O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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The Benefits of Practicing Mindfulness in Nature

The Benefits of Practicing Mindfulness in Nature

Research has consistently shown that time spent in nature helps people cope with depression and anxiety. Combined with other self-care activities, it can be as effective in treating psychological problems as anti-depressants.

But too often we run from activity to another and then finally, plop down on the worn sofa—unaware that these moments in nature are always available to us. In the park by the office, or in our own backyard, we can rest, listening to the buzz of sound all around. When we slow down enough to see the canvas of nature, we can experience contentment akin to one-ness with the natural world.

In mindfulness-based cognitive therapy and stress reduction, we ask participants to practice meditation daily, both formally and informally. Formal practice includes sitting or laying down and focusing on the breath, or on sounds– the intent is to be still and focused. Informal practice can be doing any routine activity mindfully. As the old saying has it, “Chop wood, carry water.” Some days we can eat a meal mindfully, without watching TV or reading the paper, just chewing and noticing the senses of smell, color, taste, and texture. Mindfulness can mean sitting in the garden and being attentive to the sounds of insects and the rustle of the breeze and doing nothing but sitting. (The Japanese Buddhist word for mindfulness practice, “zazen,” simply means “seated meditation.”)
Beginning a formal meditation practice can be daunting because of our innate resistance to sitting still with no distraction but paying attention to your breathing. In some meditation practices, the instruction will be to focus attention on a word, or to count to ten and start over. There are many ways to be still and it is important to try different kinds of meditation to find a practice that best suits you. When I teach Mindfulness-based stress reduction groups, participants will gravitate to one form of meditation over another. Each person is different. Some find mindfulness of sights and sound to be more effective, while others will focus on their breathing. In these classes, we practice many different ways to meditate and each participant is encouraged to find one they think they can continue to work with after the group ends.

Mindfulness Meditation: Informal Practice in Nature

But informal practice is always available and readily accessible to most of us: no special cushions, meditation rooms, or fancy teacher required. In fact, giving yourself permission to just do one thing, with presence, is a great way to slow down. If you can find some time each day to be mindful, especially in the natural world, that will go a long way in helping ease the symptoms of depression. Go outside and sit in your garden or the local park and be with nature. Even just a few minutes of watching the birds, weeding or pruning the roses will help boost your mood.

Berman, M. G., Jonides, J., & Kaplan, S. (2008). The cognitive benefits of interacting with nature. Psychological Science, 19, 1207–1212.
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta- analytic review. Journal of Consulting and Clinical Psychology, 78
Maller, C., Townsend, M., Pryor, A., Brown, P., & St Leger, L. (2006). Healthy nature, healthy people: ‘Contact with nature’ as an upstream health promotion intervention for populations. Health Promotion Inter- national, 21, 45–54.

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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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Freeing the Trapped Spirit Within

 

Increasing Joy

In Shakespeare’s play The Tempest, the spirit Ariel, living on a remote island, has been confined in a cloven pine tree by a spell. When the wise and learned Prospero, sent into exile, lands on the island, he agrees to free the spirit if Ariel does his bidding—to create a storm, a tempest so large it will cause the shipwreck of Antonio, the man who plotted his murder by sending Prospero and his young daughter out to sea in a doomed vessel.

This photo inspired me to recall Shakespeare’s last great play and to reflect on the symbolic meaning of the imprisoned spirit. Ariel is the spirit of fire, of air, of wind, or water and has the gift “to fly / To swim, to dive into the fire, to ride / On the curl’d clouds” (I.ii.190-192). He brings a balance to life, easing suffering and providing safety. He is that spirit in all of us that brings to birth the creative imagination.

Elusive Joy

Yet Ariel is elusive. He represents that inner part of us that stirs the unconscious toward freedom. Just as Ariel is imprisoned in the pine, we close off our creativity, leaving it dormant. The forgotten inner self is abandoned in childhood as the demands to prosper drive us forward into adult responsibilities. Ariel represents the inborn gift in each of us that gets trapped within.

Freeing Your Creativity

In psychotherapy, the process of looking at what we have kept secret, unknown in the depths of conventionality or conformity, lays bare this spirit waiting to be released. Sometimes it is a creative urge, to sing, to dance, to play, or to make music. Finding it again requires forgiveness, whether of self or of others who have played a part in squelching the Ariel within. By looking at our discarded parts and turning towards them, we begin to befriend our hidden, inner selves.

Setting Ariel free requires acknowledging the spirit within, giving voice to suppressed desire. But it also helps to be open to joy as it comes. William Blake’s poem “Eternity” expresses the importance of openness:

He who binds to himself a joy
Doth the wingèd life destroy;
But he who kisses the joy as it flies
Lives in eternity’s sunrise.

The spirit of Ariel may light upon your shoulder for just a moment. Being able to feel that joy in those brief moments, not clinging, just noticing and appreciating, is a step toward bringing awareness to all the moments of your life.

What part of yourself are you keeping imprisoned? As Shakespeare writes at the end of the play:

Prospero [found] his dukedom
In a poor isle and all of us ourselves
When no man was his own. (V.i.206-210)

To be fully present in life involves freeing your Ariel within. The last words of the play before the epilogue are Prospero’s to Ariel: “My Ariel, chick, / That is thy charge: then to the elements / Be free, and fare thou well!” (V.i.317-319).

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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.