Stress Part 2

Virtually everything that happens to us has the potential to be a stressor. Some common causes of chronic stress include:

1. Time, 2. Responsibilities, 3. Personal problems, 4. Work, 5. Lack of sleep, 6. Bottled up emotions, and 7. Pressure of finances.

What makes an enormous difference is the management of these sources of stress. By management, I mean how one internalizes what happens to us. Internalization of stress is a process and the process is shaped by our attitudes. Some of these attitudes can lead to an increase in stress and include:

1. Worrying about situations we can’t control

2. Not seeing choices that are available to us to manage difficulties

3. Inability to successfully access the importance of certain outcomes

4. Unrealistic expectations

5. Being overly self-critical

6. Ignoring positive feedback from friends, partners, loved ones

7. Expecting a neat and easy solution

8. An all or nothing approach

Bearing these in mind, at PsychotherapyWorks our model of treatment includes a  number of important interventions that, once practiced and rehearsed over time, can replace stress management strategies that are not working.  Such strategies include:

1. Refuting irrational beliefs of all kinds

2. Practicing positive self talk

3. Limiting comittments so that one is not overworked

4. Learning to relax

5. Using exercise to release tension

6. Learning appropriate time management

7. Learning how not to over-magnify events.

8. Learning the value of play for everyday success and happiness

Some reminders along the way:

1. Don’t sweat the small stuff

2. When managed well, it’s all small stuff

In the final analysis, too little stress makes for a boring, frustrating and basically unproductive life. Too much stress can leave us overwhlmed, irritable, exhausted and sometimes even sick. Just enough stress helps us feel motivated, excited, creative, energized, and vital.

Stress effects everybody, young children, children, adolesecents, young adults, and adults, couples, and the elderly. At PsychotherapyWorks we have used original and well researched methods to treat stress in all these populations. Check out our web site and let us know what you think.

Stress Management 101/Part 1: What is stress?

Recently I gave a talk on Stress for local professionals in the Northern Virginia area and since it was so well received it seemed a natural progression to make the data all the more available through this blog.

Its true that in my work as a psychologist I am every day working on the fundamentals of stress management. It’s not uncommon for me to say when life gives you lemons make lemonade, and then to help clients learn the simple ways in which they can shift their attitudes and behaviors about events, and experience real change in their experience of stress.

So, let’s define stress. First, stress is the body’s effort to cope with danger in life. At the most basic level, the physiology of stress is the body’s reaction to danger, change, boredom, frustration, anger, and fear. Overall, whatever is outside of the normal patterns of our daily experience, whatever tends to intrude into our lives in ways that shake things up, can be the cause of stress.

During the experience of stress, the muscular system prepares for one of two things: fight or flight. Not properly managed over the long term, stress can result in back pain, headaches, arthritis, and other muscular difficulties.

To manage the intensity of the fight or flight response, the Glandular System helps us by providing adrenaline, epinephrine, and other hormones so that we can rise to the occasion and meet the challenges implied in the stressor. However, if we don’t really manage stress well enough, what we find is that over time gastric problems, ulcers, and other intestinal difficulties can occur.

Another physiological phenomena associated with stress is related to the Autonomic Nervous System. This system regulates the parts of our bodies that work automatically: the heart beats faster, breathing becomes shallow, digestion slows, and as these processes occur, the body prepares for fight or flight. Because autonomic responses are implied in the stress reaction, the failure to handle stress appropriately can result in a variety of cardiovascular problems, high blood pressure, and nervous conditions, all of which can effect the quality and quantity of life.

Overall, stress is more than anything a fact of life and thus we are required to work on developing methods of managing stress that work for the preservation of the best quality of life possible (not only for ourselves, but also for our families). So, the central concept for managing stress is maintaining a deliberate and constant focus on the quality of life, ensuring that one is, in fact, pursuing work, love, and recreation that is satisfying, challenging, and fulfilling.

