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Below are Yehuda's responses to the Yated Ne'eman's weekly questions.
July 6, 2018
Thank you so much for your weekly column, I really enjoy the panelists’ responses. I have decided to seek therapy because of my eating habits and low self-esteem. I started seeing a therapist with whom I was very happy and I enjoyed going every week. After around two months the therapist informed me that she will be opening her own private practice and referred me to a different therapist. I had a very hard time with this as I felt rejected, and that I was part of the reason she was leaving. How do I let go of this?
It can be difficult to take the plunge and open up to a therapist about our issues and insecurities. It’s unfortunate that a seemingly positive therapeutic relationship was abruptly terminated.
I assume that you were seeing this therapist in a clinic setting. There are many reasons that a therapist might leave a clinic to open a private practice. These include financial compensation, control of the office and therapy environments, disagreements, and the interest in focusing on particular issues or populations. I wonder if your therapist knew when you began seeing her that she would be leaving in the near future. If so, this is something that should have been disclosed.
I don’t know whether your therapist described her reasons for leaving or the reason that she cannot see you in her private practice. If you were not given an adequate explanation, you can ask her to better clarify. If you feel comfortable discussing it (and feel that it would be helpful), you can explain to her that you feel rejected and hurt—and that you’re not asking for her explanation to be confrontational. Hopefully, her responses will make you feel more comfortable with her decision.
You mention that you felt rejected and that you were a part of the reason for her departure from the place where you were seeing her. I wonder if this means that on an intellectual level you recognize that your therapist had no intention of rejecting you and that her reasons for leaving are unrelated to you. If this is the case, you’re acknowledging that your sense of rejection and hurt is emotional in nature. If so, you have likely felt this way many times in the past.
You speak of low self-esteem, which can make you hypersensitive to others’ actions. Someone who has true self-esteem feels good about himself regardless of external factors like possessions, accomplishments, or others’ opinions. People who don’t feel good about themselves (based on intrinsic qualities) are often constantly focused on any clues as to what others think of them. When external factors define our feelings toward ourselves—and ultimately our happiness—we feel the need to continually monitor those factors in order to have some sense of self.
If you recognize that your feelings of rejection and hurt are due to your own insecurities, acknowledging these insecurities can help you to begin to resolve these feelings. When we consciously associate negative feelings with something other than their true source, we wind up spinning our wheels trying to deal with them. In addition, this sets the stage for the same emotions to be constantly transferred from one artificial “source” to another, thus never resolving the underlying cause.
I hope that your feelings about your experience in therapy don’t prevent you from continuing your work with someone else. Remember that it is your right to understand the therapy process and to air any concerns that you have. Hopefully, you will find someone whom you trust and with whom you feel comfortable so that you can increase your self-esteem and resolve your eating issues.
June 29, 2018
My son is a very sensitive boy and every time I tell him “no” or reprimand him for something, as I would to any of my other children, he always looks deeply hurt. Should I treat him differently than, or the same as, my other children? I feel that in life he will have to deal with “no”s and not everything will go his way and people will tell him off. Am I correct in my judgment?
Your question is multi-faceted. Your point about your son needing to learn to deal with adversity and with unwanted responses is well-taken. Obviously, you don’t want your son to learn that everything in life is easy, and that he always gets what he wants. Nor do you want him to learn to manipulate others by responding in a negative manner.
You ask whether you should treat your son differently than, or the same as, your other children. I know that this question refers specifically to the matter at hand. However, from a general standpoint, to some extent we should treat each child differently than the others. Unfortunately, children don’t come with instruction booklets. This is because each child has different issues, needs, triggers, insecurities, and other underlying factors that can affect their ability to respond appropriately to various forms of parenting and discipline.
Obviously, we treat our children differently depending on their ages. A young child might be told to do something without explanation, while an older child may deserve an age-appropriate explanation. However, some young children can appreciate an understanding of rules, while some older children can become argumentative when explanations are given. Many parents tend to speak more softly to younger children and more firmly to older ones. Sometimes, however, a younger child may need a stricter style, while an older child may respond much better to a gentler approach.
This doesn’t necessarily mean that your fundamental ideals, concepts, and parenting style need to be altered based on each child’s needs. What it does mean is that each child may respond differently to the same strategy. Even if, on the surface, the result appears to be the same, this may occur only in the short-term. Long-term results might be very different from what you were hoping to achieve.
Aside from the behavioral goals, it’s important to take into account the lasting emotional effects that your actions can cause. Though you may elicit the response that you want, your son may harbor resentment or feel badly about himself. Feelings like these can lead to significant problems later in life.
As parents, it can be difficult for us to see past the current issue in the present day. We want our children to behave appropriately and to do the right things. When we step back, however, we recognize that our job and goal is to raise our kids to be happy, productive, well-adjusted members of society. When we achieve the immediate goal at the expense of the ultimate goal, we have failed our kids. When we bear in mind both our short- and long-term objectives, we are more likely to choose the proper path.
June 22, 2018
Thank you so much for your insightful column each week. I gain a tremendous amount from your suggestions and advice. I am hoping that you can guide us. We...have a wonderful almost 10-year-old son; he is a fantastic kid, smart, conscientious, studious, well-behaved, bright...The problem is that he likes to eat and has been steadily gaining since 5 years old. First it was 10 pounds, then 20, and now more each passing year. At almost 10 years old, he is 130 lbs. As I see it, he is not very athletic, has a big appetite, and won't touch a salad or vegetables. He had been seeing a nutritionist who suggested utilizing punishments or rewards to motivate him. Will that work? Should we punish our wonderful child for gaining too much weight? We have tried rewards with minimal success. Is he just too young to understand the importance of healthy eating and the consequences of unhealthy habits? We would be grateful for any suggestions or advice.
I certainly understand your concern, and you are right to question the advice of the nutritionist. Although kids may respond positively to reward and punishment, there are facets to consider other than whether this will result in the desired weight loss.
One aspect to consider is your son’s motivation to lose weight. Does he understand the consequences of being overweight? If not, is this something that you believe should be discussed with him? If he does recognize the consequences, is he motivated to lose weight? If he is, are his reasons positive ones? Does he want to lose weight because he wants to be healthier, to feel better, and to be more active? Or does he view the goal of weight loss from a negative perspective, wanting to lose weight due to feelings of shame and embarrassment?
If your son doesn’t seem to be aware of the effects of being overweight, you can have a discussion with him about these. Naturally, you would take into account factors like his sensitivity in order to frame the conversation in a neutral manner.
For a variety of reasons, it’s important for your son’s motivation to come from a positive place. Clearly, you don’t want him to lose weight because of fear or shame; rather you want him to do so out of a healthy, responsible interest in reaching a particular goal. In addition to the obvious long-term emotional impact that negatively-based motivation can cause, people generally respond better to positive motivation. This is usually true with regard to short-term goals, and even more so in the attainment of an ongoing pattern.
At the age of ten, children often do not recognize future consequences, and therefore do not feel the need to change things that have no immediate impact on their lives. Even if your son intellectually understands the negative effects of being overweight, he might not be motivated to change at this point. This doesn’t necessarily mean that he never will be. If the issue is framed properly, at some point in the future he will hopefully decide on his own to change his behavior. If this happens, it’s much more likely that he will be able to maintain this in the long term.
June 15, 2018
I am a 19-year-old...I have tremendous emotional difficulties: anxiety, panic attacks, obsessive looping, and depression. I also struggle with trauma and an unhealthy childhood. While I was skeptical of therapy, I decided to give it a try. I saw a highly recommended therapist for 8 months and found it to be a disappointing experience. While it helped me gain clarity about myself and a brilliant understanding of mindfulness, I felt like something basic was not addressed and am wondering if my experience is typical.
I feel what I need is empathy and validation, not suggestions, insights, concepts, and modalities. Is this a therapist's job? Do I need a special type of therapist? Can a therapist just sit and be silent and feel bad for my unreal suffering and not act as if they know everything because they have a degree and experience?
Clearly, people have differing personalities, insecurities, issues and needs. Just as different therapy clients may require different approaches due to their specific thoughts and feelings, therapists vary in their issues, needs, and personalities. In a perfect world, all therapists would leave their problems and other personal feelings completely behind when entering a therapy session. In reality, however, this is impossible. As therapists, we’re supposed to strive to do this to the extent possible. This entails introspection, self-awareness, and recognition of our triggers and needs.
I’m glad that you were able to make some gains in therapy, but you identified a key issue within your therapeutic relationship. Your sense that the therapist appeared to be condescending is probably to a large degree related to their self-identity. When someone feels that they need to be self-aggrandizing, this usually points to a deficit in their self-esteem.
People who have trouble feeling good about themselves as based on their intrinsic qualities will look to external factors to boost their self-image. This often causes us to identify ourselves—to some extent—as based on our professions, possessions, and other external things. We all know lawyers who are always in lawyer mode, wealthy people who need to constantly remind others of their wealth, and others who largely define themselves as based on their professions, capabilities, or possessions.
Therapists are not immune to this need. This is the underlying reason that, as therapists, we need to be as self-aware as possible. This helps us to focus on the client in the most beneficial manner possible.
A therapist may be highly recommended for various reasons. For some, a therapist who has a good grasp of modalities and treatment protocols can do a world of good despite their need to feel superior. For many, however, this can only go so far. You recognize your need for a therapist who can help you without giving you the sense that they are the THERAPIST. I assure you that there are excellent therapists who combine the best of both worlds.
June 8, 2018
There is a specific issue that I have been holding in for a long time. I understand that it is something that is very serious and needs to be discussed with a therapist. The issue is that it is a very serious thing that I am worried will need to be brought to the attention of the authorities. This is something I don’t want to happen. So, I am stuck, not getting the help that I need. Obviously, I can’t be specific even in this confidential email. Is there anything I can do?
Unfortunately, without some specific information, there is very little advice that anyone can give you. Based on the nature of your question, I will assume that you’re referring to some kind of abuse. The rest of my response will be based on this supposition.
Since I am not an attorney, I cannot give you legal advice. Generally, however, a mandated reporter like a licensed therapist is required to report abuse if there is the sense that there is a danger of further abuse. If you’re referring to something that is no longer occurring, I don’t believe that most therapists would feel the need to report the past abuse.
I would advise you to see a therapist. You wouldn’t necessarily need to discuss this issue immediately. Once you feel comfortable enough to broach the subject, you could ask what their approach would be in the situation without giving them specific information about the abuser. If you are the abuser, or the issue that you’re referring to relates to your own impulse-control issues, you could still ask general questions to get a sense of how the therapist would handle the situation. When you feel comfortable with the therapist and with the process, you would hopefully be able to get the help that you seem to so desperately need.
June 1, 2018
I know this sounds almost cliché but I can’t get my wife to stop spending money. Sounds like a bad joke no? I work hard and make a very nice living but she seems to have no awareness of financial responsibility. Whenever I speak to her she feels bad about it but it doesn’t really stop her. I don’t want to turn this into a huge fight, and she is sensitive to confrontation, but I’m telling you it’s completely out of control. I used to be shocked by how crazy my credit card bills were but I’m numb to it now. She is otherwise a wonderful wife and mother but it’s like that one piece of her brain that could get control of that is missing. I’d appreciate either your therapeutic advice or the name of a good bankruptcy attorney. Thanks.
There seem to be a few factors involved in your situation. The obvious issue is the fact that (as you both agree) your wife spends too much money. Another factor is her sensitivity to confrontation, which makes me wonder whether you have general communication issues—and to what extent this is present in discussions about finances.
The fact that you’ve become numb to the problem may be indicative of your general reluctance to have meaningful discussions. If you sense that your wife feels criticized, her negative reaction can easily lead to a tendency to avoid sensitive subjects. This can lead to a more general breakdown in communication and a strained relationship. The rest of my response will focus on the spending issue, but can likely be applied to other areas as well.
Part of the reason that you have become resigned to the problem may be that you have the sense that your wife (at least to some degree) has a mental or emotional problem that affects her ability to control her actions. You speak of the piece of her brain that’s missing. Even if this was meant to be tongue in cheek, there is often some truth to our humor.
Another factor is your humor in itself. You referred to the situation as a cliché and a bad joke. You also ended with a joke. Humor is often used as a defense mechanism. When we do this, it’s typically to avoid something unpleasant or problematic. Your tendency to view issues in a humorous manner can be helpful in the short-term to deal with simple matters. When a larger issue is obscured through humor, however, this can lead to a more pervasive avoidance of the problem.
With regard to your wife’s seeming inability to recognize and deal with her overspending, there are a few possibilities that come to mind. It’s easy for most of us to identify an obvious issue in the abstract; seeing it clearly from a broader perspective can be more difficult. Changing behavior to match our understanding is harder still. As an example, I might decide to exercise twice a week because I know it’s good for me. But if I don’t focus on exactly how this will change my life, it’s hard to get started. Even if I have a very clear understanding of the benefits, it can still be difficult for me to change my routine.
Perhaps you could have a non-confrontational discussion with your wife about the specific impact that overspending has on your finances. If your wife has little or no involvement in the handling of the family finances, you can encourage her to take on an aspect of this. For example, you can ask her to keep a daily record of her spending, broken down into types (like food, clothing, restaurants, etc.). At the end of the week or month, you could discuss the impact that the totals have on your budget. Being more involved, and clearly seeing the actual effect, can help her to be more cognizant of her spending.
