Many people, but primarily young, educated, Western women, struggle to sustain a positive body image—for a multitude of reasons that have been discussed in previous posts. Often a negative body image leads to a poor relationship with the body and other aspects of self. It is associated with impoverished self-care and unhealthy eating and lifestyle habits.

Having a negative body image is related to general low self-esteem and depression or anxiety. Women with poor body image often struggle with boundaries in relationship to self and others. In this post, I will attempt to shed some light on the issue of boundaries related to poor body image, a concept often discussed and infrequently understood.

Women with poor body image tend to have a compartmentalized approach to well-being. For example, they may be overly focused on certain parts of the body or particular goals, such as weight loss, while devaluing other important aspects of overall health and fitness. People who have poor body image demonstrate an all-or-nothing approach to wellness, swinging from one extreme to the other, sometimes within the same day. They tend to have an exceptional level of acquired knowledge about what is healthy and set idealistic goals based on this knowledge and also are frequently disappointed and blame themselves when they are unable to attain these goals.

The lack of a holistic perspective is evidenced in an inability to balance fitness with relaxation, healthy food choices with enjoyment of food, and so on. Not surprisingly, it is common to hear that they have dissatisfying relationships with others. The all-or-nothing tendency is implicated in their sense of being overwhelmed in relationships. They sometimes become preoccupied with the other person, swinging from feeling too close to feeling uncomfortably vulnerable even feeling lost in a relationship and wanting to cut it off.

The biggest and most obvious issue I see in working with women with poor body image is that most of the information used to make decisions about relationships and well-being comes from external sources. A total and complete lack of trust in the body and the self’s ability to regulate is obvious in their decision making. There is usually a clear history in the development of this lack of trust with regard to personal, familial, and cultural messages that have been internalized. (A full discussion of these factors is beyond the scope of this article). A lack of trust in the body and in the self leads to poor listening and misinterpretation of the cues that emerge from within. After a prolonged period of not paying attention to these signals, one’s ability to understand and act in accordance to one’s own needs becomes weakened. The needs of others become the focus of too much energy and attention, often referred to as a boundary issue.

Boundaries can be physical, mental, or emotional. Clear boundary violations are easy to identify and are well known as something that is usually morally or legally wrong and/or clearly harmful to another person’s safety, integrity, or well-being. However, there is a huge gray area between what is ideal and what is harmful, and sometimes subtle violations can lead to hurt, shame, self-doubt, and low self-esteem. Violations usually happen by the person who is in a perceived position of power, as in the obvious case of an adult taking advantage of or imposing his or her personal needs on a child, or a doctor over a patient. But there are other relationships in which people can feel vulnerable and open to influence, harmful or positive. In these more subtle cases of power and vulnerability, the delivery of emotional (or more direct) messages about the self can also lead to unhealthy attitudes, self-doubt, and low self-worth. For example, people in positions of perceived or felt power who regularly directly or indirectly impose their opinions and choices can influence others to have doubts about their own choices.

A healthy boundary between people is a perceived buffering zone, whereby a felt sense of acceptable difference exists. Respectful support of differences by people in positions of perceived power and influence can help a person grow a strong sense of self and hence the ability to re-enact these perceived boundaries in other relationships. Good boundaries lead to healthy awareness of needs of the self and also positive choices that enhance the sense of self and relationships. Supporting an individual’s development involves a strong sense of self and honoring differences in others, an open attitude of acceptance and humility. A supportive stance involves allowing another person to feel, think, struggle, learn, and identify what is right for him or her without unwelcome advice or control tactics or too much distance or silence.

Recognizing and accepting differences, a supportive stance, involves sharing personal views and opinions with a sense of humility and recognizing that they are indeed personal and individual and should not be imposed on others. Offering help when it is asked for and refraining from taking over, micromanaging, or rescuing another person is important. Healthy boundaries lead to healthy relationships, and healthy relationships lead to healthy development of individuals.

Where the development of healthy boundaries has been challenged, an individual will often be overly dependent on external information and feedback to feel safe in their decision making and hence may have a poorly developed or negative sense of their own worth. In the case of the person with poor body image, this person becomes adept at information gathering, using perceived feedback to set expectations for the self that are often unrealistic. Perception itself is flawed and is often skewed towards negative, self-fulfilling ideas of self-worth. By engaging in a selection bias, people with low self-esteem will seek out and attend to cues that confirm what they think they know about themselves that is usually negative. In addition, they may believe it is possible to please others all of the time, which is clearly faulty.

Emphasis on interpretation and internalization of other people’s expectations is a recipe for impoverished self-worth. Living according to perceived notions of other people’s expectations often leads to repressed resentment, disempowerment, and disappointment. In some cases, the only way to assert the self is in a passive-aggressive manner, which is usually not received well by others. While indeed it is healthy to have a sense of social expectation and be kind and thoughtful towards others, these behaviors need to be enacted based on a clear and healthy sense of self, which requires an awareness of personal thoughts, beliefs, feelings, and needs and the differences between self and other. Healthy self and healthy relationships interrelate and influence the development of both. The development of clear boundaries has a positive impact on individuals and on others with whom they have relationships.

