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Rejuvenate your Relationships:

by The Center in PA August 6, 2024

Applying the Gottman Method, by Emily Israel, M.S.

Relationships can provide us with comfort, security, enjoyment, pleasure, love, companionship, support, safety, and care. However, we can feel very distressed when our relationships lack these positive experiences. Most of us have experienced challenges in relationships with a partner or loved one at some point. There are ways to support the development of healthy relationships, as well as ways to help a relationship that has become more conflictual become healthy once again.

John Gottman, Ph.D., and his wife Julie Gottman, Ph.D. spent many years researching aspects that support healthy couple relationships and found tools that can benefit both couples and other relationships.

Ways to support a healthy relationship according to Gottman Research: 

  • Get to know the other person’s needs, values, past experiences, priorities, and stresses.
  • Experience and express love to those with whom you share a relationship (more specific to romantic partners but can apply to other loved ones). 
  • Turn towards your loved one and respond when they engage you. Create opportunities to spend time together to support the building of connection.
  • Try to view the person from a positive perspective.
  • Management of Conflict
    • Engage in active listening skills to develop empathy: listen intently to the person’s feelings and acknowledge them by validating and summarizing what you heard them say. 
    • Avoid defensiveness: Take accountability and create an improvement plan. Acknowledge your role in an argument and pick one way you might make it better.
    • Avoid attacking the other person’s character or criticizing them: Start with “I feel” and describe what created the feeling without attacking without directing at them and share what you need to feel better.
    • Resist Stonewalling: Stonewalling is when we become frustrated in a conflict and we walk away from our significant other or withdraw. When you are tempted to tune out a loved one, consider engaging in self-soothing techniques and taking a timed break to give yourself time to calm down instead. This break should be no more than 24 hours and is meant to bring down each person’s heart rate so that you can re-engage effectively.  
  • Discuss future dreams and understand each other’s goals to create shared meaning.
  • When one person is stressed about something such as an incident at work, unrelated to the relationship, join in on how they feel and support their position on the issue.
  • Demonstrate trust and commitment to one another.

If you would like to develop these skills further and rejuvenate any of your relationships, please contact us at the Center.

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Recognizing Different Presentations of Obsessive-Compulsive Disorder (OCD)

by Brittany Keim, LPC May 9, 2024

Obsessive compulsive disorder (OCD) is characterized by obsessions and compulsions. Obsessions are recurrent and persistent thoughts or images; whereas, compulsions are behavioral or mental actions that are performed to reduce the distress or discomfort that an individual experiences. In simpler terms, an obsession is something that you cannot stop thinking about regardless of how hard you try to stop and a compulsion is a behavior that gives you short-term relief from your obsession. For instance, an individual may experience obsessions about their safety when they leave the house. In an effort to decrease their feelings or distress, that individual may stay home and this action will act as a compulsion because it is directly related to a decrease in anxiety or discomfort.

When thinking about OCD, it is important to remember that obsessions and compulsions have to result in significant distress and impairment. This means that obsessions and/or compulsions are time consuming and take away from your ability to participate in everyday activities. Significant distress and impairment may look like being late to school, skipping work, not being able to participate in activities that you once found enjoyable, etc.

Obsessive compulsive disorder is often thought of as excessive hand washing and a fear of contamination or germs, but OCD has many other presentations that can be overlooked. Knowledge of these other presentations is helpful in obtaining a correct diagnosis and receiving effective treatment. Below, I will detail common OCD subtypes, but please note that this is not an exhaustive list of presentations.

Harm OCD – involves intrusive thoughts of harming others or committing a violent act. People fear they could lose control at any moment and engage in violent behaviors. Due to this fear, individuals with this subtype of OCD may engage in significant avoidance. They may avoid interacting with others or completing everyday tasks that pose a risk (e.g., chopping vegetables).

Postpartum OCD – characterized by unwanted thoughts of harming a newborn. Individuals who experience this presentation will often avoid interacting with their baby or they will refrain from engaging in actions that are essential in taking care of a newborn (e.g., changing a diaper).

“Just Right” OCD – obsessions are thoughts and/or feelings that something is not quite right or that something is incomplete. Those who struggle with this subtype of OCD, will often wait to complete a task until it feels “right” or they will excessively engage in a behavior until it feels “right.”

