Psych Central Original articles in mental health, psychology, relationships and more, published weekly.2015-11-23T19:35:47Z Marie Hartwell-Walker, Ed.D. <![CDATA[Gift-giving: ‘Tis the Season to Be Sensitive]]> 2015-11-20T21:32:19Z 2015-11-23T19:35:47Z ]]> The first Christmas after I was married, my new mother-in-law gave me a steam iron for Christmas.

“Now you can do a better job ironing my son’s shirts,” she said.

“Thank you,” I said through gritted teeth.

The gift was a hint about as subtle as a brick thrown at my head. She wasn’t at all happy with my attitude that a man who wants ironed shirts should iron them himself. I wasn’t about to change my position because of a shiny new iron. Battle lines were drawn.

That was when I was 20. From my perspective as a mature adult, I can rewrite my story. My mother-in-law was coming from a pre-feminist world. From her point of view, she might have been trying to help me become a good wife as she understood the role. Whichever narrative is the truth, it was a gift gone wrong.

Gifts always send a message, regardless of whether that’s the intention. They reflect something about the relationship between the giver and receiver, their values and their circumstances. Does the gift show that the giver chose the gift with care or was it something that could be given to just anyone? Is there an undercurrent of tension between them or a deeply felt sense of knowing? Is the gift an attempt to correct or one-up someone else in the family? Or is it a generous act of kindness? It depends. It’s not the object that sends the message, it’s the context.

A gift certificate for ballroom dance lessons, for example, will be felt as special by a guy who wants them. But it’s a hurtful gesture if given by the sister who fears her brother’s dance moves will embarrass her at her wedding.

In some families, the aunt who gives an expensive anatomically correct doll to her niece will be seen as enlightened and thoughtful. In other families, she would be seen as pushing her agenda on the more conservative mother of the child. A donut machine will be received as a fun gift by someone who loves to bake and who has no food issues. But if the receiver struggles with her weight and is gluten-free, you have to wonder just what was the giver thinking?

Extravagant gifts from an emotionally distant parent may not be well-received by a child who sees them as an attempt to buy him off. To older children or teens, gifts that don’t match their interests only demonstrate yet again how little a parent understands or cares about them.

Even if not hostile, practical gifts aren’t always appreciated unless the recipient has indicated they are wanted. Although helpful, the holiday timing of the help may provoke shame, resentment or sadness. A care package of canned goods may be just what an impoverished relative needs but may be felt as a tactless reminder of the income gap between the giver and receiver. An elderly grandma may prefer a red boa that affirms her young spirit to a warm sweater that makes her feel generic as well as geriatric.

That iron I got from my mother-in-law? The truth is, we needed one but our budget was tight. I would have been far more grateful if she had asked us if buying an iron would be helpful — and especially if she had given it to both of us.

If you are ever tempted to use a gift to send any kind of corrective message — don’t. It will probably be interpreted as the criticism it is. It won’t put someone on a path you think they should go down for their own good. It won’t win a person over to your point of view. It won’t compensate for not spending the time and energy it takes to maintain a good relationship.

Be equally mindful of the potential negative effect of a helpful gift. It isn’t helpful if the person being helped feels offended or diminished by it. If you want to help someone out with money or practical gifts, talk to them about it. A clear, tactful discussion beforehand can make all the difference.

Gift-giving occasions are an opportunity to be your best self; to show how much you care about those you love and to bring people closer to you through thoughtfulness. This doesn’t require a ton of money. It does require a ton of thought. Sensitivity to the personality, interests and circumstances of the recipient is the key to gifting well.

That means taking time out from the pressures of the holiday season to put yourself in the shoes of the receivers and to consider whether intended gifts will communicate what you want them to. Do your homework. If uncertain what this person at this time would appreciate, ask someone who knows. Then make a promise to yourself to be more attentive to the relationship so you’ll know the person better the next time a gifting occasion comes around.

Steam iron photo available from Shutterstock

K.M. McCann, PhD <![CDATA[The Neuropsychology of the Unconscious: Integrating Brain & Mind in Psychotherapy]]> 2015-11-22T22:16:34Z 2015-11-23T19:16:21Z What makes a person stubbornly repeat harmful behavioral patterns over and over again, seemingly unaware of past outcomes? After more than thirty years of clinical and supervisory practice, Efrat Ginot […]]]>

What makes a person stubbornly repeat harmful behavioral patterns over and over again, seemingly unaware of past outcomes? After more than thirty years of clinical and supervisory practice, Efrat Ginot is convinced that the answer lies in the unconscious mind. “[U]nconscious systems are resistant to change,” Ginot writes, and “the resistance is built into the machinery of the brain/mind.”

Despite research advances on mind and behavior, the unconscious remains one of the most elusive features in the psychological repertoire. Many psychological scientists view it as the shadow of the real, though research out of Yale from 2008 suggests the unconscious is not nearly as rigid and deliberative as we once thought. Contemporary cognitive science holds that our unconscious mind processes information through subliminal means, which implies a lack of conscious awareness and a lower range of sophistication.

Perhaps the most influential notion for the Western understanding of the unconscious comes from Sigmund Freud. Although Freud’s investigation of it came from individual case study examinations and was devoid of the scientific rigor we are accustomed to today, it remains the historic foundation upon which Western theories of consciousness are frequently based. Ginot’s book, The Neuropsychology of the Unconscious: Integrating Brain and Mind in Psychotherapy, is no exception.

At first I took this to be yet another book in a long line of reductionist treatises — treatises that espouse the superiority of neuroscience and all things material over that of the qualitative and intuitive nuances required for effective therapeutic intervention. But a closer look showed that my initial notions were, at best, skewed.

Ginot’s book, while at times thickly reductionist, achieves balance. Ginot shows how having a deeper understanding of brain mechanics can improve our work with clients — and how it can enhance our understanding of the unconscious in general. Hers is not a linear argument by any means. Rather, Ginot’s brilliantly researched book comes from a place of genuine sincerity. Her goal is to shed light upon an otherwise dark arena of the brain/mind. Her method of revelation comes not from laboratory trials, but from a reputable career of working with clients and experiencing, through those sessions, how the human mind works within its varied environments.

“There exists a very delicate and shifting balance between the power of repetition and the genuine wish to change,” Ginot writes. What she refers to here may correlate with the “plastic paradox.” Neuroplasticity, as researcher and author Norman Doidge writes in a recent paper, promotes flexibility and change within the neural pathways, demonstrating that the brain remains malleable — despite the rigidity of our conditioned behaviors.

In fact, because of our behavioral rigidity, we tend to project the notion of inflexibility onto the brain. We tend to assume that it, like our unwanted habits/patterns, is also unable to change. Despite our limited thinking, however, the brain itself, as a living organ, remains flexible and capable of change, whether or not we permit our behaviors to exploit those new pathways.

It all sounds very science fiction, to be sure, almost to the point of imagining our lives as composed of many selves, controlled, at times, by the sociocultural patterns we are conditioned to, and at other times by involuntary brain-body mechanisms. But that is precisely what neuroscience has shown our brain/mind experience to be!

Although Ginot treads lightly around the concept of neuroplasticity, she tacitly invokes its presence when she discusses the influence of the unconscious, and the techniques therapists can use to help reprogram behavioral patterns. Hers is an important book because it focuses on how to help the client in practical terms. She looks at how we can apply the revelations from neuroscience to improve lives in clinical practice. (When she speaks of “self-narratives” and the “unconscious” she means it in psychodynamic terms, but her examples can just as easily serve as evidence for plasticity and rigidity and perhaps a multi-layered mind theory.)

But for all the brilliance of Ginot’s research and her years of reputable clinical practice, her book is not very accessible. Part of a professional series from Norton, it may not appeal to the lay reader unless that reader is equipped with a stellar understanding of neuroscientific and psychodynamic concepts. Ginot does offer some explanation of the terminology, but the writing style itself is more akin to scholarly journal-speak than to the fluid, lively, and easy-to-understand prose found in fellow neuropsychology writers like Antonio Damasio and V.S. Ramachandran.

As long as a reader is not intimidated or distracted by Ginot’s expository style, this is a book worth referring to time and again as a guide for turning theory into practice.

