Author Archives: Michelle

by Michelle

What Makes Marriage Work

Recommended book:

The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert

I must admit that I avoided reading this book for quite a while. I found the title pretentious and was afraid all I would find was some form of self help oversimplification and piles of platitudes.

When I did finally read the book I was surprised by its quality and the way in which the author dispels many common myths.

The Author is also able to offer many valuable practical suggestions. His ideas are based on direct observations of couples, physiological measurements, and longitudinal study, not just on his clinical experience that may be biased. During his long career he saw a wide range of couples from all walks of life. Some lived happily, some were miserable. He was able to observe a diverse sample of marriages and he became particularly interested in what the happy couples do to make their marriages thrive.

Some of the myths he dispels in this book:

1. Men and women come from different planets.

Actually for both, the most important factor in marriage is the quality of friendship that they share.

2. Affairs are the cause of most divorces.

In reality, it is the other way around. When marriages fail, one or two of the parties start to look for an affair, to meet their unfulfilled emotional needs. In most cases, the affair is not the cause of the marital dysfunction but the result of underlying problems.

3. You should never avoid conflict in your marriage.

For unimportant and small matters it is better to avoid conflict. Conflict should be reserved for the truly meaningful questions.

4. Common interests strengthen the bond in a relationship

It can strengthen the relationship, but it depends on how you interact around that common interest.

Outlines of the principles that he recommends, the principles below are paraphrased, not exactly how he worded them.

1. Get to know each other. Dr. Gottman calls it “enhancing the love maps of your partner”.  Get to know each other’s daily life, struggles, hopes, dreams, interests – and continue to know each other as each of you grow and evolve. This seem obvious, but sometimes people live together for decades, and do not know basics about their partner’s work issues, and other important information.

2. Continue to enhance the positive affect in the relationship. Respect the differences between the two of you, maybe that’s why you chose this person in the first place. Look at bad things as situational, and good as indicative of character.

3. In time of needs, go to your spouse as opposed to go for help and support to other people in your life.

4. Listen and take into consideration your spouses ideas. This rule is directed more towards men;  according to Dr. Gottman, women do it anyway. Men tend to dismiss their wives opinions. In addition to the opportunity to get good advice, you also foster respect and connection in the relationships.

5. Check the quality of your interactions. Avoid nonconstructive criticism, contempt, and silent treatment. Be aware when your partner makes a repair attempt, tries to make up for something. Be gracious enough to accept it. If you have a conflict, or difficult subject to discuss, approach the conversation with consideration and care.

6. Learn how to sooth yourself and your partner in times of stress, either externally or between the two of you.

7. Create Shared Meaning. Create a shared value system that continually connects you and your partner through rituals/traditions, shared roles and symbols.

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by Michelle

The Challenge of Covid-19

None of us would have chosen this challenge, but here we are. In this strangest of situations, some of us are overworked and traumatized, others are at home, unemployed and worry about their financial situation.

The first thing to do  is to take good care of ourselves. This is easier said than done and it includes the expected list of things:

Make sure to get a good amount and good quality sleep. Make sure to eat well. Exercise. Manage anxiety. Keep your space orderly and clean.  Limit exposure to news and social media.

These are all the usual pieces of advice that we have come to expect, but repeating these advices does not make them happen. What can we do during this lockdown period to try to adhere to these principles, and why is it more difficult than ever?

Most of us have lost the structure that underpins our normal lives, from going to work to visiting people, our lives have assumed an amorphous blob like property. Without structure we gravitate towards things that are easy and give us instant gratification, often not those things that make us healthy and happy in the long term.

Try and build structure into your disrupted life, both physically and temporally.

If you are working from home, try and have a designated work space so work does not intermingle with life. If possible, try and maintain work hours that are distinct from downtime.

If you are unemployed, try and add some structure to your life, learn a new skill if possible, take advantage of the time that has been forced on you to study that thing that you have put off for years.

Keep structure as far as going to sleep and getting up. Avoid the tendency to watch a screen into the late night and then sleep until some time  the next day. Keep a schedule of sleep as if you had some task to wake up for, even though this strikes you as slightly absurd.

Exercise is key and is as simple as taking a walk. We are blessed with wide open spaces, sidewalks and scantily traveled roads that allow us to safely go out. Spring, in spite of its back-sliding is coming. Walking will also help you sleep.