If you believe that your wife actually has a significant problem controlling herself, there may be underlying issues, like those associated with ADHD and other disorders. If this is the case, she should be seen by a professional. If she is already seeing someone, this particular issue should be brought up—not only specifically as a spending problem, but as a more general problem related to focus, distraction, self-control, or another systemic problem.
And, no…I don’t know of any good bankruptcy attorneys.
May 18, 2018
My sister has always thought that everyone was out to get her. She is extremely insecure and very sensitive. Now her paranoia has increased to the point where she is in a fight with everyone in her family. She is furious at me because she thinks I didn’t try hard enough to get her kids into high school...She thinks my brothers are trying to push her husband out of the family business. None of this is even slightly true. I mean completely off the wall with the paranoia. Obviously, she won’t listen to my advice but I have no idea how to deal with her anymore. With her immediate family, it’s really a mess. It’s like the kids are divided into teams between her and her husband. Is there anything I can do to help her or should I just run the other way (which, ironically, would be what she accuses me of) as sad as that may be?
Unfortunately, it sounds as if your sister has a persecution complex. This may not be something on which you can directly impact in any way. Reasons for your sister’s paranoia can be varied, and she may have a psychotic or personality disorder.
Paranoia is often self-perpetuating. It seems that once your sister begins to believe that someone is out to get her, she becomes hyper-focused and highly sensitized to any clues (however insignificant and unrealistic) that this is the case. These clues become magnified in her mind to the exclusion of other factors. This doesn’t allow her to identify or contemplate ideas that contradict the negative thoughts.
This often leads to self-fulfilling prophecies. The certainty that a person is her enemy can easily lead to that person’s negative reaction, in turn reinforcing your sister’s belief. This is probably the reason for the irony inherent in your recognition that sister’s actions may lead to your abandonment of her. This is doubtless something that she does to people on a regular basis.
Your role depends on a few factors, including your own emotional ability to deal with your sister’s accusations, any instinctive reactions, and your relationship with her. If you can handle her behavior and you can control your responses, there are two things that you can do to try and help her. You can let your sister know that you will always be there for her regardless of her thoughts, feelings, and actions. While not agreeing with her paranoid beliefs, you can let her know that you understand that she feels these strongly, and that they won’t drive you away. Making it clear that you are there for her despite her attempts to push you away may help her to develop a sense of trust around your relationship. She is likely craving a sense of security that will come only from someone sticking with her regardless of what she throws at them. While this may be very difficult—and maybe impossible—to achieve, it can be a lifeline for her in a world where she feels that everyone is against her.
If this does lead to a more trusting relationship between the two of you, there may come a time that you can gently persuade your sister to seek help for her emotional issues. When and how this may occur is something that you’ll hopefully know when the time comes.
May 11, 2018
Our 11-year-old son has been stealing things from his friends in school. We keep finding things in his room that we know he didn’t get from us. Recently he admitted that he took a toy from another boy’s briefcase. We are devastated. We give him everything he needs and he comes from a house that I would say has excellent chinuch [values]. I have no idea where he picked up such a horrible thing. Additionally, we are very worried that the Yeshiva will find out and he will get expelled. We are uncertain what mehalach [path] to take with him and are at a loss. A family member suggested therapy but this seems to be more of a chinuch [values] issue...While it might be hard for me to be objective I would say that he is otherwise a solid kid. Any insight into this boy or suggestions as to how to deal with him would be greatly appreciated.
There can be various motivations for your son’s behavior. Your concern is certainly valid, but it’s important for you to acknowledge your specific concern (aside from your fear that he might get into trouble at school) while, at the same time, understanding your son’s reasons for stealing. You may be surprised by your conclusions.
The things that lead adults to steal and children’s motivations for stealing are often very different. As adults, it can be challenging for us to recall and recognize childhood needs, feelings, thoughts, and impulses. For example, while an adult may steal out of perceived necessity, a child may do so specifically because he is given all that he needs. He may be stealing in order to feel a greater sense of control over his life and possessions. The adult may have underlying emotions and needs that allow him to steal, but on the surface he’ll typically justify his actions one way or the other. The child’s emotions, needs, and insecurities are usually closer to the surface. In addition, morality, conscience, and recognition of consequences often aren’t fully developed until the early teenage years.
Other motivating factors include the need for attention, a sense of being undervalued, the need for independence, and learned behavior (from family, peers, and others). Your son is likely not consciously aware of his underlying motivations. Talking with him, however, about what he feels when he contemplates taking something, and how he feels once he has taken it, can help to give you a better sense of the reasons for his actions. Once you understand what is pushing him in that direction, you’ll be in a better position to decide how to proceed.
Based on your words, it appears that you are raising you son with appropriate rules and boundaries. As adults, however, we often forget that things that are clear to us are not necessarily so for our children. Though the reasons not to steal (and to be generally honest) may seem obvious to us, a child typically does not understand these on the same level. He may not fully recognize the limits and boundaries of honesty, and he may see them simply as rules. Discussing with him the reasons for these rules can help him to better develop his sense of morality.
Whenever possible, your child should be shown how to return the stolen object, and he should not see any benefit from his negative actions. Hopefully the combination of his better understanding and firm, non-judgmental discipline will stop this problematic behavior. If the stealing continues, however—and/or you have the sense that there may be a deeper reason behind it—a therapist can help to identify his motivation and help him to deal with it in a positive way.
May 4, 2018
I am 14 years old...and I have no friends. I never really fit in. I am not interested in sports and the things that other kids are into. I feel very lonely and spend most of my day reading. I have always been very shy and I am not comfortable talking to anyone. My parents are not nogeah [involved] to talk to. Please help me. Thank you.
I’m sorry that you feel that you don’t fit in. It’s very ironic that so many kids and teenagers think that they are alone in this feeling. Although so many people feel this way, the assumption is that no one else does.
Please recognize that your feelings are very normal. In fact, I would say that most teenagers feel similarly at one point or another…and many do so for a large portion of high school. The reason that this is so difficult to discern is that teenagers can be quite adept at hiding their feelings from other—and often from themselves. Most teenagers would never discuss their insecurities with others for fear of being viewed negatively. Since we aren’t privy to others’ thoughts and feelings, we base our assumptions on their outward projections, many of which are masks that cover up their true thoughts and feelings.
Loneliness is only a part of the problem. Certainly, not having friends and being isolated from others can be very difficult and upsetting. Perhaps the larger issue, however, is the view that we form of ourselves based on our perceptions. If your sense is that everyone else is well-adjusted, it’s easy to assume that there’s something wrong with you. This contributes to low self-esteem, which can cause shyness and social discomfort, in turn leading to further isolation. As in many areas of life, this type of vicious cycle is most easily arrested in its beginning stage, before it becomes deeply imbedded in the unconscious.
People who repress their feelings often wind up depressed or anxious without a clear understanding of the cause. Your open recognition of your emotions can help you to better deal with them before they become obscured by less obvious manifestations of your thoughts (like anger and general feelings of worthlessness).
You mention that you’re not interested in sports and other typical teenage activities. What you may not realize is that there are many teenagers who have a similar lack of interest. Some of them join in simply to feel included. Others enjoy the camaraderie despite not enjoying the actual activity. Yet others find like-minded kids with whom they can feel connected.
When I was a bit younger than you, my class had an informal recess “reading club” for those of us who were happier reading than playing sports. I don’t believe that anyone actually formed this “club,” and we all read our own books individually, but it probably helped us to recognize that our interests and socialization were normal.
It can be helpful to open up to someone who can help you see things from a more realistic perspective. You mentioned that you can’t speak with your parents. If you believe that they wouldn’t understand your feelings, you may be underestimating the impact of their own childhoods and adolescent experiences and feelings. Regardless, it can be very beneficial for you to find someone like a rebbi, rav [rabbi], close relative, or a therapist who can help you to feel better about yourself. This can begin to change your feelings of shyness and discomfort, turning the self-esteem-shyness-isolation cycle in a positive direction.
April 27, 2018
Our daughter has recently asked us to see (and pay for) a therapist. She says that her reasons for this are because she feels empty, without direction in life, and is not finding fulfillment. She is 22 years old, has never had any issues before, had no major difficulties in life, has a good job and has always done well. My husband and I...think that in this case it would be more appropriate for her to create a kesher [connection] with a teacher...and not see a therapist. For matters of meaning and fulfillment we have always turned to rabbonim [rabbis]...Thank you.
You should be commended for your open-mindedness in requesting the opinion of the therapists who write in this column. Some parents would take the position that their point of view is correct, and never look further. Your ability to recognize that there can be a different point of view is commendable.
You mention the fact that your daughter does not have a mental illness. This may be so, although without further information it is impossible to say. Feelings of emptiness and not feeling fulfilled can be indicative of more significant problems. Let’s assume that your daughter does not in fact have a mental illness. This certainly doesn’t mean that she cannot gain from therapy. You wrote that we have always turned to rabbonim for these types of issues. While that may be true for many, this is not true for us all.
Many frum [religious] people see therapists for issues similar to those that you mentioned. In fact, many rabbonim strongly recommend that people turn to trained therapists for their help in dealing with these types of feelings. One reason for this is that therapists are trained to identify and help resolve troubling emotions, and can help people to work through conflicting thoughts and feelings. They are often able to help identify underlying issues and insecurities that lead to unwanted emotions.
Perhaps you have a rav whom you can consult with regard to this matter. As discussed, many rabbonim who have expertise in these issues can help to guide you. Rabbonim who are deeply involved in matters of mental health typically take all aspects of each situation into consideration before giving advice. In a matter such as you described, this advice might be for the person to speak first with a rav [rabbi], to see a particular frum therapist, or to see a therapist who is also a rav or rebbetzin. Any advice should be based on the bottom line—what is most likely to help the person achieve their goals. Putting aside your preconceived notions and your emotions, from an objective perspective what is most likely to help your daughter to become happier and more fulfilled?
I don’t know what your daughter’s feelings are about your thoughts on this matter. If she simply mentioned therapy offhand, but would entertain other options, you can discuss this with her. Perhaps she would be happy to first discuss her feelings with a rav, rebbetzin, or other mentor. Then, if a therapist is recommended you would both likely be more comfortable with the arrangement. However, if your daughter is set on seeing a therapist—and you would need to push her to see a rav—the efficacy of meetings with him would probably suffer. You seem to be caring, interested parents who have your daughter’s best interest at heart. If you can set aside your own needs and feelings your decision will likely reflect that.
April 20, 2018
My 10-year-old son constantly needs to be entertained. He is never able to just sit still and keep himself busy. He enjoys listening to Jewish tapes of stories (Rabbi Erps, Rebbe Hill, etc.) but he will listen for 5 hours straight. And he will constantly kvetch [complain] about not being able to listen if we don’t allow it. Is it healthy for someone to spend that much time like that? It’s like he has become obsessed with this stuff and like he is addicted to it. I’d appreciate your thoughts and recommendations. Thank you.
There appear to be a few areas of concern. You speak of your son’s constant need to be entertained. Without further information, I don’t have a sense as to whether this is within normal range or if it may be indicative of a problem (ADHD for instance). Many kids—and indeed some adults—don’t enjoy downtime. Children oftentimes complain of boredom. This doesn’t necessarily mean that they have a problem; most often they are simply letting their parents know that they’re bored and want something to do.
However, when a child continually exhibits other symptoms (for ADHD these include: trouble focusing, listening, and organizing, distraction, forgetfulness, and losing things), there may be a larger problem. Your son’s inability to sit still and keep himself busy—without other symptoms—may be normal, depending on factors like duration and severity, as well as availability of, and interest in, other activities. For instance, perhaps he doesn’t have siblings or available friends with whom he can play, he doesn’t enjoy reading, and there are no other obvious outlets that interest him. In this case, his need to be entertained may be attributable to simple boredom. If, however, there are people with whom he can play, he enjoys reading but has trouble focusing for long periods of time, and there are plenty of ways for him to entertain himself, he may have a focusing issue.
The fact that your son can spend hours listening to tapes may mean that he doesn’t have a general problem with hyperactivity or attention. Introducing him to other forms of entertainment can help him to expand his interests. Perhaps there are books that he would enjoy or neighbors with whom he would enjoy playing a board game. Or his ability to listen to tapes for hours might be his way of dealing with attention problems. People with ADHD often hyper-focus in order allow them to temporarily banish a constant barrage of thoughts.
You refer to your son’s obsession with, and apparent addiction to, these tapes. The distinction between an internal problem and a situational one again relates to whether there are readily available forms of entertainment of which your son can avail himself. If you think that your son may have a problem that is not explainable by circumstances, you can have him assessed by a mental health professional.
April 13, 2018
Although your responses will be too late to be beneficial to me, I hope that by writing into this panel your responses will guide others who may be dealing with a similar dilemma. My wife’s father...recently...died...after a relatively brief illness. There was a lot of disagreement between my wife and me as to how much our 3 children (ages 12, 10 and 7) should participate in the levaya [funeral], shiva etc. My wife was very concerned that the levaya (and particularly going to the beis hakevaros [cemetery]) would be traumatizing for the children. She also insisted that they remain at home and keep to a regular schedule while the shiva was in a different town. I wound up bringing them in just on Sunday afternoon to visit for a few minutes...I know that every situation is different but am sure your guidelines would help parents navigate these difficult times.
