Wellington Counseling Group

Wellington Counseling Group

Wednesday, 20 November 2019 13:16

Children and School-Related Stress

School. As a parent, what feelings were elicited for you as you read that word? Was it excitement? Worry? Dread? Stress? Pressure? For some, school is all about fun, friends, and an ease of fitting in with peers. While there can surely be excitement surrounding the social atmosphere, a genuine feeling of love of learning, and of being challenged academically, for many, school brings about feelings of anxiety and/or dread. The school setting can be an awkward environment for many students. For some, this anxiety is experienced as an internal dialogue: “Is the teacher going to call on me again,” “This class is impossible,” “Everyone but me seems to get what we’re doing,” or, “Will I have anyone to sit with at lunch today?”

Although anxiety around attending school is usually rooted within a deeper issue, school refusal affects 2-5% of school aged children (www.adaa.org). No parent wishes for their child to experience feelings of discomfort or alienation when going somewhere where they will spend the majority of their formative years. As parents, we hope our children will spend their school days engaged in learning and developing as social beings, comfortable in that ever-shifting set of demands and opportunities.

Some reasons students experience anxiety or fear about attending school may include:

1. Social Media. Technology can be a great and wonderful tool. Many schools encourage students to use technology for homework, projects, and even class work. While the benefits to using technology are numerous, there are complexities and negative aspects to its ever-growing use in schools, as well. Navigating social media as a pre- teen/teenager can be emotionally fraught and can exacerbate the feelings of stress and anxiousness a teenager may already experience.

2. Academic Stress. Stress for students during the academic year is understandably higher than during the summer months. Academic pressure--whether emanating from the home environment or the demands of the child’s program--can start to mount at a very young age and typically continues well into the college years for many students. Stress of this magnitude will affect a child’s physical and emotional wellbeing if not appropriately managed in a healthy way. In one related study, students self report having unhealthy levels of stress. Not only are they stressed to elevated levels, but students are also reporting they are unsure of how to appropriately manage that stress, which for some becomes chronic and year-long.

3. Social Conflict. Pre-teens and teenagers are at a developmental stage where friends play a more crucial role in their everyday lives and development than ever before. Your child will be testing limits while trying to negotiate new autonomy, independence, and a sense of who they are; this is developmentally normal, even desired. In doing so, however, there can emerge new family conflicts, intensification of emotions, and misconstrued communication that can leave previously happy households feeling like hormonally-fueled war zones.

At Wellington Counseling Group, we are committed to helping your young person navigate this difficult and confusing time in their lives. Our summer group titled, The Journey From Summer to Fall & Everything After, will tackle topics that pre-teens and teens are interested in discussing, and this summer, we will be running two separate groups: One for students in grades (entering) 6th-8th and one for students in grades (entering) 9th-12th.

Our group leaders foster a safe and inviting environment where pre-teens and teens can feel comfortable opening up with peers their own age to have honest discussions about their school experiences and how to manage and navigate the everyday challenges they encounter and will face in the Fall.

For more information, please contact Ashley Hodges, MSW, LCSW by phone at: (312) 738-8285, or email at This email address is being protected from spambots. You need JavaScript enabled to view it..

Resources:

Nieghmond, Patti. National Public Radio. School Stress Takes a Toll on Health, Teens and Parents Say. December 2, 2013.

Shaffer, Leah. Harvard Graduate School of Education. Social Media and Teen Anxiety: How parents can help their kids navigate the pressures of their digital lives—without pulling the plug on the positives. December 15, 2017. https://www.gse.harvard.edu/news/uk/17/12/social- media-and-teen-anxiety

Shapiro, Margaret. The Washington Post. Stressed-out teens, with school a main cause. February 17, 2014. https://www.washingtonpost.com/national/health-science/stressed-out- teens-with-school-a-main-cause/2014/02/14/d3b8ab56-9425-11e3-84e1- 27626c5ef5fb_story.html?utm_term=.80366ff47907

Wednesday, 20 November 2019 13:06

How to Help a Friend Who is Suicidal

This is the final story in a 3-part series about depression and finding support. This installment is directed primarly at those who have an affected person in their life, whether family or friend.

Every day, 123 Americans take their own lives, making suicide a leading cause of death in the United States and an undeniable public health crisis. The Centers for Disease Control recently reported that the rate of suicide has increased by 30% since 1999. Forty-nine states saw a rise of suicides in 2016.

While the data paint a grim picture, there is hope. One of the 12 known warning signs of suicide is isolation, which means that loneliness is a significant risk factor.

This is where your friendship comes in.

Before continuing, I want to emphasize that anyone who is suicidal needs to contact a medical or behavioral health professional for immediate evaluation and treatment. This article isn’t about your being a proxy or saving the day. Rather, it’s about giving you the tools to be a key member of your friend’s support system. Your role as a friend is to be there even if you’re not asked to be, and to address the topic of suicide and discuss it openly because that’s one of the most helpful things you can do.

Here’s how you can make a difference:

Be an Advocate: What to Say to Someone Who You Think is Suicidal

Few people know your friend better than you, which puts you in a good position to recognize if her behavior is out of the ordinary. Some warning signs and suicidal thoughts are clear as day: if your friend is talking about wanting to die or kill herself, it’s a red flag that requires immediate attention. Other signs, like withdrawing, or sleeping too little or too much are not so obvious or definite. If you’re worried, open the dialogue using these recommendations from the National Suicide Prevention Lifeline:

  • Be direct. Talk openly and matter-of-factly about suicide.
  • Be willing to listen, allow expressions of feelings, and accept the feelings.
  • Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad. Don’t lecture on the value of life.
  • Don’t act shocked. This will put distance between you.
  • Offer hope that alternatives are available but do not offer glib reassurance.

