Mommy Rage

August 3, 2010

Mommy Rage

Jill Kane, Psy.D.

One of my mommy patients came to her appointment crying.  “At 3:00am this morning,” she sobbed, “my four month old baby woke up and even after a long nursing she refused to go back to sleep. I was so tired and so angry that I actually yelled at my sweet, tiny baby. I was raging mad. I know she couldn’t understand my words, but I was still so embarrassed, even in front of myself. Who yells at a tiny baby like that?”

Actually, a lot of people yell at tiny babies like that. Even good, stable, not-crazy parents sometimes lose it with their kids. All “normal” parents, in fact, could probably recollect any number of times they felt like they “lost it” with their child. These are not parents who abuse their kids, although of course abuse does happen (and if it is happening for you or to someone you know, please get help immediately and see the resources at the end of this article). Typical, average, non-abusive parents sometimes have moments of pure unadulterated rage toward their children. Sometimes their anger is directed at a tiny baby, other times the anger is toward a toddler or older kid. And parents of adolescents can generally recount how many times a day their teenager make them furious.

Another patient said, “My 3 year old hit me. I told him not to hit and then he looked directly at me and hit me again. I picked him up. He hit my face. I tried a time out. He wouldn’t stay in the time out. After about 5 minutes (it felt more like an hour) of trying to get him to stay in a time out, I got pissed. I wanted to throw him against a wall, but of course I didn’t. I wanted to scream and I finally burst into tears because I was so exhausted, angry, and ashamed that I couldn’t calm myself or my child down.  This whole episode occurred because I wanted to put on his shoes so we could go to the park and play.”

Although there are a ton of books written on how to handle children’s tantrums and children’s other behavioral issues (see resources at the end of the article), there is less social or professional discussion about the mommy tantrums that are bound to occur.  Kids are difficult and all of them at times are tough to handle.  Although parents often have supportive conversations with other parents, they don’t always discuss some of their most shameful parenting moments. Because parental anger is talked about so rarely, moms (and dads) often feel isolated in their moments of rage.  They can’t help but wonder why no one else gets as angry toward their kid as they do.  Even moms who discuss their anger with others feel like they are the only ones who get THAT mad.  Often, people feel embarrassed, worried, or simply baffled by the intensity of the anger they feel.

Its time for mommy rage to come out of the closet. Everyone knows and agrees that sometimes kids can be totally infuriating. Anger is a perfectly normal reaction to frustration, aggravation and exhaustion. If you have ever felt angry, furious, and just plain pissed off at your young child, you are the rule rather than the exception.  If you are having frequent outbursts, get professional help. Frequent mommy tantrums can be destructive to your relationship with your child. However, mommy tantrum moments that happen infrequently are probably not going to harm you or your child. At some point every parent is likely to feel angry because their infant won’t go back to sleep, their colicky baby won’t stop crying, their toddler won’t stay still for a diaper change, their child will refuse to eat or wear shoes or leave the park.  Generally it is not the first conflict of wills that causes such rage in parents. Generally it is the third, fourth, or what feels like the millionth conflict of wills that sends parents from zero to sixty in mere seconds.

Although everyone has moments of intense anger, acting out that anger on a child is not okay and, in fact, not even particularly helpful. Moms tend to feel guilty and ashamed about acting out their anger (i.e.: yelling, stomping, crying, slamming doors etc). The child who is the recipient of that anger usually feels scared, insecure, out of control, and shamed. Children need their parents to be in control – especially when they are not. A parent’s rage does not make the parent feel better and the kid’s behavior doesn’t change. In fact, the behavior may become worse.

Remember: every parent gets angry with their kids sometimes. Anger is a normal human emotional response to feeling frustrated, invisible, unheard or ignored. Here are some tips on how to handle that anger for more effective parenting:

First and foremost: make a plan about what you are going to do next time you feel like screaming at the top of your lungs. All toddlers like to say “no!” All babies wake at night and can’t go back to sleep. All young kids at one point or another are going to refuse to go to bed; throw their food; draw on the wall, couch,  or floor; hit another child, and any other number of  annoying things that only kids an think of. If you have a plan on how to handle whatever the awful situation is before it happens, you have a way of combating your anger (and your kid’s behavior) before it escalates. The plan should include discipline tactics for your child (again, check out the resources at the end of this article) as well as self-discipline tactics for yourself such as knowing when to ask for help, when to take a mommy time out or a deep breath or a silent scream in the closet, or whatever you usually do to make yourself feel better.

