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Licensed Psychologist

Coping With Infertility

Listen to this podcast, a conversation between Dr. Richard Lustberg and Dr. Marlene Kasman on how to cope with infertility. This was originally published in 2007 by Suffolk County Psychological Association.
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Maybe I Have An Eating Disorder

  • I think about food all the time
  • I panic if I eat too much
  • I am terrified of gaining weight
  • I feel fat, friends tell me I'm thin
  • I don't get regular menstrual periods
  • I prefer to eat when no one will see me
  • I have lost more than 15% of my normal weight
  • I find myself compulsively eating
  • I exercise a lot
  • I tend to be a perfectionist
  • I consume less than 1200 calories a day
  • I want to be thinner than all my friends
  • I hate my body
  • I have been depressed and irritable lately
  • I use laxatives or diuretics for weight control
  • I binge and make myself vomit
  • I feel food is my enemy
  • I am preoccupied with food and weight
  • I have extreme mood swings
  • I feel tired all the time
  • I often feel cold when no one else does
  • I have noticed that my hair is dry and brittle
  • I have noticed my skin is drier
  • I have noticed my nails break easily
  • I have more cavaties recently
  • I have noticed my teeth are discolored
It would be a good idea to consult an eating disorder specialist if you have more than five of these behaviors.

Mother's Day or Doomsday

Mother's Day. Images of mothers and happy children are everywhere. It seems that everyone is part of this joyous celebration. Everyone, that is, except the woman who has not been able to conceive. For her, Mother's Day is a nightmare, a painful reminder of her failure. She feels disappointed in herself, disillusioned that her body has betrayed her, and defective as a woman. Men have been socialized to think of parenthood as one possible ingredient in their traditional adult roles; girls are programmed to think of the achievement of motherhood as an absolute necessity to their identity as adult women. They perceive a threat to their ability to become mothers as a threat to their ability to be seen as legitimate adult females. No other activity can substitute for it. A woman without children often feels cheated, angry, depressed, jealous and anxious. She doesn't have what she's dreamed of all her life. Her body isn't cooperating with her desire to become a mother. She feels like a failure. She is jealous of people who have children, and guilty for feeling jealous. She is tired of all of the questions and advice from family, friends, and even strangers. She is frustrated that the medical tests and procedures have not worked. Each month she rides an emotional roller coaster first hopeful and then devastated. Caught up in the quest to have a child, women forget that they are anything other than childless. It is important for infertile women to reclaim their lives, regain control and once again feel joy and meaning in their lives. There are powerful psychological tools that women can use to help themselves. They can learn to change their negative thoughts. They can learn how to nourish themselves. They can improve communication with their spouses. These techniques have helped many women feel more optimistic, and less anxious and stressed. They feel better, their lives feel more meaningful, and sometimes, once they have have done these things, they may find themselves pregnant.

The Flight from Conversation Part 2

We use conversation with others to learn to converse with ourselves. So our flight from conversation can mean diminished chances to learn skills of self-reflection. These days, social media continually asks us what's "on our mind," but we have little motivation to say something truly self-reflective. Self-reflection in conversation requires trust. It's hard to do anything with 3,000 Facebook friends except connect. As we get used to being shortchanged on conversation and to getting by with less, we seem almost willing to dispense with people altogether. Serious people muse about the future of computer programs as psychiatrists. A high school sophomore confides to me that he wishes he could talk to an artificial intelligence program instead of his dad about dating; he says the A.I. would have so much more in its database. Indeed, many people tell me they hope that as Siri, the digital assistant on Apple's iPhone, becomes more advanced, "she" will be more and more like a best friend - one who will listen when others won't. During the years I have spent researching people and their relationships with technology, I have often heard "No one is listening to me." I believe this feeling helps explain why it is so appealing to have a Facebook page or a Twitter feed - each provides so many automatic listeners. And it helps explain why - against all reason - so many of us are willing to talk to machines that seem to care about us. Researchers around the world are busy inventing sociable robots, designed to be companions to the elderly, to children, to all of us. One of the most haunting experiences during my research came when I brought one of these robots, designed in the shape of a baby seal, to an elder-care facility, and an older woman began to talk to it about the loss of her child. The robot seemed to be looking into her eyes. It seemed to be following the conversation. The woman was comforted. So many people found this amazing. Like the sophomore who wants advice about dating from artificial intelligence and those who look forward to computer psychiatry, this enthusiasm speaks to how much we have confused conversation with connection and collectively seem to have embraced a new kind of delusion that accepts the simulation of compassion as sufficient unto the day. And why would we want to talk about love and loss with a machine that has no experience of the arc of human life? Have we so lost confidence that we will be there for one another? We seem increasingly drawn to technologies that provide the illusion of companionship without the demands of relationship. Always-on/always-on-you devices provide three powerful fantasies: that we will always be heard; that we can put our attention wherever we want it to be; and that we never have to be alone. When people are alone, even for a few moments, they fidget and reach for a device. Here connection works like a symptom, not a cure, and our constant, reflexive impulse to connect shapes a new way of being. Think of it as "I share, therefore I am." We use technology to define ourselves by sharing our thoughts and feelings as we're having them. We used to think, "I have a feeling; I want to make a call." Now our impulse is, "I want to have a feeling; I need to send a text." So, in order to feel more, and to feel more like ourselves, we connect. But in our rush to connect, we flee from solitude, our ability to be separate and gather ourselves. Lacking the capacity for solitude, we turn to other people but don't experience them as they are. It is as though we use them, need them as spare parts to support our increasingly fragile selves. We think constant connection will make us feel less lonely. The opposite is true. If we are unable to be alone, we are far more likely to be lonely. If we don't teach our children to be alone, they will know only how to be lonely. To make room for conversation, we can create sacred spaces in the kitchen or dining room. We can make our cars "device-free zones." We can demonstrate conversation to our children. And we can do the same thing at work where we are so busy communicating that we often don't have time to talk to one another about what really matters. Employees asked for casual Fridays; perhaps managers should introduce conversational Thursdays. Most of all, we need to remember - in between texts and e-mails and Facebook posts - to listen to one another, even to the boring bits, because it is often in unedited moments, moments in which we hesitate and stutter and go silent, that we reveal ourselves to one another. I spend the summers at a cottage on Cape Cod, and for decades I walked the same dunes that Thoreau once walked, looking at the water, the sky, the sand and at one another talking. Now they often walk with their heads down, typing. Even when they are with friends, partners, children, everyone is on their own devices. So I say, look up, look at one another, and let's start the conversation.

