• Skip to primary navigation
  • Skip to main content
  • Skip to footer

O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

  • Home
  • Services
    • Therapy for Adults
    • Therapy for Children and Teens
    • Couples Counseling
      • The Gottman Relationship Checkup
    • Neuropsychological Assessment
    • Mindfulness-based Interventions
    • Special Assessments
    • Help Your Child Sleep Alone
    • For Professionals
      • For Physicians and Health Professionals
      • For Attorneys & Insurance Professionals
  • About Us
    • David O’Grady, Ph.D., ABPP
    • Susan J. O’Grady, Ph.D.
      • Policies – Dr. Susan O’Grady
  • Resources
    • Helpful Forms
    • FAQs
    • Articles and Links
  • Susan’s Blog
    • Relationships
    • Mindfulness and Meditation
    • Wellbeing and Growth
    • Psychotherapy
    • Depression and Anxiety
  • Contact Us

June 17, 2017 By Susan O'Grady 6 Comments

Using Softened Startup in Conflict Discussions

Dirty Dishes in the Sink, Smelly Socks on the Floor

Sometimes the things that drive us most crazy in a marriage are the most mundane and trivial: dishes piled up in the sink, socks dropped on the floor. We may complain, criticize, and yell, but the end effect is that the dishes don’t get done, the socks eventually migrate back to the floor, and we end up feeling even more distanced and angry toward our partner. If complaining doesn’t work, neither does ignoring what drives us crazy. Over time, a couple can see their relationship with what John Gottman describes as “negative perspective.” We get so focused on the negative that we become unable to recognize even neutral or positive actions from our partners, snowballing our unhappiness.

As a couples therapist for many years, I’ve seen the situations that bring clients to treatment range from catastrophic events like affairs and severe illness to the mundane, like smelly socks and cluttered countertops. A sampling of conflicts:

 

  • An older couple squabbles over the bedcovers: the wife says her husband hogs the blankets, leaving her freezing much of the night; she feels her husband is selfish and inconsiderate, while he thinks she should just tug harder on the covers.
  • A young husband says that his stay-at-home wife leaves dirty dishes in the sink for days on end and he ends up cleaning the kitchen every night, even if he made the meal; he feels his wife is lazy, and she feels he’s ignoring the work she has done.
  • A couple complains that they’ve stopped sleeping together because their child is too afraid to sleep alone and needs to be consoled, even at age eight. The father, now sleeping on the couch, feels left out of the closeness and warmth that mother and child enjoy, and soothes himself through weed, drinking, and internet games or porn; the mother feels she must put her child’s needs first and co-sleeping is best.

 

Without help, such situations can drive a wedge between couples that can go on for years. Research has shown that couples wait an average of six years after becoming aware of problems in their relationship to seek counseling. That’s a lot of water under the bridge, and a lot of built-up hurt, anger, and distance. By the time couples do come to counseling, their relationship has usually crumbled, with deeply entrenched negative thoughts about the marriage. Fighting about the dishes is no longer about the dishes–it’s about a partner’s poor character. “She is so self-centered”; “He is so lazy.”

How does a couples therapist help when each partner blames the other and feels like the victim? Taking sides is not an option: the partner who feels ganged up on will bolt from therapy, and nothing will change. There may occasionally arise a need to confront one partner about issues that are causing harm, such as abuse, but in my practice, that is rarely the case. That said, helping untangle years of accumulated misunderstandings is not an instant fix. Everyone becomes invested in seeing things our own way, so opening our eyes to a partner’s viewpoint is something that takes time and skill. The good news is that these skills can be taught by a therapist who helps change the dialogue.

Softened Start-up Rather than Harsh Start-up

One of the most useful and yet seemingly simple skills to teach is to complain without blame and to begin a conflict discussion with a softened start-up.

How does this look? Well, take the older couple who fights about the blankets. With a harsh start-up, the freezing wife might say “You have no idea how selfish you are! You take all the covers every single night, leaving me with just the sheet—and a thin sliver of a sheet at that!” Her husband becomes defensive: “Well, what a complainer. Just tug on the blankets, and quit blaming me! I’m asleep, I can’t help it.”

It may feel momentarily satisfying, but coming out swinging engenders a harsh reply and an unhelpful one at that. A seemingly small squabble becomes gridlocked. A softened alternative might go like this: “I realize you’re asleep and unaware of my getting cold at night when I have no blankets. It probably happens as you roll over several times during the night, leaving me uncovered. When my sleep is disturbed, I get grouchy the next day, and unfairly blame you for something you’re unaware is happening. I wonder if we can come up with a solution?”

