The GoodTherapy Blog

Two young women at the park

Remember when you were first dating your partner and the sex was hot, heavy, and frequent? As time passed and you and your partner slowly built a life together, the initial passion might have lost some of its luster or faded altogether.

As with heterosexual couples, LGBT couples often find the responsibilities of life take over as work stress, family issues, finances, and life events begin to distract from sexual connection. In fact, it’s a subject that’s quite challenging for many gay couples to talk about.

As a therapist who works with lesbian, gay, bisexual, and transgender couples, I assist with better communication and connection. Early in the conversation, couples typically talk about a variety of issues that are affecting their relationships, some easier to broach than others.

The topic of sex is a particularly tough one for many to bring up, let alone address.

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Although some couples find contentment and intimacy within sexless partnerships, an active, satisfying sex life can be an important part of human connection and self-care. Is it possible to reconnect to your partner and bring passion back into the bedroom? Absolutely. It just takes a little focus, energy, and of course desire.

Here are three tips you can use to begin the process of reconnecting to your partner sexually:

1. Start Simple

Often, couples hoping to rekindle a spark want to rush right back into sex and one or both partners end up feeling overwhelmed. So instead of trying anything, they do nothing and the frustration grows.

Building anticipation, excitement, and romantic feelings can help. Perhaps take a moment to put on some music and slow dance together, giving your bodies a chance to reintroduce themselves to each other. A little massage time is great for setting a comfortable pace for touch.

These types of activities help to create a safe bridge of connection and allow space for intimacy to develop. Once that reconnection occurs, you might find that your primal urges take over and your bodies naturally pursue the best routes to sexual release.

2. Think Creatively

Even in the most satisfying relationships, sex can become stagnant or routine at times. It’s nothing a little creative thinking can’t fix.

Is it possible to reconnect to your partner and bring passion back into the bedroom? Absolutely. It just takes a little focus, energy, and of course desire.

Consider developing a collection of sexual activities with your partner that either of you can draw upon to liven things up. This exercise can build up your sexual vocabulary and serve as foreplay in its own right.

Have each partner separately write down sexual activities he or she would like to bring into the relationship, with each idea going on its own piece of paper. Then go through the ideas together, with no judgment, and decide which ones you both would feel comfortable trying out.

Put all the slips of paper featuring ideas that you both are willing to experiment with into a hat, box, or other container. Whenever either of you wants to initiate sex, you can draw a piece of paper that represents your activity for the night. It can be fun and playful, and it may relieve the pressure of having to figure out the right activity for the moment.

3. Rediscover Life

One of the major reasons couples get bored in the bedroom is that they are bored in life generally. Look at the routines and traps you may have fallen into and notice how they have influenced your connection with your partner. Is Friday night always Mexican food night? Do you always watch the same television shows? Do you attend only events that you are comfortable attending, where you know what’s going to happen?

Although it’s lovely to be with someone you can create rituals with and let down your guard, if these rituals become cemented and inflexible, they can bring a malaise into the relationship that affects your sex life.

So look in your local paper or on social media for events in your community, check the LGBT guides, or see friends you have not seen in a while. Rekindling your passion for life can, in turn, ignite your passion for each other.

Applying the three tips above will help you create a blueprint to reconnect with your partner and reinvigorate your sex life. Satisfying sex with the same partner can be one of the delights of a long-term relationship, but sometimes you need to bring a little awareness into the room to keep the fire going.

person taking notes in journal Have you ever found yourself in such an emotional storm that you didn’t feel in control of what you were doing? When we are at our most vulnerable, we are most likely to act in the way that emotions make us want to act. As important as emotions are—they provide us with valuable information, connect us to one another, and more—they sometimes lead us down destructive paths. When this happens, it is often helpful to take a look at the situation to assess what happened, whether it was effective for us, and how we might do something different in the future.

Dialectical behavior therapy (DBT) provides us with an effective approach to look in excruciating detail at events in our lives that have not gone well so that we can better understand how such actions are connected to our emotions and to situations we encounter. It is an empowering approach, one that allows each person to become aware of emotional states in order to have choices—choices about whether to act in the way an emotion makes us want to act or to act differently.

This approach is called a behavioral chain analysis. This is an exercise you can do during a DBT individual session, but it’s also a skill you can practice on your own, outside of session. The DBT skills workbook includes worksheets to guide you along. It starts with a specific description of the problem. What happened? What event prompted you to do this? Even if you are not sure that whatever happened immediately before the problem behavior necessarily caused the problem, take note of it.

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It’s important to include an evaluation of how you were doing overall, before a distressing event or feeling came your way. Were you hungry or tired? Were you feeling run down physically? Were you upset about something that had happened the day before?

These underlying vulnerability factors make a difference. Emotional problems can’t be solved with logical solutions, so even if you know what to do, you first have to attend to your emotional needs.

Once you’ve assessed the underlying vulnerability factors, you’ll look at specific events in extreme detail. These are your “links” on the chain, and may include actions, physical sensations, thoughts, beliefs, events, and emotions.

Don’t forget to come up with a strategy to prevent repeating whatever did not work. Start with reducing your vulnerability to negative emotional events. This way, when difficult times come up—as they do for anyone—you will be in your healthiest state from which to respond.

