Posts tagged #therapy

Mental Health Within the 65+ Population and Their Caretakers

Much of the senior citizen, or 65+, population spends a large amount of time going to doctor appointments for psychical ailments and basic checkups. What many of them are not doing is going to mental health appointments for check ups or deeper issues. 

Generationally speaking, this community was born anywhere from the 1920s to the 1940s. Culturally and generationally, mental health in this time was not accepted as the societal norm and people with “mental disorders”, as diagnosed by doctors, were most likely sent to hospitals and assisted living for the rest of their lives. 

Nowadays, mental health is a big deal, to say the least. Learning about oneself, and the thoughts and feelings we have, and understanding our past and future is valued. Physical health and mental health go hand in hand, especially in the 65+ population.

There is an overabundance of life transition, including grief and loss, going on in this stage of life: retirement, kids moved away, grandchildren moved away, loss of partner, loss of friends, loss of siblings and other family members, loss of pets, change of home and neighborhood, moving into an assisted living home, and loss of self. Loss of self includes loss of own decision making, loss of independence and depending on others for help, loss of motivation, and loss of “old life”. 

Grief and loss may lead to depression or depressive symptoms including, but not limited to: feelings of sadness, emptiness, and worthlessness, loss of pleasure in things you once enjoyed, inability to sleep, drastic appetite change, low energy levels, emotionally numb, and suicidal ideations. 

*National Suicide Prevention Lifeline 1-800-273-8255*

*In emergencies of suicidal plans or actions, call 911*

Change is one of the hardest issues to overcome because there are so many things that people cannot prepare for. When changes happen in the 65+ community, people can be physically and financially ready, but mentally and emotionally, there may be much change and unpreparedness, and many emotions and thoughts swirling around, unprocessed. 

A big change among people who need care (65+ population) and their caretakers is role changing. This means that for many years (let’s say 45 years or more), the parent-child role has been structured to have the parent above the child, as the parent was in change and acted as the head of the household. Now, the child is above the parent doing care-taking activities, such as organizing finances, organizing doctor appointment schedules, meeting with doctors and lawyers, and becoming the matriarch or patriarch of the family now. 

Being a family member who is a caretaker is just as hard, if not harder sometimes. Watching the people you love change drastically and depend on you is heart-wrenching.

Issues can arise between people who need caring for and their caretakers. This includes: 1) Creating and keeping boundaries (parent-child quality time, important decision-making time, what a doctor can take care of versus what a caretaker can take care of, etc.); 2) Healthy communication (no yelling, have calm discussions, lay out the boundaries clearly, expressing and implementing expectations and roles, validation of thoughts and emotions, and understanding); and 3) Having a better understanding of what is going on for your family member mentally (see earlier parts of this post). 

It is important for the 65+ population (and their caretakers) to have helpful and strong support systems, as well as many ideas for coping skills (which are basically positive and productive distractions). A support system can include friends, neighbors, therapist, groups, clubs, and other family members. Some great coping skills include going outside for fresh air and vitamin D, outdoor activities, exercise, reading books, listening to music, coloring, and doing puzzles (this is also great for healthy brain functioning). 

If you decide to attend therapy, seeing a therapist who is non-judgmental and understanding is key. You must be comfortable with the therapist you are talking with to create positive change, or just to process emotions and talk through the pain. 

Life is continually changing and giving us easy tasks, as well as extremely difficult tasks. It is all in how you handle it, and I believe in you!

If you have any questions about this topic or other blog posts you have seen on here, or would like to set up an appointment, contact me with the information below! 


Gianna Russo-Mitma, M.S., Licensed Marriage & Family Therapist Intern

(702) 706-1811 - Practicing in Portland, OR

Let It Go

Let me preface this by saying, although I love Frozen and “Let It Go”, I promise you that this post will not be Frozen-themed…

Letting go is one of the hardest things to get through in life and in therapy. Sometimes we feel like the pain will never go away. People say that time heals all wounds, and while time helps, processing thoughts and emotions will also help. 

