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Below are Yehuda's responses to the Yated Ne'eman's weekly questions.
August 11, 2017
After my last baby, I was feeling very sad and not myself. I thought it was just because I was very tired but people said I was depressed and I had what they call the baby blues. Now I am...expecting again and I want to know what steps I can take to prevent this from happening again. I would appreciate any advice you can offer.
What used to be known as postpartum depression is a very common. Though many people refer to it as the “baby blues” regardless of severity and duration, I would differentiate between a mild episode lasting up to a couple of weeks and an episode that is more severe or lasts longer.
Most women feel tired for some time after childbirth. Many feel some sadness. This is what most people likely mean when they speak of the baby blues. These feelings most often dissipate over a couple of weeks. When these feelings persist or the new mom has constant crying spells, feelings of guilt, loss of interest in regular activities, insomnia, hypersomnia (excess sleep), or other serious symptoms of depression, it’s considered a depressive disorder.
The symptoms of depression after giving birth are thought to be due to hormonal changes due to the birthing process combined with the emotional effects of a major life event. Symptoms can occur after miscarriage and stillbirth as well. Women who have had some form of depression in the past are more likely to experience feelings of depression after giving birth.
It is important to monitor your feelings as you near the end of your pregnancy. If you begin to feel sad or have any depressive symptoms, you should speak with your doctor. Your doctor can recommend treatment, which may include medication or therapy to help reduce the symptoms. Beginning a relatively mild treatment early on may help to keep any symptoms under control without the need for more extensive treatment later on. In the event that additional treatment is required, having already begun treatment will likely reduce the severity and duration of the depression.
Another less publicized issue is postpartum anxiety. Racing thoughts, constant worry, fear of being alone with the baby, feelings of dread, and the sense that these thoughts will never disappear are some of the symptoms. As with postpartum depression, it’s important to identify any feelings of anxiety and seek treatment for them early on, so as to prevent an increase in severity and duration.
Eating and sleeping properly and exercising regularly (under your doctor’ guidance) can also help to prevent feelings of both anxiety and depression. It is quite possible that your baby blues was a one-time experience, and hopefully you’re worrying unnecessarily. Regardless, taking care of yourself will likely have positive effects on physical, chemical, and emotional levels.
August 4, 2017
My mother-in-law has been fighting a very serious illness for the last few years. At this time the doctors say that they have no more treatments to offer her. I don't think my husband really accepts the implications of this. My children have always had a close relationship with their grandmother and are always asking when she is going to get better. We have been very positive throughout this but now I am not sure how to approach it with them. I feel like I should prepare them but my husband is encouraging them to daven and telling them that with Hashem's help she will get better soon. Can you please give me some guidance as to how to proceed?
Your question is an important one that will affect many of us at one time or another. It sounds as if your husband and you are both concerned with your children’s reactions to your mother-in-law’s illness. Your husband seems to be taking a short-term approach, worried about the kids’ immediate reaction to news that their grandmother’s illness is terminal. He may also be in denial of some sort. As you mentioned, he doesn’t appear to accept the implications of the situation. This may mean that he has trouble accepting his mother’s impending death.
You seem to be more concerned with the emotional effect that a sudden death can cause. You want to begin preparing them for this eventuality. Also, if your kids sense that the situation is more serious than they are being led to believe, this can lead to more consternation than being told the truth. Fear of the unknown can often be more anxiety-provoking than the reality.
Another concern may be your children’s feelings about being misled. If they may feel that they were lied to, and that they should have been told the truth, they may become quite upset. If they sense the truth and know that they are not being told the truth, it can lead them to distrust you.
On the one hand, kids tend to be more intuitive than we give them credit for. They might have a much better idea of the seriousness of your mother-in-law’s condition than you believe. In addition, children are often more resilient than we expect. Sometimes our nervous anticipation of a child’s response to a traumatic event leads to the anticlimactic emotional equivalent of a shrug. On the other hand, it can be difficult to gauge the effect of traumatic news on anyone’s emotions—and this is especially so with young children. The simple fact that a child doesn’t appear to be bothered by something doesn’t necessarily mean that there is no emotional effect.
Of course, I’m speaking generally. Your decision will be very much dependent on factors like the ages of your children, their maturity levels, the degree to which they seem to recognize more than they are being told, and the types of emotional relationships that they have with your mother-in-law. It might be a good idea to discuss your concerns with someone who knows your family, but can be more objective.
July 28, 2017
Without getting into the gory details, my daughter is currently being treated for a substance abuse addiction. My husband and I are trying to be supportive of her while understanding that it is going to take time. We are being told that we are supposed to view this as an “illness” just like any other mental health or physical illness, such as depression or heart disease. I can’t for the life of me understand how one can compare the two. How will not taking responsibility for her behaviors and blaming an “illness” help her long term? Why is our acceptance such an integral part of her treatment? As sad as it is, she made some terrible choices and is now suffering the consequences. I know it sounds harsh, but like my mother used to say, “You made your bed, you sleep in it.” Thank you for your time.
Many diseases that are high up on the list of leading causes of death have a large degree of self-infliction. For example, if people ate healthfully and exercised regularly there would be an extreme reduction in deaths caused by diabetes and heart disease. According to many credible studies, at least 90% of all cancers are caused by diet, lifestyle, and environmental factors. When putting things into perspective, the age-old “you did it to yourself” criticism is almost no different for addiction than for cancer.
Although we tend to view mental illness as just that, mental without any physical symptoms, this is not the case. Mental illness causes physical changes to the brain’s function. Addiction and substance abuse change brain structure and the way in which the brain functions.
In addition, addiction is in many cases a result of another underlying issue. Many addicts suffer from emotional distress and other mental illnesses. They often turn to drugs as a means of silencing or suppressing emotions with which they do not know how to cope. In many cases, people become addicted due to opioid use that was originally prescribed for physical pain.
Some people have a greater propensity to become addicts than others. While we don’t have a full understanding of the causes, there are a number of factors that influence the risk of addiction. One important factor is genetics. Some people are born with a predisposition for addiction. The second factor is environment. This includes friends and family relationships, economic factors, stress, abuse, and peer pressure. Development can also play an integral role. Since teenagers are still developing their self-control and decision-making skills they are more likely to try something risky such as drugs. That can lead to changes in their brain function, making it more likely for them to become addicts.
As with many diseases, there is no cure for addiction; however, it is treatable. Recovery is the key word. Recovery is generally different for every person but there are a few common factors. In order for an addict to start on the road to recovery, it is imperative that she recognize that she cannot simply control the disease any more than someone can simply control her diabetes. Just as diabetics need to acknowledge that they can’t psychically wish their diabetes away, addicts have to recognize that they also require specific tools with which to fight their disease.
It is naturally easier for a diabetic to change his eating habits when he has the support of his family and friends. This is all the more so for someone with a mental disorder, and often essential for an addict. In addition, if your daughter recognizes that you do not consider her addiction a disease, this might affect her ability to take her first step toward recovery: acceptance. With your understanding and support, your daughter will likely have a much increased chance of success in her recovery.
July 21, 2017
I am a working mother of 6 beautiful children boruch Hashem, and I am dealing with the regular life stresses that come from parnassah, shalom bayis, and running a family etc. A friend of mine suggested something called "mindfulness" as a way to help me ease the stress. I have looked into it and am wondering if this is something that is used by the frum therapists? Also, do I need to actually see a therapist who is trained in this (for which I have no time or money or time) or is this something that I can effectively learn and do on my own?
As far as I know, there is no official “mindfulness” therapy. As such, the term has inconsistent and sometimes vague definitions. Probably the most common form of mindfulness training is mindfulness-based cognitive therapy (MBCT). Since this falls under the umbrella of cognitive-behavioral therapy (CBT) which is a very commonly used modality, it has been used by many therapists including myself.
There are various other forms of therapy that include a mindfulness component. Typically, mindfulness refers to a focus on thoughts and feelings (and sometimes actions), with the goal of better understanding and accepting them. The idea is to help the person separate from emotion-thought-behavior patterns that prevent them from breaking free from the vicious cycles that these create.
Generally speaking, mindfulness is only one of the tools within a particular therapy modality that a therapist would use. Depending on the situation, many additional tools can be used to complement the effects of mindfulness. Additionally, an eclectic therapist might use various modalities, thereby tweaking the use of mindfulness depending on which is being used at the time.
If you have normal stress levels and simply want to manage your stress in a better way, there are many books and online resources through which you can train yourself to become more mindful of your thoughts and feelings. As with many things, repetition is key. Once you find a strategy that works for you, be sure to set aside a specified amount of time on a daily basis to practice it.
If you feel that you can benefit from personalized guidance, a therapist should be able to help you to identify a few areas and strategies that you would practice on your own. This might take only two or three sessions—which might be covered by your health insurance policy.
July 14, 2017
I am worried about how my husband interacts with our children. Most of the time he is great but when he is stressed out he can really be difficult. He yells a lot and on occasion...[spanks]...the kids. He says there is nothing wrong with that and that it was never considered wrong for a father to...[spank]...and is part of...[discipline]. I think it's horrible and will ruin the children emotionally. Can you please settle this issue for us?
Clearly, there are many different parenting styles. Some can appear harsher than others. Depending on the circumstances, there can be a fine line between “punishment” and “abuse.” The location of this line depends on the definitions of these words—and people will define punishment and abuse differently. Some people will refer to both as physical; others define them both as non-physical; yet others identify one as physical and the other as non-physical.
For the sake of this response, I will classify punishment as something that is done carefully, logically, and specifically to help the child to learn an important lesson. I will define abuse as either something that is done for the wrong reason (i.e., out of anger or frustration) or something that can potentially harm the child (physically, emotionally or otherwise).
The simple fact that corporal punishment “was never considered wrong” certainly doesn’t prove that it wasn’t. Nor does the common sentiment, “We all turned out fine” prove anything. In the first place, we didn’t all turn out fine. Many of us have clear emotional scars that were caused by abuse of one sort or another…and many of us have less obvious issues that can be traced back to abusive behavior on the part of our parents. Additionally, times have changed. Although many of us would love to return to the twentieth century, we can’t compare 2017 to 1987. This is not just because laws and norms have changed. It’s also because of how abuse is experienced by the victim.
People are quick to judge an action as abusive. Actions by themselves, however, cannot be abusive. Abusive behaviors do not exist in a vacuum. Abuse can be thought of with reference to its impact. What is abusive for one person is not so for another. One child will think nothing of being casually swatted, while another might be extremely embarrassed, insulted, and hurt. Circumstances will also dictate the degree of abuse. If a teenager is pummeled by his father in a playful way, he might be perfectly fine with it. On the other hand, if he were to be cuffed gently in response to something that he did, he might feel hurt and angry.
All else being equal, when a child is punished in a calm and loving manner he is more likely to accept the punishment in a positive way. When a punishment is accompanied by stress, frustration or anger, this can cause the child to be hurt by the punishment—all the more so when it includes a physical component.
Use of corporal punishment has greatly declined over the last generation or two. Because of this, there is a greater sense that physical punishment is extreme. Children, therefore, have a very different response to being spanked than we did a generation ago. Some of us may have taken it in stride and discussed it with friends who had also been spanked. Since children today understand spanking differently, they are more likely to feel that there is something seriously wrong with the situation…or worse, something seriously wrong with them. This is what will, from the child’s perspective, define the action as abusive: the damage caused by the action, rather than the action itself.
Though we may think that we understand the impact of our actions on our children, we can only see a very small part of the effect. We can’t see the impact of our actions on our children’s thoughts, emotions, or self-esteem. Since we don’t know what the effect of our actions will be for each particular child, we need to be extremely careful in how we discipline our children.
