10 Tips to Manage Stress More Effectively

By Debra Manchester MacMannis, LCSW

OLYMPUS DIGITAL CAMERA—Countless research studies have underscored how anxiety and depression correlate significantly with an individual’s sense of control or lack of control over his or her own destiny. The same thing is true when it comes to stress.

In fact, given our mortality combined with our lack of control over so much of life, stress goes hand in hand with being human. Although we can’t make all our stresses disappear with a magic wand, we can learn to cope more effectively with stress so it doesn’t kill us.

(Although don’t all of us secretly long for a fairy godmother or a genie who will grant us three wishes and remove all the suffering in the world? I know I do).

Stress is a complicated process that affects us on every level–physically, emotionally, mentally and spiritually. Because of this, we need a holistic approach to build our resilience. It is best to work with all four levels but start wherever you know you are weakest, and build your stress-proof muscles one day at a time. Until the fairy godmother comes around, here are some lifelong practices that will help immunize you against stress.

_DSC4245Stress & the Body

Stress stimulates our fight/flight response, sending the signal to our bodies that we need to run for the hills or turn and face a threatening attacker. Our bodies rush with adrenaline and our heart rate quickens. What are the best tools to help the body recover?

Tip #1: Practice deep breathing and get regular exercise. The fastest way to calm down your nervous system is with your breath. Learn how to breathe from your belly. This is taught in yoga, in voice lessons, in self-hypnosis, and in instructional videos on line. No one thinks twice about brushing their teeth every day. If you practice self-relaxation or meditation for ten minutes twice a day for the rest of your life, you will be more able to remember how to calm your emotions when you need to do so quickly.

file451264266022It is especially helpful to get aerobic exercise because you can simultaneously breathe deeply and work out the aftereffects of stress on your body. That being said, even walking briskly, climbing stairs instead of the elevator or dancing in your living room count.

Tip #2: Spend time outdoors in nature. Numerous studies have proven that nature heals. Kids learn more in schools that have regular outdoor activities and hospital patients heal faster when they can look out windows and see natural landscapes. Even a short walk on the beach, lazing in your backyard, or sitting on a park bench will do the trick.

Tip #3: Eat healthy meals with people you love. Too many people turn to bad food habits when stressed, either eating junk food or too much food for the comfort, or missing meals for lack of time. Fill your shelves and refrigerator with healthy alternatives so you won’t be tempted, and pack protein snacks that you can take with you to work or when pressed for time.

file0001052648856Stress & the Mind

Cognitive therapy teaches people how to question their fearful, negative beliefs and to substitute them with more accurate, less stress-inducing beliefs, and these tools have been widely shown in the laboratory to be effective in altering the nature of our negative emotional responses.

Tip #4: Don’t take things that other people do or say (or fail to do or say) personally. A good mantra to reinforce this perspective is, “It’s not about me!” This is easy in principle but often difficult in practice especially with those closest to us who seem to be pushing our buttons deliberately.

file000935340585If you need reminders about learning how to respond when your buttons get pushed, check out this blog. Remind yourself that everyone else is stressed out too, struggling to regulate their emotions and often failing miserably.

Tip #5: Don’t sweat the small stuff–and realize that almost everything we get hyped up over is pretty small. My personal practice is to run my worries by the life-or-death question. For example, I hit traffic and am upset that I am going to be late for work. I ask myself if this is a life-or-death issue. The answer is almost always no, whereas driving like a madwoman to get to work on time could become life-threatening quite easily.

Tip #6: Stop complaining. Every time that we complain about something–one of the most common being the weather–we bring all things negative to the mind. Since our minds naturally associate things together, when we start on a negative train of thought, worries and fears can escalate. If you are a parent, try singing “Shake It Out and Dance” with your kids (or even by yourself if you are young at heart).

file4171335316332Stress & Emotions

Unfortunately, cognitive techniques often fail miserably. The reason why is that even mild stress can derail the ability of someone to use these otherwise effective weapons when they most need them–in real life. Because of this, we need to understand how negative emotions such as anger, fear, and grief, as well as stressful lifestyles so common in today’s families exert very powerful influences on our ability to return to a calm state, even when we have taught them cognitive behavioral skills.

Tip #7: Cry when you need to and learn how to work with your anger in non-destructive ways. Working effectively with our emotions is a book in itself. The short version is that it helps alleviate stress to allow ourselves to feel our feelings AND to learn to put them into perspective.

Tip #8: Laugh your way to health and happiness. Given how many adults turn to screen time for rest and relaxation, make sure you don’t stress yourself even further by only watching dark movies, upsetting news stories, or violent video games. Find books, movies, friends and activities that help you lighten your load.

file181242267901Stress & Spirit

Tip #9: Practice turning blame and self-pity into empathy and compassion, both for yourself and for others. The use of blame rarely generates a positive outcome or facilitates closeness and connection. If you typically beat yourself up, remember that mistakes are opportunities to learn and that you are a work in progress.

file000139584327Reach out to others for love and support. Or find someone who is even more stressed than you and provide a helping hand or shoulder to cry on. A spiritual perspective is sometimes the best or only comfort through dark and difficult times.

Tip #10: Find the silver lining in any cloud. One of the best ways to do this is to incorporate some form of spiritual or religious practice and philosophy into your life. Reading ten minutes each day–whether you choose the Bible, the Koran, the Torah, wisdom from the Dalai Llama or any other positive life philosophy–can help bring hope and perspective into your life. Add in prayer, meditation or silent contemplation.

Change Takes Time

If you take on this challenge–practicing healthy forms of stress reduction on a daily basis–your life will slowly but surely take on a different light. Change will not happen over night, and you may forget these tips when you are really under fire. But if you are anything like me, you will be a bit calmer and more unflappable a year from now. You may even be able to teach your fairy godmother a thing or two!

 



Stressed to the Limit. No End in Sight.

By Debra Manchester MacMannis, LCSW

file891237402521“Future shock is the shattering stress and disorientation that we induce in individuals by subjecting them to too much change in too short a time.” -Alvin Toffler

I received a call from a distressed mother last week asking if her whole family could come to see me. “I’m really worried,” she explained. “Every one of us in the family is completely stressed out, and we need to find out how to cope better.”

