Relationships Depression Anxiety Mental Health Information

Dr. Stan Tatkin on Co-Dependency Versus Inter-Dependency (as well as other aspects of relationships)

2/28/2016

What exactly is the difference between co-dependency and interdependency?

This is a question that comes up a lot for folks who are familiar with the idea of co-dependency. Many of us have an idea that we are supposed to "love ourselves before we can love others" and "be the source of our own happiness." We may feel that if this is not happening that we are being "dysfunctional" or "co-dependent." One of the interesting things to me about the re-focus on attachment research in the past decade of psychology has been the re-realization that humans are inherently dependent on others. We are born some of the most vulnerable babies of all species, requiring a full decade if not more of intensive parental involvement. Our brains do not actually finish maturing until halfway through our second decade of life. We have always, and continue to, live in groups or "packs". We use solitary confinement as the worst punishment for the worst humans. So how many of us got this idea that depending on others was bad or pathological seems curious indeed.

I recently encountered a podcast with Dr. Stan Tatkin, a prominent couples therapist and author who utilizes attachment theory as a foundation of his work. Among other things in this interview Dr. Tatkin shows how his model is representative of healthy interdependency versus the pathological idea of co-dependency. It would take several pages for me to summarize his theory on this point and he does a perfectly fine job on his own. So for those reasons rather than try to explain his viewpoint to you I suggest that you listen yourself:

http://www.neilsattin.com/blog/2015/12/19-recipe-for-a-secure-healthy-relationship-with-stan-tatkin/

He gets to the topic of codependency around 20 minutes in to the podcast. While you are there you may want to check out other topics in this podcast which specializes on relationships. The podcaster has many excellent guests on his shows and seems to cover a lot of important ground.

And if you are interested in learning more about healthy relationships, as always I also recommend Dr. Tatkin's audio program, Your Brain On Love, as well as his books, Wired For Love and Wired For Dating.

Wishing you happiness in your connections,

Dr. Jordan

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A Trip To The Pound

2/27/2016

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A thought occurred to me the other day in the midst of counseling a couple. One of them had recently adopted a dog from the animal shelter. She was talking about the history of the dog and why it had certain habits and fears. To all of us in the room it went without saying that since the dog had been mistreated by it's previous owners it came with "issues". I think many of us have had those experiences, like raising your hand to pet a dog and watching it flinch or cower. Our first thought in that situation is "oh dear, I bet this dog has been abused!". We generally don't get mad at the dog for misunderstanding us. Nor do we expect the dog to know that we are not the same person who previously hurt them. We are generally concerned and patient and understand it will take the dog time to trust us. We also would not be surprised if a dog trainer told us that there were some things we could do on our part to not create fear in the dog.

So while all of this is usually pretty obvious to humans in regards to dogs, the corollary to understanding our relationship partners is sadly not all that intuitive. We are often upset to find that our partners, who had previous "owners" (parents/caregivers) have baggage and a host of unconscious expectations that cause them to misunderstand us and sometimes act in ways that don't make sense. By the way, they are seeing the same behaviors in us! It's as if one dog from the pound (with their own history of having been neglected or hurt in the past) adopts another dog from the pound (with their own history also). You can imagine the problems that ensue.

If you have read my blog posts or website you may know that I practice a particular style of couples therapy-- PACT. In that style of therapy we find it useful to look for certain patterns of behavior that arise from particular histories of interactions with our early caregivers. These patterns are called "attachment styles". There are two basic styles that represent the majority of us who end up having relationship problems-- "Avoidant" (which Dr. Stan Tatkin calls "Islands") and "Resistant" (which Dr. Tatkin calls "Waves"). These two predominant patterns can be described in terms of types of dogs you may encounter at your local pound.

