Psychotherapy San Francisco by Evelyn Hoch, LCSW, MFT

                  ::  Myth # 1: Accepting what you don’t like about your partner is a recipe for disaster.

Offering psychotherapy San Francisco, I have actually found quite the opposite. Since most conflicts in relationships are unresolvable, stop trying to solve the unsolvable. Successful couples learn to live with these differences. Remember, acceptance doesn’t mean that you like it, but rather that you surrender to what is. To be truly known & accepted is the very essence / core of love.

::  Myth #2: Fighting is bad. Fighting will destroy a relationship. Good relationships have minimal conflict.

Not true. Fighting can be healthy. It gets things out in the open. What matters is ”how” you fight. Fighting can be toxic, even cause irreparable damage. In successful relationships, honor and respect are maintained — even in the heat of the battle. No below the belt, “I’m gonna get you where it hurts” behavior. Hurting your partner damages trust and intimacy in your relationship. Remember, you’re half the relationship. If your aim is to hurt your partner–you’re actually choosing to hurt yourself! Learning to fight fair is essential.

::  Myth #3: Great relationships almost always have great spontaneous sex.  Everyone knows that hot spontaneous sex is one of the best predictors of a successful relationship. 

Definitely a myth. Since the actual biochemistry of attraction and desire changes significantly over time, waiting for a feeling of overwhelming desire is self-defeating. The real secret of keeping romance alive is the willingness to show up. Prioritizing emotional and sexual intimacy is the key to keeping romance alive. Anticipation and planning can be sexy!

::  Myth #4: Happy couples prefer spending almost all of their free time together.

Not true. Actually, expecting one person to satisfy all of your needs is unrealistic and tends to lead to resentment and anger. Having some time apart — pursuing your own interests and friendships, tends to keep relationships fresh and alive. Remember to take time to nurture your relationship with yourself. The capacity to truly love another person requires self-knowing, self-acceptance and self-love.

::  Myth #5: Love yourself. You don’t need constant love, affection affirmation from your partner.

Wrong. Self-love is essential, but not a substitute for the daily verbal / non-verbal expressions of tenderness and love that we all require to feel loved. You wouldn’t put your favorite plant in a dark room, never water it and simply expect it to flourish, now would you?

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Evelyn Hoch, LCSW, MFT, is licensed both as a Licensed Marriage Family Therapist and a Licensed Clinical Social Worker. She believe psychotherapy/ counseling is essentially a journey in self-love, self-knowing and acceptance. Therapy is an opportunity to review both current and past patterns, traumas/injuries in a safe environment. Her therapeutic style is interactive, helping women explore and support the discovery of their more authentic selves, utilizing techniques drawn from various disciplines, such as communication theory, self-psychology, cognitive techniques.

by Debra Milinsky, MSW, LCSW

 ::  When those hot, sultry, end of summer, dog day blahs morph into mood indigo, winter blues…  could it be “SAD”  (Seasonal Affective Disorder)?

 “You ain’t been blue, no, no, no;  You ain’t been blue ’til you’ve had that mood indigo. That feelin’ goes stealin’ down, down to my shoes. While I sit and sigh, “So long, blues.”

“Mood Indigo”   Lyrics by Mitchell Parish  ~  Music by Duke Ellington and Barney Bigard

Come September, do you find yourself feeling a bit more tired and sluggish as the days get shorter? Do you feel depressed, hopeless and dark of mood, that increase with each passing October, November, December and January holiday? You find that you just can’t get a restful night’s sleep; can’t focus, cannot concentrate or finish tasks.

Maybe you are feeling more anxious and irritable lately. As year-end pressures build to get everything done at home and at work, you find yourself in a hurry-up-and-collapse rip-tide. All you want to do is withdraw, sleep and surrender to that urge to hibernate until spring.

Is it just the winter blues or “SAD” ?