Finally, the chain analysis includes a look at the consequences of what happened. The purpose of this is not to judge—there is no assessment of right or wrong, good or bad. Rather, you are assessing effectiveness. Did the behavior work? Did it serve your short-term and long-term goals? Did it cause any problems? This information can help you then fill in the “missing links,” the effective behaviors that will lead to an outcome more consistent with the life you want.

Also, make sure to repair any damage that was done. This will help to protect and strengthen your relationships. Don’t get stuck in criticizing yourself, though. Repair any disappointments by doing better next time.

While the behavioral chain analysis is a skill that you can apply on your own, it is often helpful to receive coaching in this technique from a therapist trained in dialectical behavior therapy. You can search the GoodTherapy.org directory to find someone who has knowledge and experience in this approach.

After practicing the chain analysis in therapy, you’ll have a skill that you can apply in your life outside of the counseling room. This will help you to better understand yourself, how your brain works, and how to become more in control of your actions while also taking care of yourself and attending to your physical and emotional needs.

hands clasped in front of face Life in today’s fast-paced world is complex, with more stressors and less direct social support than in past generations. Exposure to multiple life stressors has been shown to leave people vulnerable to illness and other negative outcomes, making it all the more important that effective coping strategies are developed and utilized.

One of the most common reactions to stressful life events and transitions is anxiety. One of the most widely reported mental health challenges that people face in the United States, anxiety affects about 40 million adults ages 18 and older.

Common symptoms of anxiety include feelings of panic, fear and uneasiness, difficulty sleeping, muscle tension, cold or sweaty hands/feet, shortness of breath, heart palpitations, restlessness, dry mouth, nausea, dizziness, excessive or unrealistic worry, and avoidance of triggering situations. Temperament and prior experiences with stressors are key determinants of whether a person develops problematic anxiety in response to life events. Though their genetics and past experiences cannot be changed, people can better prepare for the inevitable ups and downs of life by understanding their emotional responses and by nurturing healthy daily practices.

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The Fight-or-Flight Response

Fear and anxiety are natural and adaptive responses to stressors. Fear is a reaction to a present danger in the environment, while anxiety refers to the anticipation of some potential threat in the future.

When the mind perceives a threat, the nervous system activates the fight-or-flight response. A complex physiological event, the fight-or-flight response mobilizes a person for action in the face of a life-threatening danger. Because the human nervous system does not distinguish between real and imagined threats, this response system can work against a person, resulting in panic and anxiety.

The good news is that our understanding of the biological underpinnings of the fight-or-flight response has led to well-researched, effective treatments and coping methods. Below are some healthy strategies that you can begin to practice right now, regardless of whether this is a time of stress:

Practice deep breathing, meditation, or relaxation: Breathing and meditation can help you focus on the present moment and reduce ruminative worry and anticipatory anxiety. Regular relaxation exercises lower overall physiological arousal.
Look back to other stressful times: Reflect on past stressors and remind yourself that stressful periods are temporary and will pass.
Identify effective coping from the past: You’ve been through tough times in the past. Review what helped you during those times.
Accept negative feelings: Don’t deny anger, guilt, sadness, or negative feelings. Try to accept and acknowledge your feelings. Journaling can provide a safe space to express and process feelings.
Engage in active problem solving: Identify aspects of the situation that you have control over and appropriate responses.
Maintain and utilize supportive relationships: Build loving and warm relationships with trusted others you can lean on during difficult times.
Get plenty of sleep: Aim to get seven to eight hours of sleep each night. Establish a regular bedtime and wake-up time.
Exercise: Daily exercise is one of the most effective ways to reduce stress and anxiety. If cleared by your physician to do so, try to exercise vigorously four or more days a week.
Eat well: Eat a balanced diet, and don’t skip meals and snacks.
Schedule rest breaks: Set an alarm on your phone to remind you to take a few minutes several times a day to meditate, breathe, or otherwise relax.
Engage in pleasurable activities: Be sure to carve out time to engage in things you enjoy on a daily basis.
Avoid caffeine and alcohol.

Everyone goes through difficult and stressful times. It is important to cultivate a robust set of coping strategies to build your resilience and reduce the negative impact of life’s challenges. If you find that you are having trouble coping, consider seeing a therapist or seeking out a support group.

References:

Holmes, T. H., & Rahe, R. H. (1967). The social readjustment rating scale. The Journal of Psychosomatic Research, 11(2), 213-218.
Jansen, A. S. P., Nguyen, X. V.,Karpitskiy, V., Mettenleiter, T. C., & Loewy, A. D. (1995). Central command neurons of the sympathetic nervous system: Basis of the fight-or-flight response. Science, 270(5236), 644-646.
Mineka, S., & Zimbarg, R. (2006). A contemporary learning theory perspective on the etiology of learning disorders: It’s not what you thought it was. American Psychologist, 61(1), 10-26.

GoodTherapy | Don't Judge Me: Embracing Your Partner's Differences The ability to discern what we like or dislike is an important part of being an individual. It is enriching to have choices about what to eat, what we like to wear, how to decorate our space, or what our favorite movie is. Many of our choices become part of how we define ourselves.

Some of our self-definitions go deeper and concern whether we prefer to be open about our emotions. If we came from a family in which emotions were not talked about, we will most likely be less inclined to talk about emotions. Another person may have grown up in a family in which emotions were expressed openly and honestly. If two people from such different families establish a romantic relationship, problems may arise.

