EMDR and the Brain - How it Works
In 1989 a psychologist named Francine Shapiro was working with Vietnam Vets who were suffering from Post-Traumatic Stress, or what we now call PTSD – Post-Traumatic Stress Disorder. It was at various times called various things: combat fatigue, shell-shock… and of course, now we know that PTSD applies to people other than combat veterans. People who have been in a life-threatening situation, where they have witnessed someone else, or have themselves experienced a threat to their lives, frequently suffer the effects of PTSD. But back to EMDR. However, first, a little brain anatomy to help understand how EMDR works…
When we are in a situation that is threatening, our primitive survival skills kick in, and the part of our brain that is responsible for those skills – the limbic system – churns out a series of chemicals that prepare us to fight, flee (as in flight) or freeze (if you’ve ever come across a bunny on a walk in the hills somewhere, or the old "deer in the headlights," you might have noticed that it will freeze, as if it thinks that if it doesn’t move, you can’t see it and this will somehow keep it safe; this is a freeze response. You can also think of this as being too scared to do anything else – you are so scared, you can’t respond or react; you just freeze).
Your limbic system contains a number of brain structures, among them are two very important ones – the amygdala and the hippocampus. The amygdala holds all of your "body memories." Its function is to regulate arousal, control autonomic responses associated with fear as well as pain and pleasure (rapid heart beat, fast breathing, etc.), emotional responses and hormonal secretions (like adrenalin and norepinephrine). Everything that ever happened to you, from before you were born is stored here on a cellular memory level. When your amygdala processes information, it sends it to the hippocampus for short-term memory processing; then eventually the information is sent to your pre-frontal cortex, the part of your brain behind your forehead, the part that allows you to think logically, and the part that distinguishes us as humans from other animals. Although we may not know as much as we’d like about each structure in the brain, we do know that the next structure in the limbic system, the hippocampus, is very important. The hippocampus is a small horseshoe shaped structure next to the amygdala. It functions to consolidate new memories (short-term memory processing) and these memories are closely tied to emotions. It is also responsible for spatial navigation and orientation – that is, it allows you (your brain) to know where you are in space – what is up, down, left, right… basically, it let’s you know if you are standing up or lying down. The size of the hippocampus is affected by a number of things; two of these are depression and estrogen. In people with depression, the hippocampus is actually seen to shrink (this is a good reason to treat depression with medication AND therapy… but that’s another topic; see "Treating Depression"."Treating Depression". Estrogen actually increases the number of neurons in the hippocampus, thus increasing short-term memory (another good reason to ask your doctor - if you are a woman entering or going through menopause - about estrogen replacement therapy).
Another structure in the limbic system is the cinculate gyrus. This structure is responsible for coordinating sensory input with your emotions, regulating your emotional responses to pain and regulating your aggressive behavior.
Next in the limbic system is a small bundle of neurons (nerve fibers) called the fornix; the function of the fornix is still not clear to neuroscientists. We are still learning much about the brain! The hypothalamus is responsible for controlling autonomic functions (breathing, heart beat – the things we don’t have to think about but our bodies just do…), plays another role in regulating our emotions, influences our endocrine functions (our hormones), homeostasis (regulates our body temperature, fluid balance, etc.), helps to control our motor functions, regulates our thirst and hunger and regulates our sleep/wake cycle, or "biological clock."
Before I discuss the olfactory cortex and it’s importance, I will just mention the thalamus, the last structure in the limbic system. The thalamus is responsible for motor control, for receiving and processing auditory, somatosensory (emotional/sensory) and visual sensory signals, and for relaying these signals to the cerebral cortex, or the higher processing parts of the brain. The olfactory cortex is the part of the brain that is responsible for our ability to smell. If you weren’t already aware of this, there is a very strong association between odors and emotions. The smell of apple pie baking can bring back sentimental, warm memories of home and loved ones, or it might stir up unpleasant memories of abuse if every time a parent got drunk and beat up on the family, someone else baked an apple pie to try to make up for the abuse. (That being said, it is a proven fact that when people have the scent of baked apple spice in their home at an open house, the house has a higher rate of sale than those homes without a scent!) Or perhaps it brings back a memory of the time you over-ate and spent the entire night in the bathroom, trying to get rid of it. Or maybe the association with a particular aftershave has a bad association for you; or an especially good one, but you don’t really know why.
The olfactory cortex works in your limbic system in memory and trauma reactions in the following way: When you smell something familiar, even if you are not consciously familiar with it, but you have a "every time I smell Old Spice I get sick to my stomach" reaction (for example), your olfactory cortex is signaling your amygdala of an old memory buried somewhere in your subconscious. When your amygdala gets "triggered" by the odor, it kicks in and the same stress chemicals and hormones (if it was a stressful event involved with the odor) that were released during the original stressful event.
Our brains are very good at cutting off traumatic memories, especially if they happened during childhood. We call this dissociating from the trauma. Children are very good at teaching themselves how to do this, and the younger they are when trauma occurs; the better they are at dissociating from it. The problem with this is that our brain – our amygdales, our hippocampuses, and our olfactory cortexes in particular remember, regardless of what our consciousness wants to do. So at some point, eventually, something is going to trigger our "hidden" or "buried" memories. Like that odor… or maybe a sound, or a color, or an old song… we never know what it may be. And this is where a treatment technique like EMDR and be especially useful.
When I work with people who have suffered a trauma, I will often hear them say, "why do I need to revisit that in order to heal from it? Why do I need to tell the story again?" Or they may tell me, "You know, I’ve had so much therapy, and I can’t get past these anxiety attacks. How will it help me to tell it again?" The reality is that you DON’T have to "revisit" the trauma or relive it; you don’t have to tell me your whole, painful terrible story. All we need to do with EMDR is focus on one specific aspect of it – and yes, it’s best if it’s the worst part of it, or maybe I should say, the worst part that you can tolerate. You don’t have to do anymore than that – tolerate it. And I’ll be there with you, keeping you in the present and checking in with you the whole time to keep you here. What we do know about EMDR is that for some reason, when people focus on a particular aspect of their trauma, or their phobia (like a fear of heights) or their pain or their anxiety, the neurons in the limbic system rewire themselves when we do BLS, and the things that are somehow "stuck" there are "reprocessed" and the brain becomes desensitized, the memories are moved from the old limbic system to the prefrontal cortex. In short, instead of being triggered and having a fear (or flight, fight or freeze reaction) people now have a response, like, "That’s not happening to me now; I’m not in danger now; I’m safe" and when they think of the original event, or the phobia or the fear, their neurons in their limbic system no longer light up as they used to (this has been studied in actual brain scans), and the neurons in the higher thinking prefrontal cortex light up instead.
There are of course nay-sayers, just like in any field, who call EMDR "quackery" and say it doesn’t work – that it’s a gimmick. There are also those who don’t believe in hypnosis… but that’s another topic altogether.
There are many theories about how and why EMDR works. I tend to go with the science behind it, like brain scans. Some professionals think it works because the client is connected with an empathic therapist while processing disturbing images and memories. Also, replacing the negative images and thoughts with positive ones is part of the work that we do with EMDR, and also in "regular talk therapy." One might say that nothing is really what it seems - there is a lot more going on that what I have written in this relatively brief space. For more on the research behing EMDR, please visit www.emdr.org.
I’ve been practicing EMDR for 7 years, and if I went back and looked in my files, I could probably tell you how many cases I’ve treated with EMDR in that time, but I know it’s over 100. I can tell you that I’ve had at least a 90% success rate among the people I’ve treated with EMDR when it comes to trauma recovery, getting over phobias and healing from panic attacks. EMDR isn’t for everyone; in good psychotherapy, like in good medicine, there is no "one size fits all" treatment. But it’s always worth looking into it. It got me over my fear of heights!
Family and Other Problems...
New Year's Musings
Regardless of how you deal with your thoughts (unless they're a problem and are interfering with your daily life), it seems there are so many things to worry about these days. And it seems like most of us just have too much on our minds, so much so to the point of not remembering things - big and little. Most of us forget why we just went into the kitchen... "What was I going to do in here?" ... or where we put something..."I just had that pen in my hand..." and I think it's simply that we are trying to do too much.
I just came back from my neighbor's house. Their newly married son and his wife are visiting from out of state. Three family members were all sitting in the same room, two of them on their laptops, and the third one on his ITouch. The "new" American Family - a Portrait. I wish I'd had my camera. So many of us these days are spending so much time with technology that we are not spending time with each other. We find our family communication coming to a standstill or breaking down.
My daughter and her husband took their two year old to Big Bear for the week, where they have a timeshare. She called this morning to tell me there is snow, and it took them 6 and 1/2 hours to get there - it should be a 3 hour drive from the San Fernando Valley. But traffic was heavy the day after Christmas. My grandson slept for 4 hours (they timed it that way), but he woke up for the last two hours and cried all the way there. She said they might breakdown and buy a portable DVD player for the ride home. When my kids were little, we had no idea we'd ever have anything like DVDs, let alone something that would allow us to play them in the car! When we went on car trips with our kids, we played games and counted cars and out of state license plates and talked about the scenery; we listened to books on tape at times. The world is changing. When my kids were little, I admit I used Sesame Street to keep them out of my way while I made dinner or when I needed a little rest in the mid-morning. I have no problem with parents playing DVDs for kids on long trips, but I'd like to think they use it as a last resort, and don't just automatically put it on.
I teach in a graduate program at a local private university. The students bring their laptops to class and expect professors will have PowerPoint presentations for each class and that we will also post our PowerPoint's online before class so they can just download them. I've thought about banning laptops in my class. I know many of the students are surfing the net, or reading their emails during class, but I've decided that they are adults; this is grad school - if they are doing that, it is their own loss and it doesn't detract me from my teaching. They are still responsible. But I wonder how they will respond next semester when I don't do PowerPoints? I think of it as an experiment. When I was in grad school, no one ever anticipated that there would be a computer so small you would be able to take it with you anywhere! Now there are some that are so small, they fit in a purse and you don't even need a special case for them. How the world is changing... I really think someday we will evolve to the point where we can communicate telepathically and we won't need anything to do it; maybe we will evolve beyond our bodies and won't have bodies; we'll just be "energy" floating around in the ether.
Whatever you find yourself thinking about, or maybe ruminating about, I wish you a healthy and happy new year in 2010.
