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
Send your questions for Dr. Mike.
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Psych-Talk with Dr. Mike: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
Click here for Volumes I-IV
Click here for Volumes V-IX
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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.
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Q: Dear Dr. Mike, I am a 35-year-old female and single. The Jewish holidays are right around the corner, but every year right before the high holidays arrive, I get depressed. I don't understand why, but this year, the depression is worse than it was last year. Basically, everything is going okay. Could you offer some advice about this? Thanks.
A: Many years ago as a young psychotherapist working in a psychiatric day program on the upper west side of NYC, the staff would always take careful measures before the holiday season to talk about the phenomenon of the holiday blues. At this program, we were serving mostly chronic psychiatric patients who were discharged from the hospital and living in the community. What we knew back then was that there was a higher incidence of depression and suicidal attempts during the pre-holiday and holiday periods and that we professionals needed to discuss this as a preventative measure to ward off and intervene so that our clients would not do any harm to themselves.
Mental health professionals have long recognized that a lot of people do get depressed before and during the holiday seasons. A lot of this is about cognitive expectations that people have regarding the holiday season. What we're supposed to think and feel on holidays-happiness-- is often not matched by our actual situation. This cognitive discrepancy can make you feel depressed and feel like avoiding the holiday altogether.
Because holidays are anniversaries steeped in ritual and nostalgia, casting a backward glance to family get-togethers forces an inevitable comparison of the past and present. Comparing where we are today with where we may have once been or where we would like to be in the future but have not yet achieved, this can lead to a nose-dive in mood. Perhaps, the holiday triggers a memory of the loss of a loved one or the breaking up of a relationship, or memory of time spent with missed people.
Some people who have chronic illness report that holidays often remind them of when they were in better health casting doubts about their future health prospects. Some people also may have bad memories from their childhood of holidays, perhaps because they grew up in a dysfunctional family and therefore, subconsciously, the holiday triggers a bad memory from the past. Holidays always draw attention to comparing the past with the present and the future. If one has had a difficult year, people go into the holiday season, particularly, New Years hoping that things will be better. Subconsciously, they may not really believe that this resulting in developing the holiday blues.
I knew a young lady who like yourself was single, aged 30, and hoping to develop a relationship with a young man. Her track record in relationships thus far had not been so good. As the Jewish New Year approached, she became quite depressed and came into therapy to try to understand her depression. What was interesting was that her depression lifted as soon as the holidays passed and she in fact was in a pretty good mood. So, what happened to her during the holidays? Well, the holiday was like a marker of passing time, a divider of past and new, in this case, the New Year. It was a time to reflect and take stock in what she had, what she did not have, and what she would like. The results generated by her inventory made her concerned about her future, so she got depressed.
In another example, a young man, age 28, dreaded going home to be with his parents during the holidays. He knew that his parent's marriage was falling apart and his father, age 60, had just lost his job and had suffered a minor heart attack. Depression set in as the holidays approached. These are perfect examples of the holiday blues.
People don't always acknowledge that the holiday season can make them feel badly. Some people develop Woody Allen Syndrome, that is, they become very susceptible to psychosomatic symptoms. Others bury themselves in work and therefore try their best to avoid the holidays. Overeaters indulge in food and alcoholics go back to drinking or drink more or miss an A.A. meeting. Some people just take their blues out on those close to them, and rather than acknowledge that they are 'down', they fight with their partner, their kids, or in-laws or subordinates at work.
Advice for Holiday Blues Sufferers
1. Talk about your feelings to your spouse or a friend you trust or a therapist, if the depression becomes too overwhelming. Don't hold in your feelings.
2. Spend time nurturing yourself and doing things that make you feel good about yourself. Buy yourself a present, go to the gym and work out, listen to relaxing music or read a good book. Getting a massage, or having your hair cut can also make your mood feel better.