When you are calmer, consider why you are getting so angry at a particular behavior. What is the trigger? Often when your emotional resilience is low (meaning you can’t tolerate your kid for another second) it may be because you are sleep deprived, lack social or emotional support, feel isolated, helpless or just plain overwhelmed. Maybe you hate feeling like you have no control.  Maybe you are mad at your spouse but are taking it out on your kid. Maybe you are hungry (which also tends to affect mood). Maybe your current financial situation is causing lots of stress or you had a really bad day at work.  If you can assess why you are getting so angry, you may be able to figure out a way to help yourself from getting that angry again the next time. And there will be a next time!

Think about what might be going on for your kid.  Did s/he get enough sleep/food/cuddle time? Is there a new baby in the house? Have you or your spouse been gone a lot? Is s/he getting sick? Maybe they had a bad day at school or are struggling with potty training. Sometimes a child’s unreasonable behavior is due to something they don’t know how to verbalize. Understanding the child’s trigger can go along way toward preventing the battle.

If you need help managing your anger, don’t hesitate to get it. Of course feeling angry is normal, but anger that is left unacknowledged, untreated, or makes you feel bad about yourself can lead to behavior that is NOT normal.  Although physical and emotional abuse of children is more prevalent than anyone would care to admit, typical parents get angry sometimes – and even yell –  but they do not hit, berate, humiliate, or shame their child. If you have questions about whether you or someone you know is being abusive toward a child, there are a number of resources available and here are just a few:

Childhelp National Abuse Line at 1-800-4-A-CHILD or go to http://www.childhelp.org.

Child Protective Services at www.capcsac.org/cps

Prevent Child Abuse America http://www.preventchildabuse.org

First 5 California at www.First5california.com

For parenting help:

Positive Discipline by Jane Nelson

Parenting from the Inside Out by Daniel Siegel and Mary Hartzell

Raising your Spirited Child by Mary Sheedy Kurcinka

www.parenting.com

www.nlm.nih.gov/medlineplus/parenting.html

www.healthychildren.org

If you decide you want professional help, call or email me and I will be happy to refer you to the appropriate person or place. Just a few appointments with a therapist can make all the difference.

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Infertility

July 4, 2010

Secondary Infertility

Jill Kane, Psy.D.

When Janet and Bill decided to have their first child, Janet conceived right away. When their son, who is now a healthy and happy 2 -year old, had his first birthday, they felt it was time to add another child to their family. Every month the couple became excited and geared up for ovulation time. Every month, when Janet got her period, they felt disappointed.  They remained optimistic until 9 months went by and Janet still wasn’t pregnant.  They both grieved for a baby not yet conceived and were anxious that they wouldn’t be able to give their son a sibling.

It never occurred to either Janet or Bill that fertility would ever be an issue. Their first son was conceived so easily, and neither Janet nor Bill had any health issue they knew about that could interfere with conception.  They were surprised and saddened by the possibility they might not be able to have another baby and as they reached their year anniversary of infertility, Janet became depressed while Bill tried to be brave and feign an optimistic outlook.

Generally, infertility means the inability to conceive or carry a baby to term.  Secondary infertility refers to the inability to conceive or maintain a pregnancy after successfully having one or more babies.  While it is normal for conception to take a few cycles, if it has been 6 months (if you’re over 35) or 1 year if you are younger, seek advice from a medical specialist. Those who are struggling to conceive for the second  (third, fourth, fifth or tenth) time, may be surprised, confused, concerned, and saddened by their difficulties.

The causes of secondary infertility are generally the same as the causes for primary infertility.  The most common are: sperm abnormalities, “advanced” maternal age (35 +), endometriosis, fibroids, irregular or other ovulation problems, timing, and stress.  Of course there may be other reasons as well, but medical research cites these as the most frequent. Certainly the best advice is to seek help from a medical professional regarding diagnosis and treatment. There are many ways to treat infertility and it is important to seek professional advice from an infertility specialist before embarking on any fertility regime.

While medical advice is useful for the physical aspects of infertility, the emotional component should not be overlooked.  The emotional challenges of dealing with infertility month after month include feelings of grief, sadness, depression, anxiety, and stress.  Women may feel betrayed by their bodies, and they may feel a loss of their identity as a woman.  Janet felt “barren and unfeminine. Dry and old – just like an empty dusty desert.” She felt embarrassed and ashamed by her sadness, as well as worried and guilty that her healthy and happy toddler might pick up on her grief.

The emotional challenges of infertility can cause conflict in a marriage as well as social isolation. In addition, the emotional pain is often exacerbated by confusion.  Common comments from parents struggling with this issue are: “It was so easy to conceive the first time”; or, “I heard second children are conceived so much faster than a first child”; “I figured my body knew what to do now”; and,  “I thought it would be easier this time around.” For many people, the only thing that has changed is age.  Other than that there is often a sense of bewilderment that accompanies secondary infertility.