Thus, when it comes to stress, one cannot totally control events. And the good news is that you don’t have to. Rather, it’s important to know that the key to stress management is not controlling events, but controlling ones reaction to events and the stress that is produced. That said, there’s a basic stress equation. Stress is the byproduct of two things: an event and a reaction to the event. So the equation reads this way: An event + A reaction = Stress. The take home message is that stress is not simply something that happens to us. The cause or event may actually be neutral. It is one’s reaction to an event that creates the stress.

In this posting we have examined some of the physiological attributes of stress and explored the stress equation in order to answer the question: What is stress? Next week, we will look at the causes of stress specifically and ways to strategically manage stress.

Couples Therapy and Adultery

Couples come to therapy for all types of problems, and sometimes what we see with couples who are entering mid-life (ie, 35-45 years of age), is problems that arise for the couple due to one partner mistaking a call for adventure as a call for an affair. A reader recently inquired about this and I thought a response here made some sense.

At mid-life it’s often the case that we’ve achieved those goals we set for ourselves in our early adulthood. We’ve successfully achieved academic goals, established ourselves in a profession, acquired a certain degree of financial stability, purchased a home, established a community of support, had children, in short, all those important goals that were there in the 20′s and early 30′s have been met. It’s at this point that we can find ourselves asking, “What’s next?” This is an important question and one with an enormous amount of psychological validity, because it suggests the opening towards the developmental processes implied in entering the second half of life. And what’s that. Well, in short, it’s a call for adventure.

A call to adventure is important because it signals that the time has come to expand the self, to grow as a person, to reach out and challenge one self in new and novel ways. Mid-life is often a time when just such growth is required. However, it’s quite often the case that the call to adventure that one finds at mid-life can get read as a call to an affair. How’s that. Well, asking, “what’s next” for one’s life can imply a number of things, but most importantly it often suggest that one has reached a threshold with the life they have created in terms of the satisfaction one can get from it. At a certain point, if one does not take seriously the need to seek out new avenues of growth that support satisfaction and happiness, one can mistakenly begin to think that thier partner is “holding them back”, that their life is “boxing them in.” Equally so, one can become simply bored with the routine of daily life. Under such circumstances, it’s not uncommon for one partner to find themselves vulnerable to an affair.

In the context in which I’m speaking here, an affair is really a misplaced call to adventure. Whereas it certainly is adventurous to have an affair, the by-product in terms of suffering and destructiveness to others tells us that this is really a misplaced call to adventure, one that has enormous implications in terms of time, money, and stress, for one’s self, one’s partner, children, and one’s extended family. In short, the suffering that can arise form the adventure of an affair tells us that what were really dealing with here is a misplaced call to adventure in the person that opens up their world in novel ways and which makes them feel good, confident, sexy, alive and vital.

The take home message here is that mid life is a time when we often feel a call to adventure, however, it’s equally common for one to find themselves living out a call to adventure in the context of an extra-marital affair, or considering an affair as a solution to a life that has become boring or overly routine. Certainly, at mid-life one’s relationship may need a tune-up. Most long-term investments do require periodic tuning and adjustments over the lifetime. The note to sound here is that most relationship problems have solutions and at mid-life the call to support a partner as they embrace a call to adventure is one of the most positive outcomes that can arise when this type of issues is on the table. I’ve seen partners recognize that they need to try a new sport, learn to fly, get a boat, learn a new language, travel, go back to school, open a business. At mid-life these are various expressions of the call to adventure. Learning that our partners support such processes is often one of the most important aids in helping focus mid-life as a time of growth and fulfillment that ultimately benefits both partners, and the family.

At PsychotherapyWorks, we have enormous expertise in working with couples. Dr. Kothari brings experience in working with couples of all ages, races, and lifestyles. We will work with you so that your relationship can bring you the greatest possible satisfaction. After all you deserve that.

We invite your comments and questions and ask that you share your insights and observations with us.

