Thursday, December 6, 2012

Coping With The Holidays 

I hope this blog finds everyone having had a nice Thanksgiving. Some people love the holidays, some people hate the holidays, some people tolerate the holidays and some people are just overwhelmed by the holidays. Where ever you are on this continuum, you don’t need to adapt to the holiday season, rather, make the holiday season adapt to you. At this point you are probably asking yourself what I am talking about. Depending on where we are in our lives, our history will interact with and influence our experience of the holiday season. If we are older and have already experienced many losses, or we have experienced significant losses at any age, we may focus on the people we miss. We may miss past holidays that were good or we may remember in too much detail past holidays that were not so good, or even traumatic. We may feel pressured to make the holiday a certain way for our children, family members and friends, resulting in stress and anger instead of joy and happiness. We may also feel pressured to keep old family traditions alive, but they may no longer work for us. This is where we get back to making the holiday season adapt to you. It is so important to stay in the here and now. While most of us have people that we miss either due to death or distance, we need to focus on whom and what is in our lives now. If you don’t like crowds, don’t go to Black Friday and stay away from the malls in mid-day.
Go shopping at dinner time when the mall empties out or go to stores that are either not in the mall or have their own entrance. Give yourself permission to not overextend the holiday budget and make a plan of action regarding what you can spend for each person on your list. If you love to decorate, decorate. If you don’t love to decorate, then don’t. If you want to decorate differently this year, then do that. If you like holiday parties, then go to them, and if you don’t, then don’t go. If you like to entertain, then entertain and if you don’t, then don’t. Some traditions you may wish to keep and some you may wish to replace with new ones. I hope you are getting the message to embrace the holidays in anyway that works for you. Some years you may go away and some years you may stay home or visit friends and/or family. Each year does not have to be the same if you don’t want it to be, or it can be as similar to past years as you wish to make it. If you have children grieving, don’t minimize their grief, but don’t make the entire holiday about grieving. Show your children the balance of missing people, but still going forward and living life. If you have had trauma in your past associated with holidays, remind yourself that you are older, wiser, and stronger and your current holidays belong to you and not to your past. Patients often ask me for suggestions for gifts and activities for children. Here are a few suggestions for you to consider.
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Tuesday, November 27, 2012

Coping with Peri-Menopause and Menopause

Welcome back to Shrink It Down. I hope everyone had a great Thanksgiving. Today I want to talk about peri-menopause, also known as pre-menopause, and menopause. So many women come to me in a state of confusion. It is not unusual for women to be referred to me to rule out a psychological problem, even though they have no history of psychological problems and no recent history of problems other than physical and psychological symptoms that are new to them. A thorough interview often suggests peri-menopause and a referral to their Gyn. Doc. On average, most women begin their journey into peri-menopause in their late 40’s and menopause in their early to mid 50’s. However, it can start as early as the mid to late 30’s or as late as the early 50’s. A woman is not in menopause until she has missed 12 consecutive menstrual cycles. Typically, your symptoms will tell you that you are in peri-menopause long before blood work validates what you already know. Peri-menopause is a natural transition of changes and loss of hormone levels. How you deal with this journey interacts with your personality, experiences and current life stressors.
Common symptoms may include irregular periods, hot flashes, night sweats, sleep difficulties, fatigue, irritability, depression, weight gain, fuzzy and foggy thinking, anxiety, headaches, poor stress tolerance, thinning hair or loss of hair, vaginal dryness, and even joint stiffness. Decreased sexual desire is also very common. Any combination of these symptoms is a lot to deal with, especially if you have other stressors in your life such as adolescent children at home, maybe taking care of aging parents, stressful job, money problems, relationship issues, or any loss in your life. I refer to peri-menopause as a scenic journey that involves some hazing into the next chapter in our lives. Everyone has their own collection of symptoms that are most challenging to them. I strongly encourage you to focus on acceptance with elegance and a great sense of humor. If you are hot, let yourself be hot without apology and your family will adjust to freezing for awhile. If you have night sweats, keep clean sleep wear by your bed side, along with a large towel you can use to cover the damp part of your bed so you don’t have to get up and remake your bed, somehow doing this around your husband or partner. Biotin is great for thinning hair, black cohash is good for hot flashes, and your Dr. can prescribe hormonal creams for dryness. Work with your Doctor regarding hormone replacement, natural remedies, and symptom relief. Make sure you are working with someone you are comfortable with and who is receptive to both traditional and homeopathic interventions. Many women find therapy to be very helpful as they learn to deal with the physical and emotional changes they are experiencing. Two main issues that women often address in therapy are their mood regulation when their children come home from school and the after school chaos overwhelms them. Often a mild anti-anxiety in the late afternoon on a rough day can be very helpful. The second main issue is what I refer to as swiss cheese brain. This is when you have holes in your memory and the holes keep moving, like in a carnival game. The most important intervention for swiss cheese memory is that sense of humor I mentioned, and good notes. Although this is not actually one of the major problems women bring in to therapy, decreased libido can present a problem for some couples. When women bring their partners in to discuss the situation, some education and suggestions are often all it takes to get partners on the same page. Talking to friends or relatives also on this journey can be helpful, as long as it is not just a litany of complaints. This is a time when you really need to take care of yourself with eating healthy, exercise, relaxation, and socialization. There is life after peri-menopause, I promise!