Not being anxious would be unreasonable at this time. The key is to not let anxiety consume you. Watch the minimum of news you need to keep informed, dwelling on every detail of the news cycle induces anxiety and does not make you better informed.

So we are here in this odd time, our lives upended, our routines changed. Being angry at the situation we have been thrown in is useless; looking for someone to blame, a waste of time.

The question is, is there something we can take from this time, something that can be positive.

We have all collectively been forced into what people often call a retreat. Seclusion , lack of many of our usual distractions, a simplification of life-life being forced back to its bare bones of existence.

Maybe now is a good time for some introspection-is the frenetic pace of your normal life what you need and want. Is there something from this forced seclusion that you can carry back to normalcy when it resumes.

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by Michelle

Therapy in times of Corona

This is a difficult time for all of us, a time of increasing anxiety , a time of quarantine induced stress and unnatural social distancing. As a therapist I have always preferred to sit opposite my client, to be able to respond and learn from the verbal and non verbal cues. Unfortunately, in order to keep us all safe we have to physically distance ourselves. We are fortunate that today we have videoconferencing that offers a path for therapy at a distance. During this period of social distancing required to keep us all safe I am offering therapy sessions on online platforms .I have discovered in the last couple of weeks that it can be quite effective. I look forward to the time that we can meet again in person.

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by Michelle

What makes marriage work

I must admit that for a long time I refused to read Gotman’s book; The Seven Principles for Making Marriage work. It sounded like an article the you page through quickly while waiting for the checkout line to move through in the supermarket, before surreptitiously stuffing the glossy magazine back and unloading your groceries on the belt.

Well, I was wrong.

John Gottman has revolutionized the study of marriage by using rigorous scientific procedures to observe the habits of married couples.  Over many years he interviewed couples and videotaped their interactions. He used physiological measures to record their stress levels during these interactions. His study is based not only on couples that came to therapy which would not be a representative sample, but randomly selected couples as well. He observed them right after marriage and could predict with a large degree of success, who would stay together and who would not.

He derived some simple but effective rules for a successful marriage. When put down on paper, they seem obvious and deceptively simple, but he has distilled down behaviors that need to be focused on to insure a happy marriage.

1. Get to know your partner really well. Know the details of their life . Everything from their work situation, taste in food and books, and secret dreams. It sounds trivial. but sometimes people live together and are not really interested in their partner’s work situation, preferences and taste. Over the years this creates a distance between them.

2. Nurture your fondness and admiration. There is this romantic notion that you either feel love towards someone, or you do not, and there is nothing you can do about it.  This is not exactly right. We can concentrate on the positive qualities of our partner, or on those qualities or habits that irritate us. We have a choice here. happy couples respect each other. When this basic ingredient is lacking, Gottman says that the marriage cannot be saved.

3. In times of hardship turn towards each other instead of away., it is very important to stay in touch and communicate, even if the hardship stems from the relationship itself.

4. Acknowledging your partner’s small moments in life and orienting yourself towards them will maintain that necessary connection that is vital for the relationship.

5. Let your partner influence you:

“Happy couples work as a team. They make decisions together and search out common ground. Letting your partner influence you isn’t about having one person control the others; it’s about mutual respect  … It is important to maintain your own identity in a relationship, but it is equally important to yield to your partner and give in. If both partners allow one another this influence, then they will learn to respect one another on a deeper level.”

This principle is directed towards men in a straight relationship. Women tend naturally to listen and allow themselves to be influenced by the men in their life. Men tend not to. Research shows over and over again that those  men who listen to their wives, have better relationship, and many times other advantages.

Gottman got criticized over this principle more than for any other that he formulated, because it sounds so moralistic. But again, research backed his principle. Actually, Daniel Kahenman, the Nobel laurette,  showed in his research that women tend to be better investors because they are not as convinced as men that they know everything and hence tend to lose less money in the market.

6. Create shared meaning – family rituals.  “Marriage isn’t just about raising kids, splitting chores, and making love. It can also have a spiritual dimension that has to do with creating an inner life together — a culture rich with rituals, and an appreciation for your roles and goals that link you, that lead you to understand what it means to be a part of the family you have become,” Gottman says.

7. The last two principles sound a bit like the serenity prayer: Learn the difference between solvable and unsolvable problems. Learn to cope better with the first one, and learn to live with the later – with all the idiosyncrasies of your spouse.

Gottman warns us that we should avoid the worst types of communication: contempt, and stone walling.

