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Black Friday Also A Day of Listening

You could say therapists are professional listeners. That doesn't mean we don't need to be reminded to shut up and put our listening ears on, especially when it comes to our own families. That's why I love that some clever person had this idea to create a National Day of Listening.

The writer Studs Terkel practically invented oral histories. He listened to common folk, survivors of the Great Depression, tell their stories. He revealed the truth, that everyday people are the true heroes of history, as much as generals or presidents. I wish I had had the forethought to record the fascinating stories my parents had to tell of their younger days, especially my mother who delighted in telling tales from her childhood.

Happy and Safe Thanksgiving, Everyone!

Humor! The Secret to Handling Holiday Stress

In yesterday's post, When Spending the Holiday with Family is Like Walking Into a Minefield, suggestion #5 reads: See the humor whenever you can.

Humor is a magical de-stressor. We get so serious and intense about our lives we often fail to lighten up. I know it's time to unplug and restore when I lose my sense of humor. For me, as I've said before, it's the canary in the mineshaft. If that goes, I can say sayonara to everything else and hello to irritability, grinding teeth and peevishness. I become the annoyed and annoying at the same time. Yuck!

Much more fun to step outside the situation, observe and not care so much. So what if Uncle Milton has to dig up that tired, old story of how cute you were when you were five and sang the Oscar Meyer jingle in the middle of Mass? Let it go and make gagging gestures where he can't see you.

Granted it becomes a lot tougher if the stories are truly heinous or hurtful. In that case, why are you anywhere near Uncle Milton? Spare yourself and make other plans if you possibly can (Suggestion #3).

In most other situations, a bit of creativity is always welcome. I especially liked this idea from the article, Food, Kin and Tension at Thanksgiving. It's genius!

10 Survival Tips When Spending the Holiday with Family is Like Walking Into a Minefield

Why do so many of us dread the holiday family gathering? Joyce Wadler, writer for the New York Times, tackled this question in Duck! It's the Holidays. She put together a bunch of stories from the field, an oral history of holiday family horror stories. But before we get to the fun stuff, let's hear from an expert:  

Mark Smaller, who heads the public information committee of the American Psychoanalytic Association, said he believes that holidays can provoke “temporary regressions,” in which parents, adult children and siblings, once reunited, revert to decades-old patterns of behavior.

“The worst I’ve heard is when a parent says to an adult child, ‘See, when you come you spoil the whole holiday,’ ” Dr. Smaller said. “These kinds of remarks actually keep me and people like me in business.”

That's the worst he's ever heard? I'd like to meet Dr. Smaller; he sounds like a shrink with a sense of humor, my kind of guy. But I think he's also trying to be nice. Temporary regression suggests that the people involved were "-gressed" to begin with. Or at least evolved. We can't always count on that. However, if we've worked hard to grow up despite dysfunction in the family, then going back to the scene of the crime could be like a trip in Mr. Peabody's WAYBAC Machine.

Last year I wrote Ten Suggestions to Make the Holidays Bearable. A review:

1) Once you're honest with yourself and can say, "Yes, as much as I love them, my family is screwed up," you can begin to make plans to cope.

2) Ask yourself what you really want. You may be surprised by the answer. You may even decide what you want is to be with your family, warts and all. Once being with them is a choice instead of a gun-to-your-head obligation maybe you can relax.

3) Give yourself permission to have an escape route.  If you want to try having dinner with the family make plans to go somewhere you can breathe easier for dessert. In extreme cases it's a good idea to have a Plan B (i.e. leaving for good or asking the guest to leave your house) just in case.

Wadler wrote: Isn’t Asking a Guest to Leave Rude?

Good question. Let’s have an emergency consultation with Dr. Smaller.

His verdict: “One has to do something to protect oneself if people are acting in a deregulated or unreasonable way.”

So there you have it. Dr. Smaller and I agree. Take care of yourself first.

Surviving the Suicide of Someone You Love

My brother's childhood best friend committed suicide. I was 16 years old at the time, Mark (not his real name) was 21. Mark's parents were close friends of my parents; we played together as little kids, he was my first crush. We drifted apart as we grew up. Mark was a Kennedy-esque figure to me, handsome and smart. Everyone expected great things when he went off to an Ivy League law school. Then he was dead.

I have a vivid memory of walking around the neighborhood with Mark's brother at night. The adults were sitting shiva and he had to get away. Suddenly he grabbed a fallen branch and wailed it on the trunk of a tree. Raw anger.

This family did heal. Before support groups or national days of recognition they talked about the conflicting emotions pain, anger, guilt. The same tape kept playing in everyone's head: If only... If only... They used therapy, the love of family, friends and good works, to find their way through. They found a way to forgive. 