Secondary infertility isn’t discussed as often as primary infertility. The reasons for this vary:  some parents feel guilty for wanting another baby, some try to mask their sadness and grief and don’t discuss it, some think about how grateful they are for the child they do have and pretend the loss of a potential second is not as great as it really is. To make matters worse, they often don’t get the same sympathy from friends or family that a couple trying for their first baby receives.  As Janet put it, “I should be happy I have a healthy child, and my friends and family keep reminding me of this.”  Sometimes it can be hard for people to understand that you can love and adore your children and, at the same time, still grieve for the children you worry you can’t have.

For those couples that conceive but are plagued by miscarriage, the hormonal shifts further complicate the emotional picture.  Don’t underestimate the power of hormones on mood, sleep, hunger, and sexual desire.

It is important to understand the emotional challenges of secondary infertility, whether you have been trying to have a baby for a few months or a few years.  First, it really is okay to mourn the loss of a fertilized egg. It may sound strange, but the hope people have for a baby not yet conceived is very real and very powerful.  Each month, there may be a cycle of hope, excitement, disappointment, loss and grief.  Each new month, many parents find they have to learn to hold both the grief at the end of one month and the hope at the beginning of a new month simultaneously. This emotional rollercoaster can be challenging, stressful and exhausting.

In addition, many couples find that sex becomes a baby -making chore, rather than an expression of the love and intimacy that it’s meant to be. Regardless of what is happening in the moment, many couples feel they must have sex when ovulating – whether or not they are in the mood. Because the sex is so intertwined with the fierce desire for pregnancy, it loses all spontaneity, becomes mechanical and feels like a chore to be accomplished.  These feelings can obviously put stress on the marriage and it is common that couples argue more when baby making becomes a job.

There also tends to be more strife in the marriage when the mother and father are not on the same baby-making page. Sometimes one partner wants a baby more than the other or one wants to explore medical interventions while the other wants to just wait and see what happens. Sometimes anger over the situation transforms into anger toward the partner. To make matters worse, stress has been shown to increase the difficulty of conceiving a child.  There is nothing more stressful than infertility coupled with a conflicted marriage.

If you want to have another baby and can’t seem to conceive or maintain a pregnancy, see a medical professional. Know that all the sadness and stress you’re probably feeling is normal for couples struggling with this issue. It may be wise to talk with others who are going through the same thing or a professional who can help you cope with the stressors that are so commonly associated with secondary infertility.


Body Image

July 4, 2010

Body Image

Jill Kane, Psy.D.

If there are any women out there who are not concerned about their body image, I have yet to meet them. Michelle wants abs of steel, Jess worries about her thighs, Cate won’t wear tank tops because she thinks her arms are too flabby, and Sandy swears she just can’t get her pre-baby body back.  Regardless of reality, they all think they are overweight.  They exercise religiously, diet strenuously, and refuse to eat fatty foods, carbs, and sweets. They spend money on dieter’s tea, dieting pills, herbal remedies, and protein drinks. Some days they restrict their food intake, other days they eat and drink normally. Some emotionally eat; others don’t do anything and just feel bad about themselves.  Nobody feels good in a bathing suit.

Sound familiar? A multi-billion dollar industry is glad to know that most adult women, teenage girls, and a growing number of very young girls are worried about their weight.  The industry is delighted that people will spend quite a bit of money striving for some ideal body type that may or may not be possible (men and boys are also victims to this mentality). Although standards of beauty can change, throughout modern history thin is in and fat is worse than a four-letter word.  Interestingly, reality has little impact on perceived body image – meaning, that most people do not view themselves accurately and rarely have a positive view of their bodies.

Body image is a term that describes how you picture the size and shape of your body and your attitude about what you see.  Regardless of actual size, someone can have a positive or negative view of their body and thus a positive or negative view about themselves. Body image is actually quite a complex issue that is not well understood by psychologists and other researchers.  There are so many variables that influence how people see themselves and others, that it is impossible to know exactly how to help someone improve their self-image.  For example, how we view our bodies can change depending on cultural norms, self esteem, eating behaviors, mood variables, social interaction, and activity level (and probably other issues as well).

