O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

By 6 Comments

Psychotherapy: A Safe and Sheltered Space

Psychotherapy is a safe place to explore what is causing you pain and how to cope.One size does not fit all when it comes to finding a good therapist. Many variables influence the extent to which people get better, solve problems, and grow. While empirical support is important in choosing what treatment to provide, psychotherapists shouldn’t stick rigidly to what studies suggest; instead, they should work from the position of evidence-informed practice. This allows for treatments that respond to what clients bring to therapy—their unique histories, temperaments, and narratives. Sometimes what may be most helpful in the therapy is intangible and unmeasurable by any study. In research, these are referred to as non-specific effects. These are uncontrollable factors: the usually small, barely noticed interactions that create an unexpected effect in the subject. In other words, they are not a part of the research experiment.

In Irvin Yalom’s book Existential Psychotherapy, he describes how, during a cooking class, he wondered why the instructor’s meal always tasted better than any of the his attempts at the same recipe. He learned why after catching the teacher’s assistant throwing fistfuls of various spices in the dish before putting it in the oven. This story has stayed with me since reading it in the early years of graduate school. The crucial ingredients—the “throw-ins”— of good therapy may be unquantifiable, and untaught; even the therapist may be unaware of them.

In a previous post I wrote about love as part of the therapy. Love is a challenging factor to study because it is difficult to quantify and because love overlaps significantly with other emotional reactions such as respect, compassion and empathy, and curiosity.

What is the art of therapy? Sometimes it is as simple as being really present with clients during their pain. Being present means not interrupting, giving advice, or falling asleep, but instead staying tuned to a client’s process. As in meditation, a therapist who notices his or her mind wandering should first notice where it has gone (and if there is anything in that mental tangent that could provide meaning about the client’s situation) and second, return that attention to the client.

A safe and sheltered space

In ancient times a holy person who would descend into what was called an incubation chamber—a dark underground space—with someone in turmoil or grieving. They would remain together in the darkened underground space for three days. This practice illustrates how healing  comes through being present with feelings. When someone is suffering, the willingness to go into the dark with them as they express and move through their feelings is a large part of what we do as therapists. When suffering people can take what’s vague and private, locked inside their heads, and speak out loud the unspeakable, they can gain a depth of understanding and new self-compassion.

The popular 2015 Pixar film Inside Out shows how this works. Riley, the young protagonist must endure her family’s cross-country move, which takes her away from her friends, her home, and her beloved hockey team. Believing she must be perfectly mature, she suppresses her sadness. Five personified emotions–Joy, Sadness, Anger, Disgust, and Fear –live in her head and influence her actions and memories. The dominant voice is Joy, because being happy and not expressing our negative feelings is socially rewarded. But all emotions have a role to play in living well. When Riley tries to silence Sadness, she becomes numb to all feeling, including Joy, and pandemonium ensues. It’s only when Riley can fully acknowledge the sadness in her life that she can also remember the tender, loving moments. Therapy patients must similarly accept and not disown their most difficult feelings.

Good treatment isn’t always easily available. Many therapies lend themselves to apps and downloadable protocols, making these treatments more accessible for people who are unable to find (or afford) a good-fit therapist. Videoconferencing, mobile applications, g-chats, and web- or text-based therapy have a place, and can be powerful ways to change behavior and improve symptoms, especially for those who feel shy or stigmatized about talking to a therapist. But with something gained, sometimes something is also lost with techniques that avoid human interaction and relationship.

What’s missing are the powerful nonverbal communications that shed so much light on the intangibles of what might be contributing to a person’s issues. A blush, an eye-roll, a tear welling up; the fidgeting of someone with a secret, the nervous giggle or shy smile—these nuanced communications can speak in ways where texting is mute. Staying safely in front of a screen provides shelter, to be sure, but possibly also a place to hide.