Project Happily Ever After

Great name, right? Project Happily Ever After, a website/blog run by Alisa Bowman, a professional writer, was brought to my attention by a reader of this blog. Alisa's readers love her blog about her marriage and life with her family because it's fresh and very real. Alisa has ghost written and read a ton of self-help books. She is smart, genuine and has learned a lot along the way. Alisa shares how her marriage was once in dire jeopardy, how she and her husband learned to reconnect and fall in love all over again.  Her sense of humor is self-deprecating and funny!

In this post she describes how she tackles those pesky negative thoughts that can bring her down. It's all very consistent with Cognitive Behavioral Therapy. I thought you might enjoy a down to earth use of a basic CBT technique. Alison's take:

"Researchers know that depressive people like me tend to see the world through a negative lens. For instance, on an unusually hot day in the summer, a well-adjusted person might think, “This is a perfect pool day!” A depressive person like me will think, “Definitely global warming. The world is going to end soon.”

Years ago, a therapist taught me that I needed to counter my unrealistic negativity by constantly feeding myself more positive, realistic thoughts. At first, I didn’t think it would work, but she told me that was just my Negative Voice talking. Don’t you hate when your therapist has an answer for every excuse like that?

Anyway, I tried this positive affirmation business, and it worked amazingly well."

Some examples of Alison's positive self-talk are....

When Life Feels Too Hard

“Everything always works out eventually. This will, too. And if it doesn’t work out, that means I’m dead, so it won’t matter anyway.”

“Anything is possible, even this.”

“Just put one foot in front of the other.”

When I’m Too Scared to Take a Risk

“It’s better to try and fail than to not try at all.”

“I need to do this. Otherwise I’ll always wonder, ‘What if I’d had the courage?’”

When I’m Wallowing in Self Pity

“Build a bridge and get over it.”

“There are much worse things than this.”

“This, too, shall pass.”

When I Feel Overwhelmed

“I’ll get it all done. I just might not get it all done today.”

“Am I really going to care about this when I am on my deathbed?”

When I Feel Like a Good-for-Nothing Loser that My Own Dog Doesn’t Love

“I’m definitely going to get my period tomorrow.”

Six Things I love About Cognitive Behavioral Therapy

The graduate school I went to, the Derner Institute at Adelphi University, is a  professional school that teaches psychoanalytic, psychodynamic psychotherapy. It wasn't until my first post-doctoral job that I learned about cognitive behavioral therapy (CBT) and whole new approach to helping people opened up to me. I was very fortunate to get my CBT training from Dr. Arthur Freeman, who studied under Drs. Albert Ellis and Aaron Beck, the grand-daddy and daddy of CBT. Having in-depth education in both these modalities is like having a nice, deep bench for your basketball team. I can adapt easily to whatever my patient needs even if those needs change in the process of therapy.

My father was a Neo-Freudian psychoanalyst so the psychodynamic approach was super familiar to me. Discovering CBT was like discovering a whole new color in the spectrum. Awesome!

Basically and very simply put, CBT focuses on what is happening here and now to shape our thoughts which in turn influences our mood.  Psychodynamic therapy uses the exploration of past experiences and relationships, internal and external, past and present to provide insight and change in the patient. 

Both approaches have a place in treating depression, anxiety and other mood and personality disorders. Here I share a few things I love about CBT in particular:

Doing the Unthinkable – Going Offline

"The biggest source of stress in my life is the screen, the blogging." 

~Jessica Valenti, founder and editor of Feministing.com

What? I mean, let's get real here. It must be really, really nice not to have a greater crisis eating up your attention and time than blogging. On the other hand, I understand exactly what Valenti means.

Anything can cause us to lose focus on what is fundamentally important, even seemingly innocuous things. For some parents it could be getting sucked into over-scheduling extracurricular activities for the kids, for a college student it might be taking on too many credit hours, for a young professional it might be the pressure of passing their certification exams the first time around. I've known people to have serious debilitating anxiety over these things.

Why stress over such stuff when there are so many much more serious troubles in the world? Unemployment, illness, war. Take your pick.

Because it's our direct experience that's important to us, that's why. I tell my patients all the time, please, don't compare your stress to someone else's. It's like comparing pain of any kind. It can't be done. We can and I hope do, have compassion for each other but who am I to minimize the stress of a new mother just because her baby is healthy? Or of a young man, trying his hand at being an entrepreneur? These are good things, right?

Sure they are. But still it takes courage to do them and doing them can be stressful.

And what about blogging?  I know I needed a break this weekend. Not going online for a few days was hard the first day. Easier the second. Genuinely cleansing the third.