Some myths that Gottman debunks:

1. “Affairs are the root of many divorces”.  I completely agree . In my professional experience, affairs are a symptom of something that did not work well in the marriage prior to the affair. I have seen couples that were able to work their issues out in therapy after an affair, and arrived at a much better place in their relationship than before the affair.

2.” It is all about communication.” Well, it is not. Many emotionally intelligent couples learn to manage their life without having a long discussion about their relationships.

3. “Arguments are bad”. Not really. According to his research, it depends on the kind of argument. If it does not involve humiliation and contempt, there is nothing wrong with arguing. Actually, there is evidence that couples that tend to fight a lot have a better sex life than couples that do not.

Adapted from Gottman, J: The Seven Principles for Making Marriage work. Crown publishers, 1999, New York.

 

 

 

 

 

 

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by Michelle

Where you live matters: “The Geography of Bliss” by Eric Weiner

When I first studied to become a clinical psychologist, I looked at mental health issues as a reflection of the individual’s history. I focused very much on how interactions with important figures in our formative years shape and affect us for years to come.
Later, when I did my degree in social work, I delved more into the ways in which sociological and economical factors affect our personality and the challenges we face.
The “Geography of Bliss” brought me a new perspective on broader forces that shape us as people. I had not paid much attention to the way in which values of the culture we live in determine our level of happiness. In hindsight it is obvious that the culture we live in and grew up in will influence us.
This book describes the journey of a journalist through the world in search of the secret to happiness as a function of geography and culture. He makes an effort to rely on the most current research into happiness and to understand which countries are most happy and which are most miserable and why.
Even the definition and the experience of happiness is rooted deeply in place and culture. The author describes an emotion spanning the exuberance expressed in the United States (“I am so excited”) to the calm contentment of people in Switzerland.
Happiness comes in different forms in different countries that report a high average level of happiness. There is a basic low level of income that is a fundamental requirement for happiness, enough to insure a level of food security and health care. Beyond that cultures that engender a high level of happiness take many different forms.
Some of the countries that report the highest levels of happiness are Switzerland, Iceland and Bhutan.
In Switzerland the author traced the high level of contentment to a high level of personal trust between people and to the high level of organization in society. Although for some it can be stifling, on an aggregate level the very orderly society and the high level of predictability made people content.
In Iceland, on the other hand, the small community has a robust safety net and as a society accepts failure as part and parcel of what happens when people take risks and allows them to do so, so people are less oppressed by the constant fear of failure.
As opposed to the first two examples Bhutan is not a wealthy country. It is a country that takes happiness seriously. At a national level they have a concept of of Gross National Happiness in their constitution. What impressed me most in their view of happiness, informed by Buddhist practice, is to think about our death as a way to a happier life. This practice helps puts things in perspective, it urges us to put aside the petty and unimportant irritations and to focus on the important things in our lives.
On the other hand, Moldava stood out as a miserable nation. Because of the lack of trust and lack of community. In a place where where people don’t help each other, happiness is in short supply
On the extreme end of wealth, as embodied in Qatar, the old adage rings true :Money doesn’t bring happiness. With no challenges in their lives to motivate them, boredom sets in and material wealth cannot compensate for that.
After reading this book you will not find the secret to happiness, you may not be any happier, but it is a fun and interesting read and it sparked, for me, thoughts about the broader forces that shape us.
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by Michelle

A new Approach to Weight Loss: Slim by Design

Excess weight and obesity are problems that plague many of us in today’s world with easy access to plentiful food.  Excess weight has severe health implications leading to a high incidence of diabetes, heart conditions and even cancer. Obesity also has an impact on a persons self esteem and can lead to emotional problems.

We are all aware of the challenges of losing weight.  A huge industry has sprung up around weight reduction and countless books offer miracle diets that promise quick fixes. The real challenge of maintaining a healthy weight is not only to lose excess pounds but to keep the weight off over time.
Brian Warnsink offers a somewhat different approach to the issue of maintaining a healthy weight. In his approach, called slim by design, and book by the same name, Dr. Warnsink suggests simple steps to adjust our surroundings and tweak our behavior so that we will eat less, without consciously having to exert will power to achieve that goal.
Dr Warnsink points out that trying to constantly exert will power to overcome temptations , while seemingly laudable, is exhausting and when we are emotionally depleted by other demands we easily lose the self control required to monitor our food intake. His ideas have been experimentally validated and have been implemented in school cafeterias, restaurants, homes, and even at Google. The book is funny, easy to read, easy to implement. It is  a leisurely afternoon read.