While it’s important for all of us to have choices as individuals, it’s equally important for partners to be tolerant of each other’s differences. This is especially true during the early years of a partnership, when partners typically work together to define how they want their own family to be. The early years of a relationship are often about building a new family that is different from either partner’s family of origin.

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If one partner becomes judgmental and critical of the other partner’s way of being, problems generally ensue. Judgment often leads a person to become contemptuous of the other person, and contempt is hard to conceal. We all have micro-expressions that cross our faces so quickly we may not even know we have expressed the feelings associated with them. One’s partner might see those micro-expressions and feel deeply hurt by them.

It is only by working on our own way of thinking that this destructive cycle can be prevented.

Understanding a person takes a lot more intellectual and emotional work than judgment does. True understanding comes from active listening and appreciation of what the other person is trying to convey. True understanding comes from realizing that our own way of being is just that—our own way—and not everybody will want to be as we are.

The most important skill in any close relationship is the ability to understand and empathize. Empathy is the opposite of contempt, disgust, or other negative judgment. The way to empathy is through understanding, and judgment blocks understanding.

If you try to listen to, appreciate, and understand another person’s position but find you cannot, it may be that you need to recognize that your own way of thinking may be preventing you from relating well to that person. Your way of thinking and being is different from their way of thinking and being. Can you accept that? Can you accept that a person you believe you love or care about is different from you in some ways?

It is possible to love not only a person but their differences, too. In fact, true, deep, and lasting love involves a great deal of acceptance of another’s differences. Accepting a person’s differences helps you become a better-rounded, happier, more likable, more trustworthy, more mature individual.

Maturity is not something that happens to us as we get older. Maturity is something we gain through self-awareness, self-confrontation, and genuine efforts to grow and become kinder, more accepting, and at peace with other ways of being than your own.

If you need help on your journey of acceptance, consider seeking the guidance of a trained therapist.

In some a cases, a person might only be able to afford or only have access to an intern for mental health treatment, but that should not discourage him or her from treatment altogether. While there are very clear differences between a fully-licensed therapist and an intern in terms of what they have completed for licensing requirements, the capabilities of interns may surprise you, especially when coupled with the type of qualities that make a great therapist. Here, several therapists discuss the difference between therapy with an intern and a fully-licensed therapist:

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Parenting is a strange deal. It’s one role in life where there is a strong blueprint—we were all children once, and someone got us through those years—but there’s no easing in to it.

In the early days of any new job I’ve had, I’d wear that “training” badge for as long as I could. I’ve always been able to defer to someone above me who had the ultimate responsibility. When I was in retail, there was a manager. As an actor, there was a director. As a young social worker, there was always a supervisor.

A dad can’t say the same about a grandparent. The ultimate responsibility is yours. Even if you’ve been babysitting for years, even if you are the most involved uncle in the world, there is nothing that really prepares you for …

“Waaaaaahhhhh!!!”

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Read all the books (and blog posts) you want. One’s experience of fatherhood is going to be unique. It has to be, because we all are.

Deciding what kind of father you want to be is important and laughable at the same time. Laughable because the days, weeks, and years are unpredictable. Having a co-parent may make it easier, but it also introduces the unpredictability of another person.

The important part is that you want your parenting to be as intentional as possible.

Natural Parenting May Be Anything but Natural

Our main teacher(s) for this amazing, strange role is the person or people who parented us.

We may think they did an awesome job or a horrendous one, but most likely it was somewhere in between. They were like you in many ways. They were faced with a role they were not trained for, and they did what they felt was best. If you don’t give any thought to evaluating that parenting, and really looking at how you were parented, you’re likely to do one of two things:

Repeat it
Do the exact opposite

Either way, you’re not parenting how you want to; you’re going on what you think is “instinctual,” but it’s either defaulted toward or against your parents. Either way, it’s not you who’s doing the parenting.

You are not your parent(s), and your child—take a breath, as this is hard to hear for some dads—is not you.

Parenting Roles Compounded

I’ve heard it said that no two siblings have the same parents. People not only parent differently because of who they are, they do so depending on circumstances and environment. For example, people who were parents in January 2001 were very different parents in January 2002. Where we are with regard to our relationships, our careers, our confidence levels, and the amount of support we have will influence how we parent, just like it influences everything else.

This isn’t a bad thing. It just is. And it needs to be thought about.

That’s what I mean by intentional parenting.

Many dads co-parenting in the 21st century have noticed their roles shift dramatically from what they observed their fathers doing. More is expected in some ways, and that can be a challenge—especially for men who expected that their roles would be more traditional. It’s not necessarily that everyone is learning new roles outside of tradition; it’s often that their roles are traditional plus.

Many fathers receive the message that they need to make a salary and feed, bathe, and change the baby. (We of course hear this about women, too, as they are often asked to do all they do as mothers and work full time.)

It’s not getting easier for anyone.

It Starts with Knowing Yourself

Intentional parenting can occur before you have the baby as well as after, and it’s ongoing. Some of this seems like common sense. You are probably aware that you’re going to be negotiating many of these roles, especially if you have a partner. You’re constantly figuring out who’s picking up who, when, and where, for example.

But what kind of father do you want to be to your kids? Are you going to be able to show them that men can be emotional? That men don’t have all the answers all the time and they can’t fix everything? Many people grew up with a father who represented the other side of all of that. Many had a remote father who would come in to “save the day” when mom supposedly got “too emotional.”

