Depression on Easter Sunday

“Ask Ellen Anmuth Psychotherapist” is a series dedicated to readers’ questions on topics such as depression, anxiety, anger, relationships, communication, conflict resolution, grief/ loss/bereavement, genetic counseling, medical problems, and stress management.  Today’s blog is focused on depression associated with holidays.

Amy from Maine writes: “Dear Ellen Anmuth, Psychotherapist: Today is Easter Sunday, and I am feeling very depressed. I moved to Maine last October from San Diego. My family and life-long friends live in Southern California. This is the first Easter in a new place. I have been feeling depressed all week, and today was a very hard day. Please help.”

Ellen Anmuth, Psychotherapist writes: Dear Amy: Relocation to a new place can be a very difficult adjustment. When I read that you moved from Southern California in October of last year to Maine, that means that you experienced a very cold and challenging winter season. In addition, the sun sets earlier in Maine than Southern California. People who change their locations may have a condition called Seasonal Affective Disorder, related to reduced sunlight exposure.

Depression can be triggered by other factors, as well, such as a holiday spent away from family and friends. Was this your first Easter Sunday spent without these familiar faces?  Was Easter Sunday usually a day of spiritual and emotional comfort?

Finally, relocating your home involves loss and adjustment. Some people focus only on the positive aspects of a move, and try to keep up a happy face, in spite of feelings of sadness and loss. Attempting to deny the feelings of loss can create more feelings of depression. There is an expression, ‘what we resist, persists’. By talking about feelings of loss, we become more empowered to cope with the challenges. Speaking with a Licensed Mental Health professional can also be of help. Easter Sunday, Thanksgiving, Christmas, birthdays, and anniversaries of deaths can all trigger depression. Creating a support group of friends during holiday times can help to avert severe depression. It took much courage for you to relocate across the country. Sometimes it takes equal courage to reach out for help and support during the difficult times. It is wonderful that you were able to write this email. If you continue to seek local support within your community, you will find the transition to Maine easier to adapt to.

 

Ask Ellen Anmuth, Psychotherapist: Dealing With Feelings of Isolation

“Ask Ellen Anmuth Psychotherapist” is a series in which people send questions via email to Ellen Anmuth, Licensed Psychotherapist, and each month, a few  emails are selected for this blog series. Today’s topic is “Dealing with Feelings of Isolation”.

It is a very interesting time in history. Why are people feeling lonely, when the technology seems to connect people through social media? For example, people may have “Facebook Friends” who they have never actually met. The definition of “friendship” has been altered recently, to include strangers, perhaps loosely connected by business or by friends of friends. It is not surprising that people tell me that they feel disconnected, when they live in an illusion of being surrounded by “friends”.

If someone has  Facebook friends, followers on Twitter, or connections on Linkedin or on Google Plus, they may be feeling an undercurrent of loneliness, despite the illusion or appearance of connections. Additionally,the written Internet language has been reduced to micro abbreviations, and text messages have replaced phone calls for many. To what extent are deep emotions communicated digitally? Is “LOL” the mainstay and epitome of emotional expression? I think that the “glue” of relationships is  shared activities and the exchange of stories and deep feelings, to name just a few elements.The Internet often makes that difficult.

On the positive side, the social media does provide the potential for people to meet in person or on the phone, and to develop business and/or personal relationships. However, more often than not, if a person has 20,000 twitter followers, there is clearly not a connection with many of them.

How can people in this age of digital connection, address the sense of isolation that emerges from the lack of personal contact?

Diane from Ohio writes: Dear Ellen Anmuth, Psychotherapist: I have recently moved from the San Francisco Bay area to move to a small town in Ohio to take care of elderly parents. I miss my good friends and the vibrant, intellectual atmosphere of a big city, and I am feeling isolated here. I find it difficult to make new friends, and develop intellectual companionship. Any ideas?

Ellen Anmuth, Psychotherapist: Diane, you are dealing with many losses: It is likely that you are grieving San Francisco, a vibrant city with much culture and your group of friends. Allow yourself to go through a grief process, acknowledging the loss. Perhaps a grief and bereavement group may be helpful. In addition,    do you have hobbies and interests that you could get involved in? There is a website called Meetup.com, where people can search  for groups in their city, and you may find like-minded people. Many public libraries have discussion groups that you can sign up for. If caring for your elderly parents is taking up most of your time, could you hire a nurse part-time, so that you could develop new relationships and connections? Moving to a new town involves many adaptive tasks, and staying positive and optimistic is the first step toward bringing more friends into your life.