The premise is that we are  unconsciously manipulated by our physical environment and so we should use it to our advantage.

There are some obvious changes to our environment such as making healthy food, such as fruit and vegetables, easily accessible and in sight while keeping less healthy snacking food such as cereals in a harder to reach cupboard.

There are other less obvious changes to our eating habits that make a measurable change to the amount we eat. Dr Warnsink has found that the size of the plate we eat from has a large influence on the amount we eat. He suggest eating from a smaller plate.

Dr Wansink offers strategies for reducing food consumption at home,  in restaurants and for negotiating shopping in a supermarket so as to eat a more healthy diet. While some of this may seem obvious, the value of the approach is to find ways in which we do not have to consciously work at reducing calories.

Slim by Design: Mindless Eating Solutions for Everyday Life by Dr. Brian Warnsink. 

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by Michelle

Side Effects of Psychotherapy

I am a therapist and I believe in the power of therapy to alleviate suffering and contribute to people’s quality of life. I have seen it happen many times. In this post I would like to discuss some of the potential risks and  side effects that are not widely discussed.

  1. Dependence: Some clients start to depend on their therapist for every decision they need to make. A related issue is when the client effectively channels the therapist in his everyday interactions with friends and family. When the client overly identifies with the therapist it can lead to awkward social interactions and impedes the quest of the clients in finding their own voice. It is up to the therapist to point out excessive dependence, to explore its meaning and to prevent it.
  1. Reliance on the connection with the therapist as a sole resource to meet emotional needs, instead of expanding a support network. Therapy should help a person improve their social skills, expand their social network and not serve as a substitute.
  2. Not knowing when to terminate therapy: I have heard countless stories about patients wanting to stop therapy, and well-intended therapists have convinced them to stay. My policy is clear. I greatly respect the clients’ wishes to terminate therapy. There are times at which I initiate the discussion on stopping therapy. Similar to the role of a parent, there often comes a point that the client needs to be gently pushed out to stand on their own two feet.
  3. Expense. – This is probably the most recognized issue. .The money that you pay towards therapy, may prevent you from pursuing other activities that could improve your quality of life, and contribute to your growth as a person.
  4. Time – the time and energy you invest in therapy, could have been spent with loved ones, on meaningful activities that could contribute to your quality of life. No, I do not recommend avoiding psychotherapy, if you could benefit from it. I work as psychotherapist because I believe therapy can change people life. I had the privilege to witness people growth.  There is a large body of empirical evidence that supports the benefits of therapy,  above and beyond what medication alone can offer.

However:

It is OK to gauge whether there is a fit between you and your provider.

It is OK to check from time to time with your provider about the approach, directions, goals and the need for continuation.

It is OK to weigh the benefits of psychotherapy against the cost – what does it prevent you from doing because of the investment in both time and money.

It is OK to see your provider on less than a weekly basis, or as needed – provided it works for both of you.

My policy on terminating therapy is that if a client decides to quit therapy, I do not try to dissuade them unless there is a clear indication of danger.Facebookmail

by Michelle

16 Mental Health Digital Resources that I Found Interesting

Here are a few digital resources that I have found helpful. This is not an exhaustive list, but I have checked these out and found them to be good.

Wherever possible I looked for free apps. In no case do I have any commercial connection with these recommended sites.

  1. mood chart

This tool was developed for suffers of bipolar disorder.   With this tool you can track your mood, find patterns, and track how your mood is influenced by medications, events in your life, exercise, and more.  This could give you an early warning that you are starting a manic or depressive episode, so you can take measures to prevent it.

  1. Todoist

For people that suffer from ADD/ADHD , but also for all of us who want our life more organized and efficient.

This website and app helps you organize and prioritize your tasks. The free version is very good. You can pay and get some additional features.

There are many other similar tools. I found this to be the most friendly and useful for the lay person..

  1. DBT skills

DBT (Dialectical Behavior Therapy)   is a collection of practical skills to help you better manage your emotions, stress and hence your life.   This is an app that lists all the DBT skills by modules.  You can create an “emergency list” tailored to your personal preferences.  This app will probably be most useful for people already familiar with this approach.

  1. the motivation hacker

A surprising resource – a small book that describes how to set goals for yourself and how to get things done.  This appears to have been written by a geek, not a therapist. The book is based on solid understanding and research, and is better than many others written by mental health professionals.