Creating a positive body image is challenging, in part, because of cultural and societal attitudes toward thinness. The ubiquitous “thin is in” mentality is supported by the media.  Many television shows, for example, have thin actors and actresses portraying favorable qualities, while the heavier actors (and its hard to find a heavy actress on TV) play the goofy and /or passive characters. Magazines, too, suggest that to be beautiful one must be not only thin, but emaciated.  This attitude trickles down to very young children. There was a famous study done in the 1970s (Kirkpatrick & Sanders) on children as young a preschool who were shown pictures of heavy kids and normal-sized kids.  The plump kids were said to look “unfriendly, unpopular, and sloppy” and the thinner kids were perceived as “nice, kind, smart and friendly.”

As it turns out, women who are more physically active tend to have a more positive self-image – regardless of weight or clothing size.   This means that a “thin” looking woman who wears a size two may feel worse about herself than a physically active “bigger” woman who wears a size 10 or more.  Women who meditate are also more likely to have a positive self-image.  Physical exercise and meditation, however, are only small pieces of a complex puzzle.

No one is suggesting you eat nothing but jelly doughnuts, drink heavily and watch TV all day. But good health and a positive body image are not the same things.  Regardless of what you eat, how you feel, whether you exercise, or what you wear – a positive body image has little relationship to your physical self. A positive body image is really just a healthy attitude about you, which can exist regardless of body size. It might surprise you that attaining your “ideal weight” has little correlation with how you will feel about yourself. An index of your self -esteem is far more important than any BMI (body mass index) scale.  There is a pervasive fantasy that “if I only lose 5, 10, or 50 lbs, I will be happy, I will have more friends, my marriage will improve etc.”  The reality is that thin women are just as unhappy about how they look as heavy women. It’s a rare person who feels good about how they look on a day-to-day basis.

So, what to do?

Take a walk.

Seek out supportive, positive people.

Language (self talk) is important: think about the words you use to describe yourself…substitute negative words with positive ones.

Think about what you enjoy doing and do it.

Stop reading magazines that promote unrealistic (and airbrushed) images of women.

Critique television, movies, magazines etc. as you watch. Notice who is portrayed positively and who is portrayed negatively. You may be surprised (or maybe not).

Volunteer or get politically active – contributing to society promotes feelings of well being.

Find a group of people who share your interests – book club, cooking class, parenting group, walking group, etc.

Make a list of what you want you want to try and go ahead and try them one by one.

Meditate.

Be a role model for your kids. They learn by watching and listening. Give them compliments daily.  Speak kindly to yourself, about yourself. Offer your kids healthy snacks. Play tag, chase, and other active games. Take them for hikes (after all, a hike is really just a walk in a pretty place).

And, as always, if you think your views of yourself make you feel depressed, sad, anxious or just plain badly or if your poor self image is negatively impacting your parenting and/or children, seek counseling.


Insomnia Sucks

June 7, 2010

Insomnia – Jill Kane, Psy.D.

Sarah said it best:  “Insomnia sucks!” Jennifer mirrored this when she said, “I can’t sleep, I’m exhausted all the time and it’s ruining my marriage, my parenting, my mood – all are horrible and I can’t get anything done.  Help!”

Sleep complaints are a huge issue in my practice.  Sometimes the reasons are obvious and, thank goodness, temporary:  as any mom can tell you, the pregnancy and post partum period are famous for sleep deprivation. The sleep disruption is due to hormone fluctuations and of course the needs of a newborn. Generally, time solves the issue – hormones settle down, the baby begins to sleep through the night, and the sleep problem resolves itself.  Other times, and unfortunately, all to frequently, mom finds herself up in the middle of the night while everyone else in the house is sleeping soundly. As Sarah would say, “that sucks,” and she’s right.

Insomnia seems to affects nearly everybody at some point in their lifetime.  Generally, insomnia is described as either trouble falling asleep (primary insomnia) or having trouble staying asleep (secondary insomnia).  When insomnia (either kind) only occurs for a night or two, it’s no big deal; however, if it persists it can negatively affect nearly every aspect of day-to-day life.  Insomnia has been linked to depression, anxiety, poor job performance, obesity, high blood pressure, and increased susceptibility to disease (especially later in life).