In addition, ask the following questions:

  • Do you have a therapist?
  • Have you seen your therapist this week?
  • When are you next seeing them?
  • Do they know about your thoughts on this?
  • Are you worried that you might hurt yourself?
  • How long have you been feeling like this?
  • What are things that have helped you in the past when you feel this way?

Offer to sit with your friend as she calls her therapist, or if she doesn’t have one, help her find one. If you happen to know her therapist, you can contact them directly to inform the therapist that you are worried and to please follow up with your friend (note: There is no privacy law that prohibits the therapist from taking a call from you, listening, or taking action regarding the message you might leave with them, which might take the form of a check-in to your friend. But, without an authorization from your friend, they simply won’t be able to acknowledge they are treating them, nor will they offer information about the treatment).

My Friend Sounds Desperate. What the #%$@! Do I Do Now?

In an acute situation where your friend is on the verge of a suicide attempt, call 911. If you can physically be with him, stay by his side--and safely store any medications and/or firearms--until an ambulance arrives. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255. Here’s what you can expect in either scenario:

Calling 911:

  • Share all the information you can with your 911 operator. Tell the dispatcher that your friend is having a mental health crisis and explain his mental health history and/or diagnosis.
  • When an officer arrives at the home, say "this is a mental health crisis." Mention you can share any helpful information, then step out of the way.
  • The officer or paramedic can often talk to a person who is upset, calm him down and convince him to go to the hospital voluntarily.
  • In certain circumstances, police can compel a person in crisis to come to the hospital involuntarily for a mental health evaluation. The laws vary from state to state.

Calling the National Suicide Prevention Lifeline:

  • First, your friend will hear an automated message featuring additional options while the call is routed to the local Lifeline network crisis center.
  • A trained crisis worker at the local center will answer the phone.
  • This person will listen to him, understand how his problem is affecting him, provide support, and get him the help he needs.

It’s important to note that, as a friend, there’s only so much you can do. You are not responsible for saving your friend, but you can help him to safety. To use a boating metaphor, If someone falls overboard, you don’t have to be a strong swimmer to save them, but you can throw the life ring to them. Being present and not just a bystander is significant.

Checking In: Staying in Touch Can Have a Tremendously Positive Impact

You can't be with your friend at all times, and she may not always be in imminent danger. She may still be at risk, however, which is why checking in with her is important. You can tell her, “Listen, I’m going to keep calling you everyday, and if you don’t pick up, I’m going to worry.” You can also involve other friends and create a calling/texting chain to demonstrate your support.

Check on the welfare of your friend if you are worried about her or can't reach her. Call 911 to reach the first responders in your community and explain why you are concerned. Ask them to conduct a "welfare check." It is very important to consider the wisdom of conducting your own, in-person welfare check: It is my recommendation that you defer the welfare check to the professionals in your community, in order to protect your own emotional well-being in the unfortunate instance where you may be the first person to discover the aftermath of a “successful” suicide. The traumatic aftermath of discovering that a loved one has ended their life can leave life-long emotional scars.

Conclusion

Be there. Be there for your friend. You are not an expert but a conduit to the proper professionals in a time of crisis. You should know that the love and support you express is immeasurable and can help your friend during the worst of times. Understand the resources that are available to your friend, including his/her therapist, other friends, and emergency services. Be mindful of the warning signs, and always check in. Don’t be insulted if your friend thinks you’re being a pain in the ass--that means you're doing your job.

Postscript

  • One of the most stunning paradoxes of suicidality is that, sometimes the suicidal person is actually happiest during the days just preceding a suicide attempt and can appear quite up-beat. He’s reached a tonic point and is at peace because he’s made a plan. He has a new sense of hope that his pain will disappear and that his life and the people around him will all be better off for his choice. Be aware that this is not spontaneous recovery, but a red herring of the deadliest kind.
  • Nine of out ten people who attempt suicide and survive do not go on to complete suicide at a later date. It is not uncommon for survivors to gain perspective upon seeking treatment and go on to live wonderful lives.

Dr. David Rakofsky is a Chicago-based clinical psychologist and the founder of Wellington Counseling Group in Chicago and the northern suburbs.

This is the second in a 3-part series for those facing depression and hoping for help. It may also be a beneficial read for those who have a loved one showing signs of depression. Previously, we discussed how to recognize the hallmark signs of depression and how to respond.

Progress isn’t always linear when it comes to mental health treatment, especially for people with depression. Even if you are receiving treatment, your depression may stop getting better or may even worsen. Depression hurts emotionally and physically, and your level of pain is a good barometer of its impact on your quality of life. Specifically, there are several ways to tell if it’s getting worse:

  • You have extended periods of time when you notice your mood is not improving
  • You’re unable to function in your daily activities
  • You are sleeping too much or not enough
  • You are eating too much or not enough
  • You feel restless
  • You have increased feelings of hopelessness
  • Activities that usually made you happy no longer interest you
  • You keep crying without an identifiable reason or trigger
  • You feel irritable
  • You wake up several times during the night
  • You are having difficulty concentrating
  • You are experiencing physical symptoms, such as headaches and upset stomach, lethargy or inability to just get off the couch or out of bed

If you are experiencing any of these symptoms, despite receiving treatment for your depression, keep plugging away and remember to advocate for yourself. It just means you might need a different approach.

Start With Your Therapist

If you don’t think your therapy is working, start by talking to your therapist. Be direct and ask if there is a different approach you can try or if there is anything you can do make your therapy more effective. Seasoned therapists are trained in many different approaches to help people struggling with depression. Perhaps, if you feel comfortable with your therapist, he or she can try to engage you in a different way that is better suited to you and where you are at this point. If you feel you require action items or “homework” to make progress, convey that. Effective treatment is certainly not a one-size-fits-all endeavor.