July 7, 2017
My 18-year-old son has been going through a very difficult time recently. He has been acting very rebellious and his yiddishkeit [Judaism] is suffering tremendously. We have been advised by many rabbonim [rabbis] and others that the key is for my wife and me to retain our relationship with him and unconditionally love him. Though he has not shown us that he is very responsible, we did not put up a fight and allowed him to get his driver’s license. Now we are really worried about him driving in the mountains over the summer. At the end of the day, it's a sakanas nefashos [danger]. How can I not put my foot down? Still, this will I'm sure cause a huge fight and damage our relationship with him. Can you please give us some advice as to how to proceed?
I’m sorry to hear that you’re experiencing a hard time with your son. As you stated, it’s imperative that your wife and you retain a positive relationship with him. Unfortunately, there’s no cut-and-dried answer that will give you peace of mind with regard to his driving upstate. Although your question is specific to upstate driving, the more general issue is the sometimes delicate balance between discipline and a positive relationship. Although these often appear to exist on opposite ends of the spectrum, they can work in sync with one another.
I don’t know the history of your relationship with your son or how he responds to conversations or directives. Teenagers tend to test boundaries. What this generally means is that they will push the boundaries as far as they can possibly go. Once the parents give in, the bar has been set higher for that particular boundary—and often in general—until the next time the boundaries are tested. Parents often accept these circumstances out of fear that their child will become angry and do something rash. Since the child knows this, he is in control of the relationship.
If this sounds familiar, you may be in a situation where your son clearly recognizes his power over you. (In this case, the unspoken understanding may be: “If you don’t let me drive upstate, I’ll become even more rebellious.) His rebelliousness can have a variety of sources, but he may well be using it as a powerful bargaining chip. With regard to the relationship, I cannot give you specific advice, but I would recommend that your wife and you speak with a therapist about moving the relationship to a more reciprocal one.
At this time, however, it seems that your relationship with your son is lopsided. Since he has much of the power, you feel that your hands are tied. On the one hand, your son has not demonstrated the level of responsibility that might make you more comfortable with the idea of him driving upstate. On the other hand, you’re afraid that a fight might harm your relationship with him.
The ultimate decision, of course is yours. However, if you decide to allow him to drive in the mountains you can make it clear that this is a privilege that can be taken away. You can give him very specific parameters and rules that he must follow in order to keep this privilege. You might limit his driving to certain times of day, and to certain areas. You could let him know that each time he takes the car he needs to return it by a preset time. You can make it clear that if he receives a ticket (regardless of whether it’s “his fault”), he forfeits his driving rights. Consequences for violating these rules can be rigid or time-limited but should be made very clear from the beginning. Creating this kind of accountability can help your son feel that he has some control—as well as some responsibility.
June 30, 2017
My 13 year old son is very busy with how he looks. He is my oldest so it's hard for me to get a sense of what's normal for this age. My friends say it's just a stage but I am worried about it becoming a problem. He has taken up exercising and dieting and is very into it. He spends quite a bit of time each day getting dressed. He has made a few cracks to my husband about how he looks. I would appreciate any guidance you can give me as to how to manage this.
There are a number of external factors that can affect a teenager’s actions with regard to his appearance. (Yes, you now have a teenage son!) These include school, community, peers, and media. In addition there are often emotional needs that manifest as fastidiousness in areas related to appearance. Since you didn’t mention a specific concern, I’ll speak to a few areas that can relate to your son’s interest in his appearance.
A relatively rare example is body dysmorphic disorder. People with BDD are obsessed with a perceived flaw in their appearance. They spend an inordinate amount of time avoiding others or attempting to “correct” the defect in their appearance. A more common—and more general—problem is obsessive compulsive disorder. Although those with OCD can obsess about pretty much anything, including fear of illness, contamination, and loss of control, the need for perfection is often an underlying factor.
Likely the most common cause of the need for perfection is low self-esteem. Since most of us don’t have a truly good intrinsically-based sense of self, we base positive (and negative) feelings about ourselves on external factors. Our sense of identity is usually based on things like family, career, accomplishments, and possessions. At different periods of our lives, we focus on different things to help define ourselves.
Teenagers are generally in the stage that psychologist Erik Erikson referred to as “Identity vs. Role Confusion.” During this stage, according to Erikson, teenagers struggle with their sense of identity, and may feel uncomfortable about their bodies until they resolve this struggle. As such, many teenagers become concerned with their appearance. This is a concern that usually fades as they begin solidifying their sense of identity. More often than not teenagers’ focus on their appearance is something that fades as other areas demand their attention.
Generally speaking, when considering whether someone else has a problem it’s important to ask yourself two questions. The first is whether their actions are causing problems for them, or if you‘re the one who has an issue with their actions. The second question is whether the person is acting largely due to a need (emotional) or a want (logical). If, for the most part, your son simply enjoys dressing well and looking good, this is likely a normal, healthy form of expression. If, however, his actions are based mostly on an emotional need, he might have a harder time developing a clear sense of identity.
June 23, 2017
My wife and I began seeing a therapist a few months ago. After a few weeks the therapist suggested that my wife begin seeing a therapist by herself (in addition to together with me) to help her with her anxiety. Now our therapist has suggested that in addition I begin seeing another therapist to deal with some issues of my past. It's not like we started this because of a massive issue; we just had some things we needed to work on as a couple and now we are going to wind up paying 700 dollars a week for therapy?! Is this standard practice? Is this the only way to work this out? Please tell me there if there is a more effective way to go about this.
We’ve all heard that communication is crucial in relationships. Of course this is true in a general sense. However, in addition to having basic conversations about things that are important to us, it is vitally important that we step back and take an objective approach to things that bother us. Of what does communication consist? The obvious response is that communication relates to how we speak with one another. Tone, body language, and facial expressions are a close second. However, there is a much deeper form of communication within relationships that is often ignored. I’m referring to the way in which we understand the other person’s intentions.
One cause of problematic communication is that we tend to assume that other people think and feel the same way that we do, and that others have similar triggers and insecurities. Even in instances where we can intellectually recognize that this is not the case, we frequently project our thoughts and feelings onto the other person—especially when we are feeling emotional. In addition, we assume that the other person’s actions were caused by something that would cause us to act in that manner. For instance, if my wife raises her voice and tells me that I did something stupid, on some level I immediately ask myself what would cause me to say what she did in the way that she said it. If I’m the type of person who doesn’t show anger unless I despise the other person, I instinctively transfer this sense onto my wife, and assume that she despises me. It’s only when I analyze the situation that I realize that my wife might be acting angry because she feels hurt.
Unfortunately, in many cases, this becomes a vicious cycle. If I react to my wife’s anger by becoming sullen and withdrawn, this can trigger a negative feeling in her for a similar reason. This can escalate her anger response, thereby causing me to further isolate myself. Over time, this can lead to major arguments, which continue to exacerbate the problem and increase the sense that my wife despises me and doesn’t care for me.
Without specifics, it’s impossible to determine your need, or your wife’s need, for individual therapy. Although you began therapy to deal with marital problems, individual issues often arise. In fact, marriage counseling often separates into three parts: relationship matters, his issues, and her issues. Some therapists may opt to deal separately with each person’s issues, then to apply them to the relationship. Some sessions would be dedicated to helping the husband identify his needs, triggers and insecurities, while other sessions would focus on the wife’s. The understanding of how these affect the relationship would then be integrated into the way in which the couple interacts with one another.
When a therapist follows this strategy, there are a number of factors that can help to determine whether individually focused sessions should be conducted together with both spouses or alone with each identified spouse. There are instances where one spouse or both spouses have issues that call for separate individual therapy in order for them to acknowledge, communicate, and work on these. For instance, there may be individual issues that are hampering the efficacy of the joint sessions. Perhaps there are deeply embedded issues that negatively affect the relationship, and that require more intensive therapy. If a therapist believes this to be necessary, his reasoning should be discussed with his clients so that they fully understand his position. If you’re not clear on the reason for your therapist’s suggestion that you each see your own therapist, you should ask for clarification.
June 16, 2017
I have tremendous anxiety from the news, especially nowadays when there are so many videos of terror attacks and other terrible things. I saw a video of a terror attack and I think about it all the time. I had this problem a few years ago but it didn't bother me again until recently. Whenever I go to Manhattan I am so afraid of something terrible happening. Please give me advice on how to deal with this.
There are various types of anxiety and a number of techniques designed to deal with them. If you have general anxiety that tends to be exacerbated by specific news stories, you may be focusing on the obvious, more intense anxiety. However, if your general anxiety is an underlying factor, decreasing this can reduce the higher anxiety that is triggered when you’re affected by a specific event. It’s easy to blame your anxiety on the fear of a terrorist threat. You seem to recognize, however, that your level of fear is greater than the actual threat level calls for. This likely means that something is happening, without your conscious awareness, that is causing you to feel anxiety. These unconscious emotions can be much more powerful than your conscious efforts to logically eliminate the fear. Although you may tell yourself repeatedly that your fear is not warranted, your unconscious mind continuously tells you to be afraid.
Working on general anxiety can seem complicated. You would first need to discover whether you actually have general anxiety. If you acknowledge that you do, you would then work on its history, underlying fears, triggers, and many other factors. Although this may seem daunting, a proficient therapist can help you to identify and work on these. Decreasing this core anxiety can go a long way toward decreasing more obvious fears that appear closer to the surface. For instance, if someone grows up afraid of being bullied, this can lead to a general sense of timidity and fear in adulthood. When this old fear is triggered by news of a terror attack, it can force the childhood emotion to the surface. Working on resolving the childhood fear can reduce the general anxiety as well as fear that is related to specific triggers.
Another approach would focus directly on the fear by focusing on its emotional aspect. This approach would ignore the instinct to avoid the issue or to remind yourself that there’s nothing to be afraid of. It would focus instead on what you are afraid of (even if it doesn’t seem to make sense). For instance, thinking about how a terrorist attack might occur, how it would affect you, and how you would react can help you to focus on your logical thoughts about it—instead of simply feeling afraid. Identifying and challenging your specific fears intellectually can help to decrease them.
June 9, 2017
I have been seeing a therapist for the last few weeks. Recently, while I was waiting for my appointment in the waiting room, I overheard him discussing another patient on the phone. The door to his office was wide open and he knew I was there because he had buzzed me into the waiting room. Since then I just don't feel comfortable speaking with him because maybe he discusses me when there are other people listening. The problem is that it was so hard for me to come and tell him so many things and I just don't have the strength to start again with someone else. How do you suggest I approach this?
It sounds like it took you a long time to muster up the courage to see a therapist. It’s great that you were able to overcome your trepidation and open up to someone who can help. It can be difficult to acknowledge that we can use help with our issues, and it can be very difficult to admit this to a stranger. Once we do recognize our issues and speak with a therapist, creating change can be challenging.
Now you’re faced with another hurdle related to your relationship with your therapist. Once again, there is something that is uncomfortable for you to address, but you recognize that it should be discussed with him. Although this can also be daunting, there are a few things that can help you feel more comfortable bringing it up.
The obvious difference between discussing your problems and addressing the current issue is that this issue lies with your therapist and is something that he needs to change. Remind yourself that this is something that he should be addressing and that it’s not your problem. A professional therapist would want to know that he is inadvertently breaking confidentiality. He would also want you to discuss anything that makes you feel uncomfortable with the therapy process. It’s his job to create a safe and comfortable atmosphere. He will likely be thankful to you for bringing this to his attention.
If you’re concerned that your conversation will seem confrontational, you can emphasize the fact that you felt uncomfortable. Although this isn’t your problem, and you shouldn’t have to soften the message, doing so can make it easier for you to broach the subject. Speaking about it from your point of view, while at the same time recognizing that it’s not your issue, can make the discussion seem less like a confrontation. That being said, your therapist will likely be apologetic, and thankful to you for pointing out something of which he should be aware.
