Relationships - Gitu Bhatia Psy.D.

New Year Resolutions to Enhance Relationships

Every New Year presents us with a fresh opportunity to refocus our intentions for the upcoming months, as well as to make changes to those aspects of our lives that have not been fully satisfying for us. Oftentimes, even despite our initial determination, we get caught in the business of everyday life and fail to nurture our connection with those we love and care for.

I’d like to share a few simple practices to help you maintain a healthy relationship with your spouse, partner, or loved one. My hope is that with these various “instruments,” you can start creating a toolkit that can serve to achieve greater intimacy, increase communication, and improve the quality of your physical and emotional bonds.

I hope you can make the time to do some (or all) of these, as the more you implement them, the more likely you are to feel connected.

1. Come up with traditions around holidays, birthdays, or special occasions; these should be specific to this relationship and enjoyable by both parties. For example, knitting each other scarves at the beginning of winter; having a birthday picnic, participating in a yearly race together.
2. Put aside about 10 mins each day to do a “check in” with each other. I recommend taking turns (3-5) minutes each, telling your loved one relevant experiences or observations from the day. When you are done, it is the other person’s turn. Very important: remember that there is no responding or interrupting, only listening.
3. Have a date night at least once per week. Just the 2 of you- make it something fun, enjoyable, and not so expensive that it becomes stressful.
4. Individually, keep a “gratitude journal.” Either at the beginning or at the end of each day, write down something you are grateful for; it can be as specific or as general as you wish. You do not necessarily have to share it with one another, but you may if you so desire.
5. Write a description of what you want your relationship to look like at the end of next year. If 2017 is transformational and it brings you everything you ever wanted in your marriage- how would things be different? Take a trip to the future and describe what you see/fee/experience in your ideal relationship. *This is to be done individually by each partner; you can choose to discuss your vision at any time- either now or in the future.

Lastly, enjoy one another! Remember what brought you together and the deep love that holds you. Speak up, let each other know what you need, and keep in mind that you are pretty terrible mind-readers ;)

Best Wishes for 2017!

Karyn Maczka, MA, MFTI

Befriending Technology… and making it work for you!

It is not just kids who are constantly plugged into their devices anymore. We all have replaced so many things in our lives with smart phones and tablets. Not only does technology let us access the world wide web, it helps us navigate geographically, make and maintain connections through social media, and keep our hectic social and professional lives in order. People are now more likely to get news and information via technology than books and newspapers. Divorceworks App

My colleague, Dr. Linda Bortell, and I have joined the 21^st century movement and have developed an app for people going through divorce.

As many of you know, I have spent the last 30 years working with families going through this painful transition, and in the process I have learned a lot about how to help soothe and manage the negative feelings and teach those involved how to care for themselves and their children.

Many people never seek the help of a therapist, but instead suffer in isolation and subsequently find it hard to navigate this difficult journey alone. This app is a private self-help tool to help individuals understand, monitor and manage the wide range of emotions that people find themselves feeling during divorce. We have found that therapists and attorneys are making it a vital tool they recommend to help their clients through the process. We called it DIVORCEWORKS because you CAN make divorce work!

Remember to recommend it to people who may need some hand holding through technology…

Body image and a healthy sense of self

We live in a world that values appearance. Whether we like to admit it or not we form our first impressions based on very superficial features. Some of us are able to look past what is on the cover of the book and look inside for it’s true value. Others remain preoccupied with the cover and buy into the advertised message.

So when does this preoccupation with body image and appearance start? From a developmental perspective, until children are preschool age, a child’s self esteem is almost entirely based on how they are treated by their caregivers, or family and friends, with whom they come in contact. Even exposure to media at this age does not have the negative impact it has later on as children’s growing cognitive abilities expand to see themselves as separate individuals from others. In the magical early years of childhood, children may even believe, when they play dress-up, that they are truly transformed into the costume they adorn.

