My four-year-old daughter placed herself in the middle of our living room to play with blocks. She was so engrossed with building a wooden castle that she didn’t notice her two-year-old sister walking towards her with her right arm stretched far back to slap her older sister across the head. When that slap came, my older daughter went from happy to surprise to anger and then lots of tears. She ran towards me seeking justice. “Mommy, she hit me!” My younger daughter remained still, looking innocent. I immediately walked over to her with my older daughter in hand and said, “Hands are not for hitting. Say sorry for hitting please.”  I’m sure many parents can relate to this scenario. Teaching our children the skills for making amends is an important life skill and is not so much about saying the words “I’m sorry”.  

There is a belief amongst some parents that enforcing premature apologies on children is not effective. Their reasoning is that premature apologies teach children to lie and encourage insincerity. It also creates shame and embarrassment. Other studies show that young children have the ability to be empathetic even before they can speak; therefore, parents should encourage apologies (Smith, Chen, Harris; 2010). As I reflected on my research and my knowledge as a Marriage and Family Therapist, I recognized several things we can do as parents to create productive apologies: 

1. Keep yourself in check: It’s frustrating to see your children fight, especially when it happens at inconvenient times. However, it’s important to remain calm and model for your children how to handle frustration.   
2. Be immediate when possible: When you see an incident occur between your children, address it. The best time for learning and growth is when the incident is still fresh in their minds. However, when there are time constraints and the issue cannot be addressed right away, it is important to tell your children when and where it will be addressed. Be consistent when using the alternative and follow through.  
3. Ask instead of tell: Avoid lecturing. Ask questions instead. “Tell me what happened?” “What were you feeling when you hit your sister?” Validate the expressed emotion and help them to understand that it is okay to feel frustration and sadness; however, it is not okay to hit or throw things. Help them to also make the connection between emotion and action. “Look at her face, how do you think she’s feeling right now?” Asking these types of questions enhances empathy. 
4. Problem Solve: Ask questions about what they think they should do when they feel frustrated or sad. Help them to come up with solutions.  Ask questions about how they can make things better with their sibling/s. 
5. Have them practice a do-over: When your child identifies the solution, have them practice it with the other sibling/s. Praise them for their efforts at the end.    

What is more important than the phrase “I’m sorry” is what children take away from the experience. We can facilitate and enhance learning opportunities by not focusing on the phrase “I’m sorry” but instead more on what can be learned from this situation and how can we improve.  

 

Originally posted here: http://www.provofamilies.com/2018/02/07/forced-apologies/

For most of us, depression is something that comes and goes. For a few of us, it’s something that comes and stays – for reasons that we don’t always know or understand. When we lose someone lose to us or have a situation that hurts, we might feel down. This type of depression can be situational more than anything else. This happens often after women give birth. For months following, they might feel down or blue. If they are able to pull themselves out of it through sleep, eating well, taking a shower, reading a book or some any other way that they use to cope, then its usually not post-partum depression. If it doesn’t go away after these attempts, it can be something more serious and may need medical or professional help. Depression is the same way. We can’t expect to pull ourselves out of depression on our own when it is the more serious type. Counselors are trained professionals who can help. Many of them will utilize the power of your relationships and invite your family to attend sessions. This helps because you are then able to connect to those who matter most and work it out together.

Every now and then, most of us feel down or blue – this is different than depression. Situational sadness comes and goes with whatever is getting us down. For example, if you don’t get recognized for something you worked hard at, you will probably feel sad. After time, your sadness will start to disappear. It isn’t as sad over time. This is situational. Depression, on the other hand, seems to last beyond these events. Even when something potentially sad has come and gone and if there is seemingly no reason to feel sad, you still might feel sad. This can especially be true in the winter. The days are shorter and colder. This causes most of us to stop moving as much, and to stay inside. We then lack exercise and sun light. On top of that, with the Halloween, Thanksgiving, Christmas and New Year’s, we tend to eat food that isn’t as healthy. We eat more sugar. This all contributes to feeling sad when we don’t seem to have anything to be sad about. Seasonal Affective Disorder (SAD) is what happens to many people during the winter months. Most people don’t realize they have this type of problem, they just think that they are down or blue. It is more than just having the ‘winter blues’. It impedes you in your daily life and interferes with your functioning. Recognizing that you have SAD will help you know what to do to overcome and let go of it. Some of the symptoms include: feeling sad, losing interest once enjoyed, change in appetite, change in sleep (usually sleeping more), loss of energy, restless activity, feeling worthless or guilty, trouble making decisions, and thoughts of suicide or death. If you think you might have this type of depression talk with a therapist today.

