People come to see me for all sorts of reasons. But they all have something in common. Age, gender, sexual orientation, doesn’t matter; diagnosis, history or economic status don't change this factor. They come to me because things are not working well in their lives. Folks feel stuck in a rut and they can’t seem to get out. Usually by the time they end up in my office they have been mired in their situation for long enough and they are desperate for change. I’m rarely the first stop on this train of woe.
There are lots of ways to think about what ails each person. I start with a detailed history; asking about family of origin and developmental history. We discuss current themes and habits, we talk about hopes and dreams. I want to know all the details about relationships and self-care. I try to get into as much detail as possible. This is where the individual resides.
Once I have all this information, I work with the client to come up with a treatment plan. There are many different psychological theories that therapists use to help guide our thinking; Psychodynamic, Cognitive-Behavioral, Developmental, Interpersonal, and Family Systems to name a few. Each of them has their utility and their pitfalls. The one I want to look at here is called the Default Mode Network, because I think its a very useful tool to understand what's happening in our heads. I’m going to get a tad bit science heavy and nerdy, but just hold on the juice is totally worth the squeeze.
The Default Mode Network (DMN) is an organization of brain regions which interact with each other and are distinct from other brain systems. This is the system we use to operate on a day-to-day basis (how to move through the world) and contains the structure of the self (how we are in the world). This network of neurons is responsible for your memories, feelings, and reactions as well as your understanding of other people’s behaviors and their feelings, and organizes our memories and our thoughts about the past. Although the Default Mode Network was first described by Hans Berger in 1929 and has been supported by others since then, it was only in 2007 when researchers were really able to start to see the brain activity clearly in PET scans that the research on this system really took off. en.wikipedia.org/wiki/Default_mode_network
Physically the DMN is located in multiple sections of the brain, such as the older “reptilian” parts as well as the more “advanced” parts of our brains. This includes, but is not limited to the medial prefrontal cortex; the posterior cingulate cortex; the hippocampus; and the amygdala, as well as parts of the inferior parietal lobe. Want a quick refresher on brain anatomy, check it out here. brain diagrams
Why is the DMN important? Well it’s what makes you, you. This thing is the amalgam of all of your experience, thoughts, feelings, hopes, dreams and fears. The DMN is what makes us able to look at a face and recognize it as a face; and allows us to complete a task without having to learn it anew each time. The DMN is what reminds you not to eat the sushi that got you sick that one time, or evokes feelings when hearing a certain song. Accordingly, the DMN is modulated by everything that affects us; sleep, food, sex, exercise, acupuncture, meditation, drugs, etc. You name it, and it’s probably got something to do with how you experience the world. link for meditation effect on DMN
Here’s the kicker. When your brain is NOT involved in a task that requires concentration, such as giving a lecture, or focused on a task, such as cooking dinner, the sections of the DMN are more active. This is kinda cray-cray. But what it means is when you are not involved in a task fully, you might get stuck in rumination. You go sliding down the rabbit hole of: why did that person give me a funny look? Was it a funny look or not? Did I do something to deserve that look? In fact the DMN may pull us out of a task and down that same rabbit-hole. Sound familiar?
When that happens, we get pulled into all the times that we may have had a similar experience, and/or pulled into the future of fear when those feelings may come up again. This is precisely the problem with the DMN; while this network of neurons is what allows us to operate on a day to day basis, we also get caught, ensnared and reduced to the misery of rumination or habitual thinking. When you get “stuck” and start churning through our go-to mode of chasing whatever monkey-brain we each have, that is the DMN doing it’s thing.
So, knowing this the question becomes, how do we manage the monster? First (and anyone who has worked with me will tell you this is my default comment), you have to be aware of yourself. You have to be aware that you are in that space, and oops it happened again. The magic is in the struggle. Only then can we work to change the process. You have to be able to name it before you can change it. This is the work of getting to know yourself, and then laying down new neural networks. There are smaller more ways to change and more impactful ways of change, but they all start with the same step, knowing yourself.
Once you’ve committed to learning about yourself you can ask questions such as these:
What are your daily habits of thought? Are you kind to yourself or constantly critical and demeaning?
