Ask the psychotherapy expert

Vol IX: Can "fear of the future" be considered kind of stress or emotional disorder?

By DR. MIKE GROPPER
December 24, 2006 14:07
dr mike 88

dr mike 88. (photo credit: )

Dr. Mike is a licensed clinical social worker (USA and Israel) in private practice in Ra'anana. He recently wrote a column called "Psych-Talk with Dr. Mike" in which the feedback from readers was excellent. He has decided to shift gears and invite readers to submit their questions concerning a wide range of topics: child development, adult problems, addictions, ADHD, adjustment problems, crises and transitions, trauma, phobia, mental disorders such as anxiety, depression, and bi-polar. He also welcomes questions concerning your marital or couple relationship, family issues, parenting, problems at work, self-confidence, shyness and much more. "I take pleasure having the opportunity to answer your questions in what I hope will be an informative and exciting weekly column in the Jerusalem Post-online edition. Look forward to hearing from you soon." Dr. Mike Gropper, DSW (09) 774-1913 Send your questions for Dr. Mike. * * * Psych-Talk with Dr. Mike: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 Click here for Volumes I-IV * * * This column is intended solely to educate and is not a substitute for personal diagnosis or treatment. If you have a difficult problem, please seek advice from your own doctor or mental-health professional. * * * Vol IX Q: Can "fear of the future" be considered kind of stress or emotional disorder? What can be done against it? A: In today's world, a lot of people have some fear of the future. Global or national experiences that are shared by many members of the community can cause lots of people to fear the future. Some examples include global terrorism such as 9/11, living in a high crime neighborhood, or having gone through a war or a national catastrophe like Hurricane Katrina in New Orleans two years ago. However, I do not believe that this is what you refer to in your question. On a more micro or personal level, the cognitive therapists would say that there are three areas in which negative thoughts can make people feel badly: 1) fear about oneself, 2) fear about one's situation, and 3) fear about the future. Many times, these fears are neither grounded nor supported by fact. They are instead based on a distorted view which expresses itself in negative thoughts and can cause anxiety, depression, avoidance and withdrawal. Negative thinking is not good for one's physical and emotional health. Certainly, fear of the future would fall into this category, especially if this fear causes one to be phobic, avoidant, and extremely anxious and/or depressed. A person suffering from this type of extreme fear should seek professional guidance, especially from a cognitive psychotherapist in order to get a more realistic and balanced view of the world and overcome whatever difficulties have resulted from having such a fear. Good luck, Dr. Mike * * * Vol VIII Q: Dr Mike, I am middle aged, married 14 years with 2 kids, and my husband in academics is addicted to marijuana, uses it nightly, and his career has been in steady decline. He lives in his own world, I am lucky if he helps out, he mostly watches silly TV shows, and waits till kids go to bed so he can use. He's tried to get help, but therapists were not that good. Does he need a therapist who specializes in drugs and work place issues? He has anxiety problems. He's been using since he was a teen. I don't know what can be done for him; small things exhaust him, or stress him out. I am unhappy and never thought my life would turn out this way. A: Your husband is certainly addicted to marijuana, and he has been for many years. Cannabis, more commonly called marijuana, refers to the several varieties of Cannabis sativa, or Indian hemp plant, that contains the psychoactive drug delta-9-tetrahydrocannabinol (THC). The THC is the drug's hallucinogenic property and the drug also has a depressant component in that it also slows you down. All of his symptoms like living in his own world, career decline, anxiety, social withdrawal-you may think he uses the drug to cope with these and other pressures, but the drug actually creates anxiety and depression, panic attacks, social withdrawal and cognitive impairment including emotional apathy and detachment, all of which make him want to use the drug over and over. He is, in essence, out of control and unless this downward spiral is interrupted, more negative health and mental consequence, as well as career deterioration, will most likely follow. In addition, regular marijuana smokers suffer from many of the same health problems as tobacco smokers, such as chronic coughing and wheezing, chest colds, and chronic bronchitis. In fact, studies show that smoking three to four joints per day causes at least as much harm to the respiratory system as smoking a full pack of cigarettes every day. Marijuana smoke also contains 50 to 70 percent more carcinogenic hydrocarbons than tobacco smoke and produces high levels of an enzyme that converts certain