The Neuropsychology of the Unconscious: Integrating Brain and Mind in Psychotherapy
W. W. Norton & Company, June 2015
Hardcover, 336 pages

Megan Riddle <![CDATA[Cutting the Soul: A journey into the mental illness of a teenager through the eyes of her mother]]> 2015-11-22T22:14:38Z 2015-11-22T22:14:38Z It is late on a Friday night in the emergency department as I lead the mother into a small family room off the hallway. She is here with her son, […]]]>

It is late on a Friday night in the emergency department as I lead the mother into a small family room off the hallway. She is here with her son, who is now sitting in the locked psychiatric wing of the ER. We sit down on the threadbare couches.

“Tell me,” I say, “what’s been going on.” Out pours a tale of a successful young man, off to college, his bright future ahead of him — then the gradual deterioration, the precipitous decline. Now, instead of sitting in an auditorium at graduation, the mother tells me, she is sitting in the ER, holding back tears. This is not the future she envisioned for her child.

Mothers of those with mental illness share a special burden that they rest of us can only begin to imagine. They have raised and loved a person, but that person seems to have disappeared. In her book, Cutting the Soul: A Journey into the Mental Illness of a Teenager Through the Eyes of His Mother, Theresa Larsen offers us an intimate look at the experience.

At fourteen, Larsen’s son Matthew had a “subtle” intelligence. “Sensitive and kind,” he “had high expectations and unrealistic goals,” taking advanced classes and serving as the sweet older brother for his little sister. Over the course of a few months, his mood began to sink. Sometimes he isolated himself; other times, he seemed like the Matthew his mother knew.

Then one day, he came to her, apologizing. “Mom, I cut my hand,” Larsen recalls him saying. “… Don’t be angry with me please. I was messing around with my pocket knife and I cut my hand. I didn’t mean to cut it this deep.” It was the cry of a confused, distressed boy, and set both Larsen and her husband, Erik, grappling for words as they clean his wounds.

“Were you trying to kill yourself?” Erik asked.

Matthew flatly denied it. But while the cuts were not so deep as to require an immediate trip to the ER, Larsen realized they represented something far deeper. After a trip to their pediatrician, she sought out mental health treatment for her son. Thus began a disastrous series of psychiatrist visits that would make anyone in the profession cringe and want to offer her an apology.

The cutting continued. “I couldn’t help it,” Matthew told his mother. “I don’t know what to do.”

Larsen intersperses Matthew’s own journal entries from the time, giving us a glimpse into his thought process. “Only a single action can relieve me of my misery, but it has been forbidden,” he writes. “Like a match it takes a few strikes to spark my courage.”

Desperately, Larsen continued to seek answers. After trying to avoid medications for Matthew as long as possible, she realized she had to. “I needed the prescription to work,” she writes, “or Matthew’s illness was going to destroy our family.”

Matthew continued to deteriorate. His self-harm progressed to suicide attempts, his thoughts devolved into psychosis. He was hospitalized, then in residential treatment. After cutting himself with a sharp plastic object he found while in residential treatment, he writes, “This is actually the first time I wanted to cut to kill. An attempt to murder myself. I wish it worked. Damn it. … The pain I cause my parents. They hurt because of me. I cry knowing how much hurt it causes them to see me like this. I must stop! I must! I will, damn it!” But he cannot stop, and it is quite some time before he or his family find relief.

These journal entries, alongside Larsen’s own words, show us both what the son and the mother have gone through. Brushes with others with mental illness — a young man who tried to break into their house; a shooter at their daughter’s school — all made Larsen wonder what the future held for Matthew. In therapy herself, she asked, “How do I cope with Matthew dying?” As a mother, she writes, “Constantly waiting for my phone to ring with more bad news, kept me in a state of perpetual crisis.”

Larsen honestly depicts the tight-rope of fear and worry that parents in her shoes must traverse every day, balancing their own needs and those of the family at large with those of the mentally ill member.

“Maybe you need to redefine what normal is,” one of Matthew’s therapists offered at one point.

As I saw with the mother I spoke with in the ER, having a mentally ill child means redefining many things. For anyone who has had a mentally ill family member, you know there is rarely (never?) a happily ever after ending.

There is, however, a happier for now.

For Matthew and his family, the new normal, while maybe not the original plan, is one filled with hope and possibility. “Reach out and grasp hold of everything you once knew,” Matthew writes in his journal. “A love for this contentment festers inside you. Unlock the potential your life now holds.”

Cutting the Soul: A Journey into the Mental Illness of a Teenager Through the Eyes of His Mother
CreateSpace Independent Publishing Platform, December 2014
Paperback, 348 pages

Lynn Margolies, Ph.D. http:// <![CDATA[The Barriers to True Forgiveness]]> 2015-11-20T21:50:04Z 2015-11-22T19:45:09Z ]]> As holiday and other family gatherings draw near, so does the pressure to be gracious, forgiving, happy and “normal.” Our expectations of ourselves and sense of others’ expectations can fuel internal conflict and guilt — particularly in situations involving ruptured relationships with parents or others.

Most of us know that holding onto anger and grudges is toxic to mental and physical health, as well as relationships. Alternatively, forgiveness can lead to better health and well-being, and even increase overall kindness. Forgiveness means letting go of anger, resentment, and the need for vengeance or justice. Paradoxically, when we forgive, we feel more empowered, freer, and less controlled by other people, allowing us to reclaim jurisdiction over ourselves and our lives.

Why, then, in some cases, can’t we just forgive?

Well, forgiveness is not so simple. We cannot just decide to forgive and command ourselves to make it happen through sheer force of will. Forgiveness can become especially loaded when family, cultural, or religious expectations threaten to shame or scare us into taking the high road. But forgiveness doesn’t work when we force ourselves to do it out of moral principle, guilt, fear, or self-doubt. Further, forced or superficial forgiveness can backfire. Rather than set us free, it can create insidious anger, resistance, and passive-aggressive behavior alternating with depression, guilt, and shame.

Forgiveness is most complicated when the person who harmed us denies that anything happened, normalizes it, or denies the impact it had. In fact, forgiving a spouse who fails to take responsibility and repeatedly offends has actually been shown to have negative — not positive — effects, increasing victimization and lowering the forgiver’s self-esteem (McNulty, 2011).

There can be no forgiveness if “nothing happened,” if the other person is not first held accountable in our mind, and if the offender’s position has overtaken the affective reality of our subjective experience. Forgiveness is not sustainable in the absence of significant self-reflection that establishes a cohesive, consistent sense of what happened and the impact it had on us.

The problem of denial becomes particularly relevant when the harm inflicted involves implicitly or explicitly blaming the victim, is invisible to others, and difficult to prove. Examples include sexual abuse and childhood psychological maltreatment: a pattern of making the child feel worthless, unloved, endangered, or only of value in meeting others’ needs (Spinazzola et al., 2014).

In these situations, the offending person’s position of denial and blame is often internalized alongside the truth of our own experience battling to be heard. This dual track leads to wavering between defending our right to be angry and secretly feeling guilty, ashamed, and self-critical. Both sides are played out internally without resolution or integration.

In this way, the mind-bending effect of past trauma is repeated later internally, reinforcing a dysfunctional family dynamic in which there is confusion about who is doing what to whom. When emotional manipulations and distortions are disowned and hostility disguised as caring, it’s easy to lose track of what’s really happening. Blame is projected onto the victim, who internalizes and holds the guilt instead. Particular personality characteristics of the offending person can protect him or her from feeling guilty or responsible, for example: self-centeredness, blurred boundaries, lack of self-awareness, possessiveness, inability to take responsibility for one’s own feelings and behavior, tendency to misinterpret other people’s intentions, and pathological certainty of being “right.”

Anger and refusing to forgive can serve a self-protective function by creating a necessary boundary between oneself and the other person when it is not otherwise possible. Anger allows for emotional and psychological separation by creating a tangible enough barricade between ourselves and the offending other to prevent us from being overtaken by their feelings and perceptions.

Anger here can have a soul-saving function, both as a signal that there is something wrong and a protective barrier while we come to know and embrace the truth of our experience.