What are your daily habits of behavior? Do you get enough sleep? Feed yourself nourishing food? Do you exercise? Do you allow yourself pleasure?
What are your relationships like? Do you come away feeling understood or lonely after meeting people in your life?
The questions are a starting point, and the solutions are individualized. That’s where the hard work comes in, stripping away the layers of historical not-knowing to find a place where you can say, this is what works for me and stepping into that. That work can be done with a therapist, with a friend, or on your own with a journal. Solutions can involve food, sleep, exercise, meditation, drugs and connection. But only you can do it. So that’s your charge. Go forth and make change.
I spend a lot of time talking with people about sleep. A significant part of every new client meeting is delving into the nitty-gritty components of their sleep habits; the good, the bad, the ugly. We talk about caffeine intake (caffeine can influence your sleep many hours after you’ve had that precious cup of coffee), exercise and food (if and when we work-out and when and what we eat can influence our ability to fall asleep or sleep soundly), the atmosphere in the bedroom (it should be cold, dark, and quiet), sleep-timing (when do you fall asleep and when do you wake up) and lots of other minute details. Link
People who come to see me are often surprised that I’m so interested in their sleep, but there is a clear connection between sleep and mood. Link Sleep is at least as important as any other aspect of self-care; yet somehow culturally it’s okay to skimp on, or simply ignore our biologic need for sleep. Some people don’t allow themselves adequate hours, or have trouble with waking during the night. For many people, falling asleep is the hardest part, and it’s frustratingly one of those struggles that the more that you concentrate on the task, the more elusive the goal seems.
I also spend a significant amount of time talking about my client’s children’s sleep. All the same questions, plus what works for the parents? Can they set limits? Do they want their child to sleep in their own bed or does some other arrangement work better for the family?
For the past few months, one of my kids has been struggling to fall asleep. We’ve gone through every plan in the proverbial book, tried multiple solutions, with mixed success. But he’s been having a hard time falling asleep which is a very frustrating situation for me. I am by temperament and habit a morning person. When bedtime comes, I am ready to tuck my kids into their beds and start my own evening routine. My patience is thin. Whatever ability I have cultivated to stay calm through the course of the day has evaporated.
This particular night was no different. I read books, sang songs, snuggled, then stayed a little bit longer. I gave one-more-kiss. I said good-night and I left. I went to sit on the couch, thinking that I was home free, when I heard the bedroom door open and small feet pad down the hall.
“Mommy, I can’t sleep.” Rather than letting out the choice words that I wanted to, I took a deep breath, exhaled, and asked “what’s going on?” He had tears in his eyes and said, “I’m scared.” Instead of sending him back to bed, which is what I wanted to do, I invited him to snuggle on the couch and we started talking. He explained that he wasn’t scared of anything in particular, rather “something in (his) head” when he started to fall asleep would “jerk him awake.”
Just as he was starting to relax, his brain would start to puzzle over the difficult situations, which is what our brains do as they are shifting towards sleep. Link But then because he was nervous just as he would fall asleep, he’d wake himself up and the whole process would have to start over again. No wonder it was hard to fall asleep. He didn't feel safe, he couldn't let himself relax. We spoke about his worries and ways to address them moving forward. As we did, I could see his face change, his body relaxed. The whole conversation took about 30 minutes. He felt armed with a new approach and was able to go off to bed, on his own and fell asleep without any more difficulty.
With my son that night, I asked lots of questions. Slowly his story came out. He was having a struggle at school, and a similar struggle at home with his brother; he didn’t know how to handle either situation. He was sad, angry, and overwhelmed, as he voiced those feelings he was able to move through them. As we spoke I tried to stay calm, which further helped him to calm him down. As he was able to calm himself he was able to relax enough to eventually fall asleep.
I don’t mean to suggest with his story that this is the solution to every insomniac struggle. I’m positive that we will have more sleep struggles in my house. That’s inevitable. However, I think what helped my son that night was my being able to sit with him so he could voice his concerns, recognize his emotions and move on. My hope is that if we can learn to sit with and listen to ourselves, maybe we can learn something useful.
