Monday, July 9, 2012

Why Vacations Are Good For You

“No man ever steps in the same river twice.” ~ Heraclitus, 535-475 BCE

Summer is upon us now and most are fortunate to be able to take vacations.  We all know taking a vacation or break revitalizes and re-energizes us.  Then we return to our routines, back to work, to school, etc.  Although our home environment and work schedule may be the same before we left for vacation, but something is different.  What is different is ourselves.  Experiences gained from vacations change us.  We don’t return as the same person.

An example from a patient illustrates this point.  For years she and her then-husband have talked about wanting to visit an original painting by Van Gogh.  A year after they divorced, my patient decided to make a trip by herself to see the painting.  This meant for this small town girl to fly across the country, navigate her way through a big city by herself, and adjust to a different culture.  She made it and came face-to-face with the painting!  It was not seeing the painting that made a difference, but her experience traveling alone gave her the confidence and independence.  She returned home and to her job a changed person; confident in her abilities and in her interaction with others.

Make room for new experiences and challenges in your life.  Make room for new perspectives and thoughts in your mind.  They will change you.

Welcome to the Anxiety Club!

The secret access password to this club is, “Heart pounding, shallow breathing, and sweaty palms.”  My initiation to this club was in one of the most exotic locations in the world which was inside the pyramids in Giza, Eygpt.  It was summer 1985 and I was a teenager at the time.  My sister and I were standing in a chamber inside the pyramid.  It was quite a trek to reach the chamber through walking hunched over in the tunnel passage and then crawling on fours.  The chamber was dimly lit by a wall torch.  It was hot and humid.  More and more people entered the room, making the place more humid.  All of a sudden I had trouble breathing.  At the same time, I was very aware that I was underneath tons and tons of stones that composed the pyramid.  It was a heavy weight feeling.  Needing to leave immediately, I proceeded to the single entrance/exit.  One of the Egyptian tour guides blocked my escape, indicating I should pay him before leaving.  That made my panic worse.  I pushed him aside and somehow managed to get out.

Fast forward to 1999.  The same panicky feeling returned.  This time it was winter in Chicago.  I was traveling via the “El” train to the downtown Northwestern University campus for my job as a predoctoral counselor.  Since it was below zero outside, I was bundled up in my down coat, scarf, hat, gloves, etc.  It was rush hour and people were packed standing up in the train.  Suddenly the train lurched forward and stopped.  It broke down inside a tunnel.  It seemed like hours before the train moved again.  It became hot and made worse with people’s bodies pressed against mine.  My breathing space was invaded.  I was mindful of how trapped I felt, was underground, and couldn’t move.  Escape was not an option.  There was no Egyptian guide to push aside.  So what did I do?  I focused on a wall poster that was an advertisement for vacationing in Cabo San Lucas.  The advertisement showed a woman floating serenely on azure blue water among the steep cliffs, very similar to this picture shown on the left.  I pretended I was that woman and ignored where I was.  Slowly my breathing returned to normal and I was fine.

I have treated many patients with anxiety and panic attacks.  What I have found that is common among us is our mindful awareness of what is going on within our bodies and outside of our bodies especially during the attack.  That mindfulness unfortunately exacerbates the panic attack.  I teach my patients to tune out that awareness during the attack and focus on something else.  Treating anxiety and panic attacks are one of my favorite ailments to work with.  Patients are able to significantly reduce the troublesome feeling which, in turn, is rewarding for me.

Stewie, Meet Dr. Winnicott

In his 1949 paper, “Hate in the Counter-Transference” D.W. Winnicott, a British pediatrician and psychoanalyst describes the love-hate relationship a mother has for her infant baby. He outlined several reasons why a mother would harbor such harsh feelings towards her baby and some of his reasons are highlighted as follows:

“The baby is an interference with her private life, a challenge to preoccupation.”
“He is ruthless, treats her as scum, an unpaid servant, a slave.”
“She has to love him, excretions and all, at any rate at the beginning, till he has doubts about himself.”
“He tries to hurt her, periodically bites her, all in love.”
“He shows disillusionment about her.”
“His excited love is cupboard love, so that having got what he wants he throws her away like orange peel.”
“At first he does not know at all what she does or what she sacrifices for him.”
“He is suspicious, refuses her good food, and makes her doubt herself, but eats well with his aunt.”
“After an awful morning with him she goes out, and he smiles at a stranger, who says ‘Isn’t he sweet!’”

When I first read Winnicott’s paper for a psychoanalytic study group, I thought that this guy must be joking or off his rocker.  Although I thought his reasons why a mother would hate her baby were hilarious and disturbing, I as a mother, reluctantly admit there was a grain of truth in them.  I commented to my study group that Winnicott has accurately described 50 years early, a cartoon character called Stewie on the TV show Family Guy.