Consider Switching Therapists

Not every therapist is a perfect match for everybody. If you don’t feel that she or he is a good fit to help you, that’s OK. Trust your gut. Express your feelings, and your therapist may even refer you to another professional who will fit so much better. You can say, “I’d like your help in finding someone who’s a better fit for me.”

If your current therapist is unable to help you, why not check with your insurance company? They can provide a list of all the other therapists who are on your insurance plan. Discussing the discontinuation of your current therapy can be a tough conversation because you are already comfortable with your therapist, and you believe he or she has your best interest at heart. At the same time, if you are more comfortable making a clean break, go ahead. While I’ll almost always encourage having this discussion with your therapist, if you aren’t comfortable with them for whatever reason, you really don’t it owe to them. (Of course, it’s always good form to give someone the courtesy of learning in advance that you won’t be returning).

The idea of starting over with a new therapist can feel overwhelming and may even deter people from exploring other options. However, you don’t have to begin from Chapter One and retell your life story, if that’s your main concern about making the switch. You’ve most likely begun to process that material with your previous therapist, and you can allow the biographical information you previously shared to come out over time, session-by-session with a new therapist.

Explore Medication

If therapy alone isn’t helping your depression symptoms, you may want to consult your medical doctor (or your trusted therapist) about adding a medication. If you’re currently taking medication, it may be time to try a new one. While many medications are available today for depression, it often requires trial and error to find the one—or the combination—that works best for you. Medications also take time to work. Even the right one for you can take up to four weeks before any improvements are experienced.

Stay Busy Between Sessions

While trying different approaches, there are other things you can do to help keep your symptoms in check. Some suggestions include:

  • Stay active/exercise
  • Spend time with people you trust
  • Set realistic expectations. Your mood may improve gradually
  • Take time to educate yourself about depression

Remember, treating your depression takes time. Sometimes the first approach or first therapist isn’t the right fit for you. This is why it’s important to not give up, but rather, empower yourself by changing up your treatment plan when needed. Not everyone who suffers from depression experiences the same symptoms. Similarly, not everyone benefits from the same exact treatment. This is why it is important for you to learn what approach will best help you.

Dr. David Rakofsky is a Chicago-based clinical psychologist and the founder of Wellington Counseling Group in Chicago and the northern suburbs.

This is the first in a 3-part series for those facing depression and hoping for help. It may also be a beneficial read for those who have loved ones showing signs of depression. Previously, we discussed how to respond to episodes of sadness, but depression is different, as it is a clinical issue.

Let’s start from the beginning. How do you know if you are depressed? The most common symptoms of depression are: insomnia, difficulty concentrating, trouble remembering things and making decisions, loss of appetite or overeating, losing interest in things you used to enjoy, lingering feelings of sadness, and even thoughts of suicide. If you do have serious and persistent thoughts of suicide, please don’t wait to seek professional help. Instead, immediately head to the emergency room and be open with them about what you’re experiencing.

Another typical symptom of depression is isolating yourself from others, like friends and family. While this separation may feel comforting in the moment, a pattern of pulling away and avoidance can trigger shame that is sure to deepen your feelings of despair and loneliness. It also may lead you to miss out on activities you normally enjoy.

Although men can definitely experience depression, it is twice as common for women to suffer from the disease. This can perhaps be explained by the hormonal changes women experience, such as premenstrual shifts that can occur with each monthly cycle; the hormonal changes that occur with pregnancy; postpartum depression following a birth; perimenopause and menopause. Of these, postpartum depression is the most common and can be the most severe, according to the Centers for Disease Control. In fact, postpartum depression can even cause you to doubt your ability to care for your baby, and in extreme cases can lead to obsessive and intrusive thoughts about hurting yourself or your newborn.

Sometimes, depression can be caused by other underlying physical disorders. For this reason, if you have not been previously diagnosed with major depression by a medical or mental health professional, see your doctor to make sure your new and troubling mood isn’t better accounted for by some other, medically-based abnormality. It is very important to not self-diagnose your depression.

If your doctor offers you only medication or a referral to a psychiatrist or other medicating specialist, ask for some names of therapists who they already trust; depending on your severity, it may behoove you to consider counseling as an initial treatment before transitioning to medications. Talking to someone who is professionally trained to help with depression is a critical part of the process to manage your symptoms. Finding the right therapist is key. You can obtain an online list of names from your health insurance provider if it helps to narrow your search. Look for a therapist that specializes in helping people suffering from depression, and make time in your schedule to see your therapist at least weekly until symptoms improve significantly. Consistency is important when working with a professional, so make sure you feel comfortable with your therapist. It’s OK to meet with a few therapists until you find the one that feels right for you.

After you have a few sessions with your chosen therapist, he or she may conclude that medication, along with continued therapy, may be beneficial for you. If so, your therapist may refer you to a psychiatrist or nurse practitioner, medically trained and licensed professionals who carefully manage medications until the right combination is found. In some cases, you may even be able to visit your regular doctor for the right medication. But remember that medication alone typically isn’t enough. It is important to continue your work with a therapist.

Treating depression is a process, often one that takes time. Allow yourself that time. It’s easy to be spoiled by the fast therapeutic effect experienced during the first few therapy sessions. You may feel hope begin to be restored fairly soon, actually. This is when many people make the mistake of stopping their therapy sessions. However, it is vital to continue meeting with your therapist, because much of the change people feel is due to a virtual re-wiring within the brain, and these neurological processes are not instantly set. Seeds will be planted that take time to bear fruit over the course of your treatment. Fighting depression will have its ups and downs. Having a professional team working to help you will only make things easier for you. If you don’t have adequate support at home, you may want to find a local support group to keep you focused on healing. Your therapist can help with this search, too.

