conflate rest with laziness—even when they’re deeply burned out.

In this article, we unpack the mental load behind overachievement, why rest feels unsafe, and how to reclaim it as a psychological necessity—not a personal failure.

What Is the Mental Load of Overachievers?
The mental load isn’t just about doing too much—it’s about thinking about everything all the time. For overachievers, this often looks like:

• Rehearsing conversations before they happen
  
• Tracking outcomes others haven’t even considered
  
• Managing everyone’s emotions while downplaying your own
  
• Holding responsibility for things outside your control
  
• Believing the worst will happen if you’re not three steps ahead

Over time, this creates hypervigilance, which is often mistaken for “being good at your job” or “always prepared.” In reality, it’s a form of psychological exhaustion. Studies show that chronic stress and hyper-responsibility lead to burnout, cognitive fatigue, and emotional dysregulation (Maslach & Leiter, 2016).

Why Overachievers Struggle to Rest
People who carry an invisible mental load often have a trauma history of earning safety through performance. Rest isn’t seen as a right—it’s seen as a risk. In clinical terms, this is tied to maladaptive schemas around unworthiness, responsibility, and failure (Young et al., 2003).

Common beliefs include:

• “If I stop, everything will fall apart.”
  
• “If I rest, I’ll lose momentum and never recover.”
  
• “If I’m not useful, I’m not lovable.”
  
• “If I slow down, people will see the real me—and they won’t like it.”

These beliefs aren’t laziness. They’re symptoms of internalized pressure, survival adaptations, and perfectionism.

Rest Is Not the Opposite of Work—It Completes It
Cognitive neuroscience shows that rest improves executive functioning, memory, and decision-making (Mednick et al., 2003). In fact, the brain uses downtime to integrate learning, solve problems, and reset emotional thresholds (Raichle, 2015). Without rest, performance declines—not because you’re failing but because your brain literally can’t process new input.

Put simply: rest isn’t what you do when you’ve earned a break. It’s what your brain requires to keep functioning at all.

You Can’t Meditate Your Way Out of Overfunctioning
While mindfulness and self-care practices are helpful, they won’t address the core belief that you don’t deserve rest unless you’ve exhausted yourself first. Until that belief shifts, rest will continue to feel like failure.

This is where therapy becomes essential. It can help challenge these beliefs and replace them with a more sustainable self-concept—one where your worth is not tied to your output. Schema therapy, for example, specifically targets rigid mental models that keep high-functioning people stuck in burnout loops (Jacob & Arntz, 2013).

Redefining Rest for High Achievers
If rest feels unproductive or shameful, try reframing it as:

• A cognitive investment in better problem-solving
  
• A nervous system reset—not a reward
  
• A boundary between self-worth and self-sacrifice
  
• A creative incubator, not a distraction
  
• A practice in trust: believing that things won’t collapse if you step away

High achievers often wait until their bodies shut down to allow rest. But the goal is to stop using exhaustion as the only permission slip.

Rest Isn’t Laziness. It’s What Makes Ambition Sustainable.
Burnout doesn’t usually come from doing too much—it comes from never feeling like you’ve done enough. When you see rest as part of the work—rather than what you do after the work—you begin to rebuild trust in yourself and your capacity.

If you’re stuck in cycles of overfunctioning, therapy can help. Together, we can examine the roots of your overachievement, challenge the fear that comes with rest, and build a model of success that includes sustainability—not just survival.

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Jacob, G. A., & Arntz, A. (2013). Schema therapy for personality disorders—A review. International Journal of Cognitive Therapy, 6(2), 171–185.

Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15(2), 103–111.

Mednick, S., Nakayama, K., & Stickgold, R. (2003). Sleep-dependent learning: A nap is as good as a night. Nature Neuroscience, 6(7), 697–698.

Raichle, M. E. (2015). The brain’s default mode network. Annual Review of Neuroscience, 38, 433–447.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. Guilford Press.

In a world where burnout is common but quitting feels too risky, more professionals are turning to a surprising middle path: micro-sabbaticals. These short, intentional breaks—typically lasting around four weeks—aren’t vacations and aren’t escapes. They’re structured experiments designed to reignite curiosity, reset your nervous system, and recalibrate your career without blowing it all up.

While the word sabbatical used to be reserved for academics and clergy, today’s high-achievers are repurposing it into something more accessible. You don’t need six months and a research grant. You need a container for deep rest, exploration, or learning—and permission to stop performing for a little while.

This article explores the science and strategy behind micro-sabbaticals, including why they work, what to avoid, and how to design one that actually shifts your mindset, not just your calendar.

What Is a Micro-Sabbatical?
A micro-sabbatical is a 2- to 6-week break from your usual work responsibilities, deliberately structured around rest, curiosity, or creative renewal. Unlike a vacation, which often prioritizes escape or entertainment, a micro-sabbatical has an internal purpose: to reset, rethink, and re-engage.

You might:

• Pause client work to explore a side project
  
• Step away from leadership to observe and listen
  
• Take a break from all non-essential obligations to focus on one question: What do I want now?

Research on burnout shows that novelty, autonomy, and self-directed learning are essential for long-term engagement and satisfaction (Ryan & Deci, 2000). A micro-sabbatical gives you a temporary space to pursue those things without the all-or-nothing pressure of a career change.

Why Curiosity Beats Escapism
Burnout often tells you to run. But running without direction can lead to regret—or worse, repetition of the same patterns in a new context. Micro-sabbaticals work because they emphasize curiosity over escape. Instead of asking, “How do I get out of this job?” they ask, “What parts of me have I stopped listening to?”

Neuroscience supports this approach: engaging in curiosity-driven exploration activates dopamine circuits in the brain, which boosts motivation, mood, and learning (Gruber et al., 2014). Curiosity isn’t indulgent—it’s neurologically reparative.

Signs You Might Need a Micro-Sabbatical
You don’t need to be on the brink of collapse to benefit from a break. Common signs you’re due for a micro-sabbatical include:

• You feel bored and overwhelmed at the same time
  
• You can’t remember what excites you professionally
  
• You’re fantasizing about quitting, but you don’t know what you’d do instead
  
• You feel like you’re performing your role, not living it
  
• You’ve stopped making time for experimentation or wonder

What a Micro-Sabbatical Can Include
A well-designed micro-sabbatical isn’t just “doing nothing.” It’s structured spaciousness. You’re creating a temporary lab for self-reconnection. Examples of what it can include:

• Enrolling in a course that’s exciting but not “practical”
  
• Spending each morning writing, painting, or thinking without an agenda
  
• Traveling slowly with the intention of learning, not just escaping
  
• Reading a stack of books you’ve been putting off for years
  
• Hosting conversations with people outside your field to spark new ideas

The goal isn’t output—it’s input. When your brain is fed new ideas without expectation, creativity returns naturally (Csikszentmihalyi, 1996).

Designing Your Own Four-Week Experiment
You don’t need a formal leave policy to create your own micro-sabbatical. You need boundaries, intentionality, and a few clear questions:

1. What’s the question I want to sit with?
   Examples: “What would I work on if I didn’t need it to pay the bills?” “What kind of leader do I want to become?” “What have I abandoned that used to energize me?”
   
2. What will I pause? What will I protect?
   Communicate clearly about what you’re stepping back from—meetings, content creation, managerial duties—and what you’ll protect, like solo work time, health routines, or creative rituals.
   
3. What does success look like at the end?
   Set one or two loose markers of success. “I’ve read five books,” “I’ve outlined a new offer,” or even “I feel emotionally rested” are valid outcomes.
   

What to Avoid

• Overloading your sabbatical with productivity goals
  This is not the time to write your book and rebrand your business. That’s not a break—it’s a second job.
  
• Letting guilt write your schedule
  If your sabbatical turns into doing unpaid favors, catching up on admin, or helping everyone else, it’s no longer yours.
  
• Waiting for total collapse before taking one
  You don’t need to earn a break by breaking down. In fact, the earlier you step away, the less radical the reset needs to be.
  

Why It’s Better Than Quitting Cold-Turkey
While there are times when quitting is necessary, many people leave jobs without fully understanding what they’re running from—or what they need next. A micro-sabbatical gives you space to investigate without irreversible consequences.
It also signals to your nervous system that rest is allowed before it becomes a crisis, which helps build long-term resilience.

Micro Doesn’t Mean Small
A four-week break might seem short, but with the right structure, it can feel transformational. If you use that time to reconnect with curiosity, values, and play, you may return with a clearer sense of what’s next—and the energy to pursue it.If burnout has you fantasizing about quitting but you’re not sure what comes next, therapy can help you structure a micro-sabbatical with intention. Let’s turn your exhaustion into inquiry—not escape.

Book your appointment today at refreshtherapynyc.clientsecure.me.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Csikszentmihalyi, M. (1996). Creativity: Flow and the Psychology of Discovery and Invention. HarperCollins.

Gruber, M. J., Gelman, B. D., & Ranganath, C. (2014). States of curiosity modulate hippocampus-dependent learning via the dopaminergic circuit. Neuron, 84(2), 486–496.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78.

OCD and ADHD are often viewed as opposites—one marked by rigidity, the other by impulsivity. One preoccupied with control, the other seemingly ruled by distraction. But for many adults, these two conditions coexist in a complicated, confusing way that defies stereotypes and makes daily functioning feel like a battle between extremes. Recent research suggests that 25–30% of individuals diagnosed with Obsessive-Compulsive Disorder (OCD) also meet the criteria for Attention-Deficit/Hyperactivity Disorder (ADHD) (Abramovitch et al., 2015). Yet, despite this high rate of comorbidity, the intersection of these conditions is still widely misunderstood—and often missed entirely in clinical settings. For adults who’ve lived most of their lives feeling “disorganized but obsessive,” or “impulsive but perfectionistic,” this dual experience can be not only confusing but invalidating. This article explores what it means to live with both OCD and ADHD, why the combination is frequently overlooked, and how treatment can (and must) adapt to accommodate both.

Understanding OCD and ADHD as Distinct but Overlapping Disorders
To understand how these conditions can coexist, we first need to understand what each one looks like on its own. Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental rituals (compulsions) performed to reduce anxiety. Common themes include fears of contamination, harming others, making mistakes, or violating moral or religious codes. OCD is classified as an anxiety disorder and is typically treated with Exposure and Response Prevention (ERP), a form of cognitive behavioral therapy (APA, 2013). Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder marked by persistent patterns of inattention, impulsivity, and in some cases, hyperactivity. ADHD affects executive functions such as planning, organization, working memory, and self-regulation. It’s typically treated through a combination of behavioral therapy and medication, often stimulants (Barkley, 2015). While OCD is driven by fear and attempts to gain control, ADHD is characterized by difficulty sustaining focus and resisting impulses. On the surface, they may appear to cancel each other out. But in reality, they often coexist—leading to a unique and often misunderstood clinical profile.

Why Co-Occurring OCD and ADHD Is Often Missed
Part of the reason this combination is overlooked is that the traits of one disorder can mask or complicate the other. A clinician might see the perfectionism, planning, or ritualistic behavior of OCD and miss the distractibility, procrastination, and disorganization of ADHD—or vice versa. Adults with ADHD may initially appear to be obsessive when they’re really trying to compensate for inconsistent attention or memory. Conversely, someone with OCD may seem forgetful or unfocused because their mental energy is spent on managing intrusive thoughts and rituals. This misinterpretation can lead to partial diagnoses, where only one condition is acknowledged and treated. For example, stimulant medications may improve attention in someone with ADHD but exacerbate obsessive thoughts in someone with underlying OCD (Abramovitch et al., 2013). Without an accurate diagnosis, treatment may backfire—or leave major symptoms unaddressed.

What It Feels Like to Live with Both
For adults navigating both OCD and ADHD, the experience often feels paradoxical. They may be obsessive about tiny details but forget major deadlines. They may be highly perfectionistic about some tasks, while unable to complete others. They may ruminate for hours on a decision—and then act impulsively out of frustration. Daily life often includes: getting stuck in compulsive rituals while also struggling to remember appointments or where you put your keys; overanalyzing social interactions while blurting things out without thinking; procrastinating due to overwhelm, then panicking and obsessing about poor performance; feeling both out of control and overly controlling—sometimes in the same hour. This push-pull dynamic can erode self-esteem. Many adults internalize the belief that they’re “too much,” “too messy,” or “too rigid.” They may seek help for anxiety or executive dysfunction without realizing that both are rooted in an undiagnosed dual condition.

Shared Features and Diagnostic Confusion
While OCD and ADHD are distinct, they share overlapping features that can blur diagnostic clarity. Emotional dysregulation is common to both, as is executive dysfunction. Trouble starting tasks, organizing steps, and following through is seen in both disorders, though for different reasons. In OCD, avoidance and compulsions hijack attention. In ADHD, distractibility and poor working memory disrupt momentum. Perfectionism and self-doubt are also shared experiences. People with OCD often fear making mistakes; people with ADHD are often afraid they’ve forgotten something or let someone down. The result in both cases is anxiety, overcompensation, and exhaustion. These overlaps can confuse clinicians and clients alike. But just because two conditions share traits doesn’t mean they cancel each other out. They compound.

Treatment Considerations for Co-Occurring OCD and ADHD
Treating co-occurring OCD and ADHD requires nuance and flexibility. Standard treatments must be adapted to account for the ways these conditions interact. For ADHD, stimulant medications such as methylphenidate or amphetamines are often first-line treatments. However, for someone with both ADHD and OCD, stimulants can increase obsessive thinking, especially if anxiety isn’t concurrently addressed (Hirschtritt et al., 2017). Non-stimulant medications like atomoxetine may be better tolerated in some cases. For OCD, ERP remains the gold standard. However, ERP requires focus, task persistence, and the ability to tolerate discomfort—all of which may be difficult for someone with ADHD. Therapists must adapt protocols to account for attention variability, provide more structure, and pace interventions accordingly (Abramovitch et al., 2012). In both cases, treatment should be sequenced intentionally. If ADHD is severe and impairs the ability to engage in therapy, it may need to be addressed first. If OCD is the more distressing or impairing condition, targeting it may take priority. The key is recognizing that both need attention—and neither is secondary. Psychoeducation is also vital. Helping clients understand the interplay of these conditions reduces self-blame, builds self-awareness, and empowers people to track patterns and respond with intention.
Living with both OCD and ADHD doesn’t mean you’re contradictory or broken—it means you have a complex brain that operates outside the binary of “focused vs. distracted” or “organized vs. chaotic.” You may need more support, more structure, and more self-compassion—but you are not alone. An accurate diagnosis and integrated treatment plan can make an enormous difference. With the right tools, people with OCD and ADHD can move from surviving to thriving—learning how to manage anxiety, honor their focus patterns, and live without feeling like they’re at war with themselves.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Abramovitch, A., Dar, R., Mittelman, A., Wilhelm, S., & Schweiger, A. (2015). Don’t judge a book by its cover: ADHD-like symptoms in OCD. Journal of Obsessive-Compulsive and Related Disorders, 5, 49–56. https://doi.org/10.1016/j.jocrd.2015.02.004

Abramovitch, A., Mittelman, A., & Wilhelm, S. (2012). Comorbidity between ADHD and OCD across the lifespan: A systematic and critical review. Harvard Review of Psychiatry, 20(4), 214–228. https://doi.org/10.3109/10673229.2012.714618

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

Barkley, R. A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (4th ed.). Guilford Press.

Hirschtritt, M. E., Lee, P. C., Pauls, D. L., & Grados, M. A. (2017). Psychiatric comorbidity and medication use in adults with obsessive-compulsive disorder. Journal of Clinical Psychiatry, 78(4), e327–e333. https://doi.org/10.4088/JCP.15m10378

Guilt and shame are two of the most commonly experienced—and commonly confused—emotions in mental health. They often show up together, but they serve fundamentally different functions. One can be adaptive and guide you toward repair. The other can erode your sense of self and keep you stuck in cycles of self-sabotage. Understanding the distinction between guilt and shame isn’t just an intellectual exercise. It’s a foundational step toward emotional clarity, healthier relationships, and long-term mental health.

Defining the Difference

Guilt is the emotional discomfort that arises when you believe you’ve done something wrong. It’s tied to a specific action or behavior and usually prompts a desire to make amends. Shame, by contrast, is a feeling that something is wrong with you as a person. It’s not “I did something bad,” but “I am bad.” Brené Brown (2012), a leading researcher on shame, defines guilt as being focused on behavior and shame as being focused on identity. This difference may sound subtle, but psychologically it’s significant. Guilt implies that repair is possible. Shame suggests that you are fundamentally broken.

Why the Difference Matters in Therapy

Many clients enter therapy describing overwhelming guilt, but as the work deepens, it becomes clear they are actually struggling with shame. Guilt, while uncomfortable, can be productive. It often leads to remorse, accountability, and growth. Shame, however, tends to be immobilizing. It leads to hiding, perfectionism, people-pleasing, or avoidance (Tangney & Dearing, 2002). Shame is also strongly correlated with depression, anxiety, disordered eating, and trauma symptoms (Kim, Thibodeau, & Jorgensen, 2011). By learning to identify when shame is present, clients can begin to externalize it, question its origins, and develop more compassionate self-understanding.

Cultural and Family Roots of Shame

Shame is not just an individual emotion—it’s shaped by family systems, culture, religion, and societal norms. Many people grow up in environments where mistakes are punished harshly or where love and approval are conditional on performance. In these settings, guilt doesn’t get to exist as a separate emotion—it’s quickly overwhelmed by shame. For example, a child might feel guilty for breaking a rule but quickly internalize the message that they are a disappointment or a burden. Over time, this emotional conditioning creates a default lens of shame that persists into adulthood. This often shows up as a harsh inner critic, chronic self-doubt, or difficulty receiving feedback without emotional collapse.

How Shame Manifests in High-Functioning People

Ironically, shame often hides behind achievement. Many high-functioning individuals appear confident, composed, and capable, but underneath is a deep fear of being exposed as inadequate. This is sometimes called “shame-driven overfunctioning.” These individuals may be successful precisely because they are trying to outrun shame. Their inner dialogue might say: “If I can just prove myself, they’ll never see how worthless I really am.” The result is chronic burnout, emotional disconnection, and imposter syndrome (Kets de Vries, 2005). Therapy helps unravel these patterns by exploring the origin stories of shame and creating space for a more integrated self-concept—one that allows for vulnerability without collapse.

The Role of Guilt in Healthy Relationships

Unlike shame, guilt can enhance emotional intimacy and accountability. Feeling guilty after an argument or a mistake often signals empathy, relational awareness, and a desire to repair. People who experience healthy guilt are more likely to engage in constructive problem-solving, apologize sincerely, and take responsibility without self-flagellation (Baumeister et al., 1994). The challenge is when guilt becomes disproportionate. Some individuals feel guilty not only for their actions but also for setting boundaries, having needs, or simply existing. In these cases, therapy works to recalibrate the guilt response so that it reflects actual violations of values—not internalized people-pleasing scripts.

How Shame Fuels Mental Health Symptoms

Shame doesn’t just feel bad—it actively contributes to psychological distress. Research has shown that shame is associated with increased cortisol levels, dissociation, avoidance behaviors, and even physiological symptoms such as chronic fatigue and gastrointestinal distress (Andrews, Qian, & Valentine, 2002). It is also implicated in the maintenance of PTSD, particularly when trauma involves interpersonal betrayal or humiliation. Clients who carry shame are more likely to hide their symptoms, minimize their suffering, or resist therapeutic vulnerability. Helping clients name and work through shame is often the turning point in treatment—not because it’s easy, but because it dismantles the emotional logic that says, “If they really knew me, they’d leave.”

Interrupting the Cycle

Therapeutically, interrupting the cycle of shame requires a combination of insight, relational safety, and new narrative construction. Approaches like compassion-focused therapy (Gilbert, 2010) and schema therapy (Young, Klosko, & Weishaar, 2003) directly target shame-based beliefs by helping clients build internal voices that are supportive, realistic, and emotionally responsive. Cognitive strategies may help challenge distorted beliefs (“I’m a failure” vs. “I made a mistake”), while somatic interventions can address the way shame is stored in the body—often through posture, tone, or somatic withdrawal. The goal is not to eliminate guilt or shame entirely—both are natural emotions—but to right-size them, differentiate them, and move through them with agency.

Rewriting the Shame Narrative

Many people operate from an unspoken life script shaped by early shame. This script might say: “I’m not lovable,” “I always mess things up,” or “I have to prove my worth.” These stories are often outdated and unexamined—but powerful. Narrative therapy offers tools to deconstruct and rewrite these internalized stories by identifying “unique outcomes,” or moments that contradict the shame narrative (White & Epston, 1990). Therapy becomes the space where you get to ask: Whose voice is this? Where did this belief come from? And do I want it to be part of my story moving forward?

Why This Distinction Changes Everything

When you can distinguish guilt from shame, you gain emotional freedom. Guilt says: “I made a mistake, and I want to do better.” Shame says: “I am a mistake, and nothing I do will ever be enough.” When you internalize shame, you become stuck—unable to trust yourself, connect authentically, or take healthy risks. When you learn to feel guilt without collapsing into shame, you can repair, grow, and forgive yourself. For many clients, this shift is the beginning of profound change—not just in how they think, but in how they relate to themselves, others, and the world.

If you’re constantly over-apologizing, questioning your worth, or stuck in cycles of self-blame, it’s not just guilt—it might be shame. And shame distorts more than just your self-esteem. Therapy helps you recognize the difference, break the loop, and relate to yourself with something stronger than self-criticism: respect. Start that shift today at refreshtherapynyc.clientsecure.me

Written by: Keeley Teemsma, LCSW, MA

Works Cited

Andrews, B., Qian, M., & Valentine, J. D. (2002). Predicting PTSD symptoms with shame and guilt. Journal of Traumatic Stress, 15(6), 509–523. https://doi.org/10.1023/A:1020196206116

Baumeister, R. F., Stillwell, A. M., & Heatherton, T. F. (1994). Guilt: An interpersonal approach. Psychological Bulletin, 115(2), 243–267. https://doi.org/10.1037/0033-2909.115.2.243

Brown, B. (2012). Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent, and lead. Gotham Books.