Alternatively, ongoing anger can also be a sign that we are still hooked in a self-defeating pattern of trying to get validation and emotionally affect the person who hurt us. Staying emotionally entangled, whether in the relationship or in our mind, protects us from the grief and loss that comes with letting go.

When forgiveness fails, it’s not a sign of weakness, but often a warning from an authentic voice inside of us fighting not to lose the integrity of our self-experience. Struggles with forgiveness are commonly caused by unacknowledged communication from inside ourselves that need to be put into words and understood. Until we translate and process the message, it will persist in alerting us, like an unopened text, and frustrate our efforts to move forward.

Our brains keep track of our subjective perceptions, storing an implicit or visceral narrative often felt in our bodies. Before healing can happen, we have to tolerate and accept our feelings and refrain from silencing the vulnerable part of ourselves that holds our authentic experience. Empathic understanding of the injured part of ourselves is necessary to satisfy our unmet need for validation. Doing so releases us from having to keep a tenacious grip on our feelings as a means of holding on to our true self.

When we heal, we have greater flexibility and more options because we’re no longer controlled by feelings and memories taking center stage. But letting go of anger can potentially feel unsafe and complicating because it involves redefining our relationship with the offending person. However, forgiveness does not negate that the offending behavior happened, nor imply that it was deserved or defensible. Further, it does not force us into anything or dictate whether the recalibration takes place only in our inner world, or whether it crosses into our real-time relationship. Resolving anger and letting go of grudges can restore inner peace, wholeness, and a sense of freedom, reducing our susceptibility to the effects of judgment regardless of the boundaries we decide are best for us.


McNulty, J. K. (2011, June). The dark side of forgiveness: the tendency to forgive predicts continued psychological and physical aggression in marriage. Personality and Social Psychology Bulletin, 37(6), 770-783.

Spinazzola, J., Hodgdon, H., Liang, L., Ford, J. Layne, C. M., Pynoos, R., et al. (2014). Unseen wounds: the contribution of psychological maltreatment to child and adolescent mental health and risk outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 6, S18-S28.

Unforgiving man photo available from Shutterstock

Janet Singer <![CDATA[OCD and Spouses]]> 2015-11-20T21:38:29Z 2015-11-21T18:45:21Z ]]> Regardless of whether you knew your partner had obsessive-compulsive disorder before you married, my guess is life together hasn’t always been easy. Neither my husband nor I have OCD (our son Dan does) so I’m not writing from firsthand experience, but rather from my own observations and years of connecting with people who have OCD.

For the person with OCD, issues might include feeling as if your spouse doesn’t care enough or support you enough. Perhaps he or she gets easily frustrated with you, and doesn’t even begin to understand how tormented you are and why your lives (and possibly the lives of your children) have been turned upside down because of obsessive-compulsive disorder.

For the spouse of someone with OCD, maybe you feel as if your husband or wife is being selfish, following OCD’s directions with no regard for you or your children. Perhaps you feel your spouse isn’t trying hard enough to get well, and you resent him or her not only for all the slack you’ve had to pick up around the house, but also for allowing OCD to obliterate whatever joy you might still have in your lives.

You are both emotionally and physically exhausted.

To make matters worse, couples who deal with OCD might feel isolated, as it’s not the easiest subject in the world to talk about with others. If couples do reach out for help, either individually or as a couple, well-meaning friends and relatives might take sides or offer bad advice. OCD is tough to understand. Add all this to the fact that social lives tend to be negatively affected when OCD is in the picture, and you likely have two people who feel alone.

But you’re not alone. You have each other. Remember? For better or for worse.

From what I’ve seen, couples who have thrived despite OCD see themselves as a team. They work together against OCD, not against each other. What this means is that if you’re the one with OCD, you need to commit to getting proper treatment, which includes exposure and response prevention (ERP) therapy. Part of that treatment is accepting the fact that your spouse and your children will no longer accommodate or enable your OCD.

If you are the spouse of someone with OCD, you need to learn everything you can about obsessive-compulsive disorder, and even occasionally accompany your partner to his or her therapy appointments, if appropriate. Also, it’s very important to learn the correct ways to respond to your spouse when he or she is dealing with obsessive-compulsive disorder. One thing I know from personal experience is we cannot rely on our instincts when dealing with OCD. We want to naturally reassure and comfort our loved ones, but, in terms of OCD, that’s the opposite of what we should be doing.

I know I’m making it sound easy, but as most of us know, the truth is, OCD is messy. Progress is rarely linear, and there will be many ups and downs. Still, it is possible to overcome OCD. Open communication is important for couples in general, but even more so when dealing with OCD. It’s not uncommon for misunderstandings to arise. Cognitive distortions often come into play, and OCD will twist and turn things around every chance it gets. Couples need to be as open and honest with each other as they can possibly be.

Maybe the best thing couples can do is remember why they married each other in the first place. Both those people still exist, though they might be currently hidden by OCD and all the damage it has caused. But relationships can be repaired, and as you take one day at a time and move toward recovery, couples might find their marriage becomes even stronger than it was before.

Teamwork photo available from Shutterstock

Marie Hartwell-Walker, Ed.D. <![CDATA[The ‘Affair’ in Your Marriage Might Be Your Therapist]]> 2015-11-16T23:26:34Z 2015-11-17T18:45:13Z ]]> therapist_talkingCorinne is 26 years old and has been married to Ted for 5 years. She worries that her marriage isn’t what it should be. She thinks her husband is working too much and is distancing from her. She has tried to talk to him but he has suggested that she is too needy. Corinne has become increasingly depressed and irritable. She started therapy, thinking maybe he has a point. Maybe she is too needy.

Corinne’s therapist is kind and compassionate but has little training in couples work. She listens to Corinne’s complaints and validates her feelings. She suggests that Corinne trust her instincts about her marriage and says that maybe what she needed when she met Ted as a teen isn’t what she needs now. She should think about it. Further, the therapist doesn’t think neediness is the issue but is concerned about Corinne’s depression. She suggests that Corinne’s depression might be rooted in her discouragement about her marriage. She therefore refers Corinne to a psychiatrist for some medication.

When Corinne gets home, she tells Ted she’s not too needy and that their relationship is causing her depression — her therapist says so.

Ted feels defensive and angry that someone he has never met is judging him. He and Corinne have yet another argument about his commitment to his work. Corinne wishes that Ted would be as understanding as her therapist.

Over the some 40 years I’ve been a therapist, I’ve become increasingly convinced that people who describe their primary problem as conflict with their spouse are ill served by individual therapy. I’d even go so far as to say that, unless the therapist is skilled in couples work as well, individual therapy when someone is in a distressed marriage is likely to tip the balance to divorce.

Why? Because individual therapy focuses on the pain of the individual. The therapist has only the client’s reports about his or her spouse — which may be inaccurate or, however unconsciously, self-serving. Transference issues bloom as the client comes to see the therapist as the person who understands, cares and supports in ways the spouse does not. The client tries to get the spouse to do things differently — as the therapist has suggested in session. The spouse begins to wonder what her or his partner is telling the therapist and may become anxious, distrustful or resentful. The client accuses the spouse of not supporting the therapy and wonders “Why can’t you be as compassionate and wise as my therapist?”As the relationship with a third party, the therapist, becomes deeper, the spousal relationship becomes less so. This sounds very much like an “affair” to me — with all the destructive power that an affair can wreak.

The problem is compounded when there is a therapist for each partner. Now there are two sympathetic therapists listening to individuals complain “my spouse doesn’t understand me.” Instead of learning to understand each other, each member of the couple is turning to someone outside the marriage to listen to their feelings and offer solace.

Let’s say that Ted, in the story above, gets a therapist of his own. Ted tells the therapist that he loves his wife but is concerned about her depression. He adds that he has done all he can but Corinne seems to always want more. Further, he says, he hasn’t changed since they married and that it frustrates him that Corinne seems to want to change him.

The therapist affirms Ted’s feelings, telling him that he is fine just the way he is and that it is unreasonable for Corinne to try to change him. He suggests that Ted be patient because it may be that Corinne’s medicine hasn’t reached therapeutic levels.

