If your the kind of person who would spend more time looking for your list than accepting that you should just create a new list, you may be a perfectionist. 

Clinical perfectionism commonly correlates with the following psychiatric diagnoses:

• Social anxiety disorder
• Generalized anxiety disorder 
• Obsessive Compulsive disorders including hoarding disorder, body dysmorphic disorder, trichotillomania (hair pulling), excoriation disorder
• Eating Disorders like anorexia nervosa, bulimia nervosa, binge-eating disorder
• Obsessive-compulsive personality disorder  

Common Perfectionistic Behaviors

• Procrastinating
• Checking and re-checking
• Looking for Reassurance 
• Overcompensation
• Correcting and re-correcting
• Rigid oganizng and list making
• Difficulty making decisions
• Giving up 
• Maladaptive persistence
• Failure to delegate
• Hoarding
• Attempts to change others

Notice that most of these behaviors take time away from nurturing worthwhile relationships.

Perfectionism can be a challenging mindset to deal with, but with some understanding and strategies, it's possible to manage it in a healthy way. Here are some tips that may help if your struggling with perfectionism:

1. Focus on impact of your perfectionism instead of immediately trying to stop the behavior. For instance, do you procrastinate because you're afraid of failing? Acceptance and commitment therapy (ACT) is known as the "third wave" of cognitive-behavioral therapy. ACT asks you to look at the things you value in your life instead of telling you to just "stop doing that" symptom. By focusing on what you think is important for life, you have a direction, a purpose that goes beyond seeing yourself as flawed and symptomatic. ACT works to build skills NOT stop feelings. So while you might feel like a failure if you make a mistake, you still make the effort to speak up in class because you value the free exchange of ideas.  To repeat, the feeling doesn't have to change in order for you to engage in personally meaningful behavior. We call that psychological flexibility and it's critical to change.  
   
2. Set realistic goals. Instead of setting goals that are impossible to achieve, set goals that are challenging but attainable. This can help you feel a sense of accomplishment without feeling overwhelmed or discouraged.
   
3. Practice self-compassion. Perfectionists can be hard on themselves, but it's important to practice self-compassion. Treat yourself with the same kindness and understanding that you would offer to a friend who is struggling.
   
4. Focus on the process, not just the outcome. Perfectionists often focus solely on the outcome and overlook the process. By focusing on the process, you can appreciate the journey and learn from any mistakes or setbacks along the way.
   
5. Challenge negative thoughts. Perfectionists often have negative thoughts about themselves and their abilities. Challenge these thoughts by asking yourself if they are really true and whether there is evidence to support them.
   
6. Seek support. Talking to a therapist or support group can be helpful for managing perfectionism. They can provide guidance and support as you work through the challenges associated with perfectionism.

Remember, perfectionism is a mindset that can be managed with time and effort. Being kind to yourself, is a way to start the journey.

It's taken a lot of work opening more appointments for therapy. I've struggled with the idea of retiring and spending more time taking care of me. But then I get the phone call, "Do you have any openings? "I need help." Or "I'm having panic attacks."
Or "I can't get rid of my OCD. It's breaking up my marriage." 

I hang up the phone and look around my office and think..."I love spending time here. I want to help." Finding balance is also important.

                                                                                  Work-Play-Love

​It's a three-legged stool that won't stand when one leg is missing. "Write more books!" I tell myself. "That's working too."

While that's true, writing is really a passion of mine,  I just read about a recent study from Harvard that found the "key" to happiness.

These findings made a great impression on me and sealed my decision to spend a more time in the office.

​Why? 

What is psychotherapy when you cut through all the cognitive reframing, behavioral strategies, and lifestyle changes? Therapy is all about RELATIONSHIPS. I can prescribe all the right medications, all the strategies, but if I don't have a solid, caring relationship, my patient will never connect with my recommendations. It's just so much more blah, blah, blah.

Yes, sometimes I commit the cardinal sin of going overtime when something important comes up at the end of session. But, I've always had that problem, even when I was in the Air Force. I'd make up for it during my admin. time or I'd book fewer patients in the day because my patients were deploying 5-6 times and it felt too unnatural to say, "Time's up" in the middle of a breakthrough about the meaning of an important loss. It's not something I've ever been proud of, lack of discipline and such. But now that I think about it, maybe spending that extra little bit of time was helping me too. All because of the RELATIONSHIP.

To those callers I haven't work with, it may seem like I was being uncaring. But, I'm more convinced than ever that if I can't connect with your needs within the context of our relationship, then taking you on as a patient is really the worst version of being uncaring. Connecting through the relationship means caring and commitment. Commitment of time, commitment of resources, commitment to sharing the pain on the way to discovery/recovery.