Your question reminds me of a similar one that was asked a number of months ago. That parent was concerned about her 5th grade son who was traumatized by graphic Holocaust photos. As I pointed out in that week’s issue, each person has different triggers, fears, and emotional responses. Thus, one child may be nonchalant in a situation that causes significant pain for another. Additionally, a child’s age and maturity level should be taken into account before making decisions.
As parents, we try to shield our children from things that we believe can cause them harm. However, child-rearing is not an exact science. Since each child is unique in their needs and emotions, we need to approach parenting from an individualistic perspective. We also need to set aside our own feelings and insecurities in coming to a decision. Sometimes though we feel that something would be traumatic for a child, a more objective viewpoint can help us to recognize that it might actually benefit them. It can be difficult to determine a child’s response to a new situation, but an objective perspective can help us to see circumstances more clearly. One way of achieving this type of perspective is to imagine a friend asking for your opinion. This can help to minimize our subjectivity, allowing us to come to a less emotional conclusion.
A more general issue that I had mentioned is the fine line between appropriately protecting our children and being overprotective. I think that it bears repeating:
“The obvious advantage to erring on the side of caution seems clear in the short term. When we strive to protect our kids from difficulty, they appear to be safer and less distressed. In their younger years, they can seem more content. As kids grow older, however, they not only require less protection, but can be harmed by too much.
“Kids need to learn coping skills—both logistical and emotional—in order to become well-adjusted adults. Overprotection can decrease their ability to develop these skills. When this occurs, kids will often begin demanding continuous protection due to their inability to deal with problems—whether emotional or otherwise. This often becomes a cycle in which both parents and children become used to this protective relationship. They either do not recognize its problematic nature or can’t figure out how to change it.”
As parents, we are in a better position than anyone else to identify our children’s needs, and to properly base our decisions on their individual characteristics. The hardest part is often our emotional involvement in the situation, whether due to fear for our children or our own fears and triggers. Stepping back—perhaps with the help of an outside party—can help us to see the situation more clearly. Sometimes, this can make a seemingly difficult or contentious issue appear much simpler.
March 30, 2018
I took my first cigarette in 9th grade. I have been smoking steadily for the past 15 years. If I am honest I realize that it is a big health risk but that doesn’t seem to motivate me to stop. I guess I kind of “want to want” to stop. It certainly would make my wife and parents happy. My questions are: 1. Do you have any suggestions as to how to become more motivated to quit? 2. Are there any specific methods that you recommend more or less for quitting (i.e. cold turkey, slowing down, switching to an e-cigarette, hypnosis, medication, psychotherapy, etc.)? I would appreciate your input. Thanks.
It’s great that you’ve been thinking about the harm that cigarettes can cause. You seem at least somewhat motivated to stop. This can be very difficult after 15 years of smoking steadily. As you pointed out, there are many ways to try and quit smoking. Each one can be effective depending on many personal factors.
Generally speaking, in order for any method to properly work there needs to be a clear decision to quit. This should be accompanied by constant reinforcement of this decision and focus on the goal. In addition to the obvious gains (like better overall health, lowered risk of medical problems, and making yourself and others happier), you can introduce your own incentives. You might treat yourself to something after not having smoked for a week, or a month. Interim goals like these can also make the prospect of quitting seem easier.
Particular forms of quitting are specific to each individual. Some people have been able to go cold turkey focusing on things like those mentioned above. Others find that e-cigarettes help them to slowly changes their smoking habits until they no longer smoke at all. Yet others wind up smoking e-cigarettes long-term.
I wouldn’t use hypnosis until significant underlying problems and needs related to smoking are ruled out. This is because hypnosis doesn’t take into account possible emotional issues that are being “treated” with a compulsion to smoke. Psychotherapy can help to rule these out—or to uncover underlying issues, helping to decrease the need to smoke.
Regardless of your decision, identify triggers both in normal, daily situations and in avoidable circumstances. Common everyday triggers include post-meals, driving, break times, and stressful situations. Avoidable circumstances can include time spent with other smokers, using stores that sell cigarettes, and being in places where cigarettes are available.
A psychotherapist can help you to identify your specific needs and triggers, and can help you work on goals, motivation, and incentives. Good luck!
March 23, 2018
My best friend recently became engaged. I should be overjoyed; however, I am very afraid for her. She has never had great self-esteem and is not a great judge of character. Her chosson [groom] does not appear to be a good person at all. He doesn’t treat her with respect and is constantly making demeaning remarks to her in front of everyone. You can tell a lot from the way others talk about him as well. I feel like she just has such a low opinion of herself that she will marry anyone who is willing to marry her. I tried engaging in a conversation with her about him but it doesn’t go anywhere. I don’t feel like it’s my place to get involved and I don’t want to come across as the jealous friend. She doesn’t really have a close relationship with her parents and there isn’t really anyone else I see that would get involved. Do I come right out and tell her what I think and risk our relationship? Will she even hear me? What if she breaks off the shidduch [match] because of me? That isn’t a responsibility I feel ready to take. On the other hand, how can I sit back when she is clearly making a terrible mistake?
It sounds like you’re a good friend who genuinely cares. You don’t want your friend to wind up in an abusive marriage, but are concerned about the impact of your involvement. You mention a number of concerns, most of which you relate directly to concern for your friend’s welfare. I think, however, that your worries can be separated into two categories: concern for your friend’s well-being, and concern for your relationship. Though there is overlap, it can be helpful to consider these categories separately.
You seem to have only one fear about your friend’s well-being. You’re concerned that her lack of self-esteem is leading her into a bad decision. The other concerns seem to center around your relationship with this friend (and perhaps your feelings toward yourself). Your fear of being viewed as jealous, your sense that she might not listen, and worry about changes to your relationship are all related to your feelings and to how your relationship might be impacted.
The emotionally-driven aspects should (theoretically) be removed from your decision-making process. If your true concern is simply for your friend’s welfare, your own emotions should not play a part in your decision. However, life is more complicated than theory. We can’t completely separate our own emotional needs from our logical focus. Additionally, if your relationship is adversely affected by your involvement, your friend can lose the most valuable resource that she has—your friendship.
As you mentioned, your friend doesn’t really have anyone else in her life. Your close relationship can be a double-edged sword. Your words and opinions can have a significant impact on your friend, but can also lead to her being badly hurt by her perception of your meddling in her affairs. You also don’t know whether your words will have any effect, in which case you may risk your relationship with no reward.
There are two areas in which you seem to have contradictory thoughts. You don’t feel like it’s your “place to get involved,” but you clearly state that you’re the only person who can (and should). You’re worried that she might break off the shidduch, but that’s exactly what you believe she should do. It appears that your logic is telling you one thing and your emotions are telling you something else.
It’s important to identify all concerns and weigh the risks against the rewards. In order to properly do this, you need to identify those aspects of your concerns that relate to your own emotions and needs. Once you remove these—to the best of your ability—from the equation, the correct decision will likely become clearer.
March 16, 2018
My husband has had a job in finance for around 15 years. He is very good at it and makes a nice living but it is a stressful job and he is under a lot of pressure. He has recently begun complaining a lot and is overwhelmed by work. He took off a few weeks recently and that helped, but only briefly. He is talking about changing careers but I don’t know why he suddenly can’t handle it. He says he just isn’t interested and can’t take it anymore and that he never really enjoyed it. It certainly never seemed like that—he used to thrive off the pressure. I want to be supportive but it’s a huge move to leave his job at this stage. I’m not really sure what’s going on and if it’s really related to the job at all. There are no glaring issues in our lives right now that would seem to be causing this. Do you recommend that I just be supportive or is this something that will pass and I should push him to stick it out?
From a simplistic perspective, our taste for challenges can change as we get older. When we’re young and energetic, we are more likely to welcome new challenges. As young adults transitioning from lives of few responsibilities to ones that include new kinds of responsibilities, we often find new challenges exhilarating. A demanding job can seem more interesting than a sedate one.
As we grow older, however, our perspective often changes. We find that many aspects of life can be challenging. We need to juggle relationships with parents, spouses, children, associates, and others. Our responsibilities tend to grow, forcing us to cope with numerous issues. This can lead to a desire to simplify our lives. When trying to decrease stress, we generally look to the areas that we feel we can control. It can be difficult to feel a sense of power within our relationships and other areas in which others have significant input. Our jobs can seem like the area of least resistance, in which we feel that we have the greatest degree of control.
Your husband may simply want to choose a career that will help him feel less stressed in general. Or perhaps he actually wants to feel more challenged and he feels that his current job is monotonous. Or he may feel that he has little power in other areas of his life, and this is an attempt to exert some type of control. Maybe complaining about his job is simply his way of expressing his frustration about the stress in his life. It can be a combination of these and other aspects.
I can think of a few factors that are important to mention: consistency over time; stress (or disinterest) in other areas of life; and consideration of consequences. Your husband may have been consistently considering a career change for a while and has seriously considered the consequences. If this is the case and this is the only aspect of his life toward which he feels this way, this likely points to a logical and calculated decision. However, perhaps his feelings about his career tend to waver, and he has similar feelings in other areas. Maybe he hasn’t really thought much about possible consequences. If this is the case, your husband may be trying to compensate for general stress (or lack of control) by focusing on the area that he feels he can most easily change.
It doesn’t seem as if you’ve had an in-depth discussion with your husband about his feelings and motivations. You may not know how long he’s been considering a career change, whether he wants to feel more empowered, or whether he simply has interest in a more challenging position. Discussing with your husband the reasons behind his interest in changing careers can help you obtain a better idea of his motivations. This can lead to better communication about issues and stress in this area. It can also help set the stage for better future communication about feelings and concerns.
March 9, 2018
I appreciate your column and insights and I would like to get your opinion on something that has been bothering me for a long time. I am afraid to do hagbah [ritual lifting of the torah scroll]. I have only done it once in my life (with a really small Sefer Torah). I should be strong enough but I just have such a fear that I will drop the Sefer. I usually duck out of shul when it’s time for hagbah so that the gabbai [official] won’t approach me. If I do get asked I always refuse, which is embarrassing. I would appreciate any advice you could give me as to how to get over this fear.
It sounds like you clearly recognize that there is no logical reason to be afraid. Nonetheless, you are. There is a discrepancy between your logical thoughts and your feelings. The trouble is that when you’re in the actual situation, your logical thoughts take a back seat to your triggered emotions.
We all experience this type of conscious/unconscious dissonance on a regular basis. We all do things that we know we shouldn’t, feel more strongly about issues than we believe we should, and react more strongly to situations than we would like. Simply put, this is due to our emotions ruling over our thoughts. When an unconscious emotion surfaces, it causes us to “believe” what it tells us. If I feel highly anxious, my conscious mind automatically tries to tie the emotion to something within the current situation.
When the time for hagbah draws near, an emotion appears to get triggered on an unconscious level. This causes your conscious mind to try and make sense of it. The emotionally-driven conscious thought identifies the possibility that you might drop the sefer. As long as the source of the trigger is present (i.e., while you’re in shul or when the sefer torah is out) it can be very difficult to focus on your logical recognition that this makes no sense. And as long as your conscious thoughts are controlled by your unconscious fears, you will “believe” what your feelings are telling you.
What you seem to clearly believe is that you will not drop the sefer, and that there is nothing to be concerned about. In retrospect (for instance while you were writing the above request) you recognize this, and probably wonder why you can’t bring this logical reasoning into shul with you. Likely, you either think logically or emotionally. When you’re not triggered, you think logically; when triggered, you think emotionally.
When we’re thinking logically, our instinct is to “convince” ourselves not to be afraid. We focus only on our logical thoughts, reminding ourselves that our emotions don’t make sense. This instinct stops us from properly challenging our fears. What you’re not doing is identifying and analyzing your fear, then thinking about it from a new, rational perspective. This can be very difficult to do when your fear is present.
When your fear is no longer present (and you’re thinking logically) try to conjure up the feeling of fear. Try and understand its origins, the circumstances at the time, and the reasons that you were afraid. In high school, were you afraid to do hagbah for fear of being thought of as a weakling? Did you assume that a sefer torah is heavier than it really is? Were you intimidated by the attention or by the significance of doing hagbah? These are examples of the causes of fears that can be strongly triggered despite the fact that your current logical thoughts do not support them. Actually, the very fact that you no longer believe these can cause your conscious mind to shy away from acknowledging their existence. Doing so, however, and beginning to change your thoughts about past fears can reduce their potency. This can decrease the strength of your triggers, allowing you to think more logically. If you have other fears, related to religion or otherwise, following this prescription can help you to better deal with them.
March 2, 2018
Thank you for your column. I really enjoy it. I am a teenage girl who...has many things going for me; I have a great, loving family, plenty of friends, good grades and all in all I am very happy. I do suffer from trichotillomania (I pull out my hair). But just to make it clear those who don't know would not be able to tell. My friends know and really don't think about it—it really has no effect on my life. Do you think it is necessary to go for therapy or do whatever it takes to stop...? Thank you.
