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This is a really great question and answer episode. If you hear some crickets chirping in the background, that is because it’s hot as balls outside, even at 11pm and there was no way I was about to record with the window closed.

Couple of quick updates before we jump into the questions. My new book “Does My Mom Have Dementia?: How to Recognize and Deal with Dementia in Your Loved Ones” is now out on Kindle and in Print! I’d really appreciate it if you could check it out. 

I’ve also started work on my next writing project which will be an anxiety book for teens – make sure you follow along for future updates!

With that said, let’s get into this week’s awesome questions…

I have a very specific severe anxiety when driving on the highway. I have had it for years and it’s intermittent. I have never stopped driving but avoid highway driving whenever possible. I have never been in an accident. What do you suggest? I have tried acupuncture and several depression/anxiety meds. Nothing helps. Thank you

Thanks for the question. First off, nice job trying to do something about it. You mentioned that it hasn’t stopped you from normal around-town driving and that you’ve tried acupuncture and medication for it. I like that you’re not just rolling over and taking it.

Exposure’s the name of the game

While this situation sucks for you, it’s also something that likely is very treatable. This falls in phobia territory. I’m not sure if your particular aversion to driving on the highway would qualify as a full-blown phobia, but it definitely has that vibe. Fortunately, phobias have a specific, effective protocol for treatment. The name of the game here is exposure. If you haven’t yet, check out episode 98 where I talk all about exposure. I also go super in-depth into exposure work for anxiety in my online course. I take you through developing a courage ladder and working through it step by step to overcome situations that cause serious anxiety. In your case, if you have a local therapist that you could work with that focuses on treating phobias and other anxiety disorders, that would definitely be a good option. That’s probably where you would get the most bang for your buck. But there is a lot that you can do on your own as well.

What you are going to want to do is try to first determine what aspects of driving on the highway give you a hard time. When you think about driving on the highway, is it the whole experience in general, is it merging onto the freeway, is it changing lanes, is it not being able to figure out where you’re going or is it something else entirely? This can help you narrow down where you need to focus your efforts.

From there, you will want to develop a progressive exposure protocol, which I call a courage ladder. A step-by-step approach to get you closer and closer to accomplishing your goal. On that note, you should also try to define what your goal would be. What would success be in this case? Like you might have the goal of being able to drive to work or to your parents’ house on the highway rather than trying to take side streets. Or maybe you’d like to be able to go visit a friend that lives a few hours away. Once you have your goal and your particular sticking points in mind, you then want to think about the smallest level of exposure that generates a moderate amount of anxiety for you. Not something that you would have to quickly escape or endure with a ton of discomfort. But something that just starts to get the anxiety juices flowing.

For some people, this starts with something very simple like watching a youtube video of someone driving on the highway or even simply imagining the process. For others, this is actually getting behind the wheel and doing something. With driving, the situation isn’t always easy to break up into little sub-steps because it’s hard to get exposure to say one small part of merging. But the concept is the same. What you want to focus on is repetition and duration. This is what most people get wrong with exposure. Rather than just doing something real quick, feeling a ton of anxiety, and then running away from it. You want to repeat it over and over, or for a long enough time, to feel like you have mastered that action or that step.

I’m reminded of when I was taking driving lessons. One thing that freaks out a lot of people or simply gives them a hard time due to the technical aspect of it is doing u-turns. So when I was in driving school, my instructor took me over near Knott’s Berry Farm to this busy street that had two protected left-hand turns so I could just go in a loop of doing u-turns over and over and over. Seriously did probably like 25 in a row. For you this might be merging on to the freeway, driving to the next exit, and then getting off. Or it might be changing lanes, driving somewhere you don’t know, or anything else that triggers that anxiety for you. The point is you do it over and over until it’s not a barrier anymore.

Use a safety net

You can also use some sort of a safety net that you fade more and more until you don’t need it. For instance, you could bring someone along with you that makes you feel calm and confident. Maybe that makes it easier for you to drive on the highway without issue. Then you would drive with them in the back seat instead of the front. Then you would maybe have them on the phone instead of in the car with you. Then eventually they wouldn’t be there at all.

With all of this, it’s a little hard to just give you broad general advice, since it’s so personalized. But hopefully this helps you understand the concepts behind it so that you can apply it to your own situation. Again, working with a therapist could help because they can work with you on developing the exposure protocol.

