Therapy Can Work

Katherine Rabinowitz, LP, M.A., NCPsyA

Licensed Psychotherapist & Psychoanalyst
Union Square, Greenwich Village, New York, NY

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Therapy Can Work

Katherine Rabinowitz, LP, M.A., NCPsyA

Licensed Psychotherapist & Psychoanalyst
Union Square, Greenwich Village, New York, NY

Stress Management & Coping Skills


“Yesterday is gone. Tomorrow has not yet come.
We have only today. Let us begin.”
~Mother Teresa

Stress. We all experience it – it’s normal, a fact of everyday life. And not all stress is bad. Optimum levels of stress function as motivators, galvanizing us to solve problems, succeed in school, work, sports and all competitive life situations. So in small doses, stress is energizing. This kind of stress is sometimes referred to as “eustress.”

But that’s not what most of us think about when we think of stress. We think of it in negative terms, as something to, at worst, cope with or lessen, or at best, eliminate from our lives. Unfortunately, that’s not possible. Everyday events from the mundane – going to college for the first time, final exams, a new job, work deadlines, difficult bosses, moving, noisy neighbors, a fight with your other half or a parent, to more significant events like marriage, children, a big promotion; to the most difficult life changes including divorce, illness and death of a loved one – all, from the least to the most significant are sources of stress, even when they are joyful events.

Is It Real?

Most of what we identify as stressful, as in, “I’m so stressed out by (fill in the blank)” are external events over which we have no control. In extreme situations – someone holding a knife to your throat or that moment when you know you’re about to be in a car accident – it’s appropriate to be afraid, and excess adrenaline begins to pump through your system. Your body becomes highly charged in response to the stress – your heart rate and breathing speed up, and the fight or flight state of readiness takes over. In a real emergency, that’s a good thing. Usually, though, there is no immediate genuine danger, but our minds and bodies react as if there were, and work overtime defending against the perceived threat. Even though it’s often a kind of false alarm, our brains get used to that charged-up state and respond accordingly. Like a pre-set on your music system, the brain jumps right to it automatically in response to certain stimuli. It’s become “kindled,” and ready to burst into flame at the slightest provocation, whether merited or not.

Reacting to Stress

We have stories we tell ourselves about this. “I’ve got too much on my plate right now – you can’t imagine what it’s like.” “That’s just how my family is.” “You know me, I’m always hyper.” What’s key here is, it’s not the external event itself so much as our interpretation of it, and our reaction to it that causes us to feel so stressed.

We can’t change the world around us, we can’t prevent some of these stressors from occurring, but (and this is the good news) we can change how we react to them or cope with them. Some of our responses are unconscious and instinctive, others are learned, and as with much maladaptive behavior, often go way back to our earliest days.

Not everyone reacts to external stressors in the same way. Some people thrive on public presentations, others dread them. You might be someone who loves going to parties where you don’t know anyone and “working the room;” or you might find that sort of social event very stressful. A job interview is actually a pleasant challenge for some, though stressful for most. So it all depends on how you perceive what’s happening, and how you assess your ability to deal with it. Generalities are just that – they don’t necessarily apply to you. How you function best can only be determined by you. “Normal” varies and is hard to define. The key is to figure out what’s normal for you – how much stress helps you excel, how much is run-of-the-mill but tolerable and how much actually interferes with living, and, if chronic, eventually negatively affects your physical and mental well-being.

Symptoms of Chronic Stress

How do you know you are experiencing chronic stress? Again, it’s not what’s happening, but how you’re coping with it. Some things may be habits you acquired a long time ago, that you would explain to yourself (or someone else) as “just what I do,” like biting your fingernails, tapping your feet, pacing or overeating. There are dozens more, some of which may also be signs of more serious physical or mental disorders, that should not necessarily be dismissed as “just stress” and should be checked out by your doctor. Here is a partial list. It is not intended to be complete, just suggestive:

and of course the more serious symptoms of escape into and eventual dependence upon and abuse of drugs and alcohol, as well as eating disorders, heavy smoking, mood disorders and violent behavior.

I want to repeat that the items on the above list, and others not mentioned, can sometimes be symptoms of illnesses not attributable to mild or typical stress, so before chalking them up to “just stress” or ignoring them, you should always first check with your doctor to be sure.

Causes of Stress

Generally speaking, we can say that change of any kind can cause stress, even changes that are ultimately beneficial. We can all name half a dozen major events or situations that would be recognized by most people as stress-inducing

to name the most obvious ones. But not all sources of stress are of this magnitude, and not all are obvious.