Brain Power
Our brains are amazing, wonderful organs. I have just read an article in the Wall Street Journal about how our "wandering minds lead to insight." (My husband subscribes to the Journal, and gives me the articles he thinks I'd be interested in. He's nice that way...)
The article talks about studies done using brain scans and having people solve problems during the scans. No one seems to be too sure of how our brains directly lead us into insight, but they did learn that even a "wandering mind" - when someone seems to be day dreaming, or not paying attention - is hard at work. Our brains know answers to problems before we do, if that makes any sense.
You know that "Ah ha!" moments that we sometimes have? When we've been struggling with something, and we "stop" thinking about it, and a little later, the answer just seems to come to us? I remember taking algebra in college (I took it three times in Junior High School; just couldn't seem to get a grasp of it!). I would do the problems from the text book at home after class, and again I struggled. There would be at least one problem I just couldn't get, give up and go to sleep. But somehow when I got up in the morning, the answer was just there; it became clear to me. I thought that somehow my brain kept working on the problem while I slept, and now I see that I was pretty close to the truth!
The scientists in the study in this article said that "an 'aha' moment is any sudden comprehension that allows you to see something in a different light. It could be the solution to a problem (like my algebra problems!); it could be getting a joke; or suddenly recognizing a face."
Some of us solve problems through insight, some through analytic reasoning. They found that the brain wave patterns are different in these two types of problem solving. Now this is the interesting thing: our brain is most actively engaged when our mind is wandering, and we've lost track of our thoughts. So if you're sitting in your therapist's office and they don't seem to be paying attention, or their mind seems to have wandered, they are actually working on your problem! (Or maybe trying decide what to get for dinner that night...)
These scientists also found that just before the burst of brain waves that signaled insight occurred, there was a lessening of activity in the visual cortex - where our visual input is processed. This may be like when you are trying to think of something and you reflexively close your eyes, as if that helps you remember something, or think better. We all do it.
Another interesting tidbit: the researchers found that mood affects our brain on a physiological level when it comes to insightful thinking. People in a positive mood were more likely to experience insightful thinking than people in a negative mood. How you are thinking beforehand is going to affect your problem-solving abilities. So if you are in a very stressful situation, and have to make a decision or solve a problem, you are less likely to have an insight as to the solution as you are when you are in a positive mood and environment. Think about where you work - what are the conditions? Is there a lot of pressure? Do you feel pressured to come up with answers and solutions on the spur of the moment? Some people work better under pressure, and under the pressure of deadlines. These people are more analytical than insightful.
I haven't said anything about psychotherapy in this article - yet. How can therapy help your brain perform better? There are a number of ways. For example, untreated depression might lead to more depression. It's kind of like a chicken or an egg thing. Depression might change the physiology of the brain itself, making it more susceptible to more depression. Left untreated, depression is not something one just "snaps out of," although that would be much simpler. Many professionals prefer to treat depression with medication, and in many cases that may be the best approach, since depression is caused by a chemical imbalance in the brain. However, many people don't want to take antidepressants, or any other kind of medication. The fact is that researchers have found that the best treatment for depression is a combination of medication and weekly psychotherapy. The one-to-one interaction with a therapist who listens and understands, and doesn't give advice or interrupt to tell their own story actually has an effect on the physiology in the client's brain. It is sometimes referred to as a "right-brain to right-brain connection" that is not found in most casual relationships like the ones we have with friends and well-meaning family members. Other examples of how therapy can help your brain are in talking about trauma, childhood abuse, dealing with a chronic illness or chronic pain among other problems. There is a connection between our bodies and our minds, and having a therapist to help when needed can make a difference in the quality of one's life and relationships. Most people don't want to talk about their childhood, especially if there trauma or abuse or it just wasn't a happy time. But now we have scientific evidence that "just talking" does change things, and helps you feel better because just talking can help your brain rewire itself. Isn't science wonderful?
Hypnosis: What It Is and What It Isn't
A lot of people are simply curious about it, and it seems to have a air of mystery around it. Most people see examples of hypnosis on television shows or at stage shows. Pat Collins was someone who did stage shows, calling herself the "Hip Hypnotist." As a result of television shows and stage shows, people come away with a lot of misperceptions about hypnosis, about what it is and what it isn't. On television shows, characters are often in a hypnotic trance without them knowing it, and do things that they wouldn't otherwise do. This is not possible. No one will go into a deep trance without consenting to it, so they would have to know they are going to go into one, and no one, even in a very, very deep hypnotic trance would do anything they wouldn't normally do. In this way, stage shows and television give hypnosis a bad name.
In a therapeutic setting hypnosis can be a very useful tool. People will seek out a hypnotist - whether a lay (non-licensed) hypnotist or a therapist (licensed) who uses hypnosis for a variety of reasons, one of them being to help with habit control, the two most common being to lose weight or to stop smoking. What most people don't realize however, is there are many, many more situations in which hypnosis is helpful - and it is not a magic cure to stop smoking or lose weight.
Let me talk about smoking first. Cigarettes are addictive. They contain nicotine which is the addictive ingredient. Most people who smoke and are addicted to it started in their teens or even younger, and sometimes in their 20's. How does hypnosis work to help people stop smoking? First of all, the person has to be motivated to stop. As I said, it is not a magic cure, and a few sessions won't "make" someone stop if they are not ready to, and unconsciously (or even consciously) don't really want to. Most people who are trying to stop to please someone else - a spouse, a family member or even because their doctor told them to - will find it much harder, even with hypnosis. However, if someone truly wants to stop, and is motivated, hypnosis can help by giving the person positive imagery and suggestions that help them move towards their goal. Some people feel that it is helpful to go back to the root of why they started in the first place, but in my experience this isn't really as important as what keeps them smoking now. Is it that they won't know what to do with that first cup of coffee if they don't have a cigarette with it? Or what will they do with a drink? Or in social situations, while talking on the phone, when they are stressed? These are some of the things people tell me they are worried about when they think of stopping. That cigarette has become very, very important to them. I have had success helping people stop smoking by listening carefully to them in the intake session (I never do hypnosis in a first session) and using what they tell me to create a "script" that incorporates their triggers and their goals. The most effective hypnosis suggestions are ones that are personalized for the individual. (There are many, many books available with scripts and these can be useful, but most therapists will tweak them to make them better suited for each individual client.)
Hypnosis for weight loss is different, and more complicated. People who overeat do so for a reason, be it boredom, stress, trying to fill an emotional void - the list can go on and on. So when someone comes to me for hypnosis for weight loss, I have found that is most beneficial in the long run to find the reason for the overeating. Unlike smoking, which usually starts out as a rebellious thing to do because as a teenager they were told not to do it, or from peer pressure, or because everyone else in the family smoked, overeating as I said is often (but not always) an emotional issue. Some people overeat because they grew up in a home where everyone overate, and food = love. Some people are trying, unconsciously, to fill some void inside. So in using hypnosis for weight control, I almost always do regression therapy. This consists of inducing a trance state (for a definition of trance, please see the Hypnosis page on my website), and then regressing the client back to the age where they feel the issue the strongest. For one client who came to me for this problem, it turned out she was adopted and her adoptive parents would not share any information about her birth parents with her. When she would overeat the things she "knew were bad" for her, her thought was "I deserve this." In hypnosis, what came up for her was "I deserve to know where I came from." Once she made that link, she was able to control the urges to overeat and to stop eating sweets and was able to begin to lose weight.
Hypnosis is very helpful for people about to have surgery. Studies done at Harvard Medical School showed that people who had hypnosis prior to having surgery has less anxiety, less blood loss during surgery, needed less pain medication after surgery and left the hospital sooner (of course, now most surgery is same day so people go home right after... however, people still heal faster). When I have used hypnosis for people about to have surgery, I hear from them that the results listed above are what they experience. Some insurance companies are beginning to send hypnosis cd's to patients about to have surgery also.
For childbirth, hypnosis can be extremely helpful to remove the fear of pain during labor and can make the whole process relatively pain free for women who are open to the suggestions. Childbirth hypnosis takes several sessions, usually with the father (or labor coach or birth partner) present to help with giving suggestions during labor, and can serve as the "cue" to help the woman remember what she learned, and to go into, or stay in, a trance during the entire labor and delivery. Women who use hypnosis for childbirth often have a shorter labor and less bleeding during delivery and a quicker recovery because hypnosis can relieve the anxiety that is often associated with childbirth and helps them to stay relaxed during contractions instead of tightening up (which is a natural response to pain). A hypnotic labor and delivery can make it, as I said, a relatively pain free, pleasurable experience of welcoming the new life into this world, and a less stressful labor and delivery results in a happier baby!
Hypnosis has been used for chronic illnesses and for pain for some time. Irritable Bowel Syndrome (IBS)is one such situation. A psychologist, Dr. Olafur Paalson, developed a specific protocol for IBS, and distributes it at no charge to licensed professionals only. A study done in Great Britain showed that people who used hypnosis to control their IBS symptoms were able to stay off of medication for over a year as opposed to people who did not undergo hypnosis and needed more medications. This hypnosis protocol is also useful with other bowel diseases, such as colitis and Crohn's Disease. For managing and coping with chronic pain, as a therapist I teach people self-hypnosis so that when the pain is getting in the way of daily activities, the client can avoid medication but still control and manage it. Some dentists use hypnosis and have even done root canal without Novocain!
Whatever the issue is, there are too many uses for hypnosis to list and explain them all here! For more information about hypnosis, please visit the website for American Society for Clinical Hypnosis (ASCH).
"Be a Leaf"
We all have our "issues." (Yes, even therapists...) And we are all affected by them, even when we aren't aware of it. Many of us are able to go on with our lives, oblivious to why we get upset about little things that in the bigger picture don't matter, or things we have no control over. Or some of us get upset but it's brief and gone as quickly as it came. Have you stopped to think about the things that annoy you more than they should? Have you given thought to finding out why the little things bother you? Are they interfering with you life - driving people away, causing you to avoid certain situations that you might enjoy socially or professionally?
I had an issue with driving. Every time I got behind the wheel, I would get tense and I just wanted to get to where I was going and get off the road. I would get very stressed out by other drivers - like "What don't you understand about the concept of turn signal?" You know, they driver who just sort of meanders all over the road, drifting into your lane without bothering to look to see if anyone is there and you either have to veer out of the way (into another lane) or brake hard. My list goes on and on, but I won't bore you with that.
