From hoarding to handwashing to forever checking the stove, obsessive-compulsive disorder (OCD) takes many forms. It is an anxiety disorder that traps people in repetitive thoughts and behavioral rituals that can be completely disabling.
Surveys conducted by the National Institute of Mental Health show that 2 percent of the population suffers from OCD—that's more than those who experience other mental illnesses like schizophrenia, bipolar disorder, and panic disorder. OCD might begin in childhood, but it most often manifests during adolescence or early adulthood. Scientists believe that both a neurobiological predisposition and environmental factors jointly cause the unwanted, intrusive thoughts and the compulsive behavior patterns that appease the unwanted thoughts.
Unless treated, the disorder tends to be chronic—lasting for years, even decades—although the severity of the symptoms may wax and wane over the years. Both pharmacological and behavioral approaches have proven effective as treatments; often a combination of both is most helpful. For more on causes, symptoms and treatments, see our Diagnosis Dictionary.
The Varieties and Symptoms of Obsessions
These uncontrollable thoughts or behaviors can interfere with a person's work, school, and relationships. Though the behaviors may give the person momentary relief from his overall anxiety, he doesn’t derive pleasure from the obsessiveness. People suffering from obsessive-compulsive habits may also contend with motor tics or repetitive movements, such as grimacing and jerking. Research into OCD is ongoing. For example, defects called micro-structural abnormalities have been found in the brain’s white matter of those who suffer OCD, and frontline treatment for this disorder includes exposure and response prevention, as well as plain old empathy and compassion in delivering therapy.
The first symptoms are the obsessions—the unwanted ideas or impulses that occur over and over again and are meant to drive out fears, often of harm or contamination. "This bowl is not clean enough. I must keep washing it." "I may have left the door unlocked." Or "I know I forgot to put a stamp on that letter." The compulsions appear after that—repetitive behaviors such as handwashing, lock-checking, and hoarding. Such behaviors are intended to mitigate fear and reduce the threat of harm. But the effect does not last and the unwanted thoughts soon intrude all over again.
Sufferers may understand the uselessness of their obsessions and compulsions, but that is no protection against them. OCD can become so severe that it keeps people from leaving their homes. The condition strikes males and females in equal proportions.
What Causes OCD?
Current scientific thinking holds that OCD results from a confluence of factors—a biological predisposition, environmental factors including experiences and attitudes acquired in childhood, and faulty thought patterns.
The fact that many OCD patients respond to SSRI antidepressants suggests the involvement of dysfunction in the serotonin neurotransmitter system. Ongoing research suggests there may be a defect in other chemical messenger systems in the brain.
OCD may coexist with depression, eating disorders, or attention-deficit/hyperactivity disorder, and it may be related to disorders such as Tourette's syndrome, and hypochondria, though the nature of the overlap is the subject of scientific debate.
How to Treat Obsessions and Compulsions
Either psychotherapy or medication, or both, may be prescribed for OCD, and patients may respond better to one form of treatment than to the other. Studies conducted by the NIMH, however, show that combination drug-psychotherapy is best for young people. The drugs given are typically one of the so-called SSRIs, or selective serotonin reuptake inhibitors. The SSRIs fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil) have been specifically approved for the treatment of OCD. These drugs have been shown to reduce the frequency and severity of obsessions and compulsions in more than half of patients, although discontinuation of drugs often leads to relapse. Behavioral therapy for OCD tends to produce long-lasting effects. Psychotherapy generally focuses on two aspects of the disorder: unraveling the irrational thoughts involved in the condition and gradually exposing sufferers to the feared object or idea until they are desensitized to it and can tolerate anxiety without engaging in compulsive rituals.
Is OCD on the Rise?
Rates of OCD have not gone up, but public interest in the disease (and its various forms) has. Hoarders and those compelled to engage in rituals to ward off disturbing thoughts have lately appeared as characters on the big and small screens. A slew of real-life sufferers of OCD have written memoirs and sought help in the public eye. There is also evidence that subclinical obsessiveness about cleaning and germs could be on the rise.
About a third of adults with OCD developed the disorder as children. The repeated rituals those with OCD engage in, such as constant handwashing or hair-pulling, are meant to allay anxiety, but the relief does not last for long. As with many other mental health conditions in children, the best and most durable treatment is psychotherapy.