Gilbert, P. (2010). Compassion focused therapy: Distinctive features. Routledge.

Kets de Vries, M. F. R. (2005). The dangers of feeling like a fake. Harvard Business Review, 83(9), 108–116.

Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137(1), 68–96. https://doi.org/10.1037/a0021466

Tangney, J. P., & Dearing, R. L. (2002). Shame and guilt. Guilford Press.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. Norton & Company.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Creativity has long been romanticized as both a gift and a curse. Artists, writers, and innovators are often portrayed as tormented geniuses—brilliant but burdened. But is there really a connection between creativity and mental health? And if so, what does it actually look like outside of the stereotypes?

The truth is more nuanced than the tortured-artist myth. While there are certain mental health conditions that statistically correlate with higher creative output, creativity itself can also serve as a powerful protective factor—offering emotional regulation, cognitive flexibility, and a means of self-expression that enhances psychological resilience.

This article explores what current research tells us about the connection between creativity and mental health—and how to engage your creativity in a way that supports well-being rather than undermines it.

Are Creative People More Likely to Struggle with Mental Health?

Some studies do suggest a correlation between creativity and certain psychiatric traits, particularly in the areas of mood disorders, ADHD, and schizotypal thinking (Kyaga et al., 2011). For example, bipolar disorder has been linked to increased creativity during hypomanic phases, when idea generation and energy levels surge. Similarly, individuals with ADHD often demonstrate divergent thinking and an ability to make novel connections (White & Shah, 2006).

But correlation is not causation. The relationship is complex, and creative people are not doomed to suffer. Instead, many researchers believe that overlapping traits—like heightened sensitivity, nonconformity, or openness to experience—may increase both creative potential and emotional vulnerability (Kaufman, 2014).

How Creativity Supports Mental Health

Creativity isn’t just an output; it’s a process. And engaging in creative activity—whether it’s writing, painting, dancing, gardening, or brainstorming ideas—can have measurable mental health benefits.

Creative engagement has been shown to:

• Reduce symptoms of anxiety and depression (Martin et al., 2018)
  
• Improve emotional regulation (Drake & Winner, 2013)
  
• Enhance cognitive flexibility and problem-solving (Zabelina & Robinson, 2010)
  
• Strengthen self-concept and identity formation (Forgeard & Elstein, 2014)
  

Creative expression allows people to process complex emotions, gain distance from distress, and reframe internal narratives. This can be especially helpful for trauma recovery, grief work, and navigating life transitions.

The Role of Flow in Psychological Well-Being

One of the most powerful links between creativity and mental health is the concept of flow—the immersive, focused state that occurs when you’re deeply engaged in a meaningful activity. Flow is associated with increased happiness, reduced rumination, and improved motivation (Csikszentmihalyi, 1990).

In clinical settings, flow-based interventions have been used to treat depression and anxiety by helping individuals reconnect with activities that give them a sense of mastery and enjoyment. This counters the anhedonia and hopelessness that often accompany mood disorders.

Creative Practices as Emotional Regulation Tools

Unlike coping mechanisms that distract or numb, creative practices allow people to work through difficult feelings. Whether it’s journaling, collage, songwriting, or sculpting, the act of translating inner experiences into tangible form can regulate the nervous system and restore a sense of control.

Art therapy research shows that creating visual representations of internal conflict leads to greater emotional awareness and decreased psychological distress (Haeyen et al., 2015). This is especially beneficial for those who struggle with verbal expression or emotional inhibition.

When Creativity Becomes a Double-Edged Sword

While creativity can support healing, it can also become entangled with perfectionism, self-criticism, or avoidance. For example, a writer who ties their self-worth to productivity may spiral if they hit a block. Or an artist may use their work to bypass direct emotional engagement rather than explore it.

In these cases, therapy can help unpack the relationship between creative identity and mental health—and separate personal value from output. Learning to create without self-judgment is often a critical turning point in both artistic and emotional growth.

How to Support Mental Health Through Creativity

You don’t have to be a professional artist to benefit from creative expression. The key is engaging in creativity as a process, not just as performance. Try:

• Setting aside 15 minutes a day for a creative task without judgment
  
• Keeping a visual or written journal
  
• Practicing movement-based creativity like dance or walking meditations
  
• Joining a class or group that encourages playful experimentation
  
• Using art as a way to express emotions when words fall short
  

The goal isn’t brilliance—it’s connection. To yourself, to the present moment, and to something larger than the sum of your stressors.

Creativity Doesn’t Mean Chaos

It’s time to retire the myth that you must suffer to create. While emotional intensity may fuel insight, unprocessed pain doesn’t make art more real—it makes life harder. With support, structure, and intentional engagement, creativity can become one of the most stabilizing forces in your mental health toolkit.If you’re looking to explore how creativity intersects with your emotional well-being, therapy can help. Whether you’re trying to unlock your creative voice, recover from burnout, or manage the intensity that sometimes comes with a creative brain, you don’t have to navigate it alone.

Book your appointment today at

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. Harper & Row.

Drake, J. E., & Winner, E. (2013). How children use drawing to regulate their emotions. Cognition and Emotion, 27(3), 512–520.

Forgeard, M. J. C., & Elstein, J. G. (2014). Advancing the clinical science of creativity. Frontiers in Psychology, 5, 613.

Haeyen, S., van Hooren, S., van der Veld, W., & Hutschemaekers, G. (2015). Measuring the contribution of art therapy in multidisciplinary treatment of personality disorders. The Arts in Psychotherapy, 45, 1–10.

Kaufman, J. C. (2014). Creativity and Mental Illness. Cambridge University Press.

Kyaga, S., Lichtenstein, P., Boman, M., Hultman, C., Långström, N., & Landén, M. (2011). Creativity and mental disorder: Family study of 300,000 people with severe mental disorder. The British Journal of Psychiatry, 199(5), 373–379.

Martin, L. A., Oepen, R. S., Bauer, K., Nottensteiner, A., Möller, H. J., & Sperling, W. (2018). Creative arts interventions for stress management and prevention—A systematic review. Behavioral Sciences, 8(2), 28.

White, H. A., & Shah, P. (2006). Uninhibited imaginations: Creativity in adults with ADHD. Personality and Individual Differences, 40(6), 1121–1131.

Zabelina, D. L., & Robinson, M. D. (2010). Creativity as flexible cognitive control. Psychology of Aesthetics, Creativity, and the Arts, 4(3), 136–143.

Feeling overwhelmed isn’t just about being “too emotional.” It’s a physiological response to perceived overload—and it can happen to anyone. Whether triggered by stress, conflict, sensory input, or internal pressure, emotional overwhelm can cause a cascade of symptoms: racing thoughts, irritability, tension, indecision, or even total shutdown.

For many people, especially those with trauma histories, neurodivergence, or chronic stress exposure, this shutdown can feel automatic and impossible to stop. But you can learn to interrupt the cycle. This article explains the psychology of emotional flooding and offers evidence-based tools to manage overwhelm without dissociation, withdrawal, or emotional numbing.

What Is Emotional Overwhelm?

Emotional overwhelm happens when the intensity of your emotional experience exceeds your nervous system’s capacity to regulate in the moment (Linehan, 1993). When this happens, your brain may default to fight, flight, freeze—or fawn. The freeze response, in particular, can feel like shutting down: becoming detached, passive, blank, or emotionally flat. While this response can be protective in the short term, over time it erodes your sense of agency.

People with unresolved trauma, sensory sensitivity, or mood disorders are more likely to experience overwhelm because their emotional bandwidth is already taxed (Van der Kolk, 2014). You don’t need to have a diagnosable condition to feel this, though—burnout, perfectionism, and long-term stress can lead to the same freeze pattern.

Signs You’re Emotionally Overwhelmed

Recognizing overwhelm early is the first step to staying present. You might be on the brink of emotional shutdown if you notice:

• Difficulty making small decisions
  
• Sudden emotional numbness
  
• Urge to isolate or avoid contact
  
• Feeling frozen, paralyzed, or spaced out
  
• Inner dialogue that says “I can’t deal with this”
  
• Avoidance of tasks, even when they’re low-effort
  
• Physical symptoms like shallow breathing or body tension
  If this sounds familiar, you’re not broken. You’re overwhelmed—and your body is trying to help you survive the moment.

How to Stop Emotional Overwhelm Without Shutting Down

1. Learn Your Pre-Shutdown Signals
Prevention starts with recognizing your unique cues. Research shows that increased interoceptive awareness—your ability to notice internal body signals—can help regulate emotional responses (Füstös et al., 2013). Start tracking moments when you feel yourself disconnecting. Do your shoulders tense? Does your mind go blank? Does your voice get quiet?

Naming your shutdown signals is a first step toward reclaiming control.

2. Use Grounding Before Problem-Solving
Trying to “logic” your way out of overwhelm doesn’t work if your nervous system is dysregulated. Grounding techniques engage the sensory and present-focused parts of your brain to interrupt the overload. Try:

• Touching a textured object
  
• Running cold water over your hands
  
• Naming five things you can see
  
• Breathing out longer than you breathe in

Grounding lowers sympathetic arousal (flight/fight) and helps re-engage your frontal lobe, where decision-making and perspective live (Ogden et al., 2006).

3. Shrink the Task, Not Yourself
When everything feels like too much, your brain can’t filter what’s urgent from what’s just loud. Instead of “pushing through,” zoom in. What’s the next tiny step? Not the whole report—just opening the laptop. Not the entire kitchen—just putting one dish in the sink.

This technique is supported by behavioral activation strategies, which break tasks into small, tolerable actions to reduce avoidance and increase follow-through (Martell et al., 2001).

4. Validate the Feeling, Then Contain It
Overwhelm becomes worse when you shame yourself for it. Self-criticism floods the brain with even more stress hormones, increasing the shutdown response (Gilbert, 2010). Try saying:

• “Of course I feel overloaded right now.”
  
• “I don’t need to fix everything—just help myself feel safer in this moment.”
  
• “This will pass, and I’ve survived it before.”
  Once you’ve validated your feelings, gently contain them. Journaling, voice notes, or even setting a 15-minute “worry window” can help create emotional boundaries without suppressing your experience.
  

5. Ask Your Body What It Needs, Not Just Your Mind
When we’re overwhelmed, our impulse is often to overthink. But regulation happens in the body first. Consider:

• Have I eaten recently?
  
• Am I overstimulated or under-stimulated?
  
• Do I need movement or stillness right now?
  Engaging the body helps shift you out of shutdown and back into agency (Porges, 2011). This is not a distraction—it’s a recalibration.

6. Delay Major Decisions Until You’re Regulated
Overwhelm hijacks your ability to think long-term. It may tell you to quit your job, end a relationship, or change everything at once. While these decisions may still be valid later, they shouldn’t be made from a flooded nervous system. Neuroscience confirms that stress impairs prefrontal cortex function, leading to impulsive or reactive decision-making (Arnsten, 2009).
Instead, create a holding pattern: “I’ll revisit this tomorrow after I’ve done something calming.” That’s not avoidance—it’s strategy.

Why Emotional Shutdown Isn’t Failure

Many people assume emotional overwhelm means they’re weak, irrational, or mentally unwell. In reality, shutdown is a nervous system response that once kept you safe. Learning to recognize and respond to overwhelm isn’t about controlling emotions—it’s about building emotional resilience through informed, body-based self-regulation.

You don’t need to be calm all the time. You just need tools to help you return to yourself—without disappearing.If emotional shutdown is something you struggle with regularly, you don’t have to navigate it alone. Therapy can help you develop emotional regulation skills, reconnect with your body, and understand the root causes of overwhelm. Book your appointment today at

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Arnsten, A. F. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422.

Füstös, J., Gramann, K., Herbert, B. M., & Pollatos, O. (2013). On the embodiment of emotion regulation: Interoceptive awareness facilitates reappraisal. Social Cognitive and Affective Neuroscience, 8(8), 911–917.

Gilbert, P. (2010). Compassion Focused Therapy: Distinctive Features. Routledge.

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in Context: Strategies for Guided Action. Norton.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W.W. Norton.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-regulation. W.W. Norton.

Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.

Surviving a manipulative relationship—whether romantic, familial, or professional—often leaves behind emotional scars that aren’t visible but deeply felt. One of the most common consequences? A complete erosion of self-trust and personal boundaries. Manipulative people don’t just override your choices; they teach you to second-guess your own instincts. You leave the relationship unsure where your limits are—or whether you even have the right to enforce them.

Rebuilding healthy boundaries after emotional manipulation isn’t just about saying “no” more often. It’s about retraining your nervous system, rewriting internal scripts, and slowly restoring the sense that your feelings, needs, and perceptions are valid. This article outlines a trauma-informed, psychology-backed approach to recovering personal agency and reconnecting with your internal compass.

What Emotional Manipulation Does to Self-Trust

Manipulative partners often use tactics like gaslighting, guilt-tripping, intermittent reinforcement, and blame-shifting to destabilize your sense of reality (Stark, 2007). Over time, these tactics erode your ability to differentiate between what’s yours and what’s being projected onto you. In psychological terms, this leads to boundary collapse, a state where you can’t tell where others end and you begin (Herman, 1992).

Victims of emotional manipulation often develop hypervigilance, fawning behaviors, and codependent patterns as survival mechanisms (Walker, 2013). In short: you learn to prioritize keeping the peace over protecting your peace. Reclaiming your boundaries means reversing this pattern in small, consistent ways.

Step 1: Identify Where Your Boundaries Went Missing

Boundary repair begins with awareness. Start by reflecting on the areas where you felt your limits were consistently ignored or dismissed. These may include:

• Emotional boundaries (being blamed for someone else’s feelings)
  
• Time boundaries (being guilted into constant availability)
  
• Physical boundaries (touch or proximity without consent)
  
• Conversational boundaries (not being allowed to opt out of conflict)
  

Write down specific moments when you felt uncomfortable, pressured, or silenced. According to research on post-traumatic growth, making meaning of past experiences is a critical part of healing (Tedeschi & Calhoun, 2004). This isn’t about reliving trauma—it’s about spotting patterns so you can disrupt them.

Step 2: Reconnect with Your Internal Signals

After manipulation, it’s common to lose touch with your gut instincts. You may feel numb, confused, or uncertain when trying to make decisions. This is a sign of learned self-doubt, not a character flaw.

Start tracking small signals from your body and emotions. Ask yourself throughout the day:

• “Am I clenching my jaw or fists right now?”
  
• “What emotion am I pushing away?”
  
• “If I didn’t worry about upsetting anyone, what would I say or do next?”
  

Studies in somatic psychology suggest that reconnecting with bodily cues helps regulate the nervous system and supports boundary clarity (Ogden, Minton, & Pain, 2006).

Step 3: Set Micro-Boundaries First

Don’t start by confronting the most difficult people in your life. Instead, practice with low-stakes scenarios:

• Decline a calendar invite when you’re tired
  
• Ask a friend not to make jokes at your expense
  
• Stop explaining yourself when you say no
  

These “micro-boundaries” rebuild the neural pathways associated with self-trust. The more you practice, the more natural it becomes to assert your needs without panic.

Step 4: Script and Rehearse Your Limits

If confrontation causes anxiety, scripting helps. Write and rehearse boundary statements ahead of time so they feel more accessible in the moment. Examples include:

• “I’m not comfortable with that.”
  
• “I need some time to think about this.”
  
• “This isn’t a good time for me to talk.”
  

Research shows that people with assertiveness training experience higher self-esteem and lower stress (Speed, Goldstein, & Goldfried, 2017). Practicing your language before you need it builds emotional preparedness.

Step 5: Create an Internal Consequence System

Manipulative people often ignore boundaries unless there are consequences. But what matters more than enforcing consequences with others is following through with yourself.

Decide on internal rules for how you will respond when a boundary is crossed. For example:

• If a friend gossips after you asked them not to, you’ll decline their next invite.
  
• If your ex contacts you after you requested space, you’ll block the number.
  

This helps restore the core message: “I keep myself safe.”

Step 6: Recognize Your Progress, Not Perfection

Boundary healing isn’t linear. You’ll have moments when you freeze or fawn or fall silent. That doesn’t mean you’re back to square one—it means your brain is still healing from complex relational trauma. Self-compassion is essential. Keep a record of times you did speak up or chose yourself. Reminding your nervous system that progress is happening helps rewire those damaged trust pathways over time (Porges, 2011).

Step 7: Anchor Your Identity in Something Beyond the Trauma

Finally, to fully reclaim your boundaries, you need to rebuild a life where your identity isn’t organized around protecting yourself from others. Pursue joy, hobbies, values, and relationships that affirm your autonomy—not just your survival.

People who’ve experienced relational trauma often define healing as “never letting that happen again.” But true healing is about expanding into who you were before it happened—and who you can become now that it’s over.

Conclusion

Recovering from a manipulative relationship doesn’t require perfection—it requires practice. Healthy boundaries aren’t walls; they’re doors you get to open or close with intention. The more consistently you choose yourself, the more you’ll trust that you can.

Your nervous system may not believe it yet—but you’re allowed to take up space, say no without explaining, and exist without being managed. Boundaries aren’t selfish. They’re how you come back home to yourself.

Looking to work on your boundaries? Make an appointment with one of Refresh’s talented therapists at:

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence–from Domestic Abuse to Political Terror. Basic Books.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. Norton Professional Books.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-regulation. W.W. Norton.

Speed, B. C., Goldstein, B. L., & Goldfried, M. R. (2017). Assertiveness training: A forgotten evidence-based treatment. Clinical Psychology: Science and Practice, 25(1), 1–20.

Stark, E. (2007). Coercive Control: How Men Entrap Women in Personal Life. Oxford University Press.

Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1–18.

Walker, P. (2013). Complex PTSD: From Surviving to Thriving. Azure Coyote Books.

In the post-pandemic workplace, terms like quiet quitting and burnout have become part of everyday conversation. But are they the same thing? And how do you know whether you’re setting boundaries—or losing your sense of purpose? This article offers a self-assessment for burnout and explores how to differentiate healthy work-life balance from signs of emotional exhaustion. Learn how to spot the early warning signs of burnout, recognize whether you’re quietly quitting or quietly burning out, and take the first steps toward re-engagement at work.

What Is Quiet Quitting vs. Quiet Burnout?

Quiet quitting describes doing only what your job requires—no unpaid overtime, no extra projects, and no “going above and beyond.” It’s often framed as a form of workplace boundary-setting. But what if you’re not just pulling back on purpose—but because you can’t bring yourself to care anymore? That may be quiet burnout. Burnout isn’t always dramatic. It can look like emotional withdrawal, apathy, procrastination, and chronic exhaustion. Unlike quiet quitting, burnout isn’t a decision—it’s a symptom of a deeper issue.

Self-Test: Are You Burned Out or Just Setting Boundaries?

If you’re unsure whether you’re protecting your energy or slipping into burnout, use this burnout self-assessment to reflect:

• I only respond to essential messages and emails.
  
• I feel disconnected from the impact of my work.
  
• I imagine quitting without a plan—frequently.
  
• I wake up tired, even after a full night’s sleep.
  
• I avoid going beyond the basics in my tasks.
  
• I’ve lost the sense of purpose I once had.
  
• I feel emotionally numb or irritable most workdays.
  
• I dread meetings, even informal ones.
  
• I don’t contribute new ideas anymore.
  
• Working less hasn’t improved my energy.
  If you checked four or more, you may be experiencing low-grade burnout—not just quiet quitting.
  

Understanding the Signs of Workplace Burnout

Psychologist Christina Maslach defines burnout as a combination of emotional exhaustion, depersonalization, and reduced personal efficacy (Maslach & Jackson, 1981). It’s not only about long hours. Even a manageable workload can lead to burnout if the environment lacks psychological safety, recognition, or meaning. Burnout differs from fatigue. Fatigue can be fixed with rest. Burnout requires a deeper re-evaluation of your values, motivations, and work environment (Maslach & Leiter, 2016). If your job no longer aligns with your identity or sense of purpose, disengagement may follow—not because you’re lazy or entitled, but because meaning loss at work leads to emotional depletion (Keller et al., 2019).

Why Meaning Matters in the Workplace

Research shows that a strong sense of purpose in life and work improves psychological resilience and even physical health outcomes (Ryff & Singer, 2008; Kim et al., 2014). When your role no longer offers learning, growth, or alignment with your values, burnout can become chronic and self-perpetuating. Job satisfaction doesn’t just come from perks or pay—it depends on how connected you feel to the why behind your work. If that connection disappears, so does your motivation.

How to Recover from Burnout and Reignite Meaning

If you’re feeling the signs of quiet burnout, here are the first steps to re-engagement:

1. Identify What’s Missing
   Burnout often arises from a mismatch between your job demands and what you need to thrive: autonomy, creativity, connection, recognition, or purpose.
   
2. Monitor Energy, Not Just Time
   Keep an energy log instead of a time log. Track which tasks fuel you and which drain you. This helps clarify what to adjust or delegate.
   
3. Reconnect with Micro-Moments of Meaning
   Even in a job you’ve grown disillusioned with, you can still find small sparks of purpose—helping a colleague, mentoring someone, or completing a meaningful task.
   
4. Talk to Someone
   Burnout thrives in silence. Speak with a therapist, manager, or trusted mentor. Burnout recovery often begins with simply acknowledging it.
   
5. Evaluate the Role vs. the System
   Sometimes the issue is your specific position. Other times, it’s the entire work environment. If values conflict, consider whether a different role or career pivot is needed for long-term wellness.
   

Final Thoughts on Burnout vs. Boundary-Setting

The modern workplace makes it easy to confuse burnout with boundary-setting. But the difference matters. While quiet quitting can be a healthy way to protect your energy and mental health, quiet burnout requires active intervention. If you’re feeling detached, numb, or disillusioned by work, take it seriously. Burnout isn’t a personal failure—it’s a signal. And the good news is that it can be treated, especially when caught early. Use the self-assessment in this post to begin that reflection, and take the next steps toward burnout recovery, workplace wellness, and a more meaningful connection to your work.