3. Try not to isolate yourself during this time of year, because connecting with others can sometimes relieve depression - even if it is only temporary relief. If no one calls to invite you, don't feel sorry for yourself. It's a great time to invite someone to your home. If you are alone; it is a great time to join a group in some area of interest.
4. Take stock in the good things that are going right in your life and try to create positive images of these good things.
5. Don't forecast failures about your future; instead, look at the New Year as an opportunity for positive improvements in all the areas of your life.
Shana Tova and Happy and Healthy New Year to all my Readers
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Q: Your column re-inspires my hopes -- and for that I already thank you. But quite frankly, I'm running out of hope. Certainly in contrast to the abundance I was blessed by not so long ago...
In brief, I'm a 40-something Chasidic man from a completely non-religious background who has worked through a profoundly philosophical and personally introspective process to come to this lifestyle. And now here I am, with a lovely family and wonderful community... and no employment! Oh, there is plenty I could do to help my wife add a few more pennies to our tiny budget, but the point is that I've had the grandest visions of writing and teaching that are just not panning out and now I'm getting terribly depressed.
Besides the dysfunction this depression causes by keeping me from doing most of my more basic duties -- religiously and otherwise -- sometimes it brings up a dark cynicism that scares the depths of my soul! I've done a lot of research through exploring a few different psychotherapies, reading about how other religious people have made it through "the dark night of the soul" and of course my prayers.... and I'm left with this powerfully sobering conclusion: that it all boils down to a giant need for love from my father I never got.
Ok, very nice. But how in the hell to get out of it at this stage and once and for all do something productive??
A: You sound to me like you in fact have already been very productive in all of the changes that you have made, creating, as you noted, a lovely family and settling in a good community. Many people, even when there are good things going on in their lives, don't see their achievements because of they focus on other things that bring them down, like not getting enough love from your dad. Your negative self-esteem is further exacerbated by some very real problems that need to be solved such as finding employment and earning a living. You may be underestimating the effect that this is having on your mood.
I suggest that you consult with a cognitive therapist who can help you examine and challenge some of your faulty thinking that brings you down and makes you depressed. It takes time to adjust to living in a new country and finding gainful employment is a very important
part of this that you may be underestimating. Try also to consult with a psychiatrist who may be able to prescribe some antidepressant medication that can take the edge off all those bad feelings. Medication and therapy combined can give you more energy to focus more positively on solving the problem of employment and career direction which hopefully will give you an opportunity to use some of the skills you state such as teaching and writing.
Cognitive therapy can also help you deal with your feeling that your father did not love you enough and put that into some perspective and balance. Keep on praying to G-d for help to feel more positive and try to remember all of the good things that you do have especially your family and friends. Remember, there is a light at the end of the tunnel, and as you feel better, the light will also be in the tunnel too.
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Q: Hi Dr. I'm 32 years old and I am very obsessive. I check the door many times, if I forget something, when I close the store where I work, the car, the shower, etc. I have been in therapy but we didn't discuss these issues and focused more on mom, dad, etc. I'm tired of this, but it's hard for me to control it. It doesn't (I think) bother my life but it slows me down. After a year and a half in Israel I'm very tense and it raises the level of compulsivity. I have no money to afford therapy here. Can you help? Thanks.
A: What you describe are classic symptoms of Obsessive Compulsive Disorder, a common psychological problem that affects 1% of the population of adults 18 and over both in the United States and here in Israel.
The first symptoms of OCD often begin during childhood or adolescence, however, the median age of onset is 19. OCD is well named, as it is a disorder where people have obsessions and/or compulsions. Obsessions are ideas thoughts, images, impulses, etc. that intrude into one's mind and that are upsetting, such as "I wonder if I left the gas on, or Did I lock the door?" Compulsions are things people do often, over-and-over, in a stereotyped way to reduce their distress. The disorder is diagnosed if a person is suffering from these symptoms and it takes up significant time or causes dysfunction. From what you describe, it sounds like you are suffering from OCD.