Scrupulosity OCD – strict adherence to religious principles or moral ideals. Individuals will hold themselves to high moral/religious standards and feel extreme guilt or anxiety when they fall short. Some examples of compulsions are: excessively reading scripture or not allowing oneself to enjoy interests in fear that this could be considered sinful.

Relationship OCD – described as repetitive thoughts that center on doubts or fears about the relationship. The person may experience uncertainty and obsess about whether their partner really loves them or whether the relationship will last. A common compulsion related to this subtype is seeking reassurance.

Pedophilia OCD – this subtype of OCD occurs in individuals who have no desire to harm children, but are plagued with worry that they may do so. Individuals may become concerned with their thoughts towards children and/or they may fear that they may interact with a child in a way that is deemed inappropriate.

If you are currently experiencing symptoms of OCD and relate to any of the above presentations, you are not alone. Exposure with response prevention (ERP) is an evidence-based approach to treatment that has been proven to be very effective in treating OCD. Through ERP, an individual will learn to navigate their obsessions and decrease unwanted compulsions that interfere with their everyday functioning. Reach out to The Center today to learn more about receiving treatment for OCD.

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Sometimes It Helps to Name It: Talking About Loss During a Pandemic

by Christina Carson-Sacco, PsyD April 17, 2020

In Pennsylvania, where I live, we are about a month into the ‘lockdown’ caused by the COVID-19 pandemic. I’ve noticed there is a shared feeling among family, friends and patients. It’s like someone draped a blanket full of heavy feelings over the world. It’s even affecting our sleep, as most are tossing and turning with vivid, scary dreams.

Because so many people are struggling, it is important to recognize the evidence that suggests giving a name to the feelings and speaking about them can be helpful. In short, I think what we are all feeling is Loss and the resulting Grief.

In this unstable and uncertain time, it is easier to identify the anxiety we are feeling. But as time has dragged on, for many this has turned into loss and grief.

  • Sadly, for some, it is tangible loss due to the death of a loved one at a time when it is impossible to gather and mourn. For others it is a loss of less tangible things like routine, freedom, and normalcy.
  • Others have felt the loss of special events like celebrating birthdays, graduations, proms and other important milestones.
  • Most people are feeling a loss of connection with others due to the need for social distancing.
  • Some have lost financial security and jobs.
  • For many, there is a loss of a sense of safety and knowing what the future holds. People everywhere are feeling the change that is happening in the world as a loss. Maybe they are grieving for what they thought the future would look like. In many ways, this pandemic reminds me of the change in our country after the tragic events of 9/11. We all are grappling with the knowledge that things will be different after the pandemic, though we don’t know exactly how.

  • First, don’t compare your losses to the losses of others. All are real and important. Just because someone else’s loss seems bigger than yours, it doesn’t make your pain any less valid. Have self compassion and allow yourself the space and time to grieve for your losses. Keep in mind that there is no ‘right’ way to grieve. As long as it doesn’t harm yourself for others, however you or your loved ones are doing it, is ok.
  • Crying is a natural human way to cope with pain. Go ahead and cry; find privacy to do so if you need to. Keep in mind children may be crying more, too. Or sometimes they show their grief by throwing tantrums or being defiant.
  • Then express it. Say it out loud to those who support you. Write about it. Make art. However you prefer to do it, just get it out.
  • Taking time to meditate, while doing some deep belly breathing, can help us cope with challenging emotions. There are many great, free meditation videos online or apps for your phone. Aim to take a few quiet moments to breathe and meditate each day.
  • Try to stay present and focus on what is within your control. Sometimes our grief can take us down the path of ruminating on the ‘what ifs.’ When this happens, bring yourself back to the present moment. One way to do this is to look for 5 things in your surroundings and focus on each one for a moment. Another way is to use your 5 senses by finding one thing you see, one thing you smell, one thing you taste, one thing you feel, and one thing you hear.
  • Even in times of tragedy, there are positives, though we may have to search for them. Limit your exposure to negative media stories. Spend some time each day looking for the good around you, however small. Maybe there are wildflowers blooming along the path where you walk. Maybe there are news stories about people helping others. Maybe you find joy in the funny things your pets do or a special song. Search out at least one thing that makes you smile each day.
  • Lastly, if you are in need of support, reach out to a professional. Many psychologists are providing video or phone sessions. Some organizations are offering online support groups. See the resources below.