Feeling burnt out? Make an appointment with one of Refresh’s talented therapists at:

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Grant, A. M. (2008). The significance of task significance: Job performance effects, relational mechanisms, and boundary conditions. Journal of Applied Psychology, 93(1), 108–124.

Keller, A. C., Meier, L. L., Elfering, A., & Semmer, N. K. (2019). Please don’t interrupt me! Examining the effects of self‐control demands on emotional exhaustion and job performance. Journal of Occupational Health Psychology, 24(4), 513–526.

Kim, E. S., Sun, J. K., Park, N., & Peterson, C. (2014). Purpose in life and reduced incidence of stroke in older adults: ‘The Health and Retirement Study.’ Journal of Psychosomatic Research, 74(5), 427–432.

Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113.

Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15(2), 103–111.

Pines, A., & Aronson, E. (1988). Career burnout: Causes and cures. Free Press.

Ryff, C. D., & Singer, B. (2008). Know thyself and become what you are: A eudaimonic approach to psychological well-being. Journal of Happiness Studies, 9(1), 13–39.

The traditional separation of physical and mental health is no longer tenable. Increasingly, research shows that our bodies and minds are part of an interconnected system—one that communicates constantly and responds holistically to internal and external stressors. Yet, medical systems often fail to address this connection, leading to misdiagnoses, fragmented care, and unrecognized symptoms. Understanding the bidirectional relationship between physical and mental health is not just helpful—it’s essential for effective treatment and long-term well-being.

How Physical Health Impacts Mental Health

Chronic illness does more than affect the body—it reshapes emotional landscapes. Individuals living with conditions such as diabetes, cardiovascular disease, or autoimmune disorders report significantly higher rates of depression and anxiety (Katon, 2011). These emotional symptoms are not secondary; they are embedded in the experience of navigating limitations, physical discomfort, medication side effects, and fears about disease progression. The burden of illness extends into identity, disrupting one’s sense of control and security.

Hormonal and nutritional factors also play a significant role in mental health. Thyroid dysfunction, especially hypothyroidism, often mimics or worsens depression symptoms (Joffe & Levitt, 1994). Similarly, deficiencies in iron, vitamin B12, and omega-3 fatty acids have been linked to fatigue, poor concentration, and low mood (Rao et al., 2008). Even mild dehydration can impair mood and increase fatigue and confusion (Ganio et al., 2011).

Sleep is another critical physical process with mental health implications. Poor sleep hygiene or sleep disorders such as insomnia or sleep apnea are associated with increased risk of depression, anxiety, and even suicidal ideation (Baglioni et al., 2016). In fact, treating insomnia has been shown to improve mental health outcomes, underscoring how physical interventions can enhance emotional resilience.

How Mental Health Impacts Physical Health

Mental health disorders are not just “in the head.” They affect multiple biological systems, beginning with the stress response. Chronic stress, anxiety, and trauma activate the hypothalamic-pituitary-adrenal (HPA) axis, leading to sustained elevations in cortisol. Over time, this disrupts immune function, promotes inflammation, and increases risk for metabolic syndrome and cardiovascular disease (McEwen, 2007).

Depression, too, exerts measurable physiological effects. It is an independent risk factor for heart disease, and people with depression who experience a cardiac event have poorer outcomes than those without depression (Lichtman et al., 2014). Depression can also slow wound healing, compromise immune response, and increase pain sensitivity—all of which illustrate how emotional states can influence the body on a cellular level.

Behavioral factors further blur the line. Individuals with poor mental health may have reduced energy or motivation to engage in physical self-care, such as attending medical appointments, eating nutritiously, or exercising. These behaviors compound physical symptoms and can make recovery more difficult.

Shared Risk Factors and Overlapping Diagnoses

Some conditions reflect a perfect storm of shared biological, psychological, and environmental influences. For example, irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), and fibromyalgia are all associated with both heightened psychological distress and physiological dysregulation (Clauw, 2014). Patients with these diagnoses often report being dismissed or misunderstood, particularly when symptoms don’t fit clean biomedical models.

Social determinants of health also play a central role. Trauma, poverty, discrimination, and systemic barriers all contribute to both physical and mental health problems (Adler et al., 1994). These intersecting factors create a feedback loop in which physical symptoms exacerbate emotional distress and vice versa.

The Problem with Separating the Two

The legacy of Cartesian dualism—the mind-body split—has shaped healthcare systems to view mental and physical symptoms as distinct, leading to siloed care. A patient with fatigue may be referred to a neurologist, while another with identical symptoms but a history of trauma might be referred to a psychiatrist. Rarely are these perspectives integrated.

This separation contributes to stigma, underdiagnosis, and poor outcomes. Mental health symptoms in medical patients are frequently missed, while physical symptoms in psychiatric patients are sometimes dismissed as psychosomatic. Women, BIPOC individuals, and LGBTQ+ patients are especially vulnerable to this kind of dismissal (Hausmann et al., 2008).

Insurance models only reinforce the divide, often covering treatment in one domain but not both, or requiring specific diagnoses to authorize care. The result is a fragmented experience that fails to acknowledge how intimately physical and mental well-being are linked.

The Benefits of Integrated and Holistic Care

Integrated care models that combine medical and mental health services are gaining momentum. In these systems, behavioral health providers are embedded within primary care teams, offering on-site consultations and collaborative treatment planning. Studies have shown that integrated care leads to better outcomes, greater patient satisfaction, and reduced healthcare costs (Butler et al., 2008).

Beyond clinical integration, holistic practices—such as somatic therapy, biofeedback, acupuncture, and trauma-informed yoga—are also bridging the gap. These approaches recognize that healing occurs in the whole body and that physical symptoms can reflect emotional injury, and vice versa.

What Patients Can Do

If you are navigating both physical and mental health symptoms, advocate for whole-person care. Don’t be afraid to bring up physical symptoms in a therapy session or mental health concerns in a primary care visit. Seek providers who are open to collaboration across disciplines and who respect the complexity of your experience.

When discussing symptoms, be specific about their impact on daily life and functioning. Keep a journal to track patterns—such as flare-ups of physical pain during periods of emotional stress—and bring this data to appointments. When needed, don’t hesitate to seek a second opinion if your symptoms are being minimized or fragmented.

Conclusion

Mental and physical health are two sides of the same coin. The mind-body connection is not a fringe idea—it is a research-supported reality that demands an integrative approach. Only by treating the whole person can healthcare be truly effective. As patients and professionals alike begin to challenge old models and embrace holistic perspectives, we move closer to a future where all aspects of human health are honored, understood, and cared for.

Need help with your mind-body connection?  Make an appointment with one of Refresh’s talented therapists at:

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., & Syme, S. L. (1994). Socioeconomic status and health: the challenge of the gradient. American Psychologist, 49(1), 15–24.

Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., & Riemann, D. (2016). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 186, 10–19.

Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hagedorn, H., & Wilt, T. J. (2008). Integration of mental health/substance abuse and primary care. Agency for Healthcare Research and Quality (US).

Clauw, D. J. (2014). Fibromyalgia: a clinical review. JAMA, 311(15), 1547–1555.

Ganio, M. S., Armstrong, L. E., Casa, D. J., McDermott, B. P., Lee, E. C., Yamamoto, L. M., & Marzano, S. (2011). Mild dehydration impairs cognitive performance and mood of men. British Journal of Nutrition, 106(10), 1535–1543.

Hausmann, L. R., Jeong, K., Bost, J. E., & Ibrahim, S. A. (2008). Perceived discrimination in health care and health status in a racially diverse sample. Medical Care, 46(9), 905–914.

Joffe, R. T., & Levitt, A. J. (1994). Major depression and thyroid disease: a review. Acta Psychiatrica Scandinavica, 89(4), 370–373.

Katon, W. J. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience, 13(1), 7–23.

Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure‐Smith, N., & Wulsin, L. (2014). Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations. Circulation, 129(12), 1350–1369.

McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological Reviews, 87(3), 873–904.Rao, T. S., Asha, M. R., Ramesh, B. N., & Jagannatha Rao, K. S. (2008). Understanding nutrition, depression and mental illnesses. Indian Journal of Psychiatry, 50(2), 77–82.

The moment you notice a new symptom or receive a diagnosis, it’s natural to open Google. You want answers—fast. Whether it’s a rash, persistent fatigue, or something more alarming, the internet feels like an instant gateway to clarity. But while online research can empower you to make informed decisions, it can also escalate anxiety, spread misinformation, and lead you to worst-case conclusions. This is where mindfulness comes in.

Mindful research means staying intentional, aware of your emotional state, and grounded in your goals. It doesn’t mean avoiding the internet—it means using it wisely. Here’s how to research your health online without spiraling.

Why Mindfulness Matters in Health Research

Your mindset directly affects how you interpret health information. When you’re anxious or afraid, your brain is more likely to engage in confirmation bias—seeking out information that supports your worst fears while ignoring more balanced explanations (Lilienfeld et al., 2015). This can lead to “cyberchondria,” a term for health anxiety triggered or worsened by internet searches (Muse et al., 2012).

The sheer volume of medical content online makes it easy to fall into this trap. Mindfulness helps you slow down and stay conscious of how you’re reacting emotionally while reading. This awareness reduces reactivity and helps you evaluate information more rationally (Kiken et al., 2015).

Step 1: Set Your Intentions Before You Search

Before typing anything into the search bar, pause. What are you hoping to learn? Are you looking for treatment options, better understanding, or questions to ask your doctor? Or are you seeking reassurance? Recognizing your goal prevents aimless scrolling and grounds your search in a clear purpose.

It’s also important to acknowledge how you’re feeling. If you’re already anxious, wait until you’re in a calmer state. Research shows that heightened emotional arousal can impair rational decision-making and increase impulsive behavior (Arnsten, 2009). A few deep breaths or a short grounding exercise can help you engage more thoughtfully.

Step 2: Choose Your Sources Wisely

Not all websites are created equal. Reputable health sources typically end in .org, .gov, or .edu, and are affiliated with recognized institutions. Some of the best include:

• Mayo Clinic (mayoclinic.org)
  
• Cleveland Clinic (clevelandclinic.org)
  
• MedlinePlus (medlineplus.gov)
  
• National Institutes of Health (nih.gov)
  

These sources tend to offer balanced, peer-reviewed, and regularly updated information. In contrast, blogs, forums, and anecdotal reports can be misleading or emotionally charged. While personal stories may be validating, they’re not substitutes for clinical data—especially early in your research.

Watch for red flags like:

• “Cure your condition naturally in 3 days”
  
• Heavy use of fear-based language
  
• Lack of author credentials or cited research
  

Step 3: Read With a Critical Mindset

Once you start reading, pay attention to how information is framed. Are you seeing similar facts across different sources? Or are you finding contradictory and confusing claims? Trustworthy information tends to be consistent across expert sites.

Also, check the publication date. Medical advice evolves rapidly, especially in areas like neurology, endocrinology, and infectious disease. An article from 2012 might be outdated, even if it’s from a reliable source.

Be wary of single statistics or statements that sound extreme. Context is everything. For example, a statistic that says “this condition triples your risk of X” may sound dramatic—but if the original risk was 0.5%, tripling it still keeps it under 2%. That doesn’t mean it’s not serious, but the framing can dramatically affect how you perceive the information (Gigerenzer et al., 2007).

Step 4: Keep a Research Journal

One of the most mindful practices you can adopt is tracking what you’re reading. This doesn’t need to be elaborate. It can be a simple notebook or digital document where you:

• Write down key facts or findings
  
• Track which sites you visited and when
  
• Record your emotional reactions or questions to ask your provider
  

This keeps your research organized and stops you from repeating the same spiral. It also gives you a concrete way to prepare for appointments, making your conversations with doctors more efficient and collaborative.

Step 5: Know When to Stop and Seek Guidance

One of the clearest signs you’ve gone too far is when researching starts to heighten—not relieve—your anxiety. If you’re checking multiple sources in quick succession, obsessively comparing symptoms, or feeling overwhelmed, it’s time to stop. There’s no definitive line between being informed and becoming consumed, but your body will usually let you know.

Mindful research means knowing when to defer to a professional. The goal isn’t to self-diagnose—it’s to ask better questions, understand your options, and participate meaningfully in your care. Your doctor’s role is to connect the dots with clinical context you don’t have access to—and no amount of Googling can replace that expertise.

Conclusion

The internet can be a powerful tool for understanding your health, but only if used with care. Practicing mindful research helps you stay grounded, reduce unnecessary anxiety, and approach medical decisions with confidence rather than fear. You deserve accurate, empowering information—and a process that supports your well-being rather than derailing it.

Want to incorporate mindfulness into your life? Make an appointment with one of Refresh’s talented therapists at:

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Arnsten, A. F. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422.

Gigerenzer, G., Gaissmaier, W., Kurz-Milcke, E., Schwartz, L. M., & Woloshin, S. (2007). Helping doctors and patients make sense of health statistics. Psychological Science in the Public Interest, 8(2), 53–96.

Kiken, L. G., Garland, E. L., Bluth, K., Palsson, O. S., & Gaylord, S. A. (2015). From a state to a trait: Trajectories of state mindfulness in meditation during intervention predict changes in trait mindfulness. Personality and Individual Differences, 81, 41–46.

Lilienfeld, S. O., Lynn, S. J., Ruscio, J., & Beyerstein, B. L. (2015). 50 Great Myths of Popular Psychology: Shattering Widespread Misconceptions about Human Behavior.

Wiley-Blackwell.Muse, K., McManus, F., Leung, C., Meghreblian, B., & Williams, J. M. G. (2012). Cyberchondriasis: Fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet. Journal of Anxiety Disorders, 26(1), 189–196.

In recent years, “gaslighting” has entered the mainstream vocabulary with force. It’s on social media, in dating app bios, in political commentary, and even in casual disagreements. But as the word gains popularity, its clinical meaning is becoming diluted—and with that dilution comes real harm. When we call every form of dishonesty or disagreement “gaslighting,” we risk invalidating the actual psychological abuse that many people experience and making it harder to name and heal from.

As a psychotherapist, I’ve seen how confusion around these terms—gaslighting, lying, and misinformation—can keep people trapped in unhealthy dynamics or unsure whether their experience even counts as abuse. This article breaks down the real distinctions between the three, explains why they matter, and explores how misusing the term “gaslighting” can compromise both clarity and care.

What Is Gaslighting? A Psychological Definition

Gaslighting is not just lying. It is a form of psychological abuse in which a person systematically manipulates another into questioning their perception, memory, or sanity. The term comes from the 1944 film Gaslight, in which a husband dims the gas lights in the home and tells his wife she’s imagining it, leading her to believe she’s mentally unwell.

Clinically, gaslighting is often used by people with strong control needs, including narcissistic and emotionally abusive individuals. What makes gaslighting unique is that it’s:

• Intentional: The goal is to destabilize the victim’s grasp on reality.
  
• Ongoing: Gaslighting involves repeated behaviors, not one-off lies.
  
• Psychologically corrosive: Over time, the victim internalizes the manipulator’s view and loses confidence in their own.
  

Examples of gaslighting include:

• “You’re remembering it wrong. That never happened.”
  
• “You’re too sensitive. You always overreact.”
  
• “Everyone agrees you’re the problem.”
  
• “If you really loved me, you’d trust me more than your own feelings.”
  

The core message is always: Don’t trust your memory. Don’t trust your feelings. Trust me instead.

What Is Lying?

Lying is the act of knowingly providing false information. It can range from white lies to serious deceptions. Unlike gaslighting, lying doesn’t necessarily aim to erode someone’s sense of reality—it’s usually meant to protect the liar or avoid consequences.

For example:

• Telling your partner you were at the office when you were actually out with a friend is lying.
  
• Telling your boss you finished a report you haven’t started is lying.
  

Lies can be harmful, but not all lies are manipulative in the gaslighting sense. Most importantly, lying does not require the victim to question their overall perception of reality—it only aims to obscure a specific fact or event.

What Is Misinformation?

Misinformation is the unintentional sharing of false information. Unlike lying, misinformation doesn’t involve intent to deceive. Unlike gaslighting, it isn’t about control or manipulation.

Someone who spreads misinformation:

• Believes the false information is true
  
• Has no agenda to control your thoughts or feelings
  
• May be repeating something they’ve heard without fact-checking
  

A coworker who tells you the wrong start time for a meeting because they were misinformed is not gaslighting you. A friend who believes a conspiracy theory and tells you about it earnestly is spreading misinformation—not lying or gaslighting.

Why Misusing the Term “Gaslighting” Is a Problem

While it’s valid to feel upset or disrespected when lied to, calling every lie “gaslighting” can have serious consequences:

1. It trivializes real abuse
   When everything is called gaslighting, nothing is. People who are truly being gaslit may question whether their experience is “bad enough” or worthy of support.
   
   
2. It blurs accountability
   Not every harmful interaction is abuse. Misusing clinical language can prevent constructive dialogue and prematurely label others as abusive when they may simply be avoidant, disorganized, or conflict-averse.
   
   
3. It reinforces emotional confusion
   Ironically, calling non-manipulative behaviors “gaslighting” can produce the same psychological disorientation gaslighting causes. It creates overgeneralization and distrust, leading people to question valid relationships.
   
   
4. It can become a weapon
   In some cases, the term itself is weaponized—accusing someone of gaslighting can itself be a gaslighting tactic if used manipulatively.
   

How to Tell the Difference in Real Time

Ask yourself:

• Is this person trying to make me doubt my perception consistently and over time?
  
• Is this a one-time dishonesty, or is it part of a pattern?
  
• Are they denying facts I can verify, or minimizing my feelings?
  
• Are they invalidating my emotions while insisting their version of events is the only valid one?
  

If the answer to multiple questions is “yes,” you may be experiencing gaslighting. But if it’s a single lie or mistaken belief, you may be dealing with dishonesty or misinformation—not psychological abuse.

The Emotional Consequences of Each

• Gaslighting leads to chronic self-doubt, emotional dysregulation, and loss of self-trust. Survivors often present with complex PTSD symptoms.
  
• Lying can create betrayal trauma and trust issues but doesn’t usually dismantle someone’s perception of reality unless chronic.
  
• Misinformation often leads to confusion or miscommunication but doesn’t produce psychological harm unless part of a broader manipulative pattern.
  

The Role of Therapy in Untangling This

People often come to therapy unsure of whether their experience “counts.” They feel invalidated, confused, or ashamed for being hurt by something others brush off. Therapy provides a place to name what’s happening—whether it’s an emotionally abusive pattern or a boundary that’s been crossed.

A good therapist doesn’t rush to label. Instead, they help you track:

• Patterns of behavior
  
• Emotional impact
  
• Your evolving sense of self and agency
  

You don’t have to know if it’s “gaslighting” or not to get help. If your relationships make you feel smaller, more confused, or chronically unstable, that is enough reason to explore further.

How Refresh Psychotherapy Can Help

At Refresh Psychotherapy, we work with clients to navigate confusing dynamics with clarity and compassion. Whether you’ve experienced ongoing gaslighting or are simply trying to understand if your feelings are valid, our therapists provide grounded, emotionally intelligent care. We don’t rush to diagnose your relationship—but we will help you reconnect with your instincts, explore boundaries, and restore your sense of psychological safety.

We believe your feelings deserve to be understood—not dismissed. And your version of events deserves space to be heard and honored.

Did you experience trauma due to gaslighting? Make an appointment with one of Refresh’s talented therapists at:

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Sweet, P. L. (2019). The Sociology of Gaslighting. American Sociological Review, 84(5), 851–875.

Stern, R. (2007). The Gaslight Effect: How to Spot and Survive the Hidden Manipulation Others Use to Control Your Life. Harmony Books.

Graham, L. (2015). Gaslighting: Making you think you’re crazy is a hallmark of abuse. Psychology Today.

Lewandowsky, S., Ecker, U. K. H., & Cook, J. (2017). Beyond Misinformation: Understanding and Coping with the “Post-Truth” Era. Journal of Applied Research in Memory and Cognition, 6(4), 353–369.

Whitley, B. E., & Kite, M. E. (2016). Principles of Research in Behavioral Science. Routledge.

Gaslighting has become a widely recognized term, but ironically, its overuse sometimes obscures its true meaning. People use “gaslighting” to describe disagreements, minor lies, and even simple misunderstandings. But real gaslighting is not simply dishonesty—it’s a strategic, ongoing process of emotional manipulation designed to distort your perception of reality, undermine your autonomy, and keep you dependent.

From a clinical perspective, gaslighting is a form of psychological abuse. It often occurs in toxic relationships, including romantic partnerships, families, workplaces, and even friendships. And while it can be overt and cruel, the most damaging forms are often subtle—because subtle gaslighting is harder to prove, harder to name, and harder to escape.

This article is written for those who suspect they may be experiencing gaslighting and want to understand how it operates—and, crucially, how to document it. Whether you’re beginning to question your own memories or are preparing to leave an emotionally abusive situation, documentation is a powerful tool to reclaim your truth and protect your mental health.

What Gaslighting Actually Is—and Isn’t

Gaslighting is not just lying. Lying is a discrete act: someone tells a falsehood to protect themselves or avoid consequences. Gaslighting is more systemic. It involves repeated tactics that lead the target to question their memory, perception, emotions, or even sanity. It’s not just about denying facts—it’s about shifting the ground under your feet so often that you no longer know what to believe.

Gaslighting is particularly damaging because it induces cognitive dissonance—the psychological discomfort that occurs when two beliefs conflict. Over time, the victim is conditioned to resolve that dissonance by adopting the gaslighter’s version of reality rather than trusting their own.