However, the responsibility for nurturing clear boundaries falls on individuals in a position of power of any kind. Most people in some domain of their lives are in a position to help or hinder the development of another person. It is important that we always be aware of the difference between our own needs and feelings and those of others and to refrain from overstepping and imposing or, conversely, mistakenly taking on responsibility for other people in a way that invalidates or challenges their own development.

Where boundaries were violated, or not properly developed, psychotherapy can help to personalize new ways of being that include more emotional self-awareness and self-regulation, as well as assertiveness and effective communication skills. Healthy boundaries and self-esteem are achievable goals.

Related articles:
Our Bodies/Ourselves
The Vanity Myth: Eating Disorders and Beauty
Self-Esteem and Standards

Do you remember your first bully—the girl who called you fat, mocked your choice in clothes, or spread false rumors about you? Of course you do. It’s like a first kiss, a first drink, the first time you drove a car. Only this is a memory you wish you could forget. You may not recall her exact words, but you remember the girl, the time, the place. Did you ever wonder why she did it, what provoked her meanness, how she got to wield so much power?

Bullying is an intentional act of aggression in which the perpetrator belittles, controls, intimidates or harms another person. Attacks are often unprovoked, and exploit an individual’s vulnerabilities or weakness. Although male bullying is typically straightforward, often involving physical aggression or blatantly hostile taunts, female bullying may be more subtle, and therefore, harder to detect. For girls, bullying can be a means of gaining popularity, jockeying for power among peers, or asserting control. Since it is more covert, teachers and parents may overlook clues, or assume the behavior is just a normal part of social interactions.

Some forms that bullying can take include:

• Deliberate exclusion, alienation, or ostracism of a peer for no apparent reason
• Verbal attacks, such as spreading rumors or lies by word of mouth or on the internet
• Making prank phone calls, or sending harassing e-mails or text messages
• Overt forms of aggression, such as stealing, making threats, or name-calling
• Covert forms of derision or humiliation, such as giggling or whispering about the victim when she is nearby, eye-rolling, being friendly one day and ignoring her the next
• Encouraging other girls to act out against, ignore, humiliate or pick on another child

So, why do girls resort to bullying? Reasons vary, but usually include a need for control, attention, and approval, or an outlet for anger. Girls who bully may appear threatening and commit hurtful acts, but they often harbor underlying insecurities that fuel their behaviors. Some feel lonely, inadequate, and fearful, and bully to feel powerful or hide their insecurity. Some attack first before they are attacked by others. Some are angry about problems at home and lash out at peers. Occasionally, girls who bully learn these behaviors at home due to family members who are abusive or because of a hostile neighborhood environment. Popularity is no safeguard, since often the girls who bully are those who seem to have it all. Frequently, the pretty, popular, athletic girls are the ringleaders who foster a culture of bullying, even though they may have already acquired power in the social hierarchies of their schools.

The process of bullying can develop slowly over time. Girls who are popular and charismatic may attract others into their circle of friends and make them feel special. They may then try to control these girls, expect favors, or demand that the new girls bully others as well. By controlling a group of peers, bullies achieve power in numbers and go on to terrorize teens they believe are a threat. Individual victims can be targeted at random, but are often selected because of jealousy, noticeable differences, refusal to conform to the group, or a weakness that can be exploited. Bullying also can be sparked by a sudden turn of events in a friendship, where the bully feels threatened and angry, and decides that she must retaliate.

While punches are not thrown, bullying can leave a devastating mark on its victim and engender long-lasting pain and suffering. Girls are particularly vulnerable because of how much they value friendships. Victims can become depressed, anxious, insecure, and feel they are to blame. Obsessive preoccupation with perceived flaws, physical appearance, conformity, and adhering to the bully’s rules of conduct can follow. Conversely, some girls who are bullied become isolated, withdrawn, and even drop out of school. In rare instances, victims can become so depressed and hopeless that they consider suicide as their only option.

Victims often remain silent due to embarrassment, self-blame, or fear of retaliation, so incidents of bullying may go unnoticed. Investigate whether bullying is occurring if your loved one, friend, or student is showing any of the following signs: mood swings, sudden withdrawal from friends, refusal to attend school or social events, sleep problems, academic difficulties, physical complaints, weight loss or gain, or frequent crying.

If you suspect that someone you know is being bullied, it is important to offer support. Reassure the victim that the bullying will end eventually, and that you will help her identify strategies for addressing the problem. One size does not fit all, so a variety of strategies and interventions should be considered depending on the specific situation. Useful websites with anti-bullying tips are listed below. Sometimes getting advice from a therapist or guidance counselor can help. Girls who bully also benefit from counseling, where they can learn to take responsibility for their behaviors and identify appropriate outlets for their anger and need for control.

Prevention is essential, and needs to come from both the family and community. Parents need to discuss bullying with their children, even before it occurs. Teaching girls how to respond to potentially difficult situations, before a problem develops, is critical. Helping young girls improve their self-esteem by developing strong academic, athletic or extracurricular interests, and finding friends who share similar interests (so that social standing is not as critical), may minimize their vulnerability to falling victim. Schools should offer anti-bullying initiatives, including training for staff, programs for students, and counseling services when necessary. When parents, schools, and the community promote an environment where bullying is unacceptable, perhaps fewer girls (and boys) will have to encounter that first bully.