Of course,  her partner might try to laugh it off with  “Why don’t you just sleep in the guest room?”  But, soothed by a soft start-up, he could reply sincerely, without defensiveness: “I know this has been a problem for you for awhile, and I’m sorry. I don’t want you to be uncomfortable and cold at night. Maybe we can devise a way to fix this together. Let’s go to Target and see if there are blanket fasteners or something, and if not, let’s buy a fluffy down comforter and duvet.”

It would be misleading to suggest that this conversation can happen during the first few sessions. To change the way you talk about the blankets, it’s important to realize that the blankets aren’t really the problem. A skilled couples therapist will further the discussion so that each partner feels heard and understood. By uncovering what’s underneath the blankets, so to speak, the couple can see what’s really been covered over.

For the wife in my example, blankets were just one of many ways she felt her partner had been selfish and uncaring. When we discussed some of the feelings that surrounded the blanket-stealing, she was able to see things in a new light. She took ownership for communicating this and her other needs, and responsibility for doing it in a better, less judgmental way. As for her husband, he was able to see that he had in fact been acting with self-interest and ignoring his wife’s needs in many situations. But—and this is equally important—they were also better able to see each other’s good attributes once negative thinking wasn’t squeezing out relationship-enhancing thoughts.

When the concept of a softened startup is introduced in therapy, many partners will exclaim, “But that’s not the way I talk, it isn’t me!” or “Won’t I need a frontal lobotomy to talk this way?”

I chuckle, saying, “No, nothing that drastic.” It takes practice, but eventually, this way of bringing up conflict becomes second nature and feels good. A partner who joins in with a positive response helps to sustain and reinforce this healthier way of handling conflict.

What I love about doing this work with couples is the ripple effect. Not only does the couple change the way they talk to each other, but they model this better communication for their families and children. It’s important to remember that kids pick up both the good and bad things we do in front of them.

The first workshop I took with Dr. John Gottman was in 2000. I began practicing this softened startup with my husband before trying it with couples. We had a CD with practice prompts, and listened to it on a long car ride, with our kids in the back seat. Eventually, our twin daughters began answering the prompts with the softened alternative. We made it a game—yet it became a powerful tool for dealing with conflict. When the girls left home for college, they noticed that most of their dorm-mates were not able to handle conflict so well. The techniques work beyond the family setting.

You don’t have to be a psychologist (or have psychologist parents) to practice these techniques yourself. Take the dirty-dishes example—a frequent conflict for roommates as well as couples. You come home from work and see the dishes stacked high in the sink, overflowing onto the countertops. You think your stay-at-home partner should have done them. A harsh startup would be, ” I can’t believe you still haven’t done those dishes! You’re such a lazy slob.”  To that startup, a defensive comeback would be,  “Well, look at you! You’re not doing them either. So you devalue what I do all day long just because you work outside the home? I work too! You’re so full of yourself!”

You can imagine how the rest of that conversation goes—but it doesn’t have to. Practice coming up with a softened startup for this situation from what you’ve learned so far—try it out!

____________________________________

____________________________________

____________________________________

____________________________________

 

I’ll give you one way to do this, but it’s not brain surgery; you’ll find many ways to phrase a soft startup in your own words:

“You know I tend to be a neat freak. When the kitchen counters and sink are dirty, I feel uncomfortable. I know you work hard and having clean counters isn’t as important for you, but I wonder if we can together find a way to stay on top of it, as a team?”

The key to all this is to know yourself, take responsibility for your feelings and reactions, and speak about your needs and feelings without leveling a global character assault on your partner.

Now, imagine one of your ongoing conflicts, and try out in your mind a way to communicate using a softened alternative. It’s a surprisingly powerful technique.

 

 

Filed Under: Couples & Marriage & Family, Dr. Susan O'Grady's Blog, Relationships, Well-being & Growth Tagged With: Conflict Management, Couples Communication, Dealing with Conflict in Marriage, Gottman Couples Counseling, Relationships, Softened start-up

May 11, 2017 By Susan O'Grady 5 Comments

Anxiety Knows No Age Limits: Each moment is all we really ever have

We all get anxious from time to time. Even mild panic that’s morphed from mere anxiety is normal. Most often, though, anxiety will peak right before an event that makes us worry, such as an exam or dinner party—a kind of anticipatory anxiety—and then fade 10 minutes into the event. The ebb and flow of anxiety can be unpleasant but usually isn’t a major concern.