Red-Flag Behaviors That Signal Subtle Gaslighting

While gaslighting can include extreme behaviors like telling blatant lies or insisting you’re mentally unstable, most of it lives in the grey zone. Below are red flags that indicate psychological manipulation may be at play:

• Rewriting History: They insist something didn’t happen—even when you have proof—or claim you’re remembering it wrong.
• Withholding or Stonewalling: They refuse to engage when you bring up concerns and make you feel like you’re the problem for trying to discuss anything at all.
• Minimizing and Dismissing: They respond to your distress with “You’re overreacting,” “You’re being dramatic,” or “It’s not a big deal.”
• Shifting Blame: They always manage to make it your fault, even when their behavior is clearly harmful.
• Using ‘Logic’ to Undermine Emotion: They frame their dismissiveness as rationality and portray your emotional responses as irrational or unintelligent.
• Public Kindness, Private Cruelty: They behave differently in public than in private, making you question your own experience.
• Making You Doubt Neutral Observers: They suggest that friends, therapists, or colleagues are biased against them—or against you.
• Using Your Words Against You: Anything you share vulnerably can be later used to discredit or shame you.
  

Psychological Impact of Gaslighting

Gaslighting leads to more than momentary confusion—it can result in long-term psychological harm. Clinically, many survivors present with symptoms of:

• Chronic self-doubt and indecisiveness
• Generalized anxiety or panic attack
• Symptoms of complex PTSD\
• Depersonalization (feeling outside one’s body)
• Ruminative thought patterns
• Dysfunctional attachment behaviors
  

The most insidious effect is internalized gaslighting: believing the gaslighter’s narrative so completely that the survivor begins self-policing their emotions and invalidating their own instincts.

Why Documentation Is So Crucial

The goal of gaslighting is to disrupt your internal compass. The antidote to gaslighting isn’t just leaving the relationship—it’s rebuilding your sense of what’s true.

Documentation can serve several purposes:

• It preserves your version of events.
  
• It provides a timeline of behaviors that may otherwise blur together.
  
• It supports your case if legal, HR, or custody issues arise.
  
• It interrupts the “maybe I imagined it” thought loop that gaslighters rely on to maintain control.

How to Document Gaslighting Behaviors Safely and Effectively

This section offers therapist-recommended, trauma-informed practices for gathering and preserving evidence while protecting your safety and emotional well-being.

1. Keep a Secure Daily Log

Use a password-protected digital journal (or a paper one stored safely) to log:

• Dates and times of incidents
  
• What was said or done (verbatim, if possible)
  
• Your emotional and physical reaction
  
• Any witnesses or evidence
  

For example:
April 9, 7:45 PM: I told him it bothered me when he ignored my messages. He said, “That never happened—you’re imagining things again.” I felt confused and ashamed. My hands were shaking after the conversation.

This type of record not only validates your experience but also helps identify patterns of behavior over time.

2. Save Screenshots of Messages and Emails

Digital communication can be powerful evidence. Gaslighters may later claim, “I never said that” or “You misunderstood.” Screenshots provide an irrefutable record. Store them in an encrypted folder and back them up to a secure drive.

3. Record Voice Memos (Where Legal)

If legal in your jurisdiction, audio recordings of conversations can help you hear the manipulation more clearly in hindsight. Always check local laws before recording.

4. Ask Clarifying Questions in Writing

When possible, communicate difficult or sensitive issues via text or email rather than in person. This creates a written record of how the gaslighter responds. You can also use reflective questions to elicit clarity:

• “Can you help me understand why you said that I’m ‘too emotional’ when I was describing how I felt?”
  
• “Just so I’m clear—are you saying that X never happened?”
  

Even if the responses are vague or dismissive, those patterns become part of the documented behavior.

5. Maintain Emotional Validation Logs

Gaslighters rely on emotional invalidation. Keeping a record of when you felt unseen, dismissed, or manipulated helps you maintain your sense of reality. Include physical sensations (racing heart, stomach tension, etc.) to connect with your body’s wisdom.

6. Share Documentation with a Safe Third Party

Therapists, close friends, or legal advocates can provide affirmation and perspective. In some cases, sharing your logs with a therapist helps establish a clinical record, which can later be helpful for legal purposes or safety planning.

7. Prioritize Digital Safety

Never store documentation on shared devices. Use incognito browsers, secure cloud backups, and password protection. Consider using apps with disguised icons or “panic delete” features if you are concerned about your safety.

8. Use a Code System for Logs if Necessary

If you fear discovery, use a neutral-looking note system with coded language. For example, “Client C” might mean your partner, and “Session 1” might mean a particular fight. Discuss safe methods with your therapist.

Healing Starts with Reclaiming Your Reality

Gaslighting corrodes the basic foundation of mental health: trust in your own mind. But documenting your experience—privately and safely—is the first step to reversing that damage. The act of writing things down, seeing patterns, and validating your truth is healing in itself. It’s not about revenge. It’s about repair.

If you feel confused, ashamed, or unsure whether you’re “overreacting,” that’s the conditioning talking. Trust the version of you who kept track. Trust the instincts that made you start looking into this in the first place.

How Therapy at Refresh Psychotherapy Can Help

At Refresh Psychotherapy, we work with survivors of covert emotional abuse, including gaslighting. We know how isolating and disorienting it can be to constantly second-guess yourself or feel invisible in your own story. Our therapists provide a validating, structured space where you can make sense of what’s happened, restore your confidence, and begin making decisions rooted in your own truth. Whether you’re preparing to leave a harmful dynamic or healing in its aftermath, we’re here to support you in documenting safely, processing deeply, and recovering fully.

Did you experience trauma due to gaslighting? Make an appointment with one of Refresh’s talented therapists at:

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Stark, E. (2007). Coercive Control: How Men Entrap Women in Personal Life. Oxford University Press.

Sweet, P. L. (2019). The Sociology of Gaslighting. American Sociological Review, 84(5), 851–875.

Waldron, J. J. (2012). Gaslighting in Interpersonal Relationships: A Form of Emotional Abuse. Journal of Psychosocial Nursing and Mental Health Services, 50(7), 20–27.

Stern, R. (2007). The Gaslight Effect: How to Spot and Survive the Hidden Manipulation Others Use to Control Your Life. Harmony Books.

In every friend group, there’s often that person—the one who offers calm advice, listens without interrupting, diffuses tension, and seems to have it all together. If you’re reading this, chances are that person is you. You’re the go-to sounding board, the unpaid life coach, the emotional anchor. You’re the one who gets the 2 a.m. crisis texts and the “Can I vent real quick?” DMs from friends, coworkers, and sometimes near-strangers.

You didn’t ask for the role, but it found you—and you’ve gotten good at it. So good, in fact, that people forget you have needs of your own.

From a mental health perspective, being the “therapist friend” can be a double-edged sword. On one hand, your empathy and insight are strengths. On the other, they can leave you overextended, resentful, or emotionally drained. The line between supportive and self-sacrificing gets blurry—and without boundaries, the burden can start to feel like burnout.

This article is for anyone who’s exhausted from being everyone’s emotional safety net. It explores why this dynamic forms, how it impacts mental health, and what you can do to protect your energy without abandoning your relationships.

Why You Became the Therapist Friend

People who become the “therapist friend” often share several psychological traits: high emotional intelligence, strong interpersonal skills, and a history of being hyper-attuned to the moods of others. Many have experienced childhood roles that required them to become peacekeepers, parentified children, or emotional regulators for overwhelmed adults (Hooper et al., 2011). These patterns create a tendency to step into caregiving roles automatically—even when it’s not explicitly asked of them.

Others grow into the role through professional or academic training. If you’re a mental health professional, medical provider, teacher, or coach, your identity is tied to helping others—and your friends may lean on you without realizing they’re treating you more like a therapist than a peer.

But regardless of how the role starts, the result is often the same: you end up holding more emotional labor than your fair share.

The Mental Health Toll of Constant Emotional Labor

Emotional labor refers to the invisible work of managing other people’s feelings, smoothing over conflict, and staying calm even when you’re not. When this becomes your default mode in personal relationships, it can lead to:

• Compassion fatigue
• Emotional burnout
• Suppressed anger or resentment
• Reduced capacity for self-care
• Enmeshment or codependent dynamics
  

What’s more, the therapist friend often doesn’t feel allowed to struggle. People expect them to always be calm, wise, and available. As a result, they might downplay their own problems, believing they should be able to handle everything on their own.

But this belief is both unrealistic and damaging. Everyone deserves support—not just those in crisis. And no one should have to perform emotional perfection just to be accepted.

How to Recognize When It’s Too Much

Signs that the “therapist friend” role is taking a toll include:

• You feel dread when a certain friend calls or texts.
• You avoid sharing your own struggles because you’re afraid they’ll seem small.
• You feel guilty saying no, even when you’re at capacity.
• You resent how much space others take up, but feel unable to stop it.
• You notice a pattern: others vent, you listen, and nothing changes.
  

These are warning signs that your boundaries have been eroded—and that it’s time to reevaluate how much emotional labor you’re willing (or able) to give.

Protecting Your Energy: What Therapists Recommend

You don’t have to cut everyone off to reclaim your bandwidth. Here are therapist-approved strategies for maintaining your empathy without sacrificing your well-being:

1. Differentiate Between Support and Fixing
Listening with care doesn’t mean solving the problem. Instead of jumping into advice-giving mode, ask: “Do you want to vent, or would it help to talk through solutions?” This sets a limit and invites shared responsibility for the emotional exchange.

2. Set Limits on Frequency and Duration
You’re allowed to say: “I really want to be here for you, but I can only talk for 15 minutes today.” Setting time boundaries preserves your energy without rejecting the person.

3. Name Your Needs—Out Loud
Let your friends know when you need support. If the dynamic is always one-sided, healthy friends will welcome the chance to show up for you, too.

4. Redirect to Professional Resources When Needed
You can say: “That sounds heavy—I think this is bigger than what a friend can help with. Have you thought about talking to a therapist?” This reinforces that your role is a friend, not a clinician.

5. Recognize Resentment as a Signal, Not a Failure
Resentment often means you’ve overextended yourself. It’s not a sign that you’re selfish—it’s a cue that you’ve ignored your own limits.

6. Practice Saying No Without Overexplaining
You don’t have to justify your boundaries with elaborate explanations. A simple “I’m not in the right space to hold that right now, but I care about you” is enough.

7. Reframe Boundaries as Connection Tools
Boundaries aren’t walls—they’re guidelines that make deeper connection possible. They prevent burnout, resentment, and emotional depletion, allowing you to show up more fully when you do choose to engage.

When Friendship Starts to Feel Like Therapy

It’s important to ask yourself: Is this a mutual friendship, or a one-sided support dynamic? If your relationship primarily revolves around the other person’s crises, needs, and processing, it may be time to reset expectations.

Therapy-saturated friendships often lack balance. You deserve relationships where your voice is heard, your needs matter, and your presence is valued for more than your insight.

And if setting boundaries causes conflict, that’s information—not failure. It tells you how safe the relationship really is.

How Therapy at Refresh Psychotherapy Can Help

At Refresh Psychotherapy, we help clients break free from emotionally overburdened roles—including the therapist friend dynamic. If you’ve been carrying too much for too long, therapy can offer a space to explore why that role formed, what it costs you, and how to create more equitable, energizing relationships. You don’t need to give less—you just need to stop giving everything. Our clinicians support you in reclaiming your right to rest, receive, and exist without always being the strong one.

Need help protecting your energy? Make an appointment with one of Refresh’s talented therapists at:

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Grabe, S., Ward, L. M., & Hyde, J. S. (2007). The Role of the Media in Body Image Concerns Among Women: A Meta-Analysis of Experimental and Correlational Studies. Psychological Bulletin, 134(3), 460–476.

Hooper, L. M., Doehler, K., Wallace, S. A., & Hannah, N. J. (2011). The Parentification Inventory: Development, validation, and cross-validation. The American Journal of Family Therapy, 39(3), 226–241.

Figley, C. R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Brunner/Mazel.

For parents navigating immigration delays, asylum backlogs, or visa restrictions, family life doesn’t pause just because borders do. When you’re separated from your children—not by choice but by paperwork—the pain can feel relentless. Whether you’re waiting for reunification or forced to parent from afar, the distance often carries guilt, grief, and overwhelming questions: “Am I doing enough?” “Will my child still feel connected to me?” “What happens to our bond in the meantime?”

From a mental health perspective, long-distance parenting during immigration delays is a high-stakes, high-emotion experience. But it’s not one without hope. With the right combination of attachment-based rituals, secure communication routines, and tech tools that support emotional presence, parents can maintain meaningful bonds—despite miles and legal barriers.

This article explores how to protect emotional connection while physically apart, using evidence-based attachment principles and practical strategies tailored for cross-border families.

Why Long-Distance Parenting Hurts So Much

Human attachment is built on proximity, touch, and repeated daily interaction. But when immigration systems intervene—through deportation, visa denials, or protracted legal timelines—these foundations are disrupted.

Psychologically, this separation can activate grief, trauma, and helplessness. Research shows that long-term parental separation can trigger symptoms of depression, anxiety, and complicated grief in parents, particularly when the separation is involuntary (Suárez-Orozco et al., 2011). This is not “homesickness”—it’s the psychological pain of being unable to perform your role in a child’s life in real time.

The loss isn’t just about presence. It’s about missed firsts, unsaid goodnights, and the inability to comfort your child through their struggles. And for many, it’s also about the fear of being forgotten—or replaced.

Understanding Attachment Beyond Physical Proximity

While proximity supports attachment, it’s not the only ingredient. What truly matters is a child’s felt sense of connection—the belief that their parent is emotionally available, consistent, and invested in the relationship.

This means that even across distances, you can still:

• Show up emotionally
• Create predictability
• Reinforce your role as a secure base
• Celebrate the ordinary
• Repair moments of misattunement
  

These are the cornerstones of secure attachment. And they’re all possible—even when borders get in the way.

Attachment-Preserving Rituals and Routines

1. Anchor the Day
   Create a consistent time when your child can expect to hear from you—morning voice notes, bedtime video calls, or midday texts. Predictability builds trust. Even if you can’t speak daily, a structured routine (like “Tuesday story night”) becomes emotionally meaningful.
   
   
2. Mirror Real-Life Activities
   Do shared activities simultaneously—even while apart. Eat breakfast together on video. Watch the same show and talk about it. Take parallel walks and send photos. This mimics the rhythm of daily life and reminds your child you still move through the world with them in mind.
   
   
3. Rituals of Continuity
   Start shared traditions: a weekly question you always ask, a bedtime phrase, or a hand gesture that means “I love you.” These rituals act as emotional glue, especially when time zones or legal proceedings disrupt consistency.
   
   
4. Voice Over Video, When Needed
   Video calls can be overstimulating, especially for younger children or teens going through withdrawal or resentment. Don’t underestimate the intimacy of audio messages—your tone, warmth, and cadence all communicate care.
   

Tech Hacks to Sustain Emotional Presence

1. Recordable Storybooks or Audiobooks
   Record yourself reading a favorite story. Companies like Hallmark or custom audiobook platforms allow you to create tangible reminders of your voice and presence.
   
   
2. Shared Calendars and Countdowns
   Use platforms like Cozi or Google Calendar to share important dates—school events, visa hearings, or birthday countdowns. This helps your child feel like you’re part of their world, even if you’re not physically there.
   
   
3. Digital Memory Albums
   Create shared albums where your child can upload drawings, report cards, or selfies—and you can respond with comments or emojis. It mirrors the back-and-forth interaction of in-person parenting.
   
   
4. Care Packages with Symbolic Items
   Send a care package with one object that represents you—a scarf that smells like your cologne or perfume, a token from your culture, or a keepsake from your shared memory. Concrete items help reinforce abstract emotional bonds.
   

Repairing Disconnection from Afar

Every parent will miss calls. Forget a promise. Misunderstand a tone. Long-distance parenting requires you to become fluent in repair—the process of acknowledging misattunement and restoring trust.

Try using simple scripts:

• “I noticed I missed your call. I really wanted to talk. Let’s try again tomorrow.”
• “I’m sorry I seemed rushed. I was distracted, but that wasn’t your fault.”
• “I still want to hear what you had to say. Can we talk again soon?”
  

Consistent repair shows your child that your bond is resilient—and that mistakes don’t mean disconnection.

Mental Health Strategies for Parents in Limbo

You may be parenting through visa interviews, court dates, time zone gaps, and missed milestones. It’s okay if it feels like too much. Parenting from afar often leads to self-blame, but guilt is not proof of failure—it’s proof of love.

Supportive strategies include:

• Therapy with immigration-informed clinicians
• Virtual peer support groups for separated parents
• Scheduled worry time and emotional boundaries (Borkovec et al., 1993)
• Self-compassion practices to combat internalized guilt (Neff & Germer, 2013)
  

How Therapy at Refresh Psychotherapy Can Help

If you’re a long-distance parent navigating the emotional toll of family separation, therapy at Refresh Psychotherapy offers a space to process your experience without judgment. Our therapists understand the unique mental health challenges that come with immigration delays, identity strain, and attachment disruption. We offer expert-level care for parents who are striving to maintain presence and connection from afar—helping you manage guilt, anxiety, and emotional fatigue while reclaiming a grounded sense of self. You’re not alone, and you don’t have to carry the weight of this alone.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Borkovec, T. D., Wilkinson, L., Folensbee, R., & Lerman, C. (1993). Stimulus control applications to the treatment of worry. Behavior Research and Therapy, 31(3), 263–267.

Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self‐compassion program. Journal of Clinical Psychology, 69(1), 28–44.

Suárez-Orozco, C., Bang, H. J., & Kim, H. Y. (2011). I felt like my heart was staying behind: Psychological implications of family separations & reunifications for immigrant youth. Journal of Adolescent Research, 26(2), 222–257.

In multicultural workplaces, language diversity is a strength. But for many professionals who speak English as an additional language, that diversity can come with a heavy emotional cost. If you’ve ever hesitated to speak up in a meeting, rehearsed simple sentences dozens of times, or felt your heart race just before saying your name aloud, you’re not alone. This experience is called accent anxiety, and it’s a widespread—but rarely discussed—mental health challenge for multilingual professionals.

Accent anxiety isn’t about your English proficiency. It’s about the fear of being judged, dismissed, or misunderstood because of how you sound. And it’s often rooted not just in interpersonal experience, but in internalized messages about competence, belonging, and authority.

This article explores the psychological impact of accent anxiety, why language-based shame is a form of trauma, and how to use CBT-informed tools to quiet your inner critic and reclaim your voice at work.

What Is Accent Anxiety?

Accent anxiety refers to the fear, shame, or self-doubt triggered by speaking in a non-dominant accent or dialect, particularly in professional or formal settings. It may include:

• Preoccupation with pronunciation or grammar mistakes
  
• Avoiding speaking roles in meetings or presentations
  
• Over-editing emails or scripts to sound more “native”
  
• Feeling like an imposter even with subject-matter expertise
  
• Shame or embarrassment after minor communication errors
  

These reactions are not simply about discomfort—they are manifestations of internalized linguistic bias, often reinforced by social cues, microaggressions, or subtle exclusion.

The Psychological Weight of Language-Based Shame

Psychologically, accent anxiety overlaps with phenomena like stereotype threat, imposter syndrome, and social anxiety. Research has found that language-based stigma and accent discrimination can lead to increased anxiety, lower self-esteem, and even depressive symptoms, particularly in environments where one’s accent becomes a marker of “otherness” (Gluszek & Dovidio, 2010).

What makes accent anxiety especially difficult is that it often triggers an internalized message: “I don’t sound right, therefore I don’t belong here.” Over time, these experiences shape identity and erode confidence, regardless of how capable or accomplished the individual may be.

For many people, their accent carries their history, culture, and personal story. When it’s met with condescension or correction, that rejection is deeply personal. And when these moments happen at work—where performance, status, and stability are at stake—they can feel especially threatening.

Why CBT Techniques Help

Cognitive Behavioral Therapy (CBT) is an evidence-based therapeutic approach that focuses on identifying and challenging unhelpful thought patterns. It’s particularly useful for accent anxiety because it targets the automatic thoughts and cognitive distortions that lead to emotional distress and self-sabotaging behavior.

CBT doesn’t aim to eliminate your accent—it helps you stop treating your voice as a problem. The goal is not to “perfect” your communication but to build self-trust, flexibility, and emotional safety when speaking authentically.

CBT Tools to Reduce Accent Anxiety at Work

1. Thought Monitoring: Name the Inner Critic
   The first step is noticing when self-critical thoughts arise. You might hear an internal voice say, “They won’t take me seriously,” “I’m going to mess this up,” or “I should let someone else talk.” Write down these thoughts and ask:
   

• Is this objectively true?
  
• What’s the evidence for and against this belief?
  
• What would I say to a friend in this situation?
  

This exercise helps create distance between you and your anxious thoughts. Thoughts are not facts—they’re habits of mind shaped by lived experience.

2. Cognitive Reframing: Challenge Distorted Thinking
   CBT teaches us to challenge cognitive distortions like catastrophizing (“If I say one wrong word, they’ll think I’m incompetent”) or mind-reading (“They’re judging me”). Replace these with more accurate alternatives:
   

• “Everyone has an accent. My expertise speaks louder than my pronunciation.”
  
• “If I stumble, it doesn’t mean I’m unqualified—it means I’m human.”
  
• “I’ve communicated successfully before; I can do it again.”
  

Reframing doesn’t mean lying to yourself—it means telling the whole truth, not just the anxious version.

3. Behavioral Experiments: Speak Anyway
   Avoidance reinforces anxiety. The more you stay silent, the more your brain associates speaking up with danger. CBT encourages small, planned behavioral experiments—like asking a question during a meeting or introducing yourself without rehearsing.
   

Afterward, reflect:

• What did I predict would happen?
  
• What actually happened?
  
• What does that tell me about my fear?
  

These exercises retrain the brain to see speaking as tolerable—even when imperfect.

4. Self-Compassion Scripts: Rewriting Internal Dialogue
   Many people with accent anxiety carry self-talk inherited from school, workplace discrimination, or family messages. Creating a new inner narrative is a crucial step. Try using phrases like:
   

• “My voice deserves space.”
  
• “I don’t need to sound like anyone else to be heard.”
  
• “Fluency is not the same as intelligence.”
  

Self-compassion is not indulgent—it’s a corrective for internalized harm.