May 30, 2017
I know someone who has a sibling who is in his early 20's and is holding down a job. However, he is socially awkward and can really benefit from therapy. However, this person will get highly insulted after being told this and may resent the person who told him. How can he be told (by a relative or professional) that his behavior calls for therapy? Can it be said straight out? If so, how should it be done? On the other hand, is finding the right words and presenting the facts the right way to go?
It’s easy to point out problems with someone else’s behavior. However, we often define problems based on our own preconceived notions and sense of appropriateness. For instance, if this person seems loud and inappropriate, is this his problem or yours? The determination as to whether he should be in therapy depends on a number of factors. Perhaps the most basic question to be answered is: Is he happy? After all, isn’t happiness the goal that we all strive for? If he’s happy despite his social awkwardness, and is likely to continue being content, does he need therapy? If his social awkwardness causes you to feel uncomfortable, perhaps this is something that you should be dealing with.
On the other hand, if the person is unhappy, or is having clear life issues relating to his trouble socializing, a therapist can help him to identify the causes for his unhappiness. This might be the key to understanding how to approach him. I don’t think that “presenting the facts” would be the best approach. If his inappropriate behavior is the focus of the conversation, he might easily be insulted by the insinuation that there is something wrong with him. We don’t like others telling us what’s wrong with us, and we don’t like being told that we need to change.
On the other hand, focus can be placed on his subjective feelings. If someone close to him can talk with him about the things that are bothering him, he will likely be more open to looking at the causes. This can achieve two objectives. Firstly, it will allow him to identify his own issues and goals rather than having someone else tell him what he needs to work on. It can also help him to recognize that there is in fact a problem that he will want to resolve. This will give him a stronger incentive to address the issue.
May 19, 2017
I am wondering if you can help with the following question that I frequently wonder about. Why is there more of a need for therapists today than a generation or two ago? Somehow we managed fine in the past. I am not, chas v'shalom [G-d forbid], against therapists, especially those who follow Da'as Torah [torah knowledge]. I am just seeking to understand.
Your question is one that bothers many people. It can be viewed from a theological, psychological, philosophical, ideological, or pragmatic perspective. Of course, these and other perspectives often overlap. For instance, one might point to the loss of community insularity (and the resulting almost universal access to enormous amounts of information) as a cause of more increased mental health issues. Because of this, someone might feel that we are being punished for the way in which we access and use this information. The person may then question this and ask himself whether an underlying sense of guilt is leading him to feel that anything bad that occurs must be a punishment for something that he did. A more logical analysis can then lead him to a clearheaded decision about how to respond to the problem. He would thus have begun from an ideological view, transitioned to a theological one, moved on to a psychological perspective, and finally ended with a pragmatic understanding.
I am not a philosopher, a theologian, or an ideologue. However, like many people I have given this topic some thought. Your question is based on the assumption that there is a greater need for therapy in this generation than in generations past. This is likely true to some degree. Recognize, however, that in previous generations people didn’t talk about their issues with the openness with which they do today. If someone had an issue, he often suffered in silence. In addition, people who were depressed might have been identified as morose; those with ADHD were considered to be difficult or multi-taskers; and anxious people were viewed as dramatic or simply annoying. This makes it very difficult to compare the incidence of mental health issues in the past with that from today.
The fact that we are a more open society today can be a double-edged sword. Certainly there is much greater acknowledgment of problems that can be improved through therapeutic intervention. We have many more resources to help people identify issues and to educate them as to treatment. We have referral agencies, teachers, physicians, and rabbis who are much more knowledgeable and understanding about mental health issues. We have a vast array of therapies and techniques with which to help people to overcome their problems.
A possible negative aspect of the more open nature of our society is the increased tendency for people to identify normal feelings as mental health problems. For instance, more kids today are open with their parents and discuss issues that most children in past generations would never have discussed. This can lead parents to believe that their child has a major issue that needs to be dealt with professionally. When parents give their kids the sense that their feelings are problematic, this can itself lead to emotional problems. The sense that “abnormal” feelings need to be “corrected” can in turn lead to increased discussion about “problematic” feelings, thus continuing the vicious cycle.
Those of us who grew up in past generations often point to the fact that most of us didn’t need therapy as children. What we fail to recall is that we had similar feelings and insecurities, but that we didn’t necessarily discuss them with our parents. We often normalized our feelings and dealt with them on our own. Although this may not have always been the best solution, it tends to give us the impression that previous generations were more emotionally healthy.
There are many factors that likely contribute to an increase in the incidence and severity of mental health issues. In the 1940s, Abraham Maslow proposed what he termed a “hierarchy of needs.” Basically, his theory was that people tend not to focus on higher needs like self-esteem and self-actualization (essentially feeling good about oneself) until they have met more basic needs like physiological and safety needs (putting food on the table, paying bills, etc.).
In past generations, most kids were given chores. They were expected to be responsible for many of their own basic needs. If a child wanted something done, he often tried to do it himself. If he wanted to buy something, he would work to earn the money necessary. Today’s parents often try to insulate their children from adversity and hardship. Many kids are not being given a sense of responsibility and a chance to develop responses to their more basic needs. In effect, these kids are often forced to contend with higher needs at an age when they are not mentally prepared to do so. This can lead to frustrations and insecurities that were less common among the children of past generations.
May 12, 2017
Around a year ago I went through something very difficult (I am not comfortable providing all the details). I have found that the passing of time since the event, keeping busy so that I don't have time to think about it, as well as writing about it, have helped but would appreciate any other suggestions that you might have. Someone I spoke to said it was a “trauma” and that something called “EMDR” is used to treat trauma. What are some of the things that are done during EMDR? Is that the best and only way to treat trauma? Do all therapists provide the same type of treatment and if not how do I know which type would be best for me? I have been able to do all my responsibilities and be there for my family, but feel like I am always very alert—worried about danger—and can't concentrate as well. How can I get back to my former self?
Trauma affects different people in different ways. Some people are generally able to get back to normal function and emotion relatively easily after a traumatic experience. Others generally have a difficult time dealing emotionally with traumatic events. Type of trauma, individual background and triggers, coping skills, and support systems are some of the factors that can affect a person’s response to trauma.
There are a number of therapeutic processes that can help someone deal with trauma. These include CBT, psychodynamic therapy, DBT, exposure and desensitization, and EMDR. Depending on many factors, one or more modalities can be utilized. Factors include age at which trauma occurred, number of traumatic events, duration, amount of time that has passed since the trauma, and emotional reaction, among others. EMDR is a treatment protocol that is designed to help people to identify and change the way that they process traumatic events. EMDR uses eye movements along with aspects of other treatment modalities, like CBT.
A therapist can help you to identify some of the specific factors that affect your ability to effectively process your recent trauma as well as traumatic events in general. The appropriate modality or modalities would be identified. A good therapist can shift focus and modality as needed to properly address issues and needs as they are discovered.
If the traumatic event that you experienced is not associated with other past experiences (as from early childhood) a few sessions can often help you to work through the negative effects. It can be difficult, however, to verify that there is no unconscious, connected early emotion impacting on your current reaction. This is something that a therapist can help you to determine.
May 5, 2017
I am a 12th grader in what is considered a very chosuva mesivta [prominent high school]. There are some things that I would like to discuss with someone. They cause me a lot of worry but I do not feel comfortable discussing this with a rebbe [rabbi] or mashgiach [dean] in yeshiva. I think that maybe a therapist would be the right type of person to discuss this with. The issue is that my father doesn't hold of therapy. I am not sure how to bring this up with him and I don't want to get pressured to share something that I am not really comfortable discussing. I am really stuck. Can you give me advice as to how to move forward? Thank you.
A generation ago, fewer people sought the help of a therapist. Those who eventually went for help often did so because they had reached the point where they were no longer functioning normally. This had the effect of creating the impression that therapy was only for people who had severe issues. Over the years, however, it has become clear that working on problems in their beginning phase can help to avoid more severe future problems.
Fortunately, over the past generation or so, the general population and the yeshiva world in particular have become much more open to the concept and importance of therapy. However, as you point out, there are many people who feel that therapy does not help. Worse yet, there are those who secretly recognize that therapy can help and is often necessary, but they refuse to avail themselves of it due to fear of stigma or other emotional reasons.
It sounds like you could use a third party who can help to convey your message to your father without the necessity of going into details. The question is whether this third party should be a family member—like your mother—or someone who is impartial. Either way, this would need to be someone who will not pressure you for information, and who can persuade your father not to pressure you.
The fact that much of the yeshiva world has come to embrace therapy as a great asset in many areas can help you to convince your father that seeing a therapist is the right thing for you to do. If there is a rav or rosh yeshiva with whom you feel comfortable discussing the issue—and whom your father respects—he can help your father to understand how therapy works, and can help to dispel any negative associations that your father has with regard to therapy. If you don’t feel comfortable discussing the specifics of your issues, you can simply explain that you want to help your father feel more comfortable with the idea of you speaking with a therapist.
If there is no one in your life with whom you feel comfortable discussing your feelings, there are many well-known and respected rabbonim who are quite familiar with mental health issues, and who would be happy to help educate your father about the process. This can help him to feel more comfortable with the idea, and can help him to recognize the efficacy of the therapy process. If you would like a recommendation for a rav who might be able to help you, feel free to call or email me.
April 28, 2017
I am 21 year old Bochur just back from Eretz Yisroel. Can you please explain to me why some people have such a hard time waking up in the morning? This is something I constantly struggle with and I never am able to beat it. Oversleeping is something that is constantly getting in the way of my aliyah. It also really annoys my parents and rabbeim. I wouldn't say it just has to do with going to sleep late because I have friends who go to sleep really late and still somehow always make shachris. People tell me I am just lazy and should just get up, but if so I don't know how to stop being lazy. Can you please give me some advice as to how to deal with this endless problem?
The ability to wake up (and rise) early is reliant on many factors. You speak of “a hard time waking up.” If you mean that you literally do not awaken despite the use of an alarm clock or others attempting to rouse you, you should probably be tested for a vitamin deficiency—like an iron deficiency. Mental health issues like ADHD and bipolar disorder can also create for a need for longer and deeper sleep.
Your circadian rhythm (commonly known as your biological clock) helps to regulate your need for sleep. Every person has their own individualized rhythm with specific sleep requirements. In addition, your circadian rhythm changes as you age. This is the reason that children generally require more sleep than adults. There are also a few sleep stages through which you cycle a few time every night. If the time that you try to awaken coincides with a deep sleep stage, it can be very difficult to do so.
At the age of 21, you might still be in the late adolescent-early adulthood phase at which you require an average of 9 ½ hours’ sleep on a nightly basis. In this phase, your body may also be biologically set for a late bedtime, further complicating the issue. Proper sleep is critical. If you are not getting enough sleep, this can affect your general level of alertness and memory, and can lead to weight gain. Over time, it can also contribute to mental health problems, like depression.
Your friends might have an easier time waking up due to many factors. They may simply need less sleep than you do. However, if they are not getting the amount of sleep that their bodies require, this can cause long-term issues related to sleep deprivation, despite their apparent ability to easily awaken.
If you’re getting enough sleep and actually wake up but still have trouble rising in the morning, you can try two things. The first is to set your alarm for the latest time that you want to get out of bed. This can eliminate your tendency to hit the snooze button and fall back asleep. The extra few minutes of sleep can do more harm than good since they will likely interrupt then restart your REM sleep, (arguably the most important sleep stage, which helps to you to focus), thus keeping you in a fog throughout the day. The second thing that you can try is rising slowly from bed. First sit up, then breathe deeply a few times, then slowly rise to your feet. This can help to alleviate the shock of switching suddenly from a deep sleep to being fully awake.