I'm not here for the money, because we know that past a certain income, money does nothing for happiness. In fact, this same Harvard study in the Gazette used an example of a lawyer who was making tons of money and who felt unhappy as hell.

Really what I'm doing here is pushing a bit harder instead of retiring - building a few more relationships. Opening that straighter path to happiness. So let's see if you're right you Harvard researchers, if you're not, there's a certain Calla Lilies painting that's coming home with me sometime next year.

A Life Changer
Diabetes can take you from a fun, carefree life to a boot-camp existence in the blink of an eye. One morning you're minding your own business, eating, drinking, resting... watching Queen of the South on Netflix. Next thing, you're at a doctor's appointment for a routine exam being told,  "You've got Type 2 diabetes".  It was something you were always afraid could happen. Your mother has it, your grandmother had it, and your sister too. It was always kind of a ticking time bomb. But now the KAPOW has happened and you're feeling the sting of all the changes you're going to have to make to stay alive. Stay alive??
Diabetes is a killer. Six people will die from complications of diabetes every minute somewhere in the world. Diabetes is one of the top ten causes of death in the United States. 

How did I get here?
You might think that it's purely genetic but if you have Type 2 Diabetes Mellitus, it's very likely that you're overweight. In fact, people with severe obesity are 4 times more likely to get it. What's worse, you have an 80 percent greater chance of dying early because of this disease. Science has shown that you will live a shorter life, on average by about 10-15 years, if you have this condition. 

How do I get out of here?
Well, there's always medicines, diet and exercise. But how many people are really able to keep their lifestyle on this straight and narrow path? Not only that, but the medicines you'll need to keep your blood sugars in check will add up along over time. So will the doses you'll need to stay on top of the condition.
I believe that bariatric surgery is a meaningful treatment for Type 2 diabetes. Diabetes goes into remission for almost 80% of Type 2 diabetic patients who get bariatric surgery. And if it doesn't resolve, chances are high that you will see your:

• blood sugar levels (go down)
• need for medication reduced
• complications from the disease improve

You might think that weight loss surgery (WLS) resolves diabetes through weight loss, and that would make sense EXCEPT...gastric bypass surgery patients have shown that the small intestine starts to produce a molecule called GLUT-1 very soon after surgery. The GLUT-1 allows the body to regulate glucose, and this happens with gastric bypass possibly because after surgery, the food bypasses the stomach and goes straight to the small intestine.

Am I a Candidate for Bariatric Surgery?
Typically you must have a BMI over 35 in addition to diabetes in order for insurance to pay for WLS. If your BMI is over 40, you are considered to have "Morbid Obesity" and are more likely be covered.
Don't know your BMI? Check it here: www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

More Questions?
Irene, our office manager and all-around caretaker for our PsyConOps practice has had WLS. She is always happy to share her insights, and she can sign you up for our Bariatric Support Group where you can meet people who have had the surgery and want to help others. We have developed a warm and welcoming community of people who understand what it's like to struggle with weight and who haven't lost hope. If you're shy and don't want to do anything formal, just give us a call at 575-652-4383. Tell us your concerns or ask your questions. You'll discover very quickly, that we really are here to support your needs. Hablamos Espanol.

I believe this will be my last blog post on Autism Spectrum Disorder (ASD). I don't consider myself an expert on this topic, but I've done a number of ASD evaluations by this stage in my career, and I've collected multiple resources that I regularly share with my patients who are on the spectrum. I know it may sound unfair, but I favor therapy with people who are neurodiverse; they remind me that there are so many different ways to look at,  and behave in, the world. Much of the time, Aspie's (individuals with the formerly used diagnosis of Asperger's syndrome), have no idea how valuable they are to society. Questioning norms. Refusing to accept unreasonable or illogical norms, they are sometimes blunt to the point of pain. These individuals will often place truth above social pleasantries, sometimes with unintended results such as losing friendships. Like they say, "If you REALLY want toknow how you look in that red dress, ask an Aspie."

Truthfully, sometimes I feel crushed by the need for ASD assessments here in Las Cruces, NM.  I have a waiting list and it's tough telling the people who call that I won't be able to see them for months. If there are any psychologists in the local area reading this who are conducting these evaluations besides me... HELP!

In the mean time, here is a list of Ten Resources I've discovered for Adults who are or are exploring whether they are on the Spectrum and who want to know more AND who live in New Mexico.