Other helpful resources:

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Tips for Caring for your Mental Health during a Pandemic

by Christina Carson-Sacco, PsyD March 27, 2020

I have to admit, I never imagined I’d ever type the words “caring for your mental health during a pandemic,” but I guess that is a big part of this. No one expected to experience this and most do not have a reference point of some experience to draw upon. We are in uncharted territory, which is leaving many unsettled, scared, sad, angry, frustrated, or just confused. Our everyday lives have been turned upside down, and we feel powerless to stop it. 

Here are some tips, born out of my 20 plus years as a psychologist, including my recent work helping my clients weather this storm. 

Focus on what you can control. Life may feel very out of control right now. Often, we get stuck ruminating on the things we can’t control. The people not practicing social distancing. The stock market ups and downs. What can you control? If you catch yourself focusing on the uncontrollable, take a deep breath and choose one thing to focus on that you can feel power over. One thing you can control is choosing to participate in activities that make you feel better. I sometimes say, “As long as it doesn’t hurt you or someone else, and is legal, I don’t care what it is, just do it.” 

Keep perspective. What is happening is scary and we must take precautions. However, it is easy to engage in catastrophic thinking. Most people who get sick will have mild symptoms. There are ways to protect yourself and your loved ones. Vaccines and medicines are being developed. 

Limit your exposure to media. Having tons of information at our fingertips is both a blessing and a curse. When we are stuck inside, it is normal to scroll through social media or have the news on the television in the background. 

  • Make an effort to only check the news once or twice a day. 
  • Get away from social media, or at the very least, consume selectively. Unfollow extremely negative sites or people. Purposely follow positive sites like Upworthy or Good News Network. 
  • Be aware that much of the information you receive from soft sites or family and friends may not even be accurate. Try to only get news about the pandemic from reliable sources like the Centers for Disease Control (CDC). 

Stay connected. While we are practicing social distancing, we may feel lonely. Being physically apart does not have to mean being disconnected. It just may require some creativity or extra effort.

  •  Using virtual ways to connect can be fun. Facetime, Skype, and Zoom are great ways to see people you haven’t seen in a while. Think about organizing virtual book clubs or religious studies. Games can be played virtually like Pictionary, Heads Up, Scategories or trivia. Netflix Party is a way to watch movies with your friends.
  • Post videos of your performances if you have a talent to share.
  • Offer to tutor someone or read to someone. 
  • You are allowed to walk, run, or bike, so go meet a friend and stay 6 feet apart. 
  • Have a picnic but bring your own food and stay apart. 
  • Garden together or help a neighbor with their garden. 
  • Even writing letters and putting them in the mail can help us feel connected to others around the world who are going through this with us. 

Have good boundaries. While we need to stay connected, we may need to do it carefully. Some people in our lives, maybe including those we are stuck in the house with, may not always be good for our mental health. Respect that everyone is dealing with this in their own way. Take some physical space away from one another. Limit contact with people in your life who are very stressful, including on social media. Ask others to respect your needs. 

Appreciate what is good. Many of us are facing new challenges, but are being given the gift of time and being forced to slow down. Hopefully, soon our lives will return to normal and for many that means running from activity to activity in very busy lives. What can you do now that you don’t feel you normally have time for? 

  • Talking to someone you haven’t connected with in a while or who may be alone
  • Reading 
  • Crafting 
  • Learning something new like a language, a craft, a skill, or a recipe (now is a great time to teach life skills to kids) 
  • Cooking or baking 
  • House projects 
  • Games 
  • Home spa days 
  • Cuddling with pets 
  • Puzzles 
  • Exercise (look for free videos online) 
  • Meditation (there are many free apps or online videos) 
  • Exploring the outdoors including places a bit farther away than we’d normally go 
  • Doing something to help others, even small, can make us feel more in control 

One note of caution: comparing yourself to others can be harmful. Be careful not to fall into the trap of holding up your friends’ social media posts as examples of what you should be doing. You don’t have to run really far, repaint your house, or teach your child physics. Do what works for you and your family.