But the usual ebb and flow can worsen. According to the American Psychiatric Association’s most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), normal anxiety becomes diagnosable as generalized anxiety disorder when:

  • Excessive anxiety and worry occurs more days than not, for at least six months, about several events or activities (for example, performance at school or work)
  • Controlling the worry is difficult
  • The anxiety/worry includes at least three out of six symptoms (in diagnosing children, just one of these symptoms is required): restlessness or feeling on edge; being easily fatigued; difficulty concentrating, or the mind going blank; irritability; muscle tension; sleep disturbance
  • These symptoms cause significant distress in functioning
  • The disturbance isn’t related to medication, drugs, or a medical condition
  • The disturbance isn’t explainable by another mental disorder

I recently saw an 88-year old woman who was referred by her internist for anxiety. Her primary symptoms were her mind going blank, trouble letting go of thoughts, and agoraphobia (the desire to avoid leaving her home). The usual culprits were ruled out: hyperthyroidism, a medication side effect, or, given the client’s advanced age, dementia.

Composedly, my client said her anxiety came from feeling pressured to do more, and a sense of failure for not being good enough. This surprised me; I had expected her to talk about a fear of approaching mortality.

It’s a psychologist’s job to ask the hard questions, the ones that seem most obvious—the ones most friends and family wouldn’t touch for fear of making the person feel worse. So, I gently inquired if some of her anxiety could be related to thoughts about aging and death. But my client was quite definite that that was not the case! Her physician had assured her she would live to be 94 years old. I did a quick calculation—math was never my strength as I still count in my head with little dots—and determined that would give her five more years. Wouldn’t such a short countdown to death be enough to bring about anxiety, I still wondered?

Another job of a psychologist is not to jump to conclusions or make assumptions. Using inquiry, we ask for further thoughts, feelings, and associations. Some of her anxiety, she acknowledged,  was longstanding, but a new worry was that she was no longer as interested in venturing from home. What was this about?  Was she worried about taking a fall, breaking a bone, and ending up in the hospital? Again, no, it wasn’t fear that losing her balance and falling would lead to death because she knew that it most likely would. Anyone who reaches the age of 88 has seen in their own peer group how a broken hip can spiral downwards to a skilled nursing facility, with all the loss of dignity that brings.

Perhaps the most important part of our job as a psychologist is to trust that our clients know what they’re talking about. That trust is huge because it eventually leads us to an understanding of what is going on inside, in the deeper places we can touch if given time and attention. It turned out that my client’s anxiety was about just what she’d said it was. She was feeling like she should be doing more, going out more, and accomplishing more. Until she retired 23 years ago, she had been very productive in her job as an accountant. She loved her work, and she loved her retirement. She hadn’t slowed down in retirement until recently. She couldn’t understand the desire to just stay home. It was unlike her, and she felt she should be keeping up the pace she was accustomed to.

We discussed her symptoms; a mind going blank can be due to anxiety, and also to what my neuropsychologist husband refers to as benign senescent forgetfulness. (He tells me I have a mild case of it—our brains shrink as we get older, it’s entirely normal.) I also recommended that she turn off CNN. I wasn’t being flippant: Non-stop watching the news these days is making a lot of us anxious. Being bombarded with daily images of worldwide pain and suffering pervades our senses and creates disturbances that go deep into our unconscious minds, harming emotional health.

What about not wanting to leave the house? She wasn’t worried about going outside, but rather, as we figured out together, she desired to retreat from the world, to reflect and take time to appreciate her many gifts: a life well lived, a 65-year marriage to a good man, and her overall sense was that she had had a good, if not perfect, life. It was time to turn inward a bit more and let herself off the hook. Over the next several weeks, we explored how she could do just that.

Acceptance of who we are, imperfect and flawed, allows us to live more fully each moment, for as is said in mindfulness practices, each moment is all we really ever have.

Filed Under: Couples & Marriage & Family, Depression & Anxiety, Dr. Susan O'Grady's Blog, Health Psychology, Mindfulness & Meditation, Relationships, Self-care, Stress, Uncategorized, Well-being & Growth

February 7, 2017 By Susan O'Grady 4 Comments

Working with Emotions: How mindfulness and awareness help

hiding from emotions is never a good strategy
Hiding from emotions is never a good strategy

Bringing the hidden to light is an important part of psychotherapy, sometimes achieved through focus on intellectual reflections. But in recent years, mindfulness-based therapies emphasize awareness of how feelings and physical sensations are related. It is enlightening to notice what happens in the body when we feel strong emotions.