 

 

3 Strategies For Creating Deeper Relationships By Identifying Conflict Styles

What are 3 Strategies for Creating Deeper Relationships?

1) Know your conflict style. During moments of conflict, do you tend to attack or detach? If you are in an intimate relationship, what is the conflict style of your partner? If both people tend to avoid conflict, the silent treatment may go on for a while, where issues become ignored and tend to fester.  If you both are hot reactors, there may be yelling and screaming, difficulty in impulse control, and much toxic rage without purposeful conflict resolution. If one person tends to detach, and the other tends to attack, the dynamic may be complex, with an appearance of passive aggressive behavior in response to angry attacks. With these extremes of conflict styles, the outcomes may range from challenging  to perhaps, dismal.

2) Once you evaluate your conflict style, determine who in your life you have difficulty relating to. Does that person have a similar conflict style, or a different style of handling conflict? Begin an inner journey of self discovery, identifying your thoughts and feelings during moments of conflict.

3) Develop a strategy to manage conflict. If you are a hot reactor, find some anger management techniques, and learn to communicate more softly and clearly, handling one small aspect of the conflict at a time. If you tend to avoid conflict, begin with small steps to develop courage to speak your needs. Explore the possibility that you may have “inherited”some family of origin messages about open and honest communication, and the prohibition of such communication. 

Whatever your conflict style, you can grow, stretch and learn new strategies to make relationships deeper, more meaningful, fulfilling and longer lasting.

Ask Ellen Anmuth, Psychotherapist: Reduce Stress in College

“Ask Ellen Anmuth, Psychotherapist”  is a series of blog entries by Ellen Anmuth MS, MSW, LCSW,  a Licensed Clinical Social Worker. Select emails will be answered which may appeal to a broad audience.

This blog does not replace mental health counseling services, and I strongly recommend seeking the help of local licensed mental health providers when indicated. The Social Work Services Department of most hospitals can be a helpful referral source, especially if financial need is an issue.

This article will deal with two different topics from Sharon in Texas and  Don in California.

Sharon S. from Texas: “I find myself seeking approval from my family. They tend to be very controlling and critical, and I am afraid to make a decision that they may not approve of”.

Ellen Anmuth MS, MSW, LCSW: Sharon, I see that you are 20 years old, and living at home while attending community college. This can be a difficult period of life for you, in terms of a concept called, “separation-individuation”. You are in a period of life that some therapists call “The Young Adult Transition”. There are certain developmental tasks in each period of adult life, and stress can result when our inner compass differs from parents’ views.  Do you have friends you can relate to, and who share your values? What type of things do your parents disapprove of?  Are you engaging in any dangerous activity that would support their concern, or do you feel that their controlling behavior is related to treating you like a teenager, rather than a young adult? Sometimes, if parents have a difficult time adjusting to an adult child’s need for separation and individuation, conflict can emerge. Perhaps there might be counseling services through the community college, where you may be able to meet with a licensed therapist in person, to better evaluate the situation and guide you through your options and coping strategies.

Don M. from California: “I am pre-med, and so anxious about my tests that I can’t concentrate to study, and my grades are suffering. Do you have any ideas how I can study when I have so much anxiety about failing?”

Ellen Anmuth MS,MSW, LCSW:  Don, this is a question that so many others have asked me. I have an Education degree, and was an Assistant Professor of Family Medicine, teaching  medical students and doctors about psychology and education. I developed a technique to help people deal with test anxiety that was blocking their concentration. Try this: Take a sheet of paper, and make two columns: 1) The advantages of holding onto the feeling of anxiety, and 2) The disadvantages of holding onto the feeling of anxiety.  Fill out both columns quickly, writing the first things that come to mind. You will see a pattern, which will reveal information that may provide some insight. You may find that there is no logical “advantage” of holding onto the feeling of anxiety! That realization helps us to compartmentalize it away, at least temporarily, in order to concentrate.