Minor Stressors

You can probably add dozens of your own. These are all less extreme but nonetheless common everyday annoyances that over time can be responsible for a significant increase in stress levels. And all are recognizable as such.

But not all stressors are so easily recognizable. It might seem merely irritating when you discover your favorite sushi place has gone belly up, when your favorite yoga teacher is out sick, or when someone bumps into your fresh manicure. But some people unconsciously experience and react to these normal occurrences of everyday life as if they were “the end of the world,” not merely annoying. Sometimes certain personality characteristics create susceptibility to stress – like difficulty tolerating conflict of any kind, perfectionism, low self-esteem, and any one of many individual fears or vulnerabilities, like rejection, judgment, or guilt. Cumulatively, all of this takes a toll.

Consequences of Chronic Stress

When stress becomes a permanent part of the landscape in which you live, there can be serious physical and psychological consequences. Unrelenting stress wreaks havoc on the body. It wreaks havoc on the mind. It wreaks havoc on (and can destroy) relationships, both personal and professional. There is evidence that it can eventually weaken or deplete your immune system and lead to chronic physical conditions, emotional distress, and behaviors harmful to yourself and those around you. The symptoms become etched into your way of being in the world – become so much a part of who you are that it gets more and more difficult to function well. Things you might have handled capably in the past become overwhelming, and peace of mind is virtually non-existent.

Coping with the Stress

So now that we know all this, what can we do about it? Actually, there’s quite a lot we can do about it, approaching it from many different angles. Ironically, the first step is


Stress is normal, stress is a fact of life. It would be unrealistic to expect to eliminate all external stressors from daily living, especially in the busy, difficult times and city we live in. So the first step in reducing stress is accepting that there will always be some stress to cope with, and remembering that not all stress is bad. A mild to moderate amount can be motivating. Accepting that there are some things that are not within your control goes a long way towards reducing that feeling of helplessness that comes when something occurs that you can’t do anything about. And when it’s something out of your control, you’re spending precious emotional energy when you beat yourself up about it. It also helps to remind yourself that whatever it is, you will survive it. You may not like it a whole lot, but you can handle it (or learn to handle it). If you’re realistic about what can and can’t be changed, don’t sweat the small stuff, don’t try to control the uncontrollable (especially other people), recognize and accept your limits – you can’t do it all – you will be well on your way to towards life with lower and more tolerable levels of stress.

Identification & Evaluation

The next step is to take a long, hard look at what really stresses you out, how you respond to those stressors, and whether they’re really worth allowing yourself to be stressed about. (Yes, sometimes you have a choice.) A year from now, will I look back on this and think it truly mattered?

This is a part of the process that is difficult for many people. It’s easy to rationalize the ways you respond to stressful situations, because more than likely, it’s the way you’ve been doing it for a long time, and it feels “natural.” And quite possibly it’s how you saw people in your family react as you grew up, so it feels even more natural.

Being totally honest with yourself as you identify what stresses you, and how you deal with it can be tough. Is the stressor a necessary part of your life? Really? Is it permanent? Really? Do you find reasons to justify keeping that stressor in your life when in fact it’s at least possible that it’s not truly necessary? Are there changes you could make to relieve or at least reduce stress that somehow you just don’t get around to making, for all the reasons you’re able to explain to yourself?

Examining your patterns, recognizing and acknowledging the sources of your stress and your reactions to them, likely pretty ingrained and needing conscious effort to change, are the among the first things you can do to reduce stress.

Stress Avoidance

Sometimes, the very things you typically use to deal with stress actually ratchet up the level of stress rather than lowering it. It means learning to turn off that alarm we’re so used to having go off when something gets in our way. We make choices every day that can affect how much stress we encounter and experience.

If you know that leaving at a certain hour is going to mean the absolutely most crowded trains or roads, you can choose to leave 15 or 20 minutes earlier to avoid sitting in traffic or being stuffed into a crowded train. Use the time in the office to catch up on something you thought you didn’t have time for. An accident on the road is not always within your control, though putting on your makeup, texting or checking texts while driving, “just for a second,” is called asking for it. Figuring out routes around the traffic is within your control, and can be helpful. Banging your head on the steering wheel is not. Choosing public transportation, if it’s available, over driving, is another option.