I think we are all aware of an increase in road rage. It's gotten so that I'm afraid to honk at someone because you never know who might pull out a gun these days. I was coming home one night, and turning left on a left turn only arrow. The on-coming traffic had a "No right turn" red arrow, and at this particular intersection, drivers often ignored their red arrow. One night a car turned right as I was turning left, and he turned into my lane, so I honked. At the next light, which happened to be red, the driver caught up to me, rolled down his window and shouted something not so nice and spit on my car. My old mantra, "Ignore them...." played in my head and I didn't not look at him. As I drove up the road towards home, he fell in behind me and followed me, to the point that I pulled to the right and went very slow so he passed me. I didn't want him seeing where I live; it really scared me.
But back to my main point. I was having such issues with becoming stressed out driving, that I said out loud one day that I really need to work on this; it wasn't healthy getting so upset every time I got in the car. I can't control what other drives do. I knew this in my mind, but another part of me just didn't like it. So one day my daughter my daughter called and said "I have a metaphor for your driving issue. Instead of being a little fish trying to swim upstream against the current, darting in and out between the bigger fish swimming downstream, you should be a leaf." "So," I said, "I should let the current carry me." "Right" she answered. So I asked, "What about if I get stuck on a boulder? What then?" and she wisely answered that "A leaf waits for the current to come along and pick it up and carry it on the current again." I thought this was very Zen. ("Be the leaf...") So I put a sticker of a leaf on my dashboard, and whenever I feel the stress starting up, I look at the leaf, take a deep breath and let go of trying to control what I can't control. I share this with my clients when appropriate, and now I am sharing it with you.
Thank you for taking the time to read my blog. I appreciate your comments.
Steps to Communicating About Finances
We are all feeling the crunch of our current economic climate. When money gets tight stress increases and this often affects relationships. Couples may argue more, sometimes about money, sometimes about other things. What are some of the things you can your partner can do to alleviate your worries, thereby easing some of the stress?
Admittedly, not having enough money to pay the bills, losing a job or being faced with the possibility of losing your home is not an easy path to negotiate without difficulty, but if you do whatever you can to keep communicating and let each other know you are not throwing in the towel and will stand by each other though these difficult times can only help.
Here are some steps you can take, regardless of how financially secure you may or may not be:
1) Create a budget. Sit down together, and make some rules about how you will talk about this first off. Agree that you will not argue or criticize your partner if you have different opinions on what should be in the budget. Start by agreeing to just "brainstorm" it out. That means that you can both just put ideas out for now, and you can cross things off the list later, together. But for now, just get things down on paper. What should be in your budget? Major expenses that can't be set aside first; that means pay the mortgage or rent; if you have car payments; credit cards payments; medical bills. The items will of course vary by household. These kind of expenses are "fixed;" they don't change from month to month. You will need to look at your monthly bills for the past 3 - 6 months to determine the fixed expenses. Then determine "variable" expenses - expenses that change month to month, like groceries, eating out, clothing, entertainment, etc. Sometimes auto costs are variable, like gas, repairs, oil, etc. Include your yearly income, any interest or dividends you might get from bank accounts or stocks, and any other income. Subtract the fixed expenses from this, and then you can figure how much you have left for variable expenses. If you have huge credit card debt, you want to try to get it paid off as soon as possible because you may be paying a lot of interest. There are non-profit organizations that can help you consolidate your credit card debt, and even negotiate a lower interest rate for you. You may need to do some research on this. After you calculate your income, your fixed and variable expenses, you will come up with your "Net Cash Flow" - how much money you have "flowing" in and out.
2) You may want to make a "future budget" based on what you expect to be earning in the near future - do you have a new job on the horizon (some people actually are getting new jobs); is there a raise in the future? Other than that, the process is the same. But it gives you something on which to set goals for future saving and spending.
3) Calculate your Net Worth. When couple's know how much they are actually worth, it becomes more real to them. That is, when one partner says "you can't buy that because we can't afford it," often times the other partner doesn't really have a grasp of what is or isn't affordable; and sometimes the "saver" doesn't realize that something’s are more affordable than they thought. To calculate your net worth, take into consideration your "liquid assets" - money you can get your hands on right now without having to sell property, like bank accounts, cash on hand (maybe you keep a stash of cash in the house for emergencies?) and anything else that can be converted to cash now. Other assets include stocks and bonds, mutual funds, your home, your cars, collectibles, furnishings, the family silver, and perhaps money that is owed to you. You might have IRA's or 401K plans, or life insurance. These are "Other Assets" that you don't want to cash in unless it is an extreme emergency; there are large penalties for withdrawing money from retirement accounts early. Add up all the assets, and then determine your current liabilities and debts. These consist of credit card debt, personal loans you owe, mortgages, college loans, bank loans, anything else that is a loan or a payment you make on a regular basis. Perhaps there are medical bills owning; these are liabilities. When you subtract our total debt from your total assets, you will have your net worth. It may not be as bad as you think - but that isn't an excuse to spend it all!
4) Set financial goals. You should each write down what you would like to be able to do, how high or low the priority is, and how much time you want to take to reach the goal. Do you want to take a cruise somewhere? That might be a goal. Do you want to retire by a certain age? That is a goal. Write down what you would like to buy. Do you want - or need - a newer car? What is the priority? How much time do you want to take to reach that goal? Then get together and compare your lists. Rank your goals from highest to lowest. See what you have in common, then decide together what you need to do to reach a goal. Do you need to reduce monthly spending? Eat out less? Or do you want to be able to eat out at least once a week? Create a spending plan. What can each of you contribute towards your common goals?
5) Take a look at your "money personalities." This is a little harder. Share how your families handled money and what the attitude about it was when you were growing up. Did you father pay the bills and give your mother an allowance? Did it work in the reverse? Did you get an allowance when you were younger? Or did your parents just give you money whenever you asked? What conclusions did you reach about money as a child, given how it was handled? What money habits would you like to change in your current relationship? Who is the saver and who is the spender? How can you meet in the middle? Were you aware, as a child of financial conflicts at home? How were they handled? How you and your partner like to resolve financial conflicts in your relationship?
6) Goals and Motivations. What do you want, and why do you want it? Do you want a bigger house? Why? Do you need more room, or will your friends be impressed? Do you have obligations you need to save for - a college education for your children, perhaps? Why is that important to you - so you will feel like a more responsible parent, or so you will be able to say your child when to an exclusive college? What is the reason?
7) Assess your Financial Well-being. What do you feel is your level of financial stress now, from 1 - 10? How satisfied are you with your financial situation today? How do you feel about your current financial condition? How often do you worry about being able to meet normal monthly living expenses? How confident are you that you could find the money to pay for a financial emergency if it is over $1000.00?How often do you find you want to do something, like go out to eat but can't afford it? All the time? A few times a month? Never? How frequently does it feel like you are living paycheck to paycheck? You and your partner can discuss these issues and come up with a plan to ease the stress on one or each of you. If your net worth is better than you thought, take a look at that and see if helps ease some of the stress.
Money can be a very emotional issue. We learn to handle money from our parents, and if we grew up very poor, we either tend to hang on to every cent and want to not spend any of it, or if we are very comfortable and have enough, we become "big spenders" to make up for the perceived deprivation we suffered as a child. Whatever your experience was, it may be time to take a realistic look at what it is, and can be, now. If you and your partner find that you cannot discuss these issues without it leading to a fight, a good therapist, with training in this area, can help you work through these issues, as can a good financial planner if that better meets your needs.
Resolutions
Do you make New Year Resolutions? I don't; I gave up years ago because I never followed through with them. One year my husband resolved to floss his teeth daily, and he stuck to it. That's one of the differences between us - he makes up his mind to do something, and he does it. I can't seem to make up my mind to begin with. But with age comes wisdom, and this year I have some resolutions. One is to get healthy. I've been recovering from major back surgery, and finding out that it is going to be a long road back to health. And I determined to get there, for a variety of reasons, which I discuss below.
I am on a couple of professional listserves - internet discussions that are dedicated to specific topics. One of them is the Dissociative Disorders Listserve, and there has been a rather long discussion about dependency in clients, and how not to foster that. (As therapists, we want our clients to be independent, and learn that they can handle things - like crises - on their own; that they have the capability to function in the world without having to check everything out with someone else). It has been interesting for me to read it, especially as a few of the members have discussed their own physical dependency on others due to some medical reason. Those really struck home with me, as I have been recovering from back surgery for the past six or seven weeks (I lose track of the time somehow) and have learned what it is like to be dependent on others for some very simple things. For instance, I have been given doctor's orders not to bend. That means if I drop something, I can't bend down to pick it up, and I have to ask someone to do it for me. I can't lift things, which means I haven't been able to pick up my one-year old grandson; I can only let my daughter place him in my lap (of course, he's walking now so he'd much rather be running around than sitting still with me...); I haven't done much cooking because standing at the stove and moving about the kitchen still causes pain, so I depend on my husband or my other daughter who is home on winter break to prepare meals and bring them to me. I can't empty the dishwasher or get pots and pans from the lower cabinets. I can't put things away and I have to wait for someone to do that, too.
I have been walking with a cane to avoid a limp I developed following the surgery (which I am assured will pass with physical therapy), and I am moving a lot slower than I am accustomed to moving. I have to ask my husband to get a new roll of toilet paper for me, because I can't bend down to access the cabinet where we keep it. The simplest things that I took for granted I have learned to treat with a new respect. Going up steps, I must go one at a time, being sure to use my stronger leg first. A couple of times I got involved in something and forgot I am not supposed to squat down, either, and I quickly learned why: it was extremely difficult to get myself back up from that squatting position. I can't put DVD's in the DVD player, because to reach it, I have to bend down. So if I want to watch a DVD, I have to wait until someone is around to put it in for me. Like I said, the simplist things.... (You are probably wondering why we don't just place the DVD player higher up.... because there's no room for it anywhere other than on the lowest shelf of the TV stand!)
Sitting in the car for too long is uncomfortable; I have to limit my trips away from home, and recently at the market I had to ask a gentleman in the aisle to pick up something for me from the bottom shelf. If I drop something in the market, I would normally pick it up. Now, if I am alone and there is no one around, I have to leave it there, and that's very hard for me to do. There is a point to all of this, really. Just bear with me.