hydrocarbons into malignant cells. Your husband should be seen by a therapist who specializes in treating addictions and someone who is trained in cognitive-behavioral therapy and relapse prevention, a special therapy that teaches clients how to manage their addiction and prevent the relapse to it. Furthermore, he should attend a 12-step program like marijuana anonymous support group. Check out Marijuana Anonymous Online at http://www.ma-online.org/. You and your children will also need professional help to change the way the family has learned to function around his drug addiction. Both family therapy and couple therapy are necessary adjuncts of any future addictions therapy your husband undertakes. It is very important for you, as his partner, to demand that he change his habit of abusing marijuana and get help. Some partners married to addicts have developed a behavioral pattern called co-dependency. Co-dependency is present when you put his dysfunctional behavior ahead of the needs of your children and yourself. I therefore recommend that the two of you be seen by preferably the same addictions expert and to find someone who can treat both the individual and the couple/family within an addictions framework. You may want to also turn to Al-Anon and Ala-teen, a support program for families of drug addicts. See http://www.alanon.org.za/ I wish you and your husband a lot of success in overcoming this problem. Dr. Mike * * * Vol VII Q: I'm 59 and have been diagnosed bipolar for 27 years. I take my medicine and psychotherapy religiously, but I still experience anxiety. Is there anything I can do besides grin and bear it? I take Geodon, Eskalith CR Klonopin and Nadolol. A: It sounds like you have been taking good care of your bipolar illness for many years. This is very good. As a non-medical psychotherapist, I would encourage you to speak to your psychiatrist or prescribing physician about your complaint and see if there is anything he or she can do to help you via adjusting your medications to lower your anxiety. If you are not satisfied with this response, for whatever reason, then go get a second opinion from another psychiatrist, who specializes in bipolar and co-morbid illness like anxiety. The other thing I wonder about is the type of psychotherapy you are receiving. I strongly recommend cognitive-behavioral therapy (CBT), which may help you to modify your beliefs about your self and your life which may trigger anxiety. CBT also teaches clients effective coping skills that can help reduce stress and anxiety. Also, learning stress reduction techniques such as meditation, the use of imagery, and deep breathing techniques can augment medical treatment and lower anxiety symptoms. If you smoke cigarettes, this can aggravate anxiety, so get some help to quit. I suggest getting a good night sleep and exercise as additional measures that have been found to help people with excessive anxiety. Good luck. All the best, Dr. Mike * * * Vol VI Q: Dear Dr. Mike, Our dog Lucy, a mixed breed, recently passed away. Actually, she was quite ill. Upon the advice of our veterinarian, Lucy was put to sleep. Lucy was a member of our household for over nine years. She often was the center of attention since she was a very playful pet and my husband and children liked to play with her. During the nine years, Lucy was always in the kitchen when I prepared meals, especially Shabbat meals. What concerns me is how badly my husband and I have been effected by her death. I just keep on having associations to things that remind me of her. We have all been saddened by her death and can't seem to keep her out of our minds. Every time I go into the kitchen, I think I hear her paws. When I get up in the middle of the night, I still am afraid that I will step on her since she often slept near our bed. I keep on expecting to hear her scratch the front door. My husband misses his evening walks with Lucy, which he would call his "exercise." I feel guilty even writing about this with so many other things more serious going on. Do you have any suggestions? A: Many pet owners are shocked by the depth of grief they feel after the loss of a pet, albeit old age, illness, or accident. If you take a moment to think about it, pets live relatively short lives. We simply are not prepared for their death and because of the attachment that we humans make to these lovely creatures, and I would add, they make to us, their death can affect some of people as much the death of a relative or friend. Unconsciously, a pet represents many things to each pet owner. It may represent a child or even wished for pregnancy for a childless couple. It may also represent the child that left home or is in the process of leaving home. A pet may represent the wish for a sibling for an only child or the object of nurturance for someone who is alone but wants to feel and express caring. It may reflect the ideal mate or parent, ever faithful, patient and welcoming, loving us unconditionally. It can symbolize a playmate and a companion or even the connection to someone else that shared the joy of owning the pet, but is