Then children start kindergarten, and elementary school, and the feedback of others and socio-cultural biases reflected in the media start to impact self -esteem in positive or negative ways. Seeds of body dissatisfaction, disordered eating and full blown eating disorders get planted during these years. Although only a small percentage of people end up suffering from Anorexia or Bulimia or serious eating disorders, a large proportion of young girls and women, in this culture, suffer to some extent from dissatisfaction with their bodies, distorted body image and have disordered eating. Not surprisingly, but to a lesser degree, men are becoming increasingly dissatisfied with their bodies. A study in the British Journal of Health Psychology, on parental influence on dieting awareness in young children concluded, “The negative self comparisons to unrealistic images portrayed by media are not just a female issue anymore. A substantial proportion of young children have internalized societal beliefs concerning the ideal body shape and are well aware of dieting as a means for achieving this ideal. In particular, the desire for thinness emerges in girls at around age 6.

Although it seems alarming that most children are exposed to dieting parents and almost all children are exposed to popular media, there are a good number of children who seem to escape this pressure and grow to have a balanced and healthy sense of self that is not wrapped around their appearance alone. There are some protective qualities that can be encouraged in children, at a young age, to allow for development of a healthy self image.

As a society, we believe that increasing knowledge around any issue, helps prevent large scale problems like AIDS, drug abuse, drinking and driving etc. In reality these simple measures to educate have a very small impact on changing behaviors. It does not help build coping skills. It tells us what not to do without providing tools to cope with the pressures of real life. In building a healthy sense of self, “just say no”, does not seem to be a helpful approach.

On the other hand, helping children become better consumers of media is a very effective way of building resistance to societal pressures. Children can be taught critical thinking skills in simple every day situations like on their trip to the supermarket. The beautiful displays and packages communicate the glories of products, where as the product may or may not match up to the claims. Having children experience the “spin” first hand is a meaningful way of using their own instincts rather than “buy” into what is being “sold” to them. These messages can be brought to their attention with commercials, movies and even news sources. In all these small ways, children can learn that the vastly unachievable images projected by media are unrealistic and even harmful.

Another very important way for parents to be supportive of the healthy development of their children’s self esteem is to ensure that they are never teased for the way they look. People with eating disorders often report that the seed of body dissatisfaction was planted when they were teased or heard a devastating remark from someone significant in their lives, generally at a young age. Students of gymnastics and ballet are specially at a higher risk for weight and body size related remarks.

Unfortunately as a society, in placing such a high value on thinness we don’t honor the natural diversity in shapes, sizes and skin (and hair) color, on the other hand have one of the highest proportion of obese children and adults in the world. Perhaps some amount of education on healthy life style is needed at all ages.

A few things that parents can actively do to vaccinate their children against unhealthy body image:

Model a healthy and balanced emphasis to internal and external qualities by praising children for their work, effort and internal qualities with how they look. We have all heard comments that reflect the double standards of our socialization; girls hear “you look so pretty” and boys hear “you throw like a champ”.
Try to avoid social comparisons and judgements about others. It helps weaken peer pressure.
As much as possible, watch movies and TV shows with your children so you can use the teaching moments that invariably come up. It helps children know your values more explicitly.
Discuss their role models with them. Often parents are surprised that they are their children’s role models and not the popular movie or sports figures.
Avoid using terms “I was BAD” when you eat french fries or a decadent dessert. The terms “healthy” or “unhealthy” usually convey a sense of responsibility to self than “good or bad”.
Helping children expand their vocabulary of feeling words. Food often serves as an expression of emotion in the absence of open communication.

These are some warning signs that seeds, of destruction of a healthy body image, have set in:

Picky eating (obsessive concern about weight, calories, or a certain part of the body).
Possession of diet pills, laxatives, diuretics.
Excessive exercise or dieting.
Evidence of bingeing and/or vomiting.

Parents often feel the need to praise and compliment their children to foster a positive self esteem. In reality a healthy sense of self is only ultimately achieved by real accomplishments and not empty praise. Children, and adults, need opportunities to discover who they are and become aware of their strengths in a loving and supportive environment.

Anger is a difficult emotion

Anybody can become angry – that is easy, but to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy – Aristotle

Very often people struggle with knowing what they are really feeling when they are angry. On the one hand, anger is universally recognizable and understood. On the other hand, anger is a very complicated set of emotions with layers of feelings. Anger, for a lot of people, is the go-to emotion when they are hurt, afraid, disillusioned, misunderstood, or even embarrassed. Since many people are unable to understand the complexity of their anger, they are even less likely to care for, or manage, this emotion in a constructive manner.