To illustrate the importance of face-to-face therapy, there’s the example of my former client who returned to therapy after a seven-year break. He told me his physician kept increasing his antidepressant dosage, but he was getting worse, not better. After sitting with him for close to an hour, listening to the many stresses he described, I gently inquired about his subtle, yet noticeable twitching. His movements were suggestive of a genetic disorder and not merely anxious fidgeting. He immediately told me “My biological father [he was adopted at birth] was really strange before he died. He moved and twitched all the time—I haven’t thought about it in years but I know he had something wrong.”

At the conclusion of our session, he promised me that he would contact his cousin and find out the name of his father’s condition. I suspected it was Huntington’s disease, a rare genetic disorder. When he emailed me the confirmation, I was able to suggest genetic counseling and testing.

So what appeared to be depression and anxiety—and was being treated as such—was in fact a neurobiological condition. While the news was not good, he could be treated by the right physician for his condition and not keep taking medication that only made him feel worse.

The opportunity to look at your darkness with someone who respects you and your process can allow you to speak the unspeakable, giving room to the ineffable—those moments of awe that come only when we let the full range of who we are be seen and known.

Rumi stated it well in his mystical poem “A Garden Beyond Paradise”:

Everything you see has its roots in the unseen world.

The forms may change, yet the essence remains the same.

Every wonderful sight will vanish; every sweet word will fade,

But do not be disheartened,

The source they come from is eternal, growing,

Branching out, giving new life and new joy.

Why do you weep?

The source is within you

And this whole world is springing up from it.

 The joy of which he wrote cannot spring forth without awareness that it will also fade. Trust that the source of life is in sitting with and sharing the difficult parts of ourselves in a safe and sheltered space.

By 6 Comments

Marriage and Parenting: Balancing everyone’s needs

Work-life Balance —  Making Time for Yourself

When I was born, my father’s colleagues congratulated him with the cartoon below.

Being a parent requires balancing personal needs with family and couple needs.

The proud new dad is wearing a halo and peering up at a trophy of me, his firstborn, hands on my hips. Behind him is a trash can filled with his favorite toys: skis, golf clubs, bowling ball. As this cartoon acknowledges, we all understand that when kids enter the marriage, parents have more work and less free time for previously enjoyed activities. When I ask couples during their initial therapy sessions about what they do for fun, they often look at each other, shrug, and say something like “Well, we sometimes watch TV together after the kids are in bed.”

One of the hardest things about having kids is the loss of identity. Parents often feel that they have to give up their recreational pursuits because children demand all their time. But is this necessary? In fact, parents today spend much more time with their kids than they did in previous generations. Fathers spend twice as much time in child-oriented activities than they did in 1965, and mothers spend an average of 20 percent more time with their kids. Where does this extra time come from, and what is sacrificed?

Generally, when both parents work outside the home, that extra time has come from mothers dropping some housework chores since 1965, and dads picking some up. But most of the additional child-oriented time has come at the expense of time spent with partner, friends, and on personal interests.

 

 The Venn Diagram of Marriage

 

Making time for yourself in marriage as well as time for your partner, and your children is important .Think of your relationship as a Venn diagram composed of two circles, one for each partner. The circles overlap for couple time—date night, activities together, time alone together. If you have children, add a third circle for kid-oriented or family time. Depending on the ages of your children, that circle will be larger at some times than others, but the important thing is to have your own circle, large enough to have time for individual pursuits not involving your partner or the kids.

This was what my dad threw away. He trashed all those fun activities to support his family. For him, as for so many men of his generation, ”support” did not mean participating in child-oriented time; it meant working. In my parents’ conventional marriage, he was the wage earner and provider: so much so that by the time his cancer was diagnosed, he had accrued three years of sick time. Which was just the exact amount of time he used before he died.

Don’t make that mistake. Give yourself permission to pursue your passions (within reason; maybe not 18 holes of golf every weekend, as this will surely cause conflict in the marriage) and reclaim the things you loved doing before kids or find new interests that nourish you.