​These websites offer a nice compilation of tests you can take online for FREE to start your journey toward discovering whether you're on the spectrum. Remember these sites only offer screening tools and can't diagnose you. They are, however, a good way to start your exploration and may offer some insight you can bring with you to any psychological evaluation to kick things off.
1. Musings of an Aspie: https://musingsofanaspie.com/aspie-tests/
​2. Aspie Tests: www.aspietests.org/
​3. Embrace Autism: https://embrace-autism.com/aspie-quiz/

4. Advocacy
There is a New Mexico Autism Society that offers advocacy, education and support, services specific to NM. According to their website, they can support you by explaining state and federal legislation to assist families and individuals with autism. They plan activities for families and individuals with autism. They work to improve resources and are partnered with the Autism Society of America. They collaborate autism programs at the Center for Development and Disability at UNM and work with autism providers throughout the state.

5. Disability Financial Support
Adults with Asperger's syndrome may qualify for Social Security disability benefits.  An adult with autism can apply for SSI or SSDI (SSDI is only available to you if you have a work history from jobs that paid Social Security taxes).  Satisfying the requirements of a disability is not the only way to be approved for disability benefits. Individuals whose claims are not approved on the basis of specified disability listing can still seek help through a medical vocational allowance.  For more information, you can visit or call the local Social Security Office in Las Cruces: 
Las Cruces Office2141 Summit Court
Las Cruces NM 88011
(866) 563-9294
If you live elsewhere in the state of NM, you can find your local office through this website page: www.disabilitycarecenter.org/state-resources/new-mexico-social-security-disability/

6. New Mexico State Resources
This NM government website  is associated with the Developmental Disabilities Supports Division (DDSD) of New Mexico. They help with resources provided by the state for children and adults with Autism Spectrum Disorder (ASD) and their families:  ​https://www.nmhealth.org/about/ddsd/pgsv/autism/. Additional information and resources can also be found in the Autism Supports Training section of their website. They include Training links like: 

• Autism Training Calendar
• Autism Online Training E-Courses
• Autism Community Training Webinar Archive
• Autism Summer Institute
• Imagine Autism Annual Conference

7. Help with Accessing Services
To start accessing services for ASD, consider: Autism Spectrum Disorder Portal website. This is the NM Center for Development and Disability. This website has some cool features like a podcast specifically on Autism, a resource locator, online training, and even some support in Spanish. It looks like the Spanish section is a work in progress, but I went to the page and this is what they say, 
    
8. For Spanish monolinguals 
If you need autism resources including filling out social security or DD waiver forms, support groups, and have language barriers or do not know how to navigate the health system, you can call them at 505-925-6022 or send  an email at: HSC-AutismPrograms @ salud.unm.edu   

I could only find two ASD-focused therapy resources in Las Cruces, NM. I apologize but I don't have direct experience with either one of them. Most of the people I see already have counselors but they don't know they are on the spectrum until they come in for an evaluation so I don't get to see where they go once they've been diagnosed. If you know of a therapist that specializes in ASD issues/concerns, please feel free to reach out to me so I can add them to this list.

​9. Counseling Las Cruces
133 Wyatt Dr UNIT 3
(575) 526-9878

10. Aprendamos Intervention Team
301 Perkins Drive Suite B
Las Cruces, NM 88005
(575) 526-6682

If you know of some great people, resources or places here in New Mexico that can help adults on the spectrum, please send me your suggestions. You will be helping your community and that feels good!

A mom recently asked me why is her Asperger's son is so cold? His error-- not sending her a card for her birthday.  
"I told him that all I wanted was a little card from him, just something to show he cares, but he completely ignores what I need."
Is her son really a cold-hearted user who just takes and takes without giving anything back?

THE REAL DEAL:  Asperger's doesn't make people cold-hearted or even uncaring. But they DO have a HARD TIME with seeing the world from another's perspective.  WHY?  Because people with Asperger’s see the world from their own, mostly different, point of view.

Here are some of the  ways they see things differently,

- A Neurotypical person walks in a meeting room and scans the people sitting around the table, maybe checking for whose the most attractive, or the most powerful, or the best dressed. They are using the moment to get a layout of what is going on in that moment and considering what is expected of them as they walk in. Maybe even coming up with strategies for how they can meet those expectations.       
-  An Aspie walks in the same meeting room and sees the details --  the bright lighting above him, the sound of a woman's pen        tapping on the table... he looks down and sees trip hazards from computer cords crisscrossing the floor.

A Neurotypical person meets a new contact and looks them in the eyes while saying, "Hi. Nice to meet you."          
An  Aspie meets a new contact and does not look them in the eye because it feels "too intense". And they may mumble, "Hi." But don't ask them what that person looked like five minutes after its over. Most of the time, they will have trouble giving you a useful description.
 
So now that we know there's a difference. What about the son's indifference?