A critically important clinical feature of obsessive-compulsive disorder (OCD) is the pervasive secrecy of patients suffering from the condition. OCD involves recurrent, disturbing thoughts and recurrent and excessive behaviors, including rituals and constant checking. Secrecy about OCD symptoms has been responsible for a long-standing, marked underestimation of the true incidence of the illness. Although clinical recognition has increased, patients' secrecy, shame and denial continue to have an impact on assessment, treatment, and the validity of research results.
More than with many other many psychiatric disorders, OCD patients do not spontaneously or voluntarily report their symptoms to health providers or even intimate family members. OCD patients fear that revealing their symptoms will lead to severe censure and disapproval because the symptoms are often ego-dystonic and seemingly antisocial or bizarre in nature: repetitive obscene or blasphemous phrases, for example, or thoughts of attacking children or loved ones or removing one's clothes in public. Also, there is reason to believe that secrecy has its own function in both the formation and perpetuation of OCD symptoms, which serve to protect against painful anxiety.
The feelings of shame and desire for secrecy strongly influence patients' open acknowledgment of the senselessness of symptoms. OCD patients are characteristically highly concerned with approval from other people, and their acknowledgment or denial of symptom senselessness is often determined by assumptions about the expectations of interviewers, raters or administrators of self-report measures, rather than provisions of truthful accounts. There is very likely somewhat more acknowledgment of senselessness in those indulging in checking or else cleanliness behaviors, the latter being more congruent with the values of middle-class culture and therefore more individually and socially acceptable.
Attempts at diagnostic measurement, including studies of accompanying personality disorder symptoms, have been extensively confounded by the problem of shame and secrecy. These studies have shown markedly variable results. Such wide variation in itself suggests unreliability of diagnostic instruments, but less shameful-feeling obsessive-compulsive personality disorder (OCPD) patients are also secretive about reporting certain behaviors and characteristics—in this case, irrational control, hoarding, rigidity, miserliness, and meticulous perfectionism.
Sensitive extended clinical evaluations, because of trust and familiarity developed, reveal a full range of OCD patterns. Patients will readily supply answers when asked simple questions in an unthreatening manner. The questions must rely on voluntary report and in each case, the patient should be asked to evaluate the excessiveness and inappropriateness of behaviors stipulated.
How much is "excessive"? It is up to the trained clinician together with the patient to determine the answer. This orientation is also necessary for ongoing treatment and the following of specific features of the illness. In order to determine whether the patient engages in excessive checking behavior, information is gathered about job histories, including whether one repeats tasks. If so, how often?
At home, how many times is the lock on the door tested when the patient goes out, how often are the stove burners checked, how long does it take to dress in the morning? In order to assess cleanliness, the patient is asked about patterns of housekeeping, showering and handwashing. Are particular places avoided because of possible contamination or dirt? For symmetry and order, questions are directed toward preferred placement of objects in the home, pictures on the wall, and preferences about physical work environments.
For assessment of obsessional thinking, information is effectively evoked by identifying everyday difficulties in living and performing. Commonly reported problems in sleeping are followed by questions about the possibility of bothersome or repetitive thoughts that keep the patient awake. Similarly, if a patient reports distractions and inability to concentrate at work or at school, questions are asked about mental preoccupations
Obsessive disorder has long been hidden and difficult for both sufferers and therapists. Currently, various treatments are available with varying degrees of promise. A number of SSRI medications have shown beneficial effects, including clomipramine, fluoxetine, paroxetine, sertraline, and fluvoxamine—and psychotherapy is an absolute must.
Many parents come into therapy seeking help with their child’s behavior. From big meltdowns to fights with siblings, parents wonder the best way to handle behavior challenges. These four tips have been shown to help children develop skills to handle life more effectively while nurturing a parent’s relationship with their child.
What we know about harsh discipline: Despite the fact that fear-inducing discipline such as spanking and yelling can sometimes stop a behavior in the short-term, these tactics are unhealthy for developing brains and can lead to issues with self-esteem, aggression, and trust. Instead of using fear to stop an undesirable behavior, take a moment and decide to shift your approach. Help your child to expand coping and regulation skills that will over time become hardwired and continue to support them throughout their life.