Stewie is the sophisticated, intelligent, and mischievous to a sociopathic extent two-year old infant son of Peter and Lois Griffin and who was for a time being, preoccupied with matricide.  Few episodes show him fantasizing of killing his mother and vice-versa, and his anger at his mother for deciding to wean him off from breastfeeding. He makes many derogatory comments about his family in their presence, especially to his mother.

Let’s imagine Winnicott is still alive today and that Stewie is a real live person.  His mother, Lois is frustrated and has had it with Stewie, and decides to take him for professional mental help.  Winnicott accepts to treat Stewie.  Winnicott is no stranger to children like Stewie.  In fact, he altruistically on his wife’s behest, took in a young orphan boy in his home for three months, “three months of hell” as he said.  Winnicott described the boy as “the most loveable and most maddening of children.”  On several occasions when the boy misbehaved, Winnicott went as far as to shut the boy out of the house and at the same time telling the boy what happened made Winnicott hate him.  Winnicott learned from fathering the boy to be able to tolerate his own hatred towards the boy without losing his temper and murdering him.  The boy ended up doing well, attended a prestigious school.

Winnicott’s goal when working with a child like Stewie is not to make him well behaved and loveable, but to help Lois tolerate her hate towards Stewie, not express her hate to him as harm, and to be patient with hers and his hate towards each other.  As a result of better tolerating and understanding her hate towards her baby, Lois would then be free to love Stewie.  Stewie, in return would then feel loved by Lois.

The Psychotherapy Room

My Current Office Room.
The psychotherapy room with its furnishings, colors, lighting, framed pictures, and so on provides an ambient environment for the patient as well as the therapist.  The room may, based on the patient’s determination, become a safe haven to explore uncharted mental territory.  For many patients, the psychotherapy room as a whole and objects within the room is an extension of the therapist and his/her personality style.  The room space as well as the relationship developed with the therapist is what compose healing (Gerald, Psychoanalytic Psychology, 2011). 
I was mindful of these influential elements when I moved into my current office room pictured above a few years ago.  The position and placement of furniture, the colors chosen, the brightness of lighting, framed prints, etc. were among the many objects I considered based on my preference of style and taste.  I carefully considered how the objects in the room as well as the ambient environment would be perceived by whoever steps into the office.  I wanted to ensure that this room becomes a mental home for many of my patients.
Few times when patients come to my office room for the first time and when they see the couch, I hear a chuckle coming from them.  The Freudian couch has become synonymous, a symbol of psychotherapy.  Objects in the psychotherapy room have come and gone over the years and yet the couch was noted to have almost always remained in place since Freud introduced this piece of furniture in the 19th century (Lingiardi & De Bei, Psychoanalytic Psychology, 2011).  I don’t use the couch in the manner conducted by a classical psychoanalyst.  To me, the couch represents those placed in family rooms where many sit down to relax, and this is why I have it in the office room.
I have already spent countless hours with patients in that room and it always has been a place where I enjoy spending time in.  I find that the room I created is not only conductive to patients’ growth, but of mine as well.  Mi habitacion es su habitacion!  My room is your room!

Sexual Arousal Disorder

This article appeared on on June 9, 2010: 

According to Virtual Medical Centre, "Research suggests that the majority of women experience sexual dysfunction at some point in their lives, and for many it is an ongoing or recurring issue." A common type of sexual dysfunction that women experience is sexual arousal disorder. To help understand sexual arousal disorder I have interviewed Dr. Lisa Colangelo Fischer.

Tell me a little bit about yourself. 
I have a Ph.D. degree in Counseling Psychology and am in private clinical practice in Phoenix, AZ where I use contemporary psychoanalytic psychotherapy in treating adults with anxiety, depression, sexual dysfunctions, and relationship difficulties, to name a few. I am currently president of the Southwest Psychoanalytic Society.

What is sexual arousal disorder? 
Sexual arousal disorder is the physiological inability to be sexually stimulated.

What are the signs and symptoms of sexual arousal disorder? 
In order for a diagnosis of sexual arousal disorder to be made, there needs to be very little to no response physically in the genital area to any kind of sexual stimulation. This lack of response is persistent and recurrent. In women, there is very little or no vaginal swelling and lubrication. In men, there is a failure to achieve erection or to maintain erection during intercourse.