When Ted gets home, a conversation goes something like this:

Corinne: I’m so glad you’re in therapy, too. What did your therapist say?
Ted: My therapist says that you should accept me as I am and not keep trying to change me.
Corinne: Well, my therapist says my feelings are important, too, and right now I’m feeling pretty hopeless about our marriage. You never have time for me.
Ted: Well, maybe if you weren’t so depressed, we’d have more fun. My therapist wonders if your medication is doing all it should.
Corinne, starting to cry: Maybe you’re right. I don’t want to split. I just want things to be different.

Skilled therapists know better than to make judgments on the basis of one spouse’s report. They are sensitive to the possibility of being represented by the client as taking sides. They work hard to keep the partner’s needs present in the sessions through careful questions and techniques that help the client see the spouse’s point of view. However, the therapist can’t control what the client communicates to his or her spouse and has to rely on the client to accurately report their spouse’s perspective and responses as well as their progress (or lack of it) between sessions.

These challenges disappear when both people are present in session. The result often is a more accurate understanding of the couple’s problems and why, despite love, intelligence and good intentions, they haven’t been able to solve their conflict on their own.

To avoid introducing an unintentional emotional affair via therapy into a marriage, it is wise to move to couples work when the problem is something about the relationship. Why? Because when there is distress in a marriage, the marriage is the “client,” not just the two individuals. A therapist cannot accurately see the dynamics of a relationship by report from only one of the parties. One partner cannot accurately and fully read and report the spouse’s point of view, even if trying very hard to be fair and reasonable.

If, instead, both people are present, the therapist can observe up close what goes on between them. During sessions, the therapist can note the strengths in the couple as well as the problem interactions and draw on existing interpersonal skills. The couple can be helped to see where their relationship has become stuck and how each contributes to the problem. New skills in communication and problem solving can be taught and practiced under guidance from the therapist. Each member of the couple can learn how to support the other in dealing with hurts and fears from difficult childhoods, former relationships, and current confusions. In the process, the intimacy and trust in the relationship increases where it should — between the two members of the couple, not between each member and their therapist.

Should all therapy sessions with married partners be with the couple? Not necessarily. It may be important for the treating therapist to see each member of the couple alone now and then. Sometimes one or the other member of the couple wants to rehearse how to share something with the partner. Sometimes extra individual sessions help someone through a stuck place that is grounded in their pre-couple history. However, when such sessions occur, the therapist must ensure that the content eventually comes back to the couple. Otherwise, the therapist is holding information the spouse doesn’t have. This can result in the partner losing trust in both the therapist and the other partner.

Of course, there are marriages that can’t and shouldn’t be saved. When one member of the couple is being abused or exploited by someone who sees no reason to change, it is advisable, even essential, for a therapist to advocate for at least a “time out” and maybe an end to the marriage. In such cases, the goal is to help the couple do so with the least chaos and emotional harm possible. Both the victim and the abuser should be offered individual therapy to help them each recover and learn from the experience so they can move on in a healthy way.

Related articles and video:

Rolandas Malinauskas <![CDATA[Why Exercise Helps Depression]]> 2015-11-11T21:02:13Z 2015-11-15T18:45:07Z ]]> Three hundred and fifty million people worldwide are affected by depression. In the United States, in 2013, estimates revealed that 6.7 percent of all American adults had suffered from a minimum of one major depressive episode during the past year. This was a total of 15.7 million adults. Estimates also show that around 17 percent of the American population will suffer at least one major depressive episode during their lifetime.

Physical health and depression can be interrelated.

The World Health Organization has stated that there are interrelationships at play between physical health and depression. One example of this is cardiovascular disease. The disease can lead to depression, just as depression may result in cardiovascular disease.

The WHO recommends that adults between 18 and 64 years old should engage in a minimum of 150 minutes per week of moderate physical activity. Alternatively, 75 minutes of vigorous physical activity can have the same effect, as can a mixture of both in the right quantities. WHO also recommends two or more days per week of muscle-strengthening activities involving major muscle groups.

Harvard Medical School reviewed medical studies that stretch back as far as 1981, and came to the conclusion that regular exercise can improve the mood of people suffering from mild to moderate depression. Exercise also can play a supportive role in treating those with severe depression. Additionally, studies have shown that those who take part in aerobic fitness programs enjoy both short- and long-term psychological benefits.

A 2004 research study concluded that exercise often is overlooked as an intervention by mainstream services in mental health care. Evidence has shown that exercise reduces depression, negative mood and anxiety. It also improves cognitive functioning and self-esteem. The WHO recognizes that depression may be prevented in the elderly by the use of exercise programs.

The biology of depression

As time goes on, we are understanding more and more about the biology of depression. Although the term chemical imbalance is a popular way to explain what causes depression, it really doesn’t go far enough to capture the complexity of depression. There are many possible causes, which can include genetics, brain chemistry that results in faulty mood regulation, medical issues, stressful life events and medications. The consensus is that a variety of these forces interplay to trigger depression.

Genetics and depression

In 2011 a European study found clear evidence that a region called 3p25-26, which is located on chromosome 3, can be linked to recurrent severe depression. However in this area of psychiatric genetics, numerous other studies have been carried out, and findings are not always consistently replicated. Yet the field is growing rapidly and technological advances will enable larger-scale studies to be carried out.

As important as this field is, it’s vital to remember that any genetical information that is discovered as part of medical studies, or on an individual patient basis, only provides one aspect of a patient’s personal history.

Outside and inside factors make up the whole

Well-being and mental pathology are influenced by the whole sum of the outside, as well as inside factors. The main inside factors are our complex brain chemistry, genetics and the nutrition our bodies receive from food, which comes originally from the outside. Outside factors, especially in the 21st century, are numerous. However, those which are known to trigger depression are stressful life events, medications and medical issues.

The easier outside factors that we can control, which studies have shown can prevent or help depression, are nutrition and exercise. Other outside factors, such as reactions to stressful life events, can also be helped with various therapies. A regular exercise program can trigger different brain chemistry.

Exercise and brain chemistry

Areas of the brain help to regulate our moods. A combination of specific brain chemicals, nerve cell and connections growth, along with how our nerve circuits function have a huge impact on depression. Experts believe that the production of new nerve cells (neurons) can be suppressed by stress. Neurotransmitters play an important part of this complex machinery. They relay messages between neurons, playing a vital role in how our nerve cells communicate with each other.

Exercise affects brain chemistry through a variety of mechanisms, which include neurogenesis, neurotransmitter release, and endorphin release.

Exercise and neurogenesis

Neurogenesis is the process of new neurons being created. FNDC5 is a protein that is released into our bloodstream when we are sweating. Over time this protein stimulates another protein, called BDNF – brain-derived neurotrophic factor — to be produced. This then triggers the growth of new synapses and nerves, while preserving existing brain cells.

This is especially exciting for those who are struggling with depression. It is also relevant for those over 30 years old, the age at which people begin to lose nerve tissue.

Neurotransmitters released during exercise

Exercise also stimulates the sympathetic nervous system, which then triggers more neurotransmitters. On top of this, serotonin and BDNF have a reciprocal relationship, each boosting the other. Serotonin, dopamine and norepinephrine are the neurotransmitters which are known to be released during exercise.

Serotonin helps regulate our moods, appetites, sleep patterns and inhibits pain. There has been plenty of research that shows some depressed people have lower serotonin transmissions. Serotonin causes feelings of happiness and security.

Dopamine is central to movement. It is also vital in how we perceive reality and in how motivated we are. It is also part of the brain’s reward system.

Norepinephrine is responsible for constricting our blood vessels and raising blood pressure. It is also thought to be linked to certain types of depression and can trigger anxiety.

Endorphin release

Endorphins are neuromodulatory chemicals, which means that they modify the actions of how our nerve cells respond to our neurotransmitters. They are released in response to stress and pain, and also to help alleviate depression and anxiety. Endorphins spark a more intense reaction than serotonin, that could be as extreme as ecstasy and euphoria, depending on the quantity of endorphins that are circulating.

Added benefits of exercise

Each of us has different amounts of neurotransmitters and endorphins in circulation. These are strongly affected by both nutrition and physical activity. Additionally, exercise reduces immune system chemicals that can exacerbate depression.