When I first got home from the hospital following my surgery, my husband would hover nearby when I showered just in case I needed anything. I am fortunate to have someone loving and caring to help me with some very personal tasks, like bathing, and I have sympathy for those who are disabled and don't have family to care for them.
This whole experience has taught me something about being dependent and being independent. For one thing, I am fiercely independent - it's just my nature. I am a not a great employee because I don't like taking orders or being told what to do. It is not easy for me to ask for help. So it's made me think about what will happen when I get old; old like in my 70's or 80's or more (my family has a history of longevity, with most of my relatives living well into their 90's). What will happen when I am truly old (whatever we consider old now days - my parents are 83 and 93 and still live in their own home with no help other than what we can force on them) and need help? What if I outlive my husband (which I will probably do as women tend to outlive men generally, and I'm already a year older than he is), and I don't want to burden my children with my care? Will I someday need the care of a non-family member? Who will ever care for me the way a family member would? No one. The idea scares me. I have strengthened my resolve to get my body back - to get in shape when I am finally able to start physical therapy, and to maintain it. I don't want to be in a wheelchair, or need a walker, or depend on someone else to do the simplest of tasks for me - like picking something up, preparing a simple meal or washing myself.
I have to say that the thought of languishing in a nursing home scares the you-know-what out of me. Laying in a bed day after day, being at the mercy of low-paid care givers who may or may not truly care what they do and how they do it. (Please don't misunderstand this; I've know some wonderful caregivers who truly love their work and care greatly for the people they take care of). So I've decided that the only person who can help me is me. And the best way I can do that is to take care of this body I have now, and keep it well-functioning. I'm not quite sure how I'll do that, other than trying to eat right and exercising, but I'm going to do my darnedest!
The other piece of all of this, of course, is mental healh and well-being. It can get very depressing when you can't do things for yourself. I can see how and why dependent adults - many in nursing homes or assisted living facilities - get depressed. Many are just waiting to live out their lives, waiting until death comes and claims them. Many are in pain from various ailments, and are unable to do much about it, other than take medication and hope someone will come along at the right time to give them relief. It's hard to keep your spirits up when you are lying in a bed day after day, waiting for death. It's better when someone in that situation can engage in some sort of activitiy with other people, something that engages the mind and the body. Much of this is attitude. My father in law is 95, lives in an assisted living facility near us (so we see him at least weekly), and is in a wheel chair. He has been a widower for 8 years. He is sharp as a tack, and he never complains. He just gets on with the daily task of living. I admire that. I admire that my parents are able to be on their own at their ages, and are able to ask for help when they need it, and accept it even if they don't ask. I want to be one of those "old people" who people like to visit and be around. I don't want to be one of the ones who complains and moans about every little ache and pain. And most of all, I want to be able to take care of myself for as long as I can.
So I hereby resolve, in writing on the world wide web for any and all to read, to get healthy in 2009 and to stay that way as long as humanly possible!
Relationships and the Economic Crunch
In some couples, the "breadwinner", whether it is the man or the woman (I do not intend to exclude same-sex couples, it's just easier to speak of a man and a woman than to put all of it in throughout my article, so please bear with me) is worried and anxious as they see more money going out than coming in, especially if the outgoing is on items that are not a necessity - like a new dress or new golf clubs, or a new purse... so many things people want that they can't live without.... but that's another article.
And people are angry. Most of us are angry at the big guys on Wall Street who drove their companies into the ground, and walked away with millions of dollars, and seem to be getting away with it (gee, do you think maybe I'm a little angry, too?) When financial burdens - and anger towards those responsible - are added to the stress of relationships, couples may start to argue more, agree less and generally feel the relationship is near an end, or that it just isn't working out.
As I have told many of my clients, good relationships are work, and the work isn't just in the beginning, or the middle or the end - it's an ongoing process of give and take, listening and hearing, compromise and putting someone else first besides yourself. You might think that in a marriage, of course you put your spouse first! But this is often not the case, and people get angry and begin to place blame on their partner. "If you hadn't bought that new car last year, we wouldn't be in this mess now..." "If you had taken a better job, we'd have more money saved..." The list of accusations that I have heard in my office is endless.
Psychotherapy is a "service industry" - you pay a fee for a service, like maybe a gardener or a housekeeper or a window washer a few times a year. If you go to therapy, you are paying for each session as a service. In times like this when money is tight, and people are trying to figure out what to cut out of their expenses, they often drop therapy.
However, marriage counseling - or therapy, whatever you want to call it - can be extremely helpful in times like these. An independent third party who doesn't take sides and won't make judgments may be the best person to help you with your financial issues.
For example, I just took a wonderful course for therapists called "Money 1to1", which gave me the tools to help couples adjust their expectations about money, learn how to talk about money, learn to balance a budget and know what they are spending on (cash flow), learn to set aside money for the things they want (versus the things they need); how to prioritize what is most important to spend on and when to save. While I am not a financial expert and do not give financial advice or tell you what to do with your money, I can help you learn to talk about investing, retirement and even tax issues. We do this together by narrowing down what the real issues you are struggling with are and then come up with a plan for how I can help you work it out together in the shortest possible time frame.
You may be thinking "That's one more thing for me to be spending money on..." but it's really an investment in your future, and the future of your relationship. At the end, you should walk away with a better understanding of financial matters and a plan addressing what to do with your money.
Remembering Your Past: Why is it Important?
I have always been interested in the brain. One of the reasons many therapists become therapists is because of their fascination with the small organ that sits inside our skull. How can we have memory? How do we feel emotions? What is the mind? It isn't something physical you can see. If you opened your skull, you would see the brain, but where in all of that is the mind, your memories, your emotions? These are not things one can see with the naked eye, but we know they're there, because we remember things, we feel feelings... happy, sad, guilt, shame, joy and of course much, much more. So let's take a look at how neuroscientists say it works.
The brain is composed of neurons - nerve cells that transmit information to other neurons and then to various parts of the body - and glial cells, which provide structural support, regulate the Central Nervous System (CNS) and regulate the biochemical balance of the brain. When something happens to you - when you experience anything at all, whether emotionally or physically, neurons "fire" or become activated. A group of neurons fire together, and become in a sense "wired" together ("Neurons that fire together, wire together"). Each time you have the same experience (or something reminds your brain of the experience even if you are not consciously aware of it) the same neuronal bundle fires. When it fires over and over, it becomes stronger and stronger. This applies to the physical feelings and emotions associated with the experience. Let's say your mom or grandmother baked apple pie on a regular basis, and it was really good. You'd come home and smell the pie baking, and the neurons in your brain that are responsible for your sense of smell would fire. But other neurons also fired - the place where your memories are stored and regulated - the amygdala - and your hippocampus, where short term memories are processed, would also fire, and you brain began to build the neural network associated with the smell of apple pie baking in the kitchen. If your home was a happy place to be, and the smell of pie baking meant Mom was happy, and the whole family would have dinner and everyone got along, you would come to associate the smell of apple pie baking with positive feelings and good times. But if Mom only baked apply pie after she and Dad maybe had a fight, and if meal time with the family was more of a negative experience, like you were criticized for everything you did or said, or were always being questioned about everything, or if the family fought at the dinner table, the smell of apple pie might have a negative meaning for you, and whenever you smell it now, maybe you get slightly sick to your stomach, or you have a feeling of needing to flee or you get a headache, etc. You may not even remember why the smell of apple pie makes you sick, but it's associated with a bad feeling, so you try to avoid being around apple pie.
Our brains have evolved over time to be social organs, and therefore are affected by other brains - like the person you are talking to or the people you grew up with. We have some special neurons called "mirror neurons" that fire when the brain observes someone else doing something. This is one way babies learn - they see mom or dad smile, and their mirror neurons "mirror" back that smile, and the baby smiles - and at 2 or 3 months of age, and baby doesn't think "I'm going to smile now..."; he just smiles. There are times when the mirror neurons fire but the baby isn't yet capable of doing whatever it is she is seeing, but at some point, the fact that these mirror neurons in the baby's brain fired, he will be able to learn how to do them, without really thinking about it - like feeding himself, or walking, or speaking. Another way to put this is that mirror neurons connect observations and actions. We see, we observe, we act (or react). The other thing our mirrors neurons have allowed us a species to do is to be able to learn to read other people - to anticipate and predict their actions, and to activate appropriate emotional responses to them - empathy, support, emotional resonance (what the person is feeling may resonate with us because we've had that same feeling or experience. This is one reason support groups work). Being able to read the other members of our group is also a survival skill left over from prehistoric days when survival depended on being able to sense danger before it actually happened. If you watch a small child in a new environment, you will see her look at her parent's reaction before she reacts herself. If Mom or Dad is okay, then it must be okay. If Mom or Dad are upset or scared, it must not be safe. Mirror neurons help us learn to do this.
Sometimes the response is inappropriate because it is really an old emotion or feeling being triggered by neural networks that were strengthened in childhood. For example, a couple who are having communication difficulties may be having them because every time the wife tells the husband how she wants something done, it triggers his mother or father, and before he can even think about it, his brain is giving him an old message that he isn't capable or smart enough or competent; whatever the childhood message was. In turn, when the wife tries to do something like pay the bills, and if her husband always gets involved in the process, really just trying to help, it may trigger something from her childhood - like whenever she tried to do something on her own, her parent would take over, saying "No, do it this way...." The message might be "You're doing it wrong; you can't do anything right." But I've gotten off-track here. Let me back up a little.
The brain is basically composed of three main sections - the brain stem, which is located at the very base of the skull and leads into the spinal canal. (For a good "tutorial" on the brain, go to http://www.stanford.edu/group/hopes/basics/braintut/ab0.html if the link doesn't work, copy and paste into your browser). The brain stem regulates the things your body does that you don't have to think about - breathing, heart rate, digestion and so on. The midbrain, or reptilian brain, so called because it is the part of the brain we share with other animal species, like lizards. This part of the brain contains the amygdala and the hippocampus - very important structures when we talk about feeling and reacting to things. This part of the brain (the amygdala) may begin to work, or "come on-line" shortly before birth. The amygdala regulates emotions, holds our memories and tells us when the environment is safe and when it is not. It is responsible for our "fight or flight" response and tells other parts of the brain when to release adrenalin to prepare us for one of these two actions, and it also releases other stress hormones and chemicals. The reptilian brain is also responsible for our reproduction urges and sexual responses, and for learning. This part of the brain is also sometimes referred to as the "Old Mammal" brain because there other structures here that we have in common with lower mammals (like monkeys and chimpanzees).
On top of these two parts of the brain, behind your eyes and your forehead, is the "New Mammal" brain, also called the neo-mammalian brain, or cortex (which can be divided up into yet more sections). This part of the brain is responsible for conscious thought, reasoning, self-awareness type of activities.
Now, what's important here is that your cortex isn't always aware of what the reptilian brain is "thinking," or doing. Because the reptilian brain is responsible for survival, and the need to quickly assess if the environment is safe or dangerous, the neurons here fire much faster than the neurons in the cortex. Animals in the wild have to be tough and fast to survive. A zebra sees a lion, and doesn't stop to think about it; the reptilian brain just gets activated and says "Run!" and the zebra runs. The neurons in the amygdala, located in the reptilian brain, can react to a trigger in less than 100 milliseconds. Can you even conceive of 100 milliseconds? I can't. Our cortex, on the other hand, takes time to process and think, and register an experience into conscious awareness. This takes 500 - 600 milliseconds or 5 to 6 times longer than our reptilian brain takes to fire those neurons. What this means is that by the time we become consciously aware of an experience, a feeling or a reaction, it's already been processed and reprocessed in the reptilian brain, activating memories and old neuronal networks are being triggered by past learning and experiences. We may think we are making a conscious choice, but our conscious awareness is actually 90 percent influenced by what's already happened in the reptilian brain. Because so much processing takes place in the unconscious, it can cause distortion in how we perceive things - like the motives of other people around us - which triggers the old childhood stuff. The unconscious processing might cause us to remain distant, withdrawn, mistrustful or confused without even knowing why.
The man or woman who can't commit to another person, as much as they want to, are being influenced by their unconscious processing. Maybe there was a past experience they don't even remember - mom and dad fighting, an early molestation or abandonment by a parent; it might even be an experience from the first year of life, before our cortex is even formed. In fact, the cortex, the higher functioning part of the brain, continues to develop into our 20's. This is one reason teenagers and younger children have poor impulse control - the part of the brain that helps to control impulses (by thinking) simply hasn't developed completely. (So when you ask your child or teen, "what were you thinking" when they did that stupid thing, the reality is they weren't because their brain hasn't developed to the point where they can think about all the consequences. But the good news is, they can learn to think about that...)
The way our parents - mostly the main caretaker - treated us and did or didn't meet our needs in those first few years can become an automatic response in the reptilian brain, and shape our conscious experience of other people which in turn activates those 100 millisecond systems which leads us to either seek closeness, avoid it, or avoid it when someone gets too close: "Come closer; no you're too close; go away; don't leave me" is one schema that people act out over and over again when they get into an intimate relationship, but don't understand why.
When one examines their memories from their childhood, teen and college years with conscious awareness, it makes the unconscious conscious. They begin to associate current previously unexplained feelings with events that occurred long, long ago and by doing so, and consciously talking about it in the present with, as I said above, an empathic listener, the old neural networks somehow begin to rewire themselves, or new connections are formed and old triggers become less and less triggering. For some people, this can happen quickly over few months time. For others, it can take longer. It largely depends on the individual, how open they are to exploring where their feelings come from, and whether or not they have had traumatic experiences in their past.
If old trauma is uncovered, or triggers identified, or if there is an awareness of a trigger but the individual can't identify where it comes from, in addition to talk therapy, EMDR, Brainspotting or hypnosis can be helpful.
Laugher Can Be the Best Medicine
So, I was lying there and watching some rerun of a television show and there was scene that was so funny I laughed out loud. I immediately began to feel better. Why is that? What happens in the brain and body when we laugh? And is it true that laughter can heal? Norman Cousins, the author, was diagnosed with ALS - Lou Gehrigs Disease - and watched nothing but Marx Brother's films. He reported that watching 10 minutes of these films provided him with up to 2 hours of "pain free sleep." He also credited "faith, hope and love" with helping to cure him, along with massive doses of vitamin C. Today there are many who believe that Cousins didn't actually reverse a crippling and terminal disease, but that he was misdiagnosed from the beginning and that he actually had a type of arthritis.
So how does laughter help us to feel better, and can it reverse illness? For one thing, laughter releases endorphins into the body - our own natural pain killers. Studies have shown that laughing lowers blood pressure, reduces stress hormones, increases muscle flexion, and boosts immune function by raising levels of infection-fighting T-cells, disease-fighting proteins called Gamma-interferon and B-cells, which produce disease-destroying antibodies.Research results indicate that, after exposure to humor, there is a general increase in activity within the immune system, including:
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An increase in the number and activity level of natural killer cells that attack viral infected cells and some types of cancer and tumor cells. |
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An increase in activated T cells (T lymphocytes). There are many T cells that await activation. Laughter appears to tell the immune system to "turn it up a notch." |
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An increase in the antibody IgA (immunoglobulin A), which fights upper respiratory tract insults and infections. |
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An increase in gamma interferon, which tells various components of the immune system to "turn on." |
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An increase in IgB, the immunoglobulin produced in the greatest quantity in body, as well as an increase in Complement 3, which helps antibodies to pierce dysfunctional or infected cells. The increase in both substances was not only present while subjects watched a humor video; there also was a lingering effect that continued to show increased levels the next day. |
Laughter is good for your heart, because it causes the blood vessels to dilate enabling more blood to get to the heart.
Laughter provides aerobic activity, increasing the quality of oxygen taken in and giving the diaphragm a workout.
But what about the mental health benefits? Laughter reduces stress and relieves tension, reduces anxiety, anger and depression, increases an optimistic outlook and mood and tends to give people who laugh a lot a better sense of control. Of course, there are people who use humor and laughter to cover up deeper emotions, or to evade an issue. It can be frustrating if you are trying to have a serious conversation with someone who keeps making jokes - especially if you feel they are at your own expense.
There are now therapeutic techniques that involve laughter - "Laugh Therapy" may be the next big wave in psychotherapy. Think about it - most people go to therapy and naturally, the focus is on what is wrong with their life. What if instead of doing that, you went to a therapist who encouraged you to laugh out loud more? Will your problems disappear? Probably not, but you might find having a sense of humor about your problems makes them easier to deal with. Laughter is another way the body has to release emotions, just as crying and physical movement are releases. Some people deal with stress and tension by exercising. They feel better after, and their stress levels are lowered. Just as I explained that laughter releases endorphins, so does exercise. Laughter and humor are two different things. Laughter is a purely physiological process. Babies begin to laugh somewhere between 1 and 3 months, and they are not considering whether or not something is humorous! Laughter is a natural, physiological process and helps us cope with pain and relaxes us, renews our energy and in addition to the above mentioned physical benefits, it also massages our internal organs by increasing our circulation.
In my psychotherapy practice, I find that many people cannot allow themselves to cry - but they can laugh. Many of us learned at an early age that crying is not okay: "Big boys don't cry. Be a big girl; don't cry. Don't let mommy see you crying - you'll upset her. Don't cry in public; people will be uncomfortable" and the list can go on and on. But most of us were not told that laughter was a bad thing. People find it easier to laugh than to cry, and good out loud belly laughing is, as I said, a release.
Laughter does not change the facts of one's life, or people's histories of abuse and other damage. But it can help one to have a brighter outlook, and to view life on the more positive side. Laughter in therapy doesn't take away the focus from the issues that brings people in, and encouraging people to look at the lighter side is not by any means meant to invalidate traumatic histories or emotions and feelings that the client expresses. When people are constricted and fear is a part of how they live, laughter can provide a different frame of reference from which they view life. Using laughter in therapy is encouraging the client to look differently at things, to let go and release pain. Often, "making" others laugh can be about control. Just as I don't want to make people cry or discuss trauma they are not ready to discuss, it is not my intent to make people laugh. My intent is to encourage laughter, and to show people the benefits that result from laughing more often and out loud.
For people who have a history of abuse, chronic pain and illness and depression, focusing on the negatives too much doesn't lead to recovery. It leads to perpetuation of the fear associated with abuse, exacerbation of pain, and deepening of depression. Finding something to laugh about - and creating something to laugh about - leads to recovery. So find something funny. Rent a slapstick comedy, read a book that has humor in it - real, laugh out loud humor. Share jokes with family and friends; go to a comedy performance, watch the comedy channel on t.v. If you find yourself in a place with it all looks gloomy and negative, ask yourself how is it helping you to obsess on the negative? Try distracting you self with something funny; see if you don't feel better after a few minutes of good, honest laughter. Then call me and let me know how it worked!
Money and Relationships
In our culture, money represents a lot - mostly it represents how good we are. How successful, how smart, how powerful, how dependent or how independent we can be, or how desirable we are to others. Money can destroy relationships and families - "never do business with a friend or relative. Never loan money to a friend or a relative" are admonitions most adults have heard at one time or another because doing so can destroy the friendship or the relationship with a family member forever. As individuals our relationship with money is most often influenced by how our parents handled - or didn't handle - money. When I was growing up, my father earned the money and my mother handled it - she paid the bills, wrote the checks, made the household purchases and was basically in charge of the But the major spending decision were made together. Most of us are influenced in our ways with money by what our parents did. We either follow their example, or do the exact opposite - people who grew up poor and are now comfortable may hoard every extra dime, thinking that there won't be anything there when they need it, or were so put off by being poor they spend more than they can afford and end up in debt because they have strong feelings about what it was like to grow up poor. They may over-indulge their children to make up for having done without when they were young. There can be a balance, however, between going without and having to buy everything one sees. I know one man who buys toys for himself - actual toys - because when he was a child his parents couldn't afford much, and he went without a lot, including toys.
Men and women in our society often have very different views of money based on societal norms and stereotypes, although that is changing as women become more and more equal with men, especially in the business world. However, women often not paid as much as men for the same jobs (about 77 cents per one dollar a man might make). For many men having a female superior in the workplace, especially one who makes more money, can be a difficult issue. Many women feel guilty about making more than their husbands, and many men struggle with feelings of inadequacy when their wives make more. Women often feel they make more sacrifices to work outside the home - such as time with their children - and many men feel that they have no choice but to work at a job they don't necessarily like because of the need to support a family and some come to resent the partner they support.
In most couples, there is usually one person who handles the money. There is more often than not a "spender" and a "saver." This does not always align along genders or sex roles. Men often underestimate their wife's interest in investing or in having financial security for later in life, and men are usually less likely to want save for retirement. Men are also more apt to spend money for entertainment, like big-screen t.v.'s or tools or "toys" and women are more likely to want to spend more for a things like a luxury vacation, expensive clothing and household items. But when it comes to investing, even though more women are doing it today, as a rule they feel less confident in their abilities to invest than men do, and men are more likely to take bigger risks in the investments they choose, and often think they know more about money matters than women do.
When it comes to looking for a partner, women place a higher value on their prospective mate's financial success than men do. Part of this may come from the fact that historically men worked and women stayed home to raise the family. This may be an unconscious - or maybe conscious - need for the female of the species to find a good provider, just as our ancient female ancestors (think days of living in caves) were more attracted to males who had good hunting ability. For hundreds of years, a woman's entire security depended on how much money her husband could bring home to provide for her and her children, just as her ancient female ancestors depended on a strong hunter to provide food for his family.
Women still look for strong providers and tell their daughters to "marry a man who can support you in a way that you'll still have choices" when it comes to raising children and being a full-time mom. Parents want their daughters to have choices; parents assume their sons will provide for their own families some day. We still look upon grown sons as how well they have succeeded in the workplace and how good a provider they are, and when our daughter's are dating or getting married we ask "What does he do?" (I recall when my husband and I decided to marry, people would ask me that same question and when I told them his profession, they were pleased that I had "done so well" to attract a professional man. I remember thinking, "What if I told them he was a gravedigger? Would they be as happy for me?" Probably not! My worth was measured by my husband's earning power.)
Money and sex in a relationship are closely aligned. "She won't give me enough sex; He won't give enough money." It is not unusual for women to withhold sex and for men to withhold money - but it is often unconscious that this is what they are actually doing. Men may use money in the relationship to be in a position of power. "I give you everything you have; you own it all to me" and so on. Many women "hide" money feeling it is necessary to have something of their own stashed away, "just in case... Just in case I get mad and leave you, just in case something happens to you and I'm not taken care of, just in case..." I often hear men complain about not having enough sex, and women feeling like she "has to" have sex with her husband because he pays for everything and "expects" it; in a way, these women feel like they are prostituting themselves. "You support me and take care of me, I'll take care of you - sexually."
When people make a life-long commitment to be together, as in marriage, they are committing to more than just fidelity. They are becoming partners in life - and everything that happens along the way. Two people promise to love and honor each other; to be true to each other and to share everything - "in sickness and in health" is usually somewhere in the vows. Usually in the vows, there is often a promise to share all their worldly goods with each other. So when I see couples who keep their money separate, I usually find out that there are trust issues. Some women don't know how much their husbands actually earn; some husbands insist that whatever they had before the marriage should remain separate. I remember one couple where the wife didn't have access to all of their bank accounts because her husband was afraid if she did, she would spend everything they had. She had earned "her own" income and now was disabled and unable to work; she was angry that the income her husband had been earning through all of their marriage was kept from her. She trusted him to manage her income as well, and turned it over to him while she was working, and now she was totally dependent on him to support her. Because he wouldn't share information about their financial status, she felt like a child. This was not the presenting issue that brought them to therapy, but it ended up being the issue most often talked about. This was about trust. He wasn't able to trust that this woman he committed to share his life with and had a child with would honor his feelings about their financial status, and therefore he kept "his" money from her, to be doled out in a "household allowance." No wonder she felt like she was being treated as a child!
In many marriages today, husbands and wives keep their money separate - he has an account into which he puts his income; she has an account into which she puts hers. They usually share the responsibility for paying bills. One complaint I often hear is "He makes more than me, but we share all the expenses 50 - 50; that isn't fair. He makes more; he should pay more." Then the person who makes more often has a reason that it is fair - to them. In families where it is a second marriage and one partner brings children into the family it makes sense that a new spouse may not want to have to pay for someone else's child. This is something that should be worked out before hand. However, when one weds someone who has children, ideally they accept that they are also taking on that responsibility - to co parent, to be a role model for the child, to be emotionally available to them - and perhaps in many cases, to also take on the financial responsibility for that child, depending on circumstances (is there another parent contributing to child support, for instance?).
It seems like I've been rambling on and on and you're probably wondering by now, so what's her point? Well, here it is: money in a relationship speaks to intimacy and true partnership. I don't mean sexual intimacy - I mean how close are two people really? If partners don't share ALL of their resources, what else are they not sharing? What feelings are not being shared? What resentments are building up? What secrets are being kept, that if discovered could tear apart the marriage? If two people come together to share their lives with each other, in my humble opinion, that means sharing all of it - the good, the bad, the hardships, the joys, the good times and the heartaches; standing by each other through thick and thin; through illnesses, losses and times of emotional upheaval. Of course every relationship is different and partners need to discuss these things and come to mutual agreement. For some people having separate bank accounts, splitting the expenses and not disclosing everything may work. For many, it doesn't. In my experience with couples in therapy, it is very rare that one partner doesn't begin to have difficulties with this arrangement at some time or another. And as I said, how intimate are two people when one is keeping something from the other, be it feelings, dreams and aspirations, or money?
"But What if I Can't be Hypnotized..."
Last week a gentleman called looking for a therapist for his wife who has IBS - Irritable Bowel Syndrome. He found my name on the IBSHypnosis.com website. We talked for a bit, I answered his questions to the best of my ability, and his wife followed up with a call a little bit later. She had been suffering with IBS for a few years, had been to dozens of doctors, tried several medications and some alternative treatments, including "colon cleansing," or colon irrigation - another term for enemas. But that's a whole other blog...
The first thing the caller said regarding hypnosis was "I don't think I can be hypnotized." The truth about hypnosis is that if you let yourself, anyone can be hypnotized. Hypnosis is nothing more than a very deep state of relaxation. We all spend some of our awake time in a hypnotic trance - like when you're driving on the freeway and you're so "entranced" that you miss your exit, or you're doing things that you do everyday on automatic - like brushing your teeth - sometimes you can't remember if you did them. Your mind is elsewhere; in effect, you are in a trance. The best definition I once read was: "Hypnosis is a natural psychophysiological state of aroused, attentive and receptive focal concentration with a corresponding relative suspension of peripheral awareness." (H. Spiegel and Spiegel, 1987, in Trauma, Dissociation and Hypnotizability by Maldonado and Spiegel, 1998)
The next question the caller asked was: "How will I know what you're doing?" Most people are aware of what is going on around them while in a trance. If you are in a therapeutic hypnosis session, you will usually know what the therapist is doing because you will hear them. You will hear what they are saying, hear them moving around the room, hear their voice if it is closer or further from you, etc. Then she asked me, "What is it like - will I just go to sleep and the next thing I know wake up?" That part is very individual. Again, most people remember everything. And hypnosis is different from sleep in several ways. The therapist can even give you a suggestion to remember everything - or not. There is a very small percentage of the population that will be amnesic for the period that they were in a trance - but this is very unusual. Of course, if you don't want to remember anything, you probably won't...
Trust for the therapist is a very important part of hypnosis. I will never use hypnosis with a client in a first session for example. For one thing, the chances of a successful outcome are probably nil. (There are always exceptions to every rule, and there is nothing is always 100%...) Second, I need to get information, history, assess the client and the usual therapeutic stuff we do in therapy. But most importantly, the client needs to feel comfortable and be able to trust the therapist in order to relax enough and let go of control enough to enter a trance. I'm sure there are therapists and lay hypnotists (people who practice hypnosis but are not licensed therapists) who will do hypnosis in a first session. And that is their prerogative.
Some people are great subjects for hypnosis - they are what we call "suggestible." Some people resist hypnosis, and find that they either can't get relaxed enough to allow themselves to go into a trance, or it's a control issue or a trust issue. If the trust isn't there, or the "chemistry" between the therapist and the client isn't right, it just isn't going to happen.
There are many common myths about hypnosis, and there are many questions I have not discussed here. Stage hypnosis is not "real" therapeutic hypnosis, and in my humble opinion, it gives hypnosis a bad name, frightens people who may otherwise benefit from pursuing therapeutic hypnosis because they think they may be made to quack like a duck, and misleads the public. Hypnotists who do stage hypnosis owe it to the profession and the public to use the opportunity to educate people about hypnosis and the good it can do.
I invite you to visit my website for more about hypnosis, please see the Services page on my website, or the Association for Clinical Hypnosis at www.asch.net.
Should You Use Insurance to Pay for Psychotherapy?
However, when it comes to using insurance for Mental Health benefits, are you aware of how the insurance companies use the information that MUST be disclosed by your therapist? Not many people are. Are you aware of the information that your therapist MUST submit to the insurance company in order to be paid?
Your therapist is required to submit a diagnosis. Just as when you visit your medical doctor and he or she submits a bill to you health insurance company they are required to submit a diagnosis. Many insurance companies no longer cover routine preventative medical visits, such as a yearly physical, or a flu shot. Therefore, in order to be paid by insurance or for you to reimbursed, you doctor may put down something like “Sinusitis,” or “Headaches” or something relatively minor, just so there is a diagnosis. Most of these ailments plague most people at one time or another and they are pretty harmless diagnoses.
When it comes to mental health, however, many diagnoses, once made, remain on your medical history forever. Some diagnoses are considered more serious – such as Major Depressive Disorder, Bipolar Disorder, eating disorders, Panic Disorder and some schizophrenic disorders. In California, the law says that insurance companies must treat the above diagnoses the same way they treat any medical diagnosis, and must reimbursed them at the same rate. However, most mental health diagnoses, such as Generalized Anxiety Disorder, or other mood disorders, or perhaps even Post Traumatic Stress Disorder are considered “non-severe” and may not be reimbursed at all, or maybe be reimbursed at a very low rate - maybe as low as $25.00 per visit.
Regardless of your diagnosis, if at anytime in the future, you are in a position where you are trying to obtain an individual health insurance policy, or even life insurance, you will be asked if you were ever treated for a mental health issue, or a mental illness. If you have ever had any type of mental health diagnoses, you must indicate this on your application and this can be the basis for denying your application, even if your treatment was 20 or more years earlier.
In addition to telling your insurance company your diagnosis, your therapist may be asked to submit treatment plans, the number of sessions you have had and the number of sessions your therapist expects you have in the future. These are things that should be decided between you and your therapist, not by an anonymous case manager who doesn’t know anything about you or who you are. Each client should be treated as an individual, and therapy should be determined on an individual need, not on an arbitrary number determined by profit and loss of the insurance company.
Most insurance plans have the right to “audit” their contracted provider’s files with little notice. This means that someone from your health insurance company can come into your therapist’s office and read your case file. Again, no one should be reading what is in your file except your therapist and anyone you give express permission to. When you use your health insurance, you are granting them permission to obtain all of this very personal information simply by using your benefits for coverage. When you use insurance, your permission for them to read your file is implied and does not need to be expressly given by you.
If however, you pay for your therapy sessions out of pocket, everything regarding your treatment remains as it should – strictly confidential between you and your therapist. No one needs to ever know you were in therapy unless you tell them, or again, give express consent for your therapist to do so, in writing. And even a consent you give in writing to your therapist can be revoked by you at any time. Not so with the insurance company.
The decision whether or not to use your insurance for your therapy is not just a financial issue; it is also a privacy issue. This is a decision you should consider carefully. We are all aware of the expense of therapy. But rather than think of psychotherapy as an expense, try thinking of it as an investment in yourself and in the quality of your life, now and for your future.
Treating Trauma
Just the other day I had a conversation with someone who was asking me these very questions. I was asked, on the phone, "What will you do to help me?" Not having met the person face to face, I could not commit to a specific treatment modality, but I understood the need to ask and the desire to know before investing the time and money in starting therapy.
What I truly believe is that in any good therapy is that the treatment modality, while important, is less important than the fit between therapist and client, and the relationship that is built between the two. The real healing, in my humble opinion, is in the therapeutic relationship. Finding a therapist who you feel understands you, hears you and with whom you feel there is good "chemistry" is of utmost importance.
The same person I mentioned above asked me also, if there is a higher charge when I use EMDR, hypnosis, or another "treatment." The answer, of course, is no. EMDR, hypnosis, Brainspotting, etc. are all just treatment modalities - therapeutic tools. If you join a gym and pay a monthly fee, you don't pay more if you use certain equipment one time or another, or take one class or another - they are included in the price. In psychotherapy, you are paying the fee for service for the amount of time you are with the therapist. A 45 or 50 minute session will cost less than a 75 or 80 minute session (some therapists keep to 45 minutes; some to 50, and an extended session might be 75 or 80 minutes) but you are paying for the time, not the specific treatment used - at least, that's the way it's done in my practice and in those of my colleagues. But this is a separate issue and not the point of this article.
So how do I treat trauma? Let's look at a few different possibilities (some from actual cases, but the facts are changed to protect privacy):
Case One: Single Incident Trauma
A "single incident trauma" usually involves something that happened only once, such as a motor vehicle accident, a medical trauma, the loss or death of a loved one or perhaps witnessing a death or traumatic incident such as a natural disaster or accident. It might be something like being the victim of a crime, like a robbery, a home invasion or a rape. It might involve a family abuse incident that only happened once, like a one-time child abuse or domestic violence. These are all traumatic for the person who was the victim (more about the "victim" word in another article later...)
Let's take the case of a crime. A man was home alone when robbers broke in, tied him up and locked him in the bathroom. He heard them talking about him and thought they were going to kidnap him, take him to another location and kill him. The robbers left him where he was, however, but he was uncertain until another family member came home - hours later - found him tied up in the bathroom, untied him and called the police. This man also had a medical condition that was complicated by this incident. By the time he came to see me, the robbers had been caught (partly due to his description of them, and partly because they were sloppy) and the trial was approaching. He was experiencing nightmares, anxiety attacks, flashbacks to the crime and his health was being jeopardized. I met with him a few times and we determined between us that the best treatment would be EMDR. (For more on EMDR, please see my other article or see my website and go to the Services page and scroll down to EMDR.) In one session, we set up the protocol, and began to process by using auditory and tactile bilateral processing (again, please see more about EMDR on the website.) His SUDs (Subjective Units of Distress, measured on a scale of 0 -10) came down from a 9 to a 4 in the first session. In the second session, his SUDs had remained a 4 over the intervening week, and we picked up where we left off. We were able to bring his SUDs down to a 0 in the second session, and began to install his "positive cognition" (what he would like to be able to think about himself when he thinks about the incident). This is measured on a scale of 1 - 7, and is called the VOC scale - Validity of Cognition - where 1 is completely untrue, and 7 is completely true. Usually when we start out, the individual's VOC starts at a 1 or a 2, meaning they don't believe what they'd like to believe about them self when they think about the trauma is at all true. For most people, this usually increases to a 5 to a 7 in one session. That happened in this case. Sometimes a single incident trauma is the easiest to treat.
However, that isn't always true...
Case Two: Unconscious Memories of Trauma:
Let's look at the case of a teenager who suffered from anxiety attacks, had chronic insomnia and couldn't spend the night away from home. As in most cases of anxiety, there are several goals, the first being to help the individual manage their anxiety so that it doesn't interfere with their daily functioning. This might include teaching them breathing techniques to slow their breath and lower their heart rate (especially if they are having panic attacks), thought stopping (identifying negative through processes and stopping those thoughts before they can have a negative impact, and replacing them with positive ones), identifying what triggers the anxiety - for example, if someone is afraid of having a car accident on the freeway, maybe it is best to avoid the freeway until the more bothersome symptoms can be addressed. There are too many symptoms and interventions to be addressed here (I list some books on my Resources page on my website if the reader is interested). I began to see this young lady at a time there were some disruptions in her home between her parents that were also intensifying her anxiety. We talked about what was bothering her most, and I made her some relaxation CDs to help with her sleep. We continued to work together for some time, and she appeared to be resistant to letting go of her anxiety. This sometimes happens; sometimes the client has a need to hold on to their symptoms. Until and unless they acknowledge this, the truth is that there is little that I or anyone else can do. We might eliminate one symptom only to have another one take its place. One day I asked her how she felt about doing some hypnosis to find the root cause of her anxiety and she agreed, saying that she wanted to know why she always felt this way; she had felt this way ever since she could remember. The young lady turned out to be a very good subject for hypnosis, and recalled waking up one morning when she was quite young, maybe as young as 5, and finding herself home alone. She was frightened and thought her family had been kidnapped! Her parents had taken her sister to the emergency room, and asked a neighbor to look in on my client, not wanting to wake her up or take her with them. She told me that ever since she had a fear that her family would be kidnapped and she wouldn't be there to save them. This incident caused her to be fearful of sleeping at someone else's home, because when she returned to her own home in the morning, she had an unconscious thought that her family might be gone. She was afraid if she fell asleep at night then in the morning when she woke up, her family would again be gone. In this case, it was important for the client to find the source of her anxiety, not just treat the symptoms. Once we had the source, we did some EMDR sessions specific to it and she experienced a great deal of relief. She even went on a vacation with a friend and the friend's family, leaving her own family at home and experienced no anxiety at all.
Case Three: But I Don't Want to Let it Go....
As I mentioned above, sometimes people just don't want to let go of their traumas, or the resulting symptoms. Take the case of a client who had a fear of flying and who's family was getting ready to take a vacation that involved a transoceanic flight. When you have a fear of flying, even a brief flight that is under an hour can be paralyzing. But when you have to sit on a plane flying over water for hours upon hours, well, you can just imagine the stress and terror that induced! As we worked together on her flying phobia, more and more phobias surfaced (what most people call a "fear of flying" is a phobia - a fear for which there is no basis; that is, the person has not been involved in a plane crash, has not witnessed a plane crash - in fact, there are far fewer plane crashes than there are car crashes, but very few people have car phobias. Plane crashes are so rare in fact, that when they do happen, they make international news!). We continued to work together, trying EMDR, hypnosis, talk therapy, somatic therapy, cognitive behavioral therapy, exposure therapy... truthfully, I ran out of tools! I finally asked her if she was willing to let go of some of her fears, and she admitted that maybe not. We parted company, but she knows my door is always open should she desire to return, or call me for a referral to another therapist. We did make some progress, and she was able to make that transoceanic flight with her family without as much anxiety as she expected. In fact she reported back to me that she was fairly relaxed on the plane, both ways.
Case Four: Trauma from Chronic Stress:
When someone suffers from chronic stress to the extent that it is traumatizing, we call it traumatic stress. When a child grows up in a home with parents who are mentally ill, that can cause traumatic stress. One such young woman came to me complaining of panic attacks. She had no reason for them that she could identify. They had started in college, she told me, and then had subsided, and now she was in her mid 30's, married with a toddler and a newborn, and the panic attacks had started again suddenly out of the blue. She was most disturbed by the negative thoughts she was having about her husband and her children whom she loved "more than anything in this world." The first thing I did was to make a referral to a physician to rule out anything physical, such as a thyroid or hormonal imbalance. I never want to try to treat a physical issue with psychotherapy until it's been checked and treated by a medical doctor. Then I referred her to a psychiatrist for a medication evaluation. There was nothing wrong physically; she was in great health. The psychiatrist started her on an antidepressant that also worked well on anxiety. The medication helped, but did not eliminate her panic attacks. So we continued to work in therapy. As we worked together and I learned this young woman's history, I learned that her childhood had been anything but stable, and she lived in a state of constant chaos because her parents were not themselves stable. In other words, she suffered a series of emotionally traumatic events that caused her to always feel hypervigilant and chronically stressed, or what we call chronic traumatic stress. When we made a chronological time line of the events in her life, and applied EMDR to these events, again, chronologically and one by one, her panic attacks began to subside.
Case Five: Brainspotting
Brainspotting is something that is relatively new to my practice "toolbox" and has been around for just a few years. (Please click on the link for more information.) Brainspotting is an outgrowth of EMDR, and goes deeper, faster. It is ideal for almost any kind of trauma, and also works well for chronic pain, illnesses, headaches... in fact, I'd be hard pressed to find an issue that it isn't useful for, unless the client just isn't ready to "go there."
A young woman who had experienced a medical trauma was referred to me for anxiety and panic attacks, and was getting so panic-stricken she was having trouble leaving her home because she was fearful of becoming ill while out. In three sessions of using Brainspotting, we were able to reverse this fear and she was able to return to work and leave her home without problems. In processing the issue using this technique, other past traumas that she had "forgotten" (or rather pushed out of her consciousness) came up and she talked about them, processed them and released them. This process of bringing them into awareness, talking about them (and feeling them in the body as well) and releasing them is of utmost importance to processing trauma.
I feel compelled to say that it is my clients who actually treat their traumas in therapy. I am, as I have said before, merely a guide who is there to help people on their journey. I am a facilitator. Do I "treat" trauma? If you'd like to look at it that way, it's okay with me. But please be aware that when you enter therapy, you are starting something that is work, and it isn't necessarily easy work. There will be times that you will want to stop, and many people do stop before they make much progress. Sometimes you'll feel worse before you feel better. But you will, at some point, if you hang in there, feel better. Someone once said, "What doesn't kill you makes you stronger." I can't remember who said it, but I'm sure it was someone famous. And for what it's worth, I believe it. Everything is a lesson, and we keep learning. Some lessons some of us don't need, and some of them we could certainly have survived without, and for some people, it's amazing they survived those "lessons" they were given.
One more thing...
Unfortunately, there are also people who have had ongoing trauma in childhood that was unrelenting and from which they could not escape. Sometimes children learn to dissociate from the trauma in these cases. (Again, you can learn more about dissociation on my website on the "Services" page by scrolling to Dissociative Disorders, and I also encourage you to visit the International Society for the Study for Trauma and Dissociation.) When a young child, usually under the age of 5, is subjected to ongoing abuse, be it physical, sexual or emotional over and over he or she begins to want to be somewhere else, or they wish very hard that this wasn't happening to them, and they learn to literally go away in their mind. They create someone else to take their place. We call these "someone elses" alter personalities. These cases are usually very complex, and these individuals have often been in therapy for a number of years and have had a variety of diagnoses before anyone - including themselves - realize the extent of their trauma and that they have alters. The diagnosis for this "condition" used to be called Multiple Personality Disorder; now it's called Dissociative Identity Disorder, or DID. Again, please visit either my website or the ISST-D for more information on this disorder and it's treatment.
Need vs. Want
We’re taught that it isn’t polite to eavesdrop, but when I’m standing in a line, or at the counter at the post office, it’s really hard not to overhear other’s conversations. Today while I was finishing my transaction at the counter at said post office, a young man next to me was trying hard not to lose it while expressing his frustration at the fact that a package he had come to claim had been lost. The package apparently contained an engagement ring that he and his fiancée had chosen – or had designed – while in Hawaii together. I got from the discussion I overheard that he now had to explain to her, in another city and state, that his proposal would be without “the ring that she specially picked out, and was shipped here so I could give it to her when I proposed…” or something to that extent. The postal clerk was trying to explain that as the package was insured, he would not be out the cost, and his point was that it wasn’t the cost that mattered – it was the sentimentality of the item.
Which brings me to the point of all of this… or at least you probably hope it does… It’s nice to have beautiful things. It’s lovely to have beautiful things that have sentimental and important meaning to you. But the fact remains that they are just things. As my husband and I approach our 30th wedding anniversary, I realize more and more how lucky I am to have him; not what he can provide for me. And I wanted to say to that young man in the post office: “hey, it’s only a ring – at least you still have each other.”
When I got back into my car to head to the office for a couple’s therapy session I had scheduled with a young couple dealing with the possible end of their relationship, I couldn’t help but look down at my own left hand, at the simple gold band that matches the one on my husband’s ring finger that we exchanged so many years ago, and at the simple, ½ caret solitaire next to it. How many times have I looked at that solitaire and thought how nice it would
be to have something bigger, fancier? As it was, the diamond solitaire I have was my 10th anniversary present, not an engagement ring at all. But by giving me that ring, it was like my husband was saying he’d marry me all over again. And my accepting it (even if we did pick it out together) was my way of saying “yes, I’ll marry you again… and again, and again….”
When I think about how important material things seem to be to people, I can’t help but think of the times my husband and I have weathered a health crisis where he was near death, or what and how much I would have given up just to have him with me (which fortunately I still do); when our second daughter was born and was ill and had to remain in the hospital – what wouldn’t we have given up to have her whole and healthy (and thankfully, she is…); when my new grandson was born prematurely, but breathing on his own, then overmedicated by a nurse’s error in the NICU; unable to come home day by day, but finally at home, beautiful, growing and mellow and happy (wow! How’d they luck out on that???), what wouldn’t we give up if it meant that those we love stayed close and healthy, and we could reach out anytime we wanted and give them a hug, or a phone call and say, “hey? How are you doing? I love you.” Not everyone can do that. And we’ve all see those news stories in the wake of a natural disaster where people have literally lost everything except for the clothes on their backs, only to say “we’re all safe and that’s all that matters…” and yes, isn’t that all that really matters in the end?
So maybe a young man somewhere is dreading having to tell his fiancée, whom he loves so much he’d rather die than let her down; that her beautiful, special, cherished ring is gone forever, but at least he still has her around to tell. I admit that there are times I’d like a bigger this or a fancier that… but when it comes down to it, I really do have everything I need. Take a look around… do you have everything you need? Is it different from what you want? And think about what do you really need?
Marriage Counseling - How Can it Help, and How Can You Make the Most of it?
Here are some good questions you might want to consider asking if you do decide to see a therapist, weather it's for individual, family or marriage counseling:
What is your background?
Are you, or have you been married? (Why not ask? Would you take driving lessons from someone who doesn't drive? That doesn't mean that someone who's not - or has never been - married can't be an excellent therapist; but if it's important to you to know, you can still ask!)
How long have you been in practice? (Keep in mind that MFTs need 3000 hours of supervised experience before they can sit for the licensing exam; and they continue to get hours while they're in the exam process, so even before they're licensed, they have at least 2 years of experience, and usually more).
What is your philosophy regarding marriage - in other words, do you have any feelings about staying together no matter what, or regarding divorce? This might be important in the case of religious preferences. (I once had a friend refuse to go to marriage therapy because she had a fear that the therapist would tell them to get a divorce and she didn't want to have to look at that.)
Do you take custody cases (just in case this is a custody issue... be clear with the therapist up front. Some therapists, myself included, will not get involved with custody cases, and it's better for all involved to know that up front before there's an attachment to the therapist).
What are your fees, and are they flexible - in other words, does the therapist have a sliding scale, and what happens if halfway through the therapy you can no longer afford their full fee?
If you are thinking of using insurance, does the therapist bill for you, or will you be expected to pay out of pocket and then be reimbursed by the insurance company?
Do you routinely give "homework" assignments between sessions? Some people don't have time for the "assignments" a therapist might give them; some therapists don't give "assignments." (How much time do you want to devote to improving the relationship, and are the homework exercises appropriate for your situation?)
How do you feel about seeing the partners alone from time to time - what is your policy regarding this?
How do you set goals for the therapy? (What are you looking for here, as a client? Do you want the therapist to set goals for you, or do you want to set the goals with your partner? In my opinion, its more important that the goals set are yours and your partner's; the therapist might have goals for you but you all need to be clear that they are what you and your partner need, not just what the therapist thinks will be good goals...)
There are many, many more questions that you will probably think of yourself, and more that I'm sure I've been asked over the years. It's mostly important to keep in mind what your needs are when you're looking for a therapist. A therapist who will get right down to work in the session and not allow you to digress and waste time by evading the issues is important. You only have so much time for the session - you want to make the most of it. After all, it's your time. If you want to spend the session arguing with your spouse, that's up to you... but again, in my humble opinion, your therapist will help you not do this... but there are times it's important for the therapist to observe this type of interaction between you, and see how you argue, also.
Making the Most Of Your Time in Therapy:
If you do decide to seek out a therapist for marriage work, be sure you make the most of your time. It is very common for people to go to therapy and then have "nothing to talk about." It is common for couples to come and want to reenact the fight they had that week, or discuss a current conflict (which at first glance seems to make sense - isn't that why you're there, do discuss your conflicts?). However, doing so is actually a reaction and often a need to have someone - the therapist - tell you "you're right and your partner is wrong" or in other words, to feel vindicated. Or it is a way to get someone to "fix" your partner. However the best use of your time in that short 50-minute hour is for you and your partner to decide ahead of time what you want to discuss. Talk about your reasons for going to therapy together, before your session. Think about the next step you want for your relationship - like how can you be a better partner? It helps to focus on yourself and how you can change, and not how you can change your partner. You can only control yourself. Finding the answers to these questions isn't so hard - the hard part is making changes, and acknowledging why you resist change.
Learning how to think differently about a problem is often more effective than simply trying to solve it. In relationships, because you can only control yourself, it often helps to also acknowledge that your partner is limited in his/her ability to respond to you. Often we need to come to a realization that our partner is not the "Mr. or Mrs. Perfect" we envisioned, and accept their imperfections, along with our own, so you also need to recognize that you, too, are limited in your ability to respond to your partner. It goes both ways.
Going back to goals for a moment, it often helps to set more goals for yourself than for your partner. This helps to moderate your expectations of one another and you are less likely to be disappointed. It is human nature to try to change another person instead of adjusting expectations, but by doing so, again, you are more likely to be successful in nurturing the relationship along.
Some More Helpful Hints:
It is okay to argue. Growth comes from conflict. It's how you each handle the conflict that is important. But accepting that conflict is part of all relationships and leads to growth, and learning to manage the inevitable disagreements is the key to a better relationship.
We don't always hear what is said. Learning to really listen, and putting your own needs aside for a few minutes will lead to a better relationship. Everyone wants to be heard.
A couple's vision for the two together as a team and as partners requires that both of you speak from your true self, and that you each really listen - not waiting for them to stop talking while you compose your response - but that when your partner is talking, you are truly hearing what they are saying even if it's uncomfortable and you don't agree. One sign of true maturity is the patience to be able to do this.
We are all ultimately responsible for ourselves. Blaming others for how you are, or how you turned out, is an excuse to not take responsibility for your actions.
Relationships are not easy. The best ones, and the ones that last, take work. It is an ongoing process, and just when you think you can relax into the routine, something else comes along to make you sit up and take notice. As couples, we do a kind of dance throughout our lives - one partner moves in, the other might move away or come closer, and so on. There are times when you are in perfect step with each other, and there are times when you step on each other's toes. But when you weather the difficult times together, you come out the other side being stronger and usually closer.