April 10, 2017
I have struggled for years with overeating and dieting. I was put on a diet at a young age (I was not overweight; it was purely for aesthetics) and as a result I have spent over 20 years yoyo dieting. I mostly maintain a normal to slightly large physique, so my health is not in great danger. But I cannot seem to get beyond this. I use food to cope and to relieve any emotions I cannot handle. I basically wake up and crash whatever diet plan I concocted the day before. Then I feel full, bloated and guilty and come up with a new plan for the next day! I have tried OA but found it too extreme a diet. I also tried intuitive eating, just trying to eat healthier or just eating whatever I want in an attempt to put my eating issues at rest. I never seem to be able to do anything but binge. I am a mom of a busy house and I just don't know how to get over my food issues.
Overeating is a very common problem that often has numerous causes. Reasons for overeating include poor meal scheduling, possible physiological issues, and emotional needs. You suggest that your overeating is a direct result of the emphasis that was placed on dieting when you were a child. In fact, many people with eating disorders (ranging from anorexia and bulimia to binge eating) trace their eating issues to problematic childhood messages.
When a child is given the sense—intentionally or otherwise—that their value is linked to their body image, this is given a disproportionate significance in the child’s life. This can lead to poor eating habits. In addition, this sense often causes anxiety, which ironically can lead to the use of food as a temporary solution to the anxiety. Thereby a vicious cycle is created, in which the person feels anxious with regard to food, causing her to overeat to relieve the anxiety, which in the long run actually increases the food-related anxiety.
It is important to identify the emotional triggers that make us crave food. Two common childhood beliefs are that we are good only if we are thin, and that food is bad. Acknowledging these and other erroneous beliefs, and identifying current impulses similar to those that we experienced as children, can help to slow the cycle. We can thus stop and challenge the reasons that we are eating instead of simply eating emotionally without questioning whether we are actually hungry.
It can be very difficult to work on unconscious needs and impulses on your own. A therapist can help you to explore and identify these, and can help you to change your eating habits. Support groups can also be helpful. They allow you to discuss your feelings in a non-threatening and non-judgmental environment.
Perhaps the reason that you found Overeaters Anonymous to be too extreme is that you didn’t properly identify your emotional need to eat. Overly restrictive diets can trigger the very anxiety that sets an overeating cycle in motion. Intuitive eating also ignores the underlying needs, thereby causing you to fall back on childhood emotions and eating patterns. If you can begin to identify your particular emotions and your insecurities related to body image and food, you can begin changing your emotion-food-emotion cycle.
March 31, 2017
I am a 17 year old girl and one of my closest friends is constantly saying very depressing things. I'm not always sure if she is serious or just doing it to get attention. I don't know if anyone else is aware of this but she definitely does not want me to tell anyone. Point is, I'm not really sure what to do about it. It's getting to be a bit much for me but if I don't listen to her and take her seriously I don't think she will have anyone else to go to. Can you please give me some advice as to how to deal with this situation?
There appear to be two parts to your question. On the one hand, you want to know whether your friend is in need of help. On the other hand, it sounds like you’re becoming overwhelmed with your friend’s issues, and want to know if there is a better way that you can handle your emotions with regard to them.
As you suggest, people will oftentimes say things for attention. This can be especially so if your friend recognizes that her comments will go no further than you. However, this can also be the case when there is a real concern; your friend may feel safe discussing her true feelings with you because she knows that you will keep them to yourself.
Unfortunately, it can be very difficult to separate fact from fiction without knowing more about the situation. People can speak about depressing things for various reasons. Depending on the types and frequency of comments, reasons can include a psychiatric disorder, attention-seeking, situational problems (like an ill relative), and changes in mood due to a medical issue (like a thyroid condition).
The most obvious psychiatric possibility is depression. There are different types of depression. As an example, dysthymia (a general type of depression that is often mild and chronic) is marked by feelings of sadness, and loss of interest in daily activities. Other symptoms include: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.
If you believe that your friend is depressed, remaining silent may not be the best choice. Although you understandably want to keep her confidence—and don’t want her to lose the only person in whom she confides—you are not qualified to help her. Regardless of the reasons for your friend’s comments, she is placing you in an unfair position. She is naming you her confidant, but not “allowing” you to seek help for her. Though this may be her intention, it is also possible that her negative comments may be her way (conscious or unconscious) of asking you for help. Either way, you should not be put in this untenable position where you want to help but feel that your hands are tied. At the very least, you should encourage your friend to seek professional help, stressing the fact that therapy is confidential.
March 24, 2017
I recently graduated from college and began a job in an accounting firm. Although the job is working out well and I get along with everyone there, I have been feeling increasingly anxious as time goes on. I can't put my finger on what is bothering me because nothing else in my life has changed.
In school I was always a relaxed, happy, popular person. I have good relationships and I am happy with my career, but I can't seem to shake the anxiety. What can I do to help pinpoint the cause?
Very often, anxiety is an unconscious process whose causes can be difficult to identify. It is this type of anxiety that is so frustrating. When we can pinpoint a clear source for our anxiety, we can question our emotional response, challenge it, and otherwise analyze it to help reduce our problematic feelings. When an emotion appears to make no sense, it can continuously intensify due to our inability to deal with it.
Sometimes, we point to a stressor that “should” be causing anxiety. For instance, I might be feeling anxious for an unknown underlying reason, but will decide that I’m stressed out because of my job or my marriage. When this occurs, we often spin our wheels trying to resolve the identified problem. This can lead to resolution of the identified stressor—only to discover that the anxiety remains, or has increased. Or worse, we can get trapped in the minutiae of the “cause” of the anxiety, leading to a major decision like divorce (once again discovering that the anxiety hasn’t been resolved).
In your case, you haven’t identified any stressor that can be causing your anxiety. With the limited information at hand, I cannot identify for you a specific cause for your anxiety. However, I can point to two general sources of emotional upheaval that might help you to begin the process of identifying the root causes of your feelings.
On a surface level, life changes can create for feelings of anxiety and/or depression, even when there appears to be no reason for them. When you first went to summer camp, did you feel some trepidation? When you enrolled at a new school, were you nervous for a time? These feelings are normal, and generally evaporate over time. At the beginning of a new venture, regardless of its positive nature, there are many unknowns. Will I make friends? Will I like it? Will I get along with my boss and associates? Even if these issues aren’t legitimate concerns, they can persist until we feel comfortable in our new environment. If these issues begin to dissipate over time, they will likely disappear in the near future.
On a deeper level, let’s understand the reason that we have these concerns at all. Self-esteem is an underlying factor with regard to many emotions. When I have no real concern (like losing my job) why will it hurt me if I don’t make friends, or if I’m not liked at work? The general answer is: if I have the sense that I’m not liked, it can make me question my own value as a person. If my self-esteem was always grounded in being popular (or smart, funny, athletic, etc.), moving to environment where this factor is unimportant can reduce this artificial sense of self-esteem, thereby causing me to feel anxious or depressed.
I will not elaborate here on the importance of building an authentic sense of self-esteem based on intrinsic qualities, which can be the long-term solution to your anxiety issues. On an interim basis, identifying the external sources of self-esteem that are no longer being sustained can help you to put your finger on the cause for your anxiety and to begin building one that is more viable in your current environment.
March 17, 2017
I have an older (half) brother who has a serious mental condition. I'm not sure exactly what it is but he has often had to go to the hospital for a few days till he gets "stabilized". My parents don't really like to talk about it and I try not to bother them with it. I think there are also some other people in my mother’s family who have mental issues. My question is: People have told me (and I have also read online) that these types of things are in the genes and that I could also have these issues. As I get older I am more worried about it. Can you please clarify if this is true? And is there anything I can do to prevent it?
The “Nature versus Nurture” question has been hotly debated for generations. Strict proponents of the nature argument dismiss the notion that there are factors other than inborn ones that contribute to mental illness, while those who argue for the nature side insist that genetics have no role in the manifestation of mental illness. Although strict proponents of either side will probably always exist, research continues to indicate that mental illness is typically caused by a combination of psychological, biological, and environmental influences.
There are many factors that can contribute to mental illness, including family dysfunction, physical trauma, psychological trauma, death in the family, divorce, and low self-esteem. In addition, each factor impacts on the others. For instance, though we are born with all the genes that we will ever have, interactions between experiences, maturity, medications, illnesses, and many other factors determine whether or not particular genes are expressed.
Having a genetic predisposition to cancer and high blood pressure will not necessarily cause a person to develop these diseases. However smoking, alcohol use, and being overweight can turn the predisposition into an illness. From this perspective, we can recognize that although genetics can make us susceptible to a disease, they are in no way a clear predictor of that disease.
The psychiatric illnesses that appear to have the most research showing a genetic component are OCD, schizophrenia, bipolar disorder, and depression. Again, this means that genetics can play a role—not the only role—in the development of these disorders. With regard to age of onset, schizophrenia is most often diagnosed in late adolescence or early twenties. Bipolar disorder most often presents around age 25, and OCD typically manifests by age 25.
More information about your brother’s symptoms and diagnosis can help you to better research possible issues and symptoms. Awareness of these can help you to identify and deal with them early on should they appear.
March 10, 2017
I was wondering what your opinion was regarding taking anti-depressants. I have been feeling extremely tired and fatigued recently and when I went to my doctor thinking I needed some blood work he prescribed me an anti-depressant. Is this an advisable course of treatment? Do you think it would be more beneficial for me to see a therapist in addition to, or perhaps instead of, medication?
I’m not a psychiatrist and do not dispense medication, so I cannot speak to specific medication issues. However, if your only symptoms are tiredness and fatigue, there are certainly various medical, lifestyle, and other issues that should be ruled out. If your doctor prescribed an anti-depressant based simply on these two symptoms without ruling out other possibilities, you would do well to seek a second opinion.
Some of the many medical causes of tiredness and fatigue are: Anemia, Chronic Fatigue Syndrome, Kidney Disease, COPD, Diabetes, Emphysema, Heart disease, Hyperthyroidism, Hypothyroidism, Inflammatory Bowel Disease, and Sleep Apnea. I don’t know why your doctor didn’t do blood work. You could ask him, in order to get a better sense as to his thought process.
Possible lifestyle causes of fatigue include: use of alcohol or drugs, excess physical activity, lack of physical activity, lack of sleep, certain medications (like antihistamines and, cough medicines), and unhealthy eating habits. If your tiredness and fatigue began recently and are of short duration, other factors—like work stress or relationship issues—can be the culprits.
Once medical and other issues are ruled out, and it is determined that there is no physical cause for your tiredness and fatigue, you might want to consult with a mental health professional to help you deal with your symptoms and their root causes. A psychotherapist or a psychiatrist can help you to determine whether there is a mental health concern. A therapist can work with you to identify possible triggers and problems, and a psychiatrist can help ascertain whether medication is necessary and, if so, which one makes sense for you.
March 3, 2017
I'm really enjoying your column, and I'd love to hear your take on my problem. I am eighteen and I've always suffered from anxiety, and in times of stress also insomnia, but since I graduated from school last year and started working it’s gotten a lot worse. These days, I barely sleep and I am constantly in a state of sleep deprivation and exhaustion. I've tried melatonin, but it doesn't really help much. It basically only makes me drowsy, and if I'm successful in calming myself down enough, then it works, but a few short hours later I'm up again for the rest of the night. I'm not too keen on the idea of sleeping pills because they're addictive. What course of action would you recommend?