A couple of years ago, my colleagues and I wrote and published a paper on letting go and transitioning into a new journey in life, entitled “Commemorating the Past and Embracing the Future.” The paper was about an intervention that we created to allow people to make an easier and smoother transition into the next stage of life, whatever that may be. The activity is writing an obituary/eulogy, and then writing a birth announcement.

This also allows us to be the author of our own stories. We allow ourselves to have self-trust that we can get through tough situations, accept them, fix what we can, leave what we cannot, and move on to better things ahead. It also allows us to plan our goals, discovering that we know ourselves better than anyone else, and journeys are unique to every person. 

As the article states, this activity is for: 1) gaining closure; 2) putting behind negative aspects of your story; and 3) acknowledging positive aspects of your story and using those to propel forward. 

Some ideas on what to write both an Obituary/Eulogy and Birth Announcement for include: graduation, wedding, divorce, end of a friendship, moving away to a new place, kids moving out, leaving an old job, starting a new job, retirement, having children, and so much more. 

I made an easy Fill-in-the-Blank sheet for both the obituary/eulogy and the birth announcement. It’s like Therapy Mad Libs! Try it out! (See Template links below). 

Your journey is your own, and it is what you make of it. It takes everyone different amounts of time and effort to let go, move on, and start again. Good luck, you can do it! 


You can see the full abstract (or article) here: 


Gianna Russo-Mitma, M.S., Licensed Marriage & Family Therapist Intern

(702) 706-1811 - Practicing in Portland, OR


Obituary/Eulogy Template HERE

Birth Announcement Template HERE

Image from Google

Image from Google

Featured Newsletter Article

Hello all! 

I was featured in an article with the Oregon Counseling Association (ORCA) in their Summer 2015 newsletter. The article I wrote is called "Starting Over and Beginning Success Again" (page 5-6). I think this can be insightful to therapists, clients, and anyone dealing with transition and change in life (P.S. that is everyone!). Enjoy!

Posted on August 15, 2015 and filed under Success.

Sit. Shake. Heal.

In doing research for this blog post, I found many studies supporting that pets are a huge part of the healing process, physically and emotionally. Pets can help lower our blood pressure, thus reducing heart disease risk as well as decreasing stress levels. While it is important to take your prescribed medications, it also seems that puppies are a cuter solution than the emergency room. (Obviously, you should still go to the emergency room for emergencies!)

Many people that have pets and treat them as family feel a sense of purpose and belonging. This allows humans to feel like life is worth living, and to your pet, you are their entire world. Pets will love you unconditionally, not only because you feed them and give them shelter, but because you care about them and show love for them. 

When we surround ourselves with happy and positive people or animals, we become happier and healthier from our surroundings. Dogs have historically been brought in after crisis and after traumatic events (i.e. school shootings and natural disasters) in order to keep people calm and thinking positive. Recently, universities have been hiring companies to bring puppies into study halls to help students reduce their anxiety and regain emotional stability during finals week. 

As humans, touch is a very important language that we all speak. We forget sometimes the power of a hug, a cuddle, or even just a pat on the back. Even just sitting and petting your dog will improve your psychological state, and they love it, too! Additionally, be active with your pets. In Portland, it’s easy to take them places and include them in our hobbies. Car rides? They love those! Hiking? They need to release energy, too! Errands? They love new smells, and most places (without food) will allow your pet inside! 

Most of this post has been about dogs, but any pet that you love will help you! Cats, bunnies, birds, snakes, anything! Obviously puppies and adult dogs are generally more willing to jump all over you and go to public places; but maybe you have a cat like that, too. Whatever pet you have and love, make them a part of your family, daily life, and mental well-being. 