We all need a break whatever is causing us stress; a respite, a moratorium. If you can, I recommend closing the door on whatever is causing stress for you and getting back to some fundamentals like uninterrupted sleep, play time with the kids, cooking a favorite meal, eating it. 

You will get back to your unique not-to-be-compared life, refreshed and stronger.

How Can You Tell If You're Really In Love?

In my journey to true love I must have thought I was in love at least nine times. Of those nine times once was really close to the real thing but I was in high school at the time and not ready to settle down. All the other so called boyfriends I had, I look back and ask, "What was I thinking?"

Well, I doubt I was thinking at all. While the guys were nice enough, those relationships usually fell under one of three categories:  1. they were convenient, 2. I was lonely or 3. the sex was good but not much else was.

When I was twenty-nine years old I was in a relationship with a guy who was smart, attractive funny, immature and self-centered. At the time I thought, "This is as good as it's going to get. Maybe it's time to settle down."

Then I met John. It wasn't fireworks or love at first sight. It was and still is, as Miss Etta James sings, a Sunday kind of love. Warm, sure, safe.

That's why I encourage people not to 'settle' for less than good, solid love. And how can you tell the real thing from the cheap impostors?  Mira Kirshenbaum, Women & Love, Finding True Love While Staying True to Yourself,  helps us do that with this list of qualities to look for. She wrote it with women in mind but it is true for men too, everyone, gay or straight. Love is love is love. I could not improve on her list so here it is, in its entirety: 

> It's not just how you feel about him. It's about how he makes you feel about yourself.

> It's not about losing yourself in him. It's about becoming true to yourself with him.

> It's not about how great he is. It's about how great you can become along side him.

The Chronic Illness Wrangler on Steroids

Steroids, corticosteroids, prednisone.*

Do these words strike terror in your heart? Or are you grateful beyond measure for their existence? Both? Then chances are you, or someone you love, has a chronic illness that is reversed or relieved by steroids.

I have been on and off steroids, prednisone, all my adult life. Ever since my mid-twenties I’ve had a tumultuous relationship with that medication.

Steroids are miracle drugs. A synthetic compound that mimics the hormone excreted by the adrenal glands, they rev up the nervous system, reduce inflammation and suppress the immune system. Short term use, for five days to a week, is not usually a problem. The problem is with longer term use, when they are as toxic as they are beneficial. In her article Steroids’ Miracle Comes With a Caveat, Jane E. Brody, wrote:

“...as with any powerful remedy, corticosteroids come with a downside: side effects that can sometimes be as serious as the ailments they are intended to treat.”

No joke.

The doctor who first put me on prednisone neglected to tell me about the down side of the drug. My father, also a physician, didn’t warn me either. I’m still mad at both of them for this lapse in judgment (which is inconvenient because they are both dead). All they had to do was tell me:

You need this drug to keep your kidneys functioning well. You are on a high dose but we intend to taper you off after a few months, slowly, to reduce risk of a relapse and complications. In the meantime look out for:

• insomnia
• agitation
• hyper, even manic mood
• depression
  
• irritability
• increased appetite
• weight gain

In other words, expect to be a coo-coo-bird nut-case.

Totally oblivious, I went back to college where I lived alone in a little studio apartment (which sounds a lot cuter than it really was). On my first night I had a serious case of the heebee geebees. I felt like someone had injected a double espresso laced with Red Bull right into my bloodstream. By morning a million bugs were trying to worm their way into every pore of my skin. I seriously thought I was losing my mind. Frantic, I called my doctor who nonchalantly (God, I’m so mad) said, “Oh, that’s the prednisone. Relax, it will get better. Don’t change the dose, whatever you do.”

That was my first experience with prednisone and I’ve hated it and loved it ever since.

Without prednisone, many of us would be crippled, in agony, suffocating or dead. I’ve been able to live a functional life because of steroids but I've suffered from them, too. 

Twice my body became dependent on the steroid which meant every time my doctor (a new one whom I adore with all my heart) tried to get me off my kidneys would relapse. That meant I was on prednisone for years. Brody wrote:

“Steroids taken orally for more than three months can have more profound and sometimes irreversible effects. Serious side effects are more likely when steroids are taken in high doses for a year or longer.” And what are those serious side effects?

more weight gain
high blood pressure
deteriorating bone mass
diabetes
thinning skin
muscle weakness
Fat deposits on the face (moon face), stomach, chest and upper back
cataracts
glaucoma
ulcers
heartburn
easy bruising
increased sweating
acne
heart disease
delayed wound healing
increased risk of infection

And all this is in addition to the first list (see above)!!!