People with Aspergers typically care about how others feel, especially people they are connected to like a mother or father or a close friend, but they are more likely to consider their own way of looking at things first and then they get stuck there. So, in this case of a mom wanting a birthday card from her son, the son might think, "I have to go out and pick something out. Then I have to get myself to  a post office... I hate going to places with long lines...

Before he knows it, the task has morphed into a horror show and he tells himself, he'll do it later. 
 
Oh, also PROCRASTINATION can be a b-tch for people with Asperger's.  

So now, his mother's birthday comes around and her son has failed to honor his mother's "simple" request for a card because it's not really that simple for him. Also, because he has difficulty taking on his mother's point of view, he wonder's, "Why is a card such a big deal?"

If you ask him, "How would you feel if someone you loved didn't acknowledge your birthday?" He'd probably say, "Fine with me. I don't like a lot of attention on my birthday."

SO YOU SEE: Ignoring the birthday card has very little to do with his mom, and EVERYTHING to do with how her son sees the world. If you asked him, "Do you love your mom?" He'd probably say, "Yeah. I do."  But the difference between what he feels and what he THINKS and DOES can be really different.

If you think you might have Asperger's and that it was missed when  you were a child,  I can help. Just give us a call, and we can get you scheduled for an evaluation.

I'm working on a new book again. Every so often a topic presents itself as a book in my life, mostly through personal experience. Then I get obsessed. A subject for a book attacks me and becomes an itch that I need to scratch.

My first book about the Camino de Santiago was an attempt to make sense out of a life changing event-- walking an ancient pilgrimage in Spain. I wrote that book in a year while obsessing about the things that happened to me on that 500-mile journey. After that, I took a breather but the itch came back. I needed to share the lessons I gained from working with divorcing couples in the military. Every time I got tired and felt like giving up on that manuscript, I would see images of the people who survived their separation/divorce because of the principles I'd taught them. Those memories became a cattle prod for my lack of motivation and resulted in a book that, according to reviews, has stopped a lot of suffering.

And now, I'm driven by a new obsession. It happened as a result of COVID-19 when my Aspie son came to stay with us after he suffered a house fire. He is on the autism spectrum and is no longer a child. Our conflicts, and sometimes heated arguments got me to thinking about the learning curve we parents of adult Aspies (people with Asperger's syndrome) go through as we navigate the world of neurodiversity. When he was young and I wrestled with his diagnosis, there was a part of me that understood the disorder as a psychologist, but another side of me that just didn't get it.

                 "How could a kid with a Superior IQ have problems holding one end of a basic conversation?"

It was like watching a person playing a complicated board game and making it to Square 10, but collapsing on Square One. How was that even possible? Like Spock from Star Trek, who I swear was on the spectrum, for me, it was "not logical".

​Physics-no problem. Calculus-Roger that. Software programming-check. Responding when someone says, "Cold weather isn't it"-Panic attack!

What's up with that?

According to the Diagnostic and Statistical Manual of the American Psychiatric Association, the diagnostic criteria for Autism Spectrum Disorder requires that a child show  persistent deficits in each of three areas of social communication and interaction. I've tried to call attention to the main concerns by underlining and using red font.

​Here is a downloadable link to the DSM V criteria.

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
   2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
   3. Deficits in developing, maintaining, and understanding relationships, ranging from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

               AND at least two of four types of restricted, repetitive behaviors:

Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

1. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
   4. Unusual reaction to sensory inputs or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

I was supposed to attend an herbal intensive in Taos this weekend but because of COVID-19, the event was held virtually. I'm more of a hermit anyway, so the idea of getting the information in my own quiet space was still appealing. The instructor, Tiarona Low Dog, a physician and master herbalist, offered all I expected and more. There are so many ways to understand medicine. I'll start by saying that they're not just pills you down with a cool glass of water and a big swallow. 

Medicine can be an herb that you add to your food, like turmeric that is a powerful anti-inflammatory used often in Indian cuisine. The antihypertensive called garlic that you mince and cook up with some great pesto. It can be the L-theanine "chill-axation" you get with a nice oolong tea.

I  can't remember the last time (before this class) that I thought of food as  medicine. I'm too used to stuffing my face with the things I love, like refined sugars and carbs: pasta, potatoes, cookies and ice cream. I'm  more inclined to think of my meals as a minefield of calories, carbs and weight gain. Could there really be some hidden society of sages that choose their food based on a decision to feel good or to relieve depression and anxiety? Yes! And they were at my herbal conference with Dr. Low Dog this weekend. I even discovered that you can reduce the glycemic load of your meal by 35%, just by adding an acid like vinegar, lemon or lime juice, 
​How cool is that?