I wonder what led you to ask this question. Is it because of something completely external to you that doesn’t relate at all to your feelings and beliefs about the trichotillomania? For instance, are you asking only due to feedback that you received from others, or because of something that you read? After all, you stated that it has no effect on your life. In other words, does your trichotillomania not bother you in the slightest, but you’re simply curious about what a therapist might think?
If this is not the case, is there something about this that bothers you (however slightly)? If so, it’s important to acknowledge what this is. Even if you don’t wind up changing your behavior, understanding what bothers you can help you to better deal with your feelings toward the trichotillomania.
Major issues aside, there are two basic reasons for maladaptive actions: force of habit, and underlying emotions. Although one can make the case that there is an underlying cause for everything, this doesn’t mean that we need to identify the root cause for everything that we think, feel, and do. (If we did, we would have no time for anything else—and would succeed in identifying only a very small portion of our unconscious feelings and impulses.) However, certain habits are externalized manifestations of unconscious issues. When this is the case, identifying and dealing with the underlying emotion can help to both resolve the issue (i.e., anxiety, low self-esteem, etc.) and reduce the external manifestation (in your case, trichotillomania).
Perhaps there are no significant underlying factors, and the trichotillomania doesn’t bother you. Nonetheless, you might want to ask yourself whether it can cause problems for you in the future. Will your future husband, for instance, have a problem with it? Will it begin to bother you? Might your hair pulling extend to your eyebrows or eyelashes? Or might it evolve into skin picking (excoriation)?
If you have been pulling out your hair in the same way and at the same rate for years—and you’re certain that it’s simply a habit—asking yourself the above questions may be enough. However, it’s often difficult for us to identify the causes of our impulses on our own. If part of the reason that you asked this question is a niggling sense of unease, a couple of sessions with a therapist might help you to identify and deal with it—or put it to rest.
February 23, 2018
I am an adult and I have a problem. I get extremely impatient to the point of becoming highly aggravated when sitting at drawn-out events. For example, sitting at a...meal at a relative’s house gets me nervous if they extend it too long. Waiting at a doctor’s office or at a line in a supermarket can almost put me into a rage. I can't hang around too long at a wedding if I am not doing anything there. I am an adult and can control myself from exploding. What is concerning me is that I see some of my children suffer from this as well. They explode if I take a route to school that will make them sit in traffic or if I pick them up late from school. They would rather not have ice cream if it means waiting on line. It is like waiting or doing nothing is a trigger for a temper. Please help me and my family.
There are likely a few factors leading to your issues. Your children’s issues may be occurring for similar reasons, completely different ones, or a combination. Since I don’t know your childhood, family, or symptom history I can only point out common causes for the problems that you identified.
You referred to two distinct issues: impatience and anger. Although these often feed on one another, it can be difficult to figure out the original source. When your issues first began, were you feeling internally angry, which caused you to project this onto specific external people and situations? Or were you initially impatient, causing you to become angry at the things that caused your feelings of impatience?
If the initial feeling was anger, it can help to try and identify the cause. Recognizing that today’s feelings of anger are being displaced, and acknowledging their original source, can help you to begin properly dealing with them. Generally speaking, anger is not a “primary” emotion. It is usually created to deal with other more repressed emotions—like feelings of depression, insecurity, low self-esteem, and hopelessness. A therapist could help you to work on both connecting to these emotions and reducing past and present feelings of anger.
If the initial feeling was impatience, the cause may have been similar to those discussed with regard to anger, in which case working on them in the same manner can be helpful. Feelings of impatience can also be a symptom of a larger disorder. A few that come to mind are ADHD, bipolar disorder, oppositional defiant disorder, and a couple of personality disorders. These can be identified with the assistance of a qualified therapist.
Your children may be experiencing something similar to what you did. Or they may be learning from you and/or others to be impatient and angry—either generally or in specific types of circumstances. (As a child, you may have also learned from others to feel impatient and angry.) It may be a combination of internal issues and reactions learned from role models.
You mentioned that you’re able to stop yourself from exploding. How obvious to your children are your feelings of impatience and anger? In addition to the obvious manifestations of anger—from which your children learn how to think, feel, and react—kids are adept at picking up on emotional cues. Even if you think that your feelings are not very obvious, your children are likely internalizing the messages that you’re inadvertently broadcasting.
It is important to be aware—both generally and in specific situations—of the impact that your actions (no matter how insignificant seeming) have on your children. Working on your own issues can obviously have a trickle-down effect by sending a better message to your children. Also, focusing on controlling your reactions when your kids are around can help to alleviate their internalization of negative feelings and behaviors. This may also be a first step for you in dealing differently with your feelings in different types of circumstances.
February 16, 2018
My son (age 26) was diagnosed with anxiety by our family physician a few years back. I took him to a psychiatrist and he was given medication. He does very well when he is on the medication but I find he constantly skips doses. Even more concerning is that without telling me he will try and take himself off the medicine to see how he can do without it. I will often notice that he isn’t doing well and will confront him and realize he isn’t taking them. The difference between when he is taking his medication and isn’t is very significant but he doesn’t realize and/or doesn’t care. My question is really twofold. 1. At what point do I just say it’s his life and I can’t always police him to make sure he does what he is supposed to? 2. Do you have any suggestions on how to get him to be more responsible with taking his medication?
Your questions are specifically about your son’s medication, but the broader question relates to many aspects of parenting and relationships. To what extent should we be involved in helping our children and others in our lives to make decisions? Of course the answer to this question depends on many factors. The response will depend on age, personality, self-awareness, the nature of the relationship, and many other factors.
As discussed last week’s column, we want the people in our lives (and specifically our children) to attain the level of decision-making at which they will make appropriate decisions with little or no outside assistance. However, there are times when we feel the need to step in so as to avert a problematic situation. Sometimes this is the correct approach. Often, however, the question is whether we are missing the forest for the trees—are we too focused on the short-term problem to recognize any impact on the long-term goal?
Each time we make decisions for others, we take the chance of reinforcing in them the notion that they don’t need to make their own decisions. Even more problematic, this can reinforce their sense that they cannot make their own decisions.
With regard to your son’s anxiety, I don’t know all the factors involved in the situation. You have a much better idea of how he might respond and to what degree your involvement or lack thereof will impact on his decisions. If you think about your son’s qualities and personality, you also probably have a good idea of how his decision-making abilities will continue to develop with and without your involvement.
Your decision should be based on how you can best help your son given all factors and with a view to both short- and long-term effects. Although the ultimate goal is for him not to need your help in order to make proper decisions, each situation should be viewed from a pragmatic perspective. This will help you to arrive at a conclusion that will lead to the end goal without causing too much angst in the short-term…which can in turn affect the achievement of the end goal.
I...have two very wonderful young boys, ages 9 and 7. They fight a lot. I find that I am constantly refereeing their fighting. Part of me wants to just let them deal with it themselves but they wind up coming and crying to me at some point. I have no idea how I am supposed to judge and arbitrate 15 disagreements a day. Please give me some tips on how to manage this.
February 9, 2018
You presented your concern very succinctly. I think that this is a question that most people with more than one child have asked themselves in one form or another. I see two basic aspects to this type of concern. One is logical, the other emotional.
On the emotional side, to what degree is your difficulty in deciding how to proceed related to your general emotional reaction to your boys fighting and to any specific triggers within each situation? For instance, are you feeling powerless as a father? Or do certain circumstances remind you of feelings that you had as a child? To the extent that your feelings are caused by your own emotional attachment to a situation, it can be difficult to properly assess the situation from a pragmatic point of view.
In each situation, it’s important to identify—then set aside—your emotions in order to logistically decide on the best course of action. This requires introspection on your part to recognize the types of instances that lead to emotions that affect your decisions. Once these instances and emotions are clear, it will be easier to acknowledge them within the situation. At that point, you can more easily set these feelings aside and deal with the problem in a more practical fashion.
From a logical perspective, when your children fight you seem to ask yourself whether your involvement will be helpful or harmful—in both the short-term and the long-term. In the short-term, will your intervention lead to one (or both) of the children feeling hurt? When dealing only with his brother, each of your boys may feel upset about what is being said and done. When a parent gets involved, however, there is the potential for them to feel belittled, disregarded, disenfranchised, or otherwise criticized. Over time, this can lead to a deep sense of resentment and other negative feelings.
On the other hand, properly arbitrating a fight can help your sons to recognize that you care about their feelings and concerns. It can also help them learn how to deal with similar situations on their own. Modeling appropriate behavior and showing them the proper way to settle a disagreement can—over time—help them to do this better on their own.
This leads us to the other factor. From a parenting perspective, should you be constantly showing your boys how to properly resolve an argument, or are they better off figuring it out for themselves? Obviously all children and relationships are different. Depending on children’s natures, relationship, levels of maturity, and other factors, proper reactions will vary. Often, however, it’s a matter of focusing on the long-term goal. Our job as parents is to help our children reach adulthood with the best possible tools to help them navigate life. We may feel calmer after forcing our children to stop fighting. We may congratulate ourselves on defusing a tense situation. But have we helped our children to develop their own coping skills? Have they learned to deal with a future incident in a slightly better way?
This question can also be extrapolated to many areas. To what extent should we “help with” (read “do”) our children’s homework? When our child dislikes a teacher, should we intervene? If a child is unhappy in summer camp, should we visit, insisting that the camp bend their rules to allow this? Should we give our children everything in order to make them “happy?” Basically, should we fix our children’s issues or let them (or help them) to learn how to do so on their own?
These are not easy questions to answer, and each child and situation needs to be dealt with differently. However, if we identify the questions that should be asked and apply their responses to each situation, we’re more likely to come up with the appropriate response.
February 1, 2018
Our daughter went to seminary in Israel this year. This was something she had very much wanted and was looking forward to. Basically, since Succos she has been telling us how miserable she is and that she wants to come home. She is too old to be homesick and I’m not sure what is going on. She has never been the most independent girl but I didn’t think she would have such a problem there. The mechanchos [teachers] in the seminary have spoken with her (though they haven’t been as involved as I would have liked) but haven’t really made any progress. One of them recommended therapy but I am hesitant to send her to someone so far away where we can’t meet them and see how she is doing. We are at a point where we are seriously considering bringing her home but I think that would really be a blow to her self-esteem. On the other hand, how can we force her to go on being so miserable? We are looking for ideas and I hope you can help. Thanks.
There are a few aspects to your question. You state that your daughter is too old for homesickness. In order to respond to this, we need to define homesickness. Though not a “disorder” in and of itself, depending on factors like duration and severity it can be classified as an adjustment disorder. This is basically what it sounds like—significant trouble adjusting to stress. Adjustment disorders can affect people of all ages. Most commonly, adjustment disorders include depressed mood, anxiety, or both. In the case of homesickness, the stress is a negative reaction to sudden changes to things like social, academic, or home life. The underlying cause is often a sudden decrease in the sense of love, security, and protection that children associate with family and home.
Homesickness is often associated with children. The first day of kindergarten can be traumatic for a child who feels a strong need for the sense of love and security of home. For an older child, changing schools, going away to summer camp, or even a sleepover can cause feelings of homesickness. Possibly the best way to guard against future homesickness is…dealing with homesickness. As with most life adjustments, our coping mechanisms strengthen as we learn to cope with new situations. In addition, with homesickness we form a sense of security based on the new surroundings.
If your daughter has used her coping skills in the past, but hasn’t learned to form a sense of security around places other than home, it will likely be harder for her to do so in this circumstance—in which she is forced to abandon her sense of security based on home. Your parenthetical statement—that seminary faculty hasn’t been involved enough—can be a significant factor in your daughter’s trouble dealing with her feelings of homesickness. If she would form an attachment to someone in the seminary, it could help her to feel more secure.
If there is someone within the seminary who can help your daughter feel more comfortable and secure, that would probably be the best option. Although therapy can be helpful, your concerns are noted. Assuming that her homesickness is not debilitating, and there are no other factors that would require professional guidance, the main function of a therapist may be simply to give your daughter a sense of security. This would likely work better if supplied by someone within the seminary—your daughter’s new “home.”
As far as bringing your daughter home, you mentioned your concern related to her self-esteem. Additionally, this could reinforce her need for security as based on her childhood home. This could, in turn, affect her ability to cope with future issues. On the other hand, you don’t want her to be miserable.
As with many issues, feedback and self-feedback is important. If you recognize that your daughter seems less upset as time passes, be sure to mention this to her, citing specific examples (like, “You seem to be spending more time with friends,” or “You’re laughing more when I speak with you.”). If you daughter begins to see that she is moving in a positive direction, it can make it easier for her to deal with the situation.
January 26, 2018
I am a single boy who has been dating for 4 years. Whenever I start dating I get tremendous pressure from my parents to get married. I can’t think straight when I am dating because of all the pressure; of course, the shaddchanim [matchmakers] join in as well. I have started saying no to any shidduchim [matches] that are...[offered]...to me because I can’t put myself through this again. My parents seem to think that all the girls I have dated are pretty much appropriate and I just need a “push.” They undoubtedly have my best interests in mind but I don’t think that approach is good for me. Can you give me some advice on how to approach them?