OK, it is a book and not an app. But it is available only as kindle book. So it is included.

  1. PTSD coach

For people who suffer from trauma.

  1. esense skin response

Biofeedback is a promising field.  It is based on giving you immediate auditory or visual feedback on a measured response that you cannot normally sense, such as skin conductivity (GSR) or an electrical measurement corresponding to of the tension in your muscles, (EMG). These types of response are related to factors that we would like to learn to control such as stress and hypertension. Research and clinical practice show that with a feedback, you can learn to control these functions. Most are related to the autonomic system – it is a way to reduce the activity of the sympathetic branch (fight or flight) and increase the parasympathetic branch, which induces relaxation.

Many apps carry the key word biofeedback, nearly all of them have nothing to do with it. Sometimes it is a general relaxation app with nice music. Sometimes it is an app designed to train you to breathe slower and deeper, which will induce relaxation. But you do not need the app for that- you can do it on your own. Breathing is partly voluntary, and certainly you know how to control your breathing if you pay attention to it.

Esense skin response is an actual biofeedback app that  uses the GSR(electrical conductivity of the skin). It does require a pretty large investment for a skin conductivity measurement attachment.

  1. Cognitive diary self help

An app for Cognitive therapy for depression, including a cognitive diary

  1. rejection therapy

A pretty wild app designed for people who suffer from social anxiety. It consists in asking you to put yourself in absurd and embarrassing situations voluntarily. After you do it a few times, and discover that you stayed alive, you will not be so anxious in regular social circumstances. I did not dare to use it, but I believe it to be useful. Comes from the geek community in San Francisco. Essentially, it is a form of exposure therapy.

  1. Succeed socially

A website full of articles, to help the “socially awkward” people function better socially. A bit repetitive, but informative. You can read it on the web for free, or pay and get it on kindle.

  1.  Operation reaching out

This app was developed by the military, as a measure to prevent suicide among soldiers and veterans. It is useful for anyone with a  severe and persistent mental health disorder, who  may be in a situation where they may harm themselves.

The app lets you list people’s phone numbers whom you can reach out to when you are in severe distress. It encourages you to reach out for help, points out the distorted thought process when there is only tunnel vision and you cannot see other options for relieving the pain you are in.

  1. Quantified mind

A website that contains neuropsychological tests.  It lets you take them under different conditions and find out under what conditions your brain functions best. (Morning vs evening, before or after coffee/ medication/exercise/meditation, ext.) The tests are based on solid neuropsychological understanding, and test executive functions.

  1. iSleepEasy

A serene female voice helps you detach from your day and take the time to relax and sleep, in an array of visualizations and guided meditations. You can control both voice and music tracks. Includes tips for falling asleep. There are many similar apps. I liked this one the best.

  1. Relax Melodies

A free relaxation and music app.  I liked the option of mix and match nature sounds with music.

  1. Dreamboard

An interesting site for tracking your dreams. Your dreams can give you valuable knowledge about yourself and your life when you listen to them carefully and are able to decipher their code.

  1.  TED

A website that  will keep your brain alive.

If you know about any other digital resource that you found helpful, please let me know and I’ll be more than happy to include these.Facebookmail

by Michelle

Vaginismus – the unspoken sexual dysfunction.

Vaginnisums is the term used for a condition that affects a woman’s ability to engaged in any form of vaginal penetration. This includes not only intercourse, but also use of tampons, or getting routine gynecological examination. The vaginal muscle becomes spastic in an involuntary way, which makes any penetration either very painful or impossible. (From Wikipedia).
People tend to believe that with the sexual revolution, and the widely available knowledge about sexuality, this kind of dysfunction no longer exists.  This is not the case; I have come across the conditions several times in my practice just in the last year.

We do not hear about the condition, possibly because  of shame or maybe because there is no pharmacological  solution available, so there are no ads  from the  pharmaceutical companies.
However, the good news is that it is quite easily treatable. All the women that I have seen with this condition, and that have persisted with treatment, succeeded in overcoming their issue and were able to have an enjoyable sex life.
The treatment consists in learning to relax the pelvic floor and vaginal muscles, and using dilators in increasing size to learn how to get used to penetration.
You can buy the dilators with instructions from Vaginismus. It is highly advisable to use specific physical therapy that addresses this issue. In my vicinity, you can find qualified physical therapists at the University of Michigan health center. . If the issue has already created stress in the relationship and secondary emotional issues, it is important to consult a qualified sex therapist.

 

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