If you know that spending time with certain people inevitably leaves you angry and frustrated, you can choose to see that person less often. You can change the subject if certain topics set off the stress alarm. You don’t have to watch the news if it makes you anxious. You can learn to say no if you’re someone who routinely and willingly heaps more responsibility on your plate than you can comfortably handle. It might mean losing the superhero image of yourself. Organize yourself better (being disorganized is stressful), prioritize and delete those things from your to-do list that aren’t genuinely essential. This usually means being better at distinguishing among should, must and maybe I could.

And finally, respect yourself, your downtime and your personal life as much as you do your responsibilities. You’ll be surprised how much it ultimately reduces your stress.

Attitude Adjustment


Simple shifts in attitude (reframing) can alter how we perceive and therefore how we experience stressors. Having made the appraisal that there’s not a thing you can do about being stuck on the highway, it can be an occasion to become enraged (again), or it can be an opportunity to get in another chapter of War and Peace on recording. (Ok, not War and Peace, but something – a comedy station, or music.) That’s reframing.


Learning to find the humor in a given situation is helpful. Things that seem deadly serious often have a flip side that’s funny. Choose to give your mood a lift. Be willing to relabel your perception. And this includes the ability to laugh at yourself, your foibles, your quirks. We all have them. Or turn to something humorous, that you know makes you laugh.

Proactive, Not Reactive

Instead of seeing yourself as the helpless victim of circumstances, choose to do something about it, if not for this time, for the next time. Not only does being proactive make things seem less dire, it’s empowering. You discover coping skills you never knew you had.

In your choice of reactions, less is more. If you’re over the top anxious about how that test came out, why not let it be a wait and see. Being anxious won’t change the result. Pacing the platform waiting for the train, leaning over the platform edge (dangerous) to see if it’s coming doesn’t make it come any faster. Imagining your conversation about your performance review with your hateful boss spends energy that could be spent on the current project. More often than not, imagined scenarios turn out to be far less catastrophic than you envision them.

Adjust Expectations

You can also considerably lessen your stress by restructuring your standards to something less than perfect. Sometimes good enough is good enough. If you’re someone whose vocabulary contains a high proportion of shoulds (and musts), you have an opportunity to reduce self-induced stress by easing up on yourself. Being more flexible in general, being less critical of yourself and others, and being willing to give in sometimes rather than arguing, which is stressful in and of itself, frees up energy spent on stress, making it available for more positive feelings.

Physical & Physiological Coping Skills


It’s probably not news to you that physical aerobic exercise reduces stress. It’s probably also not news to you that some form of physical relaxation reduces stress. And the same goes for the importance of good nutrition, getting enough sleep, not overdoing it on caffeine, alcohol or sugar. Sound mind in sound body. Familiar, right?

Sure, but it’s sometimes hard to follow through with, in these busy times. So rather than having the time, it’s a matter of making the time – of it being the conscious, mindful choice you make to help reduce your stress. It doesn’t need to be about joining a gym or becoming an athlete. You can take the stairs instead of the elevator. Not possible for 32 stories? Or even 17? Of course not. But you could do 3 and then take the elevator. Or choose to walk a few blocks to the next stop before getting on the bus or the train. Regular exercise produces endorphins – those natural feel-good hormones – in your brain, and nothing is better than natural endorphins for releasing all that pent-up frustration. Yoga, stretching, deep breathing exercises, and meditation also help. It doesn’t matter what you do, as long as you do something.

Healthy Diet & Sleep

Eating a healthy diet won’t necessarily take away your stressors, but it will help you be better able to cope with what comes your way. A poorly-nourished body is poorly equipped to supply the brain with the necessary energy for dealing with stress.

Caffeine, sugar and nicotine are all substances that can raise blood pressure and increase your stress levels. You could forego the extra-large coffee and have a medium. You could skip dessert, the mid-afternoon candy-bar or the extra cigarette break.

Exhaustion: priding yourself on “getting by” with just four or five hours of sleep a night is not a badge of honor. It’s a sure-fire way to minimize your capability of handling stressful situations. Sleep is fuel for the brain as much as nutrition is.


Finally, though some (recently controversial) research shows that strictly in moderation (one or two drinks), alcohol can reduce risk of heart disease and other ailments as well as be relaxing, taken in excess, it not only increases risk of physical illness, it’s an indicator that you’re using it to mask or treat your stress in a way that will not work in the long run. If you find yourself using alcohol (or drugs) to solve problems, you’re risking it becoming a problem itself.