no longer at home. Pets can embody negative and positive qualities we recognize or lack in ourselves. The same pet may be all of these, alternating between roles on any given day or for each member of the family. When a pet dies, we expect that our pain will be acknowledged, even if it is not shared by our relatives, friends and colleagues. Disappointedly, the importance of its loss may not be appreciated by other people. Nevertheless, the process of grieving for a pet is no different than mourning the death of a human being. Typical emotions that reflect the grieving process include denial, anger, bargaining, depression, and finally acceptance. The time frame for this grieving process lies in the value that is placed on your pet by your family and the readiness to allow oneself to grieve. My advice is always to give yourself permission to feel the pain, talk about the loss with family, friends, your veterinarian, and each other, recalling and sharing funny and other significant personal accounts of things and times you spent with your pet. This telling process helps to validate and to let go and mourn the loss of your pet. Your grief may be compounded by lack of response from a friend or family member. Don't let it be. Realize that you do not need anyone else's approval to mourn the loss of your pet, nor must you justify your feelings to anyone. One final note: your life was and will continue to be brighter because of the time that you shared with your pet. Cherish those memories. Most people do eventually resolve their grief and feel better. However, for some, the loss of a pet can trigger some other unresolved conflicts or represent the tip of the iceberg for some other issue that you are currently going through. When this happens, don't hesitate to seek some professional advice from a trained therapist. All the best, Dr. Mike * * * Vol V Q: Dear Dr. Mike, I am getting divorced. The youngest child is 12.5 - he lives with me in England but wants to live with his father in Israel---I feel like I need to go to Israel so that my son has two parents...any thoughts on this? Thanks. A: Divorce is a complex, painful and difficult decision to make. The impact of divorce on family members, particularly the children, is great. You did not give in your question a lot of information, but I will try in my response to deal with the implications of relocation of children after divorce and children's best interests. First of all, it is a common phenomenon that either the custodial or non-custodial parent moves after divorce. One American study showed that within four years of separation and divorce, about one fourth of mothers with custody move to a new location. In another study of college-aged students who experienced divorce during their childhood, 61% experienced a move more than one hour's drive by at least one parent during their childhood. There are many reasons for this, some of which include just needing to get away from a perceived source of emotional pain, starting over, living closer to perceived sources of emotional support such as family members in one's extended family or old friends, job opportunities. The literature shows a much lower rate of relocation by either parent when there is a joint custody arrangement. In your case, it sounds like the father has returned back to his native country, Israel for some or all of the reasons given above. There are very few well-controlled empirical studies on the impact of parental moves on the well being of children of divorce. There are, however, a lot of studies in the social science literature with conflicting findings and recommendations on the impact of parental moving and children's welfare after divorce. Some reports support a policy of both parents to remain in close proximity to their children, whereas other studies conclude that what is most important is that what is good for the custodian parent is good for the child. I will try to therefore share with you some of my own clinical knowledge on this subject, taken from my practice. I think that your son's desire to be closer to his father is completely understandable, but nevertheless, this may not be the right choice for you to make, especially if you consider what you may be giving up in the process. In thinking through what is in your child's best interest, you should not discard what will also be in your best interest, or else risk the possibility of your being unhappy and perhaps not being able to make a living. In the ideal world, both parents living in close proximity to the child after divorce is the optimal arrangement. But, are you prepared and able to make such a move? What about your own sources of support and what about economic opportunities? I have had clients who were in intercultural marriages such as American wife and Israeli husband and American husband and Israeli wife. In both of these cases, one of the key factors in separating countries after the divorce was economics or the ability to find employment in order to support oneself following divorce. In one case, a divorced father stayed in the United States while his ex-wife