You refer to your issues with anxiety, since you have clearly associated this with your insomnia. Your question, however, is with regard to the insomnia. Despite your recognition that your trouble sleeping is closely linked with your stress levels, your question focuses on how to treat the insomnia. I don’t know whether you’re currently dealing with, or looking to treat, your anxiety. If you are, your insomnia should be included in the treatment of your anxiety. As a symptom of anxiety, trouble sleeping can be improved by reducing the anxiety that lies at the center of this and other symptoms. As an example, symptoms of Generalized Anxiety Disorder can include restlessness, difficulty concentrating, fatigue, irritability, and headaches, among others. Rather than treating each symptom individually, it usually makes sense to treat the source of all the symptoms.
You mentioned that you tried melatonin and are averse to sleeping pills due to their addictive properties. I am not a medical doctor, so I can’t speak to specific pharmacological treatments. There are, however, non-addictive options for the direct treatment of insomnia. In addition, if you’re willing to consider the use of medication for the treatment of the underlying anxiety, there are many non-addictive choices for that as well.
Since you have “always suffered from anxiety,” you likely know that changes and new situations can often trigger a fear response and feelings of stress. The transition from the insulated and often comfortable world of school to the relatively exposed, unfamiliar realm of the workplace can be intimidating and anxiety provoking. You may have had a similar experience upon entering high school after many years of acclimation to elementary and middle school.
There are various psychotherapeutic methods that can help to reduce anxiety, both generally and with regard to specific situations, stressors, and triggers. A competent therapist can help you to identify the method or methods that will best work for you. You can learn to decrease your anxiety, which will help to reduce all of the symptoms associated with it, including your insomnia.
February 24, 2017
I have a son who would like to see a therapist to deal with some issues. I think it would be beneficial for him but I am concerned that therapy might damage his relationship with my wife and myself. Every parent makes mistakes and I am sure we have as well, but I am worried by the sentiment I hear expressed that therapists "estrange" children from their parents. Can you please clear this up for me and perhaps give me some ideas as to how to make this a positive experience that will enhance my relationship with my child. Thank you so much for your time!
I think that it’s great that you’re considering these types of concerns. Too often, parents leave their children’s issues at the door of the therapist, assuming that they no longer need to be involved in the response to their children’s needs and issues. The fact that you’re concerned about the effects of therapy tells me that you’re considering therapy a part of your son’s approach to his issues, not the entirety of it.
There are various schools of thought with regard to the parental role in the cause of mental illness. There are those who contend that many mental illnesses are caused by bad parenting. There also those who vociferously argue that parents consistently get a bad rap. The concept of the “schizophrenogenic mother,” the mother who “causes” her child’s schizophrenia, was much-vaunted in the middle of the 20th century and still has its proponents. On the other hand, there are many groups that help parents to recognize their blamelessness within the context of their children’s mental illness.
The reality, of course, is that this issue is much too complicated to be painted with broad strokes. Naturally, children are significantly affected in many ways by their parents. Therefore, many problems can be exacerbated by the actions of parents, just as many problems can be minimized or eliminated through the actions of parents. No competent therapist will make assumptions about parental roles within a particular issue. A proper therapist will help their client to understand the issues and causes, beginning from their client’s perspective, in order to properly help him to become happier and better adjusted. This goal is generally in the best interest of all involved.
I wonder whether you have reason to believe that therapy might drive a wedge between your son and you, or if you have simply heard others associate therapy with parental estrangement. Perhaps you know someone whose relationship with his child changed for the worse while the child was in therapy. On the other hand, if your relationship with your son is already strained and you’re afraid that a therapist might reinforce your son’s notion that his problems are due to his parents’ actions, perhaps a few family sessions are in order. The parent of a teenager who is unconsciously trying to maintain complete control over his child’s life can feel threatened by the idea of a third party who can influence his child to become more independent—this despite the parent’s intellectual recognition that more independence is exactly what his child needs.
You speak of a concern that therapy might detrimentally affect your relationship with your wife. This leads me to believe that the two of you differ with regard to your approach to your son. Perhaps one of you feels the need to maintain control and has trouble letting go, while the other believes that your son needs to begin (or continue) his quest for independence. Maybe one of you reacts more strongly to your son’s perceived rebellious actions. If there is discord between the two of you, there can be a fear that a therapist may side with one parent over the other, or that the therapist will help your son to follow his own ambitions.
With regard to the therapeutic relationship, one of the factors that should be considered is your son’s age. Often the age of the client is what determines the extent of the parents’ involvement in the therapy process. For a young child, the parents often meet the therapist during the initial session, and have regular discussions with the therapist. Aside from imparting important information to the therapist, this helps to give the parents a clear sense of the goals and plans of therapy, and can help to alleviate concerns relating to the therapy process.
Older children, however, often want their relationship with their therapist to remain confidential. When this is the case, it is crucial for this expressed wish to be adhered to, in order to allow for a trusting and effective client-therapist relationship. For a parent, this can be hard to accept, since we want to be involved in our children’s lives with regard to important issues. This is especially true when our child’s wellbeing and his relationship with us (or with the entire family) appears to hang in the balance.
It’s important to recognize that a good therapist will want to focus on all aspects of a problem, including the effect on their client’s family relationships. In addition, although the therapist might not be able to share information with you, I believe that most therapists are happy to listen to your ideas and concerns, in order for them to best help your son. Periodically checking in and discussing your feelings about your son’s progress can keep you more involved, and will help the therapist to identify any relationship issues that might arise. Remember that the therapist’s primary concern should be your son’s best interest. That being said, this should take into account his wellbeing with regard to his relationships.
February 17, 2017
Thank you for your column. Since parnassa [money] pressure is something we all face, I hope you will print my question. I am the mother of a growing family, BH, and like most women today, my income is essential. Perhaps my husband is learning and I am the primary breadwinner. Or perhaps my husband is working, but his income covers basics while mine pays the tuition.
Either way, the pressure that I am feeling to increase my income as more of my children enter school is crushing. The truth is that I am not cut out to be a working mother. Far from meeting my needs for outside stimulation, my job drains the life out of me, physically and emotionally. When I come home, I have no strength left for my family, and wish everyone would just go away so I could rest or have some time to myself. After my kids are in bed, I have paperwork to complete or students to tutor at home. At that point, I have no strength left for any household tasks or phone calls, because I need time alone to unwind. (I know this is not depression, because Yom Tov [holidays], maternity leave, and even sick days are a different world. That is when I finally feel alive.)
I would appreciate your REALISTIC advice! My family needs their wife and mother back!
Move to backwoods Mississippi! Seriously though, I have spoken with many people who are dealing with this issue. We live in a society in which a family needs to earn what is considered an upper middle class income just to pay the bills. A very large portion of the frum community seems to be feeling the pressure to work inordinately hard in order to keep from drowning in debt.
I have heard from many a parent that they feel like they are being sucked dry by the stresses of life, and that they have no energy for their families. To some extent, it comes down to priorities. Should we work that much harder to afford that new watch or vacation, or should we take time off to be with the kids? Unfortunately, however, many people find themselves in the position where they need to work extraordinarily hard simply to afford the necessities.
I don’t have a suggestion that will completely change your life and allow you to feel energized after a difficult day at work. That being said, there are some things that you can try that might help you to relax both generally and after a long day. It can help to schedule tasks for specific times. For instance, instead of doing paperwork whenever you have time, try scheduling it for a specific time and for a specific amount of time (i.e., from 8:00pm to 8:30pm). This can help you to avoid the sense that you are always working. It can also help you to begin scheduling time for relaxation. If you know that your obligations are time-limited, and you can look forward to relaxation time, this can make you generally feel more calm and in control.
It can also be helpful for you to schedule time away from your house. Try to find some time to spend with your husband or with a friend or friends. Always being in the same places (home and work) can lead to feelings of being overwhelmed and the sense that you are always “on duty.” Getting away, even for just a couple of hours a week can help to reduce that sense.
February 10, 2017
I am a pre-school Morah in the local Yeshiva. There is a boy in my class who never talks above a whisper. This has been going on since the beginning of the school year. While the parents insist that the child is just shy I am convinced that this is more than that. Can you please give me an idea of where the line is between shyness and a more serious problem? I would also appreciate any strategies you can suggest in convincing the parents to go for help.
Without further information, it is difficult to guess at a possible cause for your student’s tendency to whisper. Depending on the circumstances, this can be related to feelings of anxiety, depression, social phobia or other social issues, adjustment problems, agoraphobia, or separation anxiety to name just a few. There could be family or social causes, including abuse, bullying or learned behavior.
Although the parents insist that this boy is just shy, my first question would be, “What is shyness, and why are some people shy?” Is this boy shy because he doesn’t feel comfortable within himself (low self-esteem), or does he feel neglected and uncared for, sensing that others don’t listen to him? If he is indeed “just shy,” what is behind the shyness, and will it become more problematic going forward?
You didn’t describe the reason for your sense that this is something more than “normal” shyness. In fact, you may not have clearly identified the reason for this sense. If this is based on your observations with regard to other actions on the boy’s part, acknowledging these can help you to get a better handle on the problem. For instance, perhaps he isolates himself, doesn’t initiate conversation, only speaks with one other boy, makes repetitive motions, or appears afraid of a particular person. If you can identify more specific concerns, this can help you to better formulate your concerns, and to communicate these to his parents.
February 3, 2017
I go through periods of time when I am consumed with worry about my health. I will be OK for a few months but then I wind up spending all day convinced that I have some sort of horrible illness. I wish I would be able to function normally. Why is this happening to me, and what can I do to stop it?
There can be numerous triggers for fears related to health. From a clinical perspective, Illness Anxiety Disorder requires that a number of criteria exist, such as avoidance of triggers and continuous high levels of anxiety and preoccupation with a possible illness, despite little or no physical symptoms. This disorder is a chronic condition in that it needs to be present for at least six months.
You may not have enough of the qualifications to be diagnosed with Illness Anxiety Disorder. However, as with most emotions there is a spectrum with regard to the level of anxiety experienced. In the past, I have defined anxiety (in my non-clinical vernacular) as feelings of stress that don’t logically match the situation. Using this definition, people on the lower end of the spectrum feel little to no anxiety, while those on the upper end of the spectrum feel constant anxiety. People on the lower end will are often able to adapt to stressors and changes very well. Those on the upper end usually need help dealing with the curveballs that life throws at them. It’s the people in the middle part of the spectrum who are generally okay but may, at times, need some help dealing with stress and triggers.
If you are on the lower-to-middle part of the spectrum, there may be specific triggers that cause occasional fear of illness. Direct triggers can include hearing a news report about a health issue, finding out about someone else’s illness, experiencing a minor ache, and thinking about a past illness. Less direct triggers can be hard to pinpoint, since they are often unconscious. They can range from seeing a person from your past with whom you associate a particular illness to a holiday or season that is somehow associated with not feeling well.
If your anxiety is mostly manageable, you can try to identify your particular triggers, both obvious and subliminal. This can help you to do two things. To the extent that it makes sense to avoid the clear triggers, doing so can reduce the frequency and severity of the anxiety response. As far as unconscious triggers are concerned, the more that you understand and analyze their origins the less likely it will be for them to affect you.
January 27, 2017
One of the panelists recently mentioned that “the source of the problem needs to be uncovered and healed” in order to really feel safe and secure. I’ve been wondering for a while how this is actually done in therapy. I’m married in my twenties with some kids and have been struggling with general anxiety. I’ve been seeing a therapist for a couple of months now and she’s really helped me a lot on the “uncovering” aspect through looking at my childhood. I now know that it’s not a surprise that I have insecurities as an adult. But how do I get to the healing aspect? She says that talking over and over about those childhood experiences eventually ends up healing the subconscious. I don’t see how that works. Are there specific tools or steps to get there? What do therapists typically do to "heal" the subconscious?