What we know for sure:

  1. Don’t give up friendships. Friends are good for marriage because marriage doesn’t have to meet our every need. Friends also spread the load of stress so the marriage doesn’t have to bear it all.
  2. Express your needs for support and negotiate compromises. Fairness in distributing chores and caregiving tasks will reduce stress in your relationship. Read my post about the division of labor in marriage.
  3. Make time for fun together. Having enough fun strengthens your relationship and protects it during hard times. A good rule of thumb is to schedule two dates a week, where you get a sitter, a friend, relative, or neighbor to watch the kids and you go out for coffee, a walk, or dinner. Try to make it new and invent different activities to do together. In Gottman’s work, this would be called turning toward each other.
  4. Make time for yourself. Taking time for self-care is as important as caring for your family. Self-care includes a wide range of activities: taking a yoga class, doing formal meditation, exercising, skiing, painting, or gardening, (and bowling, golf, scouting.)

By 1 Comment

Maintaining Composure as a Parent and Householder

Parenting require finding balance and composureMaintaining a graceful composure when performing life’s demanding household and child-raising chores can take a toll, leaving us feeling depleted and out of balance. But practicing the postures and meditation of hatha yoga can restore that equilibrium. Yoga practice connects us to our bodies, and thus to our bodily wisdom if it is done mindfully.

Remember: If we don’t give to ourselves by taking care of our well-being, then we cannot take care of others.

One lovely pose (asana) to try is called lalitsana, the pose of royal ease. You can see this pose in statues of Yogini Hayagriva. Yogini translates as female practitioner of yoga. In Hinduism, the god Vishnu is one of three supreme deities, called the Preserver. One of his avatars (manifestations or incarnations) is the goddess Hayagriva, which means the “horse-necked one.” She is depicted sitting on an animal in a graceful posture, lalitasana, supporting her child with one arm. Both mother and child have horse’s heads. Hayagriva is considered to embody knowledge and wisdom. In this mythology, the horse pulls the sun’s cart into the sky every day, shedding light on the world. Symbolically, Hayagriva represents the triumph of pure knowledge, guided by God, over the forces of passion and darkness.

To assume the lalitasana pose, sit on a low stool, chair, bench, or firm ottoman with your left leg bent so that the sole of your left foot rests on your right inner thigh. Allow your right leg to extend, half bent, to the floor. You may notice a sense of ease and grace as your spine becomes aligned in this pose. This asana is similar to a half lotus pose, but sitting on a chair or bench allows the right leg and foot to drape down, without the strain that sitting in lotus pose can have on the knees.

Take this pose throughout the day when you feel restless and distracted. Even a few moments will help ground you so you can return to the tasks at hand with a bit more calmness. A few minutes of mindful breathing in this pose will enhance the experience. May all mothers and fathers feel this sense of comfort!

The horse head on the voluptuous human body reminds me that our being is composed of many aspects. Being a loving parent will look different at different times and stages of your life. Practicing yoga and meditation on a regular basis will help keep you limber and supple in mind, body, and spirit. We need this suppleness to stay open to the many ways life brings us into contact with our own darker natures.

By 2 Comments

We Fear What We Cannot Control: Acknowledging Pain and Suffering

Learning to live with the things we have no control over.The German airplane crash by a suicidal pilot, the Florida shootings, the Boston bombings. Every week, we read about innocent people getting hurt or killed. We try to avoid pain and suffering; we teach children to look both ways before crossing the street, wash their hands after using the bathroom, and not to get into strangers’ cars. Even as we reassure our kids that no monsters live under their beds, we know that in the apartment down the street, there lives a convicted sex offender. How do we cope with life’s uncertainty and fear?

 

The Monster Under the Bed

We are saturated with information. Not long ago, we’d read a morning or evening newspaper and maybe watch the evening news; today, the news cycle is 24/7. And, because dramatically scary stories get our attention, the media makes sure to foreground them—not just what’s happening locally, but world-wide. We end up perceiving fearful threats all around us. The truth is, though, that we tend to overestimate certain kinds of risk while underestimating others. For example, as the Vancouver Sun notes, “We warn our kids not to talk to strangers even though 90 per cent of sexual abuse is committed by someone a child knows. And we freak out about plane crashes despite the fact driving is about 65 times more dangerous.” (“How much risk do you live with?”)