Along with the physical and psychological effects of exercise, a structured exercise program helps those with depression by giving purpose and structure to the day. Exercising outdoors comes with the added advantage of being exposed to sunlight, which affects our pineal glands, boosting our moods.

Planning an exercise program

If you or someone you know is suffering from depression, it is important to plan an exercise program that will work. Make sure the forms of exercise are enjoyable, and factor in more than one, if possible, as variety is the spice of life. Set some achievable goals and decide if you prefer to exercise in a group situation, by yourself or with an exercise partner. Many people find it helps to have a partner or group as part of their plan, to get support and to continue to feel motivated. Exercise logs can also be helpful, as a way of monitoring your progress.


Darlene Lancer, JD, MFT <![CDATA[Chronic Depression and Codependency]]> 2015-11-05T20:00:12Z 2015-11-14T18:55:21Z ]]> Dysthymia, or chronic depression, is a common symptom of codependency; however, many codependents aren’t aware that they’re depressed. Because the symptoms are mild, most people with chronic depression wait 10 years before seeking treatment.

Dysthymia doesn’t usually impair daily functioning, but it can make life feel empty and joyless. Sufferers have a diminished capacity to experience pleasure and may withdraw from stressful or challenging activities. Their emotions are dulled, though they may feel sad or melancholy or be irritable and anger easily. Unlike with major depression, they’re not incapacitated, yet they may have difficulty trying new things, socializing, and advancing in their career. Some may believe that their lack of drive and negative mood is part of their personality, rather than that they have an illness. Like codependency, dysthymia causes changes in thinking, feelings, behavior, and physical well-being.

Dysthymia was renamed “persistent depressive disorder” in the 2013 edition of the Diagnostic Statistical Manual-V. (I use the terms “dysthymia,” “persistent depressive disorder,” and “chronic depression” interchangeably.) Symptoms must have persisted for at least two years (one year for children and teens) and include at least two of the following:

  • Low energy or fatigue
  • Sleep disturbances
  • Increased or decreased appetite
  • Irritable or angered easily (for children and teens)
  • Low self-esteem
  • Difficulty concentrating or making decisions
  • Feeling hopeless or pessimistic

The symptoms must create significant distress or impairment in social, occupational, educational or other important areas of functioning. Although mood remains persistently “down,” it may improve for several weeks of feeling better. Untreated, depression soon returns for longer periods.

People are usually motivated to seek help in order to cope with a relationship or work problem or a major loss that triggers more intense symptoms. When they rise to the level of major depression, which can often occur in people with dysthymia, the diagnosis is “double depression” — major depression on top of dysthymia. Unlike chronic depression, an episode of major depression may only last a few weeks, but it makes a subsequent episode more likely.

Dysthymia affects approximately 5.4 percent of the U.S. population age 18 and older. The numbers may be much higher, since it often goes undiagnosed and untreated. Over half of dysthymic patients have a chronic illness or another psychological diagnosis, such as anxiety or drug or alcohol addiction. Dysthymia is more common in women (as is major depression) and after divorce. There may not be an identifiable trigger; however, in cases of childhood or adolescent onset, research suggests that there is a genetic component.

Although stress can be a factor in depression, some people don’t experience a life event that triggered their depression. There are individuals with chronic depression who blame their mood on their relationship or work, not realizing that their outer circumstances are only exacerbating an internal problem. For example, they may believe that they will feel fine when they achieve a goal or when a loved one changes or returns their love. They’re unaware that the real cause is that they’re striving to prove themselves to compensate for feeling inadequate, or that they have no life of their own, have sacrificed self-care for someone else, or that they feel unlovable and worthy of love. They don’t realize that their depression and emptiness stem from their childhood and codependency.

Codependents, by nature of their addiction to people, substances, or compulsive processes, lose touch with their innate self. This drains their vitality and over time is a source of depression. Denial, the hallmark of addiction, can also lead to depression.

Codependents deny their feelings and needs. They also deny problems and abuse and try to control things that they can’t, which add to feelings of hopelessness about their life circumstances. Other codependent symptoms, such as shame, intimacy issues, and lack of assertiveness contribute to chronic depression. Internalized shame from abuse or emotional abandonment in childhood causes low self-esteem and can lead to depression. Untreated, codependency worsens over time, and feelings of hopelessness and despair deepen.

Codependency and depression can be caused by growing up in a dysfunctional family that’s marked by abuse, control, conflict, emotional abandonment, divorce, or illness. The ACE Study demonstrated that adverse childhood experiences lead to chronic depression in adulthood. All subjects with a score of five or more were taking anti-depressants fifty years later. Other causes of dysthymia are isolation, stress, and lack of social support. (Research shows that people in abusive relationships aren’t likely to disclose it.)

Psychotherapy is the treatment of choice for dysthymia. It is more effective when combined with antidepressant medication. Cognitive therapy has been shown to be effective. Eliminating negative thinking can help prevent recurrence of depressive symptoms. In addition, patients need to develop better coping skills, heal the root cause, and change false shame-based beliefs that lead to feelings of inadequacy and unlovability. Goals should be to increase self-esteem, self-efficacy, self-confidence, assertiveness, and restructuring of dysfunctional thinking and relationship patterns. Group therapy or support groups, such as Codependents Anonymous or other 12-step programs are effective adjuncts to psychotherapy. Lifestyle changes, such as exercise, maintaining healthy sleep habits, and participating in classes or group activities to overcome isolation, also can have an ameliorative effect.

©Darlene Lancer 2015

Depressed guy photo available from Shutterstock

Janet Singer <![CDATA[OCD, Social Anxiety Disorder, and Treatment]]> 2015-11-05T19:49:37Z 2015-11-13T18:45:47Z ]]> Recently, I’ve been reading some articles on social anxiety, and it struck me how many of the situations and symptoms reminded me of my son Dan when he was in the throes of severe obsessive-compulsive disorder.

Those with social anxiety disorder typically are terrified of how others will perceive them, and this often leads to avoidance of various situations. While public speaking or being the center of attention in any circumstance might be obvious triggers, even something as mundane as having a cup of coffee with an acquaintance might be anxiety-provoking enough for a sufferer to just not show up. Panic attacks are common.

In this article, I talk about Dan’s sense of hyper-responsibility, which is an inflated feeling of responsibility. Because he felt his thoughts and actions might cause harm to his friends and loved ones, he dealt with this by avoiding them. He isolated himself, and while his actions could easily have been mistaken for social anxiety disorder, in his case it was his OCD that caused him to behave this way. As with social anxiety disorder, panic attacks were not unusual for him.

As is often the case, I am reminded how OCD, social anxiety disorder, depression, and generalized anxiety disorder, among others, are just labels to describe specific symptoms. Labels are a way to try to maintain some order and clarity over the messiness of mental illness. While these labels serve a purpose, I believe our main goal should always be striving to understand what is going on with the whole person.

So did my son Dan also have social anxiety disorder, in addition to his diagnoses of OCD, generalized anxiety disorder, and depression? Possibly. It certainly seems as if he fit the criteria. Thankfully, for Dan, it didn’t matter. Once his obsessive-compulsive disorder was under control, his other diagnoses fell by the wayside.

Of course, getting the right diagnosis as well as the right treatment isn’t always easy. While it is essential to have a good therapist, it is equally important for those who are suffering to be honest with their health care providers. If you have OCD or love someone with the disorder, you probably know that most OCD sufferers typically realize their obsessions and compulsions make no sense, and might even appear ridiculous. This realization, unfortunately, sometimes interferes with those with OCD being completely honest with their doctors and therapists. It’s just too embarrassing to talk about obsessions and compulsions (even though it’s likely the doctor has heard it all before) which obviously defy reason.

It’s understandable, and even ironic, that those with OCD might feel this way. We expect people with OCD and social anxiety disorder to be able to talk about these intimate details, when having coffee with someone they know might be too difficult a task. But it must be done in order to recover. For both OCD sufferers and those with social anxiety disorder, facing their fears is the ticket to living the life they want and deserve.

If you think you suffer from one or both of these disorders, I hope you’ll commit to facing your fears. You can start by meeting with a competent therapist who can help you get well.