Remember that you are not alone. Depression is a common mental illness. In fact, according to Mental Health America, depression affects more than 16 million Americans each year. It also has no bias; depression can befall anyone, regardless of age, gender or race. But if you seek help, depression can be battled successfully, thanks to a combination of therapy and other behavioral health regimens.

Dr. David Rakofsky is a Chicago-based clinical psychologist and the founder of Wellington Counseling Group in Chicago and the northern suburbs.

Wednesday, 20 November 2019 12:44

8 Ways to Pull Yourself Out of a Funk

A friend recently shared something new with me. A happy-go-lucky person, he said he falls into a funk—a brief period of feeling gloomy without knowing why—once or twice a year. Each episode lasts no longer than a few days, and he asked why this occurs seemingly out of the blue. I suggested it was neither sadness nor depression. Sadness is an emotion triggered by a difficult event, experience, or situation, while depression is a recognized mental illness that makes us feel sad about everything. A funk is a temporary dip in mood that can be normal.

Funks can take you off your game and even develop into a clinical issue over time if not addressed. Here are nine ways to pull yourself out of your funk:

1. Cardiovascular Exercise

Go out for a run, jog, or even a long, brisk walk. Get your heart pumping, and focus your eyes on the beauty or novelty of the world around you. Granted, breaking a sweat and soaking up the great outdoors doesn’t sound appealing when you’re feeling listless and down, but exercising releases endorphins, the body’s natural anti-depressants. The sudden rush of these hormones can be the thing that flips your mood around.

2. Connect with People You Trust

Social connection is not only preventive of depression but can reduce time spent in your funk. Keep a short list of people with whom you are comfortable speaking openly. You can count on them to listen, and you can be vulnerable in front of them. Apply the “Fake It Till Ya Make It” technique, which is not about being false; rather, it forces you to reach out—an action that feels unnatural and dreadful in the moment—but can be therapeutic. Push past the idea of being a burden to people because that’s just the funk talkin’.

3. Eat Comfort Food

A cheeseburger and fries can help when you’re down. Citing a recent study, Psychology Today reported that food associated with good thoughts and warm feelings not only improves a sense of well-being, it also decreases loneliness.

4. Step Away from Your Screens

When you’re in a funk, prolonged exposure to the artificial examples of human success and happiness on television certainly doesn’t help. Take a T.V. break; your shows aren't going anywhere. In addition, use social media sparingly. In your current funky state you’re more likely to absorb news on your Twitter, Facebook, or Instagram feeds through a #distortedfilter. Additionally, Social Comparison Theory—the idea that we determine our own social and personal worth based on how we stack up against others—may kick into overdrive. If you are posting and waiting for Likes and comments to fill your balloon, you are setting yourself up for disappointment. To boot, you might actually post something in this funked-up state that you’ll regret.

5. Talk to Your Doctor About Medications You’re Taking

It’s possible that side effects of your medications may be causing your funk. Consult with your doctor to rule this out. Mood alteration can be the result of sudden changes in medications regimen. Ask yourself: Have I been on anti-depressants but now take them inconsistently or have just stopped? Is this event the result of withdrawal? Do I need to consult my medical provider to revisit my dosage and consider an increase or a change of medications?

6. Meditate

Meditation is an incredibly useful tool when you’re in a funk because it can help you gain perspective and achieve a more realistic appraisal of your life. Among its many benefits, meditation can preserve the aging brain, improve concentration and attention, and reduce anxiety. It’s also free, painless, and can be done anywhere.

7. Avoid Drugs and Alcohol

There may be significant temptation to self-medicate and numb the bothersome feelings, but your goal is to face these feelings, not escape them. Leaning on drugs and alcohol as a coping mechanism can exacerbate your problem. For example, alcohol as a so-called sleep-inducer can actually disrupt sleep in the middle of the night. Inadequate sleep will likely extend a funk. A drug like marijuana has side effects like anxiety and depression. Continued use of drugs and alcohol can create a dependency or worse, addiction.

8. Always Have Something to Look Forward to

I call it “The Horizon Line of Good Events:” the importance of having things to look forward to in the immediate, intermediate, and far-off future.

  • Immediate future: something stimulating or exciting that is scheduled for today, tomorrow or in the next few weeks. You may be in a bad place now, but you are finally seeing Hamilton next Saturday.
  • Intermediate future: things you have planned over the next several months or year, such as a graduation party, bar mitzvah, or vacation.
  • Far off future: goals for how you envision your life down the line, like how and with whom you want to spend your retirement.

Funks can be unexpected events that bump you off course and wreck your mood. Episodes eventually pass, but these tips can help you climb out of funks faster and empower you with proactive tools to utilize in the future.

Coming Soon: The first story in our three-part series about living with depression will be available later this month.

Matt Hiller, LCSW, is a therapist formerly with Wellington Counseling Group. His work has included therapy with adults, adolescents, children, and families.

Why has it become hard to develop friendships?

Matt Hiller: Working as a therapist with young adults, I often meet with people who have moved to Chicago and are struggling to make friends. I think this reflects a larger trend where people are relocating for work or school and feel disconnected from their older social networks. Another factor is that there are so many things that compete for people's time and attention. Long work hours, technology, and family responsibilities often reduce the time that people have available to make new connections.

Has the prospects of networking made it hard to develop genuine friendships?

Matt Hiller: In my work, I often encourage people who have trouble making friends to attend networking events. I think they can be great opportunities to practice social skills such as making introductions, active listening, and identifying shared goals and values. My only caveat is that it is also important to build connections outside of professional contexts. So, I might encourage someone to consider how they can use networking skills in settings such as faith communities or classes.

How are friendships defined in the 21st century?

Matt Hiller: In the past, individuals often established friendships with people from their immediate communities. But now, technology has completely changed the way that physical proximity affects relationships. For example, thanks to social media, a person often knows about the political views, dietary habits, and relationship status of elementary school friends that live across the country. I encourage people to remember that actual human interaction is often an important foundation for building lasting friendships. However, I also emphasize that technology is a great way to rekindle old connections or find people who have shared interests.