Systemic Bias Isn’t Your Fault—But Healing Is Still Your Right

Accent anxiety doesn’t arise in a vacuum. Many workplaces reinforce linguistic bias by rewarding dominant norms and marginalizing others. You didn’t choose this system, and you didn’t create these fears. But you can choose to heal from them.

Affirming your voice, learning to speak with presence, and building emotional safety while navigating accent-based bias are mental health goals—not just professional ones.

Your Voice Is Enough

You may still worry sometimes. You may still overthink, freeze up, or replay conversations in your head. That’s okay. Healing is not about perfection—it’s about freedom. Freedom to speak, to share, and to be heard in the voice you actually have.You are not “less than” because of your accent. You are someone who navigates two or more linguistic worlds—and that’s a strength, not a flaw. You don’t have to lose your voice to find your place.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Gluszek, A., & Dovidio, J. F. (2010). The way they speak: A social psychological perspective on the stigma of non-native accents in communication. Personality and Social Psychology Review, 14(2), 214–237.

Tummala-Narra, P. (2021). Cultural identity, immigration, and mental health: Working with culturally diverse individuals and families. American Psychological Association.

Clark, D. A., & Beck, A. T. (2011). Cognitive Therapy of Anxiety Disorders: Science and Practice. The Guilford Press.

Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self‐compassion program. Journal of Clinical Psychology, 69(1), 28–44.

Before the rise of remote work, most adults went through their day without seeing their own face more than once or twice. But since the shift to video-based communication, it’s now routine to have multiple hours of daily exposure to your own image. For many, this repeated self-view has triggered something deeper than annoyance—it’s activated a full-blown obsession with appearance.

This experience is now so common that it’s earned a name: Zoom dysmorphia—a term coined during the pandemic to describe the uptick in cosmetic dissatisfaction and body image distortion caused by constant video conferencing. But this isn’t just about vanity or self-absorption. It’s about the way prolonged self-surveillance alters our relationship with identity, confidence, and mental health.

From a therapist’s perspective, appearance obsession born from constant on-screen reflection is a modern mental health concern rooted in body surveillance, perfectionism, and chronic self-monitoring. It disproportionately impacts people in client-facing roles, those with marginalized identities, and individuals who already carry a complicated relationship with their body or image. In this article, we’ll explore how this phenomenon develops, its impact on emotional well-being, and evidence-based strategies to reconnect with your sense of self—without needing to disappear from your screen or your life.

How We Got Here: The Age of Self-View

It’s worth remembering that evolution did not prepare us to constantly monitor ourselves in real time. Before the digital era, people primarily saw their reflections in mirrors—briefly, occasionally, and usually in private. The webcam changed that. Now, when you’re in a meeting, you’re not just paying attention to what’s being said. You’re also watching yourself nod, smile, squint, frown, or shift. You’re both performer and audience.

Over time, this dual role alters how we experience ourselves. What might begin as mild self-consciousness can turn into ongoing appearance anxiety—where you’re constantly evaluating whether you look tired, unprofessional, aging, bloated, or disheveled. For individuals with perfectionistic tendencies or high self-monitoring, this experience becomes emotionally exhausting and psychologically disruptive.

The Psychology of Seeing Yourself Too Often

Research shows that increased exposure to one’s own image is associated with heightened body dissatisfaction and negative self-evaluation (Ratan et al., 2021). The phenomenon of body surveillance—viewing oneself as if through the eyes of others—has long been studied in feminist psychology and body image research. It’s linked to reduced cognitive functioning, poor emotional regulation, and even increased risk for disordered eating and depressive symptoms (Grabe et al., 2007).

From a therapeutic standpoint, frequent self-view often reinforces maladaptive core beliefs such as:

• “My worth is based on how I look.”
• “People won’t take me seriously unless I appear polished.”
• “I’m only successful if I look a certain way.”
  

These beliefs aren’t just irrational—they’re culturally reinforced. Western society prizes aesthetic control and links personal discipline with appearance. The camera, then, becomes both mirror and microscope: a place where identity is constantly edited, compared, and critiqued.

Zoom Dysmorphia Is a Mental Health Issue

Zoom dysmorphia isn’t a vanity issue—it’s a visibility issue. When your job, social life, or education depends on being “camera-ready,” it creates internal pressure to manage not just your image but how you feel about your image.

A 2021 survey of cosmetic surgeons found a sharp rise in patients citing video calls as a motivation for seeking aesthetic procedures—especially among those who had never before expressed concern about their appearance (Rice et al., 2021). The same report noted that many patients didn’t recognize that their self-image was being distorted by angle, lighting, lens curvature, and screen fatigue.

As therapists, we often see this manifest in increased reports of:

• Perfectionism and productivity anxiety
• Body image dissatisfaction and preoccupation
• Heightened social anxiety and avoidance behaviors
• Intrusive self-critical thoughts
• Fatigue from maintaining a “work face” even at home
  

These symptoms don’t meet the clinical threshold for Body Dysmorphic Disorder (BDD) in every case—but they represent real emotional suffering that deserves attention and care.

Why Some People Are Affected More Than Others

People of all genders experience appearance pressure, but women, BIPOC professionals, trans and nonbinary individuals, and anyone who deviates from Eurocentric beauty norms are more vulnerable. For these individuals, the camera doesn’t just reflect a face—it reflects years of internalized scrutiny, cultural trauma, and invalidation.

In therapy, this often sounds like:

• “I feel like I have to look perfect to be taken seriously.”
• “I worry about looking too masculine/feminine/queer/ethnic/young/old.”
• “I hate seeing my face because it reminds me of how I was bullied.”
• “I obsess over how much I’ve aged since switching to remote work.”
  

These aren’t superficial concerns. They speak to the intersection of identity, safety, and survival. When your livelihood depends on being palatable to others—especially through a screen—your brain adapts by monitoring your image more intensely. This is not vanity. This is vigilance.

Therapeutic Strategies to Address Appearance Obsession

As therapists, we don’t treat the camera—we treat the emotional relationship people have with it. Here are several clinical strategies clients find helpful when managing camera-triggered appearance anxiety:

1. Turn Off Self-View—Routinely
Platforms like Zoom now allow users to hide their own image while remaining visible to others. Using this function isn’t avoidance—it’s regulation. Reducing constant self-view can immediately decrease body surveillance and improve focus and presence.

2. Use CBT Techniques to Challenge the Inner Critic
Identify and reframe distorted thoughts like “I look unprofessional,” “Everyone is staring at my acne,” or “No one will take me seriously if I look tired.” Ask: What’s the evidence for this? What would I say to a friend who felt this way? Over time, this loosens the hold of shame-based beliefs (Beck, 2011).

3. Implement Rituals That De-Center Appearance
Start and end calls with grounding activities that bring attention back to sensation or intention—e.g., stretching, breathing, listing what you value about the meeting beyond how you appear.

4. Set Boundaries Around Video Use
Not every meeting requires a face. Offer phone calls when possible, and normalize “camera off” days in teams or social groups. Reducing the frequency of on-camera exposure reduces chronic overactivation of appearance monitoring systems.

5. Explore Emotionally-Rooted Associations with Appearance
In psychodynamic or integrative therapy, clients often uncover early experiences (bullying, criticism, family modeling) that shaped their beliefs about appearance. Processing these associations helps break the emotional link between image and identity.

6. Reconnect With the Body from the Inside Out
Somatic interventions—such as grounding, mindful movement, or breathwork—can help retrain the nervous system to experience the body as a resource, not just an object. This is especially effective for clients with trauma histories.

7. Redefine “Professionalism” and Self-Worth
Therapy can help clients dismantle internalized capitalism and ableism—beliefs that link productivity, polish, or attractiveness with moral or social value. Redefining success around authenticity, presence, and contribution is liberating and protective.

How Therapy at Refresh Psychotherapy Can Help

At Refresh Psychotherapy, we recognize that modern life brings new challenges—and constant self-view is one of them. If you’ve noticed increasing anxiety, self-criticism, or emotional exhaustion from seeing yourself on screen, you’re not alone. Our therapists specialize in helping adults untangle performance pressure, body image issues, and self-worth from external metrics. Through collaborative, evidence-based care, we’ll support you in reclaiming your time, your energy, and your sense of self—from the inside out.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). The Guilford Press.

Grabe, S., Ward, L. M., & Hyde, J. S. (2007). The Role of the Media in Body Image Concerns Among Women: A Meta-Analysis of Experimental and Correlational Studies. Psychological Bulletin, 134(3), 460–476.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. W. W. Norton & Company.

Ratan, R. A., Beyea, D., & Li, B. J. (2021). Zooming in on Zoom Dysmorphia: Exploring the Impact of Prolonged Self-Viewing on Body Image. Psychology of Popular Media. https://doi.org/10.1037/ppm0000380

Rice, S. M., Siegel, J. A., Libby, T. A., et al. (2021). Zooming into Cosmetic Procedures During the COVID-19 Pandemic: The Provider’s Perspective. Facial Plastic Surgery & Aesthetic Medicine, 23(3), 161–167.

If you’ve ever wondered, “Is this therapy even working?” you’re not alone. One of the most common questions clients ask—sometimes after a few sessions, sometimes after years—is whether they’re actually healing or just spinning their wheels. Therapy isn’t a quick fix, and it rarely feels like one. There are no instant results or universal milestones. But healing does happen—quietly, cumulatively, and often in ways you may not notice at first.

As a psychotherapist, I’ve seen firsthand how clients mistake discomfort for failure and expect transformation to look dramatic. In reality, healing is often marked by subtle shifts: you pause before reacting, you name your emotions more clearly, or you set a boundary you would’ve avoided last year. These are not small things. These are signs that the work is taking root.

In this article, we’ll explore what emotional healing really looks like, why it often feels confusing or incomplete, and how to know whether your therapy is actually working.

Why Healing Doesn’t Always Feel Like Healing

Most people associate healing with feeling better. But in therapy, healing can involve confronting the very things you’ve spent your whole life trying not to feel—grief, shame, anger, or fear. In fact, the early stages of effective therapy may feel worse than before you started.

This is because therapy dismantles your emotional autopilot. You begin to notice old patterns, unconscious beliefs, and unresolved pain that have been quietly running your life. That awareness is disorienting at first. But it’s also necessary.

The psychodynamic model refers to this process as “working through” (McWilliams, 2011). This means revisiting emotional themes repeatedly in order to metabolize them more fully over time. It’s not linear. It’s not comfortable. But it is how change happens.

The Myth of the Therapy Glow-Up

There’s a popular misconception—fueled by social media and self-help culture—that healing should look like a radical transformation. People imagine leaving therapy with perfect boundaries, crystal-clear self-worth, and zero anxiety. But real progress is often messier. You may still cry in your car. You may still second-guess yourself. You may even feel like you’re “backsliding.” But what’s changed is your awareness, your self-talk, and your recovery time.

Healing doesn’t mean becoming a different person. It means becoming more fully yourself, with more insight, more choice, and more capacity to hold discomfort without collapsing.

Common Signs You’re Actually Healing

Here are the signs therapists often look for to determine whether a client is truly progressing in therapy:

1. You react more slowly and recover more quickly.
You still feel triggered—but you catch it sooner. Maybe you pause before sending the angry text, or you notice the spiral and step out of it. This shows improved emotional regulation and nervous system flexibility (Porges, 2011).

2. You tolerate emotional discomfort instead of avoiding it.
Instead of numbing out, blaming others, or avoiding hard conversations, you sit with difficult feelings. You don’t like them, but you no longer feel controlled by them.

3. You recognize your patterns—in real time.
You begin to say things like, “This reminds me of how I felt as a kid,” or “This is the part of me that always tries to keep the peace.” Recognizing these patterns as they happen is a huge step toward interrupting them.

4. You feel less stuck in black-and-white thinking.
You can hold two truths at once: “I’m hurt, and I know they didn’t mean it.” Or, “This feels unfair, and I still have to deal with it.” Emotional nuance is a key indicator of healing.

5. You start to update your internal narrative.
You stop seeing yourself as broken or difficult and begin to understand your behaviors as adaptations. You shift from “What’s wrong with me?” to “What happened to me, and what can I do with that now?”

6. You’re more curious than reactive.
Instead of jumping into defensive mode, you begin to ask questions—of yourself and others. You want to understand, not just escape or win.

7. You begin to set boundaries—without needing to justify them.
Saying “no” becomes less loaded. You stop over-explaining or apologizing for taking care of your own needs.

8. You no longer rely on your therapist to “fix” you.
You show up as an equal in the room, bringing questions, insights, and challenges. You begin to trust your own internal compass.

9. You notice changes in your body.
Your sleep improves. Your breath is deeper. You feel less tension in your shoulders. Healing often shows up somatically, as the nervous system recalibrates to safety.

10. You bring hard things into the room—and stay.
You don’t ghost when things get tough. You name ruptures. You share anger or disappointment. This means you’re learning to repair, not just retreat.

Why Healing Can Feel Boring, Frustrating, or Pointless

If therapy doesn’t always feel “good,” what does it feel like? Sometimes: boring. Or repetitive. Or like you’re just talking in circles. This is not unusual—and often, it’s a sign that deeper integration is underway.

Clients often expect big breakthroughs each session. But healing doesn’t require constant insight. It requires repetition, consistency, and safety. Like physical therapy, change happens through ongoing relational work, not just intellectual “aha” moments.

Also, many clients don’t recognize progress because they’ve been conditioned to associate emotional growth with productivity or visible results. But mental health doesn’t always yield measurable outcomes. It often shows up as:

• Fewer panic attacks
• More neutral days
• Less emotional whiplash
• Clearer self-talk
• More present relationships
  

How the Therapeutic Relationship Reflects Healing

One of the most underappreciated signs of healing is a shift in how you relate to your therapist. Early on, many clients idealize the therapist or fear disappointing them. Over time, a more complex relationship forms—one where rupture and repair become possible.

If you’re willing to say things like:

• “I didn’t feel heard last session.”
• “I’m scared to tell you this.”
• “I’m angry at something you said.”

That means you’re practicing new relational patterns in a secure space. This isn’t a detour from the work—it is the work.

Research consistently shows that the therapeutic alliance is one of the most important predictors of positive outcomes (Wampold, 2015). A good therapist will not only tolerate your full emotional range—they’ll help you hold it with less fear and more agency.

When You’re Not Sure You’re Healing

Not feeling like you’re healing doesn’t necessarily mean you’re not. But it can be a cue to check in with yourself and your therapist.

You might ask:

• Are we revisiting the same issues without new insight?
• Have I stopped challenging myself in session?
• Do I feel emotionally safe—but also emotionally stagnant?
• Have I shared my uncertainty with my therapist?
  

A strong therapist won’t be defensive. They’ll explore your questions with you—and be open to adjusting the work, referring you elsewhere, or naming resistance if it’s present.

Therapy Is Working If You…

• Understand yourself more deeply
• React less destructively
• Communicate more clearly
• Stay connected during hard emotions
• Make choices that reflect your values
• See yourself as worthy of care—not just survival
  

Even if no one else notices. Even if you don’t always believe it. These are signs that something is shifting.

How Therapy at Refresh Psychotherapy Can Help

At Refresh Psychotherapy, we work with people who are tired of surface-level support. Our therapists are trained to spot subtle signs of growth and to help you build a toolkit that reflects your goals—not just your symptoms. Whether you’re in the middle of deep emotional work or just starting to untangle your history, we’ll help you track the real shifts—so you can stop wondering if you’re healing and start seeing the evidence for yourself.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Etkin, A., Büchel, C., & Gross, J. J. (2015). The neural bases of emotion regulation. Nature Reviews Neuroscience, 16(11), 693–700.

McWilliams, N. (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (2nd ed.). The Guilford Press.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. W. W. Norton & Company.

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277.

Most people wouldn’t list “height” as a leadership skill—but in the workplace, how tall or short you are can impact how you’re perceived, treated, and promoted. From meetings to interviews to everyday interactions, unconscious height bias subtly shapes who gets seen as competent, who commands attention, and who’s expected to lead. And this bias affects both ends of the spectrum—people who are considered “too short” and people who are seen as “too tall.”

While height is rarely acknowledged as a workplace barrier, the mental health toll it takes is real. Whether you’re constantly underestimated or always expected to dominate the room, being outside the “average” height range can affect self-concept, professional confidence, and even identity development. This article explores how height bias shows up at work, how it impacts people on both ends of the height spectrum, and what practical steps—including communication scripts, posture techniques, and therapy—can help you reclaim your authority and peace of mind.

Heightism Isn’t Just About Shortness

Most conversations about height discrimination focus on people who are shorter than average, and for good reason: research shows that taller people, particularly men, are more likely to be hired, promoted, and paid more (Judge & Cable, 2004). One study found that each additional inch in height correlated with roughly $800 more in annual income (Persico et al., 2004). Tallness is culturally coded as powerful, assertive, and competent.

But extreme tallness can also carry a burden—especially for women and nonbinary professionals, who may be perceived as “intimidating,” “masculine,” or “unfeminine” in traditional workplace cultures. Taller individuals may be told to “tone it down,” be softer, or “stop towering over people.” They may receive unwanted comments about their bodies, or be tasked with taking charge simply because of their physical presence.

Both experiences—being perceived as too small to lead or too big to be approachable—are rooted in unconscious bias. And both can have lasting impacts on how individuals show up at work.

The Emotional Cost of Height Bias

Height bias is often invisible until it accumulates. Over time, these messages—“You’re so cute,” “You’re so intimidating,” “Stand in the back,” “Let the tall guy handle it,”—start to shape a person’s internal narrative.

Shorter professionals may:

• Feel infantilized or overlooked
• Be interrupted more often
• Be talked over or not taken seriously
• Avoid assertive speech due to internalized beliefs about status
  

Taller professionals may:

• Be expected to automatically lead, even if they’re not in charge
• Receive comments about their appearance instead of their ideas
• Be perceived as aggressive or overbearing
• Shrink themselves to appear less threatening
  

These dynamics are rarely discussed, yet they can lead to chronic anxiety, self-monitoring, and emotional burnout.

Posture Hacks That Help You Take Up Space—or Soften It

Nonverbal communication plays a huge role in workplace dynamics. Posture, gesture, and spatial awareness can help reshape the way others perceive your presence—and how you perceive yourself.

For shorter professionals:

• Elevated posture: Keep shoulders open, spine long, and chin parallel to the floor. Use open gestures rather than keeping hands folded or hidden.
• Eye-level adjustments: Use seat cushions or adjust your chair height in meetings to bring your eyes to the same level as others.
• Movement anchors: When speaking, use confident hand gestures and pause occasionally to let your words land.
  

For taller professionals:

• Grounded posture: Keep both feet on the floor and soften your shoulders. Avoid looming or leaning directly over others.
• Center alignment: Stand or sit with centered, symmetrical posture to project calm presence rather than dominance.
• Boundary awareness: Use subtle shifts in distance to reduce intimidation if people seem uncomfortable.
  

Scripts to Interrupt Bias Without Creating Conflict

Because height bias is often subtle, direct confrontation may not always feel safe or effective. Instead, you can reframe the moment with language that redirects attention to your competence and role.

When you’re underestimated:

• “Actually, I’ve led similar projects before—here’s how I’d approach this one.”
• “I know I don’t take up a lot of space physically, but I’m very clear on my strategy here.”
  

When you’re perceived as aggressive:

• “I know my presence can be intense—please let me know if my tone ever feels off.”
• “I have a lot of energy around this topic, and I’d love to channel it collaboratively.”
  

When facing body-based comments:

• “I’d love to focus on the ideas—we’ve got important ground to cover.”
• “My height’s not on the agenda, but this analysis is.”
  

These responses allow you to hold authority without creating unnecessary defensiveness.

Internal Scripts for Reclaiming Self-Perception

Cognitive restructuring techniques from CBT (Cognitive Behavioral Therapy) can help challenge distorted beliefs reinforced by social feedback. Here are some reframes to practice:

• Thought: “I don’t look like a leader.”
  Reframe: “Leadership is about clarity, not appearance.”
  
• Thought: “They’re only listening because I’m tall.”
  Reframe: “My ideas matter. My body isn’t the only reason I’m being heard.”
  
• Thought: “They’ll never respect me—I look too young.”
  Reframe: “Respect comes from how I lead, not how tall I am.”
  

Over time, reframing helps neutralize the shame and self-doubt that height-based bias can create.

How Height Bias Intersects with Gender and Culture

Gender norms shape how height is perceived. Tall women are often expected to shrink themselves, while short men are often pressured to compensate through aggression or overachievement. Nonbinary individuals may struggle with conflicting gendered expectations about presence and demeanor.

Cultural context also matters. In some cultures, physical presence is strongly tied to perceived authority; in others, deference and humility are more valued. Height bias often intersects with race, accent, or weight—making it harder to isolate.

This is why therapy can be so useful: it allows space to untangle internalized messages that stem from multiple layers of bias.

How Therapy at Refresh Psychotherapy Can Help

At Refresh Psychotherapy, we understand that height bias isn’t superficial—it’s a workplace barrier that affects confidence, performance, and identity. Our therapists work with high-achieving professionals who’ve internalized feedback about being “too much” or “not enough” based on their appearance. Whether you’re navigating leadership expectations, cultural stereotypes, or persistent self-doubt, our clinicians can help you develop new internal narratives, assertive communication skills, and a healthier relationship with your body and role. You don’t have to carry this quietly. Book your appointment today: refreshtherapynyc.clientsecure.me

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Carney, D. R., Cuddy, A. J. C., & Yap, A. J. (2010). Power posing: Brief nonverbal displays affect neuroendocrine levels and risk tolerance. Psychological Science, 21(10), 1363–1368.

Judge, T. A., & Cable, D. M. (2004). The effect of physical height on workplace success and income: Preliminary test of a theoretical model. Journal of Applied Psychology, 89(3), 428–441.

Persico, N., Postlewaite, A., & Silverman, D. (2004). The effect of adolescent experience on labor market outcomes: The case of height. Journal of Political Economy, 112(5), 1019–1053.