The Flight from Conversation

We live in a technological universe in which we are always communicating. And yet we have sacrificed conversation for mere connection. At home, families sit together, texting and reading e-mail. At work executives text during board meetings. We text (and shop and go on Facebook) during classes and when we're on dates. My students tell me about an important new skill: it involves maintaining eye contact with someone while you text someone else; it's hard, but it can be done. Over the past 15 years, I've studied technologies of mobile connection and talked to hundreds of people of all ages and circumstances about their plugged-in lives. I've learned that the little devices most of us carry around are so powerful that they change not only what we do, but also who we are. We've become accustomed to a new way of being "alone together." Technology-enabled, we are able to be with one another, and also elsewhere, connected to wherever we want to be. We want to customize our lives. We want to move in and out of where we are because the thing we value most is control over where we focus our attention. We have gotten used to the idea of being in a tribe of one, loyal to our own party. Our colleagues want to go to that board meeting but pay attention only to what interests them. To some this seems like a good idea, but we can end up hiding from one another, even as we are constantly connected to one another. A businessman laments that he no longer has colleagues at work. He doesn't stop by to talk; he doesn't call. He says that he doesn't want to interrupt them. He says they're "too busy on their e-mail." But then he pauses and corrects himself. "I'm not telling the truth. I'm the one who doesn't want to be interrupted. I think I should. But I'd rather just do things on my BlackBerry." A 16-year-old boy who relies on texting for almost everything says almost wistfully, "Someday, someday, but certainly not now, I'd like to learn how to have a conversation." In today�s workplace, young people who have grown up fearing conversation show up on the job wearing earphones. Walking through a college library or the campus of a high-tech start-up, one sees the same thing: we are together, but each of us is in our own bubble, furiously connected to keyboards and tiny ouch screens. A senior partner at a Boston law firm describes a scene in his office. Young associates lay out their suite of technologies: laptops, iPods and multiple phones. And then they put their earphones on. "Big ones. Like pilots. They turn their desks into cockpits." With the young lawyers in their cockpits, the office is quiet, a quiet that does not ask to be broken. In the silence of connection, people are comforted by being in touch with a lot of people - carefully kept at bay. We can't get enough of one another if we can use technology to keep one another at distances we can control: not too close, not too far, just right. I think of it as a Goldilocks effect.
Texting and e-mail and posting let us present the self we want to be. This means we can edit. And if we wish to, we can delete. Or retouch: the voice, the flesh, the face, the body. Not too much, not too little - just right. Human relationships are rich; they're messy and demanding. We have learned the habit of cleaning them up with technology. And the move from conversation to connection is part of this. But it's a process in which we shortchange ourselves. Worse, it seems that over time we stop caring, we forget that there is a difference. We are tempted to think that our little "sips" of online connection add up to a big gulp of real conversation. But they don't. E-mail, Twitter, Facebook, all of these have their places - in politics, commerce, romance and friendship. But no matter how valuable, they do not substitute for conversation. Connecting in sips may work for gathering discrete bits of information or for saying, "I am thinking about you." Or even for saying, "I love you." But connecting in sips doesn't work as well when it comes to understanding and knowing one another. In conversation we tend to one another. (The word itself is kinetic; it's derived from words that mean to move, together.) We can attend to tone and nuance. In conversation, we are called upon to see things from another's point of view. FACE-TO-FACE conversation unfolds slowly. It teaches patience. When we communicate on our digital devices, we learn different habits. As we ramp up the volume and velocity of online connections, we start to expect faster answers. To get these, we ask one another simpler questions; we dumb down our communications, even on the most important matters. It is as though we have all put ourselves on cable news. Shakespeare might have said, "We are consumed with that which we were nourished by."