Anti-Bullying Resources and Information:

• American Psychological Association
• GirlsHealth.gov
• KidsHealth.org
• StopBullying.gov

How often do you want sex? And is that enough? But the majority of these women are heterosexual with male partners who are – you guessed it – complaining. So I guess I should say “relatively low levels of sexual desire!”

Over and over again I’ve found that moving in together does create a drop in the frequency of sexual activity for all couples regardless of gender. Long distance romance remains exciting because it provides space and distance interspersed with sexy weekend liaisons. But which is “normal” – the level of desire we experience early in a relationship or what unfolds later on?

Research consistently shows that low sexual desire affects 10-20% of women generally, with some studies finding that 40% of midlife women report low sexual desire. However, approximately 1 in 3 women experience low sexual desire at some point, making this one of the most common sexual concerns.

This is why couples therapist Esther Perel points out that “good intimacy doesn’t always guarantee good sex.” Her book Mating in Captivity explores the paradoxical union of domesticity and sexual desire, examining what it takes to sustain passion in long-term relationships. In it she points out that “the very elements that nurture love – reciprocity, mutuality, protection, closeness, emotional security, predictability – are sometimes the very things that stifle desire.”

So these guys start to feel like a brother or worse yet a child, and sex with family members is a definite no-no in our culture. Children and pets need caregiving, which we provide as an act of love.

Recent research on heteronormativity theory supports this observation, showing that unequal distribution of household labor places considerable burden on women, leading to feelings of inequity and exhaustion that ultimately diminish desire. The blurring of maternal and partnership roles, where women often find themselves mothering their partners, can lead to feelings of overwhelm and decreased desire.

Research conducted with married women who experienced desire decline found three core themes: institutionalization of the relationship, over-familiarity, and the de-sexualization of roles. For some women, formalizing their relationship through marriage made sex so available and sanctioned that it lost the forbidden and erotic quality that had formerly ignited passion. For others, overfamiliarity with their partner led to a decline in romance and sexual experimentation, as well as loss of motivation for self-care once they had “secured” their relationship.

A third group of women reported that holding down a job, being mom, and being a wife was overwhelming and “highly desexualizing,” making it extremely difficult to shift into romantic mode after changing diapers and fulfilling their professional roles. Many of the participants in all three groups specifically noted that while they were committed to their marriage, they thought desire would return if someone new came along who desired them.

As researchers now understand, women’s desire may be driven to the same extent as it is in men by novelty and excitement. The idea that female desire is simply about loving somebody has proven to be an oversimplification.

Over and above anyone else, we are our own point of reference for how sexy we are. Feeling good about ourselves emotionally and physically appears to be a bigger mediator of female desire than relationship factors alone. Research shows that sexual self-esteem, sexual desire, and sexual assertiveness all correlate positively with sexual function in women. This certainly bears out in my conversations with female clients.

Recently, for example, a woman told me that she no longer wanted to have sex “on top” of or astride her mate, “because my stomach sticks out and it would look terrible to him from that angle!” He shook his head, “Honey, I probably don’t even have my eyes open … that used to be your favorite position because it felt best to you … what else could possibly matter?”

*If you’re experiencing concerns about sexual desire, consider reaching out to one of our qualified therapists who specialize in sexual health and relationships.*

Gewirtz-Meydan, A., Sowan, W., Estlein, R., & Winstok, Z. (2024). Rights or obligations: The extent to which sexual desire and gender roles determine sexual intimacy in romantic relationships. Journal of Sex & Marital Therapy, 50(5), 482-497.

Johansen, E., Harkin, A., Keating, F., Sanchez, A., & Buzwell, S. (2023). Fairer sex: The role of relationship equity in female sexual desire. Journal of Sex Research, 60(4), 498-507.

O’Kane, K. M. K., Goldberg, S. Y., Bouchard, K. N., & Dawson, S. J. (2023). Debunking desire: Sexual science, social media, and strategy in the pursuit of knowledge dissemination. Archives of Sexual Behavior, 52(3), 1087-1099.

Peixoto, M. M., Amarelo-Pires, I., Pereira, H., & Nobre, P. (2023). Solitary and dyadic sexual desire and sexual satisfaction in women with and without sexual concerns. Journal of Sex & Marital Therapy, 49(1), 77-87.

Perel, E. (2006). Mating in captivity: Unlocking erotic intelligence. Harper.

Rowen, T. S., & Goldstein, A. T. (2024). Sexual desire and pharmacologic management. Obstetrics and Gynecology Clinics, 51(2), 259-271.

Sims, K. E., & Meana, M. (2010). Why did passion wane? A qualitative study of married women’s attributions for declines in sexual desire. Journal of Sex & Marital Therapy, 36(4), 360-380.

Thomas, H. N., Brotto, L. A., de Abril Cameron, F., Yabes, J., & Thurston, R. C. (2023). A virtual, group-based mindfulness intervention for midlife and older women with low libido lowers sexual distress in a randomized controlled pilot study. Journal of Sexual Medicine, 20(8), 1060-1068.

Wainberg, M. L., Muench, F., Morgenstern, J., O’Leary, A., Foote, J., Krupitsky, E., & Silverman, E. (2018). Prevalence and predictors of sexual problems among midlife Canadian adults: Results from a national survey. Journal of Sexual Medicine, 15(6), 873-879.