The New York Times recently published an article called, "Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?" The author chronicled several teens' battle with anxiety over the course of a few years. The article questioned why we're seeing such a rise in anxiety among today's youth. Some young people are overachieving perfectionists with a crippling fear of failure. Others worry so much about what their peers think of them that they're unable to function. Some have endured rough circumstances throughout their young lives. But others have stable families, supportive parents, and plenty of resources. I suspect the rise in anxiety reflects several societal changes and cultural shifts we've seen over the past couple of decades. Here are the top 10 reasons:
1. Electronics offer an unhealthy escape.
Constant access to digital devices lets kids escape uncomfortable emotions like boredom, loneliness, or sadness by immersing themselves in games when they are in the car or by chatting on social media when they are sent to their rooms. And now we're seeing what happens when an entire generation has spent their childhoods avoiding discomfort. Their electronics replaced opportunities to develop mental strength, and they didn't gain the coping skills they need to handle everyday challenges.
2. Happiness is all the rage.
Happiness is emphasized so much in our culture that some parents think it's their job to make their kids happy all the time. When a child is sad, his parents cheer him up. Or when she's angry, they calm her down. Kids grow up believing that if they don't feel happy around the clock, something must be wrong. That creates a lot of inner turmoil. They don't understand that it's normal and healthy to feel sad, frustrated, guilty, disappointed, and angry sometimes, too.
3. Parents are giving unrealistic praise.
Saying things like, "You're the fastest runner on the team," or "You're the smartest kid in your grade," doesn't build self-esteem. Instead, it puts pressure on kids to live up to those labels. That can lead to crippling fear of failure or rejection.
4. Parents are getting caught up in the rat race.
Many parents have become like personal assistants to their teenagers. They work hard to ensure their teens can compete: They hire tutors and private sports coaches and pay for expensive SAT prep courses. They make it their job to help their teens build transcripts that will impress a top school. And they send the message that their teen must excel at everything in order to land a coveted spot at such a college.
5. Kids aren't learning emotional skills.
We emphasize academic preparation and put little effort into teaching kids the emotional skills they need to succeed. In fact, a national survey of first-year college students revealed that 60 percent feel emotionally unprepared for college life. Knowing how to manage your time, combat stress, and take care of your feelings are key components to living a good life. Without healthy coping skills, it's no wonder teens are feeling anxious over every day hassles.
6. Parents view themselves as protectors rather than guides.
Somewhere along the line, many parents began believing their role is to help kids grow up with as few emotional and physical scars as possible. They became so overprotective that their kids never practiced dealing with challenges on their own. Consequently, these kids have grown up to believe they're too fragile to cope with the realities of life.
7. Adults don't know to help kids face their fears the right way.
At one end of the spectrum, you'll find parents who push their kids too hard. They force their children to do things that terrify them. On the other end, you'll find parents who don't push kids at all. They let their kids opt out of anything that sounds anxiety-provoking. Exposure is the best way to conquer fear but only when it's done incrementally. Without practice, gentle nudging, and guidance, kids never gain confidence that they can face their fears head-on.
8. Parents are parenting out of guilt and fear.
Parenting stirs up uncomfortable emotions, like guilt and fear. But rather than let themselves feel those emotions, many parents are changing their parenting habits. So they don't let their kids out of their sight because it stirs up their anxiety, or they feel so guilty saying no to their kids that they back down and give in. Consequently, they teach their kids that uncomfortable emotions are intolerable.
9. Kids aren't being given enough free time to play.
While organized sports and clubs play an important role in kids' lives, adults make and enforce the rules. Unstructured play teaches kids vital skills, like how to manage disagreements without an adult refereeing. And solitary play teaches kids how to be alone with their thoughts and comfortable in their own skin.
10. Family hierarchies
Although kids give the impression that they'd like to be in charge, deep down they know they aren't capable of making good decisions. They want their parents to be leaders—even when there is dissension in the ranks. And when the hierarchy gets muddled—or even flipped upside down—their anxiety skyrockets.
EMDR is the treatment of choice for PTSD and other trauma-related conditions. EMDR stimulates the psyche’s natural healing process and changes the way traumatic memories are stored in the brain. When a trauma occurs, it becomes stored in the nervous system in its original disturbing form. EMDR shifts how trauma is stored in the brain and speeds-up the processing of traumatic events and reduces the disturbing emotions, symptoms, and negative beliefs associated with those experiences. Clients are often amazed at how issues they’ve worked on for years in talk therapy are no longer problematic.
