O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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How Anger Hurts Relationships

Getting angry…is easy and everyone can do it; but doing it . . . in the right amount, at the right time, and for the right end, and in the right way is no longer easy, nor can everyone do it. —Aristotle, Nicomachean Ethics (II.9, 1109a2

Managing Conflict Rather than Eliminating Conflict

Conflict is inevitable in any long-term relationship. In the Gottman approach to couples counseling, we help clients understand that conflict is normal. Rather than eliminating conflict, we help them learn to manage it. Why can’t all conflicts be resolved? Because backgrounds and personalities don’t match exactly. Couples will always have some areas of disagreement: neat/tidy, disorganized/scheduled, emotionally expressive/keeps feelings inside, to name a few. Even two tidy people may disagree on who does more work around the house or, perhaps, what cleaning routine to follow.

By the time couples come to counseling, they have often been having the same argument in different forms for many years. The issue has become gridlocked—and just as drivers stuck in traffic feel angry and frustrated, partners who can’t move beyond an issue start having negative feelings about each other and the relationship.

Learning to Listen Without Anger

Anger is often the result of feeling misunderstood. When one partner feels like they are not being heard on a particular issue, and they likewise have trouble listening to their partner’s point of view, anger simmers, sometimes for years—finally coming to a roaring boil.

Jim and Joan came to counseling because she felt he stopped participating in the family years ago. Meanwhile, Jim felt disenfranchised. His views and opinions on how they were raising the kids were ignored and he felt he was “just a paycheck.” Joan felt he had checked out and was uninterested in her, the kids, or their home. They were both angry; they both felt the other was wrong. When they tried to discuss this problem it always escalated to screaming and yelling, often within earshot of the kids.

When they started couples counseling, they had had this same fight many, many times. Jim would withdraw; Joan would become more focused on her friends and the women in the neighborhood, whom she confided in and got support from. Joan and Jim were emotionally estranged. Not surprisingly, intimacy, both emotional and physical, had come to a grinding halt.

Gridlocked Problems: Begining to Compromise

When I listened to them discussing a variation of this gridlocked problem, I saw that each became angry quickly, and the result was they stopped listening to the other. Joan would lecture and Jim would face the other way, clamming up. People have many ways of expressing anger: he was seething inside quietly, and she was ranting loudly, but both were angry.

I stopped them when this happened and had them take just a few minutes to calm themselves. To go from anger to calm by learning to self-soothe is an important skill in all relationships, but especially in marriage. It can take just a few minutes to do this. This isn’t about swallowing or denying anger; the trick is to then re-engage in the conflict discussion with a more receptive and less defensive tone.

Staying angry is much easier, but “doing it in the right amount, at the right time, and for the right end, and in the right way” (as Aristotle said) produces quite different results when dealing with a perpetual problem. It is okay to be angry. But understanding why you are angry, and learning to express your feelings in a way that is clear and void of the four horsemen will lead to a very different conversation with a different outcome. Once Joan and Jim learned to talk about their conflicts without getting flooded, they listened to each other with deeper respect for the other’s feelings. This is the first step in learning to compromise.

Practicing self-soothing is something you can do at any age, and at just about any time. Listen to this simple three-minute ”breathing space” to feel the difference in your thoughts, feelings, and physical sensations when you take just a few minutes out of a difficult situation. For it is not just the repeated, unmanaged fights that damage the relationship, but the skewed and distorted perceptions that keep you stuck in gridlock, stewing, for years—over the same issue.

Try this brief relaxation exercise:  Three Minute Mindfulness

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140 Characters or Less: The Three-Sentence Rule in Communication

 

Couples frequently come to therapy complaining of communication problems. Conflicts don’t get resolved. Intimacy has left the relationship. They lead parallel lives. The focus is on the kids, or their work or friends, but not each other.

During the first session of couples counseling, I take a history of the relationship and ask them to talk about a current problem for ten minutes. Invariably one partner will dominate the discussion. In subsequent sessions, I see the same thing.