There seem to be two aspects to this situation. The first is your direct question of how to approach your parents to help them understand your position. You want them to recognize that the pressure they place on you is achieving the exact opposite of what they think it will. As you state, they have your best interests at heart and appear to believe that pressuring you will make it easier for you to commit—and will ultimately lead to happiness for you. What you want them to understand is that you have the same goals, but that their pressure is making it significantly harder for you to achieve those goals.
It sounds as if you’re concerned about your parents’ reaction to your perspective. I think that it’s important for you to identify your specific concerns. This can demystify these concerns, making it easier for you to approach your parents. Sometimes, the most difficult part of having this type of conversation is simply broaching the subject. Assuming that you have a positive and open relationship with your parents, the actual discussion might not be very difficult.
One reason that initiating the conversation may be hard for you is that you don’t want to hurt your parents’ feelings. Perhaps you think that they would be insulted at the insinuation that they’re doing something to harm you. Or maybe you’re afraid that they won’t understand. Once you acknowledge your concerns, you can begin to address them. For example, after some thought, you might clearly recognize that your parents are unlikely to be hurt—or that any hurt feeling would be transitory and more than offset by the resulting positive changes. Or you may realize that the fear of your parents not understanding your feelings is based on childhood experiences, but not relevant within your adult relationship with them.
Do your parents read the Yated? Perhaps you could bring this column to their attention. If you were to discuss this week’s Q&A with them from a more objective standpoint, it might be easier for them to separate any emotional reactions from their logical perspective. This can help you ease into a discussion about your situation.
The other aspect inherent in your situation is the reason that pressure (from your parents or others) is so problematic for you. Certainly, I think that most people would be bothered by constant pressure to get married. However, it sounds as if your reaction is stronger than you want it to be. Once again, identifying the reasons behind your reaction can help to mitigate it. For example, if part of your feeling is based on a sense that your parents are disappointed in you, acknowledging this feeling can help you to challenge it with the current recognition that this is not the case, and that this sense is simply based on childhood emotions and experiences.
Hopefully, some introspection can help you in both areas. It can help you to better deal with your feelings and reactions to the pressure and with your fear of discussing your concerns with your parents.
January 12, 2018
Thank you to the Yated for this excellent column which I read weekly. I am writing regarding my father. My father is an extremely bright person and a professional who has been working the same job for many years. As he has recently entered his 60’s I notice that he just seems to be very down. My youngest sister recently got married and there is no one living at home any more. I also see that the younger people seem to be advancing in his company while his career seems to be stalled. I am not sure exactly what is going on or what I can do about it but there is clearly a real change in his mood over the last few months and I would appreciate your insight and direction. Thank you.
For most people, life changes can be disconcerting. For many, major changes can cause feelings of anxiety and sadness. Reasons for these feelings are varied. When our emotions are a direct reaction to an event and its overt impact, we generally deal with them gradually. For example, to the extent that your father’s depressive feelings are related to missing his daughter and feeling lonely, he will likely deal with these over time.
Practically speaking, your father may begin to visit your sister more often, or otherwise adjust his relationship with her to address his feelings of sadness. Or he might change other relationships to help him feel more connected to others. Emotionally speaking, he may be experiencing the classic stages of grief and loss. The “official” stages are denial, anger, bargaining, depression, and acceptance…but not everyone experiences them all or does so in this order. Your father might be emotionally working his way through a normal reaction to loss.
Often, however, normal reactions to life circumstances are exacerbated by unconscious factors. Most prominent among these is the effect of the situation on a person’s sense of self. If your father always defined himself primarily as a father, provider, and professional, recent events may have shaken his sense of self to the core. It can be harder for him to feel like a father (whose children need him) when there are no children at home. The lack of promotion might make him feel that he isn’t as good a provider as he wants to be, and his sense of being a professional may not be as dominant as it once was.
Of course there are other factors. The human mind is impossibly complicated, and we will never understand all of its facets. Your father may have other needs, issues, and insecurities (as do we all) that are impacting on his current mood. Nonetheless, I have found that the most compelling factor tends to be the underlying need for self-esteem.
Ideally, the goal should be to build a sense of self based on intrinsic qualities rather than basing it on external factors. However, most of us do focus on our achievements, roles, and other external factors to feel good about ourselves. When we identify many factors and spread our focus pretty evenly, we tend to transfer from one to the other—or identify new ones—as needed. For example, your father may begin to identify more strongly as a grandfather or as a religious person to compensate for a perceived loss in self-esteem. If you notice something like this occurring, this may be a sign that your father is beginning to adjust his sense of self to fit the new circumstances.
If, however, your father’ depressive feelings increase or continue unchanged for an extended period of time, a therapist can help him to recognize and deal with his feelings and their causes.
January 5, 2018
I have a friend who is really struggling and after many conversations he has finally agreed to go to therapy. We did a lot of research and have found some therapists that would suit him. Unfortunately he cannot afford to pay for therapy. I have offered to pay for therapy but the therapist does not want to allow us to do so. He says he believes that it is important for the patient to pay for therapy themselves and that it is not a good idea to have friends subsidize it. I would like to get the panels opinion on this and what other possibilities you think there are considering that this person does not have other good options?
There are a couple of reasons that a therapist might be hesitant to accept payment from someone other than the patient. Many therapists believe that a person is more invested in the therapy process if he is responsible for all aspects of treatment. When therapy is essentially free, the patient can develop a nonchalant attitude toward the treatment. When someone pays for something, the sense of value with regard to the item or service tends to be better retained.
Another reason that a therapist may not like the idea of accepting payment from a third party relates to confidentiality—not necessarily from a legal perspective, but from a therapeutic one. If you were to be billed every time your friend saw the therapist, you would be in the loop as far as frequency and dates of treatment. This could be uncomfortable for your friend, and possibly lead to a rift in the therapeutic relationship.
I notice that you didn’t mention the possibility of giving the money directly to your friend. I don’t know if this is due to the fact that you don’t know if you can trust him, or if you don’t want to go behind the therapist’s back. If you do trust your friend, you likely recognize that circumventing the therapist’s policy is a bad idea. It would mean beginning what should be an open, honest, and trusting relationship with a lie.
There might be other options that can be discussed with this therapist. Might he be willing to accept the money from your friend, knowing that you gave him a lump sum with no strings attached? If not, would he (and your friend) be okay with a loan? You mentioned that you found multiple therapists that would suit your friend’s needs, but you spoke of only one who objected to your proposed payment arrangement. If this particular therapist is not willing to work with you, perhaps another one would.
Although there are legitimate concerns related to third party payment, it comes down to the advantages and disadvantages within each specific situation. For example, if your friend is the type to be dedicated to the therapy process regardless, and is very open with you about everything in his life, the concern is not as compelling. If he will wind up without therapy—or with subpar therapy—unless you help him financially, there is a case to be made for working something out with your friend and a therapist.
December 29, 2017
My question is short, but not so simple. I am an addict. Being an addict is very challenging, painful and lonely, but it’s extra difficult to suffer from this disease in the Jewish community. It’s such a stigma and I have to hide my whole life from everyone. My question is, how can I learn to accept and love myself, to forgive myself for all the wrong I’ve done when I know that if people knew I am an addict, I wouldn’t be accepted or loved or forgiven?
You raise a few extremely good points. Addiction is never simple. Although many people who have never had an addiction chalk it up to lack of self-control, this is simply untrue. Although the following paragraph was printed in the Yated (on July 28, 2017), it bears repeating.
Some people have a greater propensity to become addicts than others. While we don’t have a full understanding of the causes, there are a number of factors that influence the risk of addiction. One important factor is genetics. Some people are born with a predisposition for addiction. The second factor is environment. This includes friends and family relationships, economic factors, stress, abuse, and peer pressure. Development can also play an integral role. Since teenagers are still developing their self-control and decision-making skills they are more likely to try something risky such as drugs. That can lead to changes in their brain function, making it more likely for them to become addicts.
Despite the fact that addiction has been shown to be a disease, many people still view it as a weakness, or as a personality problem. In the Jewish community (as in many others), addiction is still largely stigmatized, and addicts feel that they need to hide their illness from the very people who would normally form their support system.
Until relatively recently, this was true for most forms of mental health issues. For instance, people who were depressed or anxious often felt completely isolated and alone. They were afraid to discuss their problems with anyone for fear of being seen as weak or crazy. Thankfully, due to the efforts of many—and the ease of obtaining information—the stigma associated with mental health issues has eased to a large degree.
Although this is true for addiction to some extent, the recognition and acceptance of addiction as an illness has been a much slower process. There are many in the Jewish community (and in the mental health community at large) who work tirelessly to change the perception, and to support those with addiction in the community.
It sounds as if you are having trouble accepting yourself. You assume that you wouldn’t be accepted, loved, or forgiven—and therefore feel that you cannot accept, love, or forgive yourself. Although you may intellectually recognize that addiction is a disease, you nonetheless feel that it is your fault. This is a perfectly normal feeling, but it should be challenged. If you acknowledge that you have a problem—separate from your identity as a person—shouldn’t you be able to love yourself despite your illness? If a close friend or family member confided in you about his problems with addiction, would you be so quick to judge him? Or would you accept, love, and forgive him? If you would, doesn’t this mean that there are likely people in your life who would non-judgmentally feel the same toward you?
A positive support system is very important in fighting addiction. Hopefully you’ll be able to identify those in your life who will be there for you without judging. If you are not already attending a support group like Alcoholics Anonymous, this can be a crucial tool in your recovery. It can also function as a support system separate from your personal one.
This brings to the fore the difference (in my vernacular) between guilt and regret. Guilt is backwards-looking. Based on the past, it tells you something negative about yourself, causing much anguish—and making it harder to change. Regret, however, acknowledges the problematic action, but focuses on the future in order to allow for positive change. You can feel good about who you are as a person, while regretting past decisions and working to forge a better future.
December 22, 2017
I have many people in my life whom I feel have an inferiority complex and are in constant need of compliments and appreciation. Yet as much as I try I can't seem to fill their needs and they always feel I am under-appreciating their work. If they send me a cake for Shabbos I need to thank before, after, and once again. How do I feed their never satiated need for praise and compliments? It’s also very difficult for me to deal with their neediness. Any advice you could give me would be appreciated.
You’re not asking for the reasons behind others’ neediness and inferiority complexes. This is likely because you recognize that there is nothing that you can do to change their emotional needs.
Low self-esteem is generally the root cause of feelings of inferiority and the need for constant external validation. Since there is little that you can do to help others build their intrinsically-based sense of self, you seem to focus on building their immediate sense of self—which is based on their perception of their value in each particular situation. There are two clear effects of this. One concerns your relationship with each person, and the other relates to how people continually learn to view themselves.
As discussed, when someone has no intrinsically-based sense of self, they base their “self-esteem” on external factors. When they in addition have no well-defined externally-based sense of self, they often have a constant need for feedback in order for them to feel worthwhile. If people in your life tend to look to you for this kind of feedback, this may mean that they’ve learned that you will feed their emotional needs. Unfortunately, your positive feedback only satisfies their surface needs in the short term and with reference to the specific circumstance. This will often lead to a vicious cycle, whereby they “build a resistance” to your positive remarks, causing them to require more and better reinforcement of their tenuous sense of self.
Although you refer to many people, your relationship with each one is different. If you focus on each individual person and relationship separately, you might begin to identify needs and patterns that are specific to each. One person might require validation in a particular area. If this is validated, he might not need to be praised as often or in other areas. Another person might need to feel that you genuinely like him, but doesn’t consciously recognize this (or is embarrassed about this need), therefore looking for less obvious forms of proof of your feelings for him.
If you can identify patterns and needs, you may find that you can respond more appropriately. This can help to stop the vicious cycle, changing your relationships to more healthy ones.
December 15, 2017
At about age eleven or twelve my girls drift away from their one good friend and begin to spend time with other girls. This pattern has repeated itself several times. I think that the original friends have felt somewhat abandoned by this. I don't want to control my daughters' friendships. However, I don't want anyone to be hurt and I would like to see that my daughters have the meedah of loyalty. If this is a normal pattern of adolescence, how do we ensure that the original friend is not hurt? Thanks for your help.
Early adolescence is typically the point at which children begin to develop a sense of identity. This usually means that kids start identifying things in their lives to which they feel—or want to feel—connected. This is commonly felt and expressed by identifying with one or more aspects of their lives. Aspects can include academic achievement, capabilities, appearance, possessions, and other factors. The strongest factor, however, is often social status.
Prior to adolescence, children usually don’t sharply distinguish one another by group or type. This is the reason that they tend to gravitate to those children with whom they feel comfortable. In adolescence, however, relationships often take on a new meaning—one that relates to their self-perception. Friendships begin to speak to their sense of self, causing them to choose friends based on their burgeoning conceptualization of who they are—or who they want to be.
You express concern both for your daughters and for the friends that they leave behind. Regardless of the reasons for your daughters’ friendship changes, any impact on the friends being left behind will likely be the same. Our job in that regard may be to teach our children to treat others properly, and to be aware of the impact that we have on others. Friendships often change, but awareness of others’ feeling can help us to act more thoughtfully. Your daughters can be loyal without remaining best friends with just one person. As children grow, they tend more toward groups as opposed to exclusive friendships.