Anxious woman photo available from Shutterstock

Megan Riddle <![CDATA[Dictionary of Emotions: Words For Feelings, Moods & Emotions]]> 2015-11-01T12:32:57Z 2015-11-12T19:31:01Z How are you? I’m fine. But am I really fine — satisfactory or in satisfactory condition? Fine has become a bland, pat reply, as standard as a handshake. What if, instead, we took a moment […]]]>

How are you? I’m fine. But am I really fine — satisfactory or in satisfactory condition? Fine has become a bland, pat reply, as standard as a handshake. What if, instead, we took a moment to examine the full spectrum of human emotion — and vocabulary — and considered how we really felt?

Maybe this morning you had a breakthrough at work and now you are illuminated (free from confusion or ambiguity; clear). Or perhaps the breakthrough makes you feel particularly judicious (having good judgment or common sense in practical matters). On the other hand, after a few beers and a friend’s sob story about a cute drowning puppy rescued in the nick of time, according to Facebook, you may find more maudlin (excessively sentimental, usually with drunkenness), while a true tragedy may result in feelings of melancholy (deep, thoughtful sadness). If fine is the beige of human emotions, Patrick Michael Ryan’s book, Dictionary of Emotions: Words for Feelings, Moods, and Emotions opens us up to the full color spectrum.

Ryan is not who you might expect to be the author of such a dictionary. Rather than a psychiatrist, therapist, or academic lexophile obsessed with feelings, he is a former actor. While trying to immerse himself in each character he portrayed, he learned that acting required him to explore the varying shades of human emotion.

“I found myself searching for tools to aid in improving both my characters’ emotional development and my own emotional intelligence,” he writes. “I desired the ability to assign emotions and the intensity of those emotions to each circumstance in each scene of the script.” Not finding an easily accessible resource, he decided to create his own, writing: “I realized that a dictionary of emotions would be of value for all of us who want to expand our emotional vocabulary.”

The Oxford English Dictionary defines emotion as a “natural instinctive state of mind deriving from one’s circumstances, mood, or relationships with others.” But while emotions may be natural and instinctive, coming up with labels for them can be tough. There is, actually, a word for the inability to identify and describe one’s own emotions: alexithymia. It appears in about one in ten and is a component of a number of psychiatric conditions. After exploring Ryan’s book, you will be whatever the opposite of alexithymic is. Polylexithymic?

Though, hmm… maybe I shouldn’t make up words. It might make me appear impetuous (impulsive; unduly hasty and lacking thought or deliberation) or inane (extremely silly or stupid).  Then again, maybe I’m just self-flagellating (extremely critical of oneself).

The Dictionary of Emotions is accompanied by a separate emotion journal. The journal is a series of prompts to encourage deeper exploration of emotions as they relate to particular events. It includes places to write the event (where, when, with whom) and a section to describe your related thoughts, feelings, and emotions. Each space is accompanied by an emotional wheel, with various emotional categories (joy, trust, fear, surprise, sadness, etc.) written around the rim, “to help you identify the multiple emotions, and the intensity of emotions, that occur during a single event” in a visual way.

I could see the benefit in filling out a handful of these, particularly if you had a therapist or someone else to discuss them with. However, there are probably close to a hundred pages of the same format, which seems excessive. More than one type of exercise in the journal would have greatly increased its utility, even if the basic premise is a good one.

The dictionary itself is fun to flip through as you sample various feelings and try them on for size. But while Ryan’s decision to put words in alphabetical order might seem logical at first blush, it isn’t practical for this particular dictionary. Part of the enjoyment of the book is finding new emotion words you might not have heard of or used before. But since the words are alphabetical, you have to already know the word or its first letter to look it up.

The book does offer an abbreviated list grouped by categories — anger, anticipation, disgust, fear, joy, surprise, and trust. But grouping words around emotional themes might have proved more useful. (Perhaps Ryan’s next book can be a thesaurus.)

Still, Dictionary of Emotions is engaging. Spend some time with it, and you won’t need to say fine again.

Dictionary of Emotions: Words for Feelings, Moods, and Emotions
PAMAXAMA, September 2014
Paperback, 350 pages

Lori A. MacKenzie, MA, LMHC <![CDATA[A View from a Therapist’s Broken Chair]]> 2015-11-04T21:29:54Z 2015-11-11T18:45:48Z ]]> Have you ever wondered if your therapist has or has ever had his or her own therapist? If you were to ask, do you think he or she would tell you?

It takes a good deal of time for a therapist to develop his or her own style of conducting therapy. It is a genuine reflection of both who therapists are personally, with appropriate boundaries, merged with professional approach, preferences and expression. Erring on the side of caution, most novice therapists maintain fairly rigid boundaries. Experience brings out more of the therapist’s natural tendencies and in time, a functional balance is realized.

I have come to be known as a therapist with a more casual, easygoing interpersonal style. Unpretentious by nature, an acquaintance once described me as a “daisy among roses.” Later on, they went on to say “You’re a daisy among roses and a daisy among weeds.”

Please do not mistake casual style with indifference to the content or motivation for therapy. Despite being more informal in form of delivery, I am passionate about the content, methods and dynamics of psychotherapy. For instance, I am a stickler about therapists receiving regular supervision. Although not required once licensed, I am a staunch believer that every therapist, whether licensed and practicing one year or 30 years, absolutely needs solid clinical supervision.

Also, I think all therapists ought to have gone through counseling of their own with some minimum time commitment. I wouldn’t want to meet with a therapist who hasn’t. I have received my own therapy at several points in my life. One particular period of about 18 months was solely for the purpose of undergoing therapy in preparation to become a professional counselor. I may not know what it is like to be in recovery from drug addiction or have grown up experiencing sexual abuse, but I know something of what it is like to sit in the “other chair.” I know the risk, the fear, the need for trust, the desire for and aversion to mental challenge, the anger and the pain.

I imagine my experiences as a counselee, my inborn temperament, my early life experiences and personality development led to my inclination to favor somewhat of a more relaxed therapy style vs. the traditional formal approach. So, would I answer the above question if asked by a client? It should come as no surprise at this point that, yes, I would answer. I know many therapists who wouldn’t. Incidentally, in my experience, most clients don’t ask. A seasoned therapist usually learns how to effectively shift the boundaries depending on the client.

All of these factors which contributed to the therapist I have become helped to cushion the blow (pun intended, you’ll understand soon) on the day I leaned back in my office chair during a session, bypassing the expected familiar “catch” after the usual partial recline, and falling all the way back with my feet flying over my head, stopped only by the wall behind me (err, the one which had been behind me 10 seconds earlier).

After quickly jumping up and realizing that I was OK, my first thought was how glad I was I had not worn a dress or skirt that day. My second thought was how glad I was that the client I was with was a female. My third thought was how glad I was that it was this particular client. My fourth thought was — well, I didn’t have a fourth thought. By that point, both the client and I were in tears and hysterics laughing. Assured that I was OK, we both broke out into spontaneous, side-splitting, gasping-for-air belly laughing which lasted about 20-25 minutes. Several times, we managed to begin to settle down only to start again when one of us could no longer contain it.

When the session was over, the client turned to me before leaving and told me it was one of the best sessions she has had. The next time we saw each other, she indicated that her mood was better for the rest of that day and well beyond. When I asked her why she thought that was, she speculated about several reasons: less focus on her concerns and woes, the pure healing effect of laughter, seeing her therapist handle an undignified situation with dignity, seeing her therapist be able to laugh at herself and not flee from potential humiliation. Perhaps it was all of those, I suggested.

To me, this unplanned incident with my client and its immediate and lasting impact is richly symbolic of the significant depth, multiple layers and paradoxical nature of both the therapy process and the continuously evolving relationship between client and therapist: the idea that simple humor may meet the need when technique cannot; that a therapist’s humanity may amount to a great deal more than years of training and expertise; that modeling healthy behavior when opportunity presents itself can be a more powerful tool than teaching or prescribing behavior.