His body was wracked with tears as I opened the school’s front door. Immediately I assumed he was in pain, as he had called me from the nurse’s office to tell me he had an earache and wanted to go to the doctor. I felt guilty I hadn’t taken him earlier, but this was the easiest time for an appointment. As I opened the door he fell against my body, hugging me and sobbing, “I don’t want to go to the doctor’s office. You made me miss extra recess.”
Extra recess. He had talked about this for days. As a reward for being exemplary students the teachers gave the second grade an extra hour of recess. His 8 year old self had been so proud, so excited. I had ruined it. He was crying hard. He hadn’t let himself cry in public for months, so I knew he was really upset.
When we get angry profound changes happen in our body and brain. Emotions start in the amygdala. That’s our “lizard brain,” the part that operates without thought. Our brains are so efficient that the amygdala reacts to a perceived threat before the cortex (the part of the brain responsible for judgment and planning) can respond. In essence our brains are wired so that we can respond first and asses second. Which, may be great if you are being chased by a predator; but is not so great if you are dealing with more mundane threats, like missing extra recess.
I tried to reason with him, which infuriated him more. He started yelling at me while his arms were wrapped around my body. I was flooded with emotions. Primarily I was feeling anger at being yelled at, and embarrassment; after all the school administrators were watching this unfold. I wanted to yell back at him. I wanted to pull away. Instead I took a deep breath and hugged him. He sobbed and yelled and hugged me back squeezing a bit too hard. I wanted to pull him off of me. I wanted to disappear. But I knew that wouldn’t actually help the situation, and honestly, I didn’t want the school staff to see me unhinged. So instead I took a deep breath and said, “I’m sorry. I know how much you were looking forward to this, and you must be so disappointed.” He continued yelling at me, “You did this! You ruin everything! You’re the worst mommy in the world!”
As we become angry, our brains release neurotransmitters which do a host of things including lock our attention on the thing which is a threat. We are ready to fight, potentially for a sustained period of time. In an adult, this is when (we hope) the prefrontal cortex (planning and judgement) comes online. But the prefrontal cortex doesn’t really fully develop until sometime in the early 20s. So in my 8 year old son we were contending with someone who had very big feelings and very limited coping skills. In this moment our best hope was that my prefrontal cortex was going to step it up.
I took another deep breath and said, “I’m sorry that this happened this way. I wish it was different. I understand you are angry at me. But you have a doctor’s appointment, so let’s see if we can make the best of this.” Now, although he was still yelling and crying, he followed me into the car. As we drove I kept my attention on taking deep breaths and attempted to met his anger with softness. Eventually the sobs were quieter. After a few minutes he said, through his tears, “I’m sorry that I’m yelling at you.” I took another deep breath, quelled my wish to lecture him, thought for a minute and said to him, “I don't like being yelled at, but I really do understand that you are super upset and I wish that this had happened differently. I know that you were really looking forward to extra recess.” His breath was coming in big hiccups now as he was calming down. After a few minutes longer he said, “Can we get ice cream afterwards?” I exhaled, felt my body relax a bit, and agreed that sounded like a good compromise.
In essence, managing your anger means learning ways to strengthen your prefrontal cortex so it can regulate how you react to the feeling generated by the amygdala. The most basic of ways is using relaxation techniques, such as taking mindful breaths; or using cognitive awareness, like my knowledge that things don’t go well if I react with anger, to bring judgement into play.
I am proud of my son, for being able to put words to his hugely intense emotions. That’s a big task for any of us human beings, and kids biology makes managing emotions even harder. And I’m proud of myself for taking those breaths so I could meet his anger with softness. Much of my pride comes from the knowledge that there have been loads of times I’ve met his anger with anger of my own. Without fail, that unravels into a bigger mess. I'm sure that I'll fail again. This time I managed to squeak out a win for us both. So I gave myself a mental high-five for a job well done.
As a couple's therapist I get questions often about "what should we *do*?" This article from the New York Times gives some great ideas. For some reason I can't quite embed the link properly, so until I figure that out please just copy and paste to get to the original article.