I am used to getting calls when someone is suffering from any of a number of symptoms-illness and loss, depression and anxiety, addictions, behavioral problems in children and teens, communication breakdowns in couples–but these days more and more calls simply describe unmanageable stress as the presenting problem. What is going on?

Signs of Stress in the Familyfile0001987619617

  • Do you or your loved ones have trouble sleeping?
  • Do you lack your usual patience?
  • Are members of your family irritable, grumpy or unhappy?
  • Do you have symptoms of tension–headaches, stomach aches, neck and shoulder problems?
  • Is there never enough time to do what you want to do or even to get things done?

If you answered a resounding yes to most of these questions, you are certainly not alone. Recent studies not only in America but across the world indicate that far too many people are suffering from the excessive demands of modern life. Stressed to the limit with no end in sight.

Causes of Stress in the Family

file0001246104116Not that much of this is really escapable. Stress is woven into the fabric of life. In days of yore, the stresses may have been different and were certainly less talked about.

Stress has been studied since the 1950′s by medical doctors as well as psychologists and social scientists. Whenever circumstances put more physical or psychological demands on an individual than that person can handle, stress is the inevitable response. When pressures mount up, the body’s natural fight or flight mechanism goes into high gear.

Stress is most likely to occur whenever the demands put on us are intense, the amount of control we feel over the demands is low and the support we need is unavailable or limited. For many adults all over the world, this formula is part of daily life and stress becomes a constant companion.

Recent Study Shows Teens More Stressed Out Than We Knew

file000935340585The American Psychological Association has been looking at reported levels of stress in America since 2007. The average adult gives themselves a score of 5.1 on a scale of 10. Not too bad until you hear that 42% report stress increasing, and that most believe that closer to a score of 3 would be healthy. The sources of stress are what you might expect. Money and work top the list.

Even though most agree that stress management is important, few set aside the time they need to manage stress, and when they do, 62% of adults use screen time to manage stress. That means they surf the net or go online, watch two or more hours of TV or movies daily, play video games, and visit social media sites. That doesn’t sound very relaxing to me.

However the news of the day was that our teenagers are even more stressed out than the adults are. “We assumed that teens experience stress, but what was surprising was that it was so high compared to adults,” said Norman Anderson, chief executive of the APA. “In adulthood there are work pressures, family pressures and economic pressures, but adolescents still reported higher levels of stress.”

Study of Stress Around the World

The World Health Organization (WHO) has labeled the global impact of all forms of stress (work-related stress, home stress, and post-traumatic stress disorder) as a “silent epidemic”. In their research, called the Global Burden of Disease Survey, it is estimated that by the year 2020, depression and anxiety disorders, including stress-related mental health conditions, will be second only to heart disease in the breadth of the disabilities they will include.

Not only does stress make family life miserable, it costs a great deal economically as well–work days lost, a heavy use of medical services, higher levels of impairment of employees, diminished productivity and job satisfaction. Disabilities from stress are as significant as those caused by workplace accidents or common medical conditions such as hypertension, diabetes, and arthritis.

file9541282977224Women and Girls are in Trouble

Almost every study shows that women are even more stressed out than men. This was even true in the APA study of American teenagers reported above.

It is only conjecture whether women and girls are more sensitive to the effects of stress and pressure, are better self-reporters, or indeed suffer more than boys or men in the same environment. Or perhaps when it comes to adult women, they are stressed by the multiple demands placed on them, caring for children or aging parents, at the same time as doing jobs outside the home.

Women in Diverse Economic ConditionsUnknown

It goes without saying that women in parts of the world lacking food and clean water are subjected to levels of stress unfathomable to the average American. But how does America compare to other developed countries around the globe?

The Nielsen Women of Tomorrow Study surveyed 6500 women in 21 countries in Asia, Europe, Latin America, Africa and North America, a sample representative of 60% of the world’s population and nearly 80% of the GDP (Gross Domestic Product). What they found was that women living in countries with emerging economies (like India, Mexico or Russia) are even more stressed than those of us in developed economies (like France, USA, or file1871264468042Italy).

No End In Sight

Now you know that you are not alone. Stress has become an embedded feature in our modern world. Is there anything we can do about it? Fortunately, the answer is yes. Unfortunately, you’ll have to wait for my next blog to find out how….

 



We Are Only As Sick as Our Secrets

By Debra Manchester MacMannis, LCSW

file1801281015946“Anything will give up its secrets if you love it enough. Not only have I found that when I talk to the little flower or to the little peanut they will give up their secrets, but I have found that when I silently commune with people they give up their secrets also–if you love them enough.”  -George Washington Carver

I’ve been a psychotherapist for over thirty years. I have long ago lost count of just how many of my clients have commented–sometimes with appreciation, other times with disbelief–on how they don’t know how I do what I do. How can I possibly listen to so many terrible stories, they wonder. These comments invariably emerge after a patient has shared a deep dark secret.

I reply with my genuine feelings–I am constantly grateful and feel deeply privileged to do what I do. Although I do hear horrible stories at times–those of violence and pain, rife with injustices and betrayals–I also bear witness to the healing that can come when people reveal certain secrets about themselves or their loved ones that they thought they had to carry alone.

arguing with teenWhy Do We Keep Secrets from Others?

People keep secrets for a variety of reasons that are not necessarily good or bad. Each individual, family, and culture has spoken and unspoken rules about privacy vs. transparency. I am not suggesting that it is better to tell everyone everything.

But there are some secrets that become toxic when not revealed to anyone, ever. Underneath toxic secrets there is some fear that keeps that person from opening up. Sometimes the fear is justified but often it is misplaced, magnified or completely false. What are some of the reasons all of us keep information buried inside even when we desperately want to tell someone?

  • We keep secrets because we are afraid of being rejected by others.
  • We keep secrets because telling the truth will make us appear sick, weak, or inadequate.
  • We keep secrets to protect ourselves.
  • We keep secrets to protect others that we love.
  • We keep secrets to keep from getting into trouble with others or with the law.
  • We keep secrets to avoid feeling painful feelings such as rage, terror, grief, guilt or shame.
  • We keep secrets because of loyalty.
  • We keep secrets because we have been threatened with some punishment if we tell.
  • We keep secrets from ourselves when the secret is out of character for the person we want to be.

file2711283980668What Are Some of the Secrets I’ve Been Told? 