It’s hard to build a future when your entire life is paused. For those trapped in visa backlogs and endless immigration processing delays, daily existence often feels like waiting for permission to start living. You may be trying to advance your career, support your loved ones, or simply plan your next year—but instead, you’re held in limbo by a system that offers no timeline, no clarity, and no control.

From a mental health perspective, this kind of uncertainty is profoundly destabilizing. When the mind can’t predict what’s next, it tends to over-anticipate every possible scenario, triggering hypervigilance, hopelessness, and intrusive anxiety. This phenomenon is what we call visa-freeze anxiety—a form of chronic emotional stress experienced by people stuck in prolonged immigration queues.

This article explores how visa delays impact mental health and offers concrete, research-based grounding tools to support emotional regulation and agency.

The Psychological Toll of Living in Limbo

Immigration-related uncertainty is a known psychological stressor. Studies show that prolonged delays in legal status processing are associated with increased symptoms of anxiety, depression, insomnia, and trauma-related stress, particularly in individuals who feel trapped between worlds or unable to plan for the future (Li et al., 2020; Bhugra, 2005).

These long-term delays can chip away at your ability to stay grounded in your identity, your goals, or your relationships. There may be shame in not having “answers,” fear of losing hard-earned opportunities, or exhaustion from constantly checking for updates that never come.

Common mental health symptoms of visa-freeze anxiety include:

• Racing thoughts about “what if” outcomes
• Difficulty sleeping due to uncertainty and hyperarousal
• Social withdrawal from feelings of shame or isolation
• Impaired focus or motivation at work or in relationships
• A sense of identity erosion from being unable to make progress
  

This is not a lack of resilience—it’s a natural psychological response to prolonged, high-stakes uncertainty with no clear resolution.

Why Grounding Tools Matter

When you’re caught in chronic uncertainty, the brain’s threat system is constantly activated. Grounding techniques help regulate this physiological stress response by bringing your attention out of the future—and back into the here and now.

Grounding doesn’t mean pretending the situation isn’t hard. It means offering your nervous system relief from relentless anticipation. The goal is not to “fix” the problem but to reclaim pockets of control that help you live with more peace and agency while the system takes its course.

Evidence-Based Grounding Tools for Visa-Freeze Anxiety

1. Time-Limiting Your Worry Window
   Research shows that scheduled worry periods can reduce generalized anxiety (Borkovec et al., 1993). Set a timer and allow yourself 15 minutes a day to think about your visa case—journal, research, or vent during this time. Outside of that window, gently redirect your focus.
   
   
2. Daily Somatic Anchors
   When anxiety is future-focused, somatic anchors pull you back into the body. Try placing a hand on your chest and one on your stomach while practicing slow breathing (inhale 4 counts, exhale 6 counts) for five minutes. This calms the vagus nerve and activates the parasympathetic system (Porges, 2011).
   
   
3. Naming What’s Out of Your Control—Then What Isn’t
   Using a method from Acceptance and Commitment Therapy (ACT), try writing down two columns: one labeled “Out of My Control,” the other “Within My Control.” Visa processing is out. But your daily routines, boundaries, relationships, and self-care are within. This helps shift your energy toward action.
   
   
4. Micro-Routines for Structure
   When life feels suspended, even small routines—morning stretches, daily walks, or a weekly check-in call—can restore a sense of movement and agency. Research suggests that predictable routines buffer against anxiety and depression during periods of uncertainty (Hobfoll, 2001).
   
   
5. Connection with People Who Get It
   Visa-freeze anxiety often feels invisible to others. Joining online forums or support groups with people in similar situations provides emotional validation. Connection is a protective factor, especially when isolation or shame creep in.
   
   
6. Therapy That Validates Limbo
   Therapists familiar with immigration stress and identity issues can help process the grief and helplessness that arise from extended limbo. Therapy can also support the rebuilding of meaning, confidence, and self-worth during a time when external progress feels impossible.
   

What You’re Experiencing Is Real

Living in legal limbo can undermine your sense of identity, autonomy, and control. People experiencing visa delays often report a sense of “disappearing”—not being seen by the systems around them and not being able to fully show up in their own lives. This invisible struggle can make even basic tasks feel burdensome.

It’s important to know: this experience is real. And you’re not overreacting. A nervous system stuck in a prolonged fight-or-flight state is working overtime, which explains the fatigue, the fog, and the frustration.

Recognizing that your worth is not contingent on progress or productivity is a major emotional shift. You are still worthy, even when your life is paused. You are still you, even if the system hasn’t moved.

You Don’t Need to Wait to Take Care of Your Mind

You may not be able to move forward in the ways you hoped. But you can still reclaim your mental space. You can still build emotional capacity. You can still show up for your relationships, your values, and your well-being.

Visa-freeze anxiety is real. But so is your resilience. Not in the sense of muscling through—but in the quiet strength of grounding, naming your needs, and refusing to disappear while you wait.

You don’t have to put your life on hold to protect your mental health.

Book your appointment today.

Works Cited
Bhugra, D. (2005). Migration and mental health. Acta Psychiatrica Scandinavica, 109(4), 243–258.

Borkovec, T. D., Wilkinson, L., Folensbee, R., & Lerman, C. (1993). Stimulus control applications to the treatment of worry. Behavior Research and Therapy, 31(3), 263–267.

Hobfoll, S. E. (2001). The influence of culture, community, and the nested-self in the stress process: Advancing conservation of resources theory. Applied Psychology, 50(3), 337–421.

Li, S. S. Y., Liddell, B. J., & Nickerson, A. (2020). The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Transcultural Psychiatry, 53(5), 524–545.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W. W. Norton.

If you’ve ever found yourself overwhelmed by worry or stuck in anxious thoughts, you might have wondered whether you’re dealing with Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), or something else entirely. Both GAD and OCD involve anxiety, intrusive thinking, and emotional distress. On the surface, they can look alike. But they’re not the same—and understanding the difference is essential for finding the right path to treatment.

GAD often looks like excessive worry about everyday life. OCD, on the other hand, involves distressing, irrational thoughts that often lead to compulsions—mental or behavioral acts performed to relieve the anxiety. Both conditions are treatable, but the tools that work for one don’t always work for the other. This article breaks down the core differences between OCD and GAD so you can better understand your experience or support someone else in theirs.

What Is GAD? What Is OCD?

Generalized Anxiety Disorder is characterized by persistent and excessive worry across many areas of life—finances, health, relationships, work, safety, and more. These worries are difficult to control and are often accompanied by physical symptoms such as fatigue, muscle tension, and trouble sleeping (American Psychiatric Association, 2013). People with GAD often describe a sense that their brain won’t “turn off,” and they may feel that worry is a part of who they are.

Obsessive-Compulsive Disorder involves two main parts: obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that cause anxiety. Compulsions are behaviors or mental rituals done to try to make the anxiety go away or prevent something bad from happening. These can include checking, counting, avoiding, confessing, or repeating thoughts silently. The thoughts in OCD are usually irrational or upsetting and may have nothing to do with real-life problems (Abramowitz & Jacoby, 2015).

The Nature of Thoughts: Worry vs. Obsession

One key difference between GAD and OCD is the kind of thoughts that show up. In GAD, people tend to worry about real-life problems. The worries may be excessive or hard to control, but they usually relate to things that could actually happen, like losing a job or getting sick (Dugas et al., 1998).

In OCD, the thoughts often don’t make sense, feel disturbing, or seem completely out of character. For example, someone might have a thought like “What if I hit someone with my car and didn’t notice?” or “What if I accidentally poisoned my partner’s food?” These are not typical worries—they are intrusive thoughts that feel stuck in the brain and cause distress, even though the person doesn’t believe them or want them (Clark, 2004).

The Role of Compulsions

Another major difference is how people respond to their anxiety. In OCD, people often develop specific rituals or behaviors—called compulsions—to deal with the distress caused by their thoughts. These compulsions can be visible (like handwashing or checking the stove) or invisible (like repeating phrases in their head or mentally reviewing past events). The compulsions may temporarily reduce anxiety, but they actually reinforce the obsessive thought and make the cycle worse over time (Rachman, 2002).

In GAD, there are no true compulsions. People may try to feel better by over-preparing, avoiding triggers, or asking for reassurance, but these behaviors are more general and don’t follow a rigid pattern. GAD tends to involve a constant, low-grade sense of worry, not a repetitive cycle of intrusive thoughts followed by rituals.

Emotional Tone and Insight

In GAD, people often feel like their worries are reasonable, even if they recognize that the level of worry is excessive. The thoughts may feel helpful, familiar, or necessary. Someone might say, “I worry because I care,” or “If I didn’t worry, I’d miss something important.”

In OCD, the thoughts often feel foreign and deeply upsetting. People may think, “Why would I have a thought like this? What’s wrong with me?” These thoughts are usually unwanted and don’t match how the person sees themselves. That’s why OCD often leads to shame, guilt, or fear about what the thoughts mean. Even though people with OCD usually know their thoughts aren’t true, the fear that they might be creates intense anxiety (Abramowitz & Jacoby, 2015).

Overlap and Misdiagnosis

Because both conditions involve anxiety, they are sometimes confused—even by clinicians. Someone with OCD may be misdiagnosed with GAD if they don’t mention their compulsions or are too ashamed to describe their intrusive thoughts. This is especially common when the thoughts involve taboo subjects like sex, violence, or religion (Storch et al., 2008).

On the other hand, someone with GAD might be assumed to have OCD if their worry is intense or very repetitive, even though they don’t have true obsessions or compulsions. The result is that people may receive the wrong kind of therapy, which can delay progress or make symptoms worse.

Treatment Considerations

The treatment for GAD and OCD overlaps in some areas, but key differences matter. GAD often responds well to general Cognitive Behavioral Therapy (CBT), which helps people identify and challenge distorted thinking, along with relaxation techniques, mindfulness, and sometimes medication like SSRIs (Stein & Sareen, 2015).

OCD, however, requires a more specialized approach. The most effective treatment is Exposure and Response Prevention (ERP), a specific form of CBT that helps people face their fears without doing compulsions. ERP works by teaching the brain that the feared outcome won’t happen—or doesn’t need to be prevented. General talk therapy, reassurance, or relaxation exercises may actually worsen OCD if they reinforce avoidance or compulsive behavior (Foa et al., 2005).

If you’ve been struggling with anxiety, unwanted thoughts, or repetitive behaviors, it’s important to get clear on what kind of anxiety you’re experiencing. OCD and GAD are both treatable—but they need different tools. An accurate diagnosis can make all the difference in choosing the right path forward.

You’re not overreacting, broken, or weak. These are real conditions with real solutions. If something about your anxiety doesn’t quite fit the label you were given, you’re not alone—and it’s worth asking deeper questions.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Abramowitz, J. S., & Jacoby, R. J. (2015). Obsessive-compulsive disorder in adults. In R. L. Leahy, S. L. Holland, & L. McGinn (Eds.), Treatment plans and interventions for depression and anxiety disorders (2nd ed., pp. 269–321). Guilford Press.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 147–172). Guilford Press.

Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226.Foa, E. B., Yadin, E., & Lichner, T. K. (2005). Exposure and response prevention for obsessive-compulsive disorder: Therapist guide. Oxford University Press.

Rachman, S. (2002). A cognitive theory of compulsive checking. Behaviour Research and Therapy, 40(6), 625–639.

Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059–2068.

Storch, E. A., Abramowitz, J. S., & Keeley, M. (2008). The effect of co-occurring anxiety disorders on treatment response in pediatric obsessive-compulsive disorder. Depression and Anxiety, 25(6), 547–553.

Dating apps promise connection at your fingertips, but for many users, the experience delivers something very different: disappointment, burnout, and a quiet erosion of hope. It’s not that dating apps don’t “work”—they do for some—but they were not built to prioritize emotional compatibility, self-worth, or long-term wellbeing.

To use dating apps without losing yourself, you need more than a profile and a few good photos. You need a strategy that centers your mental health, boundaries, and emotional energy. This article outlines how to approach dating apps with realistic, sustainable expectations—so you can date without spiraling, compare without collapsing, and swipe without self-loathing.

The Illusion of Limitless Options
Dating apps are designed to simulate abundance—unlimited profiles, constant matches, and the illusion of endless romantic opportunity. But psychologically, this triggers a phenomenon known as the “paradox of choice,” in which having too many options leads to more dissatisfaction and less follow-through (Iyengar & Lepper, 2000).

In reality, most users only engage with a small percentage of matches. The rest become background noise, fostering comparison fatigue and emotional disconnection.

People also tend to forget that swiping is not dating. It’s browsing. And browsing doesn’t always lead to intimacy. Without grounded expectations, many users mistake attention for connection—and then feel confused when conversations fizzle or never move offline.

Rejection on Repeat: The Emotional Cost of Swiping
Dating apps increase exposure to rejection, often in rapid succession. You may never know why someone unmatched or ignored you. Over time, this creates a low-level but persistent sense of being unwanted, even if you’re matching regularly.

Studies have shown that frequent dating app use is associated with lower self-esteem, increased anxiety, and higher levels of body image dissatisfaction, particularly when users tie their sense of worth to responses received through the app (Strubel & Petrie, 2017).

To protect your emotional energy, treat dating apps as a tool, not a mirror. They are not designed to reflect your value or readiness for love. They’re algorithms—not oracles.

Swipe Fatigue and Burnout
Dating app fatigue is real. Many users report feeling emotionally depleted, cynical, or numb after weeks or months of swiping. This is particularly true for those looking for long-term relationships, who may feel they’re engaging in endless small talk with no payoff.

App-based dating can also trigger performance anxiety, especially when users feel pressure to “sell themselves” in a way that’s clever, attractive, or nonchalant—all at once.

Without clear internal boundaries, dating apps can shift from exciting to exhausting. You begin to log in out of boredom, loneliness, or self-doubt, not with genuine relational intent. And that’s when burnout sets in.

Setting Emotionally Sustainable Expectations
Approaching dating apps sustainably requires a shift in mindset. You are not auditioning for approval. You are screening for compatibility.
To keep your experience emotionally grounded:

• Limit time spent swiping. Try 10–15 minutes a day, not hours.
• Don’t expect chemistry from text. Text-based banter rarely predicts real-life connection.
• Set a timeline. If chatting doesn’t lead to a date within 7–10 days, it’s okay to move on.
• Let go of “the one.” Focus on finding someone curious, respectful, and interested in knowing the real you—not just a fantasy match.

Boundaries Are Not Optional
The fastest way to lose yourself in dating apps is to forget your own boundaries. Whether you’re dating casually or seeking a relationship, you need guardrails that protect your time, energy, and sense of self.

Ask yourself:

• What am I available for emotionally and practically?
• How many conversations can I manage at once without feeling overwhelmed?
• What is my plan if I start to feel depleted or discouraged?

Establishing exit strategies (e.g., breaks from the app, accountability check-ins with friends, or journaling your experiences) can help you stay attuned to your own needs.

What Success Actually Looks Like
Success on a dating app doesn’t always mean finding a partner. It can also mean:

• Gaining insight into your preferences and values
• Practicing communication and boundary-setting
• Learning to tolerate rejection without collapsing
• Reaffirming your worth, even when someone else doesn’t see it

By broadening your definition of success, you reduce the pressure to “win” and increase your capacity to show up as yourself—without the emotional whiplash of constant judgment.

Offline Integration: Where Real Connection Lives
It’s important to remember that the app is not the relationship. Sustainable dating means transitioning off the app and into real-world interactions.

Don’t linger in endless texting. Initiate or suggest a phone call. Make low-pressure plans. Pay attention to how you feel before, during, and after—not just whether the date “went well.”

And most importantly, don’t treat matches like scarce resources. If it’s not a fit, trust your gut and move on. Dating is about discernment, not perfection.

Conclusion: Swiping With Sanity
Dating apps are not inherently bad. But they are emotionally loaded, algorithm-driven environments that reward superficiality and fuel insecurity if you’re not careful.

You can use them—but don’t let them use you. Stay grounded in your values. Date with boundaries. Take breaks when needed.

Real connection doesn’t require perfect banter or a polished profile. It requires presence, patience, and the emotional endurance to stay soft—even when the apps make you want to shut down.

Swipe thoughtfully. Love is still possible. But your well-being comes first.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Iyengar, S. S., & Lepper, M. R. (2000). When choice is demotivating: Can one desire too much of a good thing? Journal of Personality and Social Psychology, 79(6), 995–1006.

Strubel, J., & Petrie, T. A. (2017). Love me Tinder: Body image and psychosocial functioning among men and women. Body Image, 21, 34–38.

Modern dating is supposed to make connection easier. But for many men, the current dating landscape—dominated by apps, inconsistent communication, and shifting social norms—is a minefield of anxiety, confusion, and rejection.

What was once a series of face-to-face interactions is now a gamified, algorithm-driven process that can leave men feeling more disposable than desired. Add in changing expectations around gender roles, consent, emotional literacy, and vulnerability, and many men find themselves navigating terrain for which they were never emotionally prepared.

While conversations about dating stress often center women’s safety and emotional labor—important issues in their own right—there’s another side of the story that gets little attention: how dating in the modern era affects men’s mental health. From rising loneliness to identity confusion, the effects are real, and they’re growing.

Dating Apps and the Illusion of Infinite Options
Dating apps have become the default platform for romantic connection. While they offer convenience, they also promote comparison, superficiality, and performance-based self-worth. Research shows that men receive fewer matches and responses on dating apps compared to women, contributing to feelings of inadequacy and low self-esteem (Timmermans & De Caluwé, 2017).

For men, especially those who are neurodivergent, socially anxious, or introverted, apps can create a sense of constant evaluation and rejection. You are swiped left on—not for your values or integrity—but often for arbitrary reasons like height, photos, or word choice.

This repeated micro-rejection can lead to what psychologists call “rejection sensitivity,” a heightened emotional reactivity to perceived rejection that has been linked to depression and social withdrawal (London et al., 2007).

The Pressure to Perform Masculinity
Despite progress in gender equality, many men still feel an unspoken expectation to initiate, lead, and perform confidence in dating—regardless of their actual emotional state. This performance of masculinity can create a significant gap between how men feel internally and how they are supposed to behave externally.

In fact, studies show that men who endorse traditional masculine norms (e.g., emotional control, dominance, risk-taking) report higher rates of psychological distress in romantic relationships (Wong et al., 2017). They’re also less likely to seek help, communicate vulnerability, or admit to confusion or fear in dating.

The result? A paradox in which men are expected to be emotionally intelligent and respectful partners, but still punished—by peers or themselves—for showing emotional need or softness.

Ghosting, Breadcrumbing, and Emotional Burnout
One of the most mentally destabilizing aspects of modern dating is ambiguity. Where relationships once followed a relatively clear set of steps, today’s dating scene is marked by blurred boundaries and inconsistent commitment.

Ghosting—cutting off all contact with no explanation—is now a common experience. So is breadcrumbing (sending intermittent flirty messages with no intent to follow through) and “situationships” (non-committal, undefined connections).

For men seeking meaningful connection, this can lead to emotional burnout. One study found that people who are ghosted experience feelings of worthlessness, confusion, and intrusive thoughts, all of which can worsen anxiety and self-doubt (LeFebvre et al., 2019).

In a context where everyone is supposed to be cool, casual, and unbothered, there’s little room for authentic expression of emotional pain.

Loneliness, Disconnection, and Erosion of Self-Worth
Men are already experiencing a loneliness epidemic. A 2021 report from the Survey Center on American Life found that the percentage of men with no close friends has increased fivefold since 1990 (Cox et al., 2021). When dating becomes another arena of rejection and disconnection, it deepens this emotional void.

For some men, repeated dating failures can trigger a collapse in self-worth, leading to withdrawal from relationships altogether. Others may internalize blame, believing they are “not enough” or unlovable. This cycle of effort → rejection → self-doubt → retreat is especially common in men with a history of social trauma or attachment insecurity.

The Rise of Dating-Related Depression and Anger
While some men respond to dating fatigue with withdrawal, others cope through anger or entitlement, particularly if they’ve been influenced by toxic online spaces like the “manosphere” or incel forums.

These subcultures weaponize dating disappointment into misogyny—but underneath that is often unacknowledged pain, shame, and emotional neglect. The danger is that without constructive spaces to process dating-related grief, many men turn inward (depression) or outward (hostility).

Clinical psychologists are seeing more men report dating-related depression, marked by hopelessness, rumination, low motivation, and social anxiety. In therapy, these men often express confusion: “I’m doing everything right—why am I still alone?”

What Actually Helps: Building Emotional Skills for a Modern Landscape
The mental health toll of dating isn’t solved by quitting apps or memorizing better pickup lines. What’s needed is a deeper internal shift:

• Recognizing that rejection doesn’t reflect worth
• Building emotional resilience and boundaries
• Expanding emotional vocabulary and relational skills
• Learning to tolerate ambiguity without abandoning self-respect 

Men who engage in therapy—particularly emotionally focused or relational therapy—learn how to regulate feelings of rejection, express vulnerability in safe ways, and create more meaningful, values-aligned dating experiences.

It’s also essential to redefine success in dating. Instead of fixating on romantic “wins,” men benefit from evaluating how aligned their behavior is with their values, how much agency they’re exercising, and how authentically they are showing up.

Connection Without Collapse
Dating in the modern era is psychologically demanding—for everyone. But for men raised with rigid emotional norms and social conditioning around performance, the emotional cost can be particularly high.

The solution is not to opt out of dating, but to opt into self-awareness. Men deserve support in navigating emotional pain, romantic uncertainty, and rejection—not shame for struggling.

When men have the space to explore their internal world, they show up in dating—not as performers—but as people. And that’s where true connection begins.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Cox, D., Orrell, B., & Suls, R. (2021). The state of American friendship: Change, challenges, and loss. Survey Center on American Life.

LeFebvre, L. E., Allen, M., Rasner, R. D., Garstad, S., Wilms, A., & Parrish, C. (2019). Ghosting in emerging adults’ romantic relationships: The digital dissolution disappearance strategy. Imagination, Cognition and Personality, 39(2), 125–150.

London, B., Downey, G., Bonica, C., & Paltin, I. (2007). Social causes and consequences of rejection sensitivity. Journal of Research on Adolescence, 17(3), 481–506.

