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Blog Articles and Resources

November 30th, 2019

11/30/2019

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Holiday Land Mines with Your Family
You will be exposed to your most powerful triggers.

By David Hanscom, MD

https://www.psychologytoday.com/us/blog/anxiety-another-name-pain/201911/holiday-land-mines-your-family

For some, the holidays are synonymous with a strong sense of familial closeness and love. But it can all be quickly sabotaged when relatives trigger each other, and chaos ensues. You’ve waited all year to be with those who you love, and then people don't getting along.

This time of year is also problematic if you are isolated without a close family support system. Loneliness is magnified. Memories flood in and what was painful becomes intolerable. Over half of Americans are socially isolated. (1) The medical wards are usually full because many people have increased problems around drugs and alcohol. It is helpful to understand the powerful nature of these childhood memories and how they are manifested in adulthood. 

Triggers
Any time you are anxious or angry, you’ve been triggered. Your nervous system has connected a current situation to a similar unpleasant past event. It doesn’t matter if the present or prior event represented a true threat. It just has to be perceived that way and the body will secrete stress hormones in its effort to resolve the problem. The sensation created by these chemicals is anxiety. Anxiety is the result of the reaction, not the cause. When you can’t solve the issue, more hormones are secreted, and you’ll become angry.


One of the most perverse aspects of the human experience is that the deeper your connections to others, the stronger the triggers. It is the reason why family dynamics can be so volatile. Most of your reactions to the world are programmed by your parents during the first 12 years of life, especially the first few. It matters little what your parents teach or preach; it’s their behaviors and attitudes that become embedded in your nervous system. If you have come from a chaotic family, your reactions to the present will be intense, although the present “danger” might be minimal. You needed to be hypervigilant as a child and your nervous system continues in this state as you age. You are and will continue to be hyper-reactive out of proportion to the circumstance. All of this is exacerbated in families dealing with chronic pain.


During the Holidays, you are around the sources of your triggers from your parents, siblings, children and other relatives. No wonder the Holidays can be problematic. Landmines are everywhere.


Suggestions
Now it’s the Holiday season, you have missed your family and want to be with them. What are you going to do? How are you going to handle if the situation if you are being triggered? Because it is likely to happen at some level. Here are a few suggestions, most of which I have learned the hard way. 
  • Remember the problem with the strong familial triggers and concentrate on enjoying your family. Play may be challenging, but it’s also the reason you want to be with them.
  • Don’t give unasked-for advice. They have survived the year without you and have you ever heard of a child listening to a parent at any age?
  • Remember that when you are volunteering advice, you are really saying, “You aren’t good enough the way you are.” That is probably what your parents did to you when you were young. It’s also why most of us have the “not good enough” voice in our heads.
  • Visualize yourself being angry and what your family is seeing when you’re in that state. Be the person you want others to be.
  • If you get upset, quickly leave the room. Nothing is ever solved in a heated argument.
  • Be curious and genuinely interested in what your family is up to.
  • Don’t discuss your pain, medical care, politics, religion, or complain – about anything. After all, it is the season of joy regardless of your belief system.
Appreciate the fact that you have the opportunity to be with your family. Loneliness is crushing. If you are in this situation, you have my deepest consideration. We will talk a lot more about this later. Reconnecting with the world is a significant part of your healing journey.
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November 21st, 2019

11/21/2019

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​“Why Aren’t You Pregnant?”
How to handle rough questions from family members.

Georgia Witkin Ph.D. 