Schools In (Managing Transitions)

Well it’s that time of year, when we labor through the hottest part of our summer months and inch our way forward towards a new academic year. Yes, in most areas, we are a short 3-4 weeks away from the first day of school. All across the country, our children are savoring those last days of “freedom” and department stores are readying their “back-to-school” advertising. Soon, the papers and TVs will be littered with all manner of back to school stuff. Certain jurisdictions will even sponsor tax-free shopping days to attract your business. Yes indeed, the school year is just around the corner.

Whereas for many children this time of year is exciting, it’s also a time of change and transition that is ripe with all kinds of psychological concerns. Whenever we see transitions in a child’s school experience, it certainly the case that the child/adolescent will be challenged. Certain of these challenges include: meeting new peers, navigating an unfamiliar environment, meeting new teachers, adapting to new levels of expectations, new structures for organizing the day, new foods, new everything. Adapting to so many changes is challenging to anybody, but especially for children. Easing the transitions and helping children adapt is an enormous priority for parents, and if your child is transitioning in any way from one school to another, it’s considerably important to be aware of how your child is managing the stress implied in navigating the change. Here’s a remarkable story of one such change.

A family that I was working with reported that their 3 year old daughter was getting ready to move from one daycare to a new daycare. This family was employed by an institution that had two day care centers, one for the first 2 and half years of life and the other for 2.5 to kindergarten. Since their daughter was 3 years old it was time for her and her friends to move to the new day care. To help the child, she went daily for a period of two weeks to the new day care center to meet her new teachers, become familiar with her new room, and overall, to gain a measure of safety in her sense of belonging to the new daycare center. Meanwhile, at the old center she was in the process of saying goodbye to all her old teachers, old rooms, and her existing daycare center recognized that it was important to honor this part of the child’s transition.

During this period of change, the parents reported that their daughter came to their bed one morning, woke up both parents, and told them a dream she had. She told them that she had a dream that she was in a plane and that she was going somewhere. Mommy was driving the plane and everything was OK. The plane landed and it was “all OK.” Daddy was there to see us when the plane landed.

This is a marvelous dream and I explored with the family the way in which the dream suggested that the child was acutely aware of being in a transition from one place to another (the plane), that the transition was safely anchored (mommy driving the plane), that the transition would go smoothly–that she would have little difficulty adapting to the process (the plane landed and it was “all OK”), and that she would feel embraced by the teachers and structure of the new center (she lands and her daddy is there is greet her).

What I found truly marvelous about this dream is that it suggests what we know as psychologists, that is, that children undergo psychological processes that are remarkable when their life propels them into transitional periods. What more, the parents of the child were concerned about their daughter’s transitional process between daycare centers and were concerned that she make a successful transition. Their concerns were warranted, and we were able to see in the dream a communication to the parents that their daughter’s transition would be safe and successful. Recognizing that the daughter’s psychological process was secure, the parents were able to let-go of the stress they had about their daughter’s transition and simply be as supportive as possible for their daughter. In the end, the parents were less stressed, felt more secure about their daughter’s process, and their child made a seamless transition between centers, and is thriving in the new daycare center.

This story echos a familiar theme: that our psychological constitution is at work in the transitional periods of our lives and that attending to the psychological needs of our children when their in such phases of their life is really the best possible expression of our parenting. Making children feel safe, allowing them to express their feelings, appropriately monitoring their safety, giving them space to adequately say goodbye to previous teachers, schools, classes, encouraging their capacity to adapt and meet the challenges of their new environments, managing our own stress during their transitions, all of this and more is the stuff of good parenting when our children are transitioning.

And it’s quite clear that children of all ages are so challenged. Whether it’s transitioning to new schools, to new grades, moving between schools in a community (from home or daycare to kindergarten to elementary school, middle school and finally, high school), or to college; the psychological process at work in adapting to the new place and all the challenges therein constituted are a core component of successfully managing the transition.