Traumatic memories are stored in the brain differently than other kinds of memories.
Research has shown that traumatic memories are primarily stored in the right hemisphere of the brain, where they do not have access to networks in the left hemisphere. The left hemisphere, however, contains important thoughts and awareness that could relieve the distress if a connection can be made between the hemispheres. EMDR therapy creates this connection by stimulating both hemispheres simultaneously — restoring the brain’s natural healing processes. EMDR helps people become unstuck and renders traumatic memories manageable.
Unresolved trauma is often retriggered by environmental cues and reminders that lead a person to re-experience the emotional, physical, psychological effects of the past in the present. Through the use of eye movements, tapping, or sounds, EMDR stimulates memory processing and fundamentally changes the way the memory is stored. With EMDR therapy, your past experiences may no longer intrude on your ability to fully engage with the present.
EMDR can aid people in experiencing less fear, panic, stress, anger and shame and access more curiosity, joy, love, gratitude, and other life-enhancing affects. In addition to the effects of trauma, EMDR is used to treat anxiety, panic attacks, phobias, addiction triggers, and performance enhancement for artists, athletes, and performers.
Treatment for Anxiety
Everyone feels anxious at times. Anxiety is an inherent part of the human condition and a natural response to everyday stress such as: relationship conflicts, financial problems, work demands, receiving a medical diagnosis, and making an important decision. However, if you suffer from panic attacks, persistent fears, worry, or phobias, are on “edge,” irritable, have difficulty sleeping and concentrating, experience frequent muscle tension, or have intense dread, you may benefit from therapy in order to get relief from the debilitating effects of anxiety and improve the quality of your life.
What is Anxiety
Anxiety and fears are the body’s natural alarm system and occur in response to danger. The emotion of fear is experienced when we are faced with a dangerous situation and has an evolutionary role in providing safety by preparing us for fight or flight. In contrast, anxiety can occur when we anticipate or perceive an imagined danger or threat, even if unreal. Anxiety can be mild, moderate, or severe. In moderation, anxiety can be adaptive in that it helps us to stay alert and focused, spurs us to action, motivates us to solve problems, and can be used as a signal that something is important to us. However, when anxiety is constant, overwhelming, and interferes with relationships, work, and other aspects of life, it stops being productive and becomes debilitating. At the severe end of the spectrum, anxiety, worry, fear, and panic cause extreme distress that interferes with one’s ability to cope with life.
A combination of factors contribute to anxiety such as: ongoing external pressures and stress, a genetic predisposition or a family history of anxiety, adverse or traumatic childhood experiences, certain medical conditions, the effects of certain medications, foods, or substances like caffeine, and negative beliefs about oneself. Anxiety manifests in a variety of ways such as: excessive worry, panic attacks, social anxiety, and physical symptoms.
My Approach to Treatment for Anxiety
Anxiety is so much a part of our modern life that it is one of the most common reasons people seek therapy. Since anxiety manifests differently in different people, my approach integrates many different modalities and approaches such as: psychodynamic psychotherapy, CBT, DBT, EMDR, and mindfulness. Psychotherapy can help you to better understand and manage the physical and psychological effects of anxiety and panic.
If we worked together we might:
The quality of our lives depends upon the quality of our relationships. Life is all about relationships. We are in relationships at all times. We are in a relationship with ourselves, with others, and with our world. As social animals, humans cannot survive without other people. We effect and are effected positively and negatively by our relationships on a daily, even hourly basis.
Attachment is the emotional bond between people. Our earliest bonds with our caretakers have a tremendous impact throughout our lives. Psychology, interpersonal neurobiology, and neuroscience have demonstrated that attachment bonds stimulate brain growth, effect personality development, social and emotional development, the ability to form stable relationships, and to effectively regulate our feelings. For better or worse, our early life experiences lay the foundation for our relationships throughout life.
Repetitive Relational Patterns
Throughout life we repeat our relationship patterns. Freud discovered what he called “the repetition compulsion,” which he described as the tendency for humans to be drawn to situations reminiscent of unresolved traumas from earlier in life. These repetitions can be seen as an unconscious attempt to belatedly master or heal our original relational dynamics with the intent of changing the outcome. Inevitably each of us brings all of our past experiences including our feelings, expectations, defenses, coping mechanisms, and beliefs to our current relationships with the unconscious hope that they will turn out better this time. The child in us thinks, “This time will be different. I will get him or her to love me. I can change him or her if only I try hard enough.”