Reasons for insomnia vary. The most common are stress, depression, anxiety, poor sleep habits, sleep apnea (or other medical condition), snoring, medication, caffeine, alcohol (too much, not too little!), changes in the sleeping environment, eating too much late at night, and a learned behavior from many sleep-interrupted nights.  Older adults have a higher incidence of insomnia than younger adults. One of the problems in diagnosing and treating insomnia is the circular problem that a lack of sleep has on mood and the impact mood has on lack of sleep.  For example, is someone depressed and therefore not sleeping or is someone not sleeping and has therefore depressed? It’s a chicken-egg situation and it is often hard to tell which came first. By the time a person becomes so tired they cry for help, it probably doesn’t much matter anyway

Depending on the cause, there are a bunch of ways to solve your sleep problems ranging from easy behavior changes to more involved interventions like medication or a visit to the sleep research/diagnostic center. If you have a hunch that depression, anxiety, or a medical condition is the origin of your insomnia, please seek medical or psychological advice. Sometimes professional intervention is a fast and effective solution.  If you think your insomnia is not fundamentally related to a medical or psychological problem, than there are a bunch of things to try before reaching for the sleep meds. Psychologists use the term “sleep hygiene” as the first line of defense against both kinds of insomnia.  Here are some of the tools:

  • ·Establish a bedtime routine and stick with it. Warm bath, brush teeth, get into bed, read, turn off light, & goodnight (This is obviously an issue with small children)
  • ·Go to bed at the same time every night
  • ·Wake up at the same time every morning (weekends included)
  • ·Keep the room dark, comfortable and quiet
  • ·If you are still awake after 30 minutes, get up. Don’t give yourself the chance to associate insomnia with your bed. Get some decaffinated herbal tea or read on the couch.
  • ·Don’t watch TV before bed because it disrupts healthy sleep and may make it harder to fall deeply asleep.
  • ·Relax – deep breaths, stretches, and light yoga can help you relax but no hard exercise after 8pm
  • ·Cut down on caffeine to one cup a day (in the morning) or cut it out completely
  • ·Do not use alcohol as a sleep aid (alcohol may help you fall asleep, but alcohol disrupts sleep patterns and you increase your chances of waking up in the middle of the night. Plus you won’t feel rested in the morning)
  • ·Eat before 8pm – but not too much. Warm milk is a natural sleep aid, but other foods also promote good sleep including avocados, almonds, eggs, bananas, halibut, tuna, potato, and walnuts (Sorry, not chocolate!).
  • ·If you wake in the middle of the night, soft music or an audio book can help you fall back asleep

If the above behavioral changes don’t help, it may be time to see your doctor. Medications like Ambien, Lunestra, and Trazadone (also an antidepressant) are often helpful in breaking the sleeplessness cycle. If depression or anxiety are possible causes, sometimes an antidepressant can work well as a sleep aid.  A doctor can also advise you about various herbal remedies – but feel free to try a sleepy tea as part of a bedtime routine.

There is no set amount of hours that count as “enough sleep.”  Some people need 8 hours, others may need 6 or 9.  If you are extremely drowsy during the day and/or extremely grumpy, chances are you are not getting enough sleep. Your best bet is to find a bedtime routine and stick with it. Stay consistent, take deep breaths, turn the TV off, and hold off on emotional or stressful conversations.  Save them for earlier in the day.  So, although insomnia “sucks” and it is a very serious condition, there are some proactive and non-medical approaches to take.

Sweet Dreams.


April 22, 2010

A Guide to Your Child’s Brain

Jill Kane, Psy.D.

Janet drove her friends crazy because she always boasted about how easy her baby was. “He was easy from the get-go,” she said.  He slept through the night by 3 months and even in the womb I could tell he was mellow.” Janet’s friends were secretly a little relieved when Janet‘s second child turned out to be more active and even a bit colicky.  “This baby is so different,” Janet complained. “In the womb she was always moving and turning, and now she’s never quiet and she never, ever sleeps!”

Janet has learned something it took generations of scientists to figure out – each pregnancy is different, at least in part, because each baby is so different.   Up until fairly recently, it was thought people came into the world a blank slate. Dating all the way back to the days of Plato and Socrates, the idea was that we all came into the world basically the same; our differences were considered to be shaped by environmental factors, the stars, or some kind of divine influence.  With the advances in brain science and developmental psychology, there is now empirical evidence to confirm what mom’s already know:  each of us are unique individuals with diverse brain functioning from conception to old age.

Although brain science is complicated, everyone can use its practical applications.  Understanding how your child’s brain works can go a long way towards knowing their personality and thus how to parent him or her most effectively. Just because one child responds well to time-outs, doesn’t mean another child will.  Knowing what works and what doesn’t work can save parents a whole lot of time, anger, stress, and worry.

The differences in our kids (or in any of us) include what is generally called temperament, but there is more to it than that. Consider this: we are all wired with a preference for either routine or for novelty. Think about where you fall on the routine-novelty continuum.  Are you organized? Do you like to plan? Conversely, are you easily bored? Do you prefer spontaneity?  Interestingly, we tend to marry our opposites. Most likely, whichever brain type you have chances are your partner has the other type.