Now, what are some of the markers that suggest that our children are having problems making the transition. First and foremost, a change in the usual experience you as a parent have of your child. Are you noticing a shift in your child’s behavior with you, with siblings, with friends that seems out of sorts with how you know your child to be. A dramatic shift in your child’s behavior may suggest the need to talk with your child about how they are managing their new environment and how they feel about the new place, as well as their feelings about any old places they may be transitioning from. The take home message here is for parents to be mindful of their children’s behavior during transitional phases of their life and to give them as many opportunities as necessary to talk with you about what’s happening for them. Secondly, are you seeing aggressive behaviors, angry behaviors, irritation that seems out of keeping with your child’s usual behavior. What we have noted over years of working with children is that so often a child who is struggling with a transition will evidence a new-found aggression. Rest assured that this is not an end in itself, but rather is an attempt by the child to get some help by getting attention paid to them. Third, are you seeing a change in academic performance that does not seem to fit how you have known the academic abilities of your child. Such a change may indicate a number of things, such as the need for a parent-teacher conference, for adjustment of the child’s learning environment. Equally so, it may indicate a problem with hearing, vision, or attention and focus problems. Moreover, an academic shift may suggest that there is an emerging area of academic weakness for the child that requires support. Finally, an unusual change in your child’s academic performance may suggest problems with peer affiliation, and could be the result of feeling overwhelmed by new peers, being bullied by certain peers, or a host of other peer related and environmental concerns.

Perhaps the single most important role for our children is played by the parents in, what Dr. Kothari calls, being “mindful” of your child’s transition, paying attention to their process, noticing shifts in their personality, behaviors, and overall mood. Research on children suggests that the more the parent is appropriately tuned in to their children’s psychological processes of adapting during times of transition, the more successful the child will be in meeting the challenges of the transition.

Sometimes our children have difficulties making transitions and the problems implied may be scary, overwhelming, or simply painful. Whenever your seeing problems that rise to such a level of concern it’s often helpful to seek out professional consultation and the research is clear, the sooner the better. At PsychotherapyWorks we are dedicated to your child’s health and well-being and Dr. Kothari is an expert in understanding the enormous web of factors that are implied in the relationship between your family and your child’s educational process. Consultation is often the most helpful way to ease your mind, acquire much needs supports for the family and the child, as well as assistance and advocacy for your child’s rights within their school system.

We invite your comments and questions about the content of this blog and hope to hear from you about ways in which you are working to support your children. Do not hesitate to write back.

Psychological Mentoring (What is it?)

As a psychologist whose practice is both academic and clinical, my research in psychotherapy outcomes has been organized around the therapeutic practice of Psychological Mentoring and in two distinct ways. First, in my academic roles Psychological Mentoring has to do with educating the next generation of psychologists so that they have a variety of skills to manage the enormous volume of complexity that is found in working with human beings. In academic psychological mentoring, I feel a responsibility to my students’ future patients. Knowing that my students are equipped with a healthy appreciation for the unfathomable complexity of human experience and how to manage that complexity in empathic and creative methods that serves the greater good. That is the way academic psychological mentoring proceeds.

Therapeutic Psychological Mentoring is a creative process anchored in the mythology of the hero’s journey, the young persons successful transition into adulthood. We see such a mythology depicted in the movies such as Star Wars, The Lord of the Rings, & The Karate Kid (just to name a few). In many years of clinical practice, what I most often see is the human experience of having become profoundly stuck in the process of making the transition to mature adulthood. This stuckness can take many forms but overall what happens is the person cannot seem to get on track with their life in a way that feels satisfying to them, and which is perceived by others close to them as an appropriate path for them to fulfill their unique potential.

I use the term “mature adulthood” in order to describe psychologically mature adulthood as discrete from and an evolution of what we popularly refer to as adulthood. The popular notion of adulthood is, in fact, a fairly simple construct that has its footing in the ability to access certain rights: the right to consume alcohol, to consume tobacco products, to vote, to access lines of credit, etc. The popular understanding of adulthood also has to do with services requirements, most of which are voluntary, such as: service in the military and participation in local community activities. What more, the popular understandings of adulthood emphasize certain roles, such as: independent living, successful financial management, domestic partnership or marriage, and the transition to father/motherhood. Though much is implied in this short list, it’s remarkable to see that the emphasis in the popular culture has less to do with the psychological processes implied in entering into mature adulthood and often has to do with biological markers, as in, ‘now your 18 so your an adult.’ What’s emphasized here is the biological marker and not the psychological process. And it’s often the case that being 18 and being ready to tackle the challenges of adulthood are completely out of sink.