Studying how people evaluate threats, or “risk perception,” helps show why this is so. Psychologist Paul Slovic has studied the subject for many years; here, blogger Sara Gorman sums up his findings: “People tend to be intolerant of risks that they perceive as being uncontrollable, having catastrophic potential, having fatal consequences, or bearing an inequitable distribution of risks and benefits.” Plane crashes feel more uncontrollable than car crashes; strangers feel scarier than people we know. But control is an illusion. Life is full of uncontrollable things, people, and events, so how do we handle risk?

We cope by using reason and denial. Reasonably, we know that life always involves some risk and that we have a natural tendency to inflate threats. You can probably think of one thing you tend to worry about needlessly or unproductively. Can you really do anything about it? Needless worry robs us of a sense well-being; straining to control things beyond our reach only creates tension. But wait—denial? Isn’t that supposed to be a bad thing? Yes, denial is counterproductive when it keeps you from acknowledging harm that you’re doing to yourself or others, like smoking, cheating on a spouse, or abusing your child. But psychologists recognize that the use of denial can be advantageous in many situations. According to the Mayo Clinic, “A short period of denial can be helpful. Being in denial gives your mind the opportunity to unconsciously absorb shocking or distressing information . . . . For example, after a traumatic event, you might need several days or weeks to process what’s happened and come to grips with the challenges ahead.” Be patient and gentle with yourself in the wake of trauma.

We also must learn to balance risk against what we lose by being too careful. When we’re too sensitive to fearful possibilities, we become paralyzed. Not letting your daughter walk home from school with her friends because a car could run a red light, or a vicious dog might be on the loose, may seem protective. But overprotectiveness is harmful because it deprives children of practicing the mastery and independence they need to grow up successfully. And, more subtly and unintentionally, your anxiety seeps into her without either of you knowing the source.

 

What if the monster under the bed survives because your imagination feeds it every night?

 

Kids need to find their own strength by testing themselves in the world. That can start as early as learning to sleep alone, in their own beds. (While in some cultures sharing a family bed is the norm, children may be given other opportunities to practice self-soothing and frustration tolerance.) Kids and parents often resist the stage when they need to soothe themselves to sleep. When we know our child is distressed and may be fearful, we rush to give comfort. But allowing a child to sleep between her parents can come at the expense of intimacy in the marriage. By resisting letting a child sleep alone, parents deprive them of learning to calm themselves and tolerate frustration. For a fuller explanation of this problem and how to address it, see Dr. David O’Grady’s “Help Your Child Sleep Alone: The Snoozeeasy Program For Bedtime Fears. ”The important thing is that we convey trust that our child can manage the little and big things that come their way and feel they have the ability to self-regulate their emotional reactions.

Of course, being able to manage emotions doesn’t mean that bad things don’t happen. In mindfulness practices, we teach that suffering is an inevitable part of living. Sickness, accidents, money problems, frustrations, and worries: There is much in life that we have no control over, and as if worrying about the present isn’t enough, we tend to ruminate over past events or future possibilities.

Even spiritual people who actively practice mindfulness can’t escape suffering. In fact, “life is suffering” is the first Noble Truth of Buddhism. I remember listening to an audio interview with the Dalai Lama, the Tibetan Buddhist leader known for his calm serenity. He coughed and hacked his way through the interview, clearing his throat every few minutes. It was an unpleasant sound, but because I was on my treadmill, I didn’t want to stop and find another CD. I suffered along with the Dalai Lama. At the conclusion of the interview, he took questions from the audience. The question was asked; “Dalai Lama, do you suffer?” He answered, “Of course I suffer, I have been coughing this entire time and it is very uncomfortable.”