Infertility and the Mind-Body Connection

Couples in distress may disagree about sexual issues, romance, money, or infidelity. They criticize and blame each other, and often cannot let go of painful incidents or arguments from years past. They are quick to bring up grievances with their partner but are unable to listen and truly hear what their partner has to say. What is going on?

Drs. Sue Johnson, Harville Hendrix and Helen Hunt, believe that the root of the problem is that the partners do not have an adequate emotional connection. They state that the need for a safe emotional connection is basic to all relationships. When that connection is present, partners feel safe with each other, and can risk emotional vulnerability as they listen and speak to each other openly about their feelings and needs. When safe connections are lost, partners seek to protect themselves and avoid hurt. They may blame each other, or even get aggressive in an effort to get a response. Alternately, they may shut down and try not to care. If the reconnection does not occur, their struggle intensifies, continues, and becomes more painful.

Think about the messages that you have received from important people in your life about closeness and trust. What did your past relationships teach you? Did you see loved ones as reliable or untrustworthy? Was your voice heard and listen to, or were you told to be "seen and not heard?" Did you learn to distance yourself, or not need others because depending on others was dangerous? Were you taught that it is weak to need closeness, or support? What strategies did you use in past relationships when things went wrong? When you felt alone or disconnected in your present relationship did you become very emotional and demanding, or were you more likely to shut down? How well do these patterns work for you in your relationships?

Relationships are never easy but as you become aware of your dysfunctional behavior patterns, you have the power to change them. You can make your relationships more meaningful by learning a new way of relating to one another. As you develop healthy communication patterns you will be building trust and allowing rewarding emotional connections.

Hold Me Tight, Dr. Sue Johnson
Making Marriage Simple, Harville Hendrix, PhD and Helen Hunt, PhD

Sorry I Worried You

A funny thing happened after I posted "Bad News." When I wrote this blog, my intention was to increase your awareness of the fragility of life. I wanted to remind you to treasure each day and live life to its fullest. After this posting, I began to receive emails and phone calls asking about my health. I was really surprised and puzzled. Why were they worried about me? As the only child of a very anxious, overprotective mother, I learned at an early age to carefully minimize and understate any problems or concerns that I might have. Never would I write in a way that I thought would create anxiety or upset others. Yet, totally unaware of the impact that this blog might have on some of you, create worry is exactly what I did do. The reactions of those who expressed concern about me reminded me of my mother who projected her own feeling of inadequacy on to me. My mother immigrated to this country as a young teenager. A foreigner, unable to speak English, she had many reasons to feel vulnerable and insecure. She was close to forty years of age when I was born, healthy, but weighing only 5 pounds. Mom felt guilty and was ashamed by my low birth weight which she saw as another personal failure. As I grew up, my mother's anxiety and overprotective behavior was troubling. As a child trying to develop my own sense of confidence and competence, I perceived Mother's fears and doubts as a lack of confidence in me. I must confess I was not very sympathetic. We never spoke about the very real origins of her worry. I was unable to empathize with her issues or realize that they came from her childhood which was quite different from my own. Perhaps if we had spoken more, I would have known that those issues did not belong to me and would have been able to say "I am sorry to have worried you." Too often I see couples who fall into the same trap because they do not communicate effectively. Expectations of each other can vary by each one's emotional needs or even differing role models from the past. Painful misunderstandings develop when they cannot speak about the differences between them. For example, one partner may expect to be taken care of while the other partner may value a more independent relationship. Different financial or sexual expectations may result in a partner feeling undesirable or like a failure. They desperately need each others' emotional support. Instead, they become more distant or antagonistic and less likely to empathize with one another, or say, "I'm sorry I hurt you."