Lots about sex. Even though it seems like sex should be easy to talk about in this day and age, it is still an area where most people feel uncomfortable revealing themselves. Revealing past and present affairs happens a lot in therapy.

Most people have complicated feelings and inhibitions about what goes on behind bedroom doors or what fantasies play out inside them. (No wonder Fifty Shades of Gray became such a bestseller.) I’ve been told secrets about homosexuality, bisexuality, transgenderism, and sexual addiction from clients who trusted me.

Equally frightening for some to reveal are facts about the absence of sex such as a lack of sexual desire, inability to orgasm, or long term celibate marriages.

file0001679856317Money. I’ve been told secrets about how much money a person has and others about just how much they have lost or gambled away. Add to that illegal acts such as bribery or embezzlement…using money for power and privilege, or buying things secretly without the permission or knowledge of a spouse.

Stealing money. Hiding it. Secrets about money are sometimes more difficult to reveal than those about sex.

Violence. I am often the first person to hear about sexual abuse, incest, or rape. Or stories of the horrors of war from combat veterans. Or domestic violence, gang crime, child abuse. I am more likely to hear stories of victimization since all my clients come to see me voluntarily.

I am always relieved when someone confesses to me their own violence to others. This is the first step that is necessary to go from denial to empathy to eventually taking responsibility for one’s actions.

file000557708328Addiction. Almost any form of addiction brings secrets and lies along with it. Add to that all the eating disorders. Since addictions are often driven by shame, acknowledging their existence begins the process of emotional detox. AA is built on this.

Illness and disabilities. Given that I’m a psychotherapist, I sort of assume that every family has some member of their extended family with a past or current diagnosis of depression, anxiety, OCD or ADHD. So what’s the problem with sharing this? The truth is that although mental illness is out of the closet far more than ever before, it still scares many people to share the painful reality.

Surprisingly, even physical issues are often kept submerged. In some families, it is taken as a sign of weakness to complain of pain or sickness. Confessing to chronic, potentially disabling illness can be very difficult for some. Here’s some illnesses that I was only told about only after a client trusted me: fibromyalgia, MS, Parkinson’s, cancer, herpes, HIV positive, chronic pain.

IMG_5787Why Tell Someone Anyway?

As they say in AA, you are only as sick as your secrets. Holding on to them can often bring even more stress, isolation, and self-doubt. Revealing them, often first to a psychotherapist or spiritual advisor, can be an enormous relief.

One of my favorite metaphors about burying toxic secrets (and the guilt and shame that accompany them) is that it is like constantly carrying around a backpack filled with rocks. It takes an enormous amount of energy to keep hauling them around.

In an unforgettable scene in the 1986 film, The Mission, Robert de Niro climbs up a huge mountain with a backpack loaded with his heavy armor and sword to do penance for being a slave trader and for the murder of his brother. Even when the Jesuit priest pleads with him to let them go, De Niro picks them back up and carries his burden up the steep and dangerous mountain they are climbing. When he finally lays down his bag of burdens, he sobs in deep remorse. And I sobbed with him.

What rocks do you carry around in your backpack? Do you really need to keep dragging them around with you? Or are you ready to take the first or the second or the next scary step of self-disclosure, sharing secrets that may lighten your load and facilitate your healing….

 



Confronting Your Ghosts of the Past: How to Assess Your Relationship

By Debra Manchester MacMannis, LCSW

file000925566270“In every conceivable manner, the family is the link to our past, the bridge to our future.” -Alex Haley

If you were one of the lucky people, raised in a happy loving family, you’ve most likely emerged with many of the skills and strengths necessary to form lasting healthy relationships…and you are probably NOT reading this blog right now.

Unfortunately, far too many people were raised by parents filled with good intentions but plagued by bad, sometimes destructive habits from their own childhood upbringing. These ghosts of the past, if not recognized, can haunt our families.

Our histories pack a powerful punch when we’ve buried (or tried to bury) old feelings as a way of avoiding the pain associated with them. Unfortunately, the unfinished business from our childhood and previous relationships also tends to get projected onto and then played out with our partner and/or our children. It is sad but true that the people we love the most in the world become the unwitting victims of this process.

file0001018506529How and Why Do Our Rational Brains Go Off Line?

Our emotional brains allowed us to survive as a species. We had to learn–and then be able to respond very quickly–about what or whom to approach and when to run like hell. Memories, especially ones with strong emotions, get wired into our brains without our awareness. Events that remind us of an emotionally charged experience from the past then trigger the same thoughts, feelings and body memories.

The emotional mind reacts to the present as if the past event were happening again. The combat veteran who leaps into the closet at the sound of a door slamming is instantly back on the streets of Iraq running for cover. Luckily, most people don’t suffer from Post Traumatic Stress Disorder, a severe syndrome now widely publicized and better understood. But our brains are wired the same. Every one of us has our “emotional triggers” or “buttons” that move our emotions to the foreground and our clear thinking gets derailed.

shadowWhat Can We Do About Our Emotional Hot Spots?

Although getting our buttons pushed can be unpleasant, the good news is that if we bring awareness to the painful aspects of our past, we can begin to exert more conscious control over our reactivity. I have addressed more about this process in a blog dedicated to just this topic. Another way to rise above our past conditioning is to take an honest look at what skills we have and what we might be missing.

The reason that my psychologist husband and I co-wrote our book, How’s Your Family Really Doing was to put resources and information directly into the hands of interested consumers–including all the people who would never seek professional help. In our therapy practice, as we gave couples and parents specific tools for how to get along better and bring out the best in each other, we kept getting the same feedback: “Why didn’t we get taught these things in high school? Therapists echoed, “Why didn’t we learn this in graduate school?”

What are the 10 Keys?

Burrowing through piles of professional literature and drawing on personal and professional experience, we assembled the ten keys to a happy, loving family. Decades of research have demonstrated that families can successfully achieve the task of raising children who are able to live independently and establish harmonious relationships of their own. The first step is to take an honest look at how you are doing on these dimensions.

file0001792779106 Here’s a quick look at the necessary ingredients for healthy relationships:

  • Key #1 Talking and Listening
  • Key #2 Expressing Feelings
  • Key #3 Adapting to Change
  • Key #4 Sharing Time Together
  • Key #5 Who’s In Charge
  • Key #6 Closeness and Distance
  • Key #7 Accepting Differences
  • Key #8 Seeing the Positive
  • Key #9 Effective Problem-Solving
  • Key #10 Parenting Together

DSCN6714Assessing Strengths and Problem Areas of the Family You Grew Up In

Once you have determined how you are doing with each of the ten keys in the present moment, it is time to uncover how the past has impacted your present relationships. Sometimes we have been determined to parent our kids differently than how we were parented–and we have succeeded. At other times, the negative patterning persists.