If you notice any of these patterns of behavior and mood changes that begin as summer fades to winter, patterns that last at least four weeks and for at least two years in a row, then you might be among the 14% of people living in northern climates who report “winter blues”, or among the estimated 6% of the US population who experience a more intense, protracted “Seasonal Affective Disorder” or “SAD” (Rosenthal, 2006.)

Less common but just as disruptive are seasonal mood symptoms that appear in the spring months, when increasing sunlight brings debilitating anxiety, a feeling of over-exposure, and the wish to isolate and crawl right back to bed.

Adapting to environmental changes is essential for survival

Sensitivity to seasonal changes and biological cycles are fundamental facts of nature that affect all organisms large and small. Animals respond more predictably to these kinds of environmental influences with distinct seasonal rituals for mating, migration, food gathering and storing, and hibernation.

When humankind began to migrate beyond the equatorial cradle of civilization where hours of sunlight and temperature are more balanced and moderate, these earliest travelers had to adjust and adapt in order to survive. Even though adaptation to the immediate external environment is necessary for survival, every living creature has an internal rhythm that has been coded in the deep structure of evolutionary memory that still marches to this ancient drumbeat.

Have we forgotten the beat of our circadian rhythm?

In earlier times when our ancestors lived close to the land and nature, sunrise and sunset regulated all activities. Then more than a century ago, the industrial revolution and demands of modern life radically changed the way we live and work. Our circadian rhythms and bio-psycho-social health needs for sensory attunement with nature, a more predictable rhythm of sleep and mealtime cycles, a good balance of work and play,  and the support and structure of family life, were no longer regulated by the natural world.

Recent technological advances and economic necessity have made the 24-7 work schedule a fixture of modern life for many world citizens in the new millennium. We work swing and night shifts, we work day jobs in office cubicles without natural light, leaving home in the early morning darkness and returning after the sun has set. We survive on less and less sleep while we frantically “multi-task.” Electronic devices allow us to communicate in nano-seconds, as well as lose ourselves and huge chunks of time while sitting virtually immobilized for hours in front of mesmerizing television and computer screens. Our ability to regulate and maintain a healthy balance of work, family and personal life have become more and more challenging and stressful.

What does sunlight have to do with it?  Mood assessment tool measures seasonal changes in the following six areas: length of sleep, social activity, mood, weight, appetite and energy level.

The surprising effects of environmental changes on mood, and particularly the loss of natural sunlight, was immediately brought home to researcher, Dr. Norman Rosenthal, when he moved from his native South Africa to New York City in 1979. Previously aware that his own moods fluctuated with the seasons, Dr. Rosenthal discovered that his mood symptoms intensified when he experienced his first northern hemisphere winter. Together with colleagues at the National Institute of Mental Health in Bethesda, Maryland, he began a several decades-long study of how brain chemistry varied with mood, developing the Seasonal Pattern Assessment Questionnaire (SPAQ), a subjective measure used to diagnose adults with this form of mood disorder.

The resulting “seasonality score” differentiates winter blues from SAD, and has been used in many subsequent studies all over the world. Research indicates that people living in the northern hemisphere are much more likely to suffer in varying degrees from winter blues and more severe SAD symptoms.

Women are more likely to have SAD than men

Studies also show that women are more likely to have SAD than men, which may be linked to hormonal changes between menarche and menopause and other psychosocial factors that show women are twice as likely to be diagnosed with depression than are men.

One million US children and adolescents, suffer from seasonal depression.

It is estimated that about 3% of US children ages 9-17, or approximately one million children and adolescents, suffer from seasonal depression, making this more subtle symptom picture as common as ADD/ADHD (Rosenthal, 2006; Carskadon and Acebo, 1993.) If you notice that your child or teen shows a pattern of beginning each fall semester with great promise until attitude and performance take a nose dive by Halloween, consider that mood and behavior consequences of seasonal changes may be the culprit! Your child is not bad… he or she may have SAD!

What you can do if you think that you or a family member may have seasonal depression?