The holiday season is one of joy and celebration with friends and family. But at any family gathering, you may be feeling anxious, wondering if you’ll be asked, “Have you met someone yet?” or, “You’re getting older. Why aren’t you pregnant yet?”
The impending gathering may be even more dreadful if you’re going through fertility treatment. The process is emotional and you may not be ready to be overwhelmed with questions. Plus, there are often babies and children running around the living room, which may cause added anxiety, sadness, jealousy, and dread.
But before you decide to skip it all and stay home, here are some strategies for dealing with your family’s well-meaning but insensitive questions:
1. Be Self-Protective. Before you spend time with your family, remind yourself that you are entitled to make your own life choices and don’t have to feel defensive. If you are not ready to start a family, or are struggling to start one, you don’t owe anybody your personal or medical information, not even your family. Tell others only what you want to share, and only when and if you decide to share it. You can always tell, you can never un-tell.
2. Take Control. If a family member gives you advice you don’t want or don’t need, take control. Let them know what you do want or need. Say something like, “I’m on advice overload but thanks,” or, if it’s a close relative, “I just need a hug and a laugh today.”
Rather than feeling like a victim of the conversation, you will be in charge and probably feel a lot more comfortable. You will also be helping others understand that even though the questions are coming from a good place, fertility and family building are very personal topics and it’s not always wise to breach the topic. 
3. Pivot. If the inquisitor is not a close relative or a favorite, just pivot. That means that when you are being asked if you’re engaged or pregnant yet, pivot the conversation to talk about another milestone or achievement: “Well, no, I’m not pregnant, but I’d love to tell you about my recent promotion.” This takes the spotlight off the question while still being able to catch up with your family member.
4. Be Honest. If you choose to talk about your age, your love life, or your fertility with family members, brave the conversation head-on. The statement, “I am struggling with infertility,” for example, will usually turn intrusive questioning into sympathetic support. If you feel like opening up more, you can do so. If you don’t, be honest about that, too, and then change the topic or walk away.
5. Label It. When all else fails, you can usually stop intrusive questions by labeling them. For example, you can say, “That’s an upsetting question," or “That’s an embarrassing question.” It’s a powerful way to remind people to put themselves in your positio
n. It also gives them feedback without direct criticism; you are labeling their question, not them. They usually get the hint.
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The Suicide Warning Signs I Wish I Had Known About

11/12/2019

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The Mighty | By Kristi Hugstand
https://themighty.com/2019/10/husband-suicide-warning-signs/?fbclid=IwAR0Wo6UO4C4y2F4obrK_L6Wq0p2S70z7EXx_FHFdecQc8yKsNxzi3vi1whc

My husband, Bill, died by suicide on an autumn day in 2012 after months of deteriorating mental health.
Through the wise and regretful lens of time, I now see that Bill’s suicide plans were plain – if not obvious. Today I live with the regret of failing to recognize the severity of the warning signs he showed in the weeks and months before his death. I share these here in my desperate hope for a future with fewer devastated wives, fewer heartbroken parents and, most importantly, fewer Bills.


He lost interest in things he once loved.
Bill wasn’t just a gym rat; he was a fitness fanatic. He competed in bodybuilding competitions across the country. He prioritized his workouts above everything else. But in the months and weeks before his suicide, Bill didn’t seem to care as much. When a friend canceled workout plans, he wouldn’t go to the gym on his own. His muscle-ripped, 250-pound frame began to shrink. He just didn’t seem to care as much.
He talked about death.
It was usually theoretical, almost like he was just making obligatory conversation, but Bill frequently, even daily, talked about death. He mentioned deceased friends or family, stories from the news or even hypothetical scenarios about his own. I knew Bill was depressed, and while the talk was morose, I assumed it was typical of someone with depression and anxiety. What I didn’t know was that it is a hallmark warning sign for suicide.
He was abusing substances.
Bill didn’t just abuse substances; he was completely dependent on them. After years of steroid use to help him excel in the competitive bodybuilding world, Bill “needed” a host of prescription painkillers and anti-anxiety drugs to combat those side effects and cope with his deteriorating mental health. Sometimes Bill would quit these cold-turkey, sending him into a spiral of withdrawal that seemed worse than the dependence. It was a cycle he could never seem to break.
His friends died by suicide.
Bill wasn’t a stranger to suicide. In fact, three of his friends had died by suicide. At the time, I had no idea that knowing people who died by suicide increased your risk for doing the same. Now I do.
He isolated himself.
While he looked like the quintessential bodybuilder, Bill was a big softie at heart. He loved people. He loved helping friends. He loved talking to strangers. He called his parents regularly. But before he died, Bill became quieter, more subdued. His happy, easygoing self was clouded with worry and sadness. Once he disappeared for long enough that I called the police to report him missing. He returned, completely surprised by my panic, simply saying he just needed some time to think. As Bill cut himself off from the people he loved, it was a clear warning he was in trouble.
He’d attempted it before.
This wasn’t the first time he’d reportedly harmed himself. Months before his death, I awoke to a suicide note, short and to the point, and panicked before hearing Bill in the shower. I ran into the bathroom, and Bill told me he’d taken a whole bottle of pills the night before. After three days at the hospital, Bill was released.