As an example of how lack of mindfulness can hurt, I would sometimes react with anger at my husband when he disagreed or corrected me. But rather than seeing my point of view, he only experienced my anger as defensiveness, while I experienced him as overbearing. The result was that I felt worse.

This pattern continued until I learned to slow down my automatic reaction of anger, by becoming aware of the physical sensations that accompanied my feelings. This allowed me to become aware of the small, fleeting, and easily overlooked span of time between my internal commentary about his comment and my emotional reaction.

What was surprisingly helpful in doing this was to become aware of physical sensations; in mindfulness practices, we call this “mindfulness of the body.” Sleuthing out my emotions when corrected by my husband, I could actually feel my hackles go up. It was subtle but unmistakable.

Sensing our Hackles Before a Fight

When a dog’s hackles go up, the hair between their shoulder blades becomes erect as an automatic reaction to feeling threatened. As Adrienne Janet Farricell, a certified dog trainer explains, special muscles attached to hair follicles “are innervated by the sympathetic branch of the autonomic nervous system and are therefore not under conscious control. The function allows the dog to appear larger, taller and therefore more intimidating than it is. This is a ‘fight or flight’ response triggered by adrenaline.”

Paying attention to my physical response after my husband criticized me, I began to sense that distinct feeling of my hackles going up. But what surprised me even more was what followed:  I felt myself contract, my shoulders dropping and my chest becoming slightly concave. I submitted instead of fighting, just as a dog lies submissively on the ground. In the animal world, cowering is a useful and self-protective signaling “I am not a threat to you, so you don’t need to attack me.“ But when we humans do that, we lose some of our power.

Paying attention to this small and subtle sequence of physical sensation help us notice the physical reactions that often precede the ultimate expression of strong emotion. Without being aware of how we succumb to our initial reactions we are unable to address the problem that’s making us react.

Making the automatic conscious is liberating on many levels. First, we gain some control over our automatic responses—something dogs cannot easily do. Second, greater physical and emotional awareness lets us link direct relationship to felt experiences. Being able to name an experience or find an image for it, as I did with the hackles example, opens our understanding, bringing meaning to what on the surface looks like plain old anger.

It is important to know that an angry outburst is not always a bad thing. Anger is a reaction that often stands in for other feelings that are less available to us. Let’s imagine a typical couple’s situation of the sort I see in my practice.  When Jill got angry at Sam, she didn’t always stop to feel what that anger signified. Their arguments escalated as they each get more flooded with emotions. But when Jill reflected on her anger, her felt-sense was of being small, childlike, and without a voice of her own. Childlike? Sure enough, just as she’d felt in her family growing up with three older brothers, she experienced Sam as being dismissive of her opinions and dominating her in a situation where she was powerless.

Sam, meanwhile, had no idea she was feeling this way, because all he saw was her childish, to him, outburst. He tagged Jill as being easily out of control, making him feel all the more self-righteous toward her, which further reinforced Jill—and Sam–feeling like Jill was the problem in the relationship. Sam was off the hook, and did not have to look at his role.

Pausing Before Reacting

As this example shows, our reactions and feelings may mean more than we consciously know. In some traditions such as Tibetan Buddhism, mindfulness translates as “to remember.” This process of witnessing our emotions and our physical sensations requires remembering to push the pause button before our automatic reactions take hold. In a disagreement between couples, this may mean agreeing to a time-out, or the pause may be as subtle as one breath—a period between two sentences. Pausing gives us the space to be aware without becoming stuck in automatic reactions, attacking back, or inwardly growing smaller and losing the essence of our feelings, which are usually quite valid.

This pause also gives us time to consolidate our understanding of our self. Jill recognized an old memory: that of being discounted, unheard, or dismissed. She also understood that when anger dominates, the more important issues get lost.

Being Alert to Underlying Emotions

Of course, staying calm while having hard conversations can be challenging. It helps to recognize the early and subtle signs that you are becoming flooded. Once flooded, meaningful conversations come to a grinding halt or turn into a yelling match. Be alert for automatic reactions. Remembering to pause before automatically reacting allows us to tune into the deeper, less conscious feeling: what emotions and what physical sensations are triggered?

At this point, we have a choice. We can either use our awareness to ask directly for a bit of time to get back in emotional balance before continuing. Or, we can use the pause to go deeper into what may be coming up from within. This doesn’t have to be a lengthy process; with practice, that pause can take mere seconds for insight to come.