Most of us associate anger with rage, being out of control or being destructive. Thinking of anger, as a constructive emotion, is often difficult because it feels corrosive and uncomfortable. Yet anger at the unjust world is what motivated the likes of Gandhi and Martin Luther King, Jr. Women, more often than men, are likely to suppress or mismanage their angry feelings. Women, in most cultures, are socialized to hide or sublimate their angry feelings. Where as men typically let out their anger in recognizable ways, women tend towards internalizing their anger or expressing it in more complicated ways. Although it may seem unfair to generalize, research support that across the board, women from different socio-cultural backgrounds, tend to use passive aggressive or manipulative means of managing or expressing their anger. For example, women are more likely to use the internet or emails as a weapon for attacking or for bullying from a safe distance. The book Mean Girls, Meaner Women, written by two psychologists, Dr. Erika Holiday and Dr. Joan I. Rosenberg, addresses this issue in greater depth and detail.

Popular wisdom about how to deal with anger is also often problematic. It is not uncommon to hear people say that they scream into a pillow or punch a punching bag to let out their anger. Unfortunately many of these strategies can have the opposite impact on our bodies, minds and relationships. Anger tends to have many physiological effects on the body, e.g., elevated heart rate, raised blood pressure, and tightening of muscles. Anger can evoke the same “fight or flight” responses in our body, as when faced with a scary situation. The strategies of punching or screaming exagerate the very feelings that we are attempting to temper. Also, a common way of dealing with anger, is expressing anger verbally in the name of communication. “You have to let it out”, is the common bias in this culture. Not all communication is effective and self- restraint is confused with being weak or passive. Letting the anger out, very often provides support for the angry person feeling even more justified in being angry. The most ineffective form of communication or of expressing anger tends to be when one is the angriest.

Interestingly, not letting out the anger, can be equally destructive. Since our minds and bodies are intimately related, unmanaged anger often shows up in the body as aches and pains, stress and even diseases like depression and anxiety. It is easy to see the link between the need to soothe difficult emotions and substance abuse or eating disorders. The more effective ways of dealing with anger requires a lot of self evaluation, changes in attitudes, re-evaluating relationships, one’s role in the relationships and cultivation of new habits. Thich Nhat Hanh provides a compassionate way of looking at anger in the book Taming the tiger within: Meditations on Transforming Difficult Emotions. In his infinite but simple wisdom, he says, “If you get angry easily, it may be because the seed of anger in you has been watered frequently over many years, and unfortunately you have allowed it or even encouraged it to be watered”. To stop watering this seed of anger, therefore, we probably have to focus our energy elsewhere, learn new coping skills and cultivate other qualities.

One of the ways of better understanding our anger and dealing effectively with anger continues to be effective communication. Unfortunately, we over use the word communication but misunderstand the essence of it. Anger gets communicated without words even more palpably than with words. Slamming doors or silent treatments are loud examples of non-verbal communication. The most important aspect of communication that is often neglected is “listening”. We are more likely view the act of listening as the time spent waiting to express our side of things or gathering up more evidence to assert our point of view. Listening with the intention of truly understanding the other is challenging and takes practice. It takes many years of training as a psychologist or a therapist to listen with unconditional acceptance.

Forgiveness is another profoundly helpful strategy to deal with unresolved or long term anger. Perhaps because it is associated with religiosity, forgiveness is also a widely misunderstood concept. People sometimes equate forgiveness with giving someone else permission to continue to wrong them or with forgetting bad events. Forgiveness is, simply, a conscious act of acceptance of the realities as they exist, and allows for healing and unburdening. It takes practice and it happens in small increments, like watering the seed and watching it sprout and grow into a healthy plant.

Mistakes are learning opportunities

If you shut your door to all errors truth will be shut out. ~Rabindranath Tagore, Stray Birds, 1916

As children we are made to fear mistakes because mistakes are often followed by some form of punishment or negative consequences. This may be the reason why we continue to view mistakes as shameful and bad rather than as learning opportunities. How do we help our children, and ourselves, view mistakes as a normal human experience or as learning opportunities? Try asking these questions with real curiosity:

Have you made this mistake before?
What circumstances led up to making these mistakes?
Are there others involved in this mistake? What is your contribution?
How have you felt after making this mistake?
How would you feel if you made the same mistake again?