These warning signs aren’t just lists included on suicide prevention websites – even though they appear on many. They’re the regretful reflections of a devastated wife. As autumn approaches, it is a significant season for me. October 10 marks the seventh anniversary of Bill’s suicide – seven years I’ve replayed these behaviors in my head, wishing I’d recognized them for what they were.
As I brace for the memories inevitably triggered by this date, it’s almost appropriate that September, National Suicide Prevention Month, precedes it. As I consider how best to honor my husband’s memory, I can think of no greater way than to help prevent more losses. If someone you love is exhibiting warning signs for suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255, or call 911 for immediate help.


RESOURCESIf you or someone you know needs help, visit our suicide prevention resources.
If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or reach the Crisis Text Line by texting “START” to 741741.
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After a Breakup: Putting Yourself Back Together

11/11/2019

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Ace* started therapy when his girlfriend of three years moved out of their home. He was depressed, lonely, and sad. At times, he said, he felt like letting go. “Life just doesn’t have meaning for me anymore,” he said. “I don’t understand what happened. How could she just stop loving me? What went wrong?”


Noreen* suffered some of the same feelings when her college boyfriend ended their relationship. “He said he just didn’t want to be tied down. But I think he found someone else. I wasn’t good enough for him.”


What Ace and Noreen were struggling with is not unusual. According to many studies, the end of a marriage or a romantic relationship is high on the list of life stressors at any age. One recent study found that many individuals who are not normally depressed can experience symptoms of depression after a breakup. In her research into the stress of breakups, psychologist Kristin Gillen of Kalamazoo, Michigan, found that “romantic relationship issues are among the most common presenting concerns in university counseling center settings.” 


It might seem like a no-brainer to understand why the end of a loving connection with someone, especially someone you thought you might spend the rest of your life with, is not only stressful, but also painful. 


But here’s something that we don’t always think about in connection with a breakup: The end of an intimate relationship can also damage the way that you think about yourself. In other words, you can lose your sense of who you are in the world, what psychotherapists call your “self” or your identity. Understanding this loss of identity can help you figure out how to recover.


When Jules* left her boyfriend of five years, she expected to feel nothing but relief. “We were angry at each other all the time,” she said. “But I didn’t realize how much I took it for granted that he would be there when I came home. It’s lonely in the apartment without him.


"But there’s something else. We had a lot of mutual friends. We’d gone to college together, and we worked together, so our friendships were all woven together. Some of our friends have stayed connected to both of us. Some have chosen sides. But that’s not the problem. What’s really bad is that I don’t feel like myself with them anymore. I’m…I don’t know…they don’t treat me the same, and I don’t feel the same. It’s subtle. I can’t always pinpoint what’s happening. But it’s there…” 


Popular literature is full of examples. Robert B. Parker, author of the well-loved Spencer mysteries, describes the loss of self in his book Early Autumn:
 

You’ve been through a lousy divorce. For sixteen years or more you’ve been a housewife, and now all of sudden there’s no man in the house. You’re a little lost. 


Author Lauren Layne describes a similar experience in one of her popular romance novels. A thirty-five-year-old woman who discovered that her now-dead husband cheated on her says:  “I’m just so aware that my only identity these days is widow. And even more alarming, even before Brayden died, my only identity was wife. Before that it was girlfriend. I just have the weird sense that I’ve lost sight of who I am. If I ever even knew.” 

That loss of identity can happen after almost any breakup, even if the relationship was short and there was no marriage involved. The truth is, it isn’t a simple loss of identity, but a loss of a feeling of continuity as well. We often feel defined not just by a relationship, but within it. Some, or many of our friendships may be tied to that partnership. We often feel that people only see us as part of the relationship, so it’s not surprising that when it ends, we might feel that we’ve lost the essence of who we are—our self.


Psychotherapists today are very much aware that our sense of self is normally somewhat fluid. In other words, we don’t have one single way of being, but rather what the psychoanalyst Phillip Bromberg calls “a multiplicity of self-states,” all living under an umbrella of an overarching sense of coherence and “me-ness.” It is this mixture of “me’s” that leads to a feeling of becoming a childhood self when we go home to visit our parents, or allows us to feel pleased with ourselves one minute and self-critical in the next. It’s a sense of being able to contain all of the different selves in a cohesive and coherent, if loosely woven whole that helps keeps us resilient.


Interestingly, according to studies in the fields of attachment and neuroscience, our sense of identity is often framed within the context of others. That’s why we say things like “he brought out the best in me,” or “she brought out a side of me I’ve never seen.” It’s not that someone else can actually “make us” feel a certain way, but that we interact with different parts of ourselves in relation to different people. In the best of circumstances, a love partner can support and know a wide range of our “selves” and help us feel an overall sense of well-being and self-satisfaction, even while recognizing and accepting some of our less likeable “selves.”