For instance, Jody and Tom came to couples therapy because Jody feels Tom never listens to her. She is upset because he tunes her out and doesn’t open up about his thoughts and feelings. Observing Jody and Tom for a few minutes gives an important clue to why they have come to this place in their relationship: Jody talks a lot. In fact, she talks in paragraphs—even pages. She is animated, eager to express herself. Tom sinks into the sofa, shoulders hunched in resignation as Jody takes over the conversation. There is no doubt that she has important points to make and makes them well, but Tom doesn’t get a chance to speak. When I prompt Jody to let Tom speak, he gets a couple of sentences out, and then Jody interrupts, speaking for him.

Who Talks More in Your Relationship?

I have seen this scenario over and over again in my work with couples. Do women talk more than men? This is a controversial issue and many factors come into play. American neuropsychiatrist Louann Brizendine reported that the average man speaks about 7,000 words a day, while the average woman clocks in at 20,000. My observations would bear that out, although admittedly, I see a skewed sample. However, I don’t think it is a genetic or neurological issue so much as a relationship one.

The very thing that Jody wants from Tom is closeness, but she doesn’t give him a chance to talk. The pattern gets further entrenched as Tom’s unexpressed resentment grows and he retreats into his own thoughts, which often see Jody in a negative light. This perpetuates the cycle, with Jody seeing him in turn as distant and aloof. Furthering the pattern is a subtle dynamic at play: as Jody sees Tom’s discomfort and reluctance, she talks for him—letting him off the hook, so to speak.

They each have a role to play in this dynamic but are not aware of their roles.
Using a variety of interventions, I have Jody and Tom change the way they talk and listen. I frequently invoke what I call the “three-sentence rule” for the partner who dominates the conversation. When they come to see the pattern, this rule is met with chuckles and relief. Jody doesn’t really want to do all the talking, and Tom wants a chance to be listened to.

Reciprocity is Essential to Good Communication

Lately, because of the popularity of Twitter, I suggest a rule of 140 characters or less. Tech-savvy couples know this means to limit talk to the most pertinent points, usually in three sentences. Pause. Give your partner a chance to respond. Resume. Reciprocity is essential to good communication. As Tom expresses himself more, Jody can relax and feel less need to control the conversation. In this way, couples learn more about each other, bringing closeness and, in time, greater intimacy. Couples are often surprised to see their patterns of communication are changeable.

So if you catch yourself speaking in paragraphs abounding with run-on sentences, stop and let your partner have a chance to speak. You may be surprised by what you learn from each other.

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Do Opposites Attract? How what once attracted us can begin to repel

We Seek Wholeness in Ourselves When we Choose our Mate

The adage “opposites attract” is often true before marriage and well into the first few years of a relationship. However, as I have seen in many years of providing marriage counseling, the powerful attraction that once drew you to your mate can fade over time. If personality differences are misunderstood, then the initial attraction will turn to ”opposites repel,” leading to negative feelings for the person you were deeply drawn to when dating.

 Using the Myers-Briggs Type Inventory in Couples Counseling

I sometimes have my couple clients take a True-False test called the Myers-Briggs Type Indicator (MBTI), a questionnaire based on the work of Carl Jung that assesses different psychological types according to four pairs of preferences: extraversion vs. introversion, sensing vs. intuition, thinking vs. feeling, and judging vs. perception. We all use all four functions, but some are more dominant than others.

The MBTI is used by, for example, vocational counselors to help people select occupations that best suit their temperaments. It has also been widely used by employers and managers to appreciate differences in workers with the aim of functioning better in teams, thus avoiding misunderstanding and increasing efficiency by reducing personality conflicts.