What type of impact does sexual arousal disorder have on a person's life? 
Sexual arousal disorder that is persistent and recurrent can have a tremendous negative impact on a person's life in four different ways:

1) Affectively, a person may become anxious, depressed, guilty, and/or have lowered self esteem and confidence.
2) Cognitively, a person may become preoccupied with feelings of inadequacy, think there's "something wrong with my body", "I'm not good enough", "I'm not womanly/manly enough", that he/she is the only one with this kind of problem, and/or worry excessively about sexual relationshipsand intercourse.
3) Somatically, a person may develop a sensory hypo-responsivity where there may be an increased lack of physical and sexual sensation. Body memory of previous sexual trauma (if any) can play a role here where the body can automatically shut off or tune out any physical/sexual sensations as a defense mechanism.
4) Relationally, a person may avoid or limit engaging in mature, emotional, and sexual intimacy with others. Sexual intercourse is unsatisfying, incomplete, and for some women, is painful.

What type of help is available for someone who has sexual arousal disorder? 
A medical professional (urologist, urogynecologist, gynecologist, and endocrinologist) can help with exploring any underlying physical causes that may exacerbate sexual arousal difficulties. Some contributing physical factors can be low levels of estrogen in women and testosterone in men, vaginal infection, chronic illnesses such as diabetes, multiple sclerosis, and damaged nerves due to genital injury. Certain prescription drugs can contribute to arousal difficulties such as some SSRIs.

A psychologist or therapist with a good understanding of both contributing and resulting psychological factors to sexual arousal disorder can help a person deal with the difficulty. There are therapists who are specifically trained in sexology to treat people with psychosexual dysfunction issues, including sexual arousal disorder.

What advice would you like to leave for someone who has sexual arousal disorder? 
You are entitled to a full, satisfying sexual life. Do not hesitate in seeking help. There are many out there dealing with the same issues as you are. As a result, professionals are better understanding and equipped to help those suffering from sexual arousal disorders.

Synchronicity as an Intersubjective Connection

At one of my supervision sessions during my internship at Northwestern University, I discussed with my supervisor about a patient with whom I worked intensively for nearly a year.  This patient was back home across the country for the summer and I hadn’t seen her in two months. I remarked to the supervisor that I hoped this patient is doing okay.  Then I walked back to my desk to check on my emails. Lo and behold, there was an email from this very patient I had been talking about!  She wrote to let me know that she is doing well.  Most recently I received contacts from two former patients within days after my thinking about them.

Most people have experienced thinking about a friend whom they haven’t seen or thought in a while and then to either run into them, receive a telephone call from the friend, etc.

What is this seemingly common and also yet uncommon phenomenon?  Some call it uncanny coincidence, some call it telepathy, and others call it intuition or serendipity.  Scientists theorize this phenomenon through quantum physics and chaos theory. Carl Jung describes this as “synchronicity” which is a part of the collective unconscious.  He said this underlying connectedness manifests itself as a meaningful coincidence that cannot be explained by cause and effect.  According to most analysts including Jung, communication is relayed not only at the conscious level, but unconsciously between individuals as well.

I believe the groundwork for synchronicity is the two different but related types of connectedness.  These two types of connection can be defined as intersubjectivity. First, a strong bond is formed between two people as part of their relationship with one another. I call this interconnectedness.  In addition to the strong relationship, the individual is well attuned to his/her own emotions and that of others, and has awareness of his/her unconscious emotions. I call this intraconnectedness.  As a result of both inter- and intraconnectedness, it becomes possible for the individual to sense or pick up emotional vibes from one another and from within.

Synchronicity, when it occurs, is a fascinating event that pays tribute to the close relationships we have with one another.

Do Women Need Sex Therapy?

"I wish my husband would take a chill pill so I can be left alone," a patient of mine recently lamented.  She was talking about the difference in their sexual desires; he wants sex more often than she does.  Compared to his sexual drive, she felt hers was inadequate. Some feminists discern it as the opposite way; compared to her sexual drive, his would appear excessive.

Some argue that the diagnosis of Hypoactive Sexual Desire Disorder (HSDD) in females should be disputed and that sex therapy for women with low libidos serves only to make them believe that they are at fault or have problems.  However, HSDD is real and affects scores of women.  HSDD if not treated hurts relationships.

After ruling out any possible underlying physical and psychological causes to this kind of sexual dysfunction, as a relational psychotherapist I approach this with the viewpoint that it is not specifically his or her problem. Rather, it is an issue of the couple. It happens that their sexual desires are at times mismatched. I encourage the couple to work together as a team, exploring options that would help make their sexual desires compatible. This approach usually brings great relief to the partner with lower sexual desire and enables the partner with the higher desire feel more included in the sexual decision making process.  Finger-pointing and blaming one another is significantly reduced.  Each partner is allowed to work intersubjectively with one another. By experiencing the other's viewpoints and emotions, a stronger bond is created.

Women with lower sex drive are more common than men. There are few cases that I had where the woman is the partner with higher sex drive and her husband was the one with the lower sex drive.  I apply the same principal of this being a couple issue. This is not to deny that there are special circumstances that may lead to the individual sexual desire difficulty. I address this on an individual basis with the goal of bringing the couple later to work together.