Trauma, abuse, neglect, and other adverse childhood experiences negatively impact the quality of relationships. A child who grew up with an abusive parent may repeatedly be drawn to abusive partners. Someone who was abandoned as a child, may be drawn to people who will leave him, and a child who grew up with an alcoholic parent, may partner with people with substance abuse problems. Unfortunately, these repetitions can cause additional suffering for ourselves and others and further entrench the distressing patterns.
Our relationships provide the potential for both our most meaningful and our most painful experiences. In addition to love, bonding, and attachment, our relationships inevitably bring up our fears, needs, desires, dependency, ambivalence, sadness, anger, jealousy, hate, resentment, and guilt. The more difficult, distressing, and traumatic our earlier relationships, the more potentially hurtful and damaging our current relationships can become. If you find yourself repeating the same painful relationship patterns over and over again, you might benefit from psychotherapy.
Psychotherapy Provides a Choice
Psychotherapy can facilitate a movement from unconscious reenactment of distressing experiences to consciousness of our patterns. Understanding of our patterns provides a choice about how we want to act in the future. Awareness is the first step toward positive change. Acceptance and compassion for ourselves is the foundation of being able to love and have compassion for the people in our lives. It is possible to heal our original relational wounds and learn how to better handle repetitive situations in order to put an end to a destructive cycle.
Most of the people I work with are concerned about the quality of their relationships. Some are individuals who seek to improve the relationship with their partner, child, family members, and work colleagues. Others come for Couples Counseling to heal and change the repetitive and conflictual patterns that threaten to destroy their bond.
If you are suffering by repetitively re-experiencing some old relational patterns, I’d like to help.
Everyone feels sad sometimes. Feelings of sadness and grief are natural and adaptive responses to loss. However, if you feel sad, irritable, or “empty” most of the time, have lost interest in activities or relationships that you once enjoyed, have difficulty concentrating, and find your appetite, sleep, or activity level has changed, you may be experiencing depression. For some people feelings of sadness and grief become overwhelming and debilitating while others find that they feel numb and have difficulty feeling anything at all. Depression occurs when these symptoms interfere with daily functioning.
If you answered yes to five or more of the above then you are probably experiencing depression and you are not alone. The good news is that depression is a treatable condition. Depression is fairly common and is one of the most common reasons people seek therapy. About 9 percent of American adults suffer from some form of depression and its rates worldwide are increasing. Major Depression, a severe form of depression, is the leading cause of disability worldwide.
Whether your depression is a reaction to a recent event or events in your life, something that you have felt off and on for years, or something you have struggled with throughout your life, there is help. Depression slows us down and provides an opportunity for self-understanding.
My Approach to Treatment for Depression
Depression is a highly treatable condition. It is complex, manifests differently in different people, and can be mild, moderate, or severe. Depression is usually caused by a combination of genetic, biological, environmental, interpersonal, psychological, and situational factors. My approach to working with depression integrates many different modalities and approaches. I would want to become as informed as possible about your particular depression so that our work can best meet your needs.
There may be a reason for what you are experiencing. If we worked together we might: Explore the history of your depression and any history of depression in your family. We might identify any patterns or triggers of your depression and explore if there are any early losses or childhood events that are contributing to it.
We can explore any life circumstances, stressors, or any repetitive relational patterns that are worsening your depression and identify any changes that you would like to make in your life. We can explore the possible “wisdom” in your depression and that it might be indicating that there is something important that is missing in your life. We might explore a possible discrepancy between where you want to be in your life and where you are currently. Perhaps you are seeking more meaning and a sense of purpose in your life. We can explore any negative thoughts about yourself and use cognitive techniques to identify any negative thought process that are fueling your depression and work to change those thoughts.
We would want to rule out any medical and biochemical causes of your depression, which is usually done by your primary care physician.
We could look at how your current lifestyle might be contributing to your depression by exploring your eating habits, exercise, and alcohol and substance use and explore any environmental influences that might be worsening your mood.
I could teach you some practical tools for shifting your mood in the moment and we could engage in dreamwork, sandplay, active imagination, or other creative methods in order facilitate the natural wisdom and healing of your imagination for integration and wholeness.