There are a number of options ranging from “do-it-yourself” life-style changes to seeking professional consultation. Anticipating the impact of seasonal changes and stepping up self-care – greater attention to sleep, healthy diet, movement and exercise – is always a good place to start. Light therapy, which seeks to augment decreasing hours of natural light during winter months with prescribed light box exposures, and cognitive-behavior therapy (CBT) interventions that identify and examine core beliefs and behaviors in order to develop more effective skills to regulate and manage mood, offer significant relief for many SAD sufferers. Anti-depressant medications that regulate serotonin and dopamine levels may also offer relief from SAD symptoms. A combination of light therapy and routine exercise to prevent seasonal symptoms and improve mood is also an effective combination for many study participants (Leppamaki, 2006.)

When it comes to diet, exercise, medication and psychotherapy, one size does not fit all.

Many of life’s problems are managed and resolved within a supportive and resourceful community of family and friends, personal resilience, and with the “tincture of time.” When distress is seasonal, lasts for a number of weeks and months, and when symptoms emerge that disrupt work, school and family life, professional consultation can offer new perspectives, resources and skills that quicken recovery and bring relief from SAD’s uninvited symptoms and suffering.

REFERENCES:

Carskadon, Mary A., PhD, and Acebo, Christine, PhD, Parental Reports of Seasonal Mood and Behavioral Changes in Children. Journal of the American Academy of Child & Adolescent Psychiatry, 32:2, March, 1993.

Leppamaki, Sami, The Effect of Exercise and Light on Mood, Academic Dissertation. Helsinki, FINLAND: National Public Health Institute, Department of Mental Health and Alcohol Research, University of Helsinki, Department of Psychiatry, 2006.

Rosenthal, Norman E., MD, Winter Blues: Everything You Need To Know to Beat Seasonal Affective Disorder. New York: Guilford Press, 2006.

Smith, Laura L., PhD, and Elliott, Charles H., PhD,  Seasonal Affective Disorder for Dummies. Indianapolis, Indiana: Wiley Publishing, Inc., 2007.

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Debra Milinsky, MSW, LCSW, is a licensed psychotherapist, practicing in Berkeley and Vallejo. She helps women and men, couples and families, mothers and daughters from diverse cultural and ethnic backgrounds, sexual and gender identities develop healthy, harmonious and satisfying relationships. She has been a guest on KISS-FM radio, Childhood Matters, discussing family violence and domestic abuse prevention and intervention, and is a Past-President of the Association of Family Therapists of Northern California. Contact her @ 510.525.7575.

A version of this article appeared in the Nov-Dec, 2010, edition of SolanoFit Magazine and can be viewed at http://sofitmagazine.com

© Copyright 2010 Debra Milinsky, MSW, LCSW

by Debra Milinsky, MSW, LCSW 

::   There is a chain letter making the rounds in which a mother offers her newly-married daughter these words  of wisdom: “Don’t forget your sisters. They’ll be more important as you get older. Remember to go places and do things with them. Remember that ‘sisters’ means ALL the women – your girlfriends, your daughters, and all your women relatives, too. You’ll need other women. Women always do.”

Everyone— girls, boys, women and men— desire healthy friendships. The wish to trust, to feel accepted, to feel valued and respected, and to have a positive sense of self, purpose and connection with others is universal.

Special learning occurs within a woman’s relationships where her self-esteem and competence are forged, enhanced, or damaged on the anvil of her relationships with other girls and women. Every woman can recall the joy of having a best friend and deep despair when that best friend’s words or deeds were wounding or rejecting.

Each passing age brings fresh challenges as social skills are practiced and honed with old friends and new acquaintances in a widening circle of all kinds life experiences and people. In order to have a friend, you must be a friend; to be a friend, you must have a friend. How is this reciprocal wisdom about valuing connections and being a good friend imparted, especially to girls as they grow up?

Essential elements for making and keeping friends

Learning about relationships begins at home and requires consistent care and attention from family members, including siblings and other caregivers. The child’s ability to name and respect her own thoughts and feelings prepares her to have empathy for others, an essential ingredient in maintaining friendships.