Couples often come into therapy for ‘communication problems’. As a therapist for the last decade, I have found that this means many things – depression, anxiety, affairs, pornography use, among other issues. Outside of Utah County, pornography use seems to be more acceptable, or at least, less talked about as an issue. Is use in other locations less, or merely seen differently? When I speak with couples, this is something that is very painful and difficult to understand and overcome. There is a tremendous amount of shame associated with use. As we work in counseling to overcome the addictive cycle, the spouse who is using has to learn to attach to their partner instead pornography. This attachment is key to recovery and future success in a relationship. John Bowlby, an early psychologist, helped define attachment theory over his career. He found that they attachment between a child and a parent is crucial to the child’s development. Likewise, the attachment between partners is also crucial. When couples are able to create a safe base or a safe haven, as Susan Johnson references in her Emotionally Focused Therapy work, they are able to be genuine and transparent with each other. They are able to show their imperfections to each other and be vulnerable and exposed because they know their spouse will accept and love them. This process is crucial to working with couples counseling for pornography use.

I am often asked the question, “Do I need medication?” As a counselor in Utah County, I work with couples, families, individuals suffering from depression, anxiety, pornography use, drug and alcohol use and other issues – all of which might need medication at some point. As a counselor, I am not trained to prescribe medication or do medication management, however, I often collaborate with practioners (i.e., MD’s, nurse practioners) who are. Together we are able to help many individuals overcome anxiety or depression. Talk therapy (couples counseling or individual therapy) and medication are often a good combination to combat the issues that bring most people into therapy.

My colleagues who prescribe medications often tell me how medications act like crutches. They aren’t meant for long term use or to be a ‘fix-all’, but rather, they are meant to give support so that an individual can gain strength. Once strong enough, the crutches are discarded and the individual moves on under their own power.

So, when clients ask if medication is warranted, I refer them to someone trained in this type of treatment. Medication is not always the answer, but there are times when it is best practice, however, to use medication and traditional talk therapy together (i.e., Bipolar disorder treatment). I refer them to see an MD, psychiatrist or nurse practioner. I encourage them to meet with someone who does Genetic testing for medications. This is a method where an individual submits a DNA sample which is sent to a lab for testing. The results show the individual and prescribing professional which meds are most likely to work with the individuals genetic structure (usually for anxiety or depression medications). My nurse practitioner colleague tells me that this ‘takes the guess work out of medication management’. Given that the typical experience for individuals trying medications is months of trial and error, this is a relief to many.

Pornography use often leaves the user feeling empty and shameful. To deal with this shame of using in the first place, they might actually use pornography again to numb themselves. This vicious cycle is played out within minutes of each other or within days, even weeks of each other.

 

I am often asked by spouses of pornography users one simple and somewhat complex question, “Why can’t they just stop using?” They tell me that they know that their spouse see’s how it hurts them and how it is ruining their lives and relationships. After a husband talks about his remorse about using pornography, a wife will often follow up with, “Then just stop it”. It isn’t this simple, however. Studies have shown the impact that pornography use has on an individual’s brain chemistry. Some would say that the brain and the person become hijacked – causing them to act in ways that they wouldn’t normally act. This is the same phenomenon that would cause a grandson to steal his grandmothers wedding ring to sell for drugs. You are not yourself, seemingly. The cycle of pornography use doesn’t make sense to those who are in it and doesn’t make sense to their loved ones.