In addition to befriending our emotional hot spots, doing a thorough assessment of the strengths and weaknesses of our family of origin (the name given to the family or families we grew up in) can pinpoint the tools we are lacking. Just as a medical doctor would not begin treatment until after a thorough examination, the first step towards improving your relationships is to take a closer look both at your strengths and at the places that could use some attention and work.

PicCollage copy 2One of the most common stumbling blocks to building loving relationships is often our experiences growing up. Since we rarely meet and marry someone whose childhood upbringing is the same as our own, our strengths and weaknesses can rub each other the wrong way. It can be extremely enlightening for both members of a couple to do The Family of Origin Assessment, and then to talk about your differences and similarities.

The next step is to develop an action plan for change. How’s Your Family Really Doing? also offers practical tips and tools for each key as well as an annotated bibliography describing dozens of self-help resources currently available. Once you know where to focus—and know that change is possible—you are well on your way to creating a happy loving family of your own.

 

 

 

 



Drowning in Love: What’s Too Much of a Good Thing?

By Debra Manchester MacMannis, LCSW

_MG_0606Definitions of smothering love: To express your love for someone too much; to cover someone or something completely; to insulate, to overwhelm.

Parenting is one of the hardest jobs around. Especially here, especially now, in our rapidly moving, constantly changing modern world. Most parents seek out this job willingly and joyfully with the best of intentions. Doesn’t everyone want to raise happy healthy children who grow up into competent independent adults? Of course. So what goes wrong?

It is easy to pick out the parents who are not doing their jobs. These are the parents who have too many problems of their own to contend with–like substance abuse, severe untreated mental illness, domestic violence or highly conflictual marriages, inadequate physical and emotional resources–so that they are clearly unable to provide the nurturing and supervision that all children need. Anyone can understand why children raised in unsafe and chaotic environments are at risk for developing emotional or behavioral problems.

But what about the kids who come from loving homes with well-meaning parents who shower their kids with attention, affection, guidance and opportunities of all kinds. Can you ever love a child too much? Probably not. Can you smother a child with too much love and attention? Yes indeed.

file9541282977224Children (And Adults) Need Both Closeness and Distance

Parents today are far better informed about the importance of forming strong secure attachments with their infants. Babies need to know that their caregivers will meet not only their survival needs but their needs for touch, empathy, and connection. But with every passing year, children also need the freedom to explore independently in order to develop a sense of autonomy.

Finding the balance between the two is an exquisite dance of moving apart and then moving together again, like breathing in and breathing out, stepping forward and stepping back, leaning in and letting go. In my experience as a family therapist, I am seeing more and more parents struggling with the desire for too much closeness, and as a result producing kids–particularly teens and young adults–drowning in parental “love”.

In one highly publicized study published in the Journal of Child and Family Studies by Holly Schiffrin and her team, young college students with hovering “helicopter” parents experienced their parents as controlling and undermining rather than supportive. Too much parental involvement was correlated with higher levels of anxiety and depression as well as decreased satisfaction with life. The overprotected students saw themselves as less competent and less able to function autonomously. The lower the sense of autonomy, the more the evidence of depression.

file0002105504188College counselors have names for these kids: crispies and teacups. The “crispies” are the college freshmen who arrive completely burned out from years of constant attention to achievement via AP classes, hundreds of volunteer hours, sports teams, and parental pressure to get into the best school. The “teacups” are so fragile that they break with the slightest stress.

These kids, suddenly on their own, without the muscles built up by independence and personal responsibility through childhood, often make bad choices regarding alcohol, drugs or sexual relationships once away from hovering parents. Many bomb out their freshman year. When I see these families in counseling, the parents are shell-shocked and confused. How did this happen when we loved our child so much?

What Are the Some Signs of Too Much Parental Involvement?

  • You are not letting your kids fail and learn from their mistakes._DSC2330
  • You are not letting your kids do things for themselves.
  • You are trying to be more of a friend than a parent.
  • You don’t want your kids to be angry at you so you fail to set boundaries and stick to them.
  • You are doing your child’s homework.
  • You are doing things for your teen that they can do for themselves: laundry, getting places, schoolwork, college applications.
  • You are more emotionally connected with your child than with your spouse or other adults.
  • Your sense of self comes from your child’s accomplishments rather than your own.

Loving Without Smothering

file6401280970192If you see some of the telltale signs of that you are an over-involved parent in the list above, here are some tips to help you create a more healthy balance of closeness and distance in your relationship. Another question to ask yourself: how many times a day do you find yourself worried about one or all of your kids? Although parenting is a tough job, it shouldn’t be all consuming.

Tip #1: Remember that the goal of parenting is to foster independence and competency. If you are too close, your teen will have to push you away even harder so find ways to let go little by little with each passing year. Think about what your kid will have to be able to do to be fully independent. Start teaching those skills and attitudes now.

Tip #2: Teach your child how to work by allowing them to complete tasks on their own according to their age and ability. If you have done too many things for your child and not allowed him or her to struggle, then you are not teaching one of the basics. Adult life is not all fun and games–and work itself can be difficult, boring even, but give us a sense of pride and accomplishment.

Tip #3: Praise effort not intelligence. Not everyone can get A’s, win gold medals, or get promoted. In order to help your child develop competency, learn self-mastery and build the muscles necessary for adulthood, parents need to focus on effort more than outcomes.

IMG_5787Tip #4: Allow your child to experience pain, loss, and failures in order to develop resilience. If you cushion your child’s life too much, and solve problems for them, you deprive them of the opportunity of learning from natural consequences. If children can learn how to handle difficult situations when they are young, they will be stronger, realistic and more resourceful as adults.

Another definition of smothering is what we do to put out a fire. If you want to love your child AND keep the fire of that child’s passion, desire for freedom, curiosity and uniqueness burning brightly, take a step back and a deep breath. Love is also about letting go.