The "Avoidant" or "Island" type of partner is like the dog at the pound who, when you approach the cage smiling and holding out a treat, backs up and hopes you will go away. You may feel hurt or rejected, even annoyed. You may think to yourself "hey, I'm the good guy here!", "c'mon buddy, give me a chance!" If you are patient and give the dog a little space in time he or she will likely relax and may even show some interest. If you open the cage and again give the dog space it will, in it's own time, come out. But don't expect this type of dog to jump into your arms in the first few minutes! He or she will need to move past you and walk around a bit, making sure that you do not represent any danger or infringement on their free will. Once the dog has established that you are OK letting it walk about freely it will likely approach you, in it's own time, and perhaps make a gesture of interest. If you move too quickly or with too much enthusiasm this type of dog will back away and then you are back to square one for a bit.

If you try to imagine what kind of history this dog has it's not hard to conjure: This dog was neglected. It had the kind of owner who put out food and water but did not show the dog much affection. The dog is not used to being engaged or approached much. When this owner did approach the dog it was likely for the dog to do something for the owner rather than the owner doing something for the dog. Perhaps it was an older dog who was too tired to run much, but the only time the owner came to it was to drag it out for a run because that's what the owner wanted to do. The owner missed the cues from the poor dog that this was only fun for the human! The owner simply threw a leash on the dog and dragged it around the block, perhaps even chastising the dog for going to slow. Then upon returning home the dog is put back into it's corner and ignored again. This dog will come to see his owner as a task-master who is only really interested in him or herself. The dog will be mistrustful of approach because it only means that the dog is now expected to do something that the dog may have no interest in. The dog has learned that the owner is not sensitive to it's needs or wants and most of the time leaves it alone. So the dog learns to entertain itself and gets pretty good at this. It can stare out the window and watch birds or run around alone in the back yard chasing squirrels. But the dog does not expect the owner to partake of these activities or show any interest in what the dog is doing. In fact, the dog comes to prefer not being noticed by the owner because the owner is only interested in their own needs and the dog finds that unpleasant and unfair.

Notice that this dog is not necessarily abused. It's just emotionally neglected. Therefore when you show a lot of enthusiasm and rush forward to give it a big hug at the pound this dog is not comfortable with that. It will try to avoid that kind of effusive contact and get more space from you. In time, if you are patient, it may become more comfortable with you and the dog may even come to enjoy a certain amount of attention. But it may also never be the kind of dog that you can scoop up and hug and smooch all over. The dog has baggage.

Now compare that to a different kind of pound pooch. This dog has been intermittently abused and praised by its owner. Confusing, right? This owner was a bit moody and wrapped up in their own dramas. On a good day they would lavish the dog with treats and hugs and then on bad days might yell at the dog or even give it a kick. The dog was not able to know from day to day what was coming. So the dog also learns to be guarded. Only when you approach this dog at the pound they don't necessarily want you to go away. Part of them is thinking "well, this could be good...you may have a treat for me". But the other part of the poor dog is thinking "yeah, but this could be bad!". So the dog may approach but with ears back and a slightly open jaw, ready to bite if things turn ugly. When you see the dog approaching you in this way you might think "geez! Here I am trying to be nice and it looks as if you may bite me!" This type of dog may even approach you and growl, only to then lick your outstretched hand. Their behavior is likely to be a confusing mix of pleasure at your attention and fear and even anger at what they perceive is potential backlash. Even more confusing is that this dog, right after growling at you, will likely follow you into the next room. The dog does not seem to want to be alone, even though half the time when you try to engage it the dog may snarl or bark at you! And even more frustrating this dog may tear up your furniture in protest if you leave it alone for too long. This dog is certainly a confusing fellow! But, if treated with love and patience, this dog will eventually growl less and lick more. However it may always be quick to curl it's lip and look like it's about to bite. It's up to you to know how to help the dog feel safe and loved and to not take it too personally when the dog seems scared or testy. This dog would, if it were human, correspond to the attachment type of "Resistant" or in Tatkin's terms, a "Wave." This dog too has baggage.