Additionally, it serves to remind both the counselee and the counselor of a crucial truth: psychotherapy is provided by a therapist with a view from a broken chair. It’s a view broken by personal weakness or sickness or grief or heartbreak; broken by conflict or pride or exhaustion or confusion. If not broken, then it’s at least limp, unsteady, worn or otherwise damaged. Limp from life’s storms, unsteady from lack of balance, worn from exhaustion and damaged by the demands and disappointments of past and current life circumstances. I contend that regardless of whether you realize it, your therapist is providing you with psychotherapy from the view from their broken chair. Regarding the perspective of the seeking, hurting and vulnerable client, there is no better view from which to guide and grow.

Daisy photo available from Shutterstock

Megan Riddle <![CDATA[Healing from Incest: Intimate Conversations with My Therapist]]> 2015-11-01T12:30:11Z 2015-11-10T19:27:55Z Many subjects we once considered taboo are now the topic of dinner conversation: the lingering stigma of mental illness; transgender rights; rape and what constitutes consent. In many ways, we are more […]]]>

Many subjects we once considered taboo are now the topic of dinner conversation: the lingering stigma of mental illness; transgender rights; rape and what constitutes consent. In many ways, we are more open and honest about things that we used to leave undiscussed.

However, one subject tends to remain unmentionable, shrouded in a complex web of shame and secrets. Incest.

In Healing from Incest: Intimate Conversations with My Therapist, Geri Henderson bravely shares her story of trauma — and, ultimately, her healing. Cowritten with her former therapist, Seanne Emerton, the book provides an honest and often painful look at Henderson’s recovery.

In bits and pieces, Henderson brings us the story of her childhood. The book begins with what might seem like the end, but is really just another step in recovery: the death of her father. She attends the funeral, something she hadn’t intended to do.

“I didn’t care, not really, not about saying goodbye to my father,” she writes. “But I was glad I had come when I found out how much it meant to my siblings. I did all the things the eldest should do — be involved in the planning, organize the music, help choose flowers and casket, and agree to say something during the funeral.”

Here we begin to see the themes of her story: the secrets she keeps, her attempts to do the “right thing” and maintain the peace in the family, her complicated feelings about her father. Slowly we work back to her childhood. Henderson describes how she did everything a little girl can do to protect herself from the early morning visits from her father. It is a chapter that will make your stomach turn.

Even today, Henderson writes, she has trouble sleeping at night, haunted by a survivor’s instinct of self-protection. Yet the book does more than serve as witness to the horrors of her abuse. Ultimately, it is the story of her personal struggle to create the life she deserves.

With frankness, Henderson shares with us how the incest, and the messages it sent her, permeated the rest of her life. “Childhood is important for learning about the world, relationships, play and a whole host of things,” Henderson writes. “When most of a childhood is missing, so are the pieces that make up a whole life.”

“It was after the rape incident,” she writes, referring not to her father this time, but an episode with another man, “that I began to accept the fact that I had no other value than sexual, at least to men.” She continues, “It wasn’t that I wanted to say yes. I didn’t believe I had the right to say no.”

This, she writes, “became a long, miserable pattern and confirmed again and again that I was amoral and wicked — just like my father had said I was.”

Though the subject is powerful — healing from grave trauma — the style of the book can at times be difficult to follow. The narrative bounces from present to past and back again, structured around themes rather than a tight timeline. Henderson acknowledges this at the beginning, writing, “There is no chronology attempted in the narratives.” Instead, she explains, she wrote each chapter based on daily incidents that acted as triggers for her past experiences.

In some ways, reading the book feels a bit like talking to someone with post-traumatic stress disorder, the stories blending one into the next without a cohesive structure. While that may in fact mirror Henderson’s experience, it sometimes distracted from the story.

With Emerton as coauthor, we are also privy to the therapeutic process as Henderson seeks help. We see her struggle to tell her family what happened. But these sections, too, made the reading choppier.

Emerton was Henderson’s therapist for a number of years, and her commentary is interspersed in italics throughout the primary narrative of the book. While Emerton’s perspective is interesting, at times it further disrupts the flow. I sometimes found my gaze skittering across the italicized text to return to the main story. That said, her input does add something to our understanding of the healing process, even if it is done in a disruptive way.

Format aside, Henderson and Emerton have bravely gone where few are willing to tread, sharing an intimate and incredibly difficult story. We see throughout the pages how much Henderson has grown and changed. She acknowledges her ongoing struggles, noting that writing the book itself has “brought new waves of shame and pain for which I was unprepared.”

But, she assures us, she can see the light of survival at the end of the tunnel — “the light of hope and healing,” writing, “Though it disappears from time to time as the road curves around one obstacle after another, it is always there, closer than before.”

Healing from Incest: Intimate Conversations with My Therapist
MSI Press, June 2015
Paperback, 190 pages

Margarita Tartakovsky, M.S. <![CDATA[Clinicians on the Couch: 10 Questions with Psychologist Joe Dilley]]> 2015-11-06T17:07:59Z 2015-11-09T18:45:40Z ]]> DrJoeDilley

In our regular interview series we turn the tables and ask clinicians questions. We delve into both their professional and personal lives. We ask about everything from what they love about working with clients to the most challenging part about being a therapist. We also ask about the biggest therapy myth and how they personally cope with stress.

Plus, they share what the biggest obstacle for clients really is, along with the one thing they wish clients knew — and a whole lot more.

This month we’re pleased to feature Joe Dilley, Ph.D, a licensed clinical psychologist who specializes in anxiety and ADHD. He provides individual, couples, group and family therapy along with comprehensive psychoeducational assessment.

He’s the co-founder of Synergy Psychological, the private practice he operates with his wife, Dr. Carrie Dilley. The Dilleys chose the name “Synergy” to reflect the complementary ways in which the mind, body and spirit interact within the healthy individual or family. The name also highlights the collaborative nature of therapy itself.

Dilley is the author of the new book The Game Is Playing Your Kid: How to Unplug & Reconnect in the Digital Age. Outside of their practice, the Dilleys most enjoy long days of “active relaxation” with their daughter, Ashton, and their son, Jack.

1. What’s surprised you the most about being a therapist?

I’ve been surprised at how few words of mine it sometimes takes to create change for a client. It’s wonderful how nonverbal and non-directive the process of really good therapy can be. Simply creating a space where your client can tell her story — a space where she knows she is heard and validated — facilitates so much healing and growth in itself.

With that kind of environmental context, sometimes the gentlest and shortest of responses on my part (whether those are nonverbal affirmations or spoken observations or questions) can have a most significant impact.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy?

The Lucifer Effect, by Dr. Philip Zimbardo (which, technically, I’m still finishing). I love how he demystifies the phenomenon of how good people can come to do bad things, and then takes a wider look at how larger systems can inadvertently induce this kind of behavior. It’s a thorough investigation into intra- and interpersonal dynamics and how they can play out, which is sometimes diabolically.

3. What’s the biggest myth about therapy?

The myth comes in two parts: 1) That there has to be something wrong with you in order to go, and 2) that therapists analyze everything you say and do.

The truth that overrides part 1 is that all of us encounter challenges, and the process of navigating those can be streamlined by coming to know ourselves better, with therapy being a vehicle for self-exploration. In fact, the therapeutic relationship represents perhaps the primary vehicle for getting to know oneself. A professional relationship in which one party is trained to deepen the other’s self-understanding would seem to be the clearest “mirror to the mind” we have available today. Mere introspection doesn’t get it done, even for those of us who are therapists, much in the same way that a barber can cut his own hair but can only be sure he’s doing it well by using a mirror.

I alluded in a previous Psych Central interview to my wish that we could all approach the act of seeking psychotherapy in a way similar to the way we seek a checkup with the dentist: unapologetically and without fear of stigma. We take care of our mouths; why not our minds?

With regard to part 2: When I meet people outside the office and they hear I’m a psychologist, they sometimes ask if they need to “watch what they say” since I’m probably analyzing them. My wife, Dr. Carrie Dilley is also a psychologist and she has the best response to that question: “We’re all analyzing each other all the time. I’m just trained in how to do it so that it’ll benefit you!”

4. What seems to be the biggest obstacle for clients in therapy?

Change, even for the better, is hard. Homeostasis — within the client’s personal habits or even within the tendencies of the family unit as a whole — tends to predominate. Getting things shifted around for the better requires some rewriting of previous “scripts” in the way we act and the way we talk to ourselves and to close others, which doesn’t happen overnight.