Another useful technique is to make a “contract” with yourself, that every day, from 8pm-10pm you will study the course material that worries you the most. Do an “imagery exercise”: Imagine putting the feeling of anxiety in a box that you can put away (metaphorically speaking). You may imagine putting a box with your anxiety on a shelf in your closet, where you can close the door, so that with your anxiety “away” for the few hours, you can focus on the subject matter. After 2 hours, if you want to find that box, open it up, and experience the feeling of anxiety again, you can. You have that control. However, after 2 hours of focused study, you may find that the anxiety can stay in the closed box, and that you feel more confident and relaxed!  In fact, you may decide to throw that black box with anxiety out into the trash, rather than keep it on your closet shelf. This is a guided imagery exercise, which may be helpful. With incremental hours of successful concentration, you will feel more in control, and more confident about passing your tests.

Ellen Anmuth Psychotherapist: Use “The Language Of Solutions” During Moments of Conflict

Ellen Anmuth PsychotherapistEllen Anmuth asks: How can you turn the language of problems into “The Language Of Solutions”?

We have all been there — a moment of tension or conflict, where the uncomfortable energy is palpable. Yes, it is a feeling, an intuitive knowing, that there is an impasse, or perhaps anger is escalating.

In these moments of tension, do you verbally  freeze up, or do you go into constructive action because you have a “toolkit” of strategies to use?

Yes, in these moments of interpersonal stress, some people detach, others verbally attack, and some people simply identify and name the problem. While naming the problem may be a good first step, it is not the full answer.What is missing here? How about suggesting a solution, or a specific request for change in behavior that, if implemented, would solve the problem?

Here is a simple example where using “The Language Of Solutions” can quickly offer a remedy to the tension in the moment. Let’s say you play tennis with a friend, and the court is reserved from Noon-1PM. You get there at 11:55, and your partner consistently arrives at 10 minutes past the hour! To make matters worse, he never apologizes, and actually takes another 10 minutes stretching. Now, your 60 minute tennis court reservation is reduced to 40 minutes of actual play time.

One option is to tell your tennis buddy that he always arrives 10 minutes past Noon, and then does 10 minutes of stretching. However what verbal strategy is missing here? The missing aspect is to ask your partner for a specific change in his behavior, such as, “I notice that rather than arrive at noon, our scheduled time to play tennis, you arrive 10 minutes past the hour, and stretch for another 10 minutes. Are you able to come 20 minutes earlier, so that the tennis play can begin at noon?”

There are other strategies that could be implemented, such as clarifying assumptions, identifying  feelings about the situation, and checking out the other person’s perceptions. Communication is very complex, and there is much to learn.

This tennis situation actually happened to me, and I implemented these strategies, to discover that  my tennis partner preferred to paint, tinker with his cars, or do a number of other activities, and tennis was not his favorite thing to do. He never told me this directly…he just came later and later!

When I let him know that I preferred to play tennis with a partner who would come on time, and who would use the full 60 minutes of play, he decided that his heart was not in the game, and in a compassionate and kind manner,we both decided to cancel any future games. I then quickly found a new tennis buddy who shared my passion for the game.

Relationships prosper and are nurtured by honest communication, gentle confrontation,  and compassionate negotiation.

The Language Of Love: Unexpected Strategies for Intimacy

What is an Unexpected, Powerful Strategy for Increased Intimacy in Relationships?

The answer may seem like a very dull response to this tantalizing question. The answer? Learn to use more “Objective Language” rather than “Subjective Language”.  You may cringe, and ask, “What are you talking about?” OK…here goes! To give an example of “Subjective Language”, I will write out a hypothetical dialogue.

Jane Doe asks, “What is the weather like today?” If I, Ellen Anmuth respond, “Nice”, that response is considered to be subjective, because the word “Nice” does not paint a “word picture” of the actual weather. A nice day for one person could be a rainy day, and for another, it could be a sunny day.

What is an example of “Objective Language”? If Jane Doe asks “What is the weather like today”, and I, Ellen Anmuth respond, “The sky is bright blue, the trees are rustling gently with the breeze, and there is not a cloud in the sky”, this response paints a “word picture” that you can visualize.