and their four children went back to Israel to live. The father had to support his children and felt that he was only able to do so by living in the United States. In this case, however, the father made sure to stay in very close contact with his four children by making arrangements with his ex-wife to visit the kids 2-3 times a year with the children going to the States during summer vacations to visit him. This was only possible because of the amicable nature of the parents' post-divorce relationship and the father's - in this case the distant parent's - great determination to stay as close and as involved as possible with his children. This father, when not actually seeing the children, made daily phone calls and/or encouraged his children to do the same in order to reinforce the bond. It worked. Your son's initial protests and demands to go live in Israel may not be a viable personal decision for you to make. Nevertheless, this does not mean that he will not be able to keep his relationship going with his dad. It is not the ideal choice for your son, but your security and happiness cannot be compromised either and you ultimately will be more effective as a parent to your son if you feel that your security, both emotional and economic, are in place. The following information may be of help to you. Preteens and adolescents and Divorce Parents Understandings

  • Understand what divorce means but may have difficulty accepting the reality of the changes it brings to their family.
  • Although thinking at a more complex level, still may blame themselves for the divorce. Feelings
  • May feel abandoned by the parent who moves out of the house.
  • May withdraw from long-time friends and favorite activities.
  • May act out in uncharacteristic ways (start using bad language, become aggressive or rebellious).
  • May feel angry and unsure about their own beliefs concerning love, marriage, and family.
  • May experience a sense of growing up too soon.
  • May start to worry about adult matters, such as the family's financial security.
  • May feel obligated to take on more adult responsibilities in the family. What parents can do for preteens and adolescents
  • Maintain open lines of communication with children; reassure children of your love and continued involvement in their lives.
  • Whenever possible, both parents need to stay involved in children's lives, know children's friends, what they do together, and keep up with children's progress at school and in other activities.
  • Honor family rituals and routines (Shabbat dinner, weeknight homework time, grocery shopping together, watching favorite television shows or movies as a family).
  • If you need to increase children's household responsibilities, assign chores and tasks that are age-appropriate (help with laundry, housecleaning, yard work, meal preparations); show appreciation for children's contributions.
  • Avoid using teenagers as confidants; plan special time for yourself with adult friends and family members.
  • Tell children who will be attending special occasions such as sporting events and graduation ceremonies, especially if you plan to take a new romantic partner. What your child needs from mom and dad
  • I need both of you to stay involved in my life. Even if you don't live close by, please write letters, make phone calls, and ask me lots of questions about whom I spend time with and what I like and don't like to do. When you don't stay involved in my life, I feel like I'm not important and that you don't really love me.
  • Please stop fighting and work hard to get along with each other. Try to agree on matters related to me and my needs. When you fight about me, I think that I did something wrong and I feel guilty.
  • I want to love you both and enjoy the time that I spend with each of you. Please support me and the time that I spend with each of you. If you act jealous or upset, I feel like I need to take sides and love one parent more than the other.
  • Please communicate directly with my other parent so that I don't have to send messages back and forth. I want you to talk with each other so that the messages are communicated the right way and so that I don't feel like I am going to mess up.
  • When talking about my other parent, please say only nice things, or don't say anything at all. When you say mean, unkind things about my other parent, I feel like you are putting me down and expecting me to take your side.
  • Please remember that I want both of you to be a part of my life. I count on my mom and dad to raise me, to teach me what is important, and to help me when I have problems. It is probably also a good idea to consult with a professional counselor to help you and your son work out any of the difficulties that you may encounter in making this decision. You may also want to join a post-divorce support group in your area. All the best, Dr. Mike * * * Send your comments >> Cafe Oleh experts have been chosen for their knowledge and reputation. Cafe Oleh does not take responsibility for any advice they offer.
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