Ask Ellen Anmuth, Psychotherapist: Reduce Stress in College

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ellen Anmuth Psychotherapist: An Analysis of Compassion, Conflict, Insight and Relationships

Compassion, Conflict and Insight…How do these 3 concepts relate to  Relationships, Happiness, Love, Romance, Communication and Anger Management?

Today is Valentines Day….a day that is correlated with with Romantic Love. Have you ever heard the quote, “The work of real love begins after the romantic fantasy ends”? The author may have been M.Scott Peck or Harville Hendrix, and I regret that my attempt at “Googling” was unsuccessful to confirm the author.(Please let me know the correct author, if anyone finds out!)

I do recall reading a chapter in a book that related to the above-mentioned quote. This concept inspired me to further my work as a Psychotherapist and Educator, relative to teaching couples how to remain loving and connected when disagreements or conflict arises. I was inspired to develop a method called “The Language Of Solutions”, in which a 4-Step Method in the form of a dialogue guide teaches couples how to stay connected in a loving manner, even if they feel hurt, angry, dismissed, misunderstood, attacked, or the myriad of other emotions that can easily tear apart a loving bond.

When people feel hurt in a romantic relationship, there may be a number of reactions. Some people attack with angry words, and other people withdraw and sulk in isolating silence and detachment.

What role does compassion and insight play during a tense moment of conflict between loved ones? The degree of “reflex anger” can be reduced. If you learn about your partner’s “family of origin” issues, you may find yourself becoming more patient and less reactive. Abusive behavior is not to be tolerated. Couples can learn skills and strategies to deal with hurt and pain that is kind and loving. Anger can be expressed lovingly and compassionately, which can increase intimacy and closeness.

Action Strategies:

1) Talk to your significant other or loved one, and explore how conflict was handled in their family. Find out if they were allowed to speak about their thoughts or feelings, or if they were punished for communicating.

2) Discuss some guidelines for conflict resolution that each person could feel comfortable with, and remind your partner during those moments of conflict to use one of the methods.

3) Keep a log or diary of the trigger events that occur, and how you react. Self awareness is the first step toward a productive and successful plan of action.

 

 

The Language Of Love: Unexpected Strategies for Intimacy

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

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

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

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

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

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

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

 

 

 

Ellen Anmuth Commetary – Gun Violence, Impulse Control Disorders and President Obama

Will President Obama and the US Government Ever Address the Issues of Mental Health, Disorders of Impulse Control, and Gun Violence? 

What is an Impulse Control Disorder? According to Wikipedia:

Impulse control disorder or ICD is a class of psychiatric disorders characterized by impulsivity – failure to resist a temptation, urge or impulse that may harm oneself or others. Many psychiatric disorders feature impulsivity, including substance-related disorders, paraphilias, attention deficit hyperactivity disorder, antisocial personality disorder, conduct disorder, schizophrenia and mood disorders. The revised fourth edition of the American Psychiatric Association‘s Diagnostic and statistical manual of mental disorders (DSM-IV-TR) includes the category, “impulse control disorders not elsewhere classified”, which consists of kleptomania, pathological gambling, pyromania (fire-starting), trichotillomania (a compulsion to pull one’s hair out), intermittent explosive disorder, and “impulse control disorders not otherwise specified”. Other disorders such as, dermatillomania (compulsive skin picking), compulsive buying and compulsive non-paraphilic sexual behaviour have been proposed for inclusion in the category.Five behavioural stages characterize impulsivity: an impulse, growing tension, pleasure from acting, relief from the urge and finally guilt (which may or may not arise).

For those people with Impulse Control Disorders or severe depression, a loaded gun nearby is a monumental danger. A few years ago, a friend of my parents, a retired medical professional, had a gun in his home. I suspect that this was intended for protection from intruders, as he never went hunting. I recall seeing him and his wife as a party, and noting how depressed she looked. A few weeks later, the news came that she had committed suicide by shooting herself in the head with the gun that was in the home.