There are a lot of little and big decisions you’re going to be making every day. Why not have an intention set before embarking on this journey? It may take exorcising some ideas of what a man is and what a father should be. How connected are you to some of the more vulnerable emotions?

Many people have a child and then realize all the stuff they thought they figured out is still there. That’s fine. The important thing is that they are aware enough of their stuff that they realize when it’s getting in the way of being the father they want to be.

Have you decided on the father you intend to become?

Spiral The power spiral is a guide to using role power wisely and well, and is of particular use to therapists. There are four aspects to the power spiral for use with ethical decision-making: gathering information, engaging compassion, resolving and repairing, and resourcing.

As a mental health professional, when you have any kind of ethical decision to make, consider the questions that guide you through the power spiral process. This process may also be helpful when you would like to harvest some learning by reflecting back on a decision or mistake you may have made.

Start by focusing your thoughts on the situation you want guidance on. Then imagine this situation in the center of a power spiral surrounded by the four aspects described next. Now imagine sitting in each of the directions of the spiral and consider questions such as the ones listed here. What insights emerge?

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1. Gather Information: The Informed Use of Power

What does your code of ethics say about this issue?
What is the impact of the power differential?
What other objective information is relevant?

2. Engage Compassion: The Conscious Use of Power

How does this issue affect you personally?
Is shame de-resourcing either you, the person you’re working with in therapy, or both?
What kind of transference or countertransference may be operating?

3. Prevent or Repair Harm: The Caring Use of Power

Some ethical decisions are involved with how to be in service to the person you’re working with and prevent harm, while others are related to how to resolve difficulties and repair harm.

Questions for being of service and preventing harm:

What are the response options?
What will be the short- and long-term impact of each of these options?
What additional factors might be important to consider? For example, you might take into account other family members, the life circumstances and abilities of the person in therapy, any risks to the person or therapist, or the spirit (versus the letter of the law, cultural norms, and spiritual beliefs).

Questions for resolving difficulties and repairing harm:

Is there a difference between intention and impact?
How do you feel toward the person you’re working with? Toward yourself?
Because of your role, what are you responsible for?
What is the best strategy for: (1) compassionately understanding the experience of the person in therapy and communicating this understanding along with genuine concern; (2) ascertaining what kind of repair is needed; and (3) following through in the most appropriate way?

4. Resource Yourself: The Skillful Use of Power

How will you take care of yourself and use the resources and support available?
How can you use this situation to self-correct and/or be more skillful in the future?
When you have done all you can, how can you best let it go?

Example of the Power Spiral Process in Action

One of my students told me about an experience that usefully illustrates this process. Names and identifying information have been changed to protect confidentiality.

A colleague referred someone to Elena, who works for an agency. The written notes about this man, David, said he wanted to get disability payments. When Elena met with David, he said he didn’t want disability assistance. Hearing that and feeling some reticence from David, Elena began working with him on feeling less shame and personal failure at needing to apply for public assistance.

This process went nowhere. David stopped coming to appointments and even filed a complaint with Elena’s boss. He said he had quit his appointments because she wasn’t giving him any help with his communication skills and managing his anger. Elena was quite surprised to hear this.

Using the power spiral process, Elena got some insights:

That the power differential might have been interfering with David’s ability to tell Elena the truth—that he wasn’t getting what he needed. Based on her notes, she had not actually asked David what he wanted help with, assuming his reticence was his discomfort with needing assistance.
That she was likely projecting her sense of shame about needing public assistance onto David, and that she wasn’t checking in with her gut sense of what was going on.
That she needed to take responsibility for being insensitive to David’s real needs and relying too much on the referral notes. She decided her best choice was to make an authentic apology to David and invite him back to work with her on anger and communication skills. Elena also understood that she needed to do some follow-up work with her boss to let him know how the complaint had been successfully handled.
Elena took the action she decided on. David came back to work with Elena on communication and anger, and was satisfied with their work. Elena learned to focus on the relationship rather than the referral notes. She was glad she had taken responsibility for her mistake and reached out to David to resolve and repair the situation.

This is a fairly simple example of how to use this process and the many insights and guidance the focused questions can provide, and demonstrates how the process can be used in supervision or with a group of peers. It is also a humbling example of how quickly and innocently we can get off course. Further, it underscores how easy it is to be rule-bound (in this case, referral notes-bound) when we most need to be attuning to ourselves and being in right relationship with the people we serve—ethics from the inside out. Finally, it is an example of how simple and straightforward it can be to work out a problematic issue.

Couple not talking after a dispute on the sofa Relationships can be challenging at times. There will always be periods when we get upset, when we feel that our needs and wants are not being met. Intimate relationships are particularly tricky territory emotionally, especially in regards to dealing with anger.

For some people, rage may boil up at a moment’s notice, while for others their fuse may take a little longer to ignite. Sometimes the situation dictates how quickly we become irritated. When our trust has been broken and we feel betrayed, we may become angrier much quicker than if we experienced, say, a minor altercation with a partner regarding finances.