When we meet our life partners they are not newly birthed puppies. They are middle-aged dogs with histories of having been, much of the time, mistreated in some way or another by someone in their formative years. It may not have been out and out abuse (although that is certainly possible), it may have been mild emotional neglect or moderate mis-attunement or confusion behaviors from distressed or overwhelmed parents. Whatever the case, they have baggage (as do we!). We need to come to expect this and not take it personally. We need to try to learn about our partner's histories and figure out how we can offer corrective experiences that will, over time and with patience, reduce their problematic behaviors. And we need to be reasonable about our expectations, knowing that while you can teach old dogs new tricks, you may have to use some pretty persuasive treats and even engage your friendly (PACT certified!) "dog trainer".

Wishing you the best in your loving connections (both human canine),

Dr. Jordan

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The Definition of Mental Health

2/23/2016

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I've heard it said that Freud's definition of the goal of therapy was this: to transform neurotic suffering into ordinary suffering. One might infer that his definition of mental health was the capacity to suffer "normally" rather than "neurotically". Freud is also purported to have said that mental health was the capacity to love and work. While I like both of those concepts I have a definition of mental health that I like even better: response flexibility. What exactly does that mean? To me, response flexibility means tht whatever situation you are in, you are able to respond in the best manner given the circumstances. Many of us actually respond to situations based on a surprisingly limited repertoire of alternatives. For instance, if you were raised in a family where conflict was avoided, when you encounter conflict I can predict you will try to avoid it if at all possible. But what if in that situation the best response is to actually engage in the conflict? What if the conflict is a conversation with your boss about why you, versus your co-worker, should be given the promotion? By avoiding conflict or discord you may sell yourself short of some important opportunities.

So in this example what can you do? If you have good mental health you would be able to respond assertively or move in to the conflictual conversation without being overly intimidated. This would predict you had either grown up in a pretty healthy family or you had worked hard to overcome your default response of avoiding conflict. In either situation if you can respond adaptively rather than reflexively you have good mental health.

Too many of us, however, don't have this kind of flexibility. We are on auto-pilot much of the time, running via default programs that we learned in our family of origin. I would argue that this is not "good" mental health! I believe all people can learn to un-do unhealthy or limiting patterns and enlarge their repertoire of behaviors. This does not mean giving up the old patterns but rather layering on new ones to allow for more flexibility in responses.

While that is my favorite definition of mental health (which incidentally also guides my work as a therapist) there are certainly others worth considering. For instance, in the Shedler Westen Assessment Procedure (SWAP–200; Shedler & Westen, 2007) mental health is defined in much more detailed terms:

● Is able to use his/her talents, abilities, and energy effectively and productively.

● Enjoys challenges; takes pleasure in accomplishing things.

● Finds meaning in belonging and contributing to a larger community (e.g., organization, church, neighborhood).

● Is able to find meaning and fulfillment in guiding, mentoring, or nurturing others.

● Is empathic; is sensitive and responsive to other people’s needs and feelings.

● Is able to assert him/herself effectively and appropriately when necessary.

● Appreciates and responds to humor.

● Is capable of hearing information that is emotionally threatening (i.e., that challenges cherished beliefs, perceptions, and self-perceptions) and can use and benefit from it.

● Appears to have come to terms with painful experiences from the past; has found meaning in and grown from such experiences.

● Is articulate; can express self well in words.

● Has an active and satisfying sex life.

● Appears comfortable and at ease in social situations.

● Generally finds contentment and happiness in life’s activities.

● Tends to express affect appropriate in quality and intensity to the situation at hand.

● Has the capacity to recognize alternative viewpoints, even in matters that stir up strong feelings.

● Has moral and ethical standards and strives to live up to them.

● Is creative; is able to see things or approach problems in novel ways.

● Tends to be conscientious and responsible.

● Tends to be energetic and outgoing.

● Is psychologically insightful; is able to understand self and others in subtle and sophisticated ways.

● Is able to find meaning and satisfaction in the pursuit of long-term goals and ambitions.

● Is capable of sustaining a meaningful love relationship characterized by genuine intimacy and caring.

● Is able to form close and lasting friendships characterized by mutual support and sharing of experiences.