One last thing: It is completely normal to talk to your pet. Sometimes we don’t want to divulge all of our secrets to friends and family, and maybe your therapy session isn’t for a few days. Your pet will never judge you and will always love you unconditionally. Whether you talk to them about the weather, your job, or something deep and personal, they will just sit there and wag their tail because they see that their human is talking to them. Honestly, I talk to my dog throughout the day! 

I always bring my dog, Guinness, to sessions (unless people are allergic or fearful of animals). He is a calming presence and is always happy to receive love and affection from anyone who walks in the door. With a smiling face and wagging tail, clients’ faces light up and it seems that they immediately feel less stress.

Adopt here, and many other places around Portland and Oregon: 


Gianna Russo-Mitma, M.S., Licensed Marriage & Family Therapist Intern

(702) 706-1811 - Practicing in Portland, OR


Heat, Heat, Go Away, Come Again...... Never

Living here in Portland, we rejoice in the summertime! The rain and gray skies are FINALLY gone; we can go outside and enjoy the lovely summer air. We can also gain the Vitamin D from the sun that we have been missing for nearly 9 months. That summer sun and warm air feels so good. Summer makes it easier to drive, hike, go to the beach, camp, take vacations, eat on patios, and so much more! 

It all sounds so delightful! But then, we realize, global warming is real and the regular 80 degree summers turn into 95 and 100 degree summer days. We then retreat to indoors, where we have already been September through May. Sure, there were only about 2 weeks this year where the heat was almost unbearable (and AC units sold out daily at places like Home Depot and Fred Meyer). Yet that feeling of “I just want to sit on my couch in a bathing suit, in front of the AC, and do nothing”  felt like it was more intense this summer. 

Many people in the Pacific Northwest are diagnosed every year with Seasonal Affective Disorder, or SAD. This is due to the winter air, rainy weather, less sunshine, and shorter days. People may start to see their moods becoming more depressed and this can affect relationships, jobs, and more. Usually, summer is not the typical time to be diagnosed with SAD. 

However, I am originally from Las Vegas, Nevada, where temperatures of upwards to 115 degrees (or more) are pretty devastating, and unfortunately, pretty normal. People become depressed, angry, and irritable; they don’t want to leave their house or see friends and family because it feels so hot to do almost anything. Even getting into the car is an achievement because the inside of a car is about an average of 45 degrees hotter. The metal seatbelt will inevitably burn you, and the AC takes longer than expected to actually get cool. I believe that diagnosing Seasonal Affective Disorder in the summer is very real. 

While Portland may not have temperatures over 105 degrees, and while you, yourself, may not have the diagnosis of Seasonal Affective Disorder, summer is still difficult. This last month has been much hotter than usual, according to many weather data reports and the obvious happening of global warming. 

Many of us get very frustrated and angry in the heat. Here are some ideas to keep your emotions and behaviors in check:

  • Breathing exercises and cooling off body temperature before going outside 
  • Recognizing when you are hot and trying to cool off before conversations with anyone
  • Use I statements (I am hot, I feel frustrated, I hate this weather, I need ice)
  • Taking a time out and finding somewhere cool to cool off (no pun intended) 
  • Ask yourself, “Am I mad at this person/event? Or am I just really hot and annoyed that I am hot and annoyed?”

Maybe you're thinking, I don't feel anger or depression in the heat, but my coping skills are unavailable because going outside and practicing my hobbies is too difficult. Try some of these ideas: 

  • If you like sports, try indoor sports, and always stay even more hydrated in summer
  • Take a class - indoor classes such as art and music (Tualatin summer camps for kids, also!)
  • Stay indoors to explore - the movie or stage theater, the library, museums, etc. 
  • Take it to the beach! There are tons of lakes, rivers, and coastal space around and outside of Portland! The Columbia River, Trillium Lake, and the Coast! 
  • Try some new recipes that include cold food, cold drinks, or frozen ingredients

What are some ideas you have to cool off your anger or your body? 

Counseling for depression and anxiety, whether it be due to summer or not, can help anyone and everyone! Please contact me if you liked what you read here and would like to set up a consultation and appointments. Good luck, you can do it!