And in that pause, when we bring awareness to physical sensations like raised hackles or a churning gut, we can use these as signals to look more deeply into our role in what is getting triggered. Too often our automatic response is to assume fault lies outside us, not within. As Cassius says, “The fault, dear Brutus, is not in our stars, but in ourselves.”

While taking responsibility for what is arising in us, we also need to be aware of its impact on others. When we do this, hackles go down and the back and shoulders lengthen, bringing real power, liberating the Self to be more fully alive and present. Our defense mechanism was only masquerading as power, and that briefly.

What is Your Role?

Taking responsibility does not result in guilty self-recrimination but liberation and power. Once we take ownership of our contribution to conflict, we can more readily bring insight and thus control over our automatic reactions. It may reveal qualities within us that are active and useful in opening us up to be freer, more whole in ways we‘ve barely glimpsed.

Being aware of our default defense mechanisms can help us deal more effectively with difficulty. While many defenses help us cope—psychologists call this defense in service of the ego—they can backfire and hurt us. Because defenses are unconscious, it’s difficult to be aware when they emerge. The best clue that our defenses are lurking is when we react with strong emotions or behaviors, such as rage or sharp criticism.

Some of the most common defenses are projection and denial. They are related in that both mechanisms protect a person’s sense of self by attributing to another (projection) or rejecting (denial) their own unacceptable impulses or feelings, which are made unconscious. Let’s see how that worked with Amie and Jon, who were locked in a cycle of blame when they came to counseling. Amie saw Jon as extremely self-centered, and Jon felt Amie was too emotional, always criticizing him and trying to control him; meanwhile, each felt innocent of playing a role in this cycle.

With therapy, both Jon and Amie could see how they projected unacknowledged parts of themselves onto the other. Amie never gave herself permission to ask for time to be with her friends or to play. She then criticized Jon for taking time for himself instead of spending time with the family. Further examination revealed that Amie’s mother was a martyr and never let anyone in the family forget it. Amie grew up feeling that taking time for herself was selfish. She denied feelings of wanting to take time for herself and projected her anxiety about selfishness onto Jon. Meanwhile, Jon disowned his own anger by projecting it all onto Amie.

This dynamic created misunderstanding and distance. Once both Amie and Jon saw their role, they not only reduced conflict but had more access to dormant passions. Replacing anger with understanding brought new ways of relating. Sex reentered the marriage, along with play and a deeper acceptance of each other.

When your hackles go up–whenever you have a strong emotional reaction–you have an opportunity to learn something new. By pausing and paying close attention to your bodily sensations and your thoughts, you can discover something unexpected, something that ultimately empowers you.

Filed Under: Couples & Marriage & Family, Depression & Anxiety, Dr. Susan O'Grady's Blog, Mindfulness & Meditation, Psychotherapy, Relationships, Stress, Uncategorized, Well-being & Growth Tagged With: Conflict in Marriage, Couples, Couples Communication, Dealing with Conflict in Marriage, Flooding, Mindfulness, Mindfulness-Based Stress Reduction

January 24, 2017 By Susan O'Grady 10 Comments

How to Be Sad

Psychotherapy for depression helps people accept that we can't force happiness.There’s a plethora of information about happiness.

My literature search on this subject yielded over 13,000 scholarly research articles and over one thousand books. Advice about how to be happy floods the internet daily with simplistic listicles and click-bait articles that make it all seem so easy.

But their advice, like telling a sad person to think about all the reasons they shouldn’t be sad, or a depressed person to just get up and exercise, doesn’t work. Thinking about the good things in life can sometimes ameliorate sad feelings, but usually, trying to grasp at happiness when in the grip of a depressed mood leads to failure. And while the research on exercise’s positive effect on depression is robust and persuasive, depressed people lack the drive to work out: that’s what depression means.

These suggestions, though well-meant, amount to telling depressed persons to snap out of it—or it’s their fault. This shames the sufferer, making things worse. And the resulting family strife doesn’t help. Well-intentioned spouses and parents who believe that snapping out of it actually is within a depressed person’s power will eventually succumb to exasperation and resignation.

A recent New York Times article gives suggestions for eliminating negative thinking, and paraphrases  Rick Hanson, author of Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence: ” it might be helpful to ask yourself if you are accomplishing anything by dwelling on your negative thoughts.”