References:

1. Gewirtz-Meydan, A., Sowan, W., Estlein, R., & Winstok, Z. (2024). Rights or obligations: The extent to which sexual desire and gender roles determine sexual intimacy in romantic relationships. Journal of Sex & Marital Therapy, 50(5), 482-497.
2. Johansen, E., Harkin, A., Keating, F., Sanchez, A., & Buzwell, S. (2023). Fairer sex: The role of relationship equity in female sexual desire. Journal of Sex Research, 60(4), 498-507.
3. O’Kane, K. M. K., Goldberg, S. Y., Bouchard, K. N., & Dawson, S. J. (2023). Debunking desire: Sexual science, social media, and strategy in the pursuit of knowledge dissemination. Archives of Sexual Behavior, 52(3), 1087-1099.
4. Peixoto, M. M., Amarelo-Pires, I., Pereira, H., & Nobre, P. (2023). Solitary and dyadic sexual desire and sexual satisfaction in women with and without sexual concerns. Journal of Sex & Marital Therapy, 49(1), 77-87.
5. Perel, E. (2006). Mating in captivity: Unlocking erotic intelligence. Harper.
6. Rowen, T. S., & Goldstein, A. T. (2024). Sexual desire and pharmacologic management. Obstetrics and Gynecology Clinics, 51(2), 259-271.
7. Sims, K. E., & Meana, M. (2010). Why did passion wane? A qualitative study of married women’s attributions for declines in sexual desire. Journal of Sex & Marital Therapy, 36(4), 360-380.
8. Thomas, H. N., Brotto, L. A., de Abril Cameron, F., Yabes, J., & Thurston, R. C. (2023). A virtual, group-based mindfulness intervention for midlife and older women with low libido lowers sexual distress in a randomized controlled pilot study. Journal of Sexual Medicine, 20(8), 1060-1068.
9. Wainberg, M. L., Muench, F., Morgenstern, J., O’Leary, A., Foote, J., Krupitsky, E., & Silverman, E. (2018). Prevalence and predictors of sexual problems among midlife Canadian adults: Results from a national survey. Journal of Sexual Medicine, 15(6), 873-879.

Mandy nuzzled her 3 month old baby happily as she warmed his bottle. It felt so good to breathe in his sweet baby smell and touch his soft delicate skin, his little body curled in a warm embrace into the curve of her neck. Mandy was starting to feel like she had her “sea-legs’ as a new mom and was particularly enamored of the fact that her new baby was sleeping through the night. The rough night-time awakenings were beginning to subside as baby Noah matured and slept for longer periods. She was looking forward to meeting a new mom friend in the park with their babies after she gave Noah a bottle.

Suddenly, in the wink of an eye, the tender moment vanished. Mandy watched the water warm Noah’s bottle on the stove. She  was blind-sided by a  horrific thought, flashing through her mind of the  water morphing into hot lava and scalding her baby boy. Mandy flinched, gasping and clenching tightly onto Noah, quickly backing away from the oven. The thought terrified her, and she could not believe such an image threatened to envelop her mind. Mandy’s entire body tensed as she began to pant, shallow breaths. She didn’t know it at the time, but, she was well on her way to her first panic attack after experiencing an intrusive thought…a hallmark symptom of perinatal depression and/or perinatal OCD.

Experiences like Mandy’s are common in some 20% of all child-bearing women who develop perinatal mood/anxiety disorders (the clinical term for depression/anxiety during pregnancy and up through the first year after having a baby). Some women develop symptoms of anxiety with intrusive thoughts while others may not experience these often debilitating and traumatic images. Others may have more depression symptoms with a smattering of anxiety, panic attacks, and sometimes intrusive thoughts.

PMADs (perinatal mood/anxiety disorders) are the clinical term for a myriad of symptoms under the umbrella of depression and anxiety from conception through the first year following childbirth.  In layman’s terms, perinatal challenges/neurobiochemical imbalances while pregnant and after having a baby often leave women completely stunned, horrified, and traumatized…because  women don’t know what hit them. And no one talks about it.

The reality is that PMADs are very common, and most likely under-reported due to the stigma connected to them. Mothers can be wracked with so much guilt about any of the symptoms, particularly if she has intrusive thoughts, that they are loathe to talk to a specialist to get help or to a family member. Many women report they feel like they are “going crazy” or afraid to be “like that woman on TV who killed her kids.”

I want to underscore the importance of supporting a woman who is experiencing intrusive thoughts to not delay in seeking help, to get help immediately with a trained specialist in perinatal challenges. The differential amongst these particular perinatal struggles is quite delicate. Furthermore, to receive the best care, she must have help from a skilled perinatal psychotherapist who can provide a comprehensive bio-psycho-social assessment and steer her in the appropriate direction for what is ideally a multidisciplinary approach to treatment.

This article is not intended to be a primer on the difference between perinatal intrusive thoughts and hallucinations since such is the subject of a workshop or conference. And, each set of circumstances requires a different course of treatment (both medically and in psychotherapy). Generally speaking, however, when a woman experiences intrusive thoughts, she is grounded in reality and horrified of the images that are occurring, feeling that her body is betraying her. She will often respond with disgust at the images and in turn demonstrate behaviors that lessen her anxiety and protect her baby (for example, Mandy avoided ovens for a time because such objects were a trigger for her). Intrusive thoughts can be part of perinatal depression and will remit with psychotherapy and in many cases, medication management (typically an SSRI), along with a good self-care plan and social supports in place.  Hallucinations, on the other hand, are considered a medical emergency and potentially part of a more rare PMAD, perinatal bipolar disorder or psychosis. In such a case, the woman is not grounded in reality, and hallucinations can cause her to do or say things that she would not normally do and have the potential to be life-threatening to her or the baby. If you suspect that you or a loved one are experiencing hallucinations, call 911 or go to your nearest emergency room immediately. Do not attempt to diagnose.