Timmermans, E., & De Caluwé, E. (2017). To Tinder or not to Tinder, that’s the question: An individual differences perspective to Tinder use and motives. Personality and Individual Differences, 110, 74–79.

Wong, Y. J., Ho, M. R., Wang, S. Y., & Miller, I. S. (2017). Meta-analyses of the relationship between conformity to masculine norms and mental health-related outcomes. Journal of Counseling Psychology, 64(1), 80–93.

Mental health treatment has historically pathologized neurodivergence—treating autism, ADHD, and other cognitive differences as deficits to be corrected. Neurodivergent-affirming care takes a radically different approach. Instead of trying to make someone appear or behave neurotypical, this model recognizes neurological differences as valid, meaningful variations in the human brain. In short: neurodivergent-affirming care rejects the idea that being different is being disordered.

At its core, neurodivergent-affirming care is grounded in the principles of the neurodiversity movement (Singer, 1999; Kapp, 2020). It emphasizes acceptance, autonomy, and authenticity over compliance, masking, or assimilation. Clinicians practicing affirming care aim to support the individual’s well-being—not just their functionality in neurotypical systems. For example, instead of teaching an autistic person to make eye contact because it’s socially expected, a neurodivergent-affirming provider would explore whether eye contact causes distress and whether it’s actually necessary for meaningful connection.

This approach matters because traditional interventions, particularly those rooted in behaviorism, have often been harmful to neurodivergent individuals. Research has shown that masking—suppressing natural behaviors to appear neurotypical—is linked to increased anxiety, depression, and suicidality in autistic adults (Cage et al., 2018; Cassidy et al., 2018). Neurodivergent-affirming care provides space to unlearn masking and begin exploring what it means to be one’s true self.

Affirming care also recognizes that many mental health challenges in neurodivergent people are not intrinsic to their neurotype, but rather the result of chronic invalidation, trauma, sensory overwhelm, and inaccessible environments (Botha et al., 2022). Instead of diagnosing these responses as standalone disorders, affirming clinicians take context into account and work collaboratively to build sustainable coping strategies that align with the individual’s needs—not societal expectations.

In practice, neurodivergent-affirming care might look like:

• Supporting stimming as a form of self-regulation rather than discouraging it.
  
• Recognizing that burnout in autistic individuals is real and distinct from depression (Raymaker et al., 2020).
  
• Questioning assumptions around “independence” and instead focusing on interdependence and sustainable living.
  
• Using identity-first language if the client prefers it, based on the growing consensus among autistic adults (Kenny et al., 2016).
  

Neurodivergent-affirming care also invites mental health professionals to challenge their own training and biases. Most clinical models were built without neurodivergent input—and certainly without their leadership. To provide affirming care, therapists must be willing to step outside traditional frameworks and make space for different ways of thinking, feeling, and communicating.

Ultimately, affirming care is not a trend—it’s an ethical imperative. As more adults seek support after a late diagnosis or self-identification, they need care that validates their identity, understands their lived experience, and promotes true well-being—not just superficial functioning.

Call to Action (CTA):
At Refresh Therapy NYC, we offer virtual therapy for adults who are looking for affirming, intelligent, and actionable support. Whether you are newly diagnosed or have known you were different your whole life, we understand the unique challenges of being neurodivergent in a neurotypical world.

Book your appointment today.

Written by: Refresh Interns

Single fatherhood comes with an image: resilient, self-sacrificing, holding the world up for your kids with quiet strength. But behind that image, many single dads are quietly drowning in anxiety. Not the momentary kind that passes after a deadline or a tough day—but a persistent, all-consuming worry that runs beneath the surface of everyday life.

It’s the anxiety of being the only one. The only one to sign the papers. The only one who shows up to parent-teacher conferences. The only one to worry, day after day, if you’re enough. While single motherhood is often publicly acknowledged and socially supported, single fathers are expected to carry the same load—silently. And that silence is costing them their health, their confidence, and in some cases, their sense of self.

Why Anxiety in Single Fathers Is So Common—And So Invisible
Anxiety in single fathers often flies under the radar because it doesn’t look like the media version of panic attacks or emotional breakdowns. Instead, it looks like overworking, chronic irritability, perfectionism, emotional shutdown, or obsessive planning.

Men are socialized to suppress emotion, solve problems alone, and measure success by productivity. Single fathers, already navigating an emotionally demanding situation, may feel they have no space to acknowledge their internal distress. But the numbers tell a different story.

According to a large-scale study, single fathers report higher levels of psychological distress and sleep disturbances than both partnered fathers and single mothers, even when controlling for income and employment status (Weitoft et al., 2003). And yet, they are significantly less likely to seek help.

In part, this is because support systems are rarely built with fathers in mind. Parenting groups, pediatrician visits, and school communications often default to addressing mothers. The absence of space creates a false narrative: that fathers don’t need support, or worse—that asking for it signals failure.

Living With the Pressure to Perform—and Never Break
Single dads are often caught in an impossible contradiction: they’re expected to do it all, but never need help. Many carry the full weight of parenting, finances, emotional labor, and logistics, with no backup and no break.

This level of chronic pressure activates the body’s stress response system—raising cortisol levels, reducing immune function, impairing memory, and increasing vulnerability to anxiety and depression (McEwen, 2000). You might feel “on edge” all the time, unable to relax even when things are going okay.

Some fathers report a specific anxiety around being perceived as an unfit parent. You might feel like every mistake is being watched more closely, every emotional lapse scrutinized. This hypervigilance can lead to self-doubt, obsessive self-monitoring, and isolation.

How Anxiety Shapes Your Relationship With Your Child
Even when you don’t express your anxiety outwardly, your child feels it. Children are incredibly attuned to the emotional states of their caregivers. When a father is stressed, tense, or emotionally withdrawn, kids can become more anxious themselves—mirroring the emotional tone of the home.

A 2016 study found that paternal anxiety and depressive symptoms significantly predict emotional and behavioral problems in children, especially when emotional attunement is low (Gustafsson et al., 2016).

That doesn’t mean your anxiety is harming your child—but it does mean that how you relate to your anxiety matters. When children see their parent acknowledge stress and still show up with care, they learn emotional resilience. When they see their parent deny, suppress, or snap under pressure, they may internalize those same coping patterns.

The Guilt-Anxiety Spiral
One of the most corrosive patterns single fathers fall into is the guilt-anxiety spiral. You feel guilty for not being “enough”—so you try harder, stretch thinner, do more. But that overextension leads to burnout and anxiety, which then triggers more guilt.

This cycle is especially common in fathers who experienced emotionally absent or critical parenting themselves. You may feel driven to give your child a radically different experience—but without adequate support, this goal can lead to perfectionism and emotional exhaustion.

You might believe you have to earn your child’s happiness, your right to rest, or even your legitimacy as a single parent. But guilt is not a good parent. It clouds judgment, narrows perspective, and leads to reactive decisions. What your child needs isn’t more guilt-driven effort—they need you, grounded and emotionally safe.

The Role of Financial and Legal Stress
For many single fathers, anxiety isn’t just emotional—it’s practical. Custody arrangements, child support, legal battles, and job insecurity add another layer of stress that can’t be resolved with mindfulness alone.

Financial pressure is a leading cause of anxiety in single-parent households, with fathers reporting high levels of distress related to housing stability, food security, and medical costs (Kendig & Bianchi, 2008).

You may find yourself constantly calculating, forecasting, and preparing for worst-case scenarios. This kind of anticipatory stress is a hallmark of generalized anxiety disorder and often goes undiagnosed in men who attribute their distress to “just being responsible.”

You’re not just carrying your own future—you’re carrying someone else’s. And that weight can become unbearable without emotional and logistical support.

Why Single Dads Don’t Seek Help—and Why That Has to Change
Despite their vulnerability, single fathers are among the least likely groups to seek mental health support. A 2020 analysis of service utilization found that only 16% of single fathers had accessed therapy in the past year, compared to 32% of single mothers (Langton et al., 2020).

Common barriers include:

• Fear of being judged as emotionally unstable or incapable
• Difficulty finding male-friendly or father-specific services
• Lack of time and financial access to therapy
• Internalized beliefs that “strong dads don’t need help”

But suppressing anxiety doesn’t eliminate it—it relocates it. It turns into irritability, insomnia, disconnection, or hopelessness. Seeking help isn’t just about you. It’s about showing your child that strength includes vulnerability, and that love includes self-respect.

Therapy Is Not Indulgent—It’s Survival
For many single dads, therapy is dismissed as something “extra.” But addressing anxiety is not optional—it’s essential. The cost of untreated anxiety includes cardiovascular strain, lowered immunity, relationship breakdowns, and poor parenting outcomes (Hofmann et al., 2012).

Therapy offers a space to:

• Disentangle thoughts from fear
• Process guilt without letting it define you
• Build strategies for sustainable parenting
• Learn how to soothe your nervous system—not just push through it
• You don’t need to be in crisis to deserve support. You need only be human, raising a child in an overwhelming world.

What Healing Can Look Like—Even If Your Circumstances Don’t Change
Your anxiety may not disappear overnight. Your custody situation may not change. Your financial strain may persist. But healing doesn’t require everything around you to shift. It requires you to shift how you respond to what’s around you.

You can:

• Breathe before reacting
• Name your feelings aloud, even if it’s just to yourself
• Make space each day for something nourishing, no matter how small
• Connect with one other adult who can hear the truth without fixing it
• Anxiety tells you the worst-case scenario is inevitable. Healing reminds you that even in uncertainty, you still have agency, dignity, and worth.

You’re Doing More Than Surviving
You are not just holding it together—you are parenting through pressure most people can’t see. You may feel exhausted, resentful, afraid, or numb. That doesn’t make you weak. It makes you real.

Single fatherhood is hard. Not because you’re doing it wrong, but because it asks everything of you. And while the world may not always recognize your effort, your nervous system does. Your child does. And somewhere inside, you do too.

You don’t have to carry all of this alone. You were never meant to.

Anxiety thrives in silence—but healing begins the moment you tell the truth about what this really feels like.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Cairney, J., Boyle, M., Offord, D. R., & Racine, Y. (2003). Stress, social support and depression in single and married mothers. Social Psychiatry and Psychiatric Epidemiology, 38(8), 442–449.

Coles, R. L. (2015). Single-father families: A review of the literature. Journal of Family Theory & Review, 7(2), 144–166.

Gustafsson, H. C., Sullivan, E. L., & Keenan, K. (2016). Paternal depression and child development: A review. Child Psychiatry & Human Development, 47(3), 397–408.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.

Kendig, S. M., & Bianchi, S. M. (2008). Single, cohabiting, and married mothers’ time with children. Journal of Marriage and Family, 70(5), 1228–1240.

Langton, C., Yoshioka-Maxwell, A., & Madkour, A. S. (2020). Mental health service use among U.S. single fathers. Journal of Men’s Health, 16(1), e12–e20.

McEwen, B. S. (2000). Allostasis and allostatic load: Implications for neuropsychopharmacology. Neuropsychopharmacology, 22(2), 108–124.

Weitoft, G. R., Hjern, A., Haglund, B., & Rosén, M. (2003). Mortality, severe morbidity, and injury in children living with single parents in Sweden: A population-based study. The Lancet, 361(9354), 289–295.

Not Just a Midlife Crisis: The Silent Mental Health Struggles of Aging Men
For many men, aging is not just a physical experience—it’s a psychological reckoning. In Western society, aging is often painted as a slow unraveling of relevance. Gray hair, softer bodies, and the creeping aches of time are not just reminders of mortality—they’re framed as signs of diminished masculinity. For men taught to associate their worth with virility, strength, and productivity, aging can feel like a profound identity crisis. But because male emotional pain is so often hidden beneath stoicism and performance, the psychological toll of aging goes largely unspoken—and unaddressed.

This silence is costing lives.

Suicide rates are highest among middle-aged and older men. Yet mental health conversations still tend to center youth or women, bypassing the distinct experiences of men as they age. As roles shift, bodies change, and careers slow down, men face a complex internal world with very few social scripts for navigating it.

This article explores how men’s mental health is shaped by aging—and how psychological tools, cultural shifts, and relational support can help rewrite the aging experience into something far more meaningful than decline.

Aging and the Collapse of Masculine Ideals
From early on, boys receive a clear—if unspoken—message: strength is value, emotion is weakness, and independence is virtue. As long as a man remains physically capable, sexually active, and economically productive, he stays within the safe bounds of culturally sanctioned masculinity.
But what happens when aging disrupts those domains?

Testosterone levels decline gradually starting in a man’s 30s, often accelerating after age 50. This can result in fatigue, irritability, sleep disruption, loss of muscle mass, and a drop in libido (Wu et al., 2008). These physiological changes, though natural, can feel like betrayals—especially in cultures that equate masculinity with physical dominance and sexual prowess.

At the same time, aging brings professional transitions. For men whose identities have been fused with career success, retirement—whether planned or forced—can trigger a loss of purpose and status. One longitudinal study found that men who retire involuntarily experience significant increases in depressive symptoms, especially when retirement is linked to declining health or economic instability (Dave et al., 2008).

In short, aging confronts men with a brutal question: Who am I when I’m no longer the provider, protector, or performer?

The Psychological Toll of Isolation
Research consistently shows that older men tend to have smaller social networks and are less likely to seek emotional support than women (Courtenay, 2000). Many rely heavily on their spouses for emotional intimacy. When relationships shift—due to divorce, widowhood, or illness—men may find themselves adrift without any close confidants.

This lack of emotional scaffolding contributes to increased rates of depression, anxiety, and suicide among aging men. The CDC reports that men over 65 have the highest suicide rate of any demographic in the U.S. (Hedegaard et al., 2023). And because depression in men is often masked by irritability, substance use, or physical complaints, it is frequently missed by both physicians and family members.

The result? An enormous burden of unspoken grief, loneliness, and self-doubt.
Even among those who do have social contact, conversations often remain superficial. Without cultural permission to speak vulnerably, many older men are isolated not by circumstance—but by silence.

Grief, Loss, and the Myth of Resilience
Aging also brings waves of grief—some visible, some invisible.

There is the grief of losing friends or siblings, the grief of changing health, and the grief of missed opportunities or unresolved regrets. But for men, who are often taught to suppress emotion and “push through,” grief can calcify into numbness, anger, or emotional withdrawal.

One insidious myth that haunts older men is that “real men” age gracefully and without complaint. But research shows that unprocessed grief and loss can manifest in somatic symptoms, chronic illness, substance use, or disconnection from others (Galdas et al., 2005).

Emotional suppression may have served earlier in life to navigate demanding careers or societal expectations. But in later life, it becomes a trap—limiting access to healing, connection, and new meaning.

How Men Can Age With Emotional Integrity
Psychological flexibility is key to navigating aging with well-being. This doesn’t mean “thinking positively” or denying real losses. Rather, it means developing the capacity to adapt, reflect, and shift one’s self-concept beyond outdated masculine ideals.

Men who are able to redefine success, find value in relationships over productivity, and embrace emotional complexity report significantly better mental health outcomes in later life (Wurm et al., 2007).

Therapeutic approaches that affirm men’s values—such as Acceptance and Commitment Therapy (ACT), Interpersonal Therapy (IPT), or even existential therapy—can help aging men make meaning of their transitions. These models avoid pathologizing and instead support identity exploration, legacy reflection, and relational depth.

Additionally, behavioral activation—an evidence-based treatment for depression—can be helpful in encouraging older men to engage in pleasurable, meaningful activities, even when motivation is low (Dimidjian et al., 2011).

Reimagining Masculinity in Older Age
To support men’s mental health as they age, we must rewrite the cultural narratives surrounding masculinity. Aging can no longer be seen as a loss of power—it must be reframed as a gain in perspective.

This requires a shift in how we talk about strength. Strength can mean showing up to therapy, crying when it hurts, admitting when you feel lost, and learning how to ask for help. Resilience is not the absence of struggle; it’s the willingness to stay emotionally present through struggle.

Peer groups, social programs, and therapeutic spaces need to be designed with men’s psychological and cultural experiences in mind. For example, “men’s sheds”—a movement originating in Australia—offer low-pressure environments where older men can gather around hobbies, projects, and skill-sharing. These spaces offer indirect pathways to connection and can reduce depression and isolation (Ballinger et al., 2009).

What Loved Ones and Clinicians Can Do
If you’re close to an aging man who seems distant or emotionally withdrawn, know that silence doesn’t mean all is well. Offer consistent presence. Ask open-ended questions without pushing for disclosure. Normalize therapy and speak positively about emotional expression.

For clinicians, don’t wait for men to report sadness. Screen for depression using questions that target irritability, sleep changes, and anhedonia. Explore their views on masculinity, aging, and identity. Many aging men are not afraid of therapy—they just haven’t had the language or models to understand what therapy can offer them.

Aging as Evolution, Not Erosion
Aging is not the enemy. For men willing to reexamine their values and embrace vulnerability, it can be a profoundly liberating phase of life. The challenge lies not in aging itself—but in the cultural narratives that shame men into silence as they age.

Mental health is not about “fixing” what aging has changed. It’s about adapting, grieving, and rebuilding a self that is no longer shackled to outdated ideals.
It’s time to stop asking men to age like machines. Instead, let’s offer them the tools, spaces, and dignity to age like humans.ur whole life, we understand the unique challenges of being neurodivergent in a neurotypical world.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Ballinger, M. L., Talbot, L. A., & Verrinder, G. K. (2009). More than a place to do woodwork: A case study of a community-based Men’s Shed. Journal of Men’s Health, 6(1), 20–27.

Courtenay, W. H. (2000). Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Social Science & Medicine, 50(10), 1385–1401.

Dave, D., Rashad, I., & Spasojevic, J. (2008). The effects of retirement on physical and mental health outcomes. Southern Economic Journal, 75(2), 497–523.

Dimidjian, S., Barrera, M., Martell, C., Muñoz, R. F., & Lewinsohn, P. M. (2011). The origins and current status of behavioral activation treatments for depression. Annual Review of Clinical Psychology, 7, 1–38.

Galdas, P. M., Cheater, F., & Marshall, P. (2005). Men and health help-seeking behaviour: literature review. Journal of Advanced Nursing, 49(6), 616–623.

Hedegaard, H., Curtin, S. C., & Warner, M. (2023). Suicide mortality in the United States, 2001–2021. National Center for Health Statistics Data Brief, No. 464.

Wu, F. C. W., Tajar, A., Pye, S. R., Silman, A. J., Finn, J. D., O’Neill, T. W., … & EMAS Group. (2008). Hypothalamic–pituitary–testicular axis disruptions in older men are linked to frailty and overall health. The Journal of Clinical Endocrinology & Metabolism, 93(7), 2737–2745.

Wurm, S., Tesch-Römer, C., & Tomasik, M. J. (2007). Longitudinal findings on aging-related cognitions, control beliefs, and health in later life. The Journals of Gerontology: Series B, 62(3), P156–P164.

We live in a world that praises being busy, rewards burnout, and treats rest like a privilege instead of a necessity. The pressure to be constantly productive isn’t just a workplace issue—it’s become a deeply internalized belief system. And it’s quietly harming our mental health.

Productivity culture teaches us that our value lies in what we produce. That rest must be earned. That slowing down is the same as falling behind. But chasing constant output comes at a steep cost: anxiety, disconnection, burnout, and a fragile sense of self-worth that’s entirely performance-based.

The Hidden Cost of Constant Output
For many people, the pressure to keep producing feels personal. It’s not just about work—it’s about being “on” all the time. Answering emails late at night, turning hobbies into side hustles, filling every open hour with tasks. Productivity becomes a coping mechanism for discomfort, uncertainty, or feelings of inadequacy.
But here’s the truth: always doing more doesn’t mean you’re doing well. And constantly pushing yourself doesn’t mean you’re emotionally okay. Over time, living this way leads to:

• Difficulty relaxing without guilt
  
• Feeling behind, even when you’re ahead
  
• Chronic exhaustion and irritability
  
• Disconnection from joy, creativity, or purpose
  

Why We Buy Into It
Productivity culture is seductive. It promises control, certainty, and a sense of accomplishment. It gives us something to point to and say, “See? I’m doing enough.” For people who struggle with self-worth, it can feel like proof that you’re good, valuable, or safe.
And in some environments, being overextended is celebrated. Hustle is glorified. Boundaries are labeled as laziness. Eventually, internal restlessness becomes a lifestyle.

You Don’t Have to Burn Out to Be Valued
Your worth is not tied to how many tasks you complete, how fast you reply, or how much you squeeze into a day. It can feel radical to stop measuring success in output—but that’s where mental health begins to improve.
When you stop equating busyness with value, you make room for:

• Rest that isn’t guilt-ridden
  
• Presence instead of pressure
  
• Boundaries that protect your energy
  
• A deeper connection to what actually matters
  

What to Do Instead
You don’t have to quit your job or abandon your goals. But you can begin to shift your relationship with productivity.
Try this:

• Start noticing when you’re doing something out of fear vs. purpose
  
• Schedule rest like it’s non-negotiable
  
• Take breaks before you’re at capacity, not after
  
• Define success by how aligned you feel, not how exhausted you are
  And if that feels hard, it’s not because you’re failing—it’s because you’ve been taught to ignore your limits. Unlearning that is the real work.
  

Mental Health Isn’t a Productivity Hack
You don’t need to optimize your way out of burnout. You need space to slow down, reconnect with your needs, and stop measuring your value by your output. Therapy can help you unlearn productivity-based self-worth and build a more sustainable, intentional life.

Ready to work with a therapist who understands what it means to feel driven, overwhelmed, and tired of it all?

Book your appointment today.

Written by: Refresh Interns

Discomfort is a part of life, but most of us spend a lot of time and energy trying to avoid it. We stay busy to avoid loneliness. We overthink to avoid uncertainty. We people-please to avoid conflict. But in the effort to escape discomfort, we often make things worse—and we miss the opportunity to build real emotional resilience.