Hopefully that helps. Just think of it as training. You will want to make sure that you work on your general coping skills like breathing strategies, catching your thinking traps before you freak yourself out, and stuff like that. Obviously I have lots of resources for those things. These skills will enable you to endure the anxiety of the exposure protocol with confidence that you will be able to ride out any significant symptoms that you come across. None of this will kill you. None of this will hurt you. It can help to plan a little bit and think of what you might do in a given situation if something were to come up, just to realize that you have options, but you don’t need to over-plan it. You got this. It just takes time and repetition.

Hi Dr. Duff! I hope you’re doing well! My husband has a super close relationship with his mother, basically to the point where I feel like a third wheel around them. I’m really glad my husband is close with his family, especially since my parents were not physically affectionate with me at all (not that they didn’t love me). Whenever my husband and I get together with his parents, his mother sits on his lap and wraps her arms around his neck and proceeds to kiss up on his face and neck. All while I’m sitting next to him and there is plenty of room on the couch for me to scoot over for her to sit with him. This is the only physical contact between the two of them that makes me actively uncomfortable to be around, to the point where I feel like I can’t sit on my husbands lap (sexually or just casually) because I feel like that contact is reserved for his mother. I hate that it indirectly affected our sexual relationship in that respect. I just found out I’m pregnant with a little boy and I can’t help but wonder if this is a normal mother/son relationship because I know I could never do that with my son. I’m also slightly concerned about my son seeing his grandmother sit on his father’s lap and how that may affect him, if at all. Is it my lack of physical affection growing up that is clouding my perception of their relationship?

Thanks for sending in this question. I’m sure you feel really mixed up about this, probably partially doubting whether you should even care. So thanks for taking the chance on writing in.

A couple of things that I think need to be stated as groundwork for this question. First off, there are definitely huge differences with regard to culture in a situation like this. I don’t know what sort of cultural influences might be there in your case. So please take whatever my advice is with that in mind. If it’s a totally normal, expected behavior in your husband’s culture, then that’s just something to consider. The other thing that we need to establish is that this is the way you feel. You feel uncomfortable with this behavior. Before trying to get into whether the behavior between your husband and his mom is right or wrong, you need to allow yourself to acknowledge that this makes you feel uncomfortable. That matters and is worth looking into all on its own.

To me, this strikes me as a lot of affection. Certainly, my psychologist senses are tingling. First impression is that this seems a little oedipal and there may also be some degree of competition going on here from your mother in laws point of view. Either way, without context I think anybody listening will agree that this is a lot of affection. I also think that while your parent’s lack of physical affection for you definitely gives important context, I don’t think that it’s necessarily causing you to overreact. There is a range of physical affection from none at all to overly affectionate and for contemporary USA, I think this falls to the higher end of the bell curve.

Talk about it

My first question is have you ever talked to him about this? I think you need to be honest with the fact that this makes you uncomfortable. It isn’t necessarily a moral judgment or something that you think is disgusting – it’s something that you are simply uncomfortable with and that’s important for you guys to establish and talk about. I honestly don’t want to go deep into the specifics of why their relationship may be like this. There could be a specific reason like he was an only child, he served as a proxy husband while his dad was never present, I don’t know. Any number of things. But the important thing is not why they act this way. It’s simply the fact that you don’t like it and it is now impacting your relationship. If you bring this up and he refuses to acknowledge it or minimizes your concern, that is something that will need to be addressed. Couples therapy can help.

The way that I would broach the subject is simple to say something like, “Honey, do you remember last week when your mom was over and we were sitting on the couch? There was plenty of room for her, but she sat on your lap and started kissing you all over. I wanted to talk about that because it makes me feel a little weird.” I’d approach it with curiosity. You could say “I’m not mad or anything, it is just a lot of affection. Have you guys always been that way?” And then you should probably let him know that this is something that you have been thinking about for a while, even though you haven’t brought it up. You could say “I haven’t brought this up because I don’t want to offend you or get between the two of you, but that level of affection just makes me uncomfortable.”

You may or may not want to bring up how it has made you feel like you can’t sit on his lap and has affected your sex life. That probably depends on how receptive he is to the conversation. If he thinks it’s no big deal, you may want to be clear that it is impacting your relationship. It should be up to him to talk to his mom or change the way he behaves with her. You can’t be the bad guy here and if he makes you out to be the bad guy like “ugh, sorry mom we have to stop being all over each other because of my wife!” that’s a problem.