Fortunately for Mandy, she realized something was amiss in her brain biochemistry and immediately sought help with a trained perinatal psychotherapist. Upon consulting with a psychiatrist specializing in reproductive mental health, she agreed to try an antidepressant (Zoloft) to help her biochemistry restore itself. Mandy’s recovery was swift because she sought help immediately, she received support, non-judgment, validation, psycho-education, as well as cognitive behavioral strategies in psychotherapy to help her diminish the anxiety and intrusive thoughts. She worked with her therapist on a solid self-care plan and put in place the help of a doula (hired caregiver specifically for new parents). Mandy feels empowered now as a new mom, free of intrusive thoughts and filled with pride at the arrival of Noah in her life. She is now on to a full recovery, enjoying her 7 month old son. (Please note: swiftness of recovery times vary with each individual’s unique circumstances).

If you or someone you love appears to have intrusive thoughts after having a baby (or even while pregnant), do not attempt to diagnose her. Do find a trained perinatal specialist to help the woman you care about to get treatment. The good news is that PMADs are treatable and temporary, and with help, women recover fully.

Other useful resources:

• Postpartum Support International—www.postpartum.net – largest non-profit dedicated to PMAD awareness; vast clearinghouse of information on PMADs, down-loadable fact sheets, online support groups for moms and dads, chat with an expert, stellar bibliography of recommended books, latest research findings and trainings in the perinatal world; current legislation in support of PMAD awareness, destigmatization, and treatment; coordinator/volunteers link callers/e-mailers with trained professionals; warmline in English/Spanish
• Postpartum Progress—www.postpartumprogress.com – most widely read blog on perinatal challenges, by Katherine Stone; the reader can subscribe to a daily news feed and a daily affirmation of hope.
• Real Mom Experts - www.realmomexperts.com – website dedicated to supporting women with PMADs, written by perinatal psychotherapists; self-care techniques for moms

Great book on intrusive thoughts:
Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood by Karen Kleiman and Amy Wenzel (2010). –excellent book for new moms dealing with PMADs, also for perinatal professionals

For people who are dating or dealing with the starting and ending of intimate relationships, a certain question tends to arise… can ex-partners maintain healthy roles in each others’ lives? And if so, when, where, how, and (most obviously) why? Sometimes an ex’s role is clear; for example, a couple who has children together will most likely continue as co-parents in the event of a separation. Other post-breakup scenarios have less obvious answers. Exes can, often unintentionally, fall into dysfunctional roles in each other’s lives, such as a baggage-laden “friend”, convenient sexual outlet, or receptacle of lingering animosity. Deciding how to continue forward, together or separately, after a relationship dissolves can be tricky for anyone. However, for several reasons, this quandary appears to be particularly challenging for lesbians.

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First of all, gay women’s friends and lovers are typically the same gender, making boundaries around friendships and romantic relationships more flexible. This is a challenge unique to lesbian relationships, simply because women—of any sexuality—tend to forge their closest bonds with other women. The potential for any gay-leaning friend or acquaintance to become a lover adds a level of challenge and confusion to many lesbian social circles. It is very common for lesbian friendships to morph into a more intimate configuration for a period of time, changing the interpersonal patterns within their friendship group. If the romantic relationship ends, it is often natural for the former couple to try to return to being “just friends”. It may sound simple in theory, but the physical and emotional intimacy shared and corresponding bonds established are not easily severed. And it’s not always the most comfortable of arrangements for the exes or for the new partners involved, to say the least.

This leads to another issue contributing to lesbian post-breakup complications… both partners in the couple are guided by the emotional physiology of the human female. In heterosexual relationships, a hormonal balance is generally struck so that reactions may be tempered through differing intensities of experience and response to emotional stimulation. Meaning men are often less emotionally reactive whereas women tend to be more highly sensitive. When both partners in a couple are sensitive women, the resulting emotional intensity can create significant difficulty for the ex-couple.

An anecdotal social review suggests it is uncommon for lesbians to neatly pronounce the death of a relationship and simply move forward separately without looking back. This may be related to the neurochemistry involved; women experience much stronger effects than men of oxytocin, the “bonding hormone”, which promotes nesting, monogamy, pair bonding, and emotional extremes. This hormone is activated very easily; a single touch starts it flowing and further intimacy-creating activities (including sex) break the dam. So, two neurochemically typical women will naturally create very tight bonds which only break with great difficulty and emotional pain. Many women avoid completely detaching from an ex in an attempt to minimize the pain involved with a breakup.