Learning to sit with discomfort is one of the most powerful, underutilized skills in mental health. It doesn’t sound exciting or glamorous, but it’s the foundation for everything from self-trust to boundary setting to lasting growth. Here’s why it matters—and how to start practicing it in real life.

Why We Avoid Discomfort
Discomfort isn’t just unpleasant. For many people, it feels threatening. Our brains are wired to protect us from pain, and discomfort often gets coded as danger. That means we instinctively reach for something—anything—that will make the feeling stop: distraction, reassurance, control, perfectionism, withdrawal, or even numbing behaviors like overworking or scrolling.
The problem is, these coping mechanisms often reinforce the belief that we can’t handle discomfort. Over time, we lose confidence in our ability to feel hard things and survive them.

The Cost of Avoidance
When we avoid discomfort at all costs, we end up:

• Staying stuck in unhealthy patterns
  
• Struggling to set or hold boundaries
  
• Reacting impulsively instead of responding thoughtfully
  
• Missing out on growth because it feels too uncomfortable
  Discomfort isn’t the problem. Our reaction to it is.
  

What It Actually Means to Sit With Discomfort
Sitting with discomfort doesn’t mean forcing yourself to suffer. It means allowing space for an uncomfortable feeling without immediately acting on it, fixing it, or pushing it away. It means recognizing that discomfort isn’t a danger signal—it’s information.
This can look like:

• Noticing the urge to fix something right away—and pausing instead
  
• Letting yourself feel anxious without jumping into overthinking
  
• Saying no to something and tolerating the guilt or fear that follows
  
• Staying present in an awkward or vulnerable moment without shutting down
  

Why This Skill Is So Hard (But So Worth It)
Most people aren’t taught how to tolerate discomfort. If anything, we’re taught to avoid it. But the ability to stay grounded during emotional discomfort is the difference between reacting and responding, between fear-based decisions and intentional ones.
It’s also a major part of what makes therapy transformative. The therapy space helps you learn how to stay with discomfort long enough to understand it—and eventually, to move through it.

How to Start Practicing
You don’t have to dive in headfirst. Start small. When a feeling comes up—anxiety, frustration, guilt—try the following:

• Name the feeling out loud or in your mind
  
• Notice where it shows up in your body
  
• Remind yourself, “This is uncomfortable, but I can tolerate it”
  
• Stay with the feeling for 60 seconds without distracting or acting on it
  Over time, your nervous system will learn that discomfort is survivable—and that you’re capable of navigating it.
  

Discomfort Is Where Growth Happens
Sitting with discomfort doesn’t make the hard parts of life easier. But it makes you stronger. More self-aware. More emotionally flexible. And far more equipped to make choices that align with who you actually are, not just what feels safe in the moment.

Ready to work with a therapist who can help you build emotional resilience from the inside out?ty without losing their drive. If you’re ready for something deeper than coping, let’s talk about what real transformation can look like.

Book your appointment today.

Written by: Refresh Interns

When we think of body image issues, we often think of women. But an increasing number of men are experiencing significant mental health challenges related to body perception—without the public awareness or social support to address it. In fact, research shows that up to 25% of individuals with body dysmorphic disorder (BDD) are male, and men are more likely to struggle with a specific subtype known as muscle dysmorphia, in which they perceive themselves as small or weak, despite being muscular or fit (Olivardia et al., 2000).

The result? A silent crisis—where men chase idealized bodies, restrict eating, overtrain, and spiral into anxiety, depression, or obsessive behavior. But because emotional distress about appearance is considered unmasculine, these issues are often hidden, dismissed, or misunderstood.

The Pressure to Look “Like a Man”
Masculine body ideals have changed dramatically over the last few decades. Where the 1950s ideal emphasized lean athleticism, today’s media presents the ideal man as hyper-muscular, vascular, and low in body fat. Superheroes, action figures, athletes, and even social media influencers all promote an unattainable physique.

This ideal is not just aesthetic—it’s tied to identity, power, and worth. Men who do not align with this image may internalize shame or inadequacy. A study published in JAMA Pediatrics found that adolescent boys who were concerned with muscularity were more likely to develop depressive symptoms and use substances like steroids (Field et al., 2014).

Men are also less likely than women to talk about body dissatisfaction or seek treatment, due to stigma. Body image concerns are often mislabeled as vanity, when in reality they can stem from deep-rooted anxiety, perfectionism, and trauma (Griffiths et al., 2015).

What Is Muscle Dysmorphia?
Muscle dysmorphia (MD) is a subtype of body dysmorphic disorder where individuals obsess over not being muscular or lean enough. It primarily affects men, and often involves compulsive exercise, rigid dieting, anabolic steroid use, and social withdrawal.

In contrast to anorexia nervosa, which is characterized by fear of fatness, muscle dysmorphia centers around the fear of being too small. But both disorders share distorted body image, impaired functioning, and co-occurring depression or anxiety (Pope et al., 2005).

Men with MD may feel intense distress if they miss a workout, avoid situations where their bodies could be judged (like beaches or locker rooms), or structure their entire lives around training and food. Left untreated, this condition can severely impact mental health and social life.

The Mental Health Effects of Poor Body Image in Men
Poor body image in men is associated with a range of mental health issues:

• Low self-esteem
• Social anxiety
• Obsessive-compulsive tendencies
• Eating disorders
• Steroid misuse
• Depression and suicidal ideation

Men who struggle with body image are also more likely to engage in compulsive behaviors like mirror checking, body comparisons, and excessive grooming (Veale et al., 2016). These behaviors are often dismissed as “normal male behavior” but can become obsessive and impair daily life.

Because body image struggles are seen as a “female issue,” men often delay or avoid seeking help. This leads to prolonged suffering and increased risk of co-occurring conditions, such as substance use disorders.

How Social Media and Gym Culture Reinforce Body Anxiety
Instagram, TikTok, and fitness apps flood men with images of shredded abs, bulging biceps, and “transformation” reels. Even fitness communities that claim to promote wellness often encourage overtraining, extreme discipline, and unrealistic goals.

Studies have shown that time spent on appearance-focused social media correlates with higher body dissatisfaction in men, particularly among those prone to social comparison (Rodgers et al., 2020).

 “Gym culture” can also fuel anxiety. While exercise can support mental health, obsessive or identity-driven exercise can worsen it. When fitness becomes a tool to fix a perceived flaw rather than support the body, it turns into punishment—not health.

Treatment and Support: What Actually Helps
Cognitive Behavioral Therapy (CBT) is the most evidence-based treatment for body dysmorphic disorder and body image distress. CBT helps individuals challenge distorted beliefs about appearance and reduce compulsive behaviors.

Other helpful approaches include:

• Exposure and Response Prevention (ERP) for mirror checking and reassurance-seeking
• Acceptance and Commitment Therapy (ACT) to shift focus from control to values
• Medication, such as SSRIs, for severe cases of BDD (Phillips et al., 2002)
  Treatment must also address underlying masculine norms—helping men expand their identity beyond appearance and performance. Therapy is not about “loving your body” in a superficial way. It’s about reclaiming your relationship with your body from shame, fear, and control.
  

What Families, Partners, and Clinicians Can Do
If you suspect a man in your life is struggling with body image:

• Avoid making comments about weight, size, or muscles
• Ask about how he’s feeling, not just how he’s looking
• Normalize therapy and mental health support
• Recognize that excessive gym behavior may be a coping mechanism

For clinicians, screening tools for BDD and eating disorders should be adapted for male presentations. Ask about appearance-related distress, not just weight concerns. Understand that “healthy” gym behavior may be masking significant psychological distress.

Men Deserve Better Than Silence
Men’s mental health and body image issues are real, common, and underrecognized. It’s time to stop framing body dysmorphia as a “women’s problem” and acknowledge the growing number of men suffering in silence.

Every man deserves to age, change, and exist in his body without shame. Muscles don’t define worth. Control doesn’t equal confidence. The most powerful transformation is internal—toward compassion, flexibility, and wholeness.

Book your appointment today.

Written by: Keeley Teemsma, LCSW, MA

Works Cited
Field, A. E., Sonneville, K. R., Crosby, R. D., Swanson, S. A., Eddy, K. T., Camargo, C. A., … & Micali, N. (2014). Prospective associations of concerns about physique and the use of anabolic-androgenic steroids in adolescent boys. JAMA Pediatrics, 168(1), 34–39.

Griffiths, S., Murray, S. B., & Touyz, S. (2015). Drive for muscularity and muscularity-oriented disordered eating in men: The role of set shifting difficulties and weak central coherence. Body Image, 15, 116–121.

Olivardia, R., Pope, H. G., & Hudson, J. I. (2000). Muscle dysmorphia in male weightlifters: A case-control study. American Journal of Psychiatry, 157(8), 1291–1296.

Phillips, K. A., Albertini, R. S., & Rasmussen, S. A. (2002). A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Archives of General Psychiatry, 59(4), 381–388.

Pope, H. G., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (1997). Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics, 38(6), 548–557.

Rodgers, R. F., Slater, A., Gordon, C. S., McLean, S. A., & Jarman, H. K. (2020). The role of social media in body image concerns among adolescent boys: A brief review. Current Opinion in Psychology, 36, 86–90.

Veale, D., Gledhill, L. J., Christodoulou, P., & Hodsoll, J. (2016). Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image, 18, 168–186.

When your child is struggling with depression, your world shrinks to their pain. You might spend nights watching them sleep just to make sure they’re safe, or spend days wondering if anything you say even matters. You try to stay calm, grounded, and supportive—but under the surface, your own mental health may be unraveling.

For fathers, this is often a silent collapse. Many were taught to be protectors, problem-solvers, and providers—not emotional anchors. And yet, when a child is facing depression, what’s needed most is precisely what men are rarely taught to develop: emotional stamina, self-awareness, and grief tolerance.

This article is not about how to fix your child. It’s about what happens to you—your identity, your mental health, and your emotional life—when the child you love is in pain.

The Invisible Toll of Holding It All Together
Most fathers don’t talk about the panic that creeps in when their child won’t get out of bed. Or the shame they feel when they get frustrated instead of compassionate. Or the confusion that comes from doing everything “right” and still watching their child spiral.

Research shows that parents of children with depression are at increased risk for anxiety, depressive symptoms, sleep disturbance, and even PTSD-like experiences, especially if they lack adequate emotional support (Wickersham et al., 2021).

Men are especially vulnerable because they tend to suppress their emotional distress, fearing that breaking down would make them less effective or less useful. But repressing grief, fear, or helplessness doesn’t protect anyone—it just isolates you.

You Can’t Pour From an Empty Self
When your child is in crisis, it can feel selfish to take care of your own well-being. But parenting a child with depression is not a sprint—it’s a marathon. You don’t need to be constantly strong. You need to be sustainable.

Ignoring your own exhaustion, guilt, and emotional confusion will only erode your capacity to parent with clarity. Research on parental burnout shows that unprocessed emotional overload in caregivers leads to detachment, irritability, and emotional numbing (Mikolajczak et al., 2018).

You are allowed to grieve. You are allowed to feel angry. You are allowed to say “I need help too.” None of this makes you a weak father. It makes you an honest one.

Masculinity, Shame, and Silent Suffering
Many fathers feel shame for even admitting how much this hurts. Society rarely gives men permission to collapse under the weight of parenting, especially when the struggle is emotional rather than logistical.

You might feel like you’re failing. You might believe you caused this. You might wonder if you missed the signs. These thoughts are common—and corrosive.

In a qualitative study on fathers of children with mental illness, researchers found that many men experience intense guilt, self-blame, and emotional isolation, yet hesitate to reach out for support due to stigma or internalized masculine norms (Moses, 2010).

But emotional suppression does not make you a better father. Presence does. And presence requires caring for your own mental health with the same dedication you offer your child.

Therapy Isn’t Just for Your Kid
It’s common for fathers to get their child into therapy, but never consider it for themselves. Yet your child’s healing may trigger long-dormant wounds in you—childhood trauma, emotional neglect, or long-held insecurities.

Fathers often report feeling like they’re “not allowed” to fall apart while their child is struggling. But therapy gives you a protected space to feel everything that parenthood has stirred up.

Men in therapy often report improved parenting, better emotional regulation, and a greater sense of meaning—even during ongoing family stress (Feinberg & Kan, 2008). You don’t need to be in crisis to go. You just need to be human.

Redefining Fatherhood During Crisis
When your child is depressed, it’s easy to feel like you’ve lost control. But this is also a powerful moment to redefine what kind of father you want to be—not the one who has all the answers, but the one who shows up with honesty and compassion.

Ask yourself:

• Can I be present, even when I feel powerless?
• Can I soften, even when I want to shut down?
• Can I let go of fixing, and instead build trust through consistency? 

These questions won’t solve everything. But they will move you toward a version of fatherhood that includes your full humanity—not just the parts that feel competent.

You Still Matter, Even Now
You may not be able to make your child feel better today. But you are not powerless. You are not invisible. And your emotional well-being is not secondary to theirs—it’s part of the healing environment they need.

A father’s love never ends. But it can—and must—include love for yourself. You are not just a witness to your child’s depression. You are a man navigating heartbreak, confusion, and uncertainty—and you deserve support too.

You’re not alone. You’re not failing. You’re just finally feeling it.

Book your appointment today.

Written by: Refresh Interns

Works Cited
Feinberg, M. E., & Kan, M. L. (2008). Establishing family foundations: Intervention effects on coparenting, parent/infant well-being, and parent–child relations. Journal of Family Psychology, 22(2), 253–263.

Mikolajczak, M., Gross, J. J., & Roskam, I. (2018). Parental burnout: What is it, and why does it matter? Clinical Psychological Science, 7(6), 1319–1329.

Moses, T. (2010). Being treated differently: Stigma experiences with family, peers, and school staff among adolescents with mental health disorders. Social Science & Medicine, 70(7), 985–993.

Wickersham, A., Sugg, H. V., Epstein, S., Stewart, R., Ford, T., Downs, J., & Fazel, M. (2021). Caregiver burden and mental health difficulties associated with adolescent depression: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 30(5), 751–761.

You’re successful, driven, and highly dependable—but beneath the polished exterior, anxiety is often calling the shots. If you’re a perfectionist, the pressure to be everything for everyone all the time may be quietly eroding your mental health.

This guide explores the connection between perfectionism and anxiety, why high achievers are more vulnerable than they appear, and how to protect your mental well-being without losing your ambition.

Perfectionism and Anxiety: A Hidden Relationship

Perfectionism isn’t about loving excellence. It’s about fear—of failure, disapproval, or not being enough. For many high achievers, perfectionism began as a coping strategy in childhood and evolved into an identity built on overfunctioning.

But the cost of high-functioning anxiety is steep:

• Constant tension and worry
  
• Fear of disappointing others
  
• An inability to rest without guilt
  
• Feeling like your value depends on performance
  

Despite appearances, high-performing individuals often don’t feel “fine.” They’re simply productive and anxious.

Signs of Perfectionist Burnout

Because perfectionism is often praised, it’s easy to miss the toll it takes. If you recognize yourself in the following, you may be experiencing burnout driven by perfectionism and anxiety:

• You feel behind, even when you’re ahead
  
• You struggle to relax, even when you’ve “earned it”
  
• You dread failure more than you desire success
  
• You procrastinate out of fear of doing something imperfectly
  
• You minimize accomplishments and focus on what’s next
  

High-functioning anxiety is real—and it’s unsustainable.

Can You Be Ambitious and Mentally Healthy? Yes.

The good news: You don’t have to choose between mental health and ambition. The key is redefining how you measure success and learning to meet your own needs without perfection as the price of admission.

How to Support Your Mental Health as a High Achiever

1. Redefine What Success Means
Success isn’t only about flawless execution. Try measuring success by:

• Progress over perfection
  
• Honest effort, even with imperfect results
  
• How aligned your work is with your values
  
• Resting when you need to, not when you’re “allowed”
  

2. Build Discomfort Tolerance
Perfectionism is often a way to avoid discomfort. Challenge yourself to:

• Send that email without triple-checking
  
• Take a break before finishing a task
  
• Leave space for things to be “good enough”
  

Each act of tolerating imperfection strengthens your resilience.

3. Talk Back to Your Inner Critic
Your inner critic might sound convincing, but it’s often just a fear-based habit. Practice asking:

• What am I afraid will happen if I don’t do this perfectly?
  
• Is this expectation reasonable—or punishing?
  
• What would I say to a friend in the same situation?
  

4. Develop Self-Worth Outside of Achievement
Explore who you are outside of what you do. This might mean:

• Trying hobbies with no productivity outcome
  
• Setting boundaries around work
  
• Valuing your presence, not just your performance
  

When your worth is no longer tied to outcomes, anxiety loses power.

5. Consider Therapy for Perfectionism and Anxiety
Working with a therapist who understands high-functioning anxiety and perfectionism can help you untangle these patterns at their root. You don’t need to be in crisis to benefit from therapy—especially when you’re tired of keeping it all together.

You Don’t Have to Earn Peace

Your ambition doesn’t need to disappear—but it shouldn’t come at the cost of your well-being. When you learn to recognize anxiety for what it is—not motivation, but fear—you gain the freedom to move through life with more peace, less pressure, and a deeper sense of self-worth that isn’t up for negotiation.

Ready to work with someone who understands the mental load of high achievement?
I help ambitious professionals untangle perfectionism and anxiety without losing their drive. If you’re ready for something deeper than coping, let’s talk about what real transformation can look like.

Book your appointment today.

Written by: Refresh Interns

Venting can feel good in the moment. You get things off your chest, release some frustration, and maybe even feel validated. But there’s a point where venting stops being helpful—and starts becoming a way to avoid real change.

In therapy and in life, there’s a difference between processing an experience and circling the same story over and over. One creates movement. The other keeps you stuck.

What Venting Does (and Doesn’t Do)
Venting gives us temporary relief. It helps us feel heard, especially if we’re used to suppressing emotions. But on its own, venting rarely leads to clarity, insight, or growth. It’s often reactive, focused on what happened and why it was unfair—without asking, “What now?”

This doesn’t mean you shouldn’t express your emotions. But when venting becomes the only thing you do, it can keep you in a cycle of frustration and powerlessness.

Doing the Work Means Looking Inward
Doing the work means asking yourself harder questions. It means going beyond how something felt and exploring what it triggered in you. It asks, “What patterns am I noticing?” “What do I actually need?” “How can I respond differently next time?”

This process requires emotional honesty, accountability, and a willingness to move through discomfort. That’s why many people avoid it. But it’s also where actual transformation happens.

Venting Looks Like:

• “I can’t believe they did that to me.”
  
• “This always happens to me.”
  
• “They’re the problem.”
  
• “I just needed to get that out.”
  

Doing the Work Looks Like:

• “Why does this pattern keep showing up in my relationships?”
  
• “What boundary was crossed, and how did I respond?”
  
• “What’s my role in this dynamic?”
  
• “What am I feeling underneath the anger or frustration?”
  

You Deserve More Than Temporary Relief
Venting has its place. Sometimes you need to let it out before you can even think clearly. But staying in vent mode can give the illusion of processing—without ever helping you move forward.

Doing the work means committing to self-awareness, emotional growth, and deeper insight. It’s not always comfortable. But it’s the difference between repeating the same story and writing a new one.

Ready to move beyond venting and start making real changes?

Book your appointment today.

Written by: Refresh Interns

Ever feel like you’re the one always checking in, managing emotions, anticipating needs, and holding space—while your partner, friend, or family member just… exists? That’s emotional labor, and it’s quietly exhausting. Often invisible, emotional labor is the mental and emotional energy required to maintain relationships, solve problems, and keep everyone feeling okay—even when you’re not.

While it’s normal for care and support to flow both ways in close relationships, emotional labor becomes a problem when it’s one-sided. If you’re constantly managing the emotional temperature of your relationship, you’re likely carrying more than your fair share—and it’s draining.

What Is Emotional Labor?
Emotional labor in relationships isn’t about performing grand gestures. It’s the subtle, constant effort of making sure everything runs smoothly emotionally. This includes things like:

• Soothing your partner when they’re upset, even if you’re overwhelmed yourself
  
• Anticipating emotional needs before they’re spoken
  
• Keeping the peace to avoid conflict
  
• Suppressing your feelings so others won’t feel uncomfortable
  
• Being the emotional “glue” in every dynamic
  When you’re the one doing most of the emotional tending—without reciprocation—it takes a toll on your nervous system, your self-esteem, and your capacity to actually enjoy the relationship.
  

Signs You’re Carrying Too Much Emotional Labor
You might not call it emotional labor, but you’ll feel it. Common signs include:

• Feeling responsible for other people’s moods
  
• Apologizing often, even when you’re not at fault
  
• Being emotionally exhausted after conversations
  
• Noticing that others rarely ask how you’re doing
  
• Feeling unseen, underappreciated, or taken for granted
  Over time, this kind of imbalance can lead to resentment, disconnection, or even burnout.
  

Why It’s So Hard to Stop
Many people—especially those who were raised to overfunction—find it hard to stop performing emotional labor. You might worry that if you stop holding it all together, everything will fall apart. Or you may have learned early on that being attuned, accommodating, or selfless was the way to earn love or avoid conflict.
But constantly prioritizing other people’s emotions doesn’t create closeness—it creates imbalance. And it teaches the people around you that your needs are optional.

What to Do About It
You don’t have to burn it all down to reset your role in a relationship. But you do have to start doing less of what’s draining you—and tolerating the discomfort that may come with it.
Here’s how to begin:

• Notice when you’re managing someone else’s emotional experience
  
• Pause before jumping in to soothe, fix, or accommodate
  
• Practice expressing your own emotions, even if it feels awkward
  
• Set small boundaries around how much you give—without overexplaining
  It may feel selfish at first. But it’s not. It’s rebalancing a dynamic that was never sustainable to begin with.
  

Healthy Relationships Share the Load
In a healthy relationship, emotional labor is mutual. You check in with each other. You support one another. You both take responsibility for emotional connection—not just one of you.
You don’t have to carry it all. You were never meant to.

Ready to work with a therapist who understands the emotional toll of overfunctioning in relationships?

Book your appointment today.

Written by: Refresh Interns