When a relationship falls apart, it’s often because a partner isn’t serving that function, and we feel more like our worst selves in interaction with them. But even when that’s the case, the end of a relationship can leave us feeling lost, disorganized, and without a coherent sense of who we are.   


Dr. Gillen studied a particular aspect of this loss of self at the end of a relationship, in order to see if she could understand something about the ways that we recover from a breakup. She looked at a specific dynamic, called Sense of Coherence (SOC), a concept was first described in the late 1970’s by Aaron Antonovsky, who was trying to understand what made some people more resilient than others. SOC is, in general, a feeling that things make sense and will work out (albeit not necessarily as planned) in the end. In other words, as Dr. Gillen explains, SOC consists of three basic components: a sense that things are comprehensible, manageable, and meaningful. 


When a relationship ends, we can lose that sense of comprehensibility, manageability, and meaningfulness, and along with it, we can lose a sense of our own cohesive self. That self can, and usually does, return over time, although frequently with some new components added as a result of both the old relationship and the breakup. 


But Dr. Gillen found that a Sense of Coherence offers an extra factor in healing from a breakup. She found that individuals in her study who had a strong SOC managed their pain in part by looking at some of the ways in which they had grown from the experience. Sometimes they saw the relationship itself as having been a learning experience, and sometimes they saw the breakup as an opportunity for personal growth, and sometimes a little of each. 


Being able to see the ways in which you grow after a breakup doesn’t take away the sadness, pain, or feelings of loss. But it can help increase your resilience and make it easier to bounce back from the experience. Some of us have more difficulty looking for these signs of growth than others, and for some of us it takes longer to get there. But if you start looking, you’ll very likely start to see some ways that you have grown in the process. And that growth is going to be part of the self that you move forward with into the rest of your life.  

​https://www.psychologytoday.com/us/blog/the-couch/201911/after-breakup-putting-yourself-back-together

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When Family Relationships Become Toxic: The Trauma of Enmeshment

