Psychological intervention can help ease life’s transitions–everything from positive events like marriage, a new baby or career advancement to more dire situations such as divorce, chronic illness, injury or the death of a loved one.
Emily Mohr, Ph.D, defines life transition as anything that shifts someone’s sense of self or identity that is not temporary, but happens because of the passage of time.”
Mohr, public education coordinator for the Massachusetts Psychological Association (MPA), southern regional representative for the MPA Board of Directors and practitioner at Child & Family Psychological Services, PLLC, in Weymouth, Massachusetts noted, “Both happy and unhappy events can prompt psychological distress, although responses differ from one person to another.”
“There are societal expectations with a positive event, [but] anything that exposes you to uncertainty carries the risk of threat. The threat comes mostly from the risk of failure, social disapproval or loss of social status,” Mohr said.
“It would be really lovely if our culture and society, in general, did a better job of not pigeonholing events into happy, sad, etc. We should have regular cultural conversations around just how complicated all these things are. It would go a long way in helping people not feel so distressed.”
Mohr added, “In any life transition situation, there are stressors that can cause depression, anxiety, changes in mood, increased irritability and reduced energy and motivation.” Some individuals might experience interruptions to sleep and social functioning or, more seriously, active or passive suicidal thoughts.
“Normalizing is an important part of therapy. Those going through life transitions have to realize it doesn’t feel great all the time,” Mohr said.
Mohr uses cognitive behavioral therapy (CBT) to help manage change and explicitly asks clients to sets specific goals. “I write a treatment plan that we can reflect back on. This blueprint keeps sessions on track and provides a framework to stay on topic.”
For some, college represents an exciting new chapter in life, but can be offset by adjustment challenges. Julie L. Quimby, Ph.D, founder and director of Psychology Specialists of Maine in Brunswick, understands intimately the issues that college students can face.
She cited the unique perception of loneliness as “a critical moderating factor” that students can mitigate by creating friendships and connections early in their college career.
“We recognize that college is a big transition. There can be a sense of loss of friendships, uncertainty in a new environment. We help students anticipate changes, provide support and help navigate ways to get more help,” Quimby said.
High-achieving students might experience “the imposter syndrome” as they now compete against others with similar academic records. “Their identity might have been attached to being at the top of the class,” Quimby said. “Fear of losing that standing is anxiety provoking.”
Well-intentioned parents can also contribute to college students’ transitional anxiety.
“Some students lean on the parents a lot. We help [parents] learn how to be responsive. This can add a layer of complexity,” she said, emphasizing that students who seek counseling throughout college tend to fare better and can anticipate upcoming challenges.
Whether college bound or not, some individuals between the ages of 18 and 29 face a number of challenges, from exploring identity and contemplating the future to changing relationships and focusing on personal growth, noted Michele Zager, Psy.D, private practitioner in Providence, Rhode Island.
During these years, individuals may question family beliefs, norms and expectations as well as their own values, she said. “They have to develop a sense of competence in their abilities, learn how to manage emotions and tolerate uncertainty. They have to understand their impact on others and tolerate others’ perspectives.”
Zager pointed out that introspection is part of normal and appropriate development, but may require intervention when it “…cause[s] distractions or impairment in functioning.”
Symptoms such as anxiety, depression, feeling paralyzed by decisions, changes in sleep or eating habits or using “quick fix coping strategies” could indicate the need for some type of intervention.
Suicidal thoughts, planning and attempts are also a risk factor during this time of life.
“Individuals are still learning coping strategies to regulate emotions. They are developing perspective on challenges as they accumulate more life experience,” Zager said.
This demographic has also grown up with social media and the Internet, factors that might contribute to challenges during a transition period, according to Zager.
“There is also FOMO – the fear of missing out. This is an age where you want to belong and your approval/acceptance could be affected,” she said. “Today’s different political and social justice movements also raise questions around identity development, sense of identity and agency. There is no blueprint to developing your identity.”
Sarah N. Gray, Psy.D, private practitioner in Arlington, Massachusetts; health psychologist and pain specialist at Spaulding Rehabilitation Hospital; assistant in psychology at Massachusetts General Hospital; and instructor at Harvard Medical School, counsels patients with chronic pain, serious illness or major injury in an effort to normalize changes.
Not only does significant injury or illness compromise physical health, it may also affect the psychological, practical, financial and social aspects of life, disrupting the “sense of self and identity,” she noted. “Patients need time and support to adjust to new ways of being. Early on, we do a lot of grief work.”
Gray uses an individualized approach to treatment that includes “…CBT, mindfulness, ACT, DBT and/or meditation to help patients cope and find a value-based life that’s right for them in the new normal,” she said.
Depending on the patient’s mood, she might use motivational interviewing to help assess the emotional state and degree of openness and willingness to engage. In some cases, solution-focused strategies work, while in others, a skills-based approach is more effective.
Patients with chronic pain versus more permanent changes, such as amputation, after-effects from stroke or spinal cord injury, sometimes harbor hope that they’ll fully recover, according to Gray.
“In those cases, I help sit with ‘not knowing.’ You don’t want to quickly move into accepting if it means no permanent change,” she said. “But hope can get in the way. You don’t want to throw the balance of hope off but need to focus on what’s most effective right now.”
Mohr added, “If you are still living, you’re vulnerable to stress-related to life transitions.”