Decision making in marriage can be challenging when partners are opposite on some personality traits. When I was ready to buy my new car I decided what I wanted, test drove it and did some quick online research to see what the inventory was, and at what price. I went to our local dealership and was quoted a price that seemed fair. I was prepared to purchase the car then and there, but since we believe that big purchases should always be discussed and agreed on, I took my decision to my partner for the final green light. He immediately jumped into the decision-making by polling every dealer within 100 miles of us and reading every consumer report written on the car.

My psychological preference is Feeling and my husband is Thinking. Both approaches have to do with decision making, and each is valid. Feeling types seek harmony with people. Thinking types seek objective clarity. Because I felt that the car salesman was honest and nice, I trusted his price quote. I didn’t want there to be discomfort or tension.

When all was said and done, he came to me with the exact price I was quoted, saying it was a good price, giving his approval. Because we respected each other’s differences, we came to an agreement.

When Jeff and Lynn came to marriage therapy they were stuck in gridlock about how to spend time in their retirement. Jeff wanted to spend time at home, tinkering with projects in the garage and watching old home movies—something he wasn’t able to do when he worked six days a week. Jeff is a typical Introvert, someone who needs alone time to recharge his batteries and who is drained by too much socializing. Lynn, in contrast, was bored with staying home and wanted to travel and see the many sights that they hadn’t had time or money for before retirement. Lynn is an Extrovert, someone who gains energy from social contact and feels drained without it. These differences made even smaller decisions difficult for Lynn and Jeff. For instance, Lynn wanted to entertain friends and loved putting on big dinner parties, but that made Jeff uncomfortable. He much preferred to have one couple over and play Pictionary. Lynn was furious at Jeff for what she considered to be thwarting her dreams. Jeff felt overwhelmed and withdrew from her when their discussions turned to these issues.

We seek what we want to complete us when we choose a mate. This is largely unconscious. When Jeff first met Lynn he was mesmerized by her vitality and adventurous spirit. He loved how she could talk to anyone. He was invigorated by her constant energy. Lynn was in love with Jeff’s calm and his ability to love the simple things in life. They were attracted to the very traits that were undeveloped in themselves.

Life transitions such as retirement often bring out differences in how a couple will make decisions. When life is routine, these personality difference can be dealt with, even masked. But with challenges such as the birth of a child or a move, the traits that you loved in your partner become the very things that drive you crazy.

The MBTI is a valuable test to help couples understand why they sometimes fight about the same things over and over again. I like it because unlike many psychological tests, the MBTI is non-pathologizing. There are no good or bad traits. Every one of the sixteen types indicates a difference in how one gathers information, organizes their life, how they like to spend their time, and how they think (or feel) through the various decisions that confront them.

After giving Jeff and Lynn the MBTI I was able to help them understand Jeff’s introversion and Lynn’s extroversion. Neither of them was wrong; they just needed to understand and appreciate their differences. We worked with ways they could get their individual needs met, and still find things to do together in retirement. They began to keep a list of activities they each wanted to do and then found ways to compromise about how to going about doing them together, honoring each other’s interests and dreams. This was immensely reassuring. Once you realize that your partner is not wrong, or odd, you can start talking compromise.

Despite my husband and I having opposite types for Feeling and Thinking, we can come to the exact same decision, as with buying the car, but we do it differently. Understanding each other saves a lot of time in the long run!

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Honoring Each Other’s Dreams: Create Shared Meaning

For Greater Intimacy, Stay in Touch With Hopes and Dreams

“Like everything which is not the involuntary result of fleeting emotion but the creation of time and will, any marriage, happy or unhappy, is infinitely more interesting than any romance, however passionate.” W.H. Auden

Any committed relationship involves struggle and growth. Handling conflict successfully together, though, both depends on and helps produce a deep knowledge of your partner—and that will surely make for an interesting marriage.

Psychologists use the term “presenting problem” to refer to the reason people seek therapy. In couples counseling, the presenting problem is likely to be some crisis such as an affair or a problem with a child. But often it is the underlying lack of emotional and sexual connection that brings people to counseling.