Your concern about your daughters is a separate concern. If they change friends based on their developing senses of identity, there are two basic possibilities. They may be choosing friends based on their current self-perception. This would mean that they identify as a particular type, and choose friends based on this. Or they may have no clear sense of self, and attempt to build one through their choice of friends and their association with a particular type. The former possibility is generally healthier than the latter, since their sense of self is largely based on themselves. The latter possibility can lead to an overly strong need for specific relationships or types of relationships.
Another possible reason for your daughters’ tendency to change their friendships is simply the recognition that they in fact have more in common with their new friends than with their old ones. As children grow into adolescents, they begin to recognize intrinsic differences in others. This can lead them to gravitate toward those who have similar traits. This is the probably the healthiest reason for relationship changes.
December 8, 2017
Hi. The concern I am writing about is my almost 15-year-old son...His personal hygiene is lacking. I do not recall ever having had an issue with him regarding this matter when he was a child. He showered, brushed his teeth and followed all the other norms regarding personal hygiene. I actually did try speaking to him about it a few times but he brushes me off. I have stopped telling him directly and instead, I will just mention "I am washing shirts today and I don't see your shirt from last night in the hamper." He refuses to wear (unscented) deodorant, and not for frumkeit [religious] reasons. He does polish his shoes before Shabbos and will make sure his hat and jacket are clean. Maybe it is laziness. Can you assist me in addressing this matter? Thank you
You mention that your son’s personal hygiene is “lacking,” but are a bit unclear on the specifics. I assume that he no longer showers or brushes his teeth on a daily basis. When you say that he doesn’t wear unscented deodorant, I assume that this means that he doesn’t wear deodorant at all. Does he ever shower? How often? How many times will he wear the same shirt before laundering?
You didn’t speak about your son’s emotional health. If he has other depressive symptoms (like changes to his appetite or sleep patterns, decreased energy or fatigue, or low self-esteem), he should be evaluated by a therapist. Since you mentioned no depressive symptoms other than yours son’s lack of hygiene, for the remainder of my response I will assume that he is not depressed and that he is otherwise well-adjusted.
If there are presently no direct consequences to your son’s lack of hygiene, he may not see any reason to change his behavior. Although you can help him to recognize specific consequences (like future cavities, gum disease, and body odor), this issue will likely correct itself over time. Your job would be to help him identify any future consequences so that he is prepared to change his behavior as necessary.
On the other hand, if your son wears shirts that are obviously dirty, or if he clearly smells, it’s highly unlikely that there are no social consequences. This is something that should be addressed for multiple reasons. In my experience, chronic laziness doesn’t usually exist as a simple standalone issue; it is generally rooted in a more specific problem. Your son may not be aware of the social connotations of his actions, and might not recognize the potential consequences. This may be his way of rebelling (perhaps feeling that being openly oppositional is not an option). He might feel that certain actions do not conform to his specific social setting.
You state that your son’s refusal to wear deodorant is not “for frumkeit reasons.” Although his stated reason for not wearing deodorant may not be halachically [Jewish law] based, this doesn’t necessarily mean that his idea of frumkeit is not in some way affecting his behavior. Frumkeit, yeshivish, and other terms have come to mean many things. They can relate to religion, morality, family, community, social caste, sense of self, spirituality, and intellect, among others. Often, these aspects become blurred. As an example, if your son feels that he won’t fit into a particular group if he is too fastidious about his appearance, he may—consciously or unconsciously—limit his adherence to certain matters of hygiene. On a conscious level, this can relate to actually being accepted; on an unconscious level, he might be attempting to develop a sense of self based on this (i.e., his concept of “yeshivish”).
I think that the first step is to have a candid discussion with your son with the intent of exploring the reasons for his lack of interest in matters of hygiene. You know your son and his likely reaction to such a discussion. Therefore, you should identify the best way to go about broaching the subject. That being said, a non-confrontational approach with the reassurance that you simply want to understand his thoughts on the subject often works best. This conversation would focus solely on his point of view. You would withhold any judgement or suggestions until you’ve had time to consider his perspective and the reasons for his actions.
Your approach to this issue will likely vary based on the reason for your son’s behavior. For example, if you feel that he is trying to rebel in some way against authority, or to establish his own sense of identity, your approach would be different than if it became clear that he doesn’t understand social norms or the consequences of not following them.
November 24, 2017
I am a young adult with anxiety and I constantly beat myself with mistakes that I make. I was wondering if you can please give me insight on how to deal with it. I'm a bit impulsive. Ex: I spent a bit too much on food recently and now I'm upset that I don't have any money left for more important things that I need. I think very bad thoughts that are not letting me move on in life. I get very tense and have negative thoughts like “You did a terrible thing.” Are there any tools that might help me? Thank you.
At first glance you seem to be referring to three distinct problems. You state that you have anxiety, and add that you beat yourself up for your mistakes. You then mention your impulsivity, and go on to further discuss your negative thoughts about yourself. Although people can have separate issues that are only peripherally related to one another, there is often an underlying problem that contributes to multiple issues.
You identified three issues. Although they might need to be dealt with separately, it’s quite possible that they all stem from one central issue. In the only sentence in which you mention anxiety you immediately comment on your self-denigration. You then state that you are “a bit impulsive,” which is again immediately followed by a discussion of negative thoughts toward yourself. This seems to point to an underlying problem that makes you feel negatively toward yourself, which is leading to the other problems.
To what degree is your impulsivity a problem per se, and to what degree is your issue the fact that you belittle yourself when you act impulsively? If you never felt badly about yourself because of an impulsive action (and were only upset about the consequence of the action) how much would it bother you? Would there be some things that you would be completely fine with, and simply try not to repeat? In fact, putting ourselves down often makes it much more difficult for us to correct problematic behavior. This is partly due to the focus on ourselves instead of on the behavior and its consequences, and partly because when we denigrate ourselves we give ourselves the subliminal message that we’re not capable of change.
A very common underlying issue is low self-esteem. If your tendency to feel badly toward yourself is not generally attributable to the specific problem at hand, the cause of these negative thoughts is often the basic inability to like who you are (or in fact to have any clear sense of who you are as a person). If you don’t know how to feel toward yourself, you’ll focus on things that you do or accomplish to gain some sense of self. Therefore, when you act impulsively—leading to a negative consequence—you point to this as an indication of something negative within you.
In previous responses (see The Couch, October 24, 2017), I have discussed the difference between a “true” intrinsically-based sense of self and a “false” sense of self based on actions, abilities, accomplishments, and other externally-based factors. The goal in this regard is to view yourself similarly to the way in which you view others (and the way in which others view you).
Ask yourself this: If I always felt positively toward myself (similar to how I feel toward someone in my life who I really like), would I continue to put myself down? Would I be better able to focus on the actual problem (like trouble with budgeting)? Would this possibly help me to become less impulsive? If you recognize that generally feeling better about yourself would alleviate your other issues, you would do well to begin working on building an intrinsically-based sense of self.
November 17, 2017
The time has come in my life for me to make a parnassah [living] to support my family. I am having a difficult time choosing what career path I would like to take and what field I want to get involved in. I am generally not a person who has a hard time making up his mind but I can’t seem to settle on something that I think I would be good at and interested in. Someone mentioned that therapists are trained in career counseling so I thought maybe you would have some ideas to help me resolve this. Thanks.
Although licensed career counselors typically have graduate degrees in a mental health-related field (like psychology or social work), career counseling is generally considered a separate specialization. Not all therapists who offer career counseling are certified in this field, and I believe that one can be certified as a career counselor without being a licensed therapist. As with any profession, you’re likely best off with someone who is experienced and licensed in the field.
Since I am not a career counselor, I cannot speak specifically about the process. Hopefully one of the other panelists does career counseling and will discuss the general process. Just based on your inquiry, it seems that you simply need someone who has knowledge of many fields, and has access to assessment tools that can help to point you in the right direction.
There are assessment tools that can be accessed online or in a library as well. This is something that you can try in order to get a general sense of the careers that might interest you. Seeing a licensed career counselor, however, will likely give you a broader perspective and experienced, educated opinions. Good luck!
November 10, 2017
Our teenage son has always been a bit of a complicated personality but he does well socially and academically. Recently we have noticed a trend where he keeps on asking to go to the doctor because of different things that are bothering him physically. My husband and I recently calculated that he has had 6 separate issues in the last year or so. Only once was there actually something wrong (strep); the other times the doctor said he was fine. He has been sent for X-rays and ultrasounds and once even wound up in the emergency room for a CT scan when he complained about a massive headache. He has complained about pain in his chest, his stomach, and his head at different times. Obviously something is going on here but it is hard to discount him when he says he isn’t feeling well. He actually went to see a therapist a few times but it didn’t really go anywhere. We also got no plan from the therapist as to how we are supposed to handle him. We are at a bit of a loss here and would appreciate your input. Thank you.
Your son’s complaints of pain can be related to several issues. Without more specific information about the settings, circumstances, history, and other criteria, my response can only be very general, as based on the specific symptoms mentioned. That being said, I will briefly address a few possibilities.
I don’t know what you mean when you refer to your son’s “complicated personality.” You follow that designation with the fact that he does well socially and academically. Does this mean that his complicated personality generally manifests in the family setting? Does he appear to be an anxious person? Does he tend to obsess about things? Has he expressed concern about a particular illness—or about illness in general—or do his complaints refer only to the pain itself?
Somatic complaints can be a bid for attention. They can be due to general anxiety, or to a specific anxiety that is being repressed. In addition, they can be an indication of general obsessiveness, or of an obsession that is limited to a specific area (like preoccupation with death).
When the main focus of concern is a preoccupation with illness, this can be due to illness anxiety disorder, which is essentially a constant fear of being or becoming ill. This often includes a focus on pain. However, in illness anxiety disorder the pain is secondary to the fear of illness.
If your son’s complaints are limited to pain, and discounting other possible causes like a need for attention, your son may have a condition known as somatic symptom disorder. Somatic symptom disorder used to be commonly known as hypochondriasis. The fact that this term was well known was a significant factor in the renaming of this disorder. Since the term had become a part of the regular vernacular, it was paradoxically both stigmatized and largely dismissed. It was renamed in part to give the issue more significance so that it would be taken more seriously.
Although you mention that your son saw a therapist, I don’t know what was done, or whether this therapist has experience with anxiety or with somatic pain. Appropriate treatment would largely depend on factors like those mentioned above. Assuming that all medical possibilities have been ruled out, a psychotherapist can help to identify the cause of the problem. Once the root causes and associated issues are identified, therapy can focus on understanding and dealing with the causes (like general anxiety or obsessive thinking), in addition to the pain itself.
November 3, 2017
Our daughter unfortunately suffers from an eating disorder. One of the things the doctor is recommending is “group therapy”. We have a number of concerns regarding this. First off, the people in the group will, presumably, be just as sick or worse than she is. We don’t want her to get any ideas that she doesn’t have already. Secondly, we are worried that she will meet people there and people will find out about her condition. Why do a bunch of strangers need to hear all about her issues? Wouldn’t she do better spending extra time with her individual therapist? Is there a benefit of group therapy that she wouldn’t get with someone privately? We are taking this very seriously and want to do the right thing. Can you please explain if this is the best thing and/or necessary? Thank you.
Eating disorders are extremely serious. Over time, they can lead to numerous health issues, including osteoporosis, heart problems, brain damage, organ failure, and infertility. There is a high mortality rate associated with eating disorders. Eating disorders are typically associated with negative body image. People with anorexia, for instance, generally feel fat and identify areas of fat on their bodies regardless of evidence to the contrary.
Your question is a common one. People are often wary of groups and meeting for the reasons that you discussed. The response will depend on your daughter’s needs. You mentioned that your daughter’s doctor recommended group therapy. You should ask the doctor for his/her reasoning. Is the recommendation based on the very general notion that group therapy can be helpful for people dealing with emotional issues? Is it less generally based on the understanding that people with eating disorders tend to benefit from groups? Is it more specific to your daughter’s particular issue and her presentation, and to the doctor’s experience is this area?
There are a number of factors that should be considered with regard to type of treatment and the timing of such. One factor is your daughter’s understanding and acceptance of the fact that she has a problem. Though group therapy may be an essential part of her treatment, your daughter’s particular needs and readiness should be assessed by her therapist and discussed with her (and you if appropriate).
You spoke of your daughter’s eating disorder, but didn’t specify the type. Although there are a number of eating disorders, the most commonly discussed are anorexia, bulimia and binge-eating. Group therapy appears to be very helpful for those with bulimia and binge-eating, and is generally recommended. For anorexia, however, the opinions on group therapy are mixed. On the one hand, many of the advantages of groups—feeling understood, accepted, and not alone, recognizing personal triggers, and being more comfortable discussing feelings—can be an integral part of treatment. On the other hand, it’s been pointed out that people with anorexia are often distrustful and that groups can become competitive rather than accepting.