Depressed people have negative thoughts. Understandable. When we’re depressed, we’re likely to feel hopeless, inadequate, and a failure. While practicing controlled breathing and mindfulness even with your eyes open, as the article suggests, will help, how do we get to the point of making these actions regular parts of daily life? When sadness overwhelms, it is often impossible to follow well-meaning suggestions with regularity. Like New Years’ resolutions, these techniques fade quickly.

When Sadness is Normal

Sometimes sadness is normal. Experiencing a range of feelings in reaction to painful life events is understandable; these life stressors would make most of us depressed. When psychologists see a client for a first appointment, we assess mood, its duration, and the severity of distress. Is the client’s symptoms within normal limits given the precipitant for entering therapy, e.g., a marital crisis, job loss, or death of a family member? We would say a client’s feelings are “within normal limits” when they come to therapy with sadness after losing a loved one.

In my own practice, a former client returned to treatment recently because his wife had just died. He spoke of his inability to shake the feelings of loss and sadness. It had only been four weeks, and he asked me if it is normal to feel depressed, and the question that inevitably follows: how long it will last? It’s okay to feel sad—but to someone grieving, the feelings can be so intense that time stands still. Four weeks can feel like four years.

It’s hard to feel deep emotional distress, of course. Indeed, because suffering is part of the human condition, we’ve devised a vast repertoire of ways to avoid experiencing our painful emotions and worrisome thoughts, including self-medicating by substance use, distraction by Facebook and other media outlets, and much more. Americans account for two-thirds of the global market for antidepressants, which also happen to be the most commonly prescribed drugs in the United States. These drugs can play a vital role in helping many people cope with chronic depression, but all too often these medications are over prescribed or prescribed without looking at inner sources of depression.

When Positive Thinking and Life Coaching Make it Worse

Or, life coaches with little training in mood disorders are prescribing positive thinking the way many physicians prescribe mood stabilizers, but even positive thinking strategies are ways to avoid painful feelings. I have seen the disastrous results of life coaches who work remotely from home, charging enormous amounts of money to people desperate for help. Sadly, these coaches have not laid eyes on the people they propose to help. They are unable to see the dangerous weight loss or weight gain or pick up the nuanced suicidal non-verbal communications.

One client I saw judged himself to be a failure after his six-month life-coaching sessions because he was unable to feel better or do the things the coach was suggesting. When I saw him after his failed coaching experience, he was in a deep depression, his sadness palpable. I asked if he was suicidal and he admitted that he was—something his coach had never asked about. Alerting his partner and suggesting hospitalization was imperative. Alarmingly, he had already seen three different psychiatrists and obtained antidepressants from each, and not one of them had inquired about suicidality.

Another example from my practice is that of a woman who saw a life coach because she hated her job. They talked about the need to follow her bliss and sever ties with her employer. She took this advice, quit her job, and when her unemployment ended, she was unable to find another job. Despondent, she came to therapy to help sort out her feelings about her life and to find a way to understand why she was unhappy at her former job. She needed to understand her role in how she was sabotaging herself. She took the long road to what ultimately brought her fullness and acceptance of life and work.

Accepting Suffering as Unavoidable

Suffering can’t be avoided. (In Buddhism, it’s the first Noble Truth.) But allowing ourselves to express sadness and to accept deep pain will eventually allow these feelings to dissipate; blocking emotions only deepens problems. Also, giving ourselves time to settle into feeling allows us to recognize that they ebb and flow. Through this, we can accept that while old age and death are inevitable, and feeling sad is part of living, suffering is impermanent. By being able to sit with emotions and not get caught up in either rumination or anxious fretting, we develop a steadiness of mind. Meditation works by settling our turbulent thoughts and emotions so that we can titrate them into tolerable moments.

What works

When sadness becomes major depression, positive thinking (and related approaches, such as life coaching) are like putting a Band-Aid on a gushing wound. Facing our pain, learning to bear our suffering, and then doing the deep inner work of understanding our role in our troubles is a way out. It is often slow and filled with obstacles. Here are some steps in the process:

  1. Become aware of subtle emotions as you experience them. By becoming aware of emotions as you feel them, rather than pushing them away, you will be better able to use them to employ coping strategies.

 

  1. When emotions become intense, know that feelings don’t stay that way forever. All emotions are transient. Practices such as regular meditation help us not just to become aware of feeling but also not to indulge them.

 

  1. Remember that subtle change is hard to see. A broken bone mends slowly; in the early stages, healing is hardly noticeable on an X-ray.

 

  1. Look deeply at ourselves and the role we play in our mood. Doing so opens what is within, leading to understanding and insight.