The decision as to whether “the source of the problem needs to be uncovered” can depend on many factors including desired length of the therapeutic relationship, short-term and long-term goals, and type, severity, frequency & progression of symptoms. A therapist who uses various therapeutic modalities can help clients to determine whether they have a need or desire to focus on the root of an issue.
Once a decision is reached to indeed work on the underlying childhood emotions and insecurities, there are different ways of going about this. Although later neo-Freudians changed and added to Sigmund Freud’s concept, “pure” Freudian psychoanalysis basically focuses on a cathartic (healing) experience through which a person can theoretically be helped and "cured."
The unconscious mind is extremely powerful; it has an effect on our every waking (and sleeping) moment. It constantly affects how we feel and how we react emotionally. Since our unconscious minds were largely formed in childhood, the signals that it sends to us are based on childhood beliefs, feelings and insecurities. Many of us go through life largely unaware of these signals, simply incorporating them into our conscious thoughts. However, it is when we have strong emotions that seem inexplicable to the logical, conscious mind that we often begin wondering what may be occurring under the surface.
Many therapists use psychoanalytic techniques to help clients to better understand early sources of their symptoms, essentially making their unconscious impulses conscious. For many people, reliving problematic childhood experiences (more than simply talking about them), leads to the healing to which you referred. Other people require the therapist to be more involved in interpretation and the understanding of mental associations. However, if after a number of sessions you are experiencing no progress (or stagnation) in this area, you should begin asking whether the psychoanalysis is being done properly, whether the therapist should consider incorporating other techniques into the therapy to enhance the results of the psychoanalytic process (like cognitive techniques to help incorporate now-conscious impulses into your normal though process) or generally whether psychoanalysis is right for you.
January 20, 2017
I have been enjoying this column in the Yated very much. I was wondering if you would be able to help me out. I’m going through a very hard period. I’m only 28 years old and I’m realizing that I have an issue in retaining information that I learn. I’m realizing it now because I got a job and it’s really affecting my job. I am slowly getting very very down on myself and I no longer have any interest in talking to people. Is there anything you would suggest? Thank you.
There are a number of reasons that you might be having trouble retaining information. If you have always had trouble retaining certain types of information, this could be due to something simple, like lack of interest in the material. If this is the case, you can identify those areas in which you have trouble retaining information. Once you have a clear recognition of these, you might try and schedule your study of these for a time when you are better able to focus—or you could ask someone for help in these particular areas. If this is not possible, knowledge of the areas in which you do retain information and those in which you have trouble can help you to choose a job or career in which you can excel.
If the problem is more general, and you have always had trouble retaining different types of information (regardless of interest or other obvious factors), it could be caused by a learning problem, like a processing disorder. Although processing disorders and learning disabilities are usually diagnosed in children, people have often gotten through school without a disorder being identified, only to have trouble later on in life. Most programs seem to be dedicated to children, but there is certainly help available for adults as well.
If you haven’t always had memory problems, or if they are becoming progressively worse, there are many factors that can be contributing to this. Some possible medical causes of memory loss include alcohol use, some medications, physical inactivity, high blood pressure, diabetes, obesity, smoking, Vitamin B-12 deficiency and Hypothyroidism. There are also various mental health issues that are associated with problems in focusing and memory retention. A few that come to mind are ADHD, depression, anxiety, OCD, and Bipolar Disorder. If you’re experiencing other symptoms along with memory issues, you should discuss these with your physician or a mental health professional.
January 13, 2017
I am in my low 20's and have OCD and Anxiety. Baruch Hashem, I am more or less stable as I am in college, and holding down a job at the same time. My question is: In a Shidduch, do you think I should look for someone who’s similar to me- someone who also has Anxiety or some other disorder, or should I rather look for someone who’s "regular" without those kinds of challenges? (Honestly, I would prefer someone who doesn't have any of those challenges but I don't know how realistic that is). I would appreciate your suggestions/advice.
There are a few aspects inherent in your question. First, I’d like to speak to the more general question of choosing a spouse. I’m often asked if people should look for someone with a personality similar to theirs, or if the old “opposites attract” adage has validity. The truth is that it’s difficult to generalize because people are complex and have differing feelings and needs. That being said, although it’s true that opposites often attract, this is often true only in the initial phase of the relationship. It can be exciting to experience a new perspective and interesting new concepts. Indeed this can be a positive thing when it broadens our horizons.
When it comes to personality traits, however, it’s important to choose someone who shares your basic values and life view. By personality traits, I’m referring to healthy feelings and viewpoints with regard to important areas in life. For instance, if you’re a thoughtful, spiritual, caring, inquisitive person who has a sharp sense of humor, you might initially be attracted to someone who has a devil-may-care attitude, appears not to care what others think, is off-the-cuff, and has a cutting sense of humor. These personality traits can seem invigorating and thrilling. In the long run, however, the disparity in basic beliefs and values can become a source of incompatibility and strife.
To more directly address your questions, you can begin by separating your healthy personality traits from any issues and mental health concerns. Although you might have a certain level of anxiety that is problematic, part of what you identify as OCD or anxiety might be an appropriate interest in doing things properly. If you are able to clearly identify this, you can recognize this as a part of your personality that you appreciate, and which you might similarly appreciate in a spouse.
It seems clear that you would rather marry someone who doesn’t have a disorder, as would most people. Fortunately, today people are much more aware of, and educated about, mental health issues and treatment. This continues to increase open-mindedness within the frum community with regard to shidduchim and marriage. Most people have, or know someone who has, a mental health disorder. Therefore it is becoming increasingly more likely that a person without a mental health disorder will marry someone who does.
Although you would like to marry someone who has no disorder, you have personal experience that shows you that these can be well-managed. In addition, the fact that someone has no overt history of mental health problems is no guarantee that they will have none in the future. Recent statistics from the National Survey on Drug Use and Health (NSDUH) have the percentage of adults in the US who experienced mental illness each year from 2008-2014 consistently hovering in the 18% range. In fact, those of us who have less obvious issues, which are not being acknowledged and addressed, can be less functional than those of us who properly identify and address our problems.
January 6, 2017
I was involved in a car accident 2 months ago. Although I fractured my arm I am BH ok. The driver of the other car was more seriously hurt and needed surgery. My friends tell me I am “traumatized” and that I talk about the accident too much. I think it's normal to be shaken up by going through such an experience. I do have trouble falling asleep at night but I don't know that it's related to the accident. Am I traumatized? Do I need professional help?
I think that most people would classify your accident as a traumatic event. People experience and react to trauma differently. Although some people having gone through the same experience might mentally shrug it off, most would feel at least a degree of nervousness or fear and might replay the event in their heads. In addition, some people having a normal reaction to an event deal with it by talking about it with others, while other people prefer to deal with it alone. In general, some people are more open and forthcoming than others. In fact, it’s quite likely that the support of your family and friends will help you to move on more quickly and easily.
There are two factors that can give you a sense as to whether you have a problem (and neither one involves someone else’s opinion of what a “normal” reaction should be). One factor is the severity of the emotional response; the other factor is the progression of the emotional response. If you felt shocked and shaken up shortly after your accident and had significant trouble falling asleep but these problems continue to progressively dwindle over time, you likely have nothing to worry about. On the other hand, if you have felt highly anxious for an extended period of time or the problems don’t seem to be decreasing, you should probably seek help.
Posttraumatic stress disorder (PTSD) is a serious condition that can have long-lasting effects. Symptoms include reliving the event, avoiding similar situations, and excessive emotion (like anger, irritability, trouble sleeping, trouble concentrating, and startling easily). Early treatment can significantly decrease or even eliminate feelings these along with feelings of guilt, helplessness and fear. If you, or someone you know, has symptoms of PTSD, psychotherapy and/or medication can be a source of significant relief.
December 30, 2016
I am a tenth grade Rebbe in a local mesivta. I am concerned that one of the bochurim in my shiur may have OCD. He is a very good bochur and does very well, but is shy and seems very anxious about his grades. I noticed recently that he spends a very long time putting on ( and taking off) his teffilin. At least 10 minutes. He is constantly adjusting them during davening. He also takes a very long time davening. How do I know the difference between dikduk bamitzvos and unhealthy behavior?
OCD (Obsessive-Compulsive Disorder) is basically comprised of two aspects: obsession and compulsion. Although some people have obsessive thoughts without compulsive behavior, the two often go together. Until recently, OCD was classified as an anxiety disorder. Indeed obsessive thoughts are often caused by, and in turn cause, much anxiety in people who suffer from this disorder.
Since OCD is largely diagnosed based on a person’s thoughts, ascertaining whether someone in fact has OCD (or another disorder) should not be based simply on observable behavior. A few of the criteria for OCD are that the thoughts are intrusive and unwanted, that the person feels driven to the behavior, and that the actions are aimed at eliminating or reducing anxiety.
One person might simply feel very strongly about davening and tefillin, and wants to fulfill them on a higher level. If there is no anxiety related to this, and the person can easily abstain from the action if he wants to (as when he has a pressing appointment), this is likely fine. Another person can feel the need to do the very same action in the very same way to reduce anxiety based around his obsessive thoughts.
In order to get a sense of what the case is in your situation, you might want to speak with the bochur to find out whether his thoughts about davening and tefillin are appropriate, and whether his actions are based on anxiety and an attempt to reduce it, or based on a healthy deliberate decision to be careful about these particular mitzvos. If it becomes clear that he has a problem, you can try to help him to acknowledge that his thoughts and actions are hurtful to him. The earlier that he goes for help, the more likely that treatment will be relatively short and effective.
December 23, 2016
How do I deal with my husband’s first family?
Both I and my husband are married for the second time after losing our first spouses.
My kids, who are all married, accept my new husband with open arms.
Half of his children, on the other hand, who are married with children and grandchildren, reject his remarriage and stopped talking with us and prevent his grandchildren, even those few who are already married, from having contact with us.
Our rav tried to intervene but they refused to mitigate. Any thoughts on the matter?
Unfortunately, there are often conflicts when various close-knit groups, with their individual needs, insecurities and idiosyncrasies, are thrust into a new social situation. When a couple marries, it is difficult for those two people to adjust to one another’s personality; it is all the more difficult for entire families to adjust to a changing dynamic.
I obviously cannot offer specific advice without having significantly more information. I don’t know why your husband’s children reject your marriage and are not speaking with you. They may have realistic concerns, or they may feel threatened in some way. Although you might feel entirely justified in your perspective, your husband’s children probably do as well. As long as each side continues to focus only on the sense that they are in the right, the other side will tend to do the same. This will continue to polarize the two sides, making it continually more difficult to repair fractured relationships.
There is likely little to nothing that you can do to directly change their viewpoint. You can only work on changing your side of the issue. One way to begin defusing a contentious situation is to remove the righteousness, indignation and anger from your part of the equation. I imagine that your husband’s children recognize that your marriage will not dissolve simply because they are not happy with it. Their goal, therefore, is not to change the actual situation. Perhaps they simply want their father (and possibly you) to validate their fears and insecurities. For instance, if they’re afraid that you are trying to replace the memory of their mother, they may be looking for their father’s reassurance that this will not happen. If they’re concerned that they will become less important to their father, they may require similar validation of these feelings. If you can identify and address their emotions, you have a good chance of bringing the families closer.
December 16, 2016
My wife has always been afraid of flying. The last time she flew, around a year and a half ago, there was some turbulence mid-flight and she got hysterical and wasn't able to calm down until we landed (thankfully this was on the way home). We have a family bar mitzvah on the west coast at the end of the month and she is already very apprehensive about going. I have tried to talk with her about the safety of flying but that just gets her upset. I would appreciate any techniques or suggestions that you have to help make this easier.