How does this example relate to romantic love and communication that enhances intimacy? In the case of a married couple, if a wife says to her husband, “I wish you would show your love more”, her husband may have an idea what she wants. However, the wife’s communication was very “subjective” because she did not define what specific behavior her husband could do that would register in her mind, heart and soul, as representing “love”. For example, would she want him to bring her flowers, empty the garbage, massage her back, or pay the bills once a month, for example? The list of possibilities are endless.

How do we decide if a word is “Subjective” or “Objective”? This is challenging, as there is a continuum of possibility. When I  ran workshops on communication, I would ask my class, “Is the word ‘Mountain’ considered subjective or objective?” Most of the class would say it was an “Objective” word. I would ask the class to close their eyes, and envision a mountain. Then, when I asked them to open their eyes, the group was amazed to learn that some people visualized a mountain in Hawaii, while others visualized a snow covered mountain in Switzerland in the winter.

The conclusion of this very complex communication challenge is this: When you think you may be communicating clearly and specifically, think again, or ask your partner what they are picturing, thinking or believing about what you are saying. Then be prepared that you may need to clarify, and attempt again to communicate more specifically what you mean. It is usually advisable to ask your partner to paraphrase his or her understanding of the message, and then….be prepared to further clarify your message! Communication is just that complex, because language is based on symbolic representation, which is different for every person.

 

 

 

To Cherish and To Love

What does it mean “To Cherish”?  How is it different from the phrase,”To Love”?

Words can stir our emotions (when we are in a neutral state), and words can reflect the intensity of our emotions (when we are in an intensely emotional state.)

Have you ever “cherished a moment” or “cherished a person”? I am sure you have. Have you ever “cherished a moment” when another living thing (like a person or a beloved pet) was not there? I suspect that we can “cherish a sunset”, or “cherish a view of the Grand Canyon” but that language usually is spoken in the context of a shared experience with a loved one.

People say, “I love my car”, and “I love you”. We rarely say, “I cherish my car”.

What is the textbook definition of “cherish”? To cherish is to treat with affection, to hold dear, to protect and care for, to care for deeply, and to treat with tenderness, to name just a few.

Tonight over a cup of tea with friends, while we were discussing the topic of LOVE, someone mentioned the word. “Cherish”. I was stopped in my metaphoric tracks. (I was seated at the time.)  I told the person who mentioned the word that she should write a blog entry on the subject, as she is writing a blog on love.

When I got home, I continued  feeling this phrase, “To Cherish”, and felt a calling to write this article,”To Cherish and To Love”.  I suspect that if 20 people write on this topic, there will be 20 very different perspectives.

Why did I feel so deeply about this word? Not sure. Could it be the recent death of my uncle, the death of a close friend a few years ago, or the death of my father 8 years ago?

When I was a small child, I recall asking my parents why we had to “waste so many hours sleeping”?  When I learned we spend 1/3 of our lives sleeping, I felt this sadness of lost opportunity to live life. This was, of course, before I had any understanding of the medical reasons for sleep.I was, however, always acutely aware of the passage of time, and even as a child, sad for wasted moments of life.

As I get older, more people I love and cherish are dying. I have always cherished them. Our lifespans are limited, and some people die unexpectedly. I now savor the moments more, experience the people I love with greater presence of mind, and cherish them  more deeply.

Ellen Anmuth Commentary – CNN’s “Black In America” TV Broadcast

How does skin color and ethnic heritage affect self concept and self esteem in America?

I am a Licensed Psychotherapist, Educator, Genetic Counselor, and the creator of “The Language Of Solutions” Self Improvement and Wellness Programs.. As a Genetic Counselor in 1978, I worked in a Genetics Division at a University Medical School setting, helping people with, or at risk for Genetic Disease and Birth Defects understand complex medical information, and to deal with the emotional impact of having genetic disease, birth defects, or neonatal loss. My training at the State University of New York at Stony Brook was “Non-Directive Genetic Counseling”. In other words, I gave information and support, and never advocated opinions related to reproductive outcomes. Much of the work was intense and crisis intervention oriented.