What traits do people look for in friends now?

Matt Hiller: I think that many of the traits that people look for in friends are universal: kindness, trust, common values, etc. However, whereas friendships in the past might have been more based on physical location, I think that shared interest is a more common foundation now. For example, many people do improv comedy in Chicago, and there are always social activities that individuals can participate in like shows and classes. Because sometimes it is hard to find the time to build deep friendships with people, it is often easier to focus on communities where people can first connect over a common activity.

How do you keep your actions from being misconstrued as flirting or trying to get something from them?

Matt Hiller: As a therapist, I often say that we cannot totally control how other people interpret our behavior. I would suggest that a good approach is to focus on respecting other people's boundaries and comfort. For example, I would encourage a person to be mindful about things like physical contact or romantically suggestive comments. Past that, honesty and trust is a foundation of any good friendship. As such, I think that it is best for a person to communicate clearly that they are just looking to be friends.

What are some things that you can do to form friendships regardless of social setting?

Matt Hiller: I think that the key to forming friendships in differing social settings is to value what makes you unique as a person and to have genuine curiosity about other people. If a person has low self-esteem, they might doubt that anyone would find them interesting, which can lead to withdrawal and isolation. And regardless of one's setting, a person can build all sorts of unexpected friendships if they take the time to listen and understand other people’s experiences.

Wednesday, 20 November 2019 12:32

Relationship Endings and Behavioral Economics

Santiago Delboy, LCSW, is a Chicago-based psychotherapist formerly with Wellington Counseling Group. His work has included therapy with individual adults and couples.

A long time ago I became interested in the intersection of economics and psychology. A few years later, I was delighted to hear that the 2002 Nobel Prize of Economics was awarded to a psychologist, Daniel Kahneman. He is one of the founders of Behavioral Economics, which studies the ways consumers make biased or "irrational" decisions, and one of the developers of Prospect Theory.

What is Prospect Theory?

Prospect theory suggests a few things about how people deal with the risk inherent to uncertain situations:

  • People are loss-averse, which doesn't just mean that we don't like to lose. Loss aversion means that we are more willing to take risks to avoid losses than to secure gains. For example, most people prefer a sure gain of $100 over a 50% chance of getting $200, but they prefer a 50% chance of losing $200 over a certain loss of $100. (As those who remember their statistics class will notice, a sure $100 or a 50% chance of $200 are theoretically the same).
  • Judgments of value and the decisions we make are relative to a specific reference point. In other words, the decisions we make are based on our perception of the status quo and the gains or losses entailed, rather than the real/objective final outcome.
  • We tend to overvalue what we feel we own, in what is called the "endowment effect". In a classic experiment, a group of participants received a mug and were told they owned it; separately, a second group was only shown the same mug, but they didn't keep it. When researchers asked the first group how much they would be willing to sell the mugs for, their asking price was more than twice what the second group said they were willing to pay. The value each group placed on the mug did not depend on the actual object, but on whether they owned it or not (i.e., on their initial reference point: owning the mug vs not owning the mug).

Prospect Theory and Relationships

After reflecting on the relationship conundrums of some of my clients, I started thinking about how prospect theory could be helpful to understand why it is sometimes difficult to end a relationship that is making us unhappy.

Dealing with uncertainty

Ending a relationship can be perceived as risky or uncertain, particularly when it has been going on for a long time. According to the principle of loss aversion, deciding to end a relationship would be difficult because the fear of perceived losses (e.g., changing the status quo, emotional or financial difficulties, esteem from others) can outweigh the potential gains of ending a relationship (e.g., peace of mind, empowerment, independence).

In other words, people would be more willing to take their chances and stay in a relationship that is not working -in order to avoid any perceived losses-, than to run the risk of ending it, even if they can see how that would be beneficial. Fear becomes more powerful than possibility.

It can get more difficult with time

In addition, the endowment effect suggests that the value we place in our relationships may depend more on how much we feel we have invested in it (emotionally, time-wise, financially, etc), than on the qualities of the relationship per se (e.g., are our needs met? do we feel nurtured and cared for?). This is a phenomenon economists call the "sunk cost fallacy," whereby people overemphasize the weight of their previous decisions - think of a company that keeps pouring money into an idea that is clearly not working, just because they already invested a lot on it. The investment already made is a "sunk cost" and could not be recovered anyway.

When we hear people talking about their difficulties ending a relationship with arguments like "we have gone through so much together" or "we have been together for so long", we might be witnessing the endowment effect and sunk cost fallacy in action. This can be particularly true in relationships where shared experiences and meaning have not been able to create and sustain emotional closeness and vulnerability.

It depends on where you are coming from

Whatever constitutes a gain or a loss, and our willingness to take our chances in the face of uncertainty, is a function of our reference point. When it comes to relationships, I understand this point to be defined by whether we feel we are in a place of scarcity or abundance.

In the experiment described above, the group who did not keep the mug was, in a way, in a place of scarcity; as a result, they did not value the mug that highly. In relationships, being in a place of scarcity might be experienced as having doubts about our own self-worth, and feel that others are potential threats to our well-being. In this case, it is harder to value the potential benefits of ending an unhealthy relationship, so the decision becomes more difficult. Moreover, people in this situation sometimes appear to be fighting to keep their relationships, scrambling for reasons to stay in it, even if it is dissatisfying, unhealthy or destructive.

On the other hand, being in a place of abundance might imply embracing acceptance and gratitude, and being aware of our doubts but secure in our sense of worth. Even if a relationship is going through difficult times and the end is imminent, the fear of potential losses may have a lower impact relative to the potential "gains" of moving on. This doesn't make the decision easy by any means, but people in this situation might appreciate that there can be growth beyond the relationship, and understand that ending doesn't mean failing.