It is really difficult for us to keep ourselves from judging and defending the mistakes. It is equally hard for us to forgive ourselves when the mistakes hurt others or have a long lasting impact on ourselves. The qualities that help in these circumstances are openness and acceptance to learn, flexibility to change our thoughts and actions, and most importantly wisdom to see the value in the mistake.

Path to success may have ten thousand steps

We live in a world where you can google and get an answer to almost every question you have. Life has become a lot easier at some levels and we have become a global community with an exchange of ideas and thoughts from all reaches of the world. There is an answer waiting for every question. One question that many people have is what is standing between them and their success in life. By success, people are often referring to tangible economic success, the kind of success Bill Gates, Oprah Winfrey, J. K. Rowling and others in that league have attained. There is a book that made it all look simpler; The Secret provided answers that appealed to the masses. There were a lot of inspiring quotes from people who have reached a level of success in their respective worlds. The law of attraction, made popular by this book, fed the same belief proposed by many self-help books; positive thinking propels us to positive outcomes in our lives. That it all resides in our thoughts and patterns of thinking leaves the rest of us believing that the ordinary successes are a result of ordinary thoughts.

Shedding light on the real secrets to success are two books, Outliers by Malcolm Gladwell and Better by Atul Gawande. These authors acknowledge the role of intelligence and ambition (nature) and opportunities (nurture) on the road to success. The 10,000 hour rule outlined by Gladwell helps us understand the many traits that successful people have in common. He provides several examples of all the work that goes into the ultimate success of most outstanding athletes, entertainers and entrepreneurs. It brings to mind the humorous line “the harder I work, the luckier I get”.

Gawande, a physician observing our health care climate, brings home more simple truths about success and failure. He attributes success to diligence, doing the right thing and ingenuity in the way we approach work. In his attempt to improve the world of medicine, he found that examining the failures is just as helpful as seeking out answers to what contributes to success. He brings home the point that we generally look for easy fixes: the one simple change that will improve every thing. It is not uncommon for people to use antidepressant as the easy fix when sad or depressed, which is a lot easier than looking into circumstances that caused the sadness, or working hard to change their outlook or find tools to cope with the circumstances. People struggling with weight issues are seduced into using appetite suppressants rather than making healthier choices every step of the way. In fact, walking ten thousand steps a day, as recommended by conventional wisdom has more benefits to the mind and body than simple weight loss. Maybe more simply, success involves thousands of hours, hundreds of little steps, and retracing steps when lost to reach the ultimate goals.

The secret to success is not really a big secret. There are things we can control and things we have little control over. Realistic assessment of our abilities, work ethic, diligence, focus, desire are within our control for the most part. The factors that are not within our control are often determined by social, economic, cultural and political forces and have more to do with the opportunities presented to us and the choices we can make in our lives. In Outliers, Gladwell even attributes success in some sports to the time of the year the athletes were born. The naive assumption that we are entirely responsible for our successes or failures is based in the widely held individualistic value system and it leads us to seek simple answers to complex problems.

The truths that our grandparents knew or that our faiths drilled into us are often not as palatable or accessible to us as what is available on the world wide web. It is this confusingly ever present web that traps us while it provides a lot of access to the world.

ABCs of Parenting

Parenting is one of the most overwhelming, challenging and complicated journeys that any of us ever planned to take. Yet, it can be made joyous and simpler. Here is what I have learned about parenting: Parenting involves teaching and teaching involves learning. If we start with learning about ourselves and know what we want to teach, parenting becomes less complicated.

A. Knowing your own values and beliefs about the world.

We often forget how we teach by example. What we do is learned more easily than what we say.

B. Setting limits that have a good logic behind them.

Setting limits without anger, threats or lectures.
Avoid power struggles by including the young person in setting limits. Children have their own wisdom so let them use it.
Have a discussion about natural consequences of behaviors. Life teaches you more lasting lessons than punishments.

C. When the limits are broken or stretched, the young person has to set it right.

Be empathic about their problem. It “sucks” to fail or make mistakes.
Let them solve the problem. Real self esteem is built on our ability to solve problems and correct our mistakes.

Sources: Parenting with love and logic by Jim Fay, and Everyday Blessings: The Inner Work of Mindful Parenting by Myla Kabat-zinn & Jon Kabat-zinn

You Can’t Just Snap Out of Depression

Source: Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, by Richard O’Connor

Depression is often dismissed as a condition of the weak and needy. The phrase “snap out of it,” is often used as by family members and friends in an attempt to help a depressed person. However, it not only invalidates the person’s experience, it also confirms their depressive outlook that no one understands. Depressed people “work harder” at living than others, and it is really “hard” to overcome depression despite the availability of medications.