 Back in 1991, a young man who was 19 years old at the time came to me as a therapy client. He was feeling very depressed, and internally conflicted on many levels. He was mixed race, born in Trinidad, and told me that his heritage was black, white, Irish, German, and more.  He had bronze skin, bright blue eyes, and a broad nose.

He said that up until age 13, while living in Trinidad, he had no awareness of the color of his skin, or even the existence of a racial identity. He was just a person, enjoying his life. When he moved to the USA at age 13, he encountered racism like a truck traveling 80 MPH hitting a concrete wall (my metaphor, not his.)

He told me his painful story of “white kids not wanting to play with him because he wasn’t white enough, and black kids not wanting to play with him because he was not black enough”. He was very well-spoken, with clear and proper pronunciation of words….a very sensitive and intellectual young man. He appeared emotionally more evolved than his chronological years.

When he came to America, and people would ask, “What are you”, implying a request to understand his mixed heritage, he would become very uncomfortable, and find himself “apologizing” for the black part of his heritage, by telling stories of slavery that somehow presented an explanation for this “less desired” part of his heritage.

Much of our work centered around building self esteem, and discussing the  undercurrent of racism in America vs. Trinidad, that caused Americans of mixed race to enter into conversations about skin color, identity and self esteem.

When  I saw the TV show tonight, “Black in America”, with Soledad O’Brien as the reporter, I was riveted to every word. The show focused on young people of mixed heritage, and different shades of skin color, and how they felt about themselves. I felt so sad, seeing their pain and torment over racial identity and self esteem.

The TV show also mentioned the “One Drop Rule”, which seems to allude to people calling themselves “Black” when 1/32 of their ancestors are black. The concept of “color-ism” was also presented, related to a photographer producing a book on the various shades of skin of people with black ancestry. I would like to learn more, if people would like to comment on this issue.

The political issues related to mixed race  in the USA are beyond the scope of this article, and beyond my expertise. However, I welcome comments in this area.

My focus of interest, as both a Genetic Counselor and a Licensed Psychotherapist, lies in how growing up mixed race or Black in America affects self esteem, and causes so much suffering in some people. I wonder: Will America ever be a place where skin color is a non issue, such as was in Trinidad 40 years ago, according to the young man who was my client in 1991?

Soledad O’Brien, on the show, “Black in America” spoke about her bi-racial heritage….mother who was Afro-Cuban, and father who was Australian-Irish.

On a personal note, I was always fascinated with the issue of our inner soul and our outer physical appearance. In college, I considered a career working with Burn Patients, whose faces were completely changed by the scarring of burns. I was fascinated to learn how the world would relate to them, and how they would feel about their self worth, in a culture that idolizes a certain concept of “beauty” related to worthiness. I felt a calling to help them to love themselves, despite what cosmetic alteration existed due to the burns, and to embrace the beautiful person inside.

When I was 15 or 16, I was an avid poet, a child of the 60’s, grappling with the social issues of the time. I  wrote a poem called “Prisoner”, and it began: “Here I am, stuck inside my face”….and the poem ended with the sentence, “….only a few people will ever meet me in person”. Perhaps I will dig into my files, find the full poem and publish it here. Apparently, being raised in Long Island, where clothes, image and jewelry  seemed very important, in my own way, I rebelled against the focus on external appearance, vs the true soul inside. Back then, I did not realize the extent to which I was riveted to the issue of  the soul, the person inside, and the over-emphasis on physical appearance.

When I was a child, growing up in the 60’s, a person of mixed race was called Mulatto. President Barack Obama, who has a family tree of a white mother and a black father is called Black, rather than Bi-Racial. I would welcome any comments about all the issues presented in this article, and any ideas about how to help others grappling with low self esteem related to physical appearance.

Please be patient, as the following policy is in place for posts.

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Ellen Anmuth Commentary

Emotions: When we “Feel” Them, we Can “Heal” Them

What could be the first step in managing emotions?

There are many approaches to handling our feelings more effectively. What could be the first, most logical step? The answer may appear elementary, but it is as follows:  Notice what you are feeling in any given moment!

This seems simple, yet the popular culture seems to send a message that it is not OK to feel. When was the last time someone said, “How are you?”, and you said, “Fine”, when you may have been feeling anger, sadness, fear or some other emotion? The tendency to deny, repress or avoid emotions is widespread.