Psychological Mentoring is intentional in looking at the psychological process that gives the person the solid footing to successfully navigate the stresses, challenges, and transitions that are naturally implied in development into mature adulthood. What I’ve been seeing for many years now in clinical practice with children and adolescents is large groups of children and adolescents whose experience emphasizes the biological markers and de-emphasizes the importance of the psychological process that is the core component for the successful management of their life in all its complexity. Equally so, what were seeing with adults is often biological adults, adult by fact of their age; but whom are psychologically locked into childhood or adolescent patterns that often have the effect of undoing their attempts at successfully managing the challenges of adult living. Adults in this situation are particularly challenged because everything in their life says “act your age”, “grow up”, “just do it”, and yet their often stuck, overwhelmed, unsure, unsafe, dis-empowered, feel unable to make sense of the simple ways they could help their own lives. What more, there is a cascade effect for such feelings, in which what first begins as feeling overwhelmed eventually becomes clinical depression or an anxiety disorder, a severe relationship complex, in which the person begins to turn on themselves. We see vegetative problems in that there are changes in sleep patterns, a change in eating habits, lack of exercise, withdrawal from friends and loved ones, with the level of severity often increasing in proportion to the length of time in which one has felt unable to cope with the demands of adulthood.

In my work as a psychologist, I regularly find myself in this kind of complex work & I have been impressed with how even the most unusual of problems in living can have as its nucleus inadequate preparation for mature adulthood. At PsychotherapyWorks our attitude towards this problem is that the problem can be solved, that the questions posed by our problems in coming to mature adulthood are important markers for development, that the fact of their being a problem implies an answer & that by answering such questions one naturally enters into the process of preparing to enter into mature adulthood.

And the method in which the questions about mature adulthood are answered is mentoring. Mentoring has many qualities, first of which is its empirical footing. In my work with graduate students we have seen over and again, that the mentoring process delivers in terms of helping individuals both recover from diagnosed medical conditions such as anxiety and depression, but also in terms of getting on track with their lives in a way that makes sense and provides personal meaning and satisfaction in their living. Self-report measures at the close of treatment have demonstrated the clinical efficacy of mentoring interventions over a 28 week period in which there was 1-2 times weekly outpatient sessions for children, adolescents, adults, and couples. Overall, the data is clear: Psychological Mentoring Works.

In our actual clinical practice, what makes Psychological Mentoring work is the relationship between the psychologist and the client. At PsychotherapyWorks we are committed to modes of relationship that meet the client’s needs. We are not about the business of deploying a “traditional” psychotherapy method in treatment. The idea of an analyst sitting quietly, taking notes, is not what were about. Psychological Mentoring implies the development of a real relationship with the client, where the client’s primary ways of concerting are often the way in which the therapist will connect with the person in the treatment. It’s not unusual to see Dr. Kothari playing a game of catch with a young man, taking a walk in the gardens or the surrounding neighborhoods or parks that are part of the beautiful landscape for the setting for the mentoring process, sitting by a local stream and talking with a young man about his life and the ways he can make his life come alive in ways that make sense to him.

Certainly Psychological Mentoring is not our only methodology. In fact we at PsychotherapyWorks are grounded in a number of empirically validated treatment methods. However, what we have found is that a core component of almost all of these treatment models is some type of Psychological Mentoring. That said, when Dr. Kothari works behaviorally with children and adolescents diagnosed with ADHD, we do both the behavioral work, the social skills training, the focus and attentional training, but we are also building the relationship with Mentoring so that the behavioral and skills training work is even more effective. Overall, this method of working on Mentoring in therapeutic work has been significantly rewarding and is a remarkable psychological tool for facilitating the development of mature adulthood.

Finally, if you have any quetions or comments we invite you to share them and we will certainly respond.