So that’s really all I have to say about this question. Who knows why they act this way together. There is no firm guideline on what’s inappropriate. That depends on your relationship. If you don’t like it, you need to say something and he needs to take you seriously.

Hi Duff, I recently discovered your podcast while searching for resources to help me in my new job. In May, I was hired as a Crisis Technician for a non-profit community mental health entity. This job is a great foot in the door for my eventual career as a licensed counselor; however, I am feeling the burnout already. I am often working with clients who are having some of the worst days of their lives. I seep compassion and empathy and this has definitely impacted my own mental health. To make matters worse, I am surrounded by fellow technicians and nurses who are majorly disgruntled at work and create a toxic workspace. How can a newbie deal with these struggles? Thanks in advance!

Thank you for trying to make a difference. This position is great experience for someone trying to become a licensed mental health professional.

First off, I want to say that it is normal for you to feel like it is a lot to work with the population that you are working with. Any organization like that should make it clear that that is part of the job. Nobody is immune to the impact of working in that sort of setting. So the first step is realizing that you aren’t weak or just blowing things out of proportion. By nature, you are in a high impact setting. As you said, you’re getting people on their worst days. Literally just about every person you talk to is in crisis. That is a lot. A full time practicing psychologist is only going to be working with a fraction of the crises that you are.

Basically this is boot camp for you. This is going to be something that really sharpens both your clinical skills and your personal strengths. As a counselor, you are going to need to have the ability to compartmentalize. Meaning, you need to be able to see situations and work with people through hard things without letting it seep all the way into your own personal life. It’s a skill that requires practice, which is exactly what you’re getting now.

Practice what you preach

It’s also important to practice what you preach. One of the things that you’re likely working with people on is the ways in which they think about and interpret their situations. That means that for you, you may need to adjust your thinking to help yourself cope as well. For instance, you might be personalizing a bit, which is when you assume that something has to do with you when it might not. For example, if you have somebody in crisis and you’re not able to get to the resolution that you would have liked in your session, you might blame yourself for that or take it personally. In reality, their crisis might have been so strong that it was always going to take a combination of things to help steer them in the right direction. Whether you’re personalizing or not, there are probably going to be some thinking traps that you’re falling into that you can identify. When you take things personally or have some sort of large emotional reaction to what happens at work, you may need to sit down with a pad of paper at home and write it out. See where you might be falling into some thinking traps (see my guide when you sign up for email list) that you can identify and work through. It can also be helpful to flip the situation and imagine that a friend of yours is going through what you are going through. This can help you go easier on yourself because you wouldn’t assume that they are not good at their job, a failure, not cracked up for this hard of work etc.

Make time for self-care

You also may need to carve out more time than usual for self-care activities. Activities that take your mind off work and replenish your energy. You need to do this otherwise you will burn out completely. This is a proactive way to avoid burnout. You won’t have to make such a point to do these activities all the time, but while you are in this more intense setting, hold yourself to it. Again, practice what you preach.

It’s also totally normal to have your own therapist. You may need a place to process both the intense stories that you are taking in and the problems in your workplace. I don’t want you to think that just because people around you are jaded and disgruntled that you are inevitably going to be burned out and just like them. A lot of that comes down to what habits you start building right now.

It also may be the case that this isn’t the right type of work for you. There are a lot of people that “do their time” working with more severe or intense populations and then go on to do less intensive work in their careers. In my line of work, I see some cases that are pretty intense and others that don’t affect me as much. I need to watch my own behavior and be sensitive to whether I need to adjust my caseload. For me, I notice that I might be more quiet, irritable, and easily overwhelmed by simple everyday life stuff. Those are my particular warning signs. You need to find yours.

Supervision and peer support are also super helpful. When you feel like you don’t know how to approach things or you wonder if you are doing something wrong, it can be really helpful to talk through some recent cases with someone else that also knows what you are talking about to get some feedback.

All in all, don’t forget that this is a job. You’re working with real people and you care about them, which is an asset. I think that the people you work with will always be thankful to have someone that is honestly empathetic and clearly wants to help. But this is still your job. That means you need to treat it like a job. Take time off when you need to, use HR when you need to, all of that good stuff. Just because it’s in the mental health field doesn’t mean that you are somehow exempt from the stuff that all other employees need to do to stay afloat. Use the resources that are available to you.

Thanks for the really good question – I think you’re going to do great in your career and I really hope it works out for you.

Thanks for listening!

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