During the initial interview, a couple will often say some variation on “We feel like roommates; there is no excitement or passion anymore.” They are living parallel lives, focusing on their kids or other pastimes that don’t involve connecting emotionally to each other. They come to therapy with patchy knowledge of each other’s hopes and dreams.

Work-Life Balance in Relationships

Sherry and Tim are an example of a couple that has lost touch with each other. Sherry explains, “My job demands all my attention. When I come home, I’m exhausted—all I want is to have some time alone. Being close feels like an effort, like another job. Even just sitting next to Tim on the sofa, I can’t relax because he might take that as a sign I’m willing to have sex.” By avoiding sex, which has come to feel like another demand on her time, Sherry actually avoids even physical contact—the hugs and kisses that express and maintain affection. The unintended result of months, even years, of avoiding Tim is what makes these spouses feel like roommates. Feeling alone and unloved, Tim gets cranky and argumentative. Small disagreements escalate, leaving both Sherry and Tim disillusioned with their relationship.

Staying Close after the Initial Romance

In the dating stage and through the early phases of a relationship, couples share their life aspirations, hopes, and dreams. Staying connected comes naturally. In time—after years of working and making a home to provide shelter and comfort, after surviving the early years of adjusting to having children—life’s challenges wear away at a couple, and they can wake up one morning and feel at a loss. Who is this person I married? (This question may be accompanied by an even deeper disconnect from one’s own inner life, but that’s a subject for another post.)

In couples counseling, one of the first steps is to find ways to get to know each other again. Couples therapists often suggest having a date night once a week. While it is important to spend time together regularly, often date night becomes just another stress in itself. Someone has to schedule it, someone has to arrange childcare, husband and wife may both be tired, and a movie plus dinner plus babysitting isn’t cheap, which may add financial stress. Add a few glasses of wine, and the table is set to rehash lingering hurts. The Four Horsemen come charging out across the restaurant and crashing into the dinner table. The date ends in disappointment, and worse, in more resentment. There’s nothing like resentment for an anti-aphrodisiac, so date night becomes fight night.

For Sherry and Tim to reconnect, they needed to remember why they married. During our sessions, Sherry and Tim were able to talk about what they appreciate about each other. Using a variety of Dr. Gottman’s interventions, such as “Expressing Fondness and Admiration” and “Relationship Enhancing Thoughts”, they were able to build back feelings toward each other that had become mired in the morass of negative thinking. Once they began to deconstruct the walls they had built, they were able to share hopes and dreams, leading to a deeper understanding of each other. Intimacy is grounded in honoring dreams and creating shared meaning in relationship.

Self-Care is Essential to a Close Relationship

Lifestyle changes, such as exercise and meditation helped Sherry to manage her stress from work and enjoy relaxing with Tim, instead of always needing alone time. Tim was able to see that Sherry’s way of de-stressing was to spend a little time alone after a hard day. Tim’s acceptance helped Sherry to feel understood, and Sherry’s relaxing helped Tim to feel loved.

These insights came because they took the time to face the scary thought that they had drifted apart. Couples therapy may not be easy, but it is often a relief to look each other in the eyes and talk about the difficult things in a safe setting. That’s important in moving toward intimacy after a long hiatus focusing on everything except each other. Rediscovering your friendship, and finding ways to talk about your hopes and dreams, will lead to honoring those dreams—and each other.

As Auden says, the marriage that has evolved through the creation of time and will is infinitely more interesting than any fleeting romance, no matter how passionate.
I will add to this by saying that a marriage can become both interesting and passionate. Getting to know each other’s hopes and dreams deeply, facing down life’s challenges together, both creates and sustains intimacy.