Kindness, respect and predictable consequences provided during formative years, can in turn be extended to others through this type of modeling that shapes positive attitudes and behaviors. When basic needs for security and acceptance are met, when exposures to danger and trauma are minimized, and as language develops and feelings are named and acknowledged, the child experiences a resilient social awareness.

Healthy friendships are built upon a foundation of mutual trust, honesty, give and take and acceptance. A true friend wants what is best for you, supporting your self-esteem and positive growth without hurtful criticism or judgment. These very measures of friendship become the standards by which to measure a friend. As your self-worth and self-confidence develop, you can use these feelings to evaluate what is constructive or out of balance in order to make better relationship choices in your life.

Another key element is sharing common interests and activities that develop over time. This allows your friendship to develop along several dimensions as well as stand the test of time. Flexibility and tolerance for inevitable differences and disappointments are the hallmarks of any maturing relationship. 

How can I know if a relationship will be healthy when I first meet someone?  

While some lifelong relationships begin with a spark of instant attraction, most take time to achieve attachment, belonging and intimacy. Enjoying mutual work or social activities, and feeling safe, secure, happy and good about your friend when you are together and also when you are apart, build a foundation for enduring attachment. Protecting and respecting each other’s likes and dislikes, boundaries and privacy, also build trust. The desire to know and be known provide ever-deepening opportunities that keep friendships alive and well.

What if my friendship is hurtful? How do I change it for the better or end it in a healthy way?

Self-esteem— positive thoughts and feelings about yourself— and self-awareness are essential for evaluating your own needs and desires, and making appropriate choices that support self-respect. Even in the best of friendships, empathic failures, misunderstandings and ruptures can arise. Your friend’s response may not meet your expectations, may hurt and disappoint you.

The best way to manage disappointment is to speak honestly and responsibly, describing how your friend’s actions have troubled or hurt you without launching a personal attack or blaming her. Finding common ground, removing obstacles as they appear and solving problems together, can actually strengthen your friendship.

When events that cause protracted suffering and undermine trust and self-esteem cannot be worked through, you may wish to seek help from other friends and family, or professional consultation. Sometimes just a break and the tincture of time can clear the air and heal the rift between you and your friend. However, if you are unable to resolve the conflict, ‘warm distancing’ and detachment may illuminate a path of least resistance to the ending.

A diverse circle of friends is your best health insurance

“Bio-psycho-social health” research examines how factors such as innate biochemistry, mental attitudes and the presence or absence of supportive friendships, affect the quality of health and longevity. It comes as no surprise that social support and shared activities boost well-being, general health and happiness. Conversely, mental and physical health often decline when relationships are troubling. A person who feels alone and disconnected from others is more likely to suffer from anxiety and depression.

Good friends take an interest in each other’s well-being, encouraging them to seek help when problems arise. Connecting with your girlfriends during stressful times provides an emotional safety net, enhances coping skills and reduces suffering. Friends can motivate each other to maintain healthy diet and exercise goals by working out or walking together.

Just as attention to diet and aerobic activities improves heart health, a diverse circle of girlfriends with whom you share a range of interests expands your options for companionship and connection. Developing different aspects of yourself through varied friendships and activities brings out your personal best and instills happiness— which are good for your heart in every sense!

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Debra Milinsky, MSW, LCSW, is a licensed couple and family psychotherapist, practicing in Berkeley and Vallejo. She helps women and men, couples and families, mothers and daughters from diverse cultural and ethnic backgrounds, sexual and gender identities develop healthy, harmonious and satisfying relationships. Contact her @ 510.525.7575

A version of this article appeared in the May-June, 2011, edition of SolanoFit Magazine and can be viewed at http://sofitmagazine.com

© Copyright 2011  Debra Milinsky, MSW, LCSW

by Evelyn Hoch, LCSW, MFT

 ::   You’re a 28 yr.old woman who has been happily partnered with a man for 3 years and recently you’ve developed a crush on a woman you work with…

You’ve been lesbian-identified for the past 15 years — ever since you fell in love with your best friend in college. Lately, you’ve been noticing guys more, even having erotic fantasies. You figure: no big deal, lots of lesbians fantasize about men. But you know in your gut this is different…

Since you were a teenager, sometimes you’d get a crush on a boy — sometimes a girl. You’ve always felt pressured to “make up your mind”. Lately you’re wondering “maybe I don’t have to”.