Although it’s generally understood that we should take a little time to cool down before our anger gets out of control, many people struggle with developing an effective “time-out” procedure. The following are some strategies that can be implemented in order to manage your anger before it gets out of hand:

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Become aware of the warning signs of anger. Look for the physical cues in your body that indicate that you are becoming angry. Are your palms sweating? Are you pacing back and forth? Is your tension rising? Try to focus on tuning in to your body and your inner indicators of anger.
Figure out your red flags. In addition to physical signs, be on the lookout for issues that tend to trigger you and your emotional state when someone brings them up. For example, do you get angry with your partner every time he or she treats you with suspicion or blame?
Rate your anger. On a scale of one to 10, how angry are you in the given situation? Try to determine at what point you would need to take a time-out in order to cool off before being able to discuss the issue rationally.
Discuss the time-out strategy with your partner when you are both calm. In order to develop an effective strategy that both parties can agree on, it’s necessary to do so when both of you are in a peaceful state.
Determine the duration for the time-out. Everyone is different when it comes to managing anger. Some people tend to remain angry for longer periods of time than others; however, you can generally figure out approximately how long it usually takes for you to calm down. Many people are able to calm down sufficiently after about 30 minutes to an hour. Before you need to take a time-out, sit down with your partner and agree upon the length of time you want to implement for time-outs. If after this time you are still very angry, you can always extend the time-out.
Signal your intention of taking a time-out. When you start arguing with your partner and you feel that you may be on the verge of losing control, indicate that you need to take a time-out. Both partners need to respect the right of the other to take this time and allow sufficient space to do so without continuing to badger the person.
Decide what you will do during your time-out. The main purpose of the time-out is to give you an opportunity to calm down, so choose an activity that will help you do so. This could be listening to music, going for a walk, working out, or journaling, for example. Be sure to communicate your intentions to your partner when you establish a time-out plan, so that he or she doesn’t feel as though you’re leaving for an undetermined amount of time.
Identify any underlying feelings you may have. During your time-out, take some time to try to figure out any deeper feelings you may have underneath the anger. For example, do you feel sad? Anxious? Unsupported? Anger tends to hide other emotions that can be better dealt with when they are seen, acknowledged, and expressed.
Become aware of any negative self-talk. Our inner dialogues can make situations much worse than they actually are, especially when we are very negative. Try to challenge negative thinking when you notice it and change your thoughts to more positive ones. Also, try to look at the situation from your partner’s point of view in order to gain a different perspective.
Discuss the issue again after your time-out. We don’t want to ignore issues that have led to arguments, so after taking time to cool down, meet with your partner to talk about your feelings. Rather than blaming the other, share with him or her the underlying emotions that you became aware of and try to forgive one another and/or reach some sort of compromise.

Anger can lead to impulsive actions that can have extremely negative effects on our relationships. Learning to keep our anger under control and manage it more effectively is important for our emotional well-being. Following the steps above to create and implement an efficient time-out strategy can help to improve your relationships and avoid having your anger get the better of you or your partner.

If anger is a serious, ongoing problem in your relationship, you may want to consider meeting with a psychotherapist in order to obtain additional help. For those in physically abusive situations, professional help can be especially important in breaking the cycle of violence. Check online for the agencies and shelters available in your area to help couples struggling with issues of domestic violence.

“The real voyage of discovery consists not of seeking new lands, but in seeing with new eyes.” —Marcel Proust’s Remembrance of Things Past

While we cannot go back and change the past or erase painful memories, we can make choices in the present. We can choose how we live our lives, change the lens through which we perceive the world, and look for the lessons along the way.

According to the famous Chinese philosopher Confucius, there are three methods to gaining wisdom: reflection, which is noblest; imitation, which is easiest; and experience, which is bitterest. Bitter though it may be, our experience of pain and suffering has the potential to become our ultimate instrument of transformation and creativity. When we are hurt, slighted, or disappointed, it can be all too easy to follow the path of least resistance and wallow in self-pity. We all do this at one point or another, and can easily remain stuck. But we can also choose another path. We can make the conscious decision to embrace our pain and use it to fuel our creative impulses.

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Maya Angelou, Frida Kahlo, Marcel Proust, and Edvard Munch, all recognized as masters in their respective disciplines, are just a handful of the many talented artists throughout time who turned unfathomable human suffering into riveting works of art. Through the process of personal catharsis and healing, each also transformed a society.

No work of visual art so simply and yet so poignantly depicts psychic pain more than Munch’s painting The Scream. Whether inspired by Munch’s sister, hospitalized for insanity at the time, or Munch’s own pain, this work is relatable as a portrait of universal human suffering. Munch shows us that when in the trenches of despair—anxiety, depression, or any number of other mental health issues—our perception of the world around us can shift wildly. In this piece, Munch’s view of his outer as well as inner landscape comes literally screaming off the palette.

When we are hurt, slighted, or disappointed, it can be all too easy to follow the path of least resistance and wallow in self-pity. We all do this at one point or another, and can easily remain stuck. But we can also choose another path.

The works of Kahlo hauntingly depict both the excruciating physical and psychological pain she experienced throughout much of her lifetime. From a deforming childhood illness and, later, a disfiguring accident which led to chronic pain, to the psychic scars of a tumultuous marriage and a social revolution, Kahlo takes unimaginable circumstances and transforms them into what are now renowned works of art—and potentially therapeutic tools. According to the American Medical Association’s Journal of Ethics, Kahlo’s work has been used by psychologists to empower women to talk about their experiences of physical and emotional pain, as in the cases of interpersonal violence, infertility, and chronic illness.