Depression has many causes apart from life circumstances. It can be a result of childhood experiences and traumas, or depression can be a result of faulty thinking patterns and ways of handling strong emotions. Regardless of the reason for depression, it should be seen as a disease since there is often a clear genetic pattern and biochemical differences between brains of depressed and non-depressed patients. Depression, similar to heart disease or alcoholism, involves a life long pattern of thoughts, behaviors and feeling and recovering from depression involves changes at all levels.

Aaron Beck, a leading researcher of cognitive behavioral therapy for depression noted that depressed people have common defective patterns of thinking. The view of self, present and future are consistently different from others who are not depressed.

Self: A depressed person views herself or himself as inadequate, defective or deprived. This sense of inadequacy keeps a depressed person from hoping for a better outlook and keeps them from even trying to improve things.
Present reality: A depressed person views the present reality as if looking through dark glasses. Others may see success while the depressed person may see the failure. The glass is always seen as half empty….
Future expectations: The depressed person expects to fail, so they tend not to put much effort into improving their circumstance. The anticipation of a hopeless future is consistent with the negative evaluation of their abilities and the realities.

Aoron Beck also noted that depressed people tend to have faulty logic in judging situations. The following distortions are fairly common in many non-depressed people as well, however, depression is maintained when these thinking patterns are rigidly in place.

Overgeneralizing: If something bad happens, it is likely to always happen that way. “I failed this test, I will never pass”.
Selective Abstraction: Judging an experience by one detail rather than the whole series of events. A depressed person may fixate on the one question they couldn’t answer in an interview, rather than look at the ten other questions that were well answered.
Excessive responsibility: Feeling responsible for bad things and giving credit to others for good things. A parent blames her self for her child crying rather than recognizing many reasons why children cry and evaluating the situation.
Self-reference: A self-consciousness that everyone is negatively evaluating them. A child may feel that the mistake he or she made at school is being talked about by everyone and that he or she is the center of (negative) attention.
Catastrophizing: Expecting the worst in most situations. “I will be late and I will get fired”. This person may be disregarding that in the ten years he or she has worked and not been late or fired.
Dichotomous thinking: Tendency to see things as good or bad or “black” or “white”. There is an element of overgeneralization in this way of thinking. They may reject all people of a certain religion or groups of people.

Once a depressed person is able to identify these negative patterns of thinking, they can start to actively dispute the negative quality or rigidity of these beliefs. Martin Seligman, a psychologist who studied depression explained depression in terms of pessimism, optimism and hope. He defined hope as having “temporary and specific explanations for bad events”. Depressed people often lack this hope and believe that bad situations are permanent and they have little power over changing the course of life.

It is strongly recommended that a depressed person keep a mood journal and write down the situations that evoke strong negative feelings or mood changes and the thoughts and beliefs that are being activated. This will allow some level of objectivity and for the depressed person to begin to dispute the beliefs that have formed over years. A sense of efficacy and hope can be introduced by making small changes. Starting a routine of daily walking, connecting with friends, meditating for five minutes daily, listening to music, or scheduling a massage can all help reestablish a hopeful and meaningful outlook on life.

In addition, depression can be helped with psychotherapy, medication, self-help and family support. It is very important for a depressed person to ask for help. It is equally important for people in relationships with depressed people to recognize depression. Frequent mood changes, irritability, angry outbursts, isolating behaviors, lack of pleasure in anything, dramatic changes in eating and sleeping patterns may all be an indication of a serious problem.

Recipe for nourishing relationships:

Spend time together, both quality and quantity are important.
Speak with affection to each other and show physical affection with touch.
Allow time for communication. This means balancing time at home with work commitments. Turn off the phone in the evenings.
Support each other’s individual interests.
Pay attention to the positives, no matter how small, and ignore the annoying things as much as possible.
Prioritize the relationship. You want to model a good relationship for your children to emulate.
Do something nice for each other on a regular basis.
Treat each other’s parents with respect and love.
Don’t let the bedroom be the last place to be at night.
Welcome changes.