 

 

 

 

 



Unhappy Relationships and Depression Go Hand in Hand

By Debra Manchester MacMannis, LCSW

file4801310649783“What is the opposite of two? A lonely me. A lonely you.” -Richard Wilbur

“It is not a lack of love, but a lack of friendship that makes unhappy marriages.” -Friedrich Nietzsche

The TV ads would have all of us believe that the best cure for depression is the latest and greatest medication. First it was Prozac and now it’s Pristiq and Abilify. Although medication is a life saver for many, for others the side effects are too debilitating, and the meds don’t seem to help enough anyway.

Study after study has shown that the best treatment for depression includes some form of psychotherapy. Once again, there is always the cure du jour–right now it is cognitive behavioral (CBT or DBT). Nothing wrong with that. It’s just that something is missing from the information.

Your doctor or family may have told you (if you are the depressed one) to get help. What you haven’t been told is to make sure you do some counseling with your spouse, your children, and/or your family as well. Here’s why this missing information is so important…

file1871264468042It is More Than Just Social Support

Psychotherapists have long known that social support is crucial–not only when the patient suffers from depression but with any physical or emotional illness or disability. When you visit your doctor for your annual check-up, how often are you asked about the quality of your relationships? We now know that this is even more important than we thought.

A new study by Alan Teo and his team in the Psychiatry Department of the University of Michigan conducted a ten-year follow-up of almost 5000 adults aged 25-75 to determine just how big a part relationship factors played in the risk of developing depression years later. Their conclusion: the magnitude of the impact of social relationship quality on risk for depression is as strong as the effect of biological risk factors (like obesity, smoking, high blood pressure) for cardiovascular disease.

file7281249918714Quality is More Important than Quantity

Perhaps surprising to many, social isolation was not predictive of future bouts of depression. Social isolation is measured by things such as whether or not you have regular contact with family, friends, and neighbors and whether you live alone or with someone. Apparently, some people are less social than others–and happily so.

It turns out that what is relevant is how each of us subjectively feel about the quality of our relationships. The study revealed that of the people who rate their relationships as positive and supportive, only 1 in 15 will develop a diagnosable depression in ten years time. In marked contrast, 1 in 7 who describe poor social relationships will get depressed. Now that’s a big difference.

file0001203965What Clinicians Should Be Asking

Most of the research to date has focused primarily on the positive aspects of social support. Teo and his researchers found that equally important–or perhaps even more crucial–is to look at the negative aspects in order to assess for social strain. This means asking questions like:

  • How do you feel about your marriage or about the person you are dating?
  • Do you feel that your partner cares about you and understands what you are going through?
  • Do you feel that your partner is critical of you too much of the time?
  • Do you know that you are loved by your spouse? your children? your friends? your family?
  • Can you share with your closest friends or family members when you are stressed or having problems?

Including questions about the client’s subjective assessment of both positive and negative aspects of their  relationships “should be considered evidence-based, much like inquiring about past depressive episodes” warns Teo.

It’s A Family Affair

file361245785428The research also indicated that not all relationships are created equal. Perhaps it should be obvious that the number one relationship that affects us is the relationship with our spouse or significant other. Second to that is our relationship to other family members. Friends are important but their presence or absence does not play a significant role in the later development of depression. Our loved ones do.

So the next time you notice relationship strains, think about which of you may be the most vulnerable to developing depression down the line. You? Your partner? One of your children? (Check out my blog on the warning signs of a troubled marriage). It might take years but the odds tell us that negativity in our relationships breeds resentment which can lead to more conflict or to isolation and loneliness. Doesn’t that sound depressing? Turns out, it is.

 

 



Guidelines for Choosing the Right Therapist–Does the Shoe Fit?

By Debra Manchester MacMannis, LCSW

file000635087969I will never forget a lecture that I heard in 1973 (which says a lot since there is so much that I don’t remember). The speaker was the late David Rosenhan, Professor Emeritus, in his popular undergraduate class in Abnormal Psychology at Stanford. Each year, at the end of the term, he gave a lecture about choosing the right therapist. His advice was wise and as relevant today as it was forty years ago.

“Choosing the right therapist,” Rosenhan insisted (and I quote loosely), “should be like buying a pair of shoes. You would never buy shoes without trying them on, seeing how they fit, picking the brand that meets your current needs, fits your lifestyle, and is affordable. Even then, if you make your purchase, take them home and find they pinch you in the wrong places, you would not say to yourself, ‘I need a new foot, something must be wrong with me!’ now would you? No, you would take back the shoes and seek out a new pair.”  So it should go, he sagely advised, with choosing the right therapist.

Myths and Misunderstandings About Psychotherapyfile6271273137854

As I mentioned in my last blog, far too many people fail to seek help or wait much too long before seeking professional guidance. There are numerous explanations for this reluctance, and unfortunately, many negative myths also surround the therapeutic process. In the forty years since the Rosenhan lecture, I’ve heard them all many times.

Myth #1: If you need therapy, you must really be sick or messed up. 
Myth #2: If you need therapy, it means the problems are your fault.
Myth #3: All therapy does is blame your current problems on the past. 
Myth #4: All therapists are the same and most therapy goes on for years.

Why Your Doctor May Not Suggest Counseling (even when it could help)

Myth #5: It won’t do any good, and my doctor didn’t suggest it either. Here’s why:

OLYMPUS DIGITAL CAMERAA big part of the problem is the lack of education about psychotherapy compared with constant advertising about the potential advantages of psychotropic drugs. In a world bent on instant answers and quick fixes, more and more people are choosing to pop a pill rather than seek out counseling.

Although decades of research show that psychotherapy is highly effective, money talks. Pharmaceutical companies today spend billions of dollars touting the effectiveness of designer drugs. According to Pew Research, in 2012, more than $24 billion was spent marketing drugs to physicians and over $3 billion on advertising to consumers.

Although Consumer Reports concluded in 1995 that psychotherapy of various types was effective for around 80% of those surveyed, they found in a follow-up survey in 2003, that 68% of the respondents seeking help for mental health issues received drugs compared to 40% in 1994. This trend persists in spite of the fact that consumers complained of more side effects than they had bargained for–40% complaining about adverse sexual side effects and 20% about weight gain.

file3641283618643Guidelines To Find the Right Therapist

1. Do some shopping before you make your choice.

People have better outcomes when they are more active and involved in choosing a therapist. Rather than just taking a referral from your insurance company or employer, ask friends or family members for names. If you know someone who has been helped by counseling, find out who they saw and what was helpful.