Behavioral Choices that Reduce Stress

You Have Choices

Much of this is common sense, and again, probably nothing you haven’t heard before. What may be new is the idea that you have choices – you are not always a victim of circumstances, and even when you are, you have choices about how to respond. Making a different choice may not come easily, and requires conscious effort and practice on a regular basis, even if you’re not in a heavily stressful situation. Current choices may be habitual and not obvious to you that they’re choices, they’re just what you do without thinking.

You can choose to turn your phone off (completely off), not look at your personal email, text, Twitter or Instant Message at work. “Just five minutes” often turns into much longer, distracts you from the tasks you’re being paid to do, and often leaves you more stressed than before. You’re preoccupied with the personal matter and unable to devote your attention to work. The benefits of multitasking are an illusion – more and more research shows there is often a net loss.

If reading the news or following the market makes you anxious, you don’t have to (unless it’s your profession, in which case it opens a whole other set of questions). You can instead choose something you enjoy. Create a wider selection of options, not just that one thing you always do to give yourself a break. Find things that engage you and take your mind off your stressful situation. This will include carving out personal time, time off, whether within a given day, or within a year. Vacations don’t need to be expensive. Staycations can be restful as long as you truly stay away from work.

If it’s relaxing to you to spend time with people, you can, but if you crave alone time, you’re allowed to give that to yourself. Social over-commitment is for some people one of the most stressful circumstances going. It’s ok to say no, but if you’re not used to being able to do that, you may want to learn. Finding more balance in your life in both areas – work and personal life – relieves a sense of being overloaded. There may be some crunch periods where it’s not possible, but if it’s never possible, and you can’t cope with that, it may be time to look for something else, or figure out why you’re not giving yourself permission to kick back and chill.

Time Management

Good time management is critical. Prioritize, and delegate when you can. When you can’t, break the project into smaller, more manageable parts, and focus only on the part you’re working on rather than being overwhelmed by the whole. The importance of setting clear, realistic goals and deadlines can’t be understated, because when goals are clear and realistic, they’re achievable. Achieving goals reduces feelings of helplessness and builds confidence.

All of this is learnable. It’s about making choices, and taking charge of difficult situations, rather than letting them stress you out and feeling defeated.

Social Help with Coping

Reaching Out

A common reaction for some people who get overwhelmed is to withdraw from the world. Unfortunately, isolating doesn’t help. It’s important to be able to reach out. To talk to people who really get what you’re going through. To ask for help from your support network of friends and family when you need it. If you don’t have a support network, you might think about how to go about building one. If you have good role models, observation of how they handle stress can be instructive.

Expanding Personal Connections

If your only friends are people from work, there’s nothing to take you away from the sense of being at work all the time. Engaging in activities you enjoy will not only distract you from your worries, but can help you break out of your old circles and produce new friendships. If you have an old friend from high school or college who lives far away and it’s not practical to see each other, you can phone, write (email, or even snail mail a card or letter), text or even communicate face-to-face electronically.

The closer the connection (in person is best when you can), the more it’s possible to diminish the feeling of facing everything alone. Relying on just one person is not as helpful as having a larger group of trusted confidants, even if you can’t tell everyone everything. That one person may not always be available, and having several people to talk to will reap fresh perspectives on old scenarios.

People who have support manage stress better and tend to have fewer health problems than those who don’t. If friends and family aren’t enough, it might be time to seek professional help. Therapy can work.

Nurture Yourself

“There must be quite a few things that a hot bath won’t cure,
but I don’t know many of them.”
~Sylvia Plath

We live in difficult times and are often faced with challenges we don’t anticipate. While all the above sections deal with various ways to cope, none is more important than finding those things that comfort you, and giving yourself permission to indulge in them. Being kind to yourself is a necessity, not a luxury. Other than maintaining a healthy lifestyle and keeping a sense of humor, regularly doing something you enjoy is about as good as it gets when it comes to reducing stress. I could make a list of options that runs several pages, but there would be no point. While I will make some suggestions that have been helpful to others, I invite you to create your own list of self-soothing options, and avail yourself of one or more of them every day.

These are just a start. They may not work for you. If they don’t, add your own ideas. What works for you may not work for someone else. There is no right or wrong here – what matters is that it works for you. Create an array of options (the same old thing does get old after a while), that are nurturing, even if only in the smallest way. Cumulatively, and if added to the coping skills discussed above, they will help reduce your stress.

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