An additional piece of scientific information helps explain the difficulty of intimate breakups between women. Brain researchers have discovered that emotional and sexual intimacy between individuals creates a physical connection in the brain which cements that relationship neurologically as a meaningful attachment. The evolutionary purpose of sexual contact and its related hormonal processes is to bond people together— and these hormonal and neurological operations are especially effective in women. So when a breakup occurs, the critical healing task is to break that physical bond of intimacy in the brain in order to move forward with emotional freedom and strength. While the bond remains in tact, so do the feelings associated with the loss of the bonded object: sadness, fear, anger, shame, and love. Again, women experience and process this connection more intensely than men do, so an intimacy bond between two women can be even more difficult to break. This phenomenon is evidenced by the number of lesbians who choose to keep their exes in their lives as friends or some permutation of such. Full severing of the intimacy bond requires physical and emotional distance, negative associations with the ex-partner, and forgiveness.These goals cannot be achieved with continued contact immediately after the breakup. Any true friendship or healthy continuation of contact is possible between exes only after the bond of intimacy is completely broken.

The conclusion to be drawn from this information is that after a period of separation and deep emotional healing, ex-partners may be able to occupy space in each others’ lives. Offered below are some healthy scenarios for continuing contact with an ex, with cautions to consider.

Exes as friends. Intimate relationships are typically based on a combination of shared interests and sexual chemistry. After the chemistry dies and the emotional intimacy vanishes, the shared interests will likely remain. Rather than avoiding the places, groups, and activities they both enjoy, exes may find it more convenient to develop a civil and friendly relationship with one another in order to be at peace when their paths cross. When an intimate relationship is lost, it can be additionally painful if a cherished social circle or activity is also affected. It may, in fact, be possible for exes to resume a functional friendship after each has thoroughly healed from the loss and resolved any lingering feelings related to the relationship or breakup.

Caution: Sharing interests with an ex may be possible, but emotional sharing or activities which may rekindle the bond of intimacy (read: substance use and/or amorous exchanges) are strictly to be avoided to keep things healthily platonic.

Exes as support. If a relationship ends constructively and sufficient time has passed for the emotional fallout to settle, continued contact with an ex may serve a purpose of support in times of need. This scenario can be tricky because, again, the support being offered cannot be emotional in nature. Sharing feelings is something to be done with intimates only, if healthy boundaries are desired. If, after recovering from a breakup, an ex-partner maintains residual concern for someone with whom she spent a significant time of her life, she may be psychologically prepared to help out during a time of need. It can be nice to have a connection with a caring individual in life, as the coming and going of hard times is a fact of human existence.

Caution: It is important for exes to monitor their feelings around their supportive interactions and regain personal space as needed to resolve any lingering emotions that might threaten their peace of mind or current relationship.

Exes as history. Intimates who have experienced important eras of their lives together are irreplaceable emblems in one another’s lives. Although they move forward on their life paths, retaining a connection with the past is something that can offer comfort and a sense of continuity along life’s long and winding road. Googling someone from long ago or occasionally checking in via email can be a perfectly reasonable way to enjoy a bit of nostalgia, reflect on the past, and gain perspective on the present.

Caution: When relationships begin to sour, human nature instinctively nudges people to reflect on the past with rose-colored glasses. It is helpful to be honest with oneself about the reasons for seeking re-connection with an ex to ensure one is not escaping from a problem in their current relationship or resurrecting emotions formerly associated with their ex.

Many people believe that negotiating intimate relationships is the crux of life’s purpose. The bonds of love and intimacy formed with others bear witness to the value of human interconnectedness. The memory of loved ones cannot easily be forgotten and, as mentioned above, new roles can sometimes be assumed once the intimate nature of a relationship has changed. These are tricky waters which require emotional strength and stamina to navigate successfully. Observing a new partner’s decisions around her relationships with exes can provide valuable information regarding her emotional needs, boundaries, and strengths. And noticing one’s own tendencies in this area can highlight areas of mental and emotional health and areas in need of attention. If personal growth and deep healing are desired, discarding exes as emotional crutches and severing outdated intimacy bonds will strongly support the goal of moving forward in a healthy, happy way.

Many people in relationships feel this way, exasperated because they are doing everything they know how to do to make their partner feel loved. Couples come into my office usually at the end of their rope because they have tried, and tried, and tried to make the marriage work and nothing they have tried seems to be making it better. This is so frustrating for couples. It drains the life out of many marriages and relationships. It pushes people so hard sometimes they end up convincing themselves they just can’t make this marriage work anymore and they end up leaving. This can be frustrating and maddening for people who want to love each other but can’t find a way to do that.

Everyone starts off with the best intentions. Good people work their hardest to make a marriage or relationship work. Usually people have lots of successes in their lives.  They look at their histories and they say to themselves, “Heck, I know how to achieve things. I am a success at school and work. I am good at getting things done. I can accomplish things. I can make this work.”  The best intentions drive people to do things for the other person. That’s our nature. If we choose to be in a relationship, we have decided to do what we can to make it work. (more…)

“The phrase ‘working mother’ is redundant.” Jane Sellman

“Making the decision to have a child-It’s momentous. It is to decide forever to have your heart go walking around outside your body.” Elizabeth Stone

I was inspired to write this article by many beautiful, courageous mothers, family, friends and clients.  I believe all moms are working moms, whether working at home and/or out of an office.  When I had my first son almost 10 years ago, I remember how difficult this transition was for me, as a mom who worked out of the home, and I needed all the support in the world. Having a baby for the first time is challenging enough. However, a second adjustment most definitely occurs when a mother returns to work after her baby is born. And if this mommy happens to also have other children, the transition can feel completely overwhelming.