These are just a few of the many faces of bisexuality. I hope the following information about bisexuality helps you clarify your own feelings and/or be more knowledgeable & sensitive regarding bisexuality in general.

What is bisexuality anyway? Bisexuality is the capacity for romantic, physical/ erotic and /or emotional attraction to more than one gender. A bisexual identity inherently challenges dualistic categories of sexual orientation (hetero/straight or queer/gay).

As the famous sex researcher Alfred Kinsey stated, “The world is not divided into sheep and goats”. Try not to assume that everyone is — or should be — straight or gay. If in doubt, assume that bisexuals are present in every group of queer or straight people. We usually are. Honoring bisexual identity is not just political correctness. It’s about demonstrating the same respect for diversity that we demand.

Isn’t bisexuality just a phase and aren’t bisexuals just “confused”? Of course, some people go through a period of bisexuality on their way to transitioning to a gay, lesbian or heterosexual identity. But for many, bisexuality continues as a long-term or lifetime orientation. Actually, researchers have found that bisexual people often go through a transitional phase of homosexuality and heterosexuality in the bi coming-out process.

Aren’t bisexuals just “oversexed” and need to have partners of different genders?

The same variety of sexual activity exists in the bisexual population as in other groups.

And the majority of bisexuals don’t feel the need to be involved with more than one sex/gender to feel satisfied. And bisexual people are as capable as anyone else of making a monogamous commitment.

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Evelyn Hoch, LCSW, MFT, is licensed both as a Licensed Marriage Family Therapist and a Licensed Clinical Social Worker. She believe psychotherapy/ counseling is essentially a journey in self-love, self-knowing and acceptance. Therapy is an opportunity to review both current and past patterns, traumas/injuries in a safe environment. Her therapeutic style is interactive, helping women explore and support the discovery of their more authentic selves, utilizing techniques drawn from various disciplines, such as communication theory, self-psychology, cognitive techniques.

by Debra Milinsky, MSW, LCSW

 ::   Life is a problem-solving process..

Even under the best of circumstances, adjusting to changes and transitions can be overwhelming and exceed your usual ability to cope and adapt. What is the best way to learn effective ways to respond to stressful experiences, to anticipate consequences and to acknowledge and manage disappointments as these arise?

A first step is to figure out what experiences and events challenge you and trigger stress, anxiety and anger. It also helps to be aware of the triggers and stress points for the important people in your life. Once mastered, these problem-solving skills become the cornerstones of resilience and the hallmarks of maturity that will last a lifetime!

Troubling emotional and physical symptoms are more likely to develop when changes are unexpected, occur simultaneously, or are unremitting without opportunities for recovery and repair. Past or current physical, emotional or sexual trauma can also disrupt a person’s sense of safety and security when not acknowledged and worked through.

These stressful circumstances and experiences can lead to a sense of powerlessness, dread, hopelessness and despair. Psychological responses such as the symptoms of a clinical depression or severe anxiety arise which interfere with personal life, create stress in your relationships and impair performance at work or school.

Of course, not all problems of everyday living result in psychological or psychiatric difficulties. Even so, one may still feel extremely challenged and stressed. Some examples of common stressful situations include: relationship problems at home or in the workplace; moving through transitions of weddings, births, children leaving home and other developmental milestones; family disruptions and separations due to military service, divorce, or death; accidents and other traumatic events; care-giving for chronically ill, special needs, disabled, dependent or aging family members; financial or legal problems; and unexpected job insecurities, job or home loss, or undesired relocation for employment.