Bad News

"I'm afraid I have bad news." The moment that you or someone close to you hears these words, your life changes permanently. Gone is the illusion of immortality. Gone are your feelings of safety and invulnerability. In that moment you realize that life is finite and does not go on forever. Suddenly you are living on the edge, day-by-day. All of the things that until now had seemed so important are now insignificant. Job success, financial gain, slights by friends or conflicts with family members now seem petty and trivial as you begin the fight to stay alive. Fear becomes a constant visitor. A black cloud that never completely goes away hovers overhead. Isn't it remarkable that it takes a jolt like that to so drastically change the perspective on our lives? We think less about past disappointments or goals for the future. We hope and live day-by-day. We wonder how we could have gotten so caught up in the minutia of our daily lives that we forgot to slow down and smell the roses. Maybe this journey thankfully is not yours, but one that you witnessed someone else going through. Maybe you were fortunate enough to get good news. How much will that near miss change the way that you live your life? How quickly will you forget and return to the old life style? Or, will you hear it as a wake-up call and have the courage to focus on what is truly important to you? You don't have to wait for the shock of terminal illness, or the sadness of watching someone that you care about waste away to take better care of yourself and live a fuller more meaningful life. The time is now!

Choosing a Therapist: Psychiatrist or Psychologist

The term "psychologist" and "psychiatrist" are often used interchangeably to describe a person who conducts psychotherapy. In fact,these two professions are not interchangeable. There are significant differences between these professional roles. Examining the educational background required for each profession can be helpful in understanding their differences. Psychiatrists go to medical school like other physicians. After three or four years they receive their M.D. degree. They spend the next four years in a residency which generally includes inpatient and outpatient rotations in general medicine, family medicine, pediatrics, neurology, and psychiatry. This residency does not usually include specific training in psychology and psychotherapy. After they complete their residency and pass the state board exam, these physicians can obtain a license to practice. As physicians, they are able to prescribe medicine and admit patients to hospitals. Clinical Psychologists typically spend five to seven years receiving graduate training in psychology in order to obtain a doctoral degree, (most commonly a Ph.D. but may be a Psy.D. or an Ed.D.), in clinical or counseling psychology. Psychology is the study of people: how they think, act, react, and interact. All course work is related to understanding every aspect of human behavior and the thoughts, feelings, and motivation underlying this behavior. Two years of supervised clinical experience follow receipt of the doctorate degree when candidates are trained to diagnose, perform psychotherapy, and help people understand themselves and address their emotional issues. Following these two years of clinical experience, they may take the state licensing exam. Only after they have met the above requirements and passed the state licensing exam are they able to practice clinical psychology and call themselves a "psychologist." Some psychologists and psychiatrists go on to receive further specialized training after attaining their Ph.D. or M.D. Degrees. Advanced programs in child, adolescent, family, marriage and couples therapy, group psychotherapy, psychoanalytic psychotherapy, and behavioral and cognitive therapy may require at least one to three years of additional coursework and supervision. A clinician who has obtained one or more Certificates in advanced training programs is among the most highly trained mental health professionals. Psychotherapy is conducted with individuals, groups, couples, and families. Psychotherapists help people to overcome stress, emotional problems, relationship problems, and troublesome habits. Psychologists treat people by providing psychotherapy focused on helping people understand the root of their problems and what they can do to change destructive behaviors, grow emotionally, and enhance their lives. Most psychiatrists in private practice focus on symptom relief using medicine to correct chemical imbalances that affect their clients. Most psychologists do not prescribe medicine. However, some psychologists who have taken advanced training in psychopharmacology can prescribe medicine as a part of their psychotherapy treatment.

What Do We Owe Our Children?

What do we owe our children? Are we wrong to spend our time and money on ourselves when our children are having hard times? These questions come up for discussion over and over again among parents of adult children. Some of these parents are part of the self made generation who started with little and became successful through years of thrift and hard work. Some pursued higher education and paid for it themselves, others did not go to college. Their goal was to give their children the comforts and advantages that they missed when they were growing up. They reminisce about their immigrant parents and are proud of their own independence and that, on their own, they became more successful than their parents. They are critical of their adult children who seem to feel entitled to the luxuries that their parents waited for for many years. Parents seem unaware that by rescuing and indulging, they helped to mold their children into adults who are less resilient when they fall on hard time. Unlike the parent's generation, their adult children are not as independent and are quite comfortable asking for childcare help or for money to help them maintain their expensive lifestyles. Some parents of the senior generation have trouble giving to themselves long after the financial necessity of counting pennies has past. The other day I spoke with an 90 year old woman who was wracked with guilt at the thought of spending some of her dwindling financial resources on her own medical needs at a time when her married child's business was slow. She was quite able to empathize with his financial concerns, but did not feel entitled to expenditures for herself that she would consider luxuries, but were truly necessities. This was very disturbing to me. So what do we owe them? One excellent answer came from Jonas Salk. He said "Good parents give their children roots and wings." Roots give them a knowledge of home and keep them grounded through tough times, and wings recognize the need for autonomy so that they feel comfortable venturing out into the world and maybe even flying farther than we ever did. Perhaps as we recognize their strengths and encourage their autonomy, we can develop a more mutual relationship with our adult children.