 

  1. Take into account what precipitates depression. Learning to tolerate understandable sadness and some depression helps normalize what we are experiencing. All emotions have a role to play in living well; we must accept and not disown our most difficult feelings.

Filed Under: Depression & Anxiety, Dr. Susan O'Grady's Blog, Mindfulness & Meditation, Psychotherapy, Self-care, Uncategorized, Well-being & Growth Tagged With: coaching, Depression, Meditation, Mindfulnees-Based Cognitive Therapy, psychotherapy, sadness

January 9, 2017 By Susan O'Grady 7 Comments

Psychologists Need Self-Care Too

Self-care and ethics for psychologistsWho Helps the Helper?

Self-care and Professional Ethics

Most psychologists get into this profession because we get deep satisfaction from helping people. But who helps the helpers?

What about us, anyway? We sit for hour after hour, year after year, listening to our patients’ troubles. We help them make sense of what brings them to our office. We help them deepen their understanding of themselves, working with them to bring meaning and healing. But as psychologists, our training is not very conducive to our taking care of ourselves. The doctorate alone requires years of study, often at great expense, to say nothing of the 3,000 hours of unpaid or poorly pay internships, post-docs, and fellowships. It doesn’t end there; paying back debt and building a practice all take a toll on our self-care.

And of course, while dealing with these stresses, we must be effective and ethical therapists, even when clients may be testing our limits, perplexing us, or causing us worry.

A therapist’s most valuable tool is the therapist’s own self. We need to model a healthy self to our patients, and this is where self-care comes in. In fact, self-care is an ethical obligation to maintain our competence as psychologists. Caring for ourselves as well as others is an inherently integrated and reciprocal process. When we “more readily realize the false demarcations between ourselves and our clients, self-care becomes both an ethical imperative, and a humanistic one.”

So as a therapist, don’t forget to ask “What about me?” Issues that can challenge self-care include:

  • Balancing our own and clients’ needs
  • Countertransference reactions such as envy or erotic feelings
  • Confidentiality

For example, let’s take envy, a problem that can loom large in this time of widening income inequality or for any therapist working with wealthier patients. No one likes to admit to these feelings, but denial is never a good strategy.

And this can especially be a problem if we feel stalled in our own lives. We’re in the trenches; meanwhile, we’re helping others live fuller lives. They write books, get fit, flourish. Good for them—but here we sit, with unfinished books, unexercised bodies, unexplored possibilities.

Here’s an example from practice.  I had a patient with a lucrative professional job who came to me for anxiety. His wife was leading one of my dream lives, an unlived life: owning, showing, and riding horses.  I thought “Damn, she is lucky.” I felt impatient with his problems and had to stop myself from telling him his wife should get a job. Because we have lots of training in recognizing when our reactions are countertransference, I was able to see my envy at the moment so as not to let it interfere with my client’s process.

Or again, I authorized a patient’s disability leave. He got four months of paid time off, lost 20 pounds, got a personal trainer, went on a luxurious retreat, and returned looking 15 years younger. Good for him again, but I was seeing 30 patients a week and couldn’t help contrasting my responsibilities with his fortune. For those of us in private practice, taking time off is tricky. We lose income, and our clients may have a hard time without the continuity of their therapy.

When our patients improve and surpass us, how do we deal with that? That’s our goal, after all, to help them attain full lives and be the best selves they can. It’s not their fault we haven’t achieved the same goals. We must move forward in our own lives if we’re going to maintain ethical principles and standards.

Another challenge can be secrecy. Keeping patients’ secrets is an ethical imperative, but not always easy. A very famous person came to me for something highly scandalous, something I was dying to tell—but even married to a psychologist, I could only mention broad strokes, no name, and no juicy details. It’d be a great story to tell at parties, but I have to keep all such secrets locked in a vault. It’s a peculiar situation to know more about the inner world of a very famous person than anyone else and not be able to tell a soul, but as an ethical psychologist, I can’t.

Heal Thyself, Know Thyself

The arduous, never-ending self-scrutiny and inner work required by our profession is like no other. Gaining deep intimacy with our clients requires us to be just as deeply familiar with our own feelings. As therapists, we’re already familiar with the value of therapeutic lifestyle changes in areas like exercise, nutrition, rest and relaxation, maintaining good relationships, and service to others. We recommend these to our clients, so we should also practice them ourselves, along with helpful interventions like apps to help monitor diet, movement, and sleep. To that list, we should add personal therapy and development for ourselves, not just clients.