Now think about this: If you are someone who prefers routine, you probably establish routines easily, become a bit anxious when you have to adapt to something new, and it may take you awhile to habituate to a routine that’s new. Generally, you fall a bit more towards the Obsessive-Compulsive side of the continuum.  On the other side of the continuum is the person who habituates easily to things, gets bored kind of easily, and enjoys risks and roller coasters. This person falls on the Attention Deficit side of the equation.  Remember – this is all a continuum of normal brains and normal functioning, simply a matter of personality and preference based on the biology of your brain (neuroscientists have identified the neurotransmitter dopamine to be involved – but that is a whole other topic).

Here is how this knowledge can help you parent your kids.  A kid who falls on the orderly side of things will probably take his time in the toy store picking out just the right toy.  He will probably do well in a structured school environment, big groups of people may be overwhelming so he may cling, and when he needs discipline, time outs will probably work quite nicely.  Knowing these things can help you plan so that the day runs more or less smoothly.  In terms of discipline, kids who fall on the Obsessive Compulsive side of things tend to respond well to punishment.  Time outs are a gentle form of that, and it will often be enough to stop the poor behavior.  Because this child like routine, transitions may go a little easier, as the child comes to know what to expect from the day (wake, diaper, breakfast, play, nap etc).  Luckily, if the routine at bedtime is consistent, getting the child to sleep will go relatively smoothly.

If your kid is more on the Attention Deficit side, she may grab the first shiny toy she sees at the store, will be antsy in a structured school program, big groups of kids will excite her, and when she needs discipline, punishment won’t work very well.  With these kids, positive reinforcement, or rewards, work much better.  Often these are the kids that are more frustrating for parents to deal with because it seems as if they are just not listening.  However, if you understand their brain, you will know that her brain is not wired for quiet routine.  Punishing a child with this kind of brain will probably cause mutual frustration and anger.  Plus, it won’t do much to curb the offending behavior anyway. Its not that this kid isn’t listening, its that her brain is wired to seek reward. When good behavior results in stickers or treats, or whatever it is your child likes, discipline should work well.  Time outs won’t work as well as redirection towards an enjoyable activity. The key is to find what your child likes and incorporate it into the day for smoother, less frustrating experiences.

Using Janet’s children as an example, the first mellow boy is probably on the OCD side of things. He likes the routine of waking, eating, sleeping. He knows what to expect and finds that comforting.  The second child is the opposite.  She wants more stimulation, she is bored more easily, and although she may feel like the more difficult child to parent, in some ways she is easier because she isn’t so rigid and anxious. Again, these are all healthy children and functional children.  They are simply wired differently. With an understanding of their brain, Janet can make parenting decisions that are the best fit to help guide and nurture them.  When the first child acts up, a time out will curb the behavior, The trick to the second child will be to keep her involved in pleasurable activities so she can remain focused and calm.

Of course, these are simple examples with simple solutions. Chances are your kids are way more complicated. Consider identifying what kind of brain your child was born with and test out different ways of relating to and disciplining them. The more knowledge you have about how your child’s brain works, the less frustrated you will become with your child.  So many times I hear that a child is stubborn, rigid, or difficult, when really it’s just that well meaning parents are using ineffective techniques to try and get the behavior they want.

All of us are born with a preference for one side of the continuum or the other and most of us are closer to the middle than the extreme.  If your child feels extreme, discuss your concerns with your pediatrician who can help you evaluate and problem solve.

Because everybody’s brain works differently, a one-size fits all approach to parenting doesn’t exist.  This can be disappointing to some because it would be so easy to simply trust the Ferber Method, refer to Dr. Spock (old school) or Dr. Brazelton, or take friend’s advice.  All of these “experts” have excellent information and good ideas to help guide parents, but knowing how your child’s brain works can help you make the most of the books you read or the advice you seek.  We have all heard that there is no manual for parenting, but brain researchers are finding keys to human behavior that can help us to parent our children more effectively.


Psychotherapy

March 18, 2010

Psychotherapy

Jill Kane, Psy.D.

It’s just after New Years and, more than likely, your resolutions are long forgotten. The goals you set are often a list of those things about yourself you want to change: you may want to lose weight or gain it, begin a new career or improve your current one, return to school, make new friends, become a better parent, or simply learn more about yourself. As much as you want to succeed with your resolutions, it’s often difficult to follow through with them on your own. If you are feeling stuck, dissatisfied, confused or unhappy, psychotherapy is a great tool to help you feel better and accomplish your goals for the New Year.

What is Psychotherapy?