If you have experienced trauma or feel stuck in your life due to unresolved emotional hurts or injuries, we could utilize EMDR or other trauma focused methods in order to aid you in moving forward. Recent scientific research has suggested that there may be an evolutionary reason for depression.
Research has shown that depression promotes introspection and increased mental acuity. Numerous studies have demonstrated that when someone is depressed their increased blood flow to certain areas of the brain. Studies have also shown that people who are depressed are better able to solve complex problems those who are not. By taking your depression seriously, you may be able to gain insight into yourself and make important changes so that you can more fully engage in and enjoy your life.
The stress of living through a pandemic is putting relationships to the test. There’s not a single one of us who isn’t dealing with a tremendous amount of stress right now. Work issues, tight living quarters, financial uncertainty, fears about the health of our loved ones, fears of getting sick ourselves, and as we all know, stress does not bring out the best in us.
So how can you keep your relationship from crumbling under the weight of these challenges?
1. Bring back date night.
Social distancing guidelines may have foiled your go-to date night plans. You can’t hire a babysitter, eat at a restaurant or catch a movie in theaters. But you can still carve out some time to connect at home setting aside at least several hours per week for just the two of you. Meet up in the backyard or on the balcony. Dress in your finest if you wish, have a drink together (non-alcoholic is fine), slow dance, and play charades or a board game. Try and keep the conversation light, humorous and optimistic. This should be a time to step away from the stress of COVID-19 and reconnect with your partner.
2. Cut each other some slack — more than you usually would.
We’re living through a highly stressful, unsettling, anxiety-inducing time. Under these conditions, it’s difficult to present the best versions of ourselves. So be gentle on each other when tensions inevitably arise. Find compassion for yourself and your partner when arguments come up and realize that it’s likely a normal reaction to an abnormal situation. Don’t rush to judge the quality of your relationship right now, and continue to find ways to communicate and be vulnerable about difficult feelings. Have compassion around the fact that this is hard.
That’s not to say everyone should get a pass for all bad behavior right now. You can gently call out your partner for their snippy remark or harsh tone without escalating the incident into a bigger fight. If one or both of you are short-tempered or impatient, don’t turn it into a federal case. Keep in mind that when we’re under pressure, most of us need some TLC far more than we need a lecture about not being nice.
3. Prioritize your alone time.
Stay-at-home orders have led to a whole lot of forced togetherness, for better and worse. It turns out that the time you used to spend on your daily commute or at the gym was actually really important for your mental health and relationship. Finding those pockets of “me” time may be a challenge these days so you need to be intentional about giving each other space. Be understanding if your partner needs some time with a book, video game, Zoom call or wants to put in some earbuds to listen to music. Also, if you are fortunate enough to be working from home right now, try to give each other your own dedicated space to work.
4. Practice self-care together.
Find a few self-care rituals that you can do together. You may have self-care rituals that you prefer to practice solo, but also try to find some nourishing activities that you can do as a couple: meditating together in the morning, walking outside after lunch, or sipping tea and sharing a few things you’re grateful for before bed.
Being able to do these things together helps to build your connection to each other, while also engaging in healthy ways to cope with the stress that comes while in quarantine. Keeping a healthy headspace will be good for you and your relationship.
5. Create a quarantine routine that works for you.
When the world around us is chaotic, maintaining a consistent daily routine can make you feel more grounded. Set some structure around your day-to-day activities. Decide mealtimes, leisure times, time as a couple or family, and time alone. This will help reduce anxiety, especially if you have kids at home.
6. Stop keeping score on who’s doing more around the house.
Couples’ systems for divvying up household duties like cooking, cleaning, laundry, walking the dog and taking care of the kids have been turned upside down during the pandemic. Though this division of labor may have had its frustrations and imbalances back then, it was at least predictable. Now, for many of us, the rules have changed. One partner may be working 18-hour hospital shifts and keeping a distance from the family, or one partner with flexible work hours doing most of the child care and home schooling. A good rule of thumb: Do as much as you can, express gratitude for your partner’s contribution and accept that there’s likely too much to do.
Given the mounting responsibilities, don’t get hung up on making sure everything’s divided evenly. Remember that your partner is probably doing their best — there’s just a lot on both of your plates right now. Do as much as you can, express gratitude for your partner’s contribution and accept that there’s likely too much to do.