*** Please always remember to NEVER leave kids or animals in hot cars! Cracked windows do NOT help. Always take them with you!


Gianna Russo-Mitma, M.S., Licensed Marriage & Family Therapist Intern

(702) 706-1811 - Practicing in Portland, OR

Co-Parenting Your Children When You Are Conflicted, Separated, or Divorced

Parenting is already difficult. You probably already knew that. Parenting when you and your co-parent (ex-partner) have a hard time communicating, or when there is conflict within the family, is even more difficult. This seemingly daunting task can be helped with successful co-parenting. First things first: separation and divorce are not the issue, conflict is the issue. When there is less conflict, there is less communal stress, more cooperation from children, and more stability in families. 

The first question to ask yourself is: Where did I come from? What did I see growing up? How did my parents treat one another? How did they reward and discipline us? How did all of these things affect me? 

Now ask yourself: What are your children seeing right now? How are they interpreting relationships? How are they understanding emotions and communication? What are you modeling to them? How will all of this affect them? 

You and your co-parent are important people; your children are even more important, and I believe that you would agree. Children come first. 

Here are just a few helpful co-parenting ideas to start using today! 

Distinguishing between negative language and positive or productive language is a great first step to take! Switching negative and unhealthy terms to more positive, neutral, or productive terms will help your children’s emotions, thoughts, and behaviors. This will also help you and will improve the co-parenting relationship. Some examples include: 

(old term = terms to start using instead)

“My ex” = “my co-parent”

“My kids VISIT their co-parent on weekends” = “My kids LIVE WITH their [mom/dad] on weekends”

“My kids have a broken home” = “My kids are lucky and have two households that love and adore them!”

“Court, custody, child support” = talk about this in private, there is no positive way to talk about this around children or teens

Can you hear the angst and anger change to healthier emotions in these phrases? What are some negative words or terms that you could change to be more positive and productive?

Another idea to try is more business-type communication. How would you talk to a colleague at work? Would you yell at, scoff, or criticize them? I certainly hope not. When talking to a colleague, you are also probably less emotional and more logical, succinct, and have boundaries. In a couples therapy situation, we would be talking more about emotions and understanding, but with co-parents, we will be talking more about “business type” communication, like with a colleague. 

Use less emotions and use more logic (i.e. dates, times, locations), be cordial (i.e. please, thank you), and have boundaries (no hitting, no screaming, be able to walk away, and only talk of children, nothing from your old relationship as a couple). 

A great way to treat your co-parent in a more healthy manner is to understand that you both love your children and have contributed to their upbringing. Understand that no one is 100% one parent, everyone is half Parent 1, and half Parent 2. Genetically, this is the case. 

So, start to understand that if you insult your co-parent, you are also insulting your children, and believe me, they hear and understand you. Make a list of the positive things you passed on to your children, and make an equal list of the positive things that your co-parent passed on to your children. 

Always remember that this process of conflict, separation, and divorce, no matter how peaceful (or detrimental) it is, there is still going to be a sense of loss from every member of the family. For you, the co-parent, you may feel loss of not only a partner, but help around the house, financial loss, and loss of self possibly; your children may feel loss of family, loss of home structure, loss of pet and neighborhood friends (if moving or going back and forth), and more.  

The best thing to do is allow your children to feel loved, attached, protected, and safe. By spending quality time with them, always reassuring your love for them, and not placing them in the middle of conflict, children have a better chance at a healthier life.

Please try some of these ideas at home with your co-parent, and always keep in mind that while compromise with your co-parent doesn’t always feel good at first, it will help your children, and with compromise, the children always win! 

Counseling for co-parents, children, and the family unit is a great idea! Please contact me if you liked what you read here and would like to set up a consultation and appointments. Good luck, you can do it! 


Gianna Russo-Mitma, M.S., Licensed Marriage & Family Therapist Intern

(702) 706-1811 - I practice in Portland, OR