I also want to add that for women who stay-at-home or who work part-time, they are working just as hard…doesn’t matter if work is at home, in an office, or both. Juggling it all can be tough, and all women need and deserve support. This article is geared mostly to the mom who is returning to an office job and/or a job that requires separating from baby. (more…)

When might earning more feel like making less for women? When it comes with the emotional baggage of being the primary breadwinner in a culture where men are expected to bring home the bacon. Earning a good income should be something for women to feel proud of, right? It is an accomplishment, a deserved reward for hard work. Yet many women feel conflicted about their status and ashamed of the role reversal. And this devalues their achievement.

Many women breadwinners downplay their success. Traditional values still dictate that the male partner in a heterosexual relationship should bring home a bigger paycheck. Male self-esteem is often linked with their financial prowess, and society has yet to challenge this expectation. Women’s financial success is such a taboo topic that the high percentage of women in this country who are primary breadwinners may be a surprise to many people. According to the U.S. Bureau of Labor Statistics, women are the sole or main breadwinners in almost a third of U.S. households. As the economy continues to falter, this percentage is predicted to climb, since unemployment has hit male-dominated fields the hardest.

Some women become primary breadwinners when they pursue a higher paying job, while their husband/partner chooses a path that offers less remuneration. A woman who is successful in real estate, for example, might earn more than her spouse who is an artist. Even if monetary success is not considered important when choosing a mate, most couples still face cultural expectations associated with this role reversal. Men can feel emasculated, women may be viewed as controlling, and both may worry about what others will think of them. A woman may resent her partner for not being able to support her, or may lose respect for him if he fails to search for better paying work, and a man may resent his breadwinner wife who seems so much more accomplished.

Women also may become sole breadwinners by default when their partner is laid off. Since the start of the recession, three out of four of those recently unemployed are men. This can be particularly devastating for families since women still only earn 78 cents to the dollar when compared to men. Women in these situations face the stress of earning the family paycheck, offering emotional support to a spouse who is often angry and demoralized, and containing their own frustration and resentment.

While ambivalence about breadwinner status may be commonplace, some women relish the opportunity. In one study, Rebecca Meisenbach interviewed female breadwinners and found that although some experienced guilt and resentment over their multiple roles, many were ambitious, took pride in their accomplishments, and enjoyed their independence. These women also found that it was critical to value their spouse’s contributions to the family, regardless of his financial success.

So how can women adjust to the primary breadwinner role, regardless of whether it is obtained by default or free choice? On the job, women need to lobby for equal pay, and challenge long-held misconceptions that men are solely responsible for their families, thereby warranting higher wages. Men and women need to resist judging one another by the size of their paycheck, and support the pursuit of a career path based on what is meaningful and fulfilling. Most importantly, couples need to communicate openly about the impact a woman’s breadwinner status has on their relationship. Partners need to remember what brought them together in the first place. Paying attention to what you enjoy and respect about your partner, how the intimacy you have can enhance your life, and how you can support each other’s career goals can hopefully offset any challenges to the relationship.

References

1. Meisenbach, Rebecca. (2009). The Female Breadwinner: Pheonomenological Experience and Gendered Identity in Work/Family Spaces. Sex Roles. Retrieved from http://www.springerlink.com/DOI: 10.1007/s11199-009-9714-5.
2. U.S. Bureau of Labor Statistics (2009). Women in the Labor Force: A Data Book. Retrieved from http://www.bls.gov.

Long after eating patterns and weight have stabilized, many women  with an eating-disorder continue to struggle with issues of body image. In fact, body dissatisfaction has become so prevalent, many authors propose it has sadly become simply part of the female experience. Body dissatisfaction is believed to be one of the highest predictors in adolescent girls who go on to develop an eating disorder.

The National Eating Disorders Association (NEDA) defines negative body image as:

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• A distorted perception of your shape—you perceive parts of your body unlike they really are
• You are convinced that only other people are attractive and that your body size or shape is a sign of personal failure
• You feel ashamed, self-conscious, and anxious about your body
• You feel uncomfortable or awkward in your body

I am a psychotherapist who specializes in the treatment of adolescents and women with eating disorders. For several years I have been leading body-image therapy groups in my outpatient practice. What follows are some of the group topics we cover as well as resources and activities I have found useful for helping people with their body image.

Generally, the group therapy series is focused on improving body image and runs for eight to ten sessions, as outlined below:

Session 1: My Body Relationship.

How do I feel about my body? To introduce this topic, group members participate in an art activity exploring how they feel about different parts of their bodies—from head to toenails. When asked to voice to the group the body part they like most, frequently the women will speak about a part that allows them to pleasantly experience some aspect of life, for example: “My hands—because I love to play the piano.” This activity allows members to recognize that some parts of their body are just fine, in their eyes. It’s not all body hatred. Great! We can build on this.

Leslea Newman’s book SomeBody to Love: A Guide to Loving the Body You Have (1991) has journaling exercises to help people creatively work toward repairing a broken relationship with the body. She recommends writing love letters, having dialogues with body parts, speaking compliments into the mirror, and more.

Session 2: Create a Vision.

How do I want to feel inside this body? If I felt this way, how would I move differently, how would I interact with others differently, what would this free me to do and experience? Using guided visualization, to step into and experience this vision, allows each person to plant and hold in their awareness a goal to guide them in the work ahead.