There are also different types of groups. Psychoeducational and cognitive-behavioral groups seem to be the most prevalent and, when properly run, are likely less prone to issues of competitiveness. That being said, each person has her individual issues that should be taken into account. If your daughter is cognizant of the fact that she has a problem, but appears unclear as to the specifics—and you sense that she feels alone in her struggle and has trouble discussing her feelings—group therapy can be a great asset. However, this is something that her therapist can help her to decide.
October 27, 2017
When I was a young boy in high school I was treated horribly by an English teacher. For whatever reason he would pick on me constantly, always pointing out when I didn't know something (I was not a good student so this was pretty often). He would embarrass me in front of the entire class and called me a "shoyta" [idiot]. It was a very bad tekufa [period] in my life but I survived. Fast forward 20 years and I...have a wonderful family with children of my own. Recently this very teacher moved to my town and began davening [praying] in my shul. He is now a CPA so I guess he figured out that teaching isn't for him. I don't think he even remembers who I am. A friend of mine who knows how miserable he made me keeps pushing me to go over to him and confront him for all the pain he caused me years ago. I really don't want to have what will be an uncomfortable confrontation for me. I am not really interested in opening that can of worms. On the other hand it's weird to have him sitting right there oblivious to the negative impact he has had on my life. I think it would be helpful to hear your opinions on how/if to proceed. Thank you.
Obviously, as you mention, this issue is yours alone since you don’t think that your teacher even remembers you. It’s likely, even if he does remember you, that he has a very different perspective on the situation. Unfortunately, teachers are often not trained to understand the emotional impact that they can have on their students. I have seen this lead to long-standing, deep emotional problems. You seem to be weighing the possible advantages of confronting him against the possible disadvantages of having an awkward conversation (and possibly uncomfortable relationship) with him.
Although many of us face similar situations and decisions, this one appears to be reminiscent of a memory that was particularly hurtful for you. You refer to your pain as related only to the past, and you state that your only issue is the weirdness factor. However, the negative feelings that were caused by your teacher’s actions have likely been triggered before by unrecognized sources, and may now be getting triggered by a more obvious source.
If you have truly dealt with the feelings that hurt you, your decision is simply a matter of what makes the most sense given the current situation. You mention, however, that you don’t want to open “that can of worms.” You also speak of the negative impact that this teacher has had on your life. This indicates to me that there are emotions from your experience with this teacher that have not been resolved. If this is the case, in a sense the current situation can be helpful in that you can now address a root cause of these emotions.
It can be very difficult to properly assess any situation that includes a large degree of emotion. Strong emotions can trick you into believing that they are logical thoughts. If, as a child, you felt (and therefore believed) that your teacher hated you and thought that you were unintelligent, the feelings associated with those thoughts can be triggered today without the associated thoughts. Since you no longer believe yourself to be unintelligent, these conscious thoughts are immediately rejected by your conscious mind as ridiculous. Nonetheless, the emotions that you felt as a child who was made to believe that he was worthless often come through unscathed. This occurs because the unconscious mind doesn’t self-filter in the way that the conscious mind does.
You can try and separate your feelings from childhood from your logical understanding of your teacher’s actions by understanding them from your own (and perhaps your teacher’s) adult perspective. For instance, had this never occurred when you were a child, but happened to you for the first time as an adult (perhaps in college), how would you understand your teacher’s actions. Would you feel and understand the situation the way that you did as a child? As an example, would you feel (and therefore believe) that there is something wrong with you—and that your teacher hates you for good reason? Or would you recognize that the teacher is flawed, might have been bullied himself, and is perhaps looking for a way to assert his dominance…or that he simply doesn’t understand the pain that he is causing?
Ultimately your decision should come down to the advantages and disadvantages of confronting your teacher. If you can separate your childhood beliefs and feeling from those from your current adult perspective, you will have a more logical and realistic grasp of these. This can help you decide whether to approach your teacher. In addition, this might help you to identify less confrontational ways of communicating with him about your classroom experience. In fact, you may discover that your sense of discomfort and weirdness will have decreased.
October 20, 2017
Thank you for taking your time each week for this column. I have found it to be very enlightening and educational. I am 33 years old and not finding fulfillment in my current occupation. I am considering going back to school to obtain a degree in social work. I have always been interested in helping people and people seem to gravitate to me when they need help solving a problem. I am curious as to what type of person you think makes a good therapist? What personal qualities would indicate that someone might make a good therapist? Are there any challenges in the profession that you think someone considering it should know about? I know these are not "therapy" questions but I hope that you would still share your thoughts on this matter. Thank you.
As with any profession, some people are more suited to social work than others. That being said, again as with any profession, there are different types of people who do well within the social work field.
Social work has many facets. Most generally, it is split into two aspects: macro and micro. While macro work refers to focus on institutions, communities, and the like, micro work is what most people associate with social work practice. This includes diagnosing and treating mental disorders. Social work programs typically include the understanding of clients’ societal and community influences in their instruction. One of the aims of social work is to combine the scientific method and science-based practice with a clear sense of the client’s perspective. This is perhaps part of the reason that the field of social work often attracts compassionate people.
One of the distinctions often discussed within social work education is that between sympathy and empathy. Whereas the former essentially refers to one’s emotional reaction to another’s plight, the latter is the ability to share another’s perspective, largely by identifying—as fully as possible—with his feelings, needs, issues, insecurities, and circumstances. The field of social work endeavors to minimize the practitioner’s own feelings (sympathy) and expand his ability to fully understand each client from that client’s perspective. Although there are many aspects to this, perhaps most important are: a) the interest in obtaining as complete a psychological/emotional view of each client as possible; b) the ability to place yourself in the other person’s shoes; and c) the ability to compartmentalize—to separate your own emotions from those of the client. This last is especially crucial; the inability to separate your own feelings, needs, and insecurities from those of the client will likely lead to inefficient (or even harmful) practice. It can also easily cause problematic emotional issues for the practitioner, and result in burnout. Compartmentalization can also help the practitioner avoid emotionally taking his work home with him.
You refer to a lack of fulfillment in your current occupation. This can be due to a variety of factors. Many people feel unfulfilled because they don’t enjoy what they do, or because they want to believe in their vocation. Perhaps you want to enjoy what you do because you believe that helping others is important. If this is the case, and you feel that the above goals and capabilities resonate with you, social work may be a profession to consider.
October 4, 2017
Can you please give me some good guidelines on how to deal with peer pressure? I am very affected by what the people around me are doing. I don't know if it's that I'm afraid of people getting angry with me or I need to be the center of attention. I think that that is my most difficult challenge and if I could just not be afraid to be different I would be a much better person.
Most often, issues with peer pressure are due to low self-esteem. Self-esteem has been defined in many ways by professionals in many fields. What they almost all have in common is their reliance on external factors to define self-esteem. Therefore, self-esteem is typically viewed as a self-image that is subject to fluctuations in mood, situation, or surroundings. This is not what I would call self-esteem. Self-esteem, by my definition, is not subject to change based on external factors.
Laymen and professionals alike tend to confuse self-confidence with self-esteem. The reason for this is that the popular notion of self-esteem is of someone who has confidence in himself (i.e. in his abilities). However, sense of self that is based on externalities like abilities is not indicative of true self-esteem. Thus, self-confidence is a false form of self-esteem, since it speaks to people’s abilities rather than to their intrinsic attributes.
It is interesting that most of us can view, and feel, about others based on who they really are, although we cannot do the same for ourselves. It may be quite easy for me to say, “Robyn is a caring person,” almost as an instinctive reaction. It requires little or no thought and is simply the way in which I see Robyn. When it comes to myself, however, it is much more difficult for me to “simply” see myself as something entirely separate from how I think others see me, what I do, my job title, etc.
The important distinction between a false sense of self-esteem and one based on true internal feelings is the basis for the feeling. If the feeling is clearly tied to external factors, it is generally not based on true internal feelings. For instance, if your attribute is “funny,” but you only feel humorous in social situations where you can monitor others’ responses, you don’t feel that “funny” is something that defines you. Rather, you feel that “funny” is something that you do.
On the other hand, someone who recognizes that he is intrinsically a funny person can sense this attribute within himself. Without relating “funny” to other people or to specific situations, he simply feels funny. That is, he recognizes aspects of himself—his thoughts and feelings—that are humorous.
Because the common conception of self-image is based on external factors, it would be natural to conclude that boosting one’s external sense of self would be part of the solution to issues with peer pressure (as well as other issues related to low self-esteem). Although this might work to some extent in the short-term, it unfortunately only reinforces the initial problem by continuing to focus on self-image as opposed to self-esteem. In the long run, this would require a constant mental reinforcement of the external quality. In addition, there would always be anxiety relating to whether this quality is good enough and whether it is sustainable. For instance, you might only feel good about yourself when you can accept your ability to socialize in groups. As soon as this breaks down, your “self-esteem” would take a hit.
As a more general example, if you were to define yourself largely as based on your job (i.e., “I am a brilliant doctor,” or “I’m a powerful CEO”), problems related to your job can have a profound impact on your self-image. This can cause high anxiety, not because of the specific job issue, but because your self-image would have been assaulted and you would have no internal sense of self on which to rely.
The first step is to clearly recognize whether your issues with peer pressure are in fact due to an underlying issue rather than a realistic source that you are defining (e.g., “People won’t like me,” or “People will be angry with me”). If you are able to identify an unconscious basis for the problem (e.g., “I don’t feel good about myself when I’m around others unless they constantly validate me”), the next step would be to begin focusing on the true meaning of sense of self. That would be the first stage of directly working on your self-esteem.
September 20, 2017
I have struggled with anxiety all my life. I spent a few years in therapy and BH[a1] have it under control to the point where is doesn't severely impact my life like it used to. My question is it ever appropriate for me to be anxious or should I always be working on trying to remain calm. I hear people say that some anxiety is good but I wonder if that applies to someone like me. Even regarding the Yemei Hadin[a2] I wonder if the yirah[a3] that I could feel is the proper avodah[a4] for me or, given my predisposition, not a good idea to focus on. Perhaps precisely the opposite…[a5] I should work on remaining calm and not getting worked up. Maybe it would be oversimplifying it but I kind of wish I had a blanket "psak" that anxiety is never good for me. I imagine people who have struggled with depression may have a similar question. Thanks.[a6]
In order to respond to your question, we first need to define anxiety. If you view anxiety as synonymous with worry or concern, it is certainly normal to have these feelings in certain circumstances. You wouldn’t expect to go on an important job interview feeling completely at ease with no sense of apprehension. Not only is it normal to worry, but it can serve a helpful purpose. Someone who has no sense of concern about his children can miss clues that point to their issues and needs. If someone existed who never worried about anything, he might be generally happy, but this would impact on the people in his life and his relationships with them—which would ultimately lead to unhappiness. “Normal anxiety” can help motivate us to achieve our goals.
The way in which I differentiate between “anxiety” and normal concern is based on whether the level of emotion corresponds to the level of danger inherent in the situation. As mentioned in the February 3, 2017 edition of The Couch, “I have defined anxiety…as feelings of stress that don’t logically match the situation…There is a spectrum with regard to the level of anxiety experienced…People on the lower end of the spectrum feel little to no anxiety, while those on the upper end of the spectrum feel constant anxiety.” In a utopian world, no anxiety would ever exist. That being said, since we are not solely logical beings, emotion will impact on almost every situation. Everyone feels some anxiety at times. While anxiety defined in this way is not helpful, it is completely normal—indeed inevitable—at some level.
In theory, the goal in therapy should be to completely eliminate anxiety of any form. In practice, however, this is impossible. You speak of having been in therapy for a few years. This often leads to the sense that the average person has no anxiety. In fact, you may feel that many people feel no worry or concern at all. You seem to be defining anxiety, worry, and concern in the same way. Perhaps it is never proper for you to feel “anxious,” but at times it may well be appropriate for you to feel some level of concern. One problem that you may be facing is the inability to differentiate between the two. Although I’ve described the logical difference, emotionally identifying and feeling them differently can be very difficult.
Some people at specific points in their struggle with anxiety should try to stay away from all triggers. However, not only is this unsustainable but it should not be the ultimate goal. The eventual goal should be to properly identify situations and their sources of concern, and to respond appropriately.
September 15, 2017
My husband recently revealed to me that he has been going to therapy for the last 6 months. I had no idea that he was going or that anything was wrong. I thought we...had a good marriage and were doing well raising our family. When I asked him why he is going he says there are certain things he wanted to discuss with someone but refuses to tell me what they are. He won't even tell me the name of the person he is seeing. I am completely locked out here. Is this considered normal? Is this acceptable practice for someone who is in therapy? Please give some hadracha [guidance] in how to deal with this?
Just as no two people are exactly alike, no two relationships are the same. The response to your questions would largely depend on the type of person your husband is and the nature of your marital relationship. Some people are generally more private than others. Many people have specific areas of sensitivity that they don’t feel comfortable discussing.
If your husband is insecure about a particular issue or feeling, he may not be comfortable discussing this with anyone, especially someone who he feels might view him differently. Your husband’s therapist is someone with whom he has a once-a-week relationship in a clinical setting—and he can terminate the entire relationship whenever he wishes. This can make it bearable for him to talk about issues that he might otherwise never properly resolve.