11/7/2019

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Psychotherapist Salvador Minuchin developed the concept of enmeshment to characterize family systems with weak, poorly defined boundaries. The entire family may work to prop up a single viewpoint or protect one family member from the consequences of their actions. In these family systems, individual autonomy is weak, and family members may over-identify with one another. For example, a child may be unable to see their own interests as distinct from their parent’s and may defend that parent’s interests even when doing so is harmful.
Enmeshment inevitably compromises family members’ individuality and autonomy. It can also enable abuse. Abuse within an enmeshed family system is a unique sort of trauma. Some survivors of such trauma may not recognize their experiences as traumatic and may even defend their abusers. Because boundaries are weak in these family systems, family members who correctly identify their experiences as traumatic may be ostracized or even labeled as abusive.
CHARACTERISTICS OF ENMESHED FAMILIESMost healthy families are loyal to one another and may share certain values. In an enmeshed family, this loyalty and shared belief system comes at the expense of individual autonomy and well-being. For example, the entire family might support the idea of the father as a wonderful parent or great leader, even though he is physically abusive.
Enmeshment does not always lead to abuse, but it is a potent tool for shielding abusers from the consequences of their actions.
Some characteristics of enmeshed family systems include:
  • Each family member fills a specific role. In most cases, these roles enable dysfunctional behavior from other family members. For example, the family peacemaker may smooth over conflicts the family abuser creates or might guilt other family members for attempting to build healthy boundaries.
  • Enmeshment often begins when one family member has a mental health condition or substance abuse issue. Enmeshment normalizes harmful behavior and can be a way to avoid treatment.
  • Enmeshed families often view dissent as betrayal.
  • Enmeshed families may demand an unusual level of closeness even from adult children. For instance, an adult child with children of their own may be expected to spend every holiday with the family. If they spend a holiday with in-laws or with their own family, the enmeshed family may shun or otherwise punish them.
  • Family members’ emotions are tied up together. It can be difficult to discern where one person’s emotions begin and anther’s end.
  • There may be unspoken family norms that family members take for granted. Outsiders may rightly view these norms as unusual or dysfunctional. For example, an enmeshed family may have a norm of never calling the police on a family member who abuses their partner.
Some people also use enmeshment to refer to covert, or emotional incest. This is when a parent or other caregiver treats a child as a partner or equal. The parent may rely on the child for support and unconditional love rather than filling these basic needs for the child.
HOW ENMESHMENT ENABLES ABUSEEnmeshment does not always lead to abuse, but it is a potent tool for shielding abusers from the consequences of their actions. Enmeshed family members may be reflexively defensive of one another and view even deeply harmful behavior as normal and good.
Enmeshment can make it difficult for a person to form close relationships with other people. Without these relationships, it is very difficult for enmeshed family members to recognize that their family’s relational style is not healthy.
Even when enmeshed family members do form outside relationships, their enmeshed family may intrude on these relationships. Alternatively, the enmeshed person may view their family as normal and their partner as the problem. For example, an adult who gets married may still prioritize their childhood family over their spouse or may expect their spouse to defer to family members or accept abusive behavior.
THE TRAUMA OF ENMESHED FAMILIESEnmeshment itself can be traumatic, especially when enmeshment normalizes abuse. In other cases, though, enmeshment is the byproduct of trauma. A serious illness, natural disaster, or sudden loss may cause a family to become unusually close in an attempt to protect themselves. When this pattern persists well beyond the initial trauma, enmeshment loses its protective value and can undermine each family member’s personal autonomy.
Enmeshed family systems are often dismissive of trauma. A parent might dismiss their drunken night of abuse as a normal reaction to a child’s bad grades. In adulthood, siblings may defend a parent’s abuse by insisting that the parent was under immense stress or that the abuse was actually the children’s fault. By dismissing trauma as normal or deserved, enmeshed family systems make it difficult for family members to understand their emotions and experiences. In this form of gaslighting, a family might consistently substitute the family’s collective judgment for an individual’s feelings. Over time, the individual family member may struggle to distinguish their own emotions from the emotions the family insists they should have.
TRAUMA BONDING AND ENMESHMENTPeople who experience trauma or intense emotions together may bond in unusual and unhealthy ways. Patrick Carnes developed the concept of trauma bonding to characterize these relationships.
With trauma bonding, the cycle of abuse tightly binds family members, creating intense emotional attachments. In abusive relationships, the abuser may become abusive and frightening, then apologetic and extremely loving. Some abusive parents attempt to compensate for their abuse with gifts, special outings, or intense love. Many survivors of abuse report that, when their parents were not abusive, they were extremely creative, dynamic, and loving.
This intermittent reinforcement of love and affection can be very difficult to escape. The longer it persists, the more difficult it may become for a person to leave. Abuse survivors may truly love their abusers and believe that their abusers love them, too.
Even when survivors correctly identify the abuse and establish boundaries or leave the relationship, trauma bonding and enmeshment can affect future relationships. The cycle of abuse can feel normal in these situations, as an intermittent schedule of love and affection becomes the person’s point of reference for a relationship. This may cause trauma and enmeshment survivors to seek out and remain in abusive or enmeshed relationships. It can also make it easier for their family to pull them back into the abuse and chaos.
People who grow up in dysfunctional family systems may ignore their own emotions. They may question their memories, wonder if their trauma really happened, or believe that they deserve to be abused. Even when a person is able to see their family through a more objective lens, establishing boundaries can prove difficult. Holidays, family vacations, and other times of intense family closeness can trigger old habits and lead to new trauma.
Therapy can help a person draw clear boundaries, take their emotions seriously, and move beyond enmeshment. A therapist is also an outside voice who can help a person understand that the behaviors their family normalized are not healthy and that they do not have to remain trapped in their usual family role forever.
To begin your search for a compassionate therapist, click here.
References:
  1. Carnes, P. J. (1997). The betrayal bond: Breaking free of exploitative relationships. Deerfield Beach, FL: Health Communications, Inc.
  2. Green, R., & Werner, P. D. (1996). Intrusiveness and closeness-caregiving: Rethinking the concept of family enmeshment. Family Process, 35(2), 115-136. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1545-5300.1996.00115.x
  3. Trauma bonding. (n.d.). Retrieved from http://www.abuseandrelationships.org/Content/Survivors/trauma_bonding.html


© Copyright 2019 GoodTherapy.org. All rights reserved.

Original article found at https://www.goodtherapy.org/blog/when-family-relationships-become-toxic-the-trauma-of-enmeshment-1016197

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    Michelle Stewart-Sandusky

    I write articles based on my experience as a therapist or a training or conference attendee.  Many of these articles are written by others who are experts in their field and I share their information as resources for others.

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