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Tuesday, October 30, 2012

 Coping With Aging Issues 

Welcome back.  Recently one of my patients asked me to write about coping with aging, so this is for her and everyone else who has had to deal with this issue either in themselves or with someone they love.  If we are fortunate, all of us will have to some day deal with the aging process.  There are as many ways to age as there are people.  However, there are some similarities that we will all face if we live long enough.  As people age they have to deal  with losses, often on multiple levels.  These losses may include loss of a spouse or partner, sometimes the loss of a child, loss of physical integrity and loss of income and life style.  The older we get, the more people we tend to lose. Not only people in our families, but friends and their family members as well.  As one patient told me, at 85, even losing actors and favorite authors was painful because it was one more connection with her world that was lost.  Grief tends to piggy back on other  losses and each time we lose someone, we may re-grieve other people we have lost.  As painful as this is, as much as this is the part of life that we do not like, it is so important that we focus on who is here, enjoying the newer members of our families, enjoying the new people we meet, and living in the present and not in the past.  While we never forget those who are gone, if we live in the present the loss is an ache rather than an acute and chronic pain.  It is important to stay as active and involved as possible.  Leave your house daily.  Don’t hide from life.  Reach out to others, such as through family, friends, clubs, volunteering, and church or temple.  If you are housebound, stay involved with people by inviting them to visit you.  Call family and friends, write them, read, watch movies, listen to the news.  If you live in a community that has social activities, go to them.  I once went to a local play in a seniors community and I was so impressed with some of the people who showed up in wheel chairs and with oxygen masks because they did not allow that to stop them from enjoying themselves.  This leads into talking about dealing with declining physical health or abilities.  Some of us stay active and in shape, some of us don’t.  

Some of us stay generally healthy, some of us have to deal with debilitating and chronic illnesses.  Again, try not to go to the past, but stay in the present and focus on what you can do.  Make your life as enriched as you can, even if you can’t leave your home alone, even if you spend much of your time in  bed or can no longer walk or get around on your own.  If you can no longer read, listen to books on tape, listen to music, record your life stories for your family, and again, invite people to visit you.  If you withdraw from life, everything is that much harder.  If you need to rest, then rest, but try and achieve as much stimulation as you can on any given day.  A major adjustment for many people is the loss of income, followed by downsizing.  Some people embrace downsizing, many others find it depressing.  Think about the pluses of downsizing.  Use this as an opportunity to give away anything you never really liked that much.  Think about what you really want or need.  If you have been storing items for years and not using them, you probably don’t need them.  While many may grieve getting rid of possessions, many also find that it is nice not be owned by their possessions.  Let someone else enjoy them.  If you have to move in with family or into a facility, make your room a reflection of who you are and surround yourself with the things that make you smile.  Remember, it is your turn to be older, wiser and revered by those younger than yourself.  Enjoy your wisdom that comes with years, and make aging a process to embrace and enjoy.  You are the role model for the next generation, and they are just behind you.