Psychotherapy is a relationship with a professional trained to help you with a range of problems – from anxiety and depression to parenting concerns, marital conflicts, and even eating issues. Some go to therapy for help with a specific concern such as coping with a pending divorce, a death in the family, or a job loss; others enjoy the process of self-discovery that takes place in the therapist’s office.

The key element in any therapy is the relationship with the therapist. It’s critical to feel comfortable with your therapist and the therapist’s job is to provide a safe place in which you can discuss whatever bothers or confuses you. The therapist acts as a guide to help you understand why you feel and behave in ways that may not be working for you. A therapist helps you identify behavior patterns and provides a means to help you change those that don’t work.

Why go to Therapy?

Anyone can benefit from psychotherapy. The process of self-understanding provides a great foundation for making good decisions throughout life. Knowing who you are, what you want, and how to get there are keys to living an emotionally healthy, happy and productive life.

Often you feel stuck but can’t change. Although sometimes you can identify what you think the problem is, the solution may be out of your awareness and difficult to see. Other times, you may think you know the problem, but after discussing it, find out it’s something else altogether. Discussing concerns with friends and family is helpful, but doesn’t always help you implement the changes you want to make. Therapy can help you identify and clarify the problem, find solutions, and feel happier and more satisfied. We don’t know what we don’t know and a professional helps you see things more clearly.

Approaches to Therapy

There are different kinds of therapy. Some therapy focuses only on individuals; others on couples, families, or groups. There are also different approaches to different problems. For example, if you have an obsessive-compulsive disorder (washing repeatedly, constantly checking the lights, hoarding) a therapist using a “behavioral” approach (systematic and concrete interventions) may be most effective. If you have a general sense of dissatisfaction, but aren’t sure why, a therapist using a “psychodynamic” approach (talking thorough unresolved issues) may be most helpful. Generally, after talking with a patient, the therapist and patient together will decide which approach is the most effective.

Choosing a therapist

The single most important factor in choosing a therapist is whether or not you feel comfortable with that person.  Feel free to “shop around.” There are excellent therapists that are Psychologists (have doctoral degrees), Marriage and Family Counselors (MFTs with master’s degrees), and Licensed Social Workers (LCSW or MSW). The difference between degrees is education and training, but more education doesn’t necessarily mean a better therapist. You need to find someone that is a good match for you.

Sometimes, medication can be an answer, but you will need a Psychiatrist (M.D.) or your primary care doctor to prescribe them. However, I strongly recommend that you see a therapist before making that decision on your own. Talking your issues over with a professional before deciding to take any medications is almost always helpful. Medications have side effects and are only helpful in specific situations.

You may want to utilize your insurance, in which case your insurance company will provide a list of therapists on their plan that you can see. You can also check for therapists on the Internet, where many list the kind of therapy they practice and provide some basic information and a picture. Ask friends and family for referrals. You may be surprised how many people you know who can recommend a good therapist. Generally, therapists offer a range of services at a range of prices and they will tell you upfront the kind of therapy they practice and what they charge.

So as you consider change in the New Year, think not only about what you want to accomplish, but how you are actually going to do accomplish it. Make your list of New Year’s resolutions – that is certainly a good place to start. However, if you find it difficult to keep those resolutions, if they are the same resolutions you make each year, and you are curious about yourself, psychotherapy is a great and interesting option. This New Year may be your best and, next year, you can truly wish yourself A Very Happy and Healthy New Year.


Postpartum Depression

March 13, 2010

Jill Kane, Psy.D.

Although new moms are expected to shed some tears after delivery, many women are shocked to find that those are tears of misery rather than tears of joy.  Having a new baby is difficult. Dealing with a newborn while depressed makes it nearly impossible. The birth of a baby is supposed to be a joyful and exciting event, yet many moms find themselves confused about how badly they feel. A mom may wonder: What’s wrong with me? Why am I feeling this way?  Did I make a mistake? Shouldn’t babies be fun? Thoughts and questions like these may be symptomatic of a very treatable illness called postpartum depression.

Although many women suffer from postpartum depression, until recently the condition has been largely ignored and under diagnosed.  Often women are too ashamed to discuss their feelings with their doctors and families and remain silent about their struggle.  They feel embarrassed, ashamed, bewildered, lonely and too depressed to do much about it.

Most new moms are tired, overwhelmed, and moody.  If you just had a baby and feel depressed, you are not alone. Postpartum depression affects up to 15% of all new mothers. Approximately 80% struggle with the “baby blues,” which is a nice term for a not very nice short-term depression. The baby blues generally abates by the second week postpartum, but if it lasts longer you probably are dealing with a clinical postpartum depression. If you are concerned about yourself, ask the following questions:

  • Do I feel sad?
  • Do I cry a lot?
  • Do I have trouble getting out of bed?
  • Do I no longer enjoy activities that I used to like?
  • Do I dread social visits?
  • Do I feel hopeless, apathetic, or intensely irritable?
  • Do I have insomnia?
  • Do I have trouble bonding with my baby?
  • Do I have negative feelings towards him/her?