Resilience rather than Reactivity…

The ability to manage these stressful life events with resilience rather than reactivity and severe, protracted symptoms depends on several important factors. These include:

• the availability of external supports, relationships and resources

• the ability to make use of all available resources and relationships offering help

• developing and utilizing tried and true coping strategies

In addition, knowing how to recognize the characteristic signs of stress, depression and anxiety before these become disabling makes it possible to take proactive steps in your own or another’s behalf and to relieve suffering sooner.

WARNING SIGNS OF STRESS

• Feeling restless, nervous, on edge, agitated, fearful or anxious
• Feeling panicky, pressured, desperate or crazy
• Feeling depressed, tired, low energy, sluggish
• Mood changes, increased anger, irritability, sadness, tearfulness, emotional numbness
• Decreased ability to concentrate, remember or make decisions
• Diminished interest in enjoyment and pleasure in normal activities including sex
• Significant changes in appetite or interest in food with unplanned weight gain/ loss
• Feeling worthless, guilty, remorseful about faults and failures
• Increased perfectionism or procrastination
• Significant disruption in sleep patterns, sleeping too much or too little
• Troubling dreams, anxiety dreams or nightmares
• Upsetting, intrusive, obsessive thoughts or feelings related to the stressful situation
• Sense of apprehension or dread, tension, worry, helplessness and despair
• Isolating, gradual pulling away from others; not opening mail or paying bills on time
• Thoughts of wanting to die, disappear, feeling alone
• Actively thinking of suicide, self-injury, or taking revenge on/ harming others
• Use of alcohol, cigarettes, street or prescription drugs to relax, sleep or cope
• Physical complaints and pain such as headaches, back and neck aches, upset stomach, nail-biting, hair twisting or pulling, malaise or frequent illnesses

HELPING CHILDREN AND TEENS COPE WITH STRESS

Children and adolescents respond to stress with many of the same symptoms as adults, and can be very reactive to the emotional or behavioral changes they observe in their parents. Depending on age and personality style, children may have difficulty expressing their discomfort verbally and truly rely on parents and other caretakers to help them describe and manage difficult experiences and feelings. Paying careful attention to any emotional, physical or behavioral change can offer important clues that alert parents to their child’s distress.

When children are unable to express thoughts and feelings directly, they may express suffering indirectly through actions that are revealed in physical symptoms and changes in behavior. Some warning signs such as physical complaints, increased clinging, whining or withdrawing; irritability, oppositional or defiant behaviors, refusal to go to school, to sleep at bedtime or in their own bed, or other protest behaviors; and any regressions in skills formerly mastered such as self-feeding or dressing. and bedwetting or soiling, should be explored further with your child in a tone that conveys caring, curiosity and understanding. Teens and adults may also express distress indirectly through somatic symptoms, isolating, becoming uncommunicative or withdrawing. They may also show changes in mood or behavior such as becoming more “touchy,” irritable or oppositional.

SEEKING CONSULTATION

Many of life’s problems are managed and resolved within a supportive and resourceful community of family and friends along with the “tincture of time.” When distress is protracted and not easily repaired, professional consultation can offer new perspectives, resources and skills that quicken the healing process bringing relief from uninvited symptoms and suffering.

_____________________________________________________________________________

Debra Milinsky, MSW, LCSW, is a licensed psychotherapist, practicing in Berkeley and Vallejo. She helps women and men, couples and families, mothers and daughters from diverse cultural and ethnic backgrounds, sexual and gender identities develop healthy, harmonious and satisfying relationships. She has been a guest on KISS-FM radio, Childhood Matters, discussing family violence and domestic abuse prevention and intervention, and is a Past-President of the Association of Family Therapists of Northern California. Contact her @ 510.525.7575.

© Copyright 2011  Debra Milinsky, MSW, LCSW