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Thursday, October 18, 2012

    Raising Children and Staying Sane 

Welcome back to Shrink It Down.  I am frequently asked about methods and strategies for parenting children as they progress through their developmental stages.  The best overall advice I can give is to stay consistent.  Your child is a master at finding loop holes, making you feel guilty, and making you second guess yourself.  How do children do this?  It is actually quite easy.  Your child is born and you fall madly in love with them and you want to protect them from every little hurt and you worry about them, and take care of all their needs.  Your child becomes the center of your universe.  One morning, your child realizes they are separate from you and they can say “no”,  they can not cooperate, they can even voice different opinions and tell you that your are mean, wrong, and no longer remember what it is like to be young.  In other words, they have the power to hurt you like no other and they have no idea the pain they deliver to you.  You, on the other hand, still have the agenda of never hurting them if you can help it.  So what is a parent to do?  Set consistent boundaries for your child and as they develop, reassess those boundaries and expand on them.  However, you must be consistent with your follow through at a very young age.  If your child learns that they have a chance of wearing you down so they can get their own way, they will do it and most likely, do it well.  When your child is very young, consequences should be brief, concrete and immediate or your child will forget why they are being punished and simply state to themselves and anyone who asks that you were just being mean.  When my twin sons were between the ages of 2 and 5, if they would fight over a toy and not share, I would put the offending toy in time out and tell them that if the toy makes them that unhappy, we would put it away.  
My friends used to laugh at that, but at that young age I found it much easier to put the offending object in time out than trying to keep them in time out.  Always do debriefing.  When I would give the toy back, we would talk about why the toy was in time out and what they needed to do to keep the toy out of time out.  Even when your child is older, about ages 5 through 10, and you put them in time out, when you go to retrieve them, debrief and discuss why they were in time out and what you expect them to do differently the next time.   As for older children, I do not believe in grounding because than the parent is grounded and the parent has not done anything wrong. I prefer to tell the child they have no privileges at all until they finish a short list of chores.  If I approve of their work, then privileges are restored.  In essence, they are grounded until the chores are completed, and this can take an hour or a month and it is their choice, giving them some control in the process.  That allows you to start the next day new.  When groundings are too long, children tend to forget their crime, and if they act out during grounding, you really have no where to go.  All that being said, look at your expectations for your child and decide if your expectations are realistic.  Children are not little adults and it is really not a priority for them to clean their room , take out the trash, or put their laundry away.  That is your priority.  If you accept that, you may find you do not get as angry, and you may even be able to laugh and play with them regarding their “not done” chores.  To help you achieve this mind set, think about how you would want an adult to deal with you at that age in that situation.  If you stay consistent throughout their childhood and parent them, you will have very little reason to parent them as they get older.  Parent now and have a friend later, be a friend  now and parent for the rest of your life. 
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Tuesday, October 9, 2012

Power vs. Empowerment

 Welcome to Shrink It Down.  This is our first blog and there were so many subjects to choose from.  I thought I would start with a general premise that I teach my patients.  Many people do not really understand the difference between power and empowerment.  Power is something we try to exert over other people, while empowerment is what we exert over ourselves.  Empowerment is the focus of many different forms of therapy, taking on many different labels.  Empowerment is based on our internal dialog, or what we say to ourselves.  If we allow other people to control out thoughts, we have given our personal power over to them.  However, if we stay in control of our thoughts and interpretations, than we stay empowered and from empowerment stems boundaries.  Boundaries are what we place around ourselves to both interact with the world and protect ourselves.  If I have no boundaries and can not find it within myself to say no, than people may be very tempted to take advantage of me.  If I have solid, balanced boundaries, than people will not be able to take advantage of me because I will be able to say no. 
Not only will I be able to say no, I will be able to say no without guilt.  Back to empowerment.  If empowerment is based on our internal dialog, than that basically means that empowerment and boundaries are based on our interpretation of what we experience.  To make our point about empowerment, let’s go back to boundaries.  If someone asks us to do something for them and we say no, and in response to our no the other person tries to make us feel guilty for saying no, we need to realize that the guilt is a manipulation by the other person to get what they want.  Their attempts to guilt us into doing what they want is the manipulation.  If we interpret their behavior as their agenda that really has nothing to do with us, than we have no reason to feel guilty.  If we have no reason to feel guilty, than it is less likely the manipulation with work.  If the manipulation does not work, it reinforces our boundaries.  It all fits together like a 3-D puzzle and as long as we put all the pieces together, we stay empowered, have good boundaries, are able to say no, and eliminate the experience of feeling guilty, thereby reinforcing the empowerment.  Of course, everything we talk about is initially easier said than done.  It takes practice, and there will be some slippage.  However, just by recognizing this cycle, even after the fact, will start to change our belief system about ourselves and contribute to greater empowerment. 

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