Artistic expression and exploration are invaluable tools in cases of childhood trauma. How does one reconcile that the same hand that betrays, wounds, and abuses is the one that he or she most needs? For countless victims of childhood abuse and neglect, violence, and other crimes of the soul, making sense of the world can seem an impossible task. Scottish poet John Burnside’s own painful and abusive childhood became the catalyst to several established literary pieces, most notably his memoir, A Lie About My Father. In this tale of forgiving, though certainly not forgetting, Burnside seeks to understand his father, an abusive man with alcoholism for whom “cruelty was an ideology,” and in this process comes to forgive the man who raised him.

Angelou’s Caged Bird is perhaps one of the finest poetic expressions of the injustice of racial oppression. Utilizing nothing more than language, she speaks to the pain of discrimination and the “shackles of racism and misogyny.” Also a victim of childhood rape, Angelou describes the “caged bird” whose “wings are clipped” or freedoms deprived, yet who chooses to use his voice for change:

But a bird that stalks
down his narrow cage
can seldom see through
his bars of rage
his wings are clipped and
his feet are tied
so he opens his throat to sing.

The caged bird sings
with a fearful trill
of things unknown
but longed for still
and his tune is heard
on the distant hill
for the caged bird
sings of freedom.

In seeking to solve the “puzzle of inequality and hate,” Angelou’s transformation of her experience paved the way for not only personal healing and liberation but, as a fierce civil rights activist, was instrumental in fueling societal change.

One need not be a poet, painter, or activist to implement the tools of creative transformation. Whether it is simply taking a course in painting or starting a journal, expressing rather than repressing may prove invaluable in the healing process. Whether out of societal or personal oppression, every caged bird has a voice—and the potential to transform a society or simply heal a soul.

References:

Angelo, F. (2013). Pain and the Paintbrush: The Life and Art of Frida Kahlo. AMA Journal of Ethics, 15 (5), 460-465. Retrieved from http://journalofethics.ama-assn.org/2013/05/imhl1-1305.html
Burnside, J. (2006). A Lie About My Father.
Lubow, A. (2006). Edvard Munch: Beyond The Scream. Smithsonian Magazine. Retrieved from: http://www.smithsonianmag.com/arts-culture/edvard-munch-beyond-the-scream-111810150/
Sethis, A. (2013). I Know Why the Caged Bird Sings by Angelou, Maya-Review. Retrieved from http://www.theguardian.com/books/2013/aug/18/maya-angelou-caged-bird-review

As parents, we frequently focus on learning how best to “discipline” our children. Yet I find the greatest challenge in learning how to be, as a parent, disciplined.

Parents must become savvy in the implementation of effective disciplinary strategies that are clear, reasonable, and enforceable, but—more importantly—parents first must test their own discipline as people. Disciplined parenting calls for heightened self-awareness.

Much of the research on parenting styles has studied the ways in which parents are responsive as well as demanding. Responsiveness is about understanding and meeting needs, while demanding-ness is about establishing and enforcing expectations. Skillful parenting in these ways undergirds two fundamental, equally necessary forces in human development: attachment and autonomy.

To the extent we are securely attached, we experience trust and emotional connection which are critical to enhancing our capacity for relating well to others. To the extent we are responsibly autonomous, we are able to self-soothe and engage in independent tasks which are critical to living well in society.

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Parenting challenges such as attention-seeking behaviors and power struggles are nearly always expressions of underlying and unresolved needs functioning toward a child’s development. As parents, we must recognize in facing such behavior that we stand at a crossroads—externally control our children’s behavior or positively influence their intrinsic development?

The American theologian Reinhold Niebuhr became famous for a prayer he often repeated in one form or another: “Lord, grant me the courage to change the things that I can, peace to accept what I cannot, and the wisdom to know the difference.” In the context of parenting, at least, change is about control.

We must learn there are limits to the effectiveness of external control in cultivating the development of our children’s character and resiliency, yet we can provide a great amount of powerful influence.

When kids misbehave, wise parents respond in ways that guide the development of the person hidden underneath the monstrous mood and the impulsive behavior. In other words, we can change the way we respond to our children’s behavior in positive ways that demonstrate greater insight, courage, and skill.

We must understand, for instance, that we cannot purely control our children’s disobedient behavior, refusal to do chores, sneakiness, shyness, moodiness, tantrums, demands, overreactions, unresponsiveness to affections or praise, or unwillingness to participate or connect.

What we can control, however, are the ways in which we establish rules and set limits, link privileges to responsibility, allow space and privacy, show interest and inquire into their lives, provide regular choices, use a calm yet firm voice, give our affections and praise, and plan and spend quality time together.

The Couch Potato

Some parents are disengaged from their children’s lives and tend to be emotionally detached, practically uninvolved, and negligent in establishing expectations and guidance. I call these parents “couch potatoes.” They are characterized by unresponsiveness to needs, few demands, and little communication.

There are several ways to traumatize with neglect. Provide food and shelter, if that, but little else. Remain emotionally distant. Be selfish and uncaring. Do not enforce any standards of any kind. Uninvolved parenting practically ensures that a child will fear and sabotage close relationships, experience heightened anxiety, and have significant deficiencies in his or her capacity for empathy and even ethical decision-making.

The Dictator

Some parents are highly demanding of their children but not responsive to their emotional needs. I call them “dictatorial” parents. These parents are generally characterized as more rigid, harsh, and demanding and tend to engage in provocative and punitive forms of discipline.

There are several ways we can make children behave—force, fear, and punishment. Dictatorial tactics serve to overpower a child. These methods may result in the restoration of order and compliance, yet far from nurturing unmet developmental needs, they simply make a child angry, resentful, fearful, and dependent upon force.