Most therapists will respond to questions you have about how they work in either a preliminary phone call or in the first office visit. Find out if the therapist has experience in the kind of problem you have. Ask about average length and cost of treatment.

Make an appointment for one visit without committing to ongoing treatment. Don’t feel pressured to make a second appointment. If the therapist you see is not comfortable with the fact that you are going to interview several therapists before choosing, that should be a red flag. It is often helpful to bring a family member or friend with you to the first visit.

file16012996431132. Find out if the therapist involves family members in the treatment process–especially if you are having marriage problems or problems with one of your children.

Some therapists only treat individuals, not couples or families. If you are single and your problems do not involve any family members, that approach may work for you. On the other hand, many problems surface in the context of our intimate relationships. Those problems are generally helped more effectively and efficiently by involving the couple or the family.

Family involvement in therapy does not imply blame of anyone. We believe that although people are trying to do “what’s best”, they can get inadvertently stuck in patterns of interaction that lead to the development of symptoms in one or more family members. Our strategy is to elicit the family’s strengths and resources and to unleash hidden potentials that are somehow blocked.

The involvement of whole families in the treatment process serves to expedite change because each family member can contribute his or her unique perspective and understanding of the problem. The family often holds resources and influence essential to the treatment process of its members.

PicCollage3. Do you want a sounding board or someone to teach you skills and offer practical tools?

Therapists differ, both in their philosophy of treatment and in how active or passive they are in the treatment process. Some spend much of the time listening, providing empathy and support, and helping you discover for yourself what changes you want to make. Others are more active–offering specific skills, suggesting new behaviors, giving homework assignments, or teaching communication or conflict resolution skills.

Think about what you want from therapy and find a therapist whose model of treatment fits the bill. This difference is more important than whether the therapist is a psychiatrist, a psychologist, a social worker or a marriage and family therapist. More relevant is the therapist’s expertise and record of success.

Clients who share the same goals as the therapist and apply what they are learning in treatment to their everyday lives report more positive outcomes. Therapy involves hard work. If you want to get more physically fit, it is necessary not only to learn how to use the equipment at the gym but to actually work out three or four times per week. So it is with counseling. Change comes from practicing new behaviors, not just talking about what isn’t working. Find a therapist who holds you accountable.

file00014658050054. Find someone that you like who makes you feel safe, understood and respected.

Not every therapist is the right one for every client–remember the shoe metaphor–there has to be a good fit. And you, the consumer, are the one who knows what is best for you.

Some people only feel safe if they work with someone of a particular gender, or culture, or sexual orientation, or age or race. Honor your needs and preferences. Don’t judge yourself if you want red shoes. Since therapy will probably involve pushing past your comfort zone, you are more likely to do so if you feel connected to your therapist and believe that he or she has the experience and knowledge to help you.

5. Get help sooner rather than later.

file6351304824633The best time to seek help in therapy is before small problems become bigger ones. People often underestimate the seriousness of their situation and wait until crises occur. We don’t usually wait to get sick to go the doctor–we get annual physicals. If you have a question or discomfort about how you or someone else in your family is doing, go for a check-up with a reputable psychotherapist. It will not only shorten your treatment time but it may prevent future troubles.

Remember the wise words of Professor Rosenhan, don’t give up hope if the shoe doesn’t fit. There’s lots of therapists out there. Find the right one for you. If the shoes doesn’t fit, don’t blame your feet. Move on.



7 Warning Signs Of a Troubled Marriage

By Debra Manchester MacMannis, LCSW

100_0321aI’ve been counseling couples and families for over three decades and one thing stands out. Most people wait too long before they reach out for help…years too long. Problems that might have been solved in five to ten sessions become crises that break up perfectly good relationships.

Since only a precious few learned the necessary skills to weather the ups and downs of a long-term relationship, it is easy to slip into negative patterns of relating–either to oneself or to loved ones–or both.

What are the warning signs of problems that need to be addressed?

Sometimes the signs are glaring and obvious–domestic violence, high levels of conflict on a daily basis, serious addictions, repetitive infidelity–but far more often, problems seem to creep up on people a little bit at a time.

file0001309677526In a famous 19th Century science experiment, researchers described how if they put a frog in a pot of boiling water, it would quickly jump out, recognizing the danger instinctively. But if the frog was put in cold water that was heated to boiling very slowly, the frog had no idea of the trouble brewing. By the time the water was boiling, the frog was dead meat.

So it can be with dysfunctional families, marriages, or even organizations. It seems OK until suddenly it doesn’t.

Warning Sign #1: You are no longer warm or affectionate with your partner.

file1601299643113Happy loving couples look up from what they are doing and smile when their partner comes home from work. They touch one another with some frequency–a hug hello or goodbye, a hand on the shoulder or leg, a kiss goodnight, holding hands watching a movie, rubbing the back of the neck after a long day.

Some people try to defend their lack of physical warmth by saying it’s not how they are built but when you see them with their children, they touch and tussle, smile and cuddle. Often when affection begins to wane in a marriage, it is a symptom of unexpressed resentment that needs to be uncovered and worked through.

Warning Sign #2: You don’t create enough time together doing enjoyable activities.

file00024844479If the only time that you spend with your mate is conducting the business of the marriage–doing chores, paying bills, managing child care–then the relationship ceases to have the qualities of a deep and tender friendship. As the old Michael Johnson song so aptly put it, “Love will get you through times of no sex better than sex will get you through times of no love…”

Happy loving couples make their friendship a priority. Even on weeks when they can’t afford the time or money for a date night, they participate in activities that bring playfulness and joy into the relationship. Some couples work out together, take walks when weather permits, play cards or games, entertain other friends and family, play sports, watch movies, or read books.

Warning Sign #3: You stop having sex or have it very infrequently.

file0001646047075One of the enjoyable activities that makes marriage special is the ongoing availability of a sexual connection. Contrary to myths perpetrated by the media, married people in general have more sex than their single counterparts, averaging between one to two times weekly after the honeymoon phase is over. If you begin to notice that the time between lovemaking is growing longer, this is another symptom of decreased connection.