What can be done?

The phenomena described by prospect theory are neither good nor bad, they just are. The question is not how to eliminate these biases, but what can we do to deal with them. Three things come to mind:

  • Awareness: How we think and feel about ourselves, others and the world, defines how we think of losses and gains. Becoming aware of our own biases, our own fears, and our own relationship histories is essential to understand the difficulties we may be experiencing today.
  • Reframing: Since we might become more willing to take risks if we frame a situation as a potential loss, we can think of the things we would miss if we don't make a decision. For instance, we can be more likely to take the chance to be vulnerable with others if we understand the risk of not doing it.
  • Gratitude: Cultivating gratitude can help us move from a place of scarcity into a place of abundance. If we can take some steps in that direction, the fear of losses may start losing its power.

Doing these things can be daunting, in particular when we are dealing with the stress of a relationship that might not be working, and many times we are too close to see them. The good news is that we don't need to do this alone.

Prospect theory is mostly based on understanding cognitive biases. The role of emotions and affect is not emphasized, and treated mostly as a source of distortion. However, when it comes to interpersonal or romantic relationships, conscious and unconscious affect is intertwined with our thoughts (rational or not) and behaviors. Hence, prospect theory alone can definitely not capture the complexity of relationships, but it can provide a lens to understand their challenges.

Wow, you’re having your first child. It’s very exciting and scary. You find yourself discussing with other people, family, friends what you’re doing to prepare, what life may be like, how you are envisioning the inevitable changes, though in reality, you can’t begin to understand what your new status as a first-time parent will truly be like. You’re wondering who the baby will look like, possibly contemplating milestones, or fantasizing about their ultimate careers. You are about to acquire a title that will never leave you once obtained, that of “parent.”

Or, you’re having your second or third child. You’re still excited and scared. You’re focused on your current child’s (or children’s) reaction to the new sibling, how it will change the dynamics in each family grouping, how your life will change with the now second or third child, but you also have a certain security in knowing that this time you possess a set of skills: How to give a baby a bath, when to start food, what to expect in developmental milestones – smiling, grasping, talking, sitting up, walking, etc. -- though the specific knowledge about the new little individual still remains a mystery.

Alternatively, you’re adopting. In addition to all the basics that go along with the first two options, you have additional concerns of what the baby’s life has been like until this point. What were the circumstances related to attachment (or lack thereof), have developmental milestones been met, the baby’s health, the health history of the family of origin. Surrogacy, too, comes with a whole host of concerns.

What all these potential scenarios have in common (unless you are knowingly adopting a special needs child) is that you, the parent, have a set of basic expectations that really are nonnegotiable. Of course, my child will smile, roll over, stand up, walk, talk, interact with other children, go to school, etc. So… what happens when a monkey wrench is thrown into this normal, totally expected progression? For the sake of this piece, we will use major learning disabilities or other disabilities where a child remains at home, not necessarily a separate care giving situation. Such examples may be those of extreme ADD or ADHD, deafness, partial sightedness, or conditions limiting physical engagement. Issues to explore are the impact of discovery, parents’ recovery enough to be proactive, the education of others (family, friends, caregivers, teachers, etc.) with whom the child interacts, necessary familial adjustments involving all units, the grieving process related to the loss, and, in most cases, emerging from the fog and realizing the unexpected gifts and growth that were part of this process.

Sometimes the potential disability is obvious and other times the signs emerge piecemeal. It may start with niggling observations as in the case of hearing impairment, that something is not quite right, but is dismissed. It may then become increasingly prominent at which point doctors’ appointments are sought followed typically by an array of specialists. The time in which to receive a diagnosis will vary and the pros and cons of waiting can be argued both ways.

When a diagnosis is dragged out, there is often relief with parents blaming themselves about having worried too much, being hysterical first-time parents, and the like. The parents want so desperately to be proven wrong about their suspicions. Alternatively, the diagnosis could be fairly quick and the reality accompanying this confirmation may be denied, met with disbelief, but most ultimately be digested and swallowed to facilitate quick, necessary self-education leading to an action plan. Literally, parents will experience all these outcomes, sometimes in a varying order, sometimes in a repeating pattern, sometimes in a “stuck” fashion and sometimes franticly. While the common orderly fashion is a possibility, it is rare due to the new overwhelming fear and the feeling that your whole child is being shoved through a funnel, creating an ever-narrowing number of possibilities for their future.

With this diagnosis comes the beginning of experiencing a loss accompanied by a grieving process. Families in this process, while generally aware they have been struck by a tidal wave, do not place the impact in the category of loss accompanied by traditional grieving, though that is, in fact, what is happening. The loss consists of certain dreams and expectations, conscious or unconscious, that are now in question. Using deafness as an example, one has the anxiety and sadness of conveying this development to family and friends, wondering how and if the child will circle through familial life cycle events, as well as dealing with the many other emerging phenomena that rear their heads with each distinct disability.

Questions begin to arise about how communication and learning will take place. Uncertainty as to how this will play out with the siblings and the family unit as a whole arises. What accommodations will have to be made? What will the financial ramifications involve? Will this improve over time or be a lifelong condition? What kind of time will it take, and how will the parent(s) be able to give appropriate attention to the other children? The list of questions goes on and usually without many satisfactory answers or results for some time.

Coping skills and resiliency become very important. These are difficult circumstances to navigate even if one has very strong coping skills and significant resiliencies. In addition to the professionals who are there for the child, the parents will more than likely need help adapting their coping skills to this new, unfamiliar situation. A professional (and many clinicians specialize in specific areas of child disabilities) will help parents to process this information -- not just the question of what will happen to my child, but what will happen to me, my family unit, the siblings, extended family and friends as a result of this diagnosis. Coping strategies for dealing with this new life reality, both in the short and long-term, will have to be peripherally determined but need to remain flexible as new information will always be entering the equation. It is ideally recommended that parents seek the help of a professional if possible, especially during this time when so much needs to be processed and decided.