 

Fight the New Drug is an organization who educates the public on the harmful effects of pornography. You will find a lot of good resources to understand this addiction. Strangely enough, it is somewhat a controversial addition. It is not included in the DSM-V (the big book of mental health disorders decided on by experts throughout the country). Educate yourself so that you can make a little more sense of it. A good counselor will also be able to help you understand the nature of this addiction as they work with you and your loved one. As a therapist in Provo Utah, I often see clients in these situations. I have several colleagues at the Center for Couples and Families that are experts in this area of treatment as well.

Secrets fuel addiction. As I’ve mentioned before in previous posts, addictions, such as pornography addictions, are a shame based experience. This means that when someone uses pornography they feel as if they are a bad person, rather than feeling that they are a good person despite making a mistake. When someone feels shame, they often compartmentalize what they have done – they hid it and separate it from who they think they really are, or, think that that mistake totally defines who they really are.

This is where secrets come into play. Over time, a man (or woman – I’ve worked with both in therapy for pornography issues) who has been using pornography and feeling shame because of it will gather many secrets. He won’t want to tell anyone what he is doing, or won’t want to tell them all that he is doing. He might only present the best parts of himself or just tell enough about his mistakes to others to appease them or to feel like he is being open. But, in fact, he is keeping secrets. These secrets start to bury him and make him feel more shame. They take effort to maintain and keep hidden. They cause him stress and to feel disconnected from others. All of these things can lead to more addictive acting out.

Being transparent is key. This, in part, is why in the 12-step model of recovery (for alcohol, sexual addiction or substance addiction) addicts are asked to write a fearless moral inventory and to share it. Being open with others can feel uncomfortable and embarrassing. Many would say, “It’s in the past – let it stay there” or, “I don’t want to hurt her, so I’m not going to tell her about it”. These mindsets only make things worse for someone using pornography and their spouse/family. Telling others and being transparent is on the path towards recovery.

Pornography counseling offers a venue to be transparent and honest with yourself and with your loved ones. A good therapist will help you through this process in a way that might be painful, but certainly not shameful.

Pornography has been called the ‘New Drug’, and rightfully so. Groups like Fight the New Drug have been working tirelessly to education people about the harmful effects of pornography. You might not need to read up on the latest research to know how damaging and painful it can be – whether it’s a personal struggle with pornography or your loved one who is using it.

 

Pornography use is often accompanied by shame. Shame is damaging. Guilt, on the other hand, is healthy. We need guilt, but don’t have to seek it out – it finds us. Guilt lets us know that we are doing something that is damaging to our body or soul. Guilt would say that, “I made a mistake, but I am still a good person’, Shame would say, “I made a mistake and therefore I am a bad person’. As a shame-based experience, pornography use goes beyond the physical act of using. It impacts our relationships, our ability to experience emotions in a healthy manner, our view and empathy towards others, and so much more.

 

What if you know that its unhealthy, but can’t seem to stop? Know that there is help. There are those around you that want to be there for you and would do anything to help. Depending on the severity of the pornography use, treatment is recommended. Without the aid of a professional, the road to recovery is difficult and sometimes seemingly impossible. My colleagues at the Center for Couples and Families often work with cases such as these.

 

At one point or another anxiety will impact you. Most of us have an experience with anxiety that makes us feel scared and stressed. Anxiety is the body’s emotional and physical response to a stressful situation or anticipation of a real or perceived difficult circumstance.

 

It’s important to understand that anxiety is largely a physical reaction to a real or perceived stressor. Calming your body down when anxious allows you to engage the coping skills you have at your disposal. When working with clients presenting with anxiety one of the first things we do is focus on techniques to cope through physical exercises such as diaphragmatic breathing or progressive muscle relaxation. After clients possess the skills to calm their bodies down when anxious, we are able to work on the emotional, relational and intellectual aspects of this difficult emotion.

 

Anxiety can often take the role of a secondary emotion – an emotion that presents itself as an attachment to your primary emotion. For example, if you are feeling sad, lonely, stressed overwhelmed you might get a general sense of anxiety. Knowing that anxiety is sometimes a secondary emotion helps you to know dig deeper to see what is really going on. Addressing the previous emotions in a specific and deliberate manner helps anxiety lessen.