What to say to children. Answer their questions in an honest but age-appropriate manner. Keep the news off and their access to online coverage limited. Be a good role model for self care and know they will pick up cues from you on how to feel about this. Remember you have more control than you may realize over how they will experience this unusual event. I had a child say to me today, “I hope summer is like this but just with more freedom.” I was happy to hear they are enjoying this down time and hope that’s what they will remember when they look back on 2020.

Reach out for help. Notice if you are struggling to sleep or eat. If you are having a lot of physical symptoms of stress like muscle pain, headaches, stomach distress, racing heart, or shortness of breath, it may be anxiety. Crying often or having many angry outbursts may be signs you are struggling. Also using alcohol or drugs to cope may mean it’s time to reach out for help. Getting help may mean connecting to supportive people in your life. Maybe it means finding an online tutor for your child or financial support through a community agency. It could mean finding an online support group. For example, Alcoholics Anonymous is holding virtual group meetings. There are hotlines for those that need to talk and are in crisis through the National Suicide Prevention and SAMHSA with both text or phone options. 

Many psychologists are offering telepsychology sessions using HIPPA compliant video formats. Our office is supporting patients through these platforms in order to keep our patients and staff safe from the virus, while still caring for patients’ mental health. Let us know if we can help you through this challenging time.

Dr. Christina Carson-Sacco is a clinical psychologist and a partner with The Center for Neuropsychology and Counseling, P.C. with offices in Warrington and Lafayette Hill, Pennsylvania. To learn more about her group practice visit www.TheCenterInWarrington.com

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Supporting Pregnant and Postpartum Women

by Lorna Jansen, PsyD January 16, 2020

 
Dr. Lorna Jansen specializes in treating children, adolescents, and families. She helps clients manage stress, deal with relationship issues, and also offers academic coaching.

In mid-December, I attended a seminar on the topic of Postpartum Depression and Related Disorders. My interest in working with women who are pregnant and new mothers stems from a long-held desire to see each child loved and cared for well. That goal has carried me through 10 years of education post high school to my current profession as a Psychologist. I love nothing more than to help a family system run more smoothly, to further a connection between a parent and child so that they can communicate more freely, to help parents see each other in the best possible light so they can work together as a team.

Having recently navigated through the pregnancy, newborn, infant phase myself, I have a new appreciation for the unique time period this is in the life of a woman. It requires a new wardrobe, new vocabulary, and an entirely new way of thinking about oneself and the world. 

The presenter at my training, Hilary Waller, MS, LPC also knows about the challenges of this phase of life. Ms. Waller spoke about her work with women at the Postpartum Stress Center in Philadelphia. That facility is one of the few of its kind and is led by Karen Kleiman, who has written about every aspect of supporting this population. During the seminar, Ms. Waller shared the knowledge and insights she’s gained from working with pregnant and postpartum moms and their families. Some of what follows was gleaned from her presentation.

The postpartum phase represents a significant shift for everyone around a new baby. First of all, this includes the mother. It is likely she will be experiencing significant hormonal changes, as well as healing from the birth. She will also have a number of emotions related to her pregnancy, labor and delivery. Often, she’ll be attempting to heal, adapt, and cope on very little sleep. She may wonder what happened to her world, or she may be contemplating how to include another little one into her existing nest. Her partner is also likely tired, worn out, and trying to meet his or her own needs with fewer resources. The baby’s extended family and friends of the parents will likely be jockeying for time to spend with him, which may or may not be given in a way that is helpful to the parents. All in all, this is a complicated time of transition.

Given the various stressors and physiological changes in play, it’s not surprising that one in seven women will suffer from a perinatal mood disorder. A perinatal mood disorder is one that occurs during pregnancy or for up to two years after delivery, clinically speaking. It includes diagnoses of depression, anxiety, OCD, panic, PTSD, bipolar, and possibly even psychosis. Due to the sleeplessness and additional stress surrounding this time, it can be difficult to understand what is normal (e.g., feeling very hormonal the first few weeks after the birth) versus what might warrant further investigation (e.g., crying most of the day and feeling hopeless months after birth). In fact, many parents experience scary thoughts, such as wondering what it would be like if they ran away and never came back, or how easy it might be to harm the child, even accidentally. Oftentimes, these thoughts do not indicate the presence of a mental disorder.