Session 3: Contributing Factors.

How did I come to define beauty? What experiences and messages contributed to my personal body opinions? Using a time-line, each group member looks at significant life events and paralleling patterns of weight and feelings about the body. The women in group often speak of having felt “different” from their peers. They feel dissimilar in their relationships with one another and with food. They also feel ambivalence about their developing bodies. We take a critical look at the media and the conflicting messages received from advertising. NEDA offers a number of handouts useful in facilitating this discussion.

Session 4: Body Talk.

What’s being said inside my head? How we talk to ourselves and what is said has a powerful effect on how we feel. Thomas Cash, PhD, in The Body Image Workbook: An eight-Step Program for Learning to Like Your Looks (2008) tells us this talk is often self-defeating, derogatory, and distorted rather than realistic. His book and audio program provide people with specific steps and tools to help them become aware of their negative body talk and begin to transform these messages.

Session 5: Body as Camouflage.

What do I hide with my body? To explore this dynamic, each group member creates a collage with magazine clippings portraying the “inside me/outside me.” People have used this activity to explore their beliefs about what others assume and expect of them, the image they try to portray, and then what they really feel like on the inside. We explore how they have used their bodies to protect or distract them from certain feelings and what it has been like to live with such a dichotomy.

Session 6: Body as a Vehicle.

What can I do and experience, thanks to my body? Sondra Kronberg, RD, writes, “True body power is the power of the body to accomplish tasks and be the vehicle through which to experience life” (Fall, 2002). As a group, we meet for a nature walk, adapted from the chapter called “Sensual Walk,” in Working with Groups to Explore Food & Body Connections: Eating Issues, Body Image, Size Acceptance, Self-Care (1996). In silence, we mindfully pay attention to the titillation of all of the senses: “Notice the smell of air, the feel of the elements, the textures beneath your feet, the views along your route, the taste on your lips, the ever-changing sounds in the background or foreground” (1996). In processing the experience, we talk about beginning a new relationship with our bodies by celebrating all the amazing things our bodies do for us and allow us to experience. Using Thomas Cash’s chapter called “Adult Pleasant Activities List” (1996), members are asked to mindfully and joyfully experience something from the list each day for the next week.

Session 7: Body as Container.

What is this spirit, this essence-of-me that lives inside my body? Kronberg goes on to write about the importance of helping our clients find their “real beauty,” that is the beauty “stored inside of them” (2002, Fall). During this session, group members create a word and picture collage of favorite things, causes they passionately believe in, relationships that matter most, compliments received, qualities of character they admire in themselves. This activity is often a favorite and reminds participants that they are so much more than the size of their clothes.

Session 8: Body as a Rich Source of Wisdom.

What can I learn if I slow down and listen to my body? This session opens with a deep-breathing exercise to practice being still, quiet, and focused. We then explore “gut instinct”—where and how we experience it in our bodies and how we have used this information to reliably guide us. Members are also invited to explore feeling states in the same way. Using a body outline on paper, members draw where in their bodies they feel anger, sadness, or loneliness, noting the size, color, and shape of each, and what distinguishes one from the other.

Session 9: Body Respect.

I can honor and take care of my body. This is a brainstorming session of all the things we can do to take care of and nurture our physical selves. Belleruth Naparestek’s affirmations are used from A Meditation for Relaxation and Wellness.

The following is excerpted from her beautiful work:

• I thank my body for all it has done for me in the past and all it will do for me in the future.
• I am learning to trust my body and to make good use of the information it offers me.
• More and more I will save my energy for what truly matters to me.
• I am aware that with each breath in I am sending precious oxygen and rich nutrients to the places in my body that need them.
• I welcome my ability to listen to the wisdom of my body and sense what it needs—telling me to rest, pace my energy, and take gentle good care of myself.
• More and more I can understand that my body is my ally, my oldest friend, and steadiest companion.

Body image work is a critical step in full recovery from an eating disorder.

Recommended Reading:

• The Body Image Workbook by Thomas Cash, PhD
• The Body Myth by Margo Maine, PhD & Joe Kelly
• Eating in the Light of the Moon by Anita Johnston, PhD
• A Meditation for Relaxation & Wellness (CD) by Belleruth Naparstek
• SomeBody to Love by Leslea Newman
• Transforming Body Image: Learning to Love the Body You Have by Marcia G. Hutchinson, EdD
• Working with Groups to Explore Food & Body Connections by S. Christian, Editor

References:

1. Kronberg, Sondra. (2002, Fall). Nourishing a Healthy Body Image: A Nutritionist’s Perspective.  Perspective.
2. Levine, Paula. (1993). The Meaning of the 3D’s, Eating Disorders & Awareness Prevention. Perspective.
3. Naparstek, Belleruth. (2002). A Meditation for Relaxation & Wellness. Akron, OH: Health Journeys.
4. Ressler, Adrienne. (2006, May) A Body to Die For: Advanced Training in the Treatment of Eating Disorders & Body Image Disturbance in Women. Perspective.
5. Hawkins, Nicole. (2009). Battling Our Bodies: Understanding and Overcoming Negative Body Images. Center for Change. Retrieved from: http://centerforchange.com/content/battling-our-bodies-understanding-and-overcoming-negative-body-images