When your child has a new diagnosis, the parent(s) is so vulnerable, scared and questioning. As help is sought, the educational process is unfolding. Ideally, parents are learning everything they can relative to the child being able to cope and hopefully eventually thrive. The parents are building a network of professionals and other families who have had similar experiences. This network is extremely important as it will ideally see the family through the child’s formative years and often into adulthood.

Numerous families recount that the most rewarding part will invariably become a journey, whether short or long, made up of the other people they met along the way resulting in lifelong relationships of support. A powerful bond grows between the people in similar situations among those with whom you never in the past would have imagined you would share anything in common. They often turn out to then be the most special people you will have met during your lifetime. While what seems so devastating at first, has many twists and turns that can be life-altering in a positive way. I trust that many parents ahead of you on this journey will vociferously support this notion.

Wednesday, 20 November 2019 12:26

Generation Compassion

I am a relatively calm person, not generally prone to panic. However, as a baby boomer, when I was told I would periodically need to post to Facebook, blog, and perform other such unnatural acts, my reaction (and that of many others in my generation) was pure, unadulterated dread. I have adapted to many new things in this fast-paced, exponentially-changing world. Social media has not been one of them. That does not mean that I do not understand the marketing benefit provided by the extensive reach of social-media platforms. But like many of my generation, I prefer individual, personal interaction and to share my life on a more-limited basis.

This is not a criticism of others who are comfortable in the social-media space. However, I personally avoid things that I consider time-eaters, which includes social networks. I admit being slow to pick up on the technology which I find counterintuitive.

As one who manages time as a precious commodity, I want to spend it doing other things. I crave reading books, love doing work as a psychotherapist, advocate for and teach about environmental issues, exercise, visit my children and grandchildren, and travel with my husband.

For reasons described above, I found trying so hard to keep up with all areas of technology robbed me of the time I wanted to spend doing other things about which I care deeply. I often see this tension in patients – of all ages – as well, but I try to be respectful of generational differences.

I am thankful for the neuroplasticity of the brain that has allowed me to engage in technology to the extent I have, but I also recognize and accept my limits. Thus, I have made a very conscious choice not to torture myself by trying to master areas of technology that are counter to the way my brain has understood things for decades when the struggle goes beyond reasonable limits. And I have found that many others in my generation have reached the same conclusion.

New York Times columnist Tom Friedman's new book, Thank You for Being Late (2016), has helped me understand my reaction to the overwhelming flood unleashed by social media. I have always had great regard for Friedman’s thinking and writing. While reading this book, I was riveted by his graphs analyzing the curve extending sharply upwards of technological growth on one axis and human adaptability on the other, no curve but a flat line with only a slight upwards slant.

According to Friedman, this is the first time in history that the exponential rate of change far exceeds people's ability to adapt. In the past, people often had up to a century to adapt to major inventions such as the steam engine and the automobile until the next one came along. Now, looking at all the technological change that has occurred just since 2007, we often have less than a year to adjust to these monumental new life-altering inventions and concepts.

When I saw Friedman's adaptability/technology curves, I felt a huge sense of validation. Despite my ability to adapt to change in the past, there was a reason I finally reached my limit and was screaming "no more” – or at least “not so fast!"

This means I have to choose where to adapt technologically. And, like many others in my generation, social media will not be one of those choices. That’s why the title of this essay – dare I call it a blog? – asks for compassion for my generation. So many boomers face ridicule from their children or co/workers when they are not adept at dealing with new, ever-changing technologies. Clearly, the brains of young people, who are introduced to computers and smartphones practically from birth, are wired differently. Meanwhile, boomers have lived five, six, seven decades without having to engage the world this way. Cut us some slack! Be compassionate – and helpful. We will gladly exchange some of our hard-earned wisdom for your patience with our “fat thumbs.” And please do not discount that wisdom. We boomers may not always be tech-savvy, but we know how to find answers by asking the right questions. Remember that the next time you initiate an online search and come up empty.

I end with a quote from Friedman's book that, much to my delight, lays out the feelings I have tried to express here.

"Finally, philosophically speaking, I have been struck by how many of the best solutions for helping people build resilience and propulsion in this age of accelerations are things you cannot download, but have to upload the old-fashioned way – one human to another human at a time."

Wednesday, 20 November 2019 12:18

Trauma is an Experience, not an Event

Santiago Delboy, LCSW, is a Chicago-based psychotherapist formerly with Wellington Counseling Group. His work has included therapy with individual adults and couples.

It seems like "trauma" has become one of those household terms everyone talks about. I took a look at the number of average monthly Google searches for "trauma" in the U.S., and found that it has grown 22% in only one year. As with other terms that became mainstream (for instance "addiction" or "narcissism"), I suspect the price of increased awareness is a diluted understanding of what they really mean.

After hearing my patients talk about their experiences, reflecting on my own upbringing, and studying some of the literature on trauma, I believe the following can be a useful working definition:

Trauma is an experience that overwhelms our capacity to regulate our emotions and results in fragmentation and dissociation.

While this may not be a comprehensive or final definition, I think it captures a few ideas that are important:

  • Trauma impairs our capacity to regulate our emotions. We feel worried, irritated, anxious, or afraid, consciously or not, and we cannot self-soothe or seek support from others.
  • Trauma creates fragmentation and dissociation. Whether we understand this as an unconscious defense mechanism (e.g., splitting, projection or repression) or as a neurological issue (e.g., thalamus gone offline, hypersensitive amygdala), dissociation is a key trait of trauma.