This is the fourth in a series of posts about Attachment and Parenting
Discipline is an action that requires us to be involved in an on-going way. Contrary to how we behave ourselves, discipline isn’t one and done. This means if you don’t like the way something went down, you can always address it later.
There are many, many moments when I have all sorts of feeling that I am not proud of or don’t like. There are many times that I respond my kids and I wish that I had a do-over. For example, recently, after asking the kids for the bazillionth time to get ready for bed I realized that I was using a tone that I didn’t like. I wouldn’t like being spoken to that way, and I know that they don’t respond well to that tone. So I stopped and took a breath and said, Hey, ya know I’m sorry I’m speaking to you so sternly. I don’t know why I spoke to you that way just now. I shouldn’t have. My son said, “Its okay. You usually talk to us like that when you are tired and just want us to go to bed.”
Wow. He got it. He understood what I’ve been trying to show him. He was climbing the scaffold that I've been building. He got that feelings are complicated. He got that love and frustration and closeness and exhaustion and amusement and boredom can all exist together in one person in one minute. He got that it’s okay for me to make a mistake and it’s important to take responsibility for your actions.
As an aside , don't mistake that interaction to mean that the kids magically became better behaved and started listening to me. Nope we still struggled that night but it somehow felt different.
This parenting thing is not easy, and I don’t claim to have all the answers. I’m constantly shifting and learning and trying to keep up with the changes. But those moments keep me engaged, the ones that sneak up and show me that my kids are becoming their own people right before my eyes and they are helping me grow up too.
This is the third post in a series about Attachment and Parenting.
My fastidious and strict German grandmother used to say: a child needs to eat a certain amount of dirt to grow up right. I always loved this. As a child it allowed me to get messy and have an excuse. As a mother, it helps me to know that a child does not need a perfect parent. A child needs a parent who is present and available.
Children need to learn about disappointment and how to overcome greed and selfishness. They need parents to teach them about limits and appropriate behaviors. They need to learn about everything from rules of conversation, table manners, what feelings are and how to mange them.
Whenever I get to this point, people ask about discipline. Each parent had their own question about the topic which I can summarize here as: How do I discipline my child the right way? I wish that there was a straightforward answer to this, but I don’t think there is. Instead I try to keep a couple of ideas in mind to help me.
First is to understand the difference between guilt and shame; guilt about something that you have done and shame is about who you are as a person. A guilty person feels badly about taking a cookie from the cookie jar. A shameful person feels they are bad for taking the same cookie.
Little kids have a hard time understanding that their feelings are transient, confusing and not the totality of themselves. They feel things intensely and assume that everyone must feel the same way that they do. If you are angry at them, they cannot fathom that you still love them. Likewise, if they are angry at you, they assume that you must also feel angry towards them.
The way that I tried to explain this idea to my kids was to tell them over and over again: I love you even when I am angry at you, and even when YOU are angry at ME, I still love you. I would tell them in the midst of the angry feeling, and at other times when we were feeling closer. I wasn’t sure if it was registering until once when I was very angry my son patted my shoulder and said: Mommy, just remember I still love you even when you are angry at me.
Turns out that was a great reminder to us both.By saying that, he reminded me that he pays attention to what I say as well as what i do. He reminded me that our connection was the primary thing, and the anger was the fleeting feeling. He reminded me that I have a choice about how I manage my feelings, which is what I'm always busy telling him he can do too.
This is a continuation of last week's post about Attachment and Parenting.
Donald Winnicott was a British Psychoanalyst who coined the phrase “the good enough mother.” For our purposes I’ll use parent in place of mother, but the idea remains the same. This ground breaking idea was that rather than being omnipotent and perfect, the Good Enough Parent keeps trying despite ongoing trials. As one person said, less goddess, more gardner.
I remember the days of having an infant. I had read that mothers are supposed to know the difference between their babies cries. Supposedly one cry meant hunger, and one meant tired, and one meant something else….this left me feeling hopeless and inferior. I could never differentiate between the cries. As hard as I tried I never was able to differentiate between a cry of hunger and a cry of exhaustion or frustration or loneliness. Nope, I felt like dismal failure at that. When I could get past that feeling of failure, I was able to notice other cues that I learned which helped me to understand what my babies needed, so that we were able to create a wordless communication.