Given the vulnerable and extremely dependent nature of a newborn, it is imperative to support a mother who is struggling at this time. A therapist who is trained in this area can come alongside a woman who is pregnant or in the postpartum phase and offer her a safe place to sort through her feelings. This professional will be able to assess the mother’s overall well-being and make a plan to help her cope with the various challenges she is facing. The therapist can help the mother find practical solutions to everyday issues such as when to eat, how to get enough water to support breastfeeding, and what adequate sleep looks like with an infant. The pair can also discuss what is important to the mother as a person who has her own needs, separate from her role as a caregiver, and how she can continue to meet those.

Ideally, the mother can ask for and receive the help she needs from her support network. Her partner and other extended family members may attend therapy sessions as well, as a way of enlisting support for the mother and strengthening the relationships therein. Often, a mother with a young baby has a number of fears and concerns, many of which are normal. However, a professional can help a woman identify where her thoughts or behaviors are indicative of something more serious and ensure she gets the help she needs.

To close, the period of time when a woman is pregnant and raising a young child is unlike any other time in her life. It is sweet and important and perpetually exhausting. Regardless of whether or not the mother is having her first or sixth baby, or adopting, she is forging a new path. Never before has she been a mother to this child. And, like any transition, there is a lot to learn and she can benefit from caring and thoughtful individuals in her life.

If you or someone you love are experiencing some of the following, you may benefit from therapeutic support: feeling overwhelmed or sad most of the day, having trouble sleeping due to anxiety, experiencing panic attacks, or having the urge to self-harm. Please call our office at 215.491.1119 to make an appointment with Dr. Jansen.

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Stop Tearing Down and Start Building: 5 Ways to Enrich your Relationships Today

by Lorna Jansen, PsyD September 10, 2018

Frustrated by the way your relationships are going? Feeling like you’re always at odds with someone at home or at work? Here are a handful of tips you can use to revitalize your relationships and improve your interactions with others.

  1. Look for the positives and focus on the other person’s strengths. For example, you might start by noticing how well your spouse manages his or her job, commitments at home, balance between free time and family time, or anything else. As you observe him or her, begin commenting about what you’ve seen like this: “You do a really good job with __________” or “I’m impressed that you were able to accomplish _________ today.” John Gottman says the magic ratio is 5 positive interactions for every 1 that is negative. In order to compensate for the inevitable bumps along the way, make a concerted effort to recognize the positive qualities of those around you each and every day.
  1. Employ active listening skills. Active listening initially includes paying attention, withholding judgment and reflecting the other person’s words by repeating them back to him or her. This is especially important—and challenging—when there is conflict. As you take the time to slow down and focus on your co-worker’s point of view, you may find yourself less focused on making your case and more willing to reach a mutually beneficial solution. If you want additional information on this topic, look here: https://www.ccl.org/multimedia/podcast/the-big-6-an-active-listening-skill-set/
  1. Take care of yourself. As you are able, focus on eating well, getting enough sleep, drinking water throughout the day, exercising, and managing your stress. This will have a positive impact on yourself and everyone around you. If you need help remembering to do these things, enlist some support partners. You might also use an app like Wunderlist to organize your goals and set reminders.
  1. Look for common interests and seek to engage in those whenever possible. When you think of your relationships, consider whether there are any favorite activities, interests, or even favorite foods that could bring you and the people you love together. For example, you might consider setting up weekly, bi-weekly or monthly dates to spend time with each of your children. Enlist their help to come up with ideas of things they’d like to do or explore with you, and work your way through the list you compose.
  1. Before you speak, consider the things you often say. If you are frequently at odds with someone in your life, think about the phrases you find yourself repeating to that person. Perhaps you need to change what you are saying so your family member can really hear the message. For example, if you find that you are constantly telling your dad that he’s embarrassing you in some way, maybe you could tell him some things you appreciate about him (see #1) and then give him a few tips about what he could say or do when he’s around your friends.

These five tips may seem simple, but will require a concerted effort on your part. If it seems overwhelming to implement all five at once, start with the one that seems the most likely to create positive change and work your way through the rest as you are able. Though you may encounter resistance at first, you will soon notice small differences in the relational atmosphere. If you or someone in your life would benefit from the help of a trained therapist as you work to improve your relationships, please call our office at 215.491.1119.

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