For anyone with depression or an impulse control problem, easy access to a gun is a high risk situation. Will the US Government ever deal with this properly? What can you do, as citizens, to make a change? Will speaking with your senators, congressmen and congresswomen help?

As a licensed psychotherapist, I noticed how difficult it is for many people to get mental health services, either because they have no health insurance, or perhaps their policies did not cover psychotherapy. In addition, the culture in general tends to stigmatize mental illness, discouraging people from seeking help, in my opinion.

Given that a portion of the population suffers from Disorders of Impulse Control, and that many mentally ill people never get treatment, how do the current policies and laws deal with the easy access of mentally ill people to obtain guns?

What can we all do to address this problem?

 

 

Ellen Anmuth Commentary – CBS Grammy Awards, Creativity and Contribution

What will your legacy be in this life? During the “In Memoriam” segment of the 2013 Grammy Award Show, I was touched by the passing of so many greats, and the wonderful music they left behind for us to enjoy.

Marvin Hamlisch and Donna Summer are just two of the amazing talents that are no longer with us, to continue their composing and performing.

Do you have a creative contribution to leave as a legacy? Certainly, the areas of music and art are challenging professions to break into, and make a mark.

However, in today’s world of You Tube and Internet publishing, I wonder if you may be holding back in sharing a musical gift to the world?

Take a chance….let your musical mind wander, and start to compose. Perhaps you can sing a song you love,  and sing it with your own brand of uniqueness and passion. Many people post these songs on You Tube.

Who knows how much joy another person may feel from enjoying your artistic expression?  Will you let your artistic expression be revealed and shared, or will you die without sharing your blessings and talents with the world?

To Cherish and To Love

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

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

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

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

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

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

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

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

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

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

Ellen Anmuth Commentary: An Unmet Need in Bereavement Services

Ellen Anmuth CommentaryAs a Licensed Therapist in the field of Genetic Counseling and Clinical Social Work, and having been trained in Grief and Bereavement, I would like to appeal to my colleagues in the field of Death and Dying, Grief, Loss and Transition Counseling Services.

Have  my fellow colleagues in the Mental Health Service Professions noticed a service that has been absent?

At least in my geographic area, there are bereavement groups for parents of children who died, for adults who have lost a spouse or life partner, for people in the divorce process, and yet I have noticed an absence of any support group services for the death of a friend.

I would appreciate comments from the mental health practitioners about this glaring omission in services.

The death of a friend, in my opinion, has a unique footprint, a grief process different from any other bereavement process.

I would also appreciate any comments from individuals in the community, any family doctors, internists, specialists ,clergy,University or College Professors, or from any grieving person who could not find a support group for the death of a friend.

Colleagues…let’s assess this situation, and deliver better services!

Ellen Anmuth Commentary

Coping with Death: What is Complicated Bereavement?

Coping with DeathWhat is a Complicated  Bereavement?

Back in 1975, when I was taking a Masters Degree program in Health Science and Genetic Counseling, we studied many theories of coping with the death of a loved one. The area of study is called “Grief and Bereavement”.

The field of “Genetic Counseling” was very new back then, with only a  handful of colleges and universities offering this professional training. The curriculum included learning to do crisis intervention after the dealth of a baby or child, the death of a teenager or adult,  or the birth of a child with genetic abnormalities. We also studied many theories of how people cope with  any type of loss.

One on the very interesiting theoretical models we learned was a paradigm with a continuum (think of an example of a  continuum as a thermometer in which a person can have a high fever of 106, be sub-normal at 97 degrees, or have any body temperature in between.)

There is a continuum of how people deal with the loss or death of a loved one, from “Complicated” to “Uncomplicated”, and all degrees in between.

What is an example of an “uncomplicated bereavement” process?