The World Health Organization defines mental health as "as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community." They go on to elaborate that "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

The question of what defines good mental health is certainly worth entertaining. How do you know if you need to work on yourself if you don't know what the goal is? I encourage you to give some thought to what definition of mental health appeals most to you and then check yourself accordingly. Not to skewer yourself for failing that standard in some ways (after all that would not be very mentally healthy!) but rather to see areas where you may want to change and grow. None of us can be 100% mentally healthy all of the time, but all of us are capable of improving.

Therapy is an amazing tool for growth, as are 12-step groups, meditation practices, support groups, spiritual practices and even yoga when the philosophical aspects are included. I encourage you to think about ways that you can assist yourself in growing towards more mental health.

Best wishes,

Dr. Jordan

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Youtube for Anxiety?

2/11/2016

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Many people who contact me are suffering from anxiety. Anxiety can cause a number of problems ranging from irritability, depressed mood, lack of productivity or insomnia.

The first thing I always want to know is are they exercising? Most of my patients who have anxiety find that exercising vigorously most days of the week will reduce their anxiety a considerable amount.

That said exercise is not usually sufficient to remove all anxiety from someone who struggles with it. We almost always need to look at other lifestyle factors (like reducing caffeine and other stimulants) as well as other techniques such as diaphragmatic breathing, guided relaxation practices and mindfulness meditation practices. What follows are some basic videos that people can watch in order to learn how to use these techniques to help with anxiety.

The first link is for teaching diaphragmatic breathing. Some people call it "belly breathing". The reason it's helpful to learn this technique is that if you can fully engage your diaphragm by doing this type of breathing it stimulates the parasympathetic part of your nervous system. That part of the nervous system is what causes your body to relax. If you have been stressed out then your nervous system most likely is sympathetically activated, meaning that the sympathetic branch of the nervous system is dominant. This part of the nervous system (the sympathetic branch) dumps a lot of adrenaline and cortisol (stress hormone) into your bloodstream which causes symptoms of anxiety like shallow breathing, sweating, hot flashes, increased heart rate, stomach upset, headaches, muscle tension, etc. The way to stop this stress response is to activate the parasympathetic nervous system by doing diaphragmatic breathing.

This link will give you a super simple explanation of diaphragmatic breathing :

https://youtu.be/0Ua9bOsZTYg

This link will show you a person doing diaphragmatic breathing so you can follow along and practice it:

https://youtu.be/8-_NNCrrdus

This next one is a specific pattern of breathing that also activates the relaxation response and this is another good tool for turning off the stress pattern if you have started to feel anxious:

https://youtu.be/YRPh_GaiL8s

You can also do the diaphragmatic breathing with a 4-7-8 pattern, or if you prefer you can use any pattern where you exhale longer than you inhale (so for example inhale for 5, hold for 2, exhale for 6, or any other variation as long as the exhale is longer than the inhale).

In order to maximize benefit you should try to practice some form of relaxation breathing at least 2x/day for at least 5 minutes each time. Once you have the hang of it you can increase to up to 10 min each day. Many folks make one of those times when getting ready to fall asleep. It can help you relax and fall asleep if anxiety tends to keep you awake.

The next tool in the anti-anxiety arsenal are mindfulness meditations. These have been shown to reduce anxiety and depression, improve concentration and attention and even improve control over your emotions. Studies show that doing this just 11 minutes each day will produce actual structural changes in the brain (increased activity of the frontal lobe). It helps reduce symptoms of ADHD, depression and anxiety as well as increasing emotional control.

At first you should probably just try 3-4 minutes of mindfulness at a time. Doing too much at once can make it annoying and then you might get turned off to it. Try to start with 3-4 minutes each day and after a few days add another minute, do that for a few days, then add another minute and so on. Eventually you will want to do at least 11 minutes each day of mindfulness meditation.