This is because our work depends on the personal/professional therapeutic bond. In turn, this largely reflects and depends on the therapist’s interpersonal skills and capacities, which must be developed in the therapist’s personal growth. The link between ethics and self-care is professional competence, which is necessary to protect our patients. Clients’ experiences of the therapeutic relationship—the respective interpersonal capacities of the client and therapist—are among the strongest predictors of outcome in psychotherapy. Those of us who are reluctant to practice self-care techniques should remember that we are decreasing our competence as therapists.

More information on these principles can be found in the American Psychological Association’s “Ethical Principles of Psychologists and Code of Conduct.”

Taking care of ourselves

When we say we’re not taking care of ourselves, what does that mean? Examples include overbooking or double-booking clients and working late; taking no breaks; being distracted, impatient, or bored; giving clients the same exercise as last week; talking about your problems instead of the client’s; or falling asleep. As you can see, these actions affect clients as well as ourselves. If we’re not getting our needs met, we may look to our clients to meet them, a violation of their boundaries.

Occupational hazards

In our jobs, occupational hazards include isolation, demands on body and psyche, frustration, and never-ending self-scrutiny. Burnout, compassion fatigue, secondary traumatic stress, suicidal patients or our own suicidal feelings, depression, anxiety, boredom, conflicts with co-workers, practice logistics, insurance company hassle, money problems, personal losses—these can all add to professional stress. To cope, we need inner strength, self-soothing skills, and awareness of our own strengths and vulnerabilities.

Even when we’re well aware of the damages we’ve suffered, we can fall into the mistake of projecting all such woundedness onto patients, and claiming the role of healer—and healed—for ourselves. Self-knowledge helps prevent this trap. It’s also important to seek peer support through professional groups and other networks, social support from friends, and develop coping methods like cultivating humor and a positive attitude.

Occupational Privileges

 As psychologists, we live a life of service. We are always growing and our work protects us from stagnation. As Irvin Yalom states in his book The Gift of Therapy, we daily transcend our personal wishes and turn our gaze toward the needs and growth of the other. We take pleasure in the growth of our patients and also in the ripple effect–the salutary influence our patients have upon those whom they though in life.   Viewed the right way, the very stresses of our job help prevent stagnation. Continual growth and self-examination help us to see the world, ourselves, and our patients for what they are, making us better able to help—which is what brought us into this field in the first place.

The result of my exploration on this topic is that I am taking a sabbatical during the month of January. I plan to write, read, and spend more time deepening my self-care.

References

In pursuit of wellness: The self-care imperative. Barnett, J. E., Baker, E. K., Elman, N. S., & Schoener, G. R. (2007). Professional Psychology: Research and Practice, 38(6), 603–612. http://doi.org/10.1037/0735-7028.38.6.603

What Therapists Don’t Talk About and Why: Understanding taboos that hurt us and our clients.  Kenneth S. Pope, PhD, Janet L. Sonne, PhD, and Beverly Greene, PhD Second Edition, APA Books, second edition, 2006.

Ethics, self-care and well-being for psychologists:  Reenvisioning the stress-distress continuum. Wise, E. H., Hersh, M. A., & Gibson, C. M. (2012). Professional Psychology: Research and Practice, 43(5), 487–494. http://doi.org/10.1037/a0029446

Ethical principles of psychologists and code of conduct. The American Psychologist, 57(12), 1060–1073. http://doi.org/10.1037/0003-066X.57.12.1060

Filed Under: Dr. Susan O'Grady's Blog, Health Psychology, Psychotherapy, Self-care, Uncategorized, Well-being & Growth Tagged With: Practicing what we teach, Psychologist Ethics, Self-care

  • Go to page 1
  • Go to page 2
  • Go to page 3
  • Interim pages omitted …
  • Go to page 11
  • Go to Next Page »

Dr. Susan J. O’Grady is a Certified Gottman Couples Therapist

Learn more about marriage counseling and couples therapy »
Learn more about the Gottman Relationship Checkup »

Connect with Dr. Susan on Social Media

  • Instagram
  • LinkedIn
  • YouTube

Dr. David O’Grady is a Board-Certified Neuropsychologist

Learn more about medical-legal examinations Learn more about neuropsychological testing Learn more about services for professionals

Join Our Email List

We will NEVER share your personal information with anyone, period.

Privacy Policy

Our Privacy Policies Have Been Updated

Copyright © 2023 · Dr. David D. O'Grady and Dr. Susan J. O'Grady