However, in this post I want to expand on the idea that trauma is not about a past event, but about a present experience.

I think the idea of trauma as a present experience is captured dramatically and beautifully in a 1930 painting by Belgian artist René Magritte.

The Titanic Days

I liked Magritte since I was a little boy, but I saw "The Titanic Days" (Les jours gigantesques) for the first time a couple of years ago, at a special exhibition at the Art Institute of Chicago.

I was stunned by the power and the violence of this piece. What I see is not a rape attempt happening now, but how a past experience is stored in the woman's body and felt in the present moment. I see the terror of her frozen expression, reminiscent of the so-called “thousand-yard stare,” the tension of her entire body and the desperate attempt to push back an attacker from a real or imagined past. I notice the stark contrast of colors in the woman's body and I see the traumatic struggle between life and death, and the need to keep part of her in the shadows. No words are required to convey the drama, and no words could probably do justice to the horror; trauma, in fact, impairs our capacity to develop a cohesive narrative. The experience is overwhelming and occupies most of the space on the canvas, yet the atmosphere feels completely desolate: we know nobody will come to her help. Is the blue background a wall, keeping this woman cornered against the attacker living in her body and in her mind, or does it suggest an abyss, making the woman one step away from oblivion?

We can only imagine the details of what actually happened in this woman's past. Was she sexually abused as an adult by a coworker? Was she touched in uncomfortable ways as a young girl by a family friend? Was she somehow sexualized when she was a toddler by her father? How much of what happened was real and how much a creation of her mind?

These are important questions to consider, but not as important as the terror, the isolation, and the helplessness she is experiencing in the present moment. When I stand in front of this painting, much like when I sit across from my patients in therapy, what I see is this woman's suffering in the here and now. I don't need to know all the actual details of her story, but I am curious about the meaning she assigned to it, about how it feels in her body, her mind and her spirit, and about the ways it might be getting in the way of being her full self.

Trauma is like a splinter

I remembered Magritte's painting some months ago, when I read Bessel van der Kolk, a leading trauma researcher, suggesting the metaphor of trauma as a splinter: it is the body’s response to the foreign object that becomes the problem, more than the object itself.

This idea has been around for some time. Almost twenty years ago Peter Levine, developer of the somatic experiencing approach for trauma treatment, wrote:

"Traumatic symptoms are not caused by the triggering event itself. They stem from the frozen residue of energy that has not been resolved and discharged; this residue remains trapped in the nervous system where it can wreak havoc on our bodies and spirits." - Peter Levine, 1997

It is worth noting that this notion is even older. Not to make the point that everything goes back to Freud, but over a hundred years earlier he and Breuer advanced a similar idea in “Studies on Hysteria”:

"Psychical trauma – or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as the agent that still is at work." - Sigmund Freud & Josef Breuer, 1895

I think there is value in talking about "traumatic events," but I believe that it is critical to shift our focus toward the ways in which trauma stays with us. Trauma is not remembered, but reenacted. It is not about something that happened in the past, but about its consequences in the present, about the conscious or unconscious meaning we give to our experience, and how that experience defines how it feels to be in our body and in our mind.

From traumatic experience to healing experience

The notion of trauma as an experience is valid for traditional PTSD trauma (e.g., when there is a specific event or situation that triggers the traumatic experience, such as sexual abuse, a war or a natural disaster), and for complex developmental trauma, which is more insidious.

Complex trauma is characterized by an upbringing defined by patterns of inconsistency, neglect or abuse. Emotions are not expressed, not allowed, or even punished. A specific "big" event is not necessary; repeated and chronic interpersonal wounds can overwhelm the child's capacity to regulate emotions, and create fragmentation and dissociation.

Most people I have seen in therapy have experienced some form of developmental trauma. They felt unseen and unheard by physically or emotionally absent parents. They did not feel taken care of, taken seriously, or taken into account. They believed their needs were not important and would ever be met. They had to carry within, in silence, destructive family secrets. They had to be parents to their parents from a very early age. They needed to constantly perform, or pretend to be someone else, in order to feel accepted or loved. They had to learn to soothe themselves. They lived feeling that nothing they did would ever be enough.

All these experiences from the past are reenacted and experienced in the present, keeping them from feeling safe, loved, worthy, and trusting in others or themselves. They get in the way of becoming self-aware, of letting go of control, of developing vulnerable and intimate relationships. They make them feel either in high alert or depleted. These experiences keep them from being fully alive.

The most important thing therapists can do to work through traumatic experiences of this kind is to offer the opportunity for a healing experience.

The essence of that healing experience is not a matter of technique, approach or theory, and goes beyond the promise of providing a safe, calm and reliable environment. I believe the question is about love, authenticity and curiosity.

For me, the question is about being self-aware and curious about my own reactions, about how I think of, feel with, and relate to the person in front of me. It is about being a human being first and a psychotherapist second, which is a difficult task. Often times I get caught up in the need to make sure that I am saying the right words, giving the best feedback, offering the most insightful interpretation, or providing a useful perspective. Instead, I can trust that my presence, my curiosity, my compassion and my humanity, with its flaws and imperfections, is the first thing that matters.

Do my patients feel heard and seen by me? Would they tell me if they didn't? Do they feel there is room for their feelings toward me, whether they come from a place of anger, hurt, sadness, joy, love or desire? Can they express them trusting that our relationship will survive? Can they count on me, and trust that I will provide safe boundaries? Can they feel that every part of themselves is acknowledged, accepted and valued?

I believe these are the types of questions that define a healing therapeutic experience. They matter not only because they allow patients to recognize current dysfunctional relationship patterns in their lives, but mainly because they have the potential to provide an experience that was not available to our patients when they were growing up. We cannot change the past, but we can offer them the opportunity to experience and develop self-awareness, acceptance, and unconditional love.

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