If you answer yes to any of these questions AND your feelings last more than a couple of weeks, you are probably struggling with postpartum depression.

If you are thinking about hurting yourself or your child get help immediately.

It is important to understand that depression is not your fault. Nobody chooses to be depressed and generally women want to have a healthy and happy baby and family life. No one knows exactly why some women suffer from postpartum depression and other women don’t.  Interestingly, some women get postpartum depression after their first baby and not their second, or they get depressed after the birth of their third with no previous history of it at all.  There is not necessarily a pattern and it can happen to any mother.

It is generally believed that hormones play a large role in the process. As most women can already tell you, moods are greatly affected by hormones. After childbirth, there is a dramatic drop in estrogen, progesterone, and sometimes even the thyroid hormones. These hormonal changes can lead to fatigue and mood swings, especially when accompanied by blood loss from delivery and changes in blood pressure.

Other factors that can contribute to postpartum depression are sleep deprivation, anxiety over how to care for your child, feelings about changing your identity and feeling a loss of control over your life.  If your baby is demanding, if you are a single parent or feel a lack of support from your partner and/or family, if breastfeeding is difficult, if the birth was challenging, and if you are having financial problems or experiencing other life stressors you may be more prone to postpartum depression.

Postpartum depression is serious. Depression can interfere with parent-infant bonding, which hurts the baby psychologically, and also leaves mom feeling even more guilty and hopeless. If left untreated, it can lead to a more chronic depressive illness.

Thankfully, postpartum and other types of depression are very, very treatable.  Talk therapy, often in combination with medication, are the most common and effective treatments.  Of course, many women object to taking medication while breastfeeding.  The general consensus from physicians, however, is that while antidepressant medications do end up in breast milk, some end up there more than others.  Zoloft (a common medication prescribed for depression) seems to be the best medication for breastfeeding moms because less of it ends up in the breast milk. Prozac (another common anti-depressant) appears in larger amounts in the breast milk than Zoloft. Regardless, infants do not seem to be harmed by the anti depressant medication that their mother’s take.

Before taking any medication, weigh all the pros and cons. If your depression is severe and is impacting your ability to bond with your baby, it is probably better for you to take medication and for your baby to have formula if you are worried about the medication’s effects on your child. Leaving depression untreated is worse for both you and your baby than the medication itself. Remember, many moms have taken antidepressants while pregnant and breastfeeding and experienced no ill effects. Please talk with your doctor for more information.

Although talk therapy (generally in combination with medication) is a proven method to treat depression, if for whatever reason you don’t want treatment, here are some things you can do at home to make life a little easier.  Take a short walk as often as possible, nap when your baby naps, eat small amounts of healthy food frequently throughout the day, make arrangements for child care so you can have some time alone and some time alone with your partner or a friend.  Ask for help from family or friends, try an activity you used to enjoy, write in a journal, and utilize the mother’s club – talk to other moms – you might be surprised how much that helps!

One last note: Depression is the most common but not the only postpartum mood disorder women experience. Some women get anxiety symptoms postpartum.  Panic attacks feel like your heart is racing, you can’t catch your breath, and there may be chest pain and dizziness. Women can also get specific phobias about caring for their newborn.  For example, a mom with a postpartum phobia may avoid giving her baby a bath for fear of hurting him or her.  Postpartum OCD, can also occur. Symptoms include scary and intrusive thoughts and images about hurting the baby. Women who have postpartum OCD are terrified and even though they are good mothers, they have intense fears about their ability to care for their child. Women with postpartum psychosis hear voices in their head or have other sensory hallucinations. If you feel like any of these things are happening, either for you or someone you know please get help.  Postpartum depression, postpartum anxiety and postpartum psychosis are all treatable.  You don’t need to suffer. If you feel like you want to hurt yourself or hurt your baby, call for help immediately.

Having a new baby is hard for everybody. It’s a great challenge but also a great joy. If you are feeling all the stress and none of the joy, know that these feelings are common and there is help available. Don’t be afraid to ask.  You’ll be glad you did.

For more information and other resources, check out the website www.postpartum.net and the book Postpartum Depressions for Dummies by Shoshana Bennett,  Ph.D.

Jill Kane, Psy.D. is a Psychologist in Petaluma and San Rafael, CA

You can visit her website and http://www.drjillkane.com