Lots of folks–more often women in my experience–condone their behavior by saying they don’t want to have sex if they don’t feel like it but this position readily becomes a self-fulfilling prophecy. Both men and women get a boost of oxytocin–the bonding hormone–when sexual or even when cuddling, so paradoxically, if you have sex, you will then feel close (and more sexual) again. It’s a bit like priming the pump.

Warning Sign #4: One or both partners stop good self-care.

Marriage takes commitment and caring, both for oneself and for your partner. When either person begins to take the relationship for granted, resentments often build. Recent surveys have shown that both men and women are turned off when their mate puts on weight, stops dressing fashionably or grooming adequately.

Happier couples still dress up when they go on a date night as if they were courting a new relationship. Since a big part of our attraction to others is visual, it is important to want to look good for each other.

best oneWarning Sign #5: You blame your partner for your unhappiness (even if you don’t say it out loud).

Couples that don’t fight or fight very infrequently seem to have the illusion that their marriage is going well even when it isn’t. (The water is getting hotter by the minute but you and the frog are still unaware). If you feel constantly criticized or are feeling critical of your partner on a regular basis, it is a sign that issues need to be put on the table rather than shoved under the rug.

file9841279612478Warning Sign #6: You are lonely even when your partner is in the same room.

If you feel lonely in your marriage, it is time to take action. Most likely, your partner is also feeling the same thing. Loneliness is the fertile soil for affairs. Most infidelities are not due to sexual desires–although certainly sexless marriages contribute to longing–but they begin more innocently as a desire for friendship.

If you and your mate are not listening to one another’s pains and pleasures and providing support and empathy, then it is natural to look for support elsewhere. Don’t wait for the crisis and heartache of an affair. Even feeling the desire to look outside your marriage should make warning bells go off in your head.

file000905908966Warning Sign #7: Contempt has crept into your conflicts.

Be on the lookout for contempt–it is a relationship killer of massive proportions. Contempt is a form of criticism with a twist of judgment and bitterness thrown in.

It is signaled by rolling eyes and a downturned mouth indicating disgust. In John Gottman’s research, made more famous with Gladwell’s book Blink, contempt is one of the most obvious signs of an impending crisis. Simply observing couples arguing for a few minutes can help a trained observer accurately forecast the fate of a relationship.

valentine_4Get Help Before It’s Too Late!

The point of my sharing these warning signs is to light a fire in your awareness before it’s too late. If you read this and are worried because you have all seven signs a-blazing, take heed but don’t panic. With courage and commitment–and the right therapist–you can work together to create or recreate the relationship that makes you feel liked, loved and respected. Look forward to the next blog about finding the right therapist when you need one.

 

 



NEWSFLASH! Free Technique for Healing Pain Described

By Debra Manchester MacMannis, LCSW

file000912201749What if you turned on the news to the following headline…FREE new technique–with no known side effects–is found to improve the mood of 88.8% of users!!! Would you be curious or do you already know what it is?

Touted throughout history, described by Aristotle, Freud, and modern day psychotherapists of many theoretical backgrounds–the answer is allowing yourself a good cry. Weeping helps almost everyone, young and old, male and female.

Not All Tears Are the Same

Our eyes produce three kinds of tears–each of which serves a different function. Every time we blink, our eyelids produce continuous or basal tears to keep the surface of our eyes protected and moist and also necessary to help protect us from getting infections of the eyes.

file0001186408096Reflex tears, like basal tears, are 98% water. Their production is triggered when a foreign object or something irritating gets into the eye by accident, acting like a natural eye shower to keep our eyes clean.

Emotional tears are composed differently and include an endorphin and natural painkiller called enkephalin. “Emotional tears contain higher concentrations of proteins, manganese, and the hormone prolactin which is produced during stress-induced danger or arousal,” says Dr Carrie Lane of the University of Texas. This difference explains why “crocodile tears” (the type used for manipulation and trickery) are not the same as real ones.

Crying Helps Us Heal

sunday 015Dr. William Frey from the University of Minnesota is a biochemist who has been studying crying for over thirty years. He found that emotional catharsis helps shed both stress hormones and toxins. Simultaneously, crying stimulates the body to produce endorphins which not only help reduce our experience of pain but also help turn up the volume of our immune system.

Tears can make us feel better and physically stimulate healing at the same time, which is a pretty powerful combination. If you find this subject fascinating, check out Frey’s book, Crying: The Mystery of Tears. Frey is a believer in what is dubbed “the recovery theory” which hypothesizes that we literally cry things out as a way of helping the body recover from physical or psychological stressors.

Other evidence of substances only found in emotional tears helps support this theory as well. Emotional tears have higher levels of certain proteins as well as manganese and potassium. Manganese is an essential nutrient that must be kept in balance for optimum health.

file000730027686It helps to maintain normal blood sugar levels, to increase the health of nerves, and to keeps bones strong (to name only a few of its many functions). Potassium is necessary for the functioning of all living cells, helping to maintain fluid and electrolyte balance.

Why Women Need to Cry More

Studies have found, that on the average, women cry around 47 times per year while men average 7 crying spells each year. Until puberty, there’s not much difference between boys and girls unless, of course, boys have been shamed or ridiculed for displaying the “weakness” sometimes associated with tears. If the parents and culture allow, both little boys and little girls cry on a regular basis–and should be allowed to–in order to stay healthy and resilient.

After puberty, hormone differences help explain why women cry more often. Women produce more prolactin, the hormone found in emotional tears. In fact, prolactin levels are highest during pregnancy and breastfeeding. They actually increase to ten times their normal level. (I’m glad there is finally something to explain my excessive tears at MacDonald’s commercials, the local news, and a sideways look from my husband during my pregnancies and postpartum).

file000445653028Crying As a Way to Resolve Painful Events

While some researchers believe that crying is cathartic simply because it releases tension that builds up during stressful events, others believe that crying is the body’s innate mechanism to work through painful events that are still unresolved. Why else would people pay good money to get scared out of their wits by frightening films? Or spend hours watching soup operas or tear-jerkers or films about deeply unsetting subjects? Perhaps we are trying to jump-start the flowing of emotions any which way we can…

I’ve written about the healing effects of laughter in other blogs, and how sometimes we laugh so hard that we cry or we laugh when the more appropriate emotional response would be tears. These examples show how grief and catharsis come in many shapes and sizes, tailored by messages passed down in our family of origin, our ethnic and religious mores and beliefs, our shaping by age and gender.