With anxiety in general, and with phobias in particular, logically explaining why fears are not warranted is usually not very effective. Among the reasons for this is the fact that the person is most often well aware of the fact that her anxiety is not logical, and she has likely tried telling herself many times exactly what you’re trying to tell her. Despite this, the anxiety persists.
Although we all feel certain levels of stress, anxiety by definition is emotional. Think of this in terms of levels of stress vs. anxiety. On a scale from 1-100 (where 1 represents no stress/anxiety and 100 reflects the highest possible level of stress/anxiety), if a particular stressor shouldlogically rate a 20, but your stress level is 60, your “effective anxiety” is 40—the difference between the “normal” stress level and your actual stress level. This means that two thirds of the stress is emotional. This anxiety will not respond to logical reasoning because it is not logical.
There are various techniques that can help your wife to reduce her fear, including identification of the original source of the fear and its subsequent reinforcement. A simpler strategy is to help your wife to focus on the emotional aspect of her fear. This means abandoning your instinct to explain why there’s nothing to be afraid of; focus instead on what she is afraid of. For instance, allow her to recognize her fear that the plane will take a downward plunge, causing it to break apart, leading to a crash, etc. This will allow her to begin to correct her emotional assumptions with facts, like the existence of air pockets, the expertise of aviation engineers, and the miniscule possibility of a crash. If she can acknowledge her specific fears (despite their illogic) and begin to challenge them intellectually, this can help to decrease her fear.
December 9, 2016
I am a regular frum girl, 15 and in high school. My parents never got along well and recently told us kids that they are getting divorced? Is my life finished? Will everyone look at me with pity? Will I be able to do a good shidduch? Does the fact that my parents divorced make it more likely that I might get divorced? Any information or chizuk that you can give me is appreciated.
Please remember that you’re a person, not a statistic. No person or situation has the power to affect your life more than you do. At age 15, you are still learning to experience your own independence and autonomy. It may still seem as if the people and circumstances in your life can shape your future far more than you can. Optimally, as you grow older you will recognize more of your individuality, and learn to increasingly view yourself as the master of your own destiny.
The fact that your parents never got along doesn’t mean that you will have the same experience. Your parents’ decision to get divorced does not resign you to a life of misery. People who know you might feel sorry for you, but they will likely view you based on who you are as a person rather than as a child of divorce. Remember that you are a person, not just to yourself but to others as well. Your friends and acquaintances should see you for who you are, not as a consequence of a particular circumstance.
Though we are usually very good at judging others, it can be very difficult for us to see ourselves from a realistic perspective. It might be easier to look at this from an objective viewpoint. Imagine a friend going through the same situation. How would you view her? Would you feel that her life was finished? Would you look at her with pity? Would you assume that she would be unable to get a good shidduch? Would you assume that her parents’ divorce would cause her to get divorced herself?
If your responses are more positive with regard to your friend than toward yourself, recognize that this is likely how others will see you as well. Regardless of your responses, remember that your value lies within yourself, not in others’ perceptions of you. Anyone who might refuse to see your value is not worthy of you.
December 2, 2016
My son's Menahel called us in for a meeting. He said that while our 7th grade son is smart and has friends, he acts chutzpadig and doesn't listen to authority. The menahel said that he thinks our son has ODD and gave us the number to a (costly) therapist. Do we really need a therapist for.this? Isn't this a regular kid who misbehaves that for generations parents and schools found some way to deal with. Must everything become a label and a diagnosis?
Without knowing the details of your son’s behavior in school, it’s difficult to determine the necessity of bringing in a therapist. Very often a child’s behavior at home does not reflect his behavior in school. Some kids are models of good behavior at home, while in school they act out (or vice-versa). This can be due to various factors, like respect for parents, fear of being punished at home, or some issue in school.
Regardless, in his capacity as your son’s principal, the menahel should not be suggesting diagnoses. If he has a problem with your son’s behavior, that is what he should be discussing—the behavior, not his theoretical diagnosis. As to his recommendation of the costly therapist, this may be due to his experience with this therapist’s results.
My suggestion is to have another meeting with the menahel once you have prepared the questions that you feel are important to have answered. Some of these questions might be: “When did the chutzpadig behavior begin?” “Is there a specific time of day or week that my son exhibits inappropriate behavior?” “Is there a particular member of the faculty to whom this behavior is addressed, or is it more general?” “Is there a common factor associated with the behavior, like being among a specific group or being in a particular situation?” “What are the specific types of problematic behavior?” “What steps has the school taken to address the problem, and what have the results been?” “What made you recommend this particular therapist?”
Assuming that the menahel is able to properly answer these questions, you should then have a much better understanding of the situation, and some of the issues that you raised might be resolved. You would then be able to make a more informed decision as to whether more can be done in school or at home, or whether a therapist is a good idea. If you do decide to have your son see a therapist, there are referral agencies, like Relief Resources, that can help you to decide which therapist would be right for him.
November 25, 2016
I am in my 30s married with kids and work part time. Since before my marriage (about 15 years ago) I have always been somewhat moody, but I not exactly sure why. At times I just want to go under the covers and don't want to have anything to do with anyone. Other times I am full of energy. Winters are particularly hard. A friend said that I might have bipolar disorder, but I am doing ok as a wife and as a mother and holding down a job. My life is not falling apart. Do I need to see a professional?
No professional should diagnose or rule out a diagnosis sight unseen. There are many factors that go into a diagnosis and treatment plan. Also the process of diagnosis and treatment is generally not a linear one. Rather, it often follows an indirect path depending on the person’s background and the information being offered.
You speak of having been “moody” for many years. You also mention that there are times that you feel depressed and other times during which you energetic. Without further information, it’s difficult to get a full understanding of the issues that you face. That being said, I will make a couple of assumptions and base my response on those.
It sounds as if you are describing your moodiness as intermittent feelings of depression. I will assume that your reference to moodiness is simply that. When you say that there are times that you are full of energy, I will assume that you are describing energy as simply a lack of depressed feeling, rather than manic (or over-the-top) feelings of euphoria, hyperactivity, and impulsivity. In other words, there are times that you feel depressed and times that you don’t.
Based on these assumptions, it doesn’t sound like Bipolar Disorder, though of course even notwithstanding these assumptions there may be other factors that will not be addressed in this response. One diagnosis that I would consider is Pervasive Depressive Disorder (previously called “Dysthymic Disorder”), which is essentially general depression. Your mention of increased symptoms in the wintertime would have me consider Seasonal Affective Disorder, which causes depression during a particular season. This occurs most commonly in the winter. In fact, SAD has been called “winter depression.”
No one should have to live with constant feelings of depression. There are various clinical approaches that can help alleviate depressive symptoms. It sounds as if you could benefit from psychotherapy to address your symptoms and their causes. A good therapist could help you to better deal with and reduce your feelings of depression.
November 18, 2016
What is the balance between getting what you want, sometimes being pushy.., and letting go? Example, I called doctor to get an appointment for one of my children, they were overbooked and only let him come for culture. The culture was negative and my son was complaining about his ears... so I was a little pushy, and the nurse did let me into a room. Now I am not sure that my son saw a good example... luckily, the nurse came to tell me, “'it's good you were pushy, that’s how you get things in life. Other mothers give up too fast, you were pushy so you got what you needed.” I used to be weaker, but have learned that I am the only one who can take charge of my life... just don’t know when I may 'try my luck' to get what I want and when to give up. Are there any general guidelines by which I can gauge if I’m pushing the boundaries too far?
There can be a fine line between being a pushover and being too abrasive. Unfortunately, in our society, not being assertive is often viewed as a sign of weakness, while being assertive can be seen as aggressive or antagonistic. Unfortunately, there is also something of a double standard with regard to gender, where a man is more often viewed positively when asserting himself while a woman may be perceived as strident and annoying. (As an example, compare many people’s response to Hillary Clinton’s assertiveness and their response to Donald Trump’s. Though Trump may be considered brash and aggressive, Clinton is often seen as shrill and irritating.)
It’s important not to allow yourself to be led by your emotions or insecurities. If you’re afraid of how you might be perceived by the people around you, it can be difficult to properly assess the situation and come to an appropriate decision. Similarly, if you have an unsubstantiated fear of being taken advantage of, this can lead you to act against what your logic would dictate.
On the other hand, if you can step back and view each situation based on logical thought, you will likely gain clarity on the proper course of action. First, it’s important to identify any emotions or insecurities that might be getting in the way of your decision. Once you have a clear sense of how these are impacting on your view of the circumstances, it will be easier to view the situation from a more objective standpoint. Once you’ve done this, you will likely find that you are less uncertain of yourself and of your decision.
November 11, 2016
I am working on myself to rid myself of childhood trauma that has affected my behavior. I am aware of triggers, and that certain reactions are not healthy or acceptable. I would like some guidance on how to change bad habits that have become ingrained in my personality. While I’m aware that they can be unhealthy, some behaviors have become so much a part of me that I don’t know another way to behave.
There are numerous forms of therapy that can help in changing unhealthy and unwanted behavior. Some emphasize the behaviors themselves, others focus on the thought processes leading to the behaviors, and yet others try to identify underlying emotional issues and triggers.Though individual needs and responses vary, the best results are often achieved when a combination of approaches are used.
You appear to have good insight into both your problematic behaviors and their causes. This is an essential first step in working on changing behaviors, thoughts, and emotions.
A typical process often involves a trigger (i.e., someone glaring at you) causing an emotion (i.e., anger), leading to a thought (i.e., “I need to defend myself”), ending in an action (i.e., yelling at the offender). In many instances, we are consciously unaware of one or more of these steps.For instance, someone might find himself yelling without knowing the reason.Sometimes, other “reasonable” explanations are identified, like the person convincing himself that he was yelling to teach the other person to be more respectful.Though you seem to be aware of your triggers and actions, it might be helpful to identify any emotions and thoughts that exist.
Once problematic thoughts are acknowledged, you can begin challenging inaccurate thoughts and beliefs. You can work on dispelling myths that tell you that your thoughts—and possibly therefore your actions—are appropriate.In a similar vein, once you identify specific emotions you can ask yourself if these feelings accurately reflect the situation or if they might be related to other issues or past situations.
With regard to direct behavior modification, it can be helpful to isolate related factors like when and where each behavior occurs (and when and where it specifically does not occur), and detailed, specific mechanics of the behavior (what you do and how you do it).Once you have a better recognition of these related factors, you will likely be more alert to problematic behaviors, and be better able to change behaviors as they begin.
Often, the sources of our triggers are deeply embedded in childhood experiences and insecurities. Allowing yourself to recognize early instances of an emotion can help you to put the emotion into perspective.For instance, you might recall that you used to feel angry when teachers glared at you, reminding you that this made you feel hurt and worthless.This could help you to recognize these same emotions in the current situation, allowing you to focus on the differences between childhood and current experiences.In addition to helping change behavior, this can also help to reduce the power of the trigger.
November 4, 2016
My daughter is 6 1/2. Last year the school brought to our attention that she is displaying possible signs of ADD and they recommended an evaluation. Our pediatrician suggested that since preferred reputable specialists don’t take my insurance, and it’s a very costly evaluation, and being that my daughter is still very young, we can wait until after first grade when we’ll have more information on which to evaluate her. Additionally, he said it is not recommended to start medication at this young age.
However, I am concerned that if she needs help why not be proactive and get her the help now. She has a very healthy self-esteem and I don't want she should lose it if she does poorly in her school work.
When is the right time to evaluate for ADD?
Is there a benefit of having a diagnosis if I won't be medicating her until we have exhausted all other options?
What’s the benefit of having a diagnosis if I won't be medicating her until we have exhausted all other options?
Who would be suggesting other options, the doctor or do I have to search for them myself?