The Peer

Some parents are highly responsive to their children’s perceived emotional needs but not very demanding. They are overly responsive to a child’s wants and seldom establish or enforce consistent rules or limits. I call them “peer” parents. Others may characterize them as soft or pathetic in their approach to discipline.

There are several ways we can get children off our backs—whine, appease, avoid. Permissive parents are warm and nurturing with their children, yet may fail to engage in effective guidance. By overvaluing friendliness and undervaluing other aspects and principles, parents may inadvertently reward or reinforce immature or deviant behavior.

The Disciplined Parent

Parents who are highly attuned and responsive to their children’s needs and are also highly demanding of them in guiding them toward maturity and independence are, by necessity, disciplined in their parenting. Disciplined parents are firm but not rigid; they are willing to make an exception when the situation warrants.

Disciplined parenting engages in responsive and restorative discipline that focuses on instilling key values and skills, including self-soothing, delaying gratification, constructive communication, fairness, and citizenship. Disciplined parenting serves to empower a child, focusing on responding to developmental needs (the responsive aspect) and teaching how to make things right after they’ve gone wrong (the restorative aspect).

How would you describe your own approach to parenting and discipline?

Young Girl Staring out Window As a therapist, I’ve used eye movement desensitization and reprocessing (EMDR) therapy to treat many adults with mental health issues resulting from trauma. This method of therapy is also safe and effective for children and adolescents, provided that the therapist is skilled and trained in working with this population and in this modality.

What Is EMDR?

When a painful or upsetting experience happens, the memory of the experience sometimes stays “stuck” in the body and mind. Over time, the occurrence may manifest anew in disturbing and invasive ways.

Dr. Ricky Greenwald, a pioneer in developing EMDR therapy for children and teens, describes EMDR as “a non-drug, non-hypnosis psychotherapy procedure. The therapist guides the client in concentrating on a troubling memory or emotion while moving the eyes rapidly back and forth (by following the therapist’s fingers). This rapid eye movement, which occurs naturally during dreaming, seems to speed the client’s movement through the healing process.”

After experiencing trauma, a child may have recurring nightmares or cope by avoiding things associated with the disturbing experience. For example, a child who experienced a car accident may exhibit defiant behavior when in a vehicle, or protest having to travel in the first place.

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Essentially, EMDR can help the brain “digest” the memory of the traumatic event.

How Does EMDR Help Children?

EMDR is effective and well supported by research evidence for treating children with symptoms accompanying posttraumatic stress (PTSD), attachment issues, dissociation, and self-regulation. It has also been effective in treating symptoms related to guilt, anger, depression, and anxiety, and can be used to boost emotional resources such as confidence and self-esteem.

During the past five years, the World Health Organization and the California Evidence Based-Clearinghouse for Child Welfare recommended two psychotherapies for children, adolescents, and adults with PTSD: trauma-focused cognitive behavioral therapy and EMDR. Of the two modalities, some of the research describes EMDR as “significantly more efficient.” My experience as a therapist echoes these recommendations.

One Therapist’s Experience with EMDR

I have personally witnessed children and teens improve in their overall functioning after being treated with EMDR, sometimes after only a few sessions. These children experienced PTSD symptoms as a result of bullying, psychological abuse, sexual abuse, and invasive medical procedures. Some of these traumas occurred at the hands of someone with malicious intent; others were formed from the child’s perceived intent.

Since our emotional states are a result of how we perceive the world, a child may have stress related to a memory that, to anyone else, would not seem to be a “big deal.” In an effort to help their children “get over it,” parents often tell them things such as, “It’s not that bad,” or, “He wasn’t that mean to you.” But if the experience was traumatic to the child, it was traumatic—period.

In an effort to help their children “get over it,” parents often tell them things such as, “It’s not that bad,” or, “He wasn’t that mean to you.” But if the experience was traumatic to the child, it was traumatic—period.

Trauma can result from one event, multiple events, or a series of them. These events can cause children to see the world as dangerous and can alter their ability to function. A child may experience anxiety, fear of death, panic, powerlessness, anger, and deep sadness. When the trauma is a result of violence perpetrated by a caregiver they trust, it becomes overwhelming and can cause a child to be in a constant state of worry. This, of course, interferes with the child’s ability to trust or to sustain and maintain relationships.

Therapy can be a scary prospect to a child. When I explain to a child that our brains are amazing things that have the ability to heal themselves, and that I will help their brains do just that, they usually react with curiosity and intrigue and the process becomes much less scary.

What to Look for in an EMDR Therapist

The safety of any treatment modality depends on the practitioner’s aptitude to administer it. A licensed therapist who is fully trained in EMDR is well equipped to help a child or teen. The therapist should have training in how to apply the method to the child’s specific developmental needs and an ability to explain the process to the child in a way he or she will understand. A full history should be obtained from the parents, who should be considered partners in tracking changes in the child as the treatment progresses.

EMDR is often used in combination with other therapeutic modalities, such as art therapy, sand tray therapy, play therapy, yoga therapy, and even animal-assisted therapy. A therapist who offers a multifaceted approach, based on the child’s unique needs and interests, is ideal.

If interested in seeking the help of an EMDR-trained therapist, search GoodTherapy.org’s directory for a therapist near you.