It might seize you in the middle of the night, or perhaps at the beginning of a work meeting, or maybe while driving your kids to soccer practice. Wherever it happens, it can overwhelm you. Your mind won’t stop running. Your body is tense. Your heart is racing. You can’t breathe! You can’t relax and enjoy yourself. If you have ever felt a combination of these sensations, you have probably felt anxiety—a common experience among adults and adolescents. Whether you accept it or not, anxiety is part of a normal, healthy life. Diagnosable anxiety disorders, however, are different than normal, everyday anxieties. A hallmark characteristic of an anxiety disorder is excessive fear or anxiety about a real or perceived threat (DSM-V).

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 40 million people in the United States suffer from an anxiety disorder in a given year. That’s 18 percent of the population! Specific anxiety disorders include generalized anxiety disorder, selective mutism (failure to speak in social situations even when able to speak in other situations), specific phobias (fear of animals, objects, etc.), social anxiety disorder, panic disorder, or agoraphobia (fear of having a panic attack or other embarrassing symptoms in locations such as public transportation, standing in a line, etc.). Some anxiety disorders, such as phobias and generalized anxiety disorder, most often begin in childhood around 11 years old and can continue into adulthood if left untreated. These two disorders are the most common anxiety disorders in adulthood according to SAMHSA.

Because of their belief that things will not change, or that they just need to get over it, many suffering with an anxiety disorder do not seek treatment. The good news is that anxiety is treatable! Your biology has a lot to do with an anxiety disorder; therefore, a first step in reducing anxiety includes dealing with the body’s physical response to stress.

Diaphragmatic Breathing

Your body’s internal organ regulator, your autonomic nervous system (ANS), has two applicable parts of the solution. First is the sympathetic nervous system (SNS), which is in charge of your fight-or-flight responses. This part, for example, pumps up the mailman’s body so she can outrun that dog hiding in the bushes. Second is the parasympathetic nervous system (PNS), which aids in calming your body. This part helps her body deescalate after she has escaped that dog so she can return to delivering the mail as usual.

When you feel anxious, your SNS is engaged. To help calm your body in these moments, the key is to activate your PNS. The exercise outlined below (partially adopted from The Anxious Brain: The Neurobiological Basis of Anxiety Disorders and How to Effectively Treat Them) triggers this part of your ANS.

How to do it:

1. Lie down, stand, or sit in a comfortable position. Make sure you are “grounded” by creating an open posture with both feet on the floor and your back against a chair or bed. If you are crying, in the fetal position, or hunched over, this technique is difficult to do.
2. Breathe in deeply. Picture a water balloon being filled with water as you first fill up your abdomen with air and then your chest. Feel the warmth and the weight of the air as you breathe in.
3. Breathe out with an elongated breath—longer than it took you to breathe in. Purse your lips as you breathe out. This will slow your breathing. Breathing out slowly will help activate the PNS, which helps calm your body—the whole purpose of this breathing technique.
4. As you breathe in and out, focus on the physical sensations you experience. Focus on your feet touching the ground, your abdomen and lungs expanding and contracting, the feel of air rushing over your tongue and through your pursed lips. Notice how your head, arms and hands feel. Doing this will help you be present and in-the-moment.
5. Practice! This is a skill that must be developed. Try doing it while you are at work, stopped at a traffic light, or at home. Do each cycle (breathing in and breathing out) ten times or more, as you learn to engage your PNS.
6. If you feel dizzy, light headed or out of breath, do not continue this technique. If your breathing is restricted or obstructed there may be other issues to consider. Speak with a therapist or doctor about the appropriateness of this exercise for you. This technique is a good start to help reduce anxiety in the moment, but is most successful when done in conjunction with therapy.

Anxiety disorders affect millions. Those who suffer with anxiety often feel there is no solution. But basic biology tells us differently. Activating our PNS through breathing techniques really does work—give it a try next time you feel anxiety creeping in. You might be surprised at how effective these simple breathing techniques can be!

Originally published on Utah Valley Health and Wellness Magazine

Written by Dr. Triston Morgan