Later I discovered that recent infant-parent studies found in the BEST CASE SCENARIO mothers were able to understand their infants needs only 30% of the time on the first go. Let me repeat that 30% of the time the BEST parents were getting it right. That. Blew. My. Mind. 30% is the best you can shoot for? Seriously? I can do that!
This is so important to remember because it means that the bond is not created by instinctively knowing what your child needs. Nope. Importantly, the bond is created in the space between the mistake and the repair. Mistakes and missteps are inevitable. And actually, the attachment bond is strengthened each time the parent realizes that they haven’t fixed what ails and tries again....and again...and again. The bond is created in the behavior that says: I’m here. I hear your pain. I’m not going away. I will try to help you.
As a parent we don't have to know what we are doing all the time. We just have to be able to communicate that we are willing to try to help them figure out a solution.
Recently I led a discussion group at a neighborhood preschool. I began by asking folks to share their greatest surprise about parenting. Not surprisingly, the overwhelming majority said they were shocked at the depth of feeling, most often—but not only—anger that arose while caring for the very kids that they loved so very much.
I emphatically agree. I love my kids and I get sooooo angry at my kids. That surprised me too. At first. But when I was able to take a step back and get some space from the feeling I remembered: Not only is anger okay, it is expected. All feelings are normal and important to recognize, and most important is what you do with that feeling.
I received a lot of great feedback from the participants that night, and a lot of questions since, so I’m going to put together a series of blog posts, hoping that they will be helpful to someone in the future.
Let’s start by talking about attachment. Attachment has become sort of a parenting buzzword, so I want to make sure that we all know what it is. Attachment is the bond between two people. The bond could be between siblings or partners but for the purposes of our discussion we will talk about the bond between parent and child. The goal as parents is to create a bond that feels secure and reliable so that the child feels safe to go off on their own in the world. After all most of us aren’t hoping for kids who will be dependent upon us for the entirety of their lives, right?
Attachment means there is a desire for regular contact with the other person, and there is some stress when the other person is not there. This is the concept of missing people when they are not with us. To clarify this point, stress is a necessary fact of life and parents have to help their child learn to tolerate larger/longer separations so they can go off on their own. That process happens as the child learns to keep an image of the parent in their head. Recognizing that the parent still exists when they are not physically with them is a major developmental milestone for kids, and each person has their own unique way of learning and tolerating separation. This is why the games peek-a-boo and hide-and-seek are favorites with the under 10 crowd, they are using play to figure this out on their own.
One parent in the pre-school group said: It’s incredibly stressful to have to constantly be one step ahead of my children. Always trying to anticipate their needs feels impossible and exhausting. How does the attachment process happen then? How does a parent know when and how to respond to a child’s needs? After all kids are continually changing.
It is exhausting because it is impossible. Secure attachment does not require the parent to respond immediately to every cry and desire of the infant or child. Nor does attachment require that the parent be physically present all the time. Nor does the parent need to be one step ahead, anticipating every need. Attachment creates a scaffold for the child so that they can learn to operate in increasingly complicated ways, on their own.
Here are my questions for you, my readers. How do you know that your child is attached to you?How do you know that you are attached to your child? How do you scaffold for your children what you want them to know? What questions do you have about attachment?
Many people have asked me, "What exactly is depression?" and "What can I do for myself or a friend or family member if I or they are depressed." This short cartoon answers many of the FAQ that I get. Take a few minutes to watch it and educate yourself.
I had food poisoning this week. Getting sick was an uncomfortable experience to be sure; not only the acute phase of ridding my body of the poison, but the after affects of feeling low energy and "off." The experience reminded me how thankful I am for my health. Then Kismet! My dear friend and colleague, Dr. Sarah Sarkis, published this article on Elephant Journal. The article talks about the connection between gut-health and mental health. If you've ever suffered from not feeling well physically or emotionally, this article may have something of interest to you.