Psychologists and behavioral scientists are not sure what causes OCD, but there is reason to believe it is partly genetic. What we do know is that contrary to Freudian thinking, it is not caused by bad toilet training. I see the OCD symptoms as an over learned response to stress that acts a container for keeping a lid on anxiety and other unwanted or suppressed feelings. The behavior is also conditioned because the compulsions are triggered by thoughts or worries and one begins to learn to associate specific compulsive behavior with lowering stress.
The treatment of choice for OCD is cognitive-behavioral therapy. Cognitive behavioral therapy, or CBT, is a treatment method that includes doing things like intentionally exposing a person to what they fear (called Exposure) and stopping them from carrying out compulsions (Called Response Prevention). An example of this treatment intervention could be to allow yourself to tolerate the fantasy or belief of the worst thing that will happen if you refrain from initiating the compulsive behavior. Learning to correct faulty thinking such as if I do not check the door several times, the house will be robbed, is also a major part of the treatment. It also includes methods like looking at errors or problems in thinking that lead to distress. It has been shown that CBT is as effective, or more effective, as a treatment for OCD, than medication. Most people who go through CBT will get a significant benefit in reduction of symptoms.
Nevertheless, about 70% of those suffering from OCD can benefit from taking medications because it reduces anxiety and allows people to do the exposure-based things that really help.
In your case and anyone with mild to moderate Obsessive-Compulsive Disorder, they may get as much help as they need from Cognitive Behavioral Therapy alone and never need to take medication.
Experts on children recommend that all children with OCD get CBT and some get medications. My clinical experience has shown that CBT is the treatment of choice for those suffering from OCD with medication given as an adjunct to treatment.
There are several good OCD self help books and some good support groups.
I often recommend Lee Baer's Getting Control, or Hyman and Pedrick's The OCD Workbook.
For most people with OCD, however, it is a chronic problem and needs to be managed, but it can be managed quite successfully with the proper treatment. In your case, you should speak to your therapist about wanting CBT for your symptoms. If your therapist states that this is not his/her orientation of practice, try to find someone who does do CBT and has experience with treating OCD. Good luck.
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Q: I've been in psychodynamic therapy since December 2006. I see my therapist once a week and I feel like we're not making any progress. I'm dealing with repressed grief regarding a deceased parent and friends who were killed by terrorists.
Over the past 4 months I have noticed my therapist tearing up during sessions. This happened again last night when I told him about my new boyfriend. This "tearing" makes me feel embarrassed so I decided to confront him about it. He said "I have a cold." I'm not sure I believe this. He then lit into me regarding my new boyfriend and how I'm putting distance between me and him (the therapist) since this new man is in my life. I am completely baffled right now. I left with a sick feeling in my stomach because it seemed like he was treating me badly and he cut our session short.
I know all about transference, etc., but I honestly didn't think I was projecting my current love relationship onto him. Do you think I should find another therapist? This man makes me feel worse. Or is feeling worse part of the therapy process?
A: You may know about transference, but what you probably do not know about is counter transference. Counter transference is the reaction of the therapist's feelings to the client's emotional story or the therapist treating or responding to the client from some place in his/her own personal life which is counter productive and may be not recognized by the therapist. All therapists need to be trained in recognizing their counter transference reactions to their clients and to know how and what to do with these feelings in order to use them as part of the helping process.
In some cases, certain feelings or emotional reactions can go unrecognized and interfere with the treatment process, especially if the therapist acts on the emotions and these become part of the treatment process. I would definitely confront the therapist about your disbelief in the reasons for the tearing. What also concerns me is his reaction about your new boyfriend and it putting distance between you and him. Now, it may be that he is concerned that a relationship at this time is interfering with the therapy and he is worried about this for you, but it also may be some counter transference issue that he is not managing well. Once again, speak to him about this. Give him a chance to try to help you work it out with you. But, at the end of the day, if you still feel uncomfortable with this therapist, I would suggest you try another psychotherapist who comes highly recommended by people you trust.
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