The other way that crying helps in the resolution of past trauma–especially when done with a safe, loving supportive person–is that we are allowed to express emotions that were often suppressed or forbidden at the time. Often new insights and fresh perspectives come only after the painful feelings have been acknowledged and expressed.

file9541282977224Crying As a Signal to Loved Ones

Another function of crying is that it signals the need for help, which is one reason why babies and young children need to cry more often than many adults. Tears sound an alarm that something is wrong that needs attention. Emotional crying–when effective–thus helps to strengthen our attachment to others and to elicit empathy and comforting touch from others.

This explains why crying in the company of another person is associated more often with positive mood change than crying alone or crying in a crowd. If you want to feel better, allow yourself to cry as long as you need to. Don’t stop yourself. When you cry with another person, you are really giving yourself and them a gift.

Since I know that tears are one of the most powerful tools for healing available, I feel happy and relieved when someone allows themselves to cry in front of me or in my arms. Although it is painful to see a loved one suffering from pain or loss, none of us can escape the suffering that comes with being human. What we can do is offer our calm presence, without judgment, and feel grateful for the tears that fall. Tears are precious medicine for body, mind and soul.

 



Change Your Attitude & Life Will Follow

By Debra Manchester MacMannis, LCSW

PicCollage copy 2“They must often change, who would be constant in happiness or wisdom.”  -Confucius

Each January, as the kids go back to school after winter break, after we have watched the ball drop in Times Square and rung in the new year, most of us can’t help but think about the ways we want the next year to be different–and better–than the last. What about you? Are there any bad habits you want to break or new goals that you have set for yourself?

If you are inspired to make some changes in yourself, your family or in other relationships, remember that even change for the better is stressful and discombobulating. As creatures of habit, we get used to the way things are–even when the status quo is no longer very appealing or sometimes downright awful.

Unfortunately, many people make New Year’s resolutions, fail to keep them, and then beat themselves up for failing. Sound familiar? Here’s some hints that may make you more successful in accomplishing your goals…

It All Starts with Attitudefile7181334521100

Do you remember the children’s story, The Little Engine That Could? When a red train full of cargo breaks down on the track, a little blue train takes it upon herself to attempt the difficult feat of pulling a load of toys over the mountain. She succeeds only when she tells herself, “I think I can, I think I can, and then delights in her success by saying to herself, “I thought I could, I thought I could!” The little engine models an empowering self-concept, fostering perseverance in the face of hardship.

When you are taught to believe in yourself, confronting an obstacle pushes you to try harder rather than giving up. If you think less of yourself, you will have trouble even getting started let alone persevering when the going gets tough. If you anticipate failure, why bother?

One way to change your attitude is to think about problems, setbacks, or obstacles as situations demanding attention and new strategies. When you hear yourself using the word “problem,” try substituting the word “situation”. This situation is worth facing to see what else might be done about it.

Or for an even more positive spin, you can think of the “problem” you are facing as an “opportunity” to learn some new ideas or tools or as a “compelling challenge” or as a hurdle to be jumped. The words won’t change the problem in and of themselves but they will help to open the door to possible new strategies for change and growth.

DSC_0390_Iván_Melenchón_Serrano_MorgueFileBe Realistic About Change

In one of my favorite movies ever, What About Bob?, psychiatrist Dr. Marvin (played exquisitely by Richard Dreyfuss) instructs Bob (the inimitable Bill Murray) to stop trying so hard and to take baby steps towards change, setting small reasonable goals one day at a time. Although the movie takes this idea to a hysterical level, the principle is sound. Don’t bite off more than you can chew.

Throwing in a dose of humor will also help. Watch What About Bob? if you haven’t seen it (or any other film that makes you laugh at our human foibles) or just be reminded by watching a three-minute clip here.

Another reason that most of us make numerous attempts to change, but then revert to old behaviors, is because the new behaviors don’t always get the desired results fast enough. We live in a culture that likes quick fixes–crash diets, pills for pain, instant messages, everything short and sweet. Most important changes–like confronting dysfunctional patterns of relationship, emotional baggage, or life style habits–take a long time.

Things Can Get Worse Initiallyfile000557708328

John Steinbeck once queried, “I wonder why progress looks so much like destruction.” This favorite quote of mine can serve as  a touchstone during times of rapid and radical change. Given how easy it is, in the face of change, to feel that everything around you is being destroyed, we all need something to bolster our courage to hang in there.

I remind others (and myself) that whenever we embark on a new path, things usually get worse before they get better. When parents decide it is finally time to begin to set limits, kids often act out even more than before. When partners decide to be more assertive with one another about areas of disagreement, bigger conflicts are usually the first sign of change.

Many couples report how when they finally get away alone together–sometimes after years because of having babies and young children–all they do is fight. Does this mean they are no longer in love? Usually the opposite is true. The renewed closeness can bring up old stored-up resentments, fears of abandonment, and the longing for more intimacy. As any change begins, old habits must die first–which is why progress often looks a bit like destruction.

file000443155139Become An Expert Observer

Almost all bad habits start with a cue (or stimulus) that leads to the behavior that has some reward attached to it. If you can follow this sequence of events and make a tiny change to disrupt the pattern, voila!–change can begin, one tiny step at a time.(Watch this three minute clip from The Power of Habit to get the quick version.)

It helps to substitute a new behavior when trying to eliminate an old destructive pattern. Once you have examined thoroughly the habit loop you are trying to break, change the time, the place, or alter the sequence that leads to the undesired behavior.

Imitate the behavior of someone you admire and ask them how they maintain their positive routine. Give yourself lots of pats on the back or gold stars for every little step you take. This is why AA gives people chips as they accumulate weeks, months, or years of sobriety.

Track your progress on your calendar or with an app on your cell phone. If your goals were not realistic, go back and set new intermediate steps that you can more easily accomplish. And always remember that the road to success is always paved with failures. You are not alone.

 

 



 
How's Your Family Really Doing?
Don MacMannis, Ph.D. & Debra Machester MacMannis, MSW are the author of How's Your Family Really Doing?.

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