References:

California Evidence-Based Clearinghouse for Child Welfare. (2010). Retrieved from http://www.cebc4cw.org
Gomez, A. (2008). Beyond PTSD: Treating depression in children and adolescents using EMDR. Paper presented at the annual meeting of the EMDR International Association, Phoenix, AZ.
Jaberghaderi, N., Greenwald, R., Rubin, A., Zand, S. O., and Dolatabadi, S. (2004). A comparison of CBT and EMDR for sexually abused Iranian girls. Clinical Psychology and Psychotherapy, 11,358-368.
Trauma Institute & Child Trauma Institute. (2015). Eye Movement Desensitization & Reprocessing. Retrieved from http://www.childtrauma.com/treatment/emdr/
World Health Organization. (2013). Guidelines for the Management of Conditions Specifically Related to Stress. Geneva, Switzerland. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK159725/

GoodTherapy | The Brain in Defense Mode: How Dissociation Helps Us Survive According to Ross and Halpern (2011), there are several definitions of dissociation. One of them (referred to as “the general systems meaning of dissociation”) is “the opposite of association” or the disconnection of two or more things that were once associated with each other. Another definition, presented by Steinberg and Schnall (2001), defines dissociation as “an adaptive defense in response to high stress or trauma characterized by memory loss and a sense of disconnection from oneself or one’s surroundings.”

Dissociation occurs when someone disconnects from some part of himself or herself or the environment. It can occur in a number of different ways, including disconnection from one’s emotions, body sensations, memories, senses, etc. A normal and common phenomenon, dissociation can happen in mild forms even when there is not imminent danger or stress. Think of a time you drove somewhere, arrived, and then couldn’t remember the drive because your mind was wandering; an instance when you lost track of time because you were engrossed in a riveting television show; or when you disconnected from body sensations to avoid going to the bathroom when you were on a tight deadline at work.

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Dissociation is something we all do, and it is a vital part of our ingrained survival system. It is a part of the system that helps us to cope with stressful situations, which may otherwise feel overwhelming (Steinberg and Schnall, 2001). It is built in and is not pathological (Ross and Halpern, 2011). However, when a trauma occurs, sometimes this built-in system disconnects to a greater degree in an effort to protect the individual from traumatic material, body sensations, emotions, or memories that may be overwhelming.

Dissociation related to trauma occurs in varying degrees. On the lower end of the dissociation spectrum, for example, let’s say someone was in a car accident. A few days after the accident, the person finds that he or she cannot recall parts of the accident, even though reports of others were that he or she was conscious and responsive during those times he or she cannot recall. On the other end of the spectrum, someone who was severely abused throughout life can dissociate to the point that he or she has more than one personality, all of whom display and contain their own characteristics and who hold different memories associated with the trauma.

For the traumatized individual, dissociation may help him or her to survive circumstances that may have otherwise been intolerable. Dissociation can help a person feel as if situations, his or her body sensations, emotions that would have been overwhelming, etc., are muted and distorted so he or she can then go into “autopilot” mode and survive extreme situations and circumstances. When trauma is ongoing, dissociation can become “fixed and automatic” (Steinberg and Schnall, 2001). When this is the case, integration of memories becomes difficult for the brain, and the brain also continues to send of signals of danger, even when the traumatic situation is over (Steinberg and Schnall, 2001). This can continue for years after a traumatic situation has ended.

According to Steinberg and Schnall (2001), the five central symptoms of dissociation are:

Amnesia: Loss of memory for short or long periods of time. This can include not recalling all or part of an incident or time period.
Depersonalization: Feeling detached from yourself, parts of your body, and your emotions—like you are on autopilot or robotic.
Derealization: Feeling detached from your surroundings and people who were once familiar—like the world around you isn’t real.
Identity confusion: Feeling “uncertainty, puzzlement, or conflict about who you are” (Steinberg and Schnall, 2001).
Identity alteration: Alterations in personality and behavior that others notice. Sometimes this manifests as feeling as if you don’t have control over other personalities or your body.

For someone who is concerned that he or she is experiencing a more-than-normal incidence of dissociative symptoms, help is available. Several accurate tests are available through therapists and psychologists who have been specially trained in diagnosing and treating dissociation and trauma.

The goal in therapy is not to eliminate dissociation completely, but rather to help the brain and body to update to the current circumstances. Specifically, this would include helping a person to integrate current information about the present circumstances in which they live. If no danger currently exists, helping the brain and body to learn how to be safe would be one part of treatment. Working toward being able to maintain awareness of the present moment, body sensations, emotions, surroundings, etc.—also known as mindfulness—is one way to start to address dissociation, especially prior to any trauma work that needs to be addressed.

As a therapist, I appreciate dissociation as a valuable gift our brains are able to give us when we endure trauma. I emphasize to the people I work with in therapy that dissociation has helped them to survive, and we can acknowledge that this is a defense that has perhaps worked for longer than it was intended. It is important to remember that experiencing more than a regular level or type of dissociation as a result of trauma does not make a person defective. Rather, it shows that he or she has been able to live through and survive extraordinary circumstances that no one would be able to endure without the brain’s ability to dissociate.

References:

Ross, C., and Halpern, N. (2009). Trauma Model Therapy: A Treatment Approach for Trauma, Dissociation and Complex Comorbidity. Richardson, Texas: Manitou Communications.
Steinberg, M., and Schnall M. (2001). The Stranger in the Mirror. New York, New York: Harper.