Anger, sadness, fear, guilt, shame, hopelessness, and the myriad of other feelings that we experience can overwhelm us, in my opinion, because we have not been taught how to effectively manage them.

When you feel emotions, do you reach for a drink, or open the refrigerator when not really hungry? If you are angry or irritable, do you find that you might interact with someone else with more impatience or hostility?

In 1985, I took a course on how to manage feelings. We were instructed to observe our feelings, and attempt to bring them up, rather than try to avoid them. One technique we were taught was to drive our cars without turning on the radio. (Back then, there were no cell phones or other devices to distract.)

That is not so easy! Try to drive your car in silence, and notice when you have an urge to turn on the radio. Does that happen after you have an unpleasant emotion or thought?

Managing emotions is a complex process, and yet, avoiding the tendency to deny them is the first step. Yes, the first step to healing feelings is to, in fact, FEEL THEM.

Action Tips:

1) Keep a log or journal or your emotions, and what usually happens before you have the feeling.

2) Notice what you do after you connect with the unpleasant feeling. Do you reach for food, alcohol, or drugs?

3) Have a conversation with friends and family, and if they are receptive, have a discussion about recommended methods to manage emotions in a healthy way.

Update–March 2014…..For those readers who first read this entry last year, have you kept a log of your emotions related to events in your life? An “event” could be an “internal event” or an “external event”. What do I mean by that? An external event is something that happens within your environment, such as a person speaking to you in a harsh manner, finding out about a death in the family, etc. On the other hand, an internal event is something that happens within you, such as a thought, feeling, memory, flashback, or some other experience within yourself. It may be helpful to begin to better discern when an “internal event” causes another “internal event”. For example, if you suddenly have a flashback of an unpleasant experience, you may find yourself having an internal dialogue that is self critical. Then you may feel sadness or guilt. How do you turn around this escalating spiral of negativity? Often, this happens unconsciously. Practice being more aware, by asking yourself, “What am I feeling now?”, or “What am I thinking now?” From this type of inner awareness, you may be able to manage your emotions more effectively.— Ellen Anmuth, MS, MSW, LCSW, Licensed Psychotherapist, Genetic Counselor, and Founder of “The Language Of Solutions” Self Improvement and Wellness Programs.

 

 

Relationships: Creating Deeper Connections (Is the time right?)

Relationships are fluid….like an intricate and delicate dance, the relational system is ever-changing. Sometimes relationships become more distant and detached, and other times,  people in relationship become more deeply connected.

 How do we create deeper connections?

Perhaps the first question may be, “do you want to deepen the relationship you are in?” Depending upon the nature of the relationship, firmer boundaries may be advantageous.

What do I mean by “boundaries”? Boundaries can be understood as the separations between people. For example, in the workplace, some relationships are meant to be more distant, in that it may be unwise to share too much personal information, especially during  a crisis, such as a divorce.

In personal relationships, such as friendships, the dance of relationship seems to be in assessing the “climate” of intimacy vs. distance, in terms of how much personal information to disclose.

In relationships that are becoming romantic, the dance step still remains a fluid process. For example, how much vulnerability do you disclose, and at what stage in the relationship?

For most people, timing is important, and it may be advisable to disclose small bits of vulnerable information at first, to assess how such tender information if handled by the other person. In a healthy and loving relationship, past hurts and vulnerabilities, if handled appropriately, can be help build a foundation of trust and deepening love.

In romantic relationships that are longstanding, if a person begins to disclose vulnerable information outside the relationship, this could be a sign that intimacy is beginning to deteriorate, and the relationship may benefit from therapy by a licensed mental health professional.

TIPS:

1) Assess carefully when you are ready to disclose some vulnerability in a developing relationship.

2) Notice how you feel when you disclose this information. Does the other person seem to connect with you more deeply, or run away?

3) Check in with yourself. What expectations do you have of this potential friend or partner? What do you think is a healthy balance of opening up some vulnerability, but not overwhelming the other person with too much information for their comfort zone?

4) In attempting to create deeper connections, it is important to evaluate the readiness and ability of the other person to handle such disclosures.

Relationships: Creating Deeper Connections