And as if present suffering isn’t enough, letting worry about the past or future take hold leads to more suffering. When we suffer from the fears we have about the dangerous, uncertain world we live in, we may think the answer is to run away somehow: shopping, clicking, using drugs or alcohol, or eating when we’re not hungry, for example. But pursuing pleasure doesn’t make our painful fears go away. Instead, our efforts backfire because we feel guilt, or dig ourselves deeper into debt, or become unhealthy—and the fear still exists.

Learning to look at our suffering and accept that it exists is a skill. Meditation or relaxation training can help us develop the skill of self-soothing, thereby enabling us to feel less afraid of both real and imagined monsters. As we do this, we also help those around us to be calmer and stronger.

 

How to Self-Soothe

 

Practice some form of deep relaxation, meditation, or yoga daily. This will change your psychophysiological baseline so that you are generally more resilient when worry or stress takes over.

  1. Accept that that suffering is part of life. We suffer, our children will suffer, and strangers we hear about in the news suffer. Acknowledging suffering helps because we are not pushing fears down, which paradoxically only makes them grow larger.
  2. Develop a spiritual practice. This helps us develop the strength to look deeply at our suffering; the insights gained about ourselves provide perspective and something to hold onto when our fears run amok.
  3. During difficult moments, use a short breathing practice (such as the Three-Minute Breathing Space or just silent focus on your breath) to stay calm during difficult moments. Being conscious of our breathing brings mindfulness to the present moment and helps pause the thought stream of rumination.
  4. Recognize your suffering without judgment. Some fears are truly awful, yet by staying in the present moment, we avoid getting trapped by our thinking. Look deeply at the source of your feelings, find their roots, and work on transforming the fears that need to be changed. This will allow space to nourish the feelings that bring peace and well-being.

This short relaxation exercise may help you to develop skills to relax in moments of anxiety and worry, as well as provide a foundation to help change the automatic, reflexive ways your mind and body respond to stress.  https://youtu.be/TCCA1kGSnB8

By 7 Comments

Standing Behind the Waterfall: Learning to Change Distorted Thinking with Mindfulness

Giving yourself a ledge to stand on as you watch your thoughts will help get perspective.
Getting a Different Perspective

Thoughts are not facts. When we’re upset, our thoughts seem valid—yet it’s exactly when our emotions get stirred up that our thinking can easily become distorted. Conclusions based on distorted thinking can’t be trusted.

When my friend Sharon returned from a business trip, she was feeling disturbed and uncomfortable. As she described her experience, she clarified why: She had been working remotely in Africa and knew few of the other participants in her company’s conference. She wanted to be included, but wasn’t part of the main team; she felt uncharacteristically shy and felt that her participation wasn’t up to her typical style. Sharon was aware of the tremendous talent that surrounded her and wished she’d had more opportunity to interact with her co-workers.

Taking a Different Vantage Point Gives Perspective When Thoughts Are Overwhelming

Sharon observed her feelings and thoughts with great skill, teasing out the mixture of sometimes conflicting emotions she felt, but importantly, she wasn’t condemning herself or anyone else. If her thought had been “I’m so inept, I can’t compare to these other people,” she might have gotten carried away with ruminations about her inadequacies. By asking herself “What is this I am feeling, in this moment?” Sharon gave herself a vantage point—feeling anxious is not the same as being worthless.

Teachers of meditation often use the image of the sky to illustrate how thoughts, like clouds, come in and out of our mind. The sky is always there, even when dark clouds momentarily obscure the sky. In another moment, the sky might be a brilliant blue with white downy clouds moving slowly or swiftly across its surface. We use these images to show that clouds come and go changeably, just like our thoughts, but mind and sky always remain. Sitting in meditation, we witness the changes of thought and feeling but don’t partake in them, just as the sky is unchanged by the clouds.

One of the exercises used in mindfulness-based cognitive therapy is that of standing behind a waterfall. Standing behind the rushing water and watching it without getting swept away by the torrent gives us a ledge to stand on, just as meditation gives us the perspective to look at our thoughts. We don’t have to believe everything we think, and we don’t have to be deluged by ruminations arising from anxiety or depression.

Try this short meditation: