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MIND, BODY & SOUL Treating Obsessive Compulsive Disorder

A Publication of

In Collaboration With:

A Mental Health Magazine

May 2014

The Art of Parenting Adult Children


& MIND, BODY SOUL

MIND, BODY SOUL CONTENTS &

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MAY 2014

& Further Reading MIND, BODY SOUL

RELATIONSHIPS

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PARENTING

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Understanding the Challenging Child By Dr. Sara Teichman, PsyD

By Chana Kaiman, LCSW and Miriam Yerushalmi, MS

TREATMENT

The Best Parenting Tool

By Sara Pinkesz, MHC, CASAC-T

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An Ongoing Search for the Right Path By Esther Fuchs, LCSW

I Don’t Like My Kids’ Friends

Living with Obsessive Compulsive Disorder (OCD) By Dr. Pamela P. Siller, MD

THERAPY

By Mark Staum, LCSW

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Compassionate Parenting: The Secret to Healthy and Successful Children

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Attending Couple Therapy When One Partner is Absent

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Being Part of the Group

By Dvorah Levy, LCSW

By Audrey Grazi, LCSW

SELF-IMPROVEMENT

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Six Easy Steps to Foster Emotional Resilience in Retirement By Joel Verstaendig, PhD

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GRIEF

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Abandonment – When Loved Ones Pass By Marlene Greenspan, MA, LPC

DIAGNOSIS

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The Marah Shchorah: Understanding and Undoing Depression

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By Sararivka Liberman, LCSW

& MIND, BODY SOUL Is a publication of the Jewish Press Published since 1960 and in collaboration with Nefesh International

ARTICLE COORDINATOR Chaim Sender, LCSW SENIOR EDITOR Lisa Twerski, LCSW SUPPLEMENT COORDINATOR Shaindy Urman Rabbi Simcha Feuerman, LCSW-R, President, Nefesh International Miriam Turk, LCSW - Executive Director, Nefesh International Alice Tusk, LMSW - Director of Operations, Nefesh International DESIGNER Alana White • lanala8@gmail.com

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May 2014


& MIND, BODY SOUL

LOOKING TO LIFT YOUR SPIRITS, SOCIALIZE, LEARN NEW SKILLS, FIND EMPLOYMENT?

Dear Readers, T

here’s a core reason that most people go to therapy – to feel better. Whether it’s an addict who has hit rock bottom, someone who is suffering from anxiety or depression, a couple who feels miserable with their marriage (or their spouse), or any of the other reasons someone might seek out a therapist – they all have that same basic goal in mind. As was mentioned in past editions of this publication, people encounter problems along the way to finding the right therapist, including: identifying the real problem, finding a therapist who’s a good match, and other factors. But there’s another impediment that can get in the way of someone attaining that fundamental goal. That is, perhaps surprisingly, wanting to feel better – even wanting to see a therapist – but not really wanting to be in therapy. That’s because in order to feel better – being in therapy doesn’t always feel good. Brocha, a woman in her twenties and married for five years, came in to discuss how unhappy she was in her marriage. She and her husband have one child, and from her perspective, can’t agree on anything with regards to parenting. She was coming to seek counsel on how to handle this situation, and to deal with the fact that she was married to someone she was having such a hard time parenting with, that she couldn’t envision herself having more children with him. In talking about personal history, Brocha briefly made mention of the fact that she had had a much younger sibling who had died suddenly right before the birth of her daughter. When Brocha mentioned this, she started visibly shaking, appearing extremely anxious, but stated that that was not why she had come, that it wasn’t important to go into more details about that, and quickly changed the subject. This is just one of the many types of scenarios that take place in therapy, where someone is in a lot of pain and wants things to improve, but is hoping that they can achieve that without having to fully engage and explore everything that may be contributing to their current distress. Usually this is because really getting to the core of things will entail more pain in the short term and relief only after a significant period of time and a great deal of work. The scenario involving Brocha is one that is actually a bit easier for the clinician to help a client with, because in this case, at least one area of resistance is obvious to the therapist. In this instance, the therapist could point out what is being avoided and how, despite the person’s protests to the contrary, it might be extremely important to address. Pushing someone to go faster than they can tolerate is still not appropriate; however, when the person is willing to at least acknowledge the ”sore spot” to the ”doctor,” at the very least a conversation can ensue about what could be done, and how to deal with that spot in the least invasive, safest, or least painful way. What about cases when someone leaves out the painful subject or details altogether, not even bringing it up because it’s “something that’s not important to discuss”? Perhaps they tell themselves that it isn’t important to even mention, that it’s insignificant or irrelevant to what they sought help for, when in fact, keeping quiet is done in the service of keeping their extremely sore spot well protected. Usually, something of the core issue will eventually find its way into the treatment room. The problem is that it can get very frustrating for the client when they don’t see improvement, they’re not feeling better, and instead they feel like they are getting nowhere. From their perspective, they’re attending therapy regularly, they are participating in treatment – so why aren’t they feeling better or why aren’t things getting better? There isn’t any one answer to that question. There are a lot of possibilities as to why someone might not be finding that therapy is helping them in their lives, and not all of those possibilities fall on the shoulders of the client. However, if you as the consumer want to do your utmost to get the most out of your process, ask yourself whether you are protecting something, perhaps out of fear, embarrassment, pain, or because you figure, “it’s not really relevant here,” and try sharing it with your therapist. After all, if you want things to change, it’s important to not just go see a therapist, but to also really be in therapy.

Lisa Twerski,

May 2014

WE LC OM E TO

ALWAYS MOVING FORWARD OHEL’s Kadimah provides a warm and welcoming environment for men and women managing their mental illness COMPUTERS CULTURAL LEARNING EDUCATION T ADVANCEMEN

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For more information: 1-800-603-OHEL kadimah@ohelfamily.org • www.ohelfamily.org/kadimah

LCSW

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& MIND, BODY SOUL

Book Review The Art of Parenting Adult Children

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their children closer to the model they desired, these parents caused a break in their relationships with their children. As a result, these children often went even further away from their parents’ ideal. Parents who justify being hard on their children by attributing it to tough love and saying that this is the only way to ensure their children become good people do not realize how counterproductive such an attitude can be. Treating children as if there is something wrong with them because of their choices and trying to figure out “what went wrong” is a damaging attitude that only sends them the message that they are not loved or accepted the way they are and that their parents cannot look past their choices to appreciate who they are as individuals. Receiving the message that they only have worth if they reach the parents’ standards is hurtful and limiting and breeds resentment. The goal should be unconditional love, not tough love. Loving your children as they grow up no matter what, regardless of religious or personal choices – that is the best way to keep relationships with your adult children stable. Because as Isay points out, adult children are now capable of leaving behind toxic relationships with parents by closing down from then emotionally, withholding details about their lives, and moving far away. What this means for parents in the Jewish community who want to remain in their children’s lives and stay close with them is that they must always show unconditional love and support. This encourages their children to feel more comfortable with them and keep them involved and up to date on their lives. When your children confide in you or share a part of their lives with you, do not pass judgment or make them regret sharing with you. One of the most crucial things is to listen, and try to understand and empathize without passing judgment or making demands or pressuring children into certain choices. When children become fully actualized adults and develop their own styles of thinking and sets of beliefs, the parents’ main job becomes to listen to what the children are trying to say and take it seriously. If your children are making personal decisions that you disapprove of, listen to them first and try to understand their motivations and their points of view in order to foster healthy, loving relationships. Fortunately, the key message of Isay’s Walking on Eggshells is a positive one. She reiterates throughout the book that no matter how many mistakes a parent may have made in raising a child, children are usually willing to reconnect and rebuild relationships when they receive the message that their parents are willing to accept them as they are and want to remain close to them.

By Hannah Rozenblat

he question of how to parent one’s children once they have grown up is a much-discussed topic in our community. Naturally, parents’ concern for their children does not stop once the children become legal adults, and if anything, increases when parents feel they are losing control over the child’s life. After investing so much effort into their children all these years, it is difficult for parents to take a step back and allow these new adults to lead their own lives and make their own decisions, particularly in the realm of religion. But although many Jewish speakers and writers declare that the parents are responsible for their children’s choices and Torah observance no matter the child’s age, that viewpoint is unsatisfactory as it denies adult children their status as fully recognized human beings who are capable of making their own decisions. I recently read Jane Isay’s Walking on Eggshells, which deals with relationships between parents and adult children in a profoundly sensitive, rational way with the goal of improving those relationships. Instead of decrying “the way young adults are today” as many unfortunately do, Isay acknowledges the reality of the relationship between parents and their adult children, focusing on how to maintain and improve the relationship instead of uselessly blaming the adult children and the society of which they are a product. Isay’s book helps parents and their adult children understand each other’s positions better so that fragile relationships can be strengthened for the benefit of both sides. Isay addresses the issue of religious differences between parents and children, encouraging parents to give adult children unconditional love and support even if their religious choices are disappointing to the parents. This is a painful issue for many in the Jewish community. After investing in their children, parents feel responsible for the outcome and take it personally when their children do not meet their religious expectations. From simple things such as modes of dress to more significant religious choices such as whether or not to be religious at all, a crucial aspect of growing up is learning to make decisions for oneself, even if those decisions may hurt one’s parents. Until parents and communities can accept this and treat young adults with respect and with the understanding that they are capable of making their own choices, these young adults are more likely to leave the community and escape from an institution that they feel is restrictive and oppressive. I know many individuals who felt driven off by their parents’ attitude. Instead of accomplishing anything or bringing

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May 2014


& MIND, BODY SOUL

By Dr. Sara Teichman, PsyD

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ost children who are brought to therapy have typical run-of-the-mill issues like low self-esteem or poor peer relations. Sometimes, however, parents bring in a really difficult, out-of-control child who is what we used to call a “problem child.” This child may be angry, moody, aggressive and undisciplined. He has difficulty learning and is unmanageable in school. Often the parents are at the end of their rope, having exhausted their bag of tricks: ignoring, consequences, punishment, and maybe therapy. Sometimes parents are optimistic, or naïve, believing that all they need are some tips to make their child behave. Parents often consult with a professional because they want “the answer.” It is quite an art for the therapist to convey that there are no simple answers for complex problems. There is no magic pill, piece of advice, strategy, bracha or segulah that can by itself adequately and comprehensively address this situation. What is needed instead is a process of trying to understand the child – his strengths and weaknesses, his needs and wants – not simply a focus on eliminating his troubling behavior. However, the difficulty, shame and embarrassment of raising a child with challenging behavior may overwhelm the parent; after all, a child is his parent’s report card. So, despite the best of intentions, the parent may fall into the trap of caring more for the behavior than the child himself. Yet a child is not his behavior. Behavior is simply the language of childhood. Challenging behavior signifies that the child is in pain; he cannot regulate his mood or impulses and he suffers the consequences of adult disapproval and peer rejection. As important as it is to teach him appropriate behavior [and that is important!], his behavior is a symptom and not the issue. The issue is his pain and helping the child deal with it is the first responsibility. It is axiomatic that children do well if they can and that no child gives more pain than he feels. More than anything, children want approval, and if they can do what is asked of them in order to get it, they will. But when the child cannot do what’s required, he both feels bad about himself and also earns the disapproval and criticism of others. Then, when he feels the pain of rejection, he acts out, or in. Neither giving him medicine nor teaching him to have derech eretz will alleviate his pain. It takes some skill and training to figure out the puzzle that is the child. There are a number of diagnostic possibilities here, from ADHD to abuse/neglect, from depression to low selfesteem, from ODD [oppositional defiant disorder] to overly permissive parenting. Because there are radically different approaches for, say, a child who is depressed or a child with ADHD,

May 2014

it is essential to determine the nature of the issues before beginning to address them. Most likely, there isn’t any one thing, but rather a combination of factors that affect the child. For example, a child with ADHD who has permissive, unstructured parents is bound to have disorganized, chaotic behavior [doing whatever he wants] which impacts negatively on his school performance. Or, a child with

the professional may suggest, like individual or family counseling, parenting classes, or special education. An evaluation for medication by a child psychiatrist may be appropriate; there are medications for depression and ADHD. However, just like antibiotics cannot cure every condition, there is no medication that addresses chutzpah or anger which are more often reactions to the child’s environment.

low self-esteem who feels disliked by his peers may have lots of feelings of anger and depression. And, though it is a consideration to give medication to a child who is depressed, there is no pill in the world that can remedy the pain of abuse or neglect. What sometimes derails the “understanding” process is that parents feel under the gun; everyone around them is urging them to do something. None of us like to be criticized, but it seems like an out-of-control child invites the well-meaning comments, suggestions, advice and perspective of others. The social pressure this engenders often propels the parent to seek a quick fix solution, rather than work at a comprehensive understanding of their child. It takes a lot of courage and stamina to work at the longterm and not the short-term, the whole child and not just his behavior, and the future – not merely the present. When the severity of the symptoms and the seriousness of their repercussions call for professional help, both the parents and the child would do well to meet with an experienced, competent mental health professional. Once there is a mutual understanding of a child and his issues, there are a number of strategies that

Last, but certainly not least, may be the need for a behavior modification program or behavior therapy. Everyone must learn appropriate behavior in order to function effectively in our families and social world. No matter what the pressure or distress, disability or challenge – correct behavior is our entry card into the world. We are derelict in our duty if we fail to provide all our children with the tools to manage their impulses and behavior so that they can be welcomed as full-fledged members of society. It is not easy being the parent of the more difficult child. It’s not something we willingly sign up for or even the cards we expect to be dealt. But when the therapist, parent and child work together on the process of figuring out those cards, that enhances the chances of playing the cards right and getting a winning hand.

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Dr. Sara Teichman, PsyD maintains a private practice

in Los Angeles, California where she specializes in individual, parenting and marital concerns. In addition, she is the Clinical Director at ETTA at OHEL. She is the author of a bi-weekly parenting column, “Child in Mind – Ask Dr. T” in Binah magazine. Dr T. also gives lectures on parenting and a variety of clinical issues in person and by teleconference all around the United States. To contact Dr. Teichman, email sara.teichman@etta.org.

PARENTING

Understanding the Challenging Child


PARENTING

& MIND, BODY SOUL

The Best Parenting Tool By Sara Pinkesz, MHC, CASAC-T

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havy looks at her son with frustration. He has just told her that he is sick of yeshivah and wants to go to work. She wonders, why can’t he just be a “normal yeshiva boy”? Where did she go wrong? Why wasn’t she capable of passing on her beliefs to her own son? Chaim argues with his daughter who doesn’t want to go to seminary. She feels that it’s a waste of time since she’s not planning to teach. She wants to work, make some money, and possibly take some college courses. This was not the future he had envisioned for his daughter. What kind of parent is he if he can’t transmit his values to his daughter? As parents, although we have tried to do the best we could, we often look at the end product, our children, and feel that we have failed. We may blame it on ignorance, lack of patience, stress or any of the myriad of issues that decorate our lives, but we are sure we messed up. And then... the guilt sets in. How could I have said that? How could I have done that? I can’t believe I lost my temper like that. I’ve traumatized my child. I am just not a competent parent… and so on. We are eaten up with guilt for what we have done, intentionally or not, to our children. What do we do now? How can we deal with our feelings of defeat, our belief that we have destroyed the future generation, possibly even generations? The answer may surprise you. We forgive ourselves – yes, believe it or not, that will make the greatest change. No matter what we did, as terrible as it might seem, we must forgive ourselves or we are doomed to be parental failures, destined to be stuck in the rut of our dysfunctional behavior. As long as we are consumed with guilt for all the “terrible” things we have done, we cannot move forward and become better parents. Sometimes we need to apologize, depending on the child’s maturity. But whether we do or not – whether they forgive us or not – we need to forgive ourselves. We must remember, not only that we are human, but that we are part of God’s plan. Just as our parents were often a challenge to us, so are we a challenge to our children. This isn’t an excuse to be bad parents; this is a reason to forgive ourselves for our past offenses. Yes, we may have damaged our children, but teshuva does not mean being consumed by guilt. It means feeling sorry for what we’ve done and committing ourselves to avoid repeating our transgressions, whatever they may be. We cannot improve and develop our future if we haven’t let go of the past. We need to be able to move on. Moving on frees us to grow to be better parents in our interactions with our children. We can learn how to communicate effectively, discuss our conflicting viewpoints, often involving their obligations, and thrash out our differ-

ences. We also can accept our children as they are, even if they have not met our expectations, or our dreams. It means understanding that children have their own paths and we need to celebrate their own particular positive traits. It means understanding that although our parenting contributed to who they are, there are other

go, because they have no value and serve no purpose. Even if we are disappointed or hurt by their life decisions, we can more easily accept our children and their choices if we can acknowledge that it’s not our fault. Our children may want different lives, spouses, or careers than we may have planned for them,

factors that have had a great influence on them, too. Their conduct, manners, performance, aspirations and appearance are not a direct reflection of our success or failure as a parent. If we can take a step back as we learn to forgive ourselves, we can look at them without judgment. We can realize that our anger at them for not being what we expected, for not turning out the way we would have wanted, is directed more at ourselves than at them. Although we are saying: Why can’t they be like everyone else – or better?, we are actually thinking: What could I have done differently to make them be like everyone else? It’s time to let these destructive thoughts

but they still need our approval to attain true happiness. Our children need to know that we understand them and can value their struggles and the solutions that work for them. When we can reach the point that we can accept their choices, we have attained the purpose of our lives as parents: Giving our children the independence to forge their own path.

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Sara Pinkesz, MHC, CASAC-T currently works as a

Young Adult Counselor at Peaceful Home Associates. She is also in private practice dealing with troubled teens and young adults, specializing in drug addiction. She can be reached by calling 917.686.3987 or via email: spinkesz@ gmail.com.

May 2014


& MIND, BODY SOUL

By Esther Fuchs, LCSW e are living in difficult and turbulent times. Never in history has it been harder or more challenging to raise children. As a result, parents of even physically and emotionally healthy children are constantly seeking guidance. Seeing and reading how much can go wrong, parents understand that they need to set the

pushes away and the right hand draws you back close), and will know how to set firm limits with an abundance of love. However, if you did not experience your own parents this way, it can leave you with “emotional baggage.” These are superfluous feelings from childhood that can weigh you down, but no matter how hard you try, they remain attached to you. You may say to yourself: “My parents did this to me, it was awful, I will never do this to

was so painful for him that, at a young age, Mordechai made a decision never to allow himself to become angry or to even express a strong personal opinion. Rivkie came from a family where they “let it all hang out.” It was a large household where there was constant drama. Anger and explosiveness were always in the air. Rivkie had internalized this as “normal.” This couple needed to learn how to regulate

right environment in their home. They want to know what kind of soil to cultivate to raise children as happy and successful human beings and ovdei Hashem. To begin, we need to realize that each child has his or her own techunos (innate characteristics), and nitiyos, (behavioral propensities). Psychological research has proven the Torah’s wisdom when it says: “Chanoch l’naar al pi darko.” Each child needs a custom-made parenting plan. What worked for Yankie might not work for Shloimie, because they are innately wired differently. So how does a parent begin? The Torah teaches us that by developing ourselves into better people, we naturally become better parents. The real challenge of parenting is transforming ourselves. “K’shot atzmicha, v’az kshot acheirim.” First fix yourself up and then you will be able to fix others. To a large degree, we learn to parent from the way we were parented. To the extent that you were fortunate to have had adequate parenting, you will likely have internalized the principle of chanoch l’naar al pi darko. It will also be more natural for you to be guided by the concept of: “Smol docha viyimin mekareves,” (the left hand

my children,” but under stress you find yourself repeating that pattern. Stress can cause unclear thinking that can cause us to go back to the default setting of our own childhoods. So what is the solution? Are you trapped? Absolutely not! The key to changing your programming is awareness. Whether through self-awareness or someone else pointing it out, you need to have the courage to accept the challenge and the willingness to change. You will need to work hard and get support and guidance to change that behavior. Parents need to make conscious changes. It is difficult to implement any of the parenting techniques you learn without being ready to work on transforming yourself. Case in point: Rivkie and Mordechai came for counseling because of problems they were having parenting their son. He was explosive at home when everything did not go his way, and had frequent meltdowns over small things. In their first session, the parents both spoke about their own childhoods. Mordechai described being a rambunctious child in need of frequent discipline. His father screamed at him whenever he misbehaved. This yelling

their emotions more effectively and to practice expressing their feelings to one another in a calm, open manner. Mordechai had been withdrawn and fearful that contradicting his wife’s opinion would cause an explosive reaction. Rivkie had been expressing her feelings in a loud and intimidating manner, and then complaining that Mordechai was emotionally unavailable. When I reflected back to them that behaviors they had learned in childhood were not working in their marriage or with their children, they were eager and motivated to change. Our sessions led to their relationship strengthening, and as a result, their son’s behavior problems disappeared. To be an effective parent we start, not by focusing on the child’s process, but on our own. Individuals who have transformed into better parents have essentially worked on transforming themselves.

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Esther Fuchs, LCSW is in private practice with over 25 years of experience providing Torah and evidence- based practice to families and children. She can be reached at 917.348.9809.

PARENTING

An Ongoing Search for the Right Path


PARENTING

& MIND, BODY SOUL

I Don’t Like My Kids’ Friends By Mark Staum, LCSW

In this example, we can see the following:  Mrs. Langford asked David what happened without immediately assigning blame to David or forbidding him to invite Charlie over ever again.  Mrs. Langford listened carefully to David and promoted a healthy dialogue without ever cutting off the lines of communication.  Mrs. Langford helped David to reflect on what had happened and think about making better choices in the future.

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onsider the following exchange between Jack and his mother: Jack: I would really like to go to Brian’s house for a sleepover. A few other kids in the class will be going as well. Mother: Well, I don’t really like Brian so much. I don’t like it when you guys are together! Jack: Why, what are you talking about? He is a really good friend of mine! Mother: It doesn’t matter, you are just not going! In the above example, we see that Jack’s mother does not approve of a specific friend, yet she doesn’t communicate the reasons for her lack of approval which, unsurprisingly, seems to make Jack very angry. The “cutting off ” statement by his mother – You are just not going! – does not seem to help the situation either. A parent recently related the following to me about not liking his child’s friends: “I know that I have control over my kid until he reaches middle school, maybe the beginning of high school. After that, there is not much I can do when I don’t like something that he does.” The above statement is very powerful because it allows us to reflect on the delicate balance between controlling our kids’ choices and empowering them to make their own choices. How does this balance work when there is something that I, the parent, really don’t approve of, but I am not quite sure whether I should raise the issue or leave it alone? This question becomes even more challenging when friendships and peer groups become a very strong part of a child’s identity. As parents, we may feel that at a certain point we almost have no right to infringe on the lives and social choices of our children. However, at every stage of child development, parents should feel that there are opportunities and ways to address any area in their child’s life that bothers or troubles them. And yes, this includes talking to children about their choice of friends. The key, however, is to communicate – utilizing communication skills to express an opinion, but still listening and valuing your child’s opinion. Your child needs to sense that you get it, and that even though you may disapprove of a specific peer interaction, you also fully understand why this particular friend or this peer group is important to him/her. Your validation does not necessarily need to stand in the way of setting firm guidelines and/or consequences, but it needs to be clear to your child that you value their feelings and input as well, even if you disagree. Consider the example of Mrs. Langford who gets a call from a parent that her son Jonathan and his best friend Charlie were bullying David on the bus: Mrs. Langford: Jonathan, I received a call from David’s mother today that you and Charlie were teasing him on the bus. Can you tell me what happened? Jonathan: I was sitting next to Charlie on the bus and all of a sudden, he started to make fun of David’s clothes. I thought that it was kind of funny so I sort of joined in! Mrs. Langford: Okay, thanks for being honest about what happened. Don’t you remember that we had a talk about Charlie’s behavior last week? Remember the time that he came over to the house and started using foul language in the backyard? Do you remember the talk we had about having fun without using that type of language? Jonathan: Yes, I remember. Mrs. Langford: I am becoming a little concerned about your friendship with Charlie. It is probably very difficult to make good choices when others around you are not, but making good choices is something that we discuss at home all of the time. In this situation, do you think that you could have done anything differently? Jonathan: Well, I could have told Charlie to leave David alone or maybe tried to make a joke to change the conversation away from David’s clothes. Mrs. Langford: Yes! Those are very good ideas. Maybe you should give some thought to whether Charlie is a real good friend if he seems to always be picking fights, bullying kids and using bad language.

When assessing a situation of “I don’t like my kids’ friends,” here is a list of important questions to ask ourselves:  Did I communicate to my child the specific issue that is bothering me about this friend?  Did I also listen and give proper time and consideration to my child’s feelings?  Did I validate and show understanding that this friendship is important to him?  Did I teach or give insight to my child to make better choices in the future? Of course, there are situations that may demand consequences or more firm guidelines relating to harmful social interactions. Our role as parents when it comes to our kids’ friends does not only need to be one of control. Instilling values, communicating, and listening respectfully are invaluable “seeds” that we plant inside our children to help them make positive choices throughout their lives. Mark Staum, LCSW is the school therapist for the PTACH program @ MTA, special-

izing in child and family mental health. In the past, Mark has developed social skills groups for both elementary and middle school aged children, as well as many different workshops related to the social and emotional development of children and adolescents. To learn more, please visit his website, www.markstaum.com, or email: mstaumlcsw@ gmail.com.

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May 2014


& MIND, BODY SOUL

Abandonment – When Loved Ones Pass By Marlene Greenspan, MA, LPC

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Recommended Reading: Angel, M. 1997. The Orphaned Adult. New York: Jason Aaronson Fumia, M. 2003. Safe Passages. York Beach: Conari Press Lamm, M. 2004. Consolation. Philadelphia: Jewish Publication Society Lamm, M. 2006. The Jewish Way in Death and Mourning, revised and expanded. New York: Jonathan David

May 2014

needs. An adult is basically self-sufficient physically, although he may have emotional needs that cannot be discerned immediately and that need tending. The feeling of being abandoned exerts itself gradually and steadily. Judaism prepares individuals to heal the grief within slowly, in five stages, from the time between death and burial to the first three days of shivah, to the rest of shivah, to shloshim, and to the end of the first year. For those who need more help, psychologists have found that the rawest part of grieving takes 3 to 5 years. It does not take away the scar of loss, but that time period strengthens healing feelings. While it is not possible for this loss to be reversed, there are many things an individual can do to mitigate the pain. One comfort is that, as

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time goes on, the pain dulls and good memories come to the surface. Laughter and warm feelings in those stories come to replace the pain because those memories remain as long as an individual chooses to keep them. As long as an individual has a purpose, his/her life continues. One thing to remember is that these experiences occurred in the past and cannot be repeated. Time moves on and so must individuals. It does not hurt to remember, as long as one does not stay locked in the past. People who have lost children, spouses, siblings or parents sometimes set up regular donations or foundations to fund research into devastating illnesses or traumatic and unexpected accidents. In this way, they can enjoy memories of their loved one and move on into the future without sentencing themselves to be trapped in a very sad past. Of course, adults understand (for the most part) that they are not abandoned by choice when someone passes from illness, trauma, or in the natural end of their days. It is just that mourners have neither expected to be in that position so soon nor thought they would feel the loss as such wrenching pain. There are many different places that one can receive assistance in getting balanced again once a loved one has passed, and many therapists specialize in helping people get past the hardest part of their grief. One man tells the story of how as his last day of shivah came to a close, he had a dream of his wife giving him an important message: “Jack, look at this road that I’m showing you. It’s the path I have to take now. I’ll come back from time to time to see how you are doing, but this is where I have to go right now.” Although the man felt very lonely, he understood that he had his own path to follow from then on. For everyone whose time has not yet come, it is just a matter of learning to cope with the greatest challenge of all. Help is available for those who want it. Marlene Greenspan, MA, LPC is currently in private

practice and the director of Counseling for Better Living. Formerly in the yeshiva system for many years, she has taught, created social skills programs, written weekly Counseling Corner articles, given workshops, and published professional articles for Nefesh, ACA, ASCA, and the OU, among others. She can be reached at counselingforbetterliving@gmail.com.

GRIEF

eath, at any age, means painful finality. Whether the deceased was a friend, spouse, sibling, parent or child, the loss of this dear person is permanent and the ones left behind feel abandoned and alone. There is no further opportunity to share thoughts, experiences, ideas and apologies. No further opportunity to be companions along the way. The loved person is here no longer and that conclusiveness is all-encompassing. This realization of finality usually surfaces after all the other feelings that come with dealing with death have been expressed, including denial, anger, and so on. There is a certain helplessness and hopelessness to feeling abandoned that seems to stretch on into a dismal future. When that loved person leaves, there is a big hole left in one’s heart. And the longer the relationship with the departed was, the deeper the pain. No matter how old an individual is when a parent passes, the child still feels forsaken and deserted. In most instances, young children will be able to adapt to the absence of a parent, depending on how the person’s life continues. At first the pain is very great and extremely difficult to contemplate. “Where is Mommy?” “Why isn’t Daddy coming home?” are heard frequently among young children. If the child is fortunate, there is another parent and positive family or hired helpers to keep the children’s lives going as smoothly as possible. On the other end of the spectrum, if the child is not as fortunate, the family is broken up and the child is raised by cold, sometimes even hurtful, individuals. Then it is strength of mind and heartfelt courage that somehow help the child grow up until he can support himself. Of course, the age of the child when the parent

passes determines a lot of what follows in his/ her life and choices. What about the older child? Is it easier when a parent dies when the child is almost an adult, or already an older adult? These people are considered old enough to cope, yet inside they may be suffering even more than younger children, who frequently accept the parent’s loss and go on with their experiences as part of healing.A big difference between younger and older people in dealing with loss has to do with helplessness. A young child is helpless and depends on the adults around him to take care of him and his


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The Marah Shchorah: Understanding and Undoing Depression By Sararivka Liberman, LCSW

DIAGNOSIS

O

nce known as “the common cold of mental illness,” depression has been recognized throughout history. Dovid was summoned to the court of Shaul to alleviate the king’s depression with music. The Rambam, himself a physician, provides an explicit treatment for depression. In his writings, Rav Nachman of Bratzlav offers support and encouragement to anyone suffering from the low self-esteem – “falling in one’s own eyes,” in his words – and the despair that so many of us experience during depressive episodes. In the U.S., an estimated 5–12% of men and twice as many women will experience a diagnosable depression during their lifetime. In any given month, an estimated 5% of all Americans meet the criteria for a Major Depressive Disorder, a severe form of the condition. In short, depression is likely to touch our lives through our own struggles, or by affecting those close to us. Depression is considered a mood disorder. Indeed, depressed people often feel sad, unhappy, apathetic, irritable, hopeless, desperate, and/or resigned. But depression involves many aspects of our lives: It affects our physical selves, often causing a loss of appetite or overeating, insomnia or sleeping too much, fatigue and low energy. It can change our thinking, interfering with normal memory and concentration as it increases negativity, guilt, worthlessness, and pessimism. Motivation plummets, and functioning is impaired; even simple tasks may seem overwhelming. Depression costs us dearly in terms of human misery, troubled relationships, lost productivity, and even suicidal thinking and behavior. This painful and widespread problem demands a thoughtful response. Is depression an illness? The American Psychiatric Association says so. New York City’s Department of Health and Mental Hygiene says so. Pharmaceutical companies say so. But not everyone agrees. Experts concur that there are certain advantages to a medical model of depression: It reduces self-blame, and increases the likelihood that those suffering will seek appropriate help. (If I have a sore throat, I don’t think of it as a sign of personal weakness or failure. I call my doctor for a throat culture, and take the antibiotics he prescribes.) However, the disease model may not be completely accurate. While biological predispositions, hormonal influences, and other physiological factors clearly play a role in some cases of depression; no simple, clear causal relationship has been proven. While certain levels of neurotransmitters, naturally occurring chemical messengers in the brain, tend to be abnormally low in depressed individuals; we

don’t know whether the low levels cause the depression, or whether depression lowers the levels: It’s the old “chicken and egg” question. The best predictor of depression is a stressful life event, such as the death of a loved one or job loss. What does that have to do with biochemistry? And certain forms of psychotherapy have been demonstrated to produce the same changes in neurotransmitter levels that antide-

“Depression involves many aspects of our lives: It affects our physical selves, often causing a loss of appetite or overeating, insomnia or sleeping too much, fatigue and low energy…”

the behaviors they choose in response to their moods, and how these behaviors, in turn, affect their moods. They focus on experimenting and discovering what behaviors bring them closer to the results they want. Rochel* was strongly affected by her husband’s death. While she went back to work right after shivah and maintained relationships with family and friends, months afterwards she was clearly depressed. Fortunately, she became aware of her condition, and put a behavioral activation approach in place. She made only two changes: She took a walk for exercise at least five days a week, and did something enjoyable (or something that she thought might be enjoyable, or that she would have enjoyed before she felt depressed) once a week. She continued to

pressant medications do. A realistic picture of depression, then, seems to be more complex. Perhaps depression is best understood as an interactive process involving many aspects of our experience – our environments, our bodies, our feelings, our behaviors, our thoughts, and our relationships. This more sophisticated view of depression makes sense to many mental health professionals, and opens up a number of possibilities for effective intervention. So what’s the good news about depression? In three letters, it’s EBT: Evidence-based treatment. The growing trend in mental health is to help people using proven methods. Scientific research demonstrates that these treatments work well and work better than standard (or nonspecific) approaches. Most EBT’s work on a shortterm basis. Participants often make significant progress and are sometimes able to successfully complete therapy after 10 to 16 sessions. Here’s what research tells us works to undo depression: Behavioral Activation This approach sees the basic problem with depression as “shutting down.” In a misguided attempt to feel better, or with the mistaken belief that they shouldn’t or can’t do what they don’t feel like doing, depressed people often avoid activity, including social activity. They avoid the very behaviors that might give them a sense of pleasure, accomplishment, mastery, or problem-solving. The key to behavioral activation is to help depressed people re-engage with life. Participants collect information on

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mourn her husband, but her depression lifted within two to three months. Behavioral activation has been proven to be effective in both overcoming depression and preventing future relapse. An excellent selfhelp book on this method is Addis and Martell’s Overcoming Depression One Step at a Time.

Cognitive Therapy

exchange she’d had with her daughter, and said that she’d be better off dead. “She said: ‘You have no friends! You have no life!’ and it’s true. I don’t.” We examined the beliefs that fueled Adina’s painful feelings: I pointed out that Adina was alive, so, by definition, she had a life. “Oh, you know what I mean!” she argued. We considered her specific experience. Taking a more comprehensive view, we agreed that there were some aspects of her life, such as being a mother and earning a living by holding down a steady job, that pleased her, while others, such as her depression, anxiety, and being divorced that were painful. Adina also acknowledged that she was doing something about these problems – getting therapy, going to the gym, and working with shadchanim – and that she could possibly do more to enjoy a richer, fuller, more joyful life. I also pointed out that Adina had mentioned a number of friends, and asked how that fit with her belief of having none. As many depressed people do, Adina disqualified the positive. She told me that she hadn’t had much contact with one friend in quite a while, and that she thinks another only gets in touch when she wants something from her. She said that other people have more and better friends, and are more active cultivating those friendships. (The unofficial term for this is “comparisonitis,” and it’s a shortcut to depression!) We agreed that a more accurate idea was that she had some measure of enjoyment and support in her friendships, although they weren’t all she’d like them to be, and that she could choose to work on developing more and better connections with others. By challenging her perfectionistic, allor-nothing thinking and recognizing “shades of grey,” Adina arrived at a more realistic, useful, and compassionate view of herself and her situation. Her mood improved, and hope replaced her suicidal thinking. Cognitive therapy takes a while to learn, but is well worth the effort. It has been proven to treat depression and to prevent relapse. Greenberger and Padesky’s Mind Over Mood is an excellent self-help manual on this approach and the book that I recommend to my clients more than any other.

Interpersonal Psychotherapy

As the name implies, IPT emphasizes the importance of interpersonal relationships on our wellbeing and focuses on improving a depressed person’s relationships with significant others. IPT recognizes how relational difficulties can contribute to depression and how depression, in turn, frequently characterized by social withdrawal and low levels of functioning, often leads to further relational problems. Specifically, IPT focuses on one or more of the following problem areas: Role disputes (conLiberman Continues on Page 12 ➙

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DIAGNOSIS

Cognitive therapy emphasizes that humans are meaning makers: We always interpret our experience. I learned this from my Tanach teacher, the great Nechama Leibowitz, z’l, who defined parshanut as attributing meaning to sensory data. What does it mean, for example, if I lift my hand? How you feel and what you do in response both depend on how you interpret it. You may decide that I’m waving in greeting, or that I’m motioning you to come over. You may decide that I’m simply stretching my arm to get

out the kinks. You may think that I’m indicating that you should stop, slow down, or lower your voice. Maybe you think that I’m about to shake your hand. Maybe you think I’m about to hit you. Do you see how the meaning you give it changes your experience? According to most cognitive therapists, except on a level of reflex, we humans rarely react directly to our environment. Instead, our reactions are mediated by our cognitions – our thoughts, beliefs, and interpretations of the world. Al regel achat, the idea behind cognitive therapy is that you feel the way you think. Your thinking causes you to feel the way you do. And when you’re depressed, your thinking tends to be negativistic and distorted. The focus of cognitive therapy is on identifying and changing distorted thinking. Adina* struggled with severe depression since her divorce. She once described a heated


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DIAGNOSIS

Liberman Continued from Page 11 ➙

flicting expectations about role behavior in a particular relationship,) role transitions (changing roles when, for example, we get married or divorced, have a child, move to a new community, enter or retire from the workforce, get a promotion, or go back to school,) unresolved mourning, and deficits in social skills. Research suggests that since women’s self-concepts tend to be inextricably linked to their important relationships, the IPT approach may be particularly useful for them. Debbie* stated that her husband, Yehudah*, caused her depression. When I met with the two of them, I noticed that almost all of their communication took the form of quoting rules to each other, and criticizing each other for not following them. “You’re the husband! You’re supposed to support me financially!” Debbie would say. “You’re the wife! You’re supposed to have a home-made meal ready for me when I come home every day!” Yehudah would respond. Their conflict, a classic case of role disputes, was making them both very unhappy. As they focused on improving their relationship, they developed alternative ways of communicating – actively listening, expressing ap-

preciation, asking for what they wanted instead of demanding or blaming, negotiating their differences – and they grew closer. Debbie was pleased with her improved mood, and surprised by her increase in energy. “Our marriage is not problem-free,” she said, “but we catch ourselves when we get into destructive patterns. We know what doesn’t work, we know how to do what does work, and, most of all, we’re working as partners: Now we’re on the same team.” IPT is demonstrated not only to reduce depression, but also to improve social functioning.

Acceptance and Commitment Therapy

Given how much they suffer, depressed people often struggle long and hard to eliminate or at least reduce their symptoms. They also frequently also avoid situations and activities that they believe may trigger depression. From the perspective of Acceptance and Commitment Therapy (ACT), this attempted “solution,” while understandable, is a big part of the problem. We all experience a range of inner experiences, including painful feelings, troubling thoughts, uncomfortable physical sensations and reactions, unwanted, intrusive memories, and problematic urges. That’s part of being hu-

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man. To a large degree, this is inevitable, and beyond our control. Not only can we not win the struggle, but the struggle – or the avoidance – takes our focus, attention, energy, and investment away from what really matters: the life we want to lead. ACT promotes a dual approach to

“ACT has been proven to be an effective treatment for depression that sometimes produces additional benefits after therapy is completed. …” reducing depressive suffering: Accept the inner experience: You don’t have to want it or like it, and you also don’t have to involve yourself with it, identify with it, fight it, or push it away. Then clarify your values and commit to acting on them. Use your resources to move toward a rich, full, meaningful life. Karen* struggled with depression for years, and it worsened after she relocated to a new community following a painful break-up. She criticized herself for her weight and her single status, as well as for not having met her vocational and financial goals. She wanted to help herself, and eventually identified some coping strategies that decreased her symptoms, but found that they did not do so consistently over time. When they didn’t work or when she didn’t use them, she’d blame herself and feel more depressed. ACT proved to be revolutionary for Karen. She concluded that she might never extricate herself from depressive thoughts and feelings, but that she need not entangle herself in them, either. Instead of revolving her life around managing or controlling her depression, she made a conscious and deliberate choice to focus on what was truly important to her. She appreciated and nurtured mutually supportive friendships. She started a job search for a position that offered more creativity and reward. She consulted with a nutritionist and developed an eating plan that left her feeling more satisfied and energized. She rediscovered her interest in art and resumed painting. She acknowledged her deep and genuine spirituality and sought and found a shul to whose rav and members she related. She spent more time outdoors appreciating nature. She realized her value of chesed through volunteer work. Her depression became less impactful as she cultivated her expanding and increasingly fulfilling life.

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ACT has been proven to be an effective treatment for depression that sometimes produces additional benefits after therapy is completed. The Mindfulness and Acceptance Workbook for Depression by the husband-and-wife team of Strosahl and Robinson is an excellent resource on this approach.

Medication

May 2014

Exercise

Aerobic exercise has been demonstrated to be an effective antidepressant. (There was once a psychiatrist who was so impressed with the research findings on aerobic exercise in decreasing both depression and anxiety, that he started conducting all of his sessions while running with his patients! Of course, aerobic exercise has other important benefits as well, especially in enhancing cardiovascular health.) There is some research that suggests that other forms of exercise, including strength training, also decrease depression. (Again, there are many physical advantages of strength training, especially for women over age 35.) Do all cases of depression require professional help? I believe that depression requires intervention. Some people, like Rochel in the example above, are able to undo depression by implementing their own self-help strategies. However, this can be hard to do because of the nature of depression: It decreases mo-

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tivation, energy, and hopefulness. It increases pessimism, discouragement, and helplessness. It interferes with thinking and creative problem-solving. It causes people to withdraw from their support network instead of engaging it. Also, in cases where depression leads to suicidal risk or severely impaired daily functioning, self-help may simply not suffice, or may not work quickly enough, and more intensive treatment may be needed. For these and other reasons, professional help may be the best option. To get the most out of therapy, you may wish to read Preson, Varzos, and Liebert’s short, practical book, Make Every Session Count: Getting the Most Out of Your Brief Therapy. *All identifying information has been altered, and case examples are composites of a number of different individuals. Sararivka Liberman, LCSW-R, has been a psychother-

apist for 30 years. For the past 20 years, she has provided supervision and training to mental health professionals. She currently serves as a Master Trainer in EvidenceBased Practice at the Jewish Board of Family and Children’s Services and an Administrative Supervisor at the agency’s Boro Park counseling center. She also maintains a private practice for adults in Flatbush. Contact information: 718.393.7750; sliberman@jbfcs.org.

DIAGNOSIS

There are a number of safe, effective medication options for many depressed individuals. As a non-prescribing psychotherapist, I strongly urge anyone considering antidepressant medication to consult with an expert in psychopharmacology – a psychiatrist or a specialized nurse practitioner – and to openly share their symptoms and questions. Many people deny themselves effective medical treatment because of unfounded fears of side effects and/or addiction. A responsible practitioner will discuss the benefits and risks of medication with you, and address your concerns clearly and honestly. A good clinician will include you as an important member of your treatment team. Because medication affects body chemistry, it may be just as important to communicate with your provider about stopping medication as start-

ing it; it is not safe to abruptly stop taking certain medications. Both Adina and Debbie, in the examples above, benefited from a combination of medication and evidence-based psychotherapy.


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Compassionate Parenting: The Secret to Healthy and Successful Children By Chana Kaiman, LCSW and Miriam Yerushalmi, MS

T

he quality of our closest relationships profoundly affects how we feel about ourselves. Our relationships have real and measurable consequences on our lives and those around us. The way we communicate both verbally and non-verbally affects the emotional, cognitive and physical development of our children, as well as our physical and mental health. Child-rearing is complex. Any parent can attest to the many rewards and equally distressing moments. Volumes of theories and practical approaches will not suffice to adequately explain parenting. Don’t we wish there was a manual? Each child is a unique, dynamic individual who changes almost daily. For parents to properly guide their children, it is important to consider the environment that the parents create at home. We primarily focus on the communication style between the adults, which is the template for the children’s present and future relationships. Chanie Geisinsky, a respected Rebbetzin, describes successful childrearing as 50 percent consistent chinuch (Jewish education) and 50 percent shalom bayis (atmosphere in the home). A healthy relationship between you and your spouse is critical to the success of every aspect of your child’s healthy development, both physical and spiritual. Treating your spouse positively in front of your children is paramount. Why are relationships one of the most challenging aspects of the human condition? The Torah teaches us that no element of life is devoid of meaning and purpose, and we believe that every interaction is divinely designed. So too, relationships are an important process that leads to completion (shleimus). We as human beings have a variety of emotions

and personality styles that impact the way we think and feel about the people in our life. In the midst of a contentious moment, it is difficult to grasp the higher purpose of elevating one’s soul to a more peaceful and unified state. Realize that provocations with your spouse, child or other, are all meant to result in you being more patient, enduring, understanding and tolerant. No one gets it right all of the time or even half of the time. Dr. Wile, originator of the Collaborative Couples Therapy model, states: “Solve the moment rather than the problem.” Perfecting relationships is a lifetime journey, one interaction at a time. When husband and wife get along and demonstrate respect for each other, it helps the children get along better, and also lays a foundation for children to respect their parents. It is acceptable to occasionally express disagreements amicably in front of children. According to Tina B. Tessina, author and psychotherapist, couples should definitely discuss many issues in the presence of their children. It teaches the children how relationships work. However, never let your children hear the two of you argue in a state of rage or anger; this is toxic! Seeing parents in such a state makes children feel terrified, unsafe, and heartbroken. In addition, when one parent yells and shames the other parent, the children witnessing these events feel ashamed as well. Our Sages teach that the greatest suffering is shame, and this is especially true in the case of children. Shame may cause a child such distress that eventually his life becomes unbearable and he may have little energy to achieve his potential. Even when one spouse may think the other needs to improve his/her communication, they should refrain from criticizing the other. It is better for a child to receive some overly strict discipline than to see parents fighting over this issue. Instead, after such an episode, when the spouse is not present, tell the children, “Tatty/ Mommy may speak very strongly to you, but know that we both love you and mean well.” When the situation has calmed down, the parents can work together on reducing the amount of stress in the home, making the other aware when they speak aggressively or act tense. Bringing up the topic in a calm atmosphere, which is particularly important if the spouse is sensitive to criticism, can help them reflect on their own behavior and be more open to change. For instance, a parent may say, “I think that we can both work on decreasing the stress in this home. Let’s help each other act more calmly in front of the children, especially when we have to discipline them.” By preparing a strategy in advance, a person can prevent many conflicts. If you cannot come up with an amicable solution, ask the advice of a Rav or a spiritual advisor who knows your spouse. New research has revealed that exposure to common family problems during childhood and early adolescence affects brain development, which could lead to mental health issues in later life. The study led by Dr. Nicholas Walsh, lecturer in developmental psychology at the University of East Anglia, used brain imaging technology to scan teenagers aged 17-19. He found that those who experienced mild to moderate family difficulties between birth and 11 years of age had developed a smaller cerebellum, an area of the brain associated with skill learning, stress regulation and sensory-motor control. The researchers also suggest that a smaller cerebellum may be a risk indicator of psychiatric disease later in life, as it is consistently found to be smaller in virtually all psychiatric illnesses. Dr. Walsh said: “These findings are important because exposure to adversities in childhood and adolescence is the biggest risk factor for later psychiatric disease.” Also, psychiatric illnesses are a huge public health problem and the biggest cause of disability in the world. Fighting is an indication that your communication isn’t working. When one or both parents are tired or stressed, an occasional

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dispute is understandable. However, ongoing conflicts are cause for concern and need to be addressed seriously.

Action Plan to Avoid Fighting in Front of the Child

May 2014

preparing his people in the desert as they were going to be involved in the mundane life, to get accustomed to sacrifice perfectionism and be at peace with the process of becoming complete. Shalom – making peace with inadequacies. Visualize Yourself

“Each child is a unique, dynamic individual who changes almost daily…”

Points for Practical Reflection

your children come home, consider that they may have had many “muddy moments” before coming through your door. Treat them with compassion. Do your best to help them feel better. At the very least, do not throw more mud at them. Following are some important points that can help dramatically improve the way you relate to your family.

Deactivate Your Ego When It Threatens to Upset Your Family

Take note when you allow your ego to get in the way of dealing with family issues. One way to break that habit is to pay attention to body signals that can warn you when you are about to lose control. For instance, before you raise your voice to yell, does your stomach tie itself into knots, does your nose flare, or does your face get hot? These body signals are warning you to take a deep breath and, if need be, walk away until you calm down.

Affirmations

Repeat the following affirmations throughout the day, even before a challenging situation arises: “I want to unite, not to win.” “I want peace, not victory.” “Making peace is the greatest victory.” “My goal is to give peace of mind, not pieces of my mind.” “Shalom bayis is the surest path to raising emotionally healthy children.” “My efforts to become a positive role model will maximize my success as a parent.” Let’s keep in mind that beyond all the pragmatic benefits of improved relationships, shalom bayis is a mitzvah for the purpose of perfecting the soul. The reason why the Jewish people gave the peace offering (korbon shlomim) soon after matan Torah was because they had reached a spiritual state of elevation. Hashem was symbolically

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Not Criticizing Your Family Members

They are the most precious part of your life. Picture yourself refraining when feeling the impulse to act unkindly.  Cultivating an attitude of gratitude helps give your partner a feeling of security, which in turn brings peace and harmony to a home.  Helping your spouse selflessly benefits you spiritually and physically, because acting generously enhances your health and longevity.  In order to promote peace in your home, heal your relationship to money, whether you spend too much or too little.  Raising your voice in anger, speaking sarcastically, or otherwise belittling your spouse or children, indicates that your animal soul has taken over.  When one spouse expresses patience, perseverance, and a deep commitment to the marriage, amazing turnarounds can be achieved, even when the partner is the chief cause of the problems.  When a spouse helps their partner feel confident and self-accepting, they will treat one another as equals and even as superior.  A parent must model the qualities of thoughtfulness, sensitivity, and generosity that will set the standards for the children.  Professional counseling that is sensitive to Torah ethics and values may be useful in helping you achieve healthier perspectives on your marriage.  A spouse should strive to be the partner’s cheerleader rather than being an adversary. Miriam Yerushalmi holds an MS in Psychology and

Family Therapy. She was trained at Pepperdine University and is uniquely skilled at combining behavioral and humanistic approaches to address a wide spectrum of psychopathology. Miriam works in private practice with families and children, restoring healthy functioning through multisensory systems approach. Miriam lectures internationally and has over 250 audio classes available on CD. She authored multiple books on marriage, family and mastery of emotional self-integration. Additionally, Miriam leads a non-profit organization, providing a resource for the needy to access appropriate Mental Health care. Chana Kaiman, LCSW is a psychotherapist, lecturer and author whose specialty is in working with children, adolescents and families. She earned her degree at Wurzweiler School of Social Work. Chana has background training in the Interpersonal/Relational model and applies psychodynamic strategies for stabilizing crisis cases at IDCC. She brings a unique approach to collaboration of supports in treatment. Chana can be reached at chanat01@aol.com.

RELATIONSHIPS

V Turn around and walk away if you think you’ll have a hard time dealing with your urge to fight. Recognize that when you don’t walk away, you are putting your need to vent ahead of their well-being and peace of mind. V After you walk away, write down everything you’re thinking and feeling, so you can discuss it later when the children aren’t around. V If you’re going to have a discussion, take it somewhere private. Deal with your spouse closely and personally to minimize distractions and interruptions. Express your needs to your partner; they may not know what those needs are. Be articulate, state what you need, plainly and specifically. Remain calm. V Work out the problem. Cooperation, not competition, is needed to find a solution to the issue. V Share a moment of peace, and verbalize your feeling of resolution like saying: “I’m glad we talked” to reaffirm your bond once a decision has been reached. A teacher moved to a town and began giving a shiur, which quickly became popular. One of the established teachers thought that the teachings were cultish, so he slandered the new teacher and urged people not to attend his shiur. One rainy day, as this teacher was walking down the street, he saw the new teacher slip and fall in the mud. The teacher hurried over to him. He bent down as if to help the fallen man, but instead picked up some mud and threw it at him, hissing disgustedly: “You deserve it!” then he walked off. The new teacher got up and ran after the other man. “Wait, teacher, please!” he called out. The teacher continued walking, but the mud-stained teacher called out again: “Please wait!” The teacher slowed down slightly. “Please, teacher,” the new teacher gasped, “please, accept my apologies. I do not know exactly how I have hurt you, but the pain I caused you must have been great for you to hate me.” Both men stopped walking. The new teacher asked humbly: “Please tell me, what I have done to you? I must know so that I can do teshuvah properly.” The other teacher was taken aback. For a moment, he doubted the new teacher’s sincerity, but searching the man’s mud-streaked face, he only saw true humility. Astonished and ashamed, he thought to himself: “This is a G-dly man before me!” He embraced the new teacher and said, “It is I who must do teshuvah.” After that, the relationship between the two men improved. They began studying together and became close friends.

This sort of self-reflection is especially important in regard to your relationship with your children. When they behave disrespectfully to you, stop and think to yourself: “What have I done to cause them to be in this mood?” There is a second lesson to glean from this story. Every day children are under pressure from parents, teachers, bus drivers and siblings. They “fall in the mud” many times over the course of the day. When


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Living with Obsessive Compulsive Disorder (OCD) By Dr. Pamela P. Siller, MD

TREATMENT

I

do not have OCD. I just need to work on my middos... Many people are familiar with the publicized symptoms of OCD (Obsessive Compulsive Disorder). These stereotyped symptoms generally include excessive hand washing and turning lights on and off multiple times. Although this is correct, these are not the only ways that OCD can manifest itself. Bracha entered into my office reluctantly, stating that she came because she needed to work on her middos. When asked to elaborate, she explained that she was always worried that she was not as popular as her sisters, and that her children will not be as well-liked either. She described these thoughts as bothersome, and difficult to accept. She reported that she found it very difficult to distract herself when these thoughts began, and when she tried to think of a diversion, she became increasingly uncomfortable. She found herself counting all of her friends’ names in her head in order to count how many people “liked” her. If she said a name out of order, she had to start over. In order to deal with these thoughts, she began to learn Pirkei Avos (Ethics of our Fathers), and concluded that she needed to be happy with who she is, as “one who is rich is happy with what he has.” She decided to seek treatment when she became increasingly frustrated with her inability to “become a better person.” She began to lose sleep because of these thoughts, and food began to lose its appeal. Concentration suffered as these worries became increasingly overwhelming. After careful questioning and explanations, she was able to understand that this was not indicative of a character flaw. Rather, this was a symptom of a psychiatric condition on the anxiety disorder spectrum. Obsessive Compulsive Disorder consists of obsessions, defined as “unwanted intrusive thoughts,” and compulsions, which are “actions performed to ward off the obsessions.” These obsessive thoughts could range from the thought to physically hurt somebody, (voiced by a mild mannered, docile older female), to the fear of contamination and germs which was thought to lead to immediate death if a doorknob was touched by the bare hand. These thoughts usually cause great

distress to the person, which may further confound the diagnosis, as secondary depression (with the associated symptoms of change in sleep, appetite, energy level, and concentration), may occur. Compulsions are usually bothersome as well, as the person feels that they cannot control these actions and they do not make sense, yet they cause a significant feeling of discomfort and anxiety when they are not immediately indulged upon. They often are linked directly to the obsession, such as hand washing excessively when the obsession involves germs, but at times they do not correlate directly, such as the need to put on the right sock six times. Treatment for OCD can consist of both therapy and medication management. Both can be helpful if done properly. The mainstay of medication management consists of using an antidepressant, such as Zoloft, Prozac, Paxil, Celexa or Lexapro. The most efficacious of this category includes the lesser known Luvox and Anafranil. Usually the dosages effective for OCD are higher than utilized for depression or anxiety. Therapy for OCD is often cognitive-behavioral, which includes exposure and response prevention. The premise of response prevention is exposing the person to the feared stimulus for increasingly longer periods of time, before the compulsion is allowed to be performed. The cognitive portion includes recognizing and dealing with the catastrophic thoughts and/or exaggerated sense of responsibility. Usually this therapy is short-term, and is often very successful. Education regarding the origins of anxiety and OCD is often very beneficial as the stigma and fear can be overwhelming. It is imperative to understand that this is a medical/psychiatric condition that does not reflect on one’s character traits and value/worth as a person. Rather, it needs to be treated as one would any medical anomaly, so as to restore, a happy, healthy and productive lifestyle.

“Compulsions are usually bothersome as well, as the person feels that they cannot control these actions and they do not make sense, yet they cause a significant feeling of discomfort and anxiety when they are not immediately indulged upon…”

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Pamela P. Siller, MD is a Board Certified Child, Ado-

lescent and Adult Psychiatrist who provides medication management as well as individual and family therapy to children and adults. She maintains a private practice in Great Neck, New York. Dr. Siller is also an Assistant Professor of Psychiatry at Westchester Medical Center, where she is the Division Chief of the Child and Adolescent Psychiatry Division and is a staff psychiatrist at Interborough’s mental health center in Brooklyn.

May 2014


& MIND, BODY SOUL

Attending Couple Therapy When One Partner is Absent By Dvorah Levy, LCSW

I

May 2014

Dvorah Levy, LCSW is a psychotherapist in private

practice working with individuals and couples and specializing in relationship issues: marriage, parenting and dating. She maintains offices in Hewlett and Flatbush. Dvorah is trained in Emotionally Focused Couple and Gestalt therapies. She can be reached at 516.660.7157.

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Therapy

deally, for a couple to work on their marriage, it is best to have both partners come in to therapy. Unfortunately though, that doesn’t always happen. Many times one spouse cannot convince his/her partner to join him/her, and that’s when one partner ends up in my office alone. What happens then? Can couple therapy actually work with just one partner? Sara felt very criticized by her husband. He tended to point out the very thing that hadn’t been done yet or wasn’t done right when he came home from work at the end of the day. He was quick to comment negatively on her driving, and just about anything else she did. Her patience for tolerating this much criticism was wearing thin, and she found herself snapping at him and then withdrawing into a cold silence. Sara was becoming increasingly dissatisfied with her marriage, and we could assume that her husband shared a similar experience. However, he was not willing to come into couple therapy. In our first session, Sara asked if therapy would help if she comes in alone. The answer came with time. Sara now knows that her individual therapy sessions have helped, both individually and in her marriage. Couples engage in cycles of interaction. Interactions that feel good become positive cycles; interactions that are conflictual and leave partners feeling distant are often self-perpetuating negative cycles. How we hear or perceive our partner determines what we think, which influences what we feel. And what we feel often determines what we do. A couple’s interaction can be likened to a dance. Dance steps are determined by music, which in the case of relationships, are one’s emotions. We feel something, then we do something. A common cycle in relationships begins when we perceive hurt, which is then followed with instinctive attack or withdrawal, two knee- jerk reactions that ensure distance rather than closeness and perpetuates a cycle of hurt and misunderstanding. The power to change a negative cycle lies in changing how we hear and understand our partner, and how we respond when we feel hurt. This is what couple therapy targets. In session, Sara was able to identify why her husband spoke to her so critically. In this particular case, she understood it was his anxiety. Working hard and balancing the financial needs of the family was a huge strain, and when her

husband anticipated waste, carelessness or ineffectiveness, he was triggered to feel anxiety. We would have helped her husband describe his experience if he were coming to sessions but since he wasn’t, Sara intuited what she thought may be going on for him. Sara developed a new lens from which to hear and understand what her husband was saying when he sounded critical. The thought that it was not that she was doing something wrong when he spoke to her critically, but rather was experiencing his own distress, enabled her to feel compassion. After all, they were in the same financial boat, and his caring and hard work was something from which she benefited. This more compassionate and understanding thinking created an alternative response. No longer did she require her knee-jerk protective stance of defending herself by verbally attacking or withdrawing, now she was more likely to respond with: “I know this upsets you. I will try to stop,” or with problem solving: “If the mess in the house is unnerving to you then we can…” (whatever that solution may look like.) Once Sara showed understanding as to where her husband was coming from and began to respond to him more sensitively, his response to her changed. He was soothed, felt calmer, and this translated into his being less critical. In a dance, when one person changes their steps, the other is forced to follow or toes end up getting stubbed. So too in the marriage “dance.” As one person works on him or herself and subsequently grows and changes their reactions, it is likely that the other spouse will also change his or her sequence of reacting and responding. To work on a marriage, it is preferable that couples come in to therapy together. Hopefully, they can then work on gaining insights into their cycle of interaction, into themselves and their partner. Emotional safety, connection and intimacy are enhanced through understanding the layers of actions and reactions, that “dance” that goes on between couples. However, for those times when only one partner is ready to come in, it is possible to be in couple therapy alone and improve one’s marriage.


& MIND, BODY SOUL

Being Part of the Group

TAFKID

assists families whose children have been diagnosed with a variety of disabilities and special needs.

Services provided by TAFKID include:

D Family Support Services & Information D Educational Advocacy D Individual Case Consultation D Referrals to Doctors, Therapists, Schools and Government Programs

D Parent Matching D Family Recreation Programs D Parent Training and Meetings D Guest Lecturers D Community Sensitivity and Training D Informational Publications D Pediatric Equipment Lending Program D Tape/Video Lending

Therapy

is a not-for-profit organization services are free of charge to all families. For more information call TAFKID at (718) 252-2236 or e-mail: tafkid@aol.com

By Audrey Grazi, LCSW

A

s a graduate social work student in 2008, my vision for helping people was exhilarating and somewhat idealistic. My favorite part of the school semester was going to the NYU bookstore to purchase the required books for my classes and browse through some of the other sections to see what the future would bring for the other courses that would be coming my way. I didn’t know what to expect from the group therapy course I was about to begin, but from the looks of the big fat books I was purchasing, it seemed I had a whole bunch of information to learn. As with all the knowledge that I gained in graduate school, my hope was always to bring it back to my community as a way to help others. And, as it turns out, group therapy has tremendous potential to help people on their road to recovery. Groups vary in style, structure and content. Whether it is a support group, self-help group, psychotherapy group, open-ended or closed group, confidentiality remains the central premise for helping groups succeed and be used as an important intervention. Group therapy programs are becoming a growing modality for community mental health centers and for private practitioners, as it can be cost effective and have lasting and satisfactory results. Group therapy has the potential to help people in various ways that individual therapy cannot. Social group work requires leaders to bring hidden and underlying issues and feelings to the surface, in a public way. Many times this can be a deviation from societal norms, as well as a crossing of boundaries that clients think are taboo. However, it lies within the skill of the group leader to be able to break through individuals’ inhibitions and facilitate the group in a way that allows the client to examine and grapple with all positions and options involved, which will make the process a success. The leader can be vulnerable and flexible, but at the same time, be able to take and give control in ways that benefit the group and the individual at the same time. The group interaction becomes valuable for reflection and understanding by members. When members are experiencing similar situations, they can effectively come together to provide each other with acceptance, reassurance and encouragement. This decreases isolation and stigma, promotes problem solving, accesses strengths, develops common interests, provides information and education, facilitates mutual aid, changes attitudes and behaviors and allows clients to find new ways of relating to others. Regularly talking and listening to others can be a helpful way of putting your problems in perspective. When hearing others speak about similar experiences and issues, group members feel some relief knowing that they are not alone.

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Being part of a group offers diversity from people with different personalities and different backgrounds, which helps to see things from a new lens. By understanding how other people tackle problems and make positive changes, members can discover a whole range of strategies for facing their own concerns. Group therapy allows for an expert facilitator, as well as group members, to help contribute to learning many ways of coping with anxiety, depression, trauma, bereavement and emotion dysregulation. When choosing a group, one thing to consider is whether it is an open or closed group. An open group allows for new members to join at any time, while a closed group is when all the

members join the group at the same time. Like most things, both have their advantages and disadvantages. An open group means you can join at any time, but it also means there may be an adjustment period for a newcomer to be part of an existing group. Closed groups will only contain the same members you started the cycle with, but it may mean having to wait for the next group to start. Another thing to take into account is how many members are in the group. Small groups may allow for more individual attention, but larger groups offer more diversity and variety of opinions from more of its members. It is common for people to participate in both individual and group therapy as methods of treatment. With the support of both, one can boost his/her chances of making lasting and valuable changes. Group therapy may enhance personal growth when progress in individual therapy has been stalled. Open and honest communication and confidentiality make for good, solid groups. The bond formed from a group of people who are at first strangers, can be amazingly strong, supportive and healing. Audrey Grazi, LCSW currently has a private practice

providing individual and group therapy. DBT group forming now, Dialectical Behavioral Therapy groups help individuals regulate emotions using effective coping skills. For more information, email agrazi48@gmail.com.

May 2014


& MIND, BODY SOUL

Six Easy Steps to Foster Emotional Resilience in Retirement By Joel Verstaendig, PhD

“D

May 2014

Dr. Joel Verstaendig, a “Baby Boomer,” is a psychologist

with over 30 years of clinical experience. He is an engaging public speaker whose presentations are informative, educational,and entertaining. He can be reached at: drjoelv@aol.com or 516.933.6196. Visit his website, at www. drjoelvpsychology.com.

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Serena Wieder, Ph.D.

CLINICAL PSYCHOLOGIST Co-Creator of the DIR Model

Is pleased to announce the opening of her New York practice for Autistic Spectrum, Sensory Processing and related emotional and learning disorders at all ages. Co-Author of The Child with Special Needs, Engaging Autism and Visual Spatial Portals to Thinking, Feeling & Movement

575 West End Ave (88th Street) Ground Floor A New York, New York 10024 Phone: 240-423-3673 E-Mail: serenawieder@gmail.com

Self-Improvement

on’t trust anyone over 30!” This was one of the battle cries of the “Baby Boomer” generation during the 1960’s. It is sobering to realize that these same people have reached or will soon reach the age of retirement. While the media is saturated with information and recommendations for the baby boomers regarding the need for an adequate retirement income, little or no thought is given to the emotional needs and challenges of the retiree. This is unfortunate as there certainly are many stressors related to retirement. Consider the following vignette: Several years ago, my brother-in-law and I were watching a group of children playing together at a neighborhood birthday party. At one point, he pointed to one particular child and said: “That child needs treatment.” I was bewildered. At that time I had been a practicing psychologist for almost 25 years and I had known that child for many years, yet I had never been cognizant of any emotional issues. Furthermore, my brother-in-law is not a mental health professional. What was he noticing in a brief observation that I had not discerned over the years? Finally, with some trepidation and embarrassment I asked what he had seen. “Look at that overbite!” he exclaimed. My brother-in-law, you see, is an orthodontist. We were both watching the same child, but from our respective professional perspectives. Yes, our jobs and professions not only help us define how we view ourselves, but to a large extent they can affect the way we view the world. It is, therefore, understandable that retiring can lead to an emotional upheaval, resulting in a loss of selfesteem and a depletion in one’s sense of purpose. In 1996, Fortune Magazine published an article about Lee Lococca, the man who brought Chrysler back from the brink of bankruptcy in the 1980’s. He had retired for about three years, but then returned to work. He stated that his three years of retirement were more stressful than his 47 years in the auto business. He said that he missed his old friends and the structure of his job. In that article he wrote: “You can plan everything in life and then the roof caves in on you because you haven’t done enough thinking about who you are and what you should do with the rest of your life.” Examples of retirement stressors are many. For example, after one retires, one may begin to miss the workplace challenges, and the camaraderie that was shared with co-workers. The relationship between spouses can deteriorate. For example, if a retiree was an administrator at work, he/she might now decide to exercise his/ her administrative authority in the home. If a

retiree is not engaged in fulfilling activities, the lack of meaning in his/her life can lead to boredom and depression. Most important, one might feel distressed facing the fleeting nature of time. Most of us go through life rarely considering our mortality, and we conduct our lives as if we have an unlimited amount of time for living. Retirement represents a hard to ignore wakeup call for the retiree that he/she is in the final stage of life. So what can one do to foster emotional resilience in retirement? Here are six steps that can assist us in this endeavor: V Recognize that retirement has its own set of challenges. The first step in dealing with any problem is to recognize it and define it. Conduct an honest assessment of your retirement stressors and acknowledge them. Once this is done you can strategize and develop a plan to address them. V Evaluate your life up to the present, and explore what you would have liked to do, but did not. Consider what prevented you from engaging in these activities. Can you do them now? What has to be accomplished in order to initiate the process? V Take the time to face the fact that life is transient. Life can be so much richer if we accept this hard cold fact and focus on the things in life that are truly important rather than waste time and energy obsessing over silly concerns. Warren Zevon was interviewed on the Late Show with David Letterman following his having been diagnosed with terminal lung cancer. Letterman asked Zevon if there was anything he understood now, facing his own mortality, that he didn’t before. Zevon replied: “Just how much you’re supposed to enjoy every sandwich.” V Increase your sense of gratitude by taking the time to acknowledge all of the good things in your life. Research has shown that making an effort to actively appreciate all of our blessings, the minor ones as well as the major ones, is strongly correlated with a sense of optimism, satisfaction, and contentment. V Resolve to live a life of self-compassion and dispute your self-limiting beliefs, laugh more, and live life in a mindful manner. V Eat well and exercise as appropriate. A healthy diet and physical exercise are essential for a sense of well-being. The retirement years can be the best years of your life. Using the above six steps as guideposts will help enrich them with fulfillment and meaning.


July 31, 2014

Mbs may 2014