All of the following videos have good technique so you can try them all and see which ones you like. You can also search yourself on youtube for other ones. But remember even if the video is 20 or 30 minutes just do 3-4 minutes at first. You will not be able to empty your mind, it is totally normal to have thoughts intruding constantly. That's fine. The goal is just to notice the thoughts and then let them go. I think of them like people walking into the room and I notice them and say "hi" and then let them walk away and I let them go. The goal is not really to empty your whole mind because the human brain does not work that way. It's just the process of acknowledging the thoughts and letting them go that builds the brain in the areas that benefit you.

https://youtu.be/8v45WSuAeYI

https://youtu.be/Fpiw2hH-dlc

https://youtu.be/7nTzx5V6oFU

And finally here are links to guided imagery for sleep. These are great to help you fall asleep. You just start playing it when you lay down to sleep and usually folks fall asleep before the whole program finishes.

https://youtu.be/l4r6r2lGKgU

https://youtu.be/zOFxVMlnNdw

https://youtu.be/Z94V5-K-1bA

If you don't like any of these you can search with keywords "guided imagery for sleep" or "hypnosis for sleep" to try some other ones. You can also specify in your search male or female voice, music vs. nature sounds, etc.

If you have other youtube videos that you have found useful for managing anxiety or for falling asleep I would love to hear about it! Send me an email or post your comment below.

Thanks and stay tuned to more ideas on managing symptoms of anxiety without medications.

Best wishes,

Dr. Jordan

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Relationships in the Digital Age

2/2/2016

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Have you ever wondered how a text stands up to a phone call? Or a phone call to an in-person meeting? What about emails? How have all of these modern developments affected our human relationships?

There is new research coming out now that these forms of electronic communication are NOT equivalent to the old-fashioned face-to-face talking/interacting. Which makes sense when you consider that the human brain would have a lot of trouble evolving at a pace to keep up with the latest iPhone app or emoticon. Our brains were wired for in-person interactions in which we can use data from the visual stream, and vocal tone, volume and pitch. We intuitively know what a frown means even when no words accompany it, and we also know that even if said with a smile certain words uttered in a snarly tone mean a fight is brewing. These kinds of nuances cannot be parsed out by the human brain when the message is communicated via text or email and may only be partially correctly decoded in a phone-call or audio message. Furthermore not only is it likely that the message can be mis-interpreted but our poor brains also can't derive the type of support that they need from these relationship proxies.

In one study done with girls who were put into a stressful situation it was shown that being able to either talk to a comforting person (their moms) over the phone or meeting up with this person after the stressor reduced physical signs of stress (levels of cortisol) compared to texting, which did nothing for stress. Additionally being able to talk on the phone or in person with the support-person caused a release of oxytocin, a hormone that helps us bond and mitigates the effects of stress. Again this effect was not seen with texting.

In another study done on adults over 50 researchers found that the probability of having depression increased as the frequency of in-person contact with other people decreased. Meaning that the less real-live contact that these people had with other humans increased the likelihood that they would suffer depression. Humans need other humans and we need to be with each other in ways that are not purely viritual.

So keep those you love close-- close enough to see, touch and hear without the interloping of wires and circuitry. And reach out to them frequently for contact and connection. Save the less personal forms of communication for business and less significant relationships if you want to be happy and healthy. At least until Mother Nature comes out with thehumanbrain2.0. But I'm not holding my breath.

Wishing you happiness and connection,

Dr. Jordan

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Reflections on all things psychological and the science of being human

Dr. Stan Tatkin on Co-Dependency Versus Inter-Dependency (as well as other aspects of relationships)

A Trip To The Pound

The Definition of Mental Health

Youtube for Anxiety?

Relationships in the Digital Age

Krista Jordan, Ph.D.

Archives

Categories

Reflections on all things psychological and the science of being human

Dr. ﻿Stan Tatkin on Co-Dependency Versus Inter-Dependency (as well as other aspects of relationships)

A Trip To The Pound

The Definition of Mental Health

Youtube for Anxiety?

Relationships in the Digital Age

Krista Jordan, Ph.D.

Archives

Categories

Dr. Stan Tatkin on Co-Dependency Versus Inter-Dependency (as well as other aspects of relationships)