7. Don’t try to resolve long-standing conflicts right now.
This probably isn’t the best time to hash out major relationship problems that existed prior to the quarantine. If there are smaller, specific grievances you need to air, bring them up but stay focused on the issue at hand. Avoid resorting to criticism or making sweeping generalizations that attack your partner’s character. For example, don’t criticize or try to control a partner who wishes to return to work. Instead, state how you feel and make the small request for change. Saying something like, ‘I get scared at the idea of you going back to the office so soon. Can we decide together around the timing for that?’ is much more likely to get a positive response.
For some couples, things have gotten better and for others, much worse. If it’s gotten really contentious between you both, online therapy is readily available to help you better navigate your relationship. Don’t hesitate to get professional help.
With the current coronavirus pandemic that is sweeping through our country and the world. We are reminded daily of the suffering families and individuals are experiencing with the loss of their loved ones. Their grief and loss can become ours. The people that remain behind after they lose someone that they loved and cared for are experiencing great sadness, grief and loss. I am reminded of the five stages of grief and loss that were first proposed by Elisabeth Kubler-Ross in her 1969 book On Death and Dying.
The 5 stages of grief and loss are: Denial and isolation, Anger, Bargaining and Depression; Acceptance. People who are grieving do not necessarily go through the stages in the same order or experience all of them.
The stages of grief and mourning are universal and are experienced by people from all walks of life, across many cultures. Mourning occurs in response to an individual’s own terminal illness, the loss of a close relationship, or to the death of a valued being, human, or animal. In our bereavement, we spend different lengths of time working through each step and express each stage with different levels of intensity. Contrary to popular belief, the five stages of loss do not necessarily occur in any specific order. We often move between stages before achieving a more peaceful acceptance of death. Many of us are not afforded the luxury of time required to achieve this final stage of grief.
The death of our loved ones might inspire us to evaluate our own feelings of mortality. Throughout each stage, a common thread of hope emerges: As long as there is life, there is hope. As long as there is hope, there is life.
Many people do not experience the stages of grief in the order listed below, which is perfectly okay and normal. The key to understanding the stages is not to feel like you must go through every one of them, in precise order. Instead, it’s more helpful to look at them as guides in the grieving process — it helps you understand and put into context where you are.
Please keep in mind that everyone grieves differently. Some people will wear their emotions on their sleeve and be outwardly emotional. Others will experience their grief more internally, and may not cry. You should try and not judge how a person experiences their grief, as each person will experience it differently.
1. Denial & Isolation
The first reaction to learning about the terminal illness, loss, or death of a cherished loved one is to deny the reality of the situation. “This isn’t happening, this can’t be happening,” people often think. It is a normal reaction to rationalize our overwhelming emotions.
Denial is a common defense mechanism that buffers the immediate shock of the loss, numbing us to our emotions. We block out the words and hide from the facts. We start to believe that life is meaningless, and nothing is of any value any longer. For most people experiencing grief, this stage is a temporary response that carries us through the first wave of pain.
As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family.
Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us even more angry.
Remember, grieving is a personal process that has no time limit, nor one “right” way to do it.
The doctor who diagnosed the illness and was unable to cure the disease might become a convenient target. Health professionals deal with death and dying every day. That does not make them immune to the suffering of their patients or to those who grieve for them.
Do not hesitate to ask your doctor to give you extra time or to explain just once more the details of your loved one’s illness. Arrange a special appointment or ask that he telephone you at the end of his day. Ask for clear answers to your questions regarding medical diagnosis and treatment. Understand the options available to you. Take your time.
The normal reaction to feelings of helplessness and vulnerability is often a need to regain control through a series of “If only” statements, such as:
If only we had sought medical attention sooner…
If only we got a second opinion from another doctor…
If only we had tried to be a better person toward them…
This is an attempt to bargain. Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable, and the accompanying pain. This is a weaker line of defense to protect us from the painful reality.
Guilt often accompanies bargaining. We start to believe there was something we could have done differently to have helped save our loved one.
There are two types of depression that are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words.
The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug.
Reaching this stage of grieving is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.
Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own impending death or such, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying loved ones may well be their last gift to us.
Coping with loss is ultimately a deeply personal and singular experience — nobody can help you go through it more easily or understand all the emotions that you’re going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolong the natural process of healing.
Marriage & Family Therapist and Registered Addiction Specialist