5. What’s the most challenging part about being a therapist?

Balancing the need to be present and engaged with the need to maintain boundaries that allow you to stay effective, not just sympathetic; and that allow you to rejuvenate through ultimately “letting go” of the intimate emotional content your clients present to you each day.

6. What do you love about being a therapist?

I love how interesting people’s life stories are. I love being able to catch glimpses of the huge, collective narrative we are all participating in together, as a function of the human condition. It’s fascinating to get an idea of how things fit together in a macro sense. It’s incredible how this life in which we find ourselves impacts, and is impacted by each of us.

I also love being able to speak into someone’s life (again, sometimes nonverbally, if you will) in a way that immediately enriches it.

7. What’s the best advice you can offer to readers on leading a meaningful life?

My experience is that meaning is derived from purpose, because purpose offers context. In other words, purpose begets context begets meaning. In fact, without context, there’s no meaning. The greater purpose we determine that we have (and that our seemingly insignificant daily highs and lows have) affords the context in which to interpret our existence and the experiences we have during it.

So leading a meaningful life probably requires us to consider and pursue what our greater purpose is and to develop some working understanding, however limited it may be, of what our day-to-day experiences mean and what greater significance they might bear.

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?

Not only would I choose it again, I would do so and “double down.” I would choose it again and pursue it with even more zeal and gusto. If I had known how much I would end up loving what I do every day, I would have pursued the steps required to get here with an even greater assurance that all the hard work was going to pay off in spades — and not just for me in terms of my enjoyment, but for my clients and the way that I seem to be capable of helping them.

I like to think that if I were doing it over again, I would take any adversity more in stride, knowing that it is all part of the pruning process to get me to a most desirable outcome in the end.

9. If there’s one thing you wished your clients knew about treatment or mental illness, what would it be?

I want everyone to know that there’s a movement in our field called “Positive Psychology” that says, essentially, “Wait a minute. Psychologists are in the business of promoting well-being, not just treating symptoms.” So while mental illness exists, the way many of us modern psychologists go about conceptualizing the arc of therapy or the trajectory of recovery differs from a more medical model whose focus is disease.

We look at where the person’s been and what about their life needs to be addressed, But we offer continued, preventive support in ways that promote resilience and thriving in the now and for the future.

10. What personally do you do to cope with stress in your life?

I tend to engage in relatively spontaneous forms of self-care: I happen to believe in God, so when I encounter a difficult situation, I find it helpful to pray through it, and when I’m conscious of a blessing coming my way, I express my gratitude for it.

More ostensibly, if I have a couple hours on a weekend, I might trek over to Hollywood and peruse Amoeba Records where I collect vinyls, or if I find myself with a few minutes during the week, I’ll sneak out of the office for a quick mindfulness walk.

I don’t know if I find anything more relaxing than reading the paper with a cup of coffee, but I don’t sit still for long. During grad school, I stayed outside by training for, and running in the Chicago Marathon on behalf of the American Cancer Society. These days, with two young kids, I still try to make running part of my self-care, but I conquer considerably shorter distances. I decided the other day to train for a 10K this fall that promotes the makeover of the LA River. The finish line is at the entrance to a brewery, which also might have added to this race’s appeal …

Jan Stone <![CDATA[Book Review: Meditation as a Way of Life]]> 2015-11-01T12:21:31Z 2015-11-08T19:21:13Z Meditation is rarely easy. But for some, the practice seems too centered on a faith or belief system that may not match their own. Alan Pritz, an interfaith minister and spiritual disciple of Paramahansa Yogananda, […]]]>

Meditation is rarely easy. But for some, the practice seems too centered on a faith or belief system that may not match their own. Alan Pritz, an interfaith minister and spiritual disciple of Paramahansa Yogananda, offers Meditation as a Way of Life: Philosophy and Practice to people of all religions.

Based on the mind-body principles of meditation from a classical yogic perspective, the book is full of concepts — concepts that Pritz encourages us to learn before we move on to the actual techniques. He writes in depth about awakening, self-consciousness, self-awareness, reality, enlightenment, and mysticism, and gives readers a sense of the essential attitudes and behaviors necessary for inner awakening. These, he writes, “are the cornerstones of spiritual training.” And, he posits, “Although soul growth is a delicate thing to measure, there attributes, when perfected, demonstrate proof of soul maturity.”

Once we as readers have a substantial understanding of the spiritual journey that enables a spiritual awakening, we move on to more of the praxis. Pritz provides concrete directions on how to use our energy, also referred to as life force, chi, qi, or prana. Energy-building practices are as important as meditative ones, he writes, and he includes exercises and sequences for both.

Finally, Pritz covers concentration and how to control it consciously and with mantras, bringing us to the pivotal point: attaining self-realization through meditation.

The path, Pritz knows, is difficult and long. “Even small steps forward are significant,” he encourages us. What we do in our practice, he writes, helps make internal connections more enduring.

And to help us keep at it, Pritz offers some wisdom. “Take solace from Yogananda’s counsel that saints are merely sinners who never give up,” he writes.

Pritz shares that a friend who read a draft of the text asked for a roadmap, a how-to-proceed guide, and the author complied. So, for more practical and commonplace questions about meditation, readers can turn to the end of the book.

Meanwhile, the appendix covers spirituality and religion, complete with Mayo Clinic definitions, presumably to aid those who might feel conflicted. (Though if someone has enough doubts about whether meditation jives with their faith, they probably won’t get all the way to the last pages.)

This is a thorough tour of meditation, and the concepts can be dense to navigate. One can certainly flip to the end for that easier roadmap — but as Pritz demonstrates, the truth is in the details.

Meditation as a Way of Life: Philosophy and Practice
Quest Books, August 2014
Paperback, 288 pages

Lauren Suval <![CDATA[The Rumor: A Novel]]> 2015-11-01T12:22:01Z 2015-11-08T03:16:21Z Did you hear? Grace, mother of two and wife of real estate mogul “Fast Eddie,” is in the midst of a passionate love affair with Benton Coe, the architect. (They must be […]]]>

Did you hear? Grace, mother of two and wife of real estate mogul “Fast Eddie,” is in the midst of a passionate love affair with Benton Coe, the architect. (They must be doing much more than chitchatting about the intricacies of her lavish garden.) And, did you know? Supposedly, her garden will be featured in a big spread in The Boston Globe. And what will we do about Grace’s daughter, Allegra? Was that marijuana she was found with in a scandalous photograph?

Meanwhile, Madeline, Grace’s best friend, has a book deadline approaching, and she purchases a space in town to write. Unless it’s that her marriage is on the rocks, of course.

In her latest novel, The Rumor, Elin Hilderbrand brings readers back to Nantucket. With her trademark imagery and profoundly rich character development, we delve into daily life on this charming island — gossip included.

Madeline, though she means to write something else, ends up using her best friend’s affair as the premise for her own upcoming novel, bringing about a personal dilemma that many writers struggle with: Should we create a great read even if it means ruining someone’s privacy?

I am not writing this, Madeline thought. I am not writing this. But she was writing it,” Hilderbrand writes. “The words were flowing out of her like something she spilled on the page. Grace had said it herself: Everything was normal and boring. And now … now, my life is a novel.”

As a writer, I constantly evaluate my boundaries. What is personal enough to share, to solidify a connection with an audience, but what’s too personal to publish? The line of public disclosure is not an easy one to tread.

And if others’ lives get pulled into story lines — not just the writer’s own secrets — the boundaries become even murkier.

But whether or not you relate directly to this writerly dilemma, The Rumor gets us thinking about the emotional impact of gossip. While people may talk about others in their social circles from time to time, generating stories just for the sake of it can lead to hurt feelings and strained relationships.

The book is certainly striking a chord with readers: a bestseller with 170,000 copies in print.

Thomas Farragher’s column in The Boston Globe — that is, the Globe in real life, not the book — calls Hilderbrand a “literary dynamo.”

“I think I write the best beach books out there because they have some heft to them,” Hilderbrand told Farragher. Indeed, The Rumor is both a substantive beach read and a fantastic look at what happens when we dish about our friends.

The Rumor
Little, Brown, June 2015
Hardcover, 384 pages