From personal experience, I can talk about my Grandfather, who lived to be two months short of his 100th birthday. I lived near him when he died, visited often, and  never had a conflict with him. When he finally died, I cried profusely, sobbing in the nursing home. You might ask, “How is this considered an uncomplicated bereavement, because you are sobbing?”

The answer: People still grieve and cry in an uncomplicated bereavement. I had no regrets or guilt feelings….I just knew I would miss this amazing man.

People move through this type of grief process without the “complicating issues” of guilt, anger, regrets or other painful emotions.

What is an example of a “complicated bereavement”?  A dramatic example might be a child that is killed by a drunk driver.  A more subtle example might be that someone died, and your last words with the person were  hostile, or you had an unresolved argument.

This continuum is not a black or white situation. Think of it more like shades of grey, in that aspects of complication might present in any loss situation.

Coping Strategies after a Death of Loss

1) After a death or loss, think of anything you regret, feel guillty about, feel angry about, or wish you did differently.

2) Begin to keep a journal of your feelings and thoughts.

3) If you feel “stuck”, as though you are not moving through the grief process, perhaps you can consider professional help.

 

 

Women who Sacrifice for Men: When Neediness Jeopardizes Safety

When does neediness for a man’s approval put a woman in danger?

Have you ever deferred taking care of your emotional or physical heath because you feared disapproval or abandonment by a man?

Recently, a  very educated colleague named Sheila called me as she was driving to meet a man for a drink. She had not yet met him in person, but had only connected with him via an Internet Dating site.

She lives about 20 miles from my home, and while driving, she called me to ask for directions to the restaurant. I told her how to get there, and then she told me that the indicator light was showing low air pressure in her tires.

It was Friday early evening, and I told her, “You are in luck….there is a tire place en-route to the restaurant, and they are open for another hour. Just drive by, and they will put air in your tires”.

Her response was shocking to me. She said, “Since I am meeting him for the first time, I do not want to be late”. I responded that the guys at the tire place are excellent, fast and trustworthy, and that it will only take a few minutes of time. I also mentioned that since she can reach her new date by cell phone, he would understand that taking care of tires is a valid reason to run 10 minutes late. I re-emphasized the it would take at most, 10 minutes.

She refused to consider my suggestion, stating that this would be a good test of his chivalry, to allow him to take care of the tires. I told her that there are no tire places available after 7 pm on a Friday evening, and that her idea to have him “rescue” her was unlikely to be successful. I emphasized my concern for her safety, driving home on the highway for 20 miles late at night on tires with under-inflation.

She could not hear any of my suggestions, and sure enough, there were no places to fill up her tires, and she drove another 20 miles on the highway on tires that may have been unsafe.

The next morning, she told me  she needed to cancel plans with 6 women friends she planned to meet at a museum at 11am, since she did not get up early enough to deal with the tires.

She confidently affirmed  that the women would understand that these things happen in  life. (She did not tell her friends that she, in fact, decided not to ask a man to wait 10 minutes the night before, in order to put air in tires.)  I was intrigued with her double standard, having no problem disappointing her woman friends because she did not want a potential new man in her life to wait 10 minutes.

The next words out of her mouth were even more perplexing. She said,
“My life is always filled with obstacles”, and conveyed a perception of “victim consciousness” that “troubles in life seem to find her and taunt her”.

She was unable to see the obvious, that she failed to take the logical action, which was to quickly get to the tire place, on the way to her restaurant, and ask the stranger she had not yet met to wait 10 minutes.

Tips to Consider: 

1) Have you ever put your life or safety at risk because you wanted to impress a man?

2) Do you tend to sacrifice taking care of your needs, and potentially jeopardize your safety, because you fear abandonment by someone you are trying to impress?

3) Where in your childhood history might this tendency to abandon yourself begin?

4) Whose love did you not get as a child, that may be unconsciously running your behavior?

5) What will it take to make these emotional patterns more in conscious control, and heal the childhood wounds that may be unhealed?