There are a number of questions that should be addressed. Which member of the school’s faculty contacted you?Was that person reporting first-hand information, or was he simply relaying information obtained from another source?What are the “possible signs of ADD” that concern him?Do you observe similar signs at home?Is your pediatrician very familiar with mental health issues and local specialists, or is he only assuming that there are no competent practitioners who accept your insurance?Is he qualified to determine the appropriateness of ADHD medication?
There can be various reasons for many of the symptoms associated with ADHD. For example, symptoms like trouble focusing and distraction in school can be due to ADHD, or they can be indicative of high intelligence, which can cause the child to be easily bored.Kids who grasp concepts more quickly than others often lose interest when the lesson becomes repetitive for them.Regardless, it’s important to identify the problem, rather than focusing on a label, like ADHD.
It’s important for you to meet with the people who interact with your daughter on a daily basis to get a clear sense of their specific concerns. Once you understand the potential problem, possible causes can be discussed.If you determine that a professional should be consulted, an ADHD specialist can help identify causes and possible corrective action.There are some very good specialists who accept insurance.A mental health referral agency like Relief can help to guide you in choosing the right professional for your daughter.A proper evaluation should give you a sense as to whether there is a clinical cause for concern or, if not, what corrective action can be considered.Depending on the issues and causes, solutions can range from medication to therapy to classroom modifications or accommodations.
Once alerted to a possible diagnosis, parents sometimes become overly vigilant in identifying behaviors and assigning labels to them. Although your daughter may have problematic symptoms, be careful not to attribute typical behaviors (like normal disinterest in homework or the occasional careless mistake) to a disorder.
Remember to focus on the problem—not the label—in order to ascertain whether it requires intervention, and if so which specific intervention is appropriate.
October 16, 2016
My wife and I are married for five years. My wife is the youngest in her family and often her mother gives her opinions or makes requests that she feels that she can't decline. She is also very often the person who has to take care of family events. She would like to stand up for herself and be able to decline, how she can do that in a way that won’t offend. I also feel that, while I respect my mother in law, she sometimes oversteps her place, in areas where I feel that I should be the one to make decisions.
In families, individual roles are tend to be defined in childhood and continuously reinforced as the family matures and changes. Roles can include the responsible child, the scapegoat, the rebel, etc.These roles are generally shaped based on the perceived needs within the family.This perception can be that of the child, or one created by multiple family members or by the family as a whole.
When a role becomes too rigid, this is often due to a variety of factors, which usually reinforce the child’s needs. Examples of these needs include the alleviation of guilt, a sense of responsibility to keep the family from becoming chaotic, and building a sense of self around the role.Even once the original family members are married with their own families, these roles often persist.Depending on many factors, including the original needs, personal development, and roles within the current family, roles can be reinforced to the point that they seem unchangeable.
If we do not identify the causes and development of our roles, we tend to assume that they are the result of current issues, family obligations, or legitimate needs. These often erroneous beliefs can be continuously supported by original and/or current family members.If we don’t recognize these needs and unhealthy relationships, we tend to assume that our roles are a part of our personalities or simply ingrained habits.It is only once we acknowledge possible underlying needs that we can begin separating appropriate actions and beliefs from those rooted in childhood insecurities.
I don’t know what your wife’s role was as a child (responsible; scapegoat; easygoing) or if that role has continued or evolved. Your wife can ask herself if her mother is generally demanding and overbearing, or if she acts this way only with her.If their relationship issues are related to old, unhealthy family roles, understanding the original needs and the development of her role can be very helpful to your wife in beginning to change her childhood beliefs.
I imagine that logistically your wife can figure out how to respond to her mother—it seems that her siblings are able to effectively decline their mother’s requests. If there are underlying needs, resolving them will make it easier for your wife to appropriately deal with her relationship with her mother.Either way, it is important for your wife and you to work on a concerted strategy to begin changing the relationship and roles.Though there may be fear of resentment and anger, doing so in a considerate yet firm manner can lead to a healthier, mutually respectful relationship.
October 2, 2016
I have a teenage son who I noticed was acting out of sorts. I attributed it to be a “stage” and did not make anything of it. A few weeks ago, I got a call from my son’s menahel telling me that my son was involved in some things that required help from an outside source. They would provide the “professional” and make sure my son was taken care of with the best care. I felt that cooperating with the yeshiva was the best route to take and I adhered to all the measures that were to be taken. Among them were paying for the “professional” and not informing my son that I was aware of his circumstances. It has been a few weeks now and I am keeping up my end of the deal. I pay for each session and my son has no idea that I know about the situation. However, when I ask about the progress of my son and for some details on new developments, I am told “it’s handled” or “under control.” This is my son. Until when do I cooperate and not fight for information? Until when do I sit back and allow my son’s life the good and the bad, accomplishments and failures be “handled” by his yeshiva and not by me; his father? Please give me some insight on how to continue on with this situation. Thank you.
There appear to be two issues here: confidentiality vs. parental involvement; and school policy vs. parental involvement. There are legal, ethical, and relationship concerns that play into both of these issues. My understanding is that generally minors do not have the right of confidentiality. That being said, ethics often dictate that a therapist withhold information from parents in order to foster trust, independence, responsibility, and other qualities. When a school is involved, they may have reasons of their own to handle certain issues within school guidelines.
Without knowing the school’s position, I wonder whether they discussed their reasoning with you as to why they would prefer to handle the situation on their own. Sometimes this can be a school’s way of maintaining control; other times they have concerns about how a particular parent generally deals with problematic situations or how the parent responded to the current issue. If your son’s menahel has not been forthcoming with regard to the reasons for his reticence, the first step might be to discuss this with him. If his temperament, your relationship with him, or some other factor precludes this, you should consider involving a third party like a rav or another professional.
That being said, it’s important not to allow your emotions or your ego to be involved in any part of your decision. If your son is doing well, and his acting out continues to improve (and your only concern is that you are being wronged), you need to remind yourself that your only concern should be the welfare of your child—especially if your involvement might hamper the process. On the other hand, if you are not seeing positive results and you have a legitimate concern about the efficacy of the current treatment, there should be a dialogue about how best to approach the situation. In this regard as well, be sure to separate any emotional or ego concerns from your decision and from your response, keeping constant focus on the goal: your son’s ultimate welfare.
September 23, 2016
My 18 year old daughter has been having issues with frumkeit, and seems to be moving in the wrong direction. She has had trouble with anxiety and trust issues in the past and seems generally unhappy. My other kids are being affected by her constant anger and comments. My husband and I find ourselves constantly arguing over the proper way to handle the situation, and we feel that there’s no one to whom we can turn for help. How can we properly deal with this as a couple and as a family? How can my husband and I help my daughter deal with all of her issues while respecting her choices even if we don't agree with them?
Very often, a significant portion of a parent’s emotional reaction to a child’s behavior is due to the parent’s sense that she must have done something wrong, or that she is being judged by others as based on her child’s actions. It’s important to recognize that your situation is not at all unusual. Though it’s easy to feel that you’re alone in this and that everyone else seems to have kids, families, and lives without major issues, this is in no way true.
When we have strong feelings about something important to us, we often get the sense that we would clearly see such strong emotion in others if they were going through something similar. Therefore, if we don’t see these emotions, we assume that all is well with others, and that we’re the only ones dealing with these kinds of issues. Even when we intellectually recognize that someone else has a particular problem with one of their kids, since we don’t see or feel their pain—and we don’t judge them—our level of emotion with regard to the problem is significantly minimized. We can therefore see the issue much more clearly.
If your husband has considerable insecurities related to the situation and you don’t, or vice-versa, or you each have different insecurities (i.e., one of you wants to be seen as open-minded and the other wants to be seen as perfect), this can lead to substantial differences in your responses. This could also lead to one or both of you feeling that the other is uncaring or unsupportive. In addition, when parents are in constant disagreement about something so important, the children pick up on this (even when the parents believe that they are being surreptitious about it). Often, the negative impact on the family and children is caused or exacerbated by the parents’ reactions rather than those of a particular child.
Sometimes I will ask a client to imagine a close friend confiding in them about the exact same predicament that they are experiencing, and to imagine their own response to their friend. The result is often that they much more clearly identify an appropriate response, and sometimes are quite adamant about it. When this occurs, they can more easily separate their situational concerns from their own insecurities, and focus on the former. Your husband and you can try doing this together in order to isolate the actual problem and to appropriately deal with it. No one knows your daughter better than you do. Once you’re able to focus on the issues with less emotional interference, you might find that you know exactly what to say and do in order to help your daughter.
If your daughter feels that her role in the family (and perhaps in the community and in life) is being defined by her family’s sense that she is a rebel or a maverick, she can easily accept that label and allow it to become a large part of her sense of self. If your husband and you are on the same page, it’s likely that your daughter’s actions within the family will moderate, and you might find her being less obviously angry.
If she feels that your husband and you are reacting from a logical place without emotional judgement, your daughter’s anxiety and trust issues can also improve. That being said, there may be a deeper source for her issues with trust and anxiety. If you believe that this may be the case, it would be a good idea to broach with her the subject of seeking professional help, bearing in mind her level of sensitivity to her sense that she is being judged as problematic.
With regard to your daughter’s issues with frumkeit, there are many rabbonim who have experience in these matters, and who can help you to handle the situation with sensitivity so that neither your daughter nor you feel like you’re being judged.
September 16, 2016
This past summer I had an anxiety attack. It came as a surprise because last year I was depressed but at the beginning of the summer I made it my business to get out of the rut. And since then I’ve been very busy going to classes and having a very small business which allows me to express myself. I’ve been in therapy for about a year now and I really feel like I’m on the road to recovery, being emotionally aware and stable. How and why is it that at this point I suffered from an anxiety attack. I’ve had four since the summer. Maybe I need a different form of therapy. How can I know when and if it’s time to change tactics or therapists? I can’t go on like this, I feel like it’s holding me back and inhibiting me tremendously.
I’m not sure what you mean when you refer to an anxiety attack. Although this is a commonly used term, there are many different forms of anxiety and levels of severity. A “panic attack” is a sense of terror, along with a physical reaction, which leads to yet higher anxiety. Physical symptoms can include profuse sweating, weakness, dizziness, tingling, numbness, heart palpitations, fear of having a heart attack, and subsequent fear of another panic attack. Panic attacks can be frightening in the extreme. If you are having panic attacks, a therapist can help, but you will likely want to see a psychiatrist who can prescribe something to alleviate the symptoms until you learn to decrease the frequency and severity. Educating yourself about panic attacks can help to decrease the fear associated with the attacks.
Often, however, when people speak of anxiety attacks, they simply mean that they have a constant level of anxiety that began at a particular point, or that they experience waves of anxiety. These can range from a general feeling of concern to many specific fears, and can fluctuate or remain at one basic level of severity. It sounds like you may be having waves of recurring anxiety without a specific identifiable cause or fear.
One thing to bear in mind is that the very lack of an identifiable fear often exacerbates the anxiety. This may be part of what is causing your anxiety. Learning to acknowledge possible underlying fears—even if they make no logical sense—can help to change this dynamic.
There are a number of forms of therapy that can help to address this form of anxiety. An eclectic therapist is capable of utilizing various therapy modalities either individually or concurrently to achieve the maximum benefit. If your therapist mostly uses only one modality (i.e. cognitive therapy or psychoanalysis), and you are no longer seeing gains, this should be discussed with the therapist in order to ascertain whether she can continue to help you with the particular issue that you’re experiencing.
Sometimes, the therapist-client relationship becomes stagnant and, if not addressed, the therapy process can get stuck in a continuous loop. This can be due to many factors. If this issue is addressed, an honest and competent therapist can help you to decide whether she is the proper professional to help you achieve your goals.