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ADHD Medications in Childhood: Dependency and Addiction in Adulthood

ADHD Medications in Childhood: A Cautionary Tale

The NY Times article ‘Drowned in a Stream of Prescriptions’ was all too familiar. Over the years, I have seen college kids who were started on stimulants for ADHD while still in elementary school. Some of these kids needed the medications and were helped immensely by the proper diagnosis. Some were medicated without need. The decision to medicate is often made by families who are frustrated and at wit’s end

Proper Diagnosis is Crucial

When kids are having troubles with peers, inattentiveness, temper tantrums, and other behavioral problems, they are usually referred to a psychiatrist or a behavioral pediatrician for evaluation. Many of the screening exams use good reliable questionnaires that assess the child’s behavior at home and in school. Parents and teachers are asked to fill out checklist forms to help with the diagnosis.

If a diagnosis is made, and stimulant medications started, everyone waits to see the effect. Typically, if learning and behavior improves, it confirms the ADD or ADHD diagnosis. These children go on in school, graduate, and go onto jobs or college. But for optimal results, it is necessary to work in concert with the school, family, and a counselor—either an academic tutor or a psychologist—to help the child and his family organize and structure a learning environment and routine that will provide the infrastructure to support him in the future.

In the case of  Richard Fee, there was gross negligence on the part of the prescribing psychiatrists, leading to addiction and culminated in suicide. As the article points out, “Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.”

Obtaining Stimulants in College is Easier than Parents Realize

When kids enter college, they face tremendous pressure to perform academically. Combine this with the structure-less college life of dorm parties, alcohol, and pot, and the situation is ripe for acquiring stimulants from whatever source is most available. Kids sell stimulants to other kids. But the cost per pill is high and it is cheaper to go the ‘legal’ route and get a prescription, paid for by insurance. The symptoms and signs of ADD are available on the best health websites. The symptoms listed are identical to the ones that the psychiatrist will ask about. They are yes or no questions, easy to misguide the examiner. Many of these college kids go to clinics where the physician hands them a script after asking the questions, the kid has come prepared to answer from his web search. They walk away with the prescription and use it along with other stimulants like such as caffeinated energy drinks. When decongestant meds became harder to get, the energy drinks combined with prescription stimulants produced the desired effect of counteracting the sedating effects of alcohol and pot, and gave a buzz lasting all night. From that point on, the cycle repeats until the kid is addicted both physiologically and psychologically. Classes are missed because the sleep cycle is thrown off.

Psychotherapy: Learning to Cope without Dependency

When a family refers their grown son or daughter to psychotherapy it is usually at a crisis state. Like Richard, in the Times article, Ray came to psychotherapy at his mother’s urging. Ray moved home after a year of college. The first time we met in my office he was guarded, monosyllabic, and made no eye contact. He furtively glanced out my window at the trees and seemed absorbed in thought. Tears streaming down his face, he looked tortured. Eventually, he admitted to using Adderall abusively. He told me what a joke the treating psychiatrist was, how he gave him prescriptions during a five-minute meeting. But Ray kept going back for more meds. He was angry but also shamed. Irritability, staying up all night, then sleeping all day was his life. He chuckled to himself in a way that reminded me of schizophrenia. I was concerned he would take his life and got him to sign a suicide contract, promising me he would take the procedures we outlined if he were to feel like harming himself. After a month of twice weekly appointments, Ray opened up about his loneliness, his lack of friends in childhood, and his estrangement from his family. He was able to see his role in some of this, how he pushed his mother and father away with his anger. While much of his anger was due to the stimulants, he was beginning to see how deep his emotional pain went.

After about a month of therapy, Ray went to the prescribing doctor and told him that he had lied about having ADD. He told his parents too. Without my knowledge, Ray took himself off all his drugs—cold turkey. He withdrew from Adderall, pot, and caffeine and the effects were initially unbearable. Yet within several weeks, he was clean and feeling better. Gradually Ray discovered that he liked himself, not a lot, but he was okay with himself. He re-enrolled in college and at the termination of our therapy; he had just graduated with a BA. Ray was fortunate. He sought therapy, and his parents were willing to pay for him to see me. Most importantly, he had the fortitude to hang in there with the pain of withdrawal and the physiological symptoms.

Ray was lucky. Richard was not.