Alternately, your husband might have an issue that relates to your relationship with him. If this is the case, he may be uncomfortable discussing it with you specifically…or perhaps he doesn’t want you to feel hurt by something that upsets him. Regardless, if your sense is that your husband simply needs a safe and impartial person with whom to discuss his feelings, it’s important to allow him this space in order for him to deal with his issues on his own terms. The fact that he spoke with you about being in therapy may be his way of letting you know that he will further open up to you at a rate at which he feels comfortable.
If the two of you generally have an open relationship (within which you discuss fears, insecurities, emotions, and embarrassing issues) this situation would appear to be a departure from the norm. It can certainly be frustrating to see your intimate relationship seemingly take a turn toward secrecy.
Recognize, however, that everyone has secrets. Some relate to past actions or experiences, and others relate to feelings like guilt, embarrassment, or insecurity. I’m sure that there are some things that you wouldn’t discuss with your husband simply because it would be uncomfortable. You probably don’t view this as withholding information because it seems to affect you alone. The difference may be that your husband is becoming more cognizant of some of his emotional issues and is learning to resolve them.
If your husband is finally working on emotions that negatively affect him, he probably feels that therapy is the venue in which he can unselfconsciously do so without the fear of being embarrassed or disparaged. Depending on the issue, your husband’s personality, and his communication methods, his disclosure of the fact that he’s in therapy may be the first step toward the strengthening of your relationship.
September 8, 2017
Our 19-year-old son is sadly no longer shomer torah umitzvos [observant]. This is a tremendous source of pain and turmoil for the entire family. My wife and I are trying very hard to do what is best for him in accordance with the guidance we are receiving from Rabbonim [rabbis] and professionals. With lots of thought and hard work, we are slowly working on repairing our relationship with our son. Our question is regarding our other children. While the older kids seem to understand the situation we are concerned about the younger ones. They (ages 9 and 11) look up to their oldest brother and they are the only ones in the family to whom he acts warmly. We certainly think that the relationship is good for him but are concerned that it is detrimental to them. We have noticed they have started using some of his "street lingo" and have asked for clothes like he wears. They are also definitely aware of his flagrant violations of Halacha [Jewish law]. I have no doubt that they also picked up on the fact that he gets a lot of attention and has very few rules. We are not sure how to address this. This is even more complicated by the fact that if our son figured out we had discussed it with the little ones he would be furious and all the hard work we put into the relationship would go down the drain. We are really stuck and would appreciate your thoughts on this complicated issue.
The issue that you’re facing is a difficult one. I’m happy to hear that you are reconciling with your son. I took note of the fact that you wrote that your son “is sadly no longer shomer torah umitzvos.” Many young people experience doubt and confusion about their self-identity. This often leads to major decisions and lifestyle changes. Other factors, like family involvement (on which you seem to be working) can have a powerful effect as well. Oftentimes, those who emotionally resolve or refocus these issues return to their original decisions and lifestyles—or chose yet another.
At 19 years of age, your son’s decisions and future are hardly unshakeable. Perhaps the wording can be “…is currently not shomer torah umitzvos.” Your words, facial expressions, and other projections broadcast your thoughts and feelings. If your clear sense is that your son’s decisions have been set in stone, he is probably more likely to continue to define himself in this way. If, on the other hand, he had the sense that you recognize his continuing capacity for change he might feel more open to the concept of change.
My response to your questions is contingent on a few factors. Is your son’s religiosity a taboo subject, or do you openly discuss it with him? Do you talk with him about specific actions? How openly do you discuss the fact that he does things that you don’t like? To what degree do you think that he would understand the problem relating to your other children? How willing might he be to help you to deal with this?
The more general question applies to families, groups, schools, and other institutions that have responsibility toward multiple children. Although each child is an individual concern, how should this be weighed against the responsibility to the other children and to the institution? Some schools, for instance, will readily sacrifice one child for the good of the others (feeling that harm to the school and to the student body warrants the expulsion of one child). Other schools feel strong responsibility toward each child (and may also believe that an atmosphere of openness and acceptance are positive for the school and for the students). Families can be fragile institutions. The mental and emotional environment can have a strong impact on many aspects of the ever-changing and intertwining relationships inherent in a family.
If you have open discussions about your son’s actions and lifestyle, you probably have a good sense as to whether he would understand the issue and be willing to help you with it. If you tend to avoid the subject—in addition to projecting your sense of the permanence of his decisions—you are likely making wrong assumptions about your son’s thoughts, feelings, and understanding of the situation within the family. You may assume that he doesn’t care about your feelings or concerns, when these may be a major factor in his decisions.
If you are able to have an adult, non-confrontational discussion with your son about his thoughts and feelings, you can begin to correct some of these misperceptions. You might find that he is not averse to helping in certain areas. Over time, discussions like this can help to strengthen your relationship with your son. Once he gets the sense that you are interested in how he thinks and feels, he may be more willing to recognize your concerns. At that point, you could begin talking with him about specific actions that can be detrimental to his young siblings. These types of candid conversations can also open your son up to the idea of you discussing certain things with his siblings. If you have trouble initiating these types of discussions, a professional can help you to have dispassionate and productive conversations.
With regard to your younger children, it is important for them to realize that rules and boundaries exist for them as separate from anyone or anything else. Despite actions by friends, siblings, or others, they need to have the clear sense that certain actions specifically by them are unacceptable. The way, and degree to which, others’ actions are discussed with them is contingent on factors like age, intelligence, and personality.
Acknowledgement that certain things are accepted when done by a nineteen-year-old does not necessarily constitute acceptance of this for younger children. After all, a five-year-old can recognize that he is not allowed cross the street even though his ten-year-old brother does. A twelve-year-old understands that he can’t drive a car though his seventeen-year-old sister can. Clear, personalized rules and boundaries can help to make your family more structured and individualized, yet cohesive.
September 1, 2017
At the end of last year my son’s menahel [principal] requested that we set him up with therapy for the upcoming year. My son is 12 years old and has been misbehaving in class, makes all sorts of trouble to get attention, and has been very chutzpahdik [disrespectful] to Rabbeim [rabbis] and teachers.
There is a family friend who is a LCSW and we arranged with him to "learn" with my son twice a week but really it would be therapy. My son’s menahel says this is not adequate. I would like to know your opinion on this matter. I think that someone he knows and is comfortable with, who he can develop a shaychus [relationship] with and who understands therapy would be most beneficial to him. I don't think it is necessary for my son to "officially" go to a therapist which would impact his self-esteem and cause him to think of himself as having issues, when we have this as a possibly better alternative. Can you please share your thoughts on this matter?
You raise a few very good questions. It’s difficult to respond to a general question when referring to a specific situation. Generally speaking, there may be benefits and detriments to “therapy” that is not identified as such.
You mention your concern about your son’s self-esteem and his recognition that he has issues. There are a number of factors that can affect these. I understand your sense that being in therapy might make your son feel badly about himself. However, there’s a good chance that he already feels this way because of incidents with his yeshiva’s teachers and faculty. Often, kids act out specifically because of these kinds of feelings. When they don’t feel good about themselves (either in general or within the social/academic setting of school) this can cause them to act out. This can be for a number of reasons, including a bid for attention, a need for unconditional acceptance, and an attempt to create an alternate sense of self based on negative actions.
In fact, seeing a therapist often helps kids recognize that they do have value and that they are important. This, in and of itself, can help to decrease the unwanted behaviors. Therapy is not magic. It doesn’t work simply because the person providing it is trained and has letters after his name. Although a therapist may be able to apply certain techniques unbeknownst to the client, these will be limited. In addition, important aspects of therapy will be missing. These include the client’s recognition of goals, follow-up, self-feedback, and self-reinforcement. Much of the power of therapy is based on the person working on himself during the time when he’s not with the therapist.
People’s feelings about therapy—and what seeing a therapist says about them—vary greatly. In some circles, therapy is an accepted way of identifying issues, working on them, and becoming happy and well-adjusted. In other circles, therapy is still viewed as a stigma and is avoided at all costs. Children who are unaware of what therapy is will usually pick up on cues, defining therapy in the way that it is portrayed in their immediate circle. The most influential part of this circle is typically his parents.
As parents, we have the tremendous ability (and responsibility) to help our children to view things in the way that will be most beneficial to them. You likely don’t view therapy as something negative. In fact, your son is already “seeing” a therapist. You just don’t want your son to feel badly toward himself due to being in therapy. You have the ability to change his perception of therapy, allowing him to enjoy the full benefits of the experience. This, of course, assumes that he has a preconceived negative perception of therapy. He may possibly feel positively (or neutrally) toward therapy. After all, people talk about therapy all the time (for instance, in this column). Some of his friends may have mentioned being in therapy.
If properly presented, you might be pleasantly surprised at his reaction to the idea of speaking with someone to help him with some issues. If he realizes that you want to help him become happier and better adjusted, and that you view a therapist simply as someone who can help in these areas, he will be less likely to be negatively affected.
August 25, 2017
My 5th grade son recently came home from a friend’s house frightened and in tears. He was literally shaking. When I finally managed to calm him down he told me that his friend had been showing him books with pictures of the Holocaust. There were pictures of the mass graves, crematoria, and people being shot and hanged…including little children. My husband and I sat with him for a long time trying to reassure him and calm him down. I also had a serious discussion with this friend’s mother. While the immediate issue has passed I wonder what advice you would give for dealing with such a situation? I also wonder what follow up if any you would recommend.
Every child (and indeed every person) is unique in his triggers, fears, and emotional responses. Though we try to shield our children from things that we believe can cause them harm, it can be quite difficult to determine a particular child’s response to specific material. Perhaps, based on your son’s temperament or previous reactions, you would have predicted that he would react badly to those pictures. Or you may have assumed that he wouldn’t have been as upset by them as he was.
It seems that your son’s reaction was quite different from that of his friend. His friend may have had more exposure to information on the Holocaust or to graphic concepts and images in general. It’s possible that it was the abruptness of your son’s exposure to this type of material that caused him so much distress. You were eventually able to calm your son down. I don’t know what was discussed but I wonder whether part of what helped to calm him were your more clinical descriptions of what happened during the Holocaust. In contrast to what must have been his sudden exposure to highly graphic images, he may have thereby been given a more complete perspective. This would have helped him to compartmentalize his thoughts about what he saw, thus reducing his fear.
The instinctive reaction of many parents would be relief at a crisis averted. They would be happy to leave the subject alone after the initial intervention. I was happy to see that you recognize that follow-up can be important. Assuming that you did in fact discuss the Holocaust more broadly with your son, it might be a good idea to ask him occasionally for his thoughts on what was discussed. If you didn’t discuss it with him, you could feel him out with regard to his comfort level with such a discussion. As mentioned, his ability to place the images that he saw—and thus his feelings—into a more intellectualized context (place, time, situation, etc.) can help him to give him a less fearful perspective of the Holocaust.
Your question raises a larger issue that relates to this discussion. There is often a fine line between appropriately protecting our children and being overprotective. The obvious advantage to erring on the side of caution seems clear in the short term. When we strive to protect our kids from difficulty, they appear to be safer and less distressed. In their younger years, they can seem more content. As kids grow older, however, they not only require less protection, but can be harmed by too much.
Kids need to learn coping skills—both logistical and emotional—in order to become well-adjusted adults. Overprotection can decrease their ability to develop these skills. When this occurs, kids will often begin demanding continuous protection due to their inability to deal with problems—whether emotional or otherwise. This often becomes a cycle in which both parents and children become used to this protective relationship. They either do not recognize its problematic nature or can’t figure out how to change it.
Over the last generation or so, we seem to have become more overprotective as parents. I can remember, as a child, climbing trees, building a treehouse, and running across the top of an eight foot cinderblock wall. If I saw my kid doing things like these, I would probably cringe. It would be difficult for me not to stop him. Of course, decisions should be made based on factors like a child’s age and maturity and the level of danger. The advantages of becoming self-sufficient and of learning from mistakes need to be weighed against possible consequences. This decision is also based on parenting style and the parent’s level of anxiety in each situation. One parent might feel that the possibility of a sprained ankle is a small price to pay for their child’s sense of independence. Another parent may see this as foolishness or worse, opting to encourage independence in other ways. Regardless, it is important to see the big picture and to recognize that our individual decisions can affect our children more generally in the long run.
August 18, 2017
I am writing about a very painful matter that unfortunately other parents are struggling with as well. As I write this letter at the end of July my daughter does not yet have a high school for next year. I will leave aside the larger communal issue of children not getting into schools because I don’t think this is the forum for it but suffice it to say that she is an excellent girl with...good character...and has had good grades throughout elementary school. She is keeping up a pretty strong face but I know this is bothering her terribly. I can’t imagine how painful it must be to hear all her friends talk about their plans for next year while she has none. While I am hopeful that things will work out, in the end this is a stressful time for the whole family. I would greatly appreciate your advice on how to help her/us through this difficult time.
As you mention, your situation is painful for your daughter as well as for the rest of the family. There are a few things to consider with regard to how everyone deals with this emotionally.
We often project our own feelings onto others. We assume that they are feeling what we are. Recognize that there are multiple people involved in this issue—your daughter, you, and other family members. Each person will respond to this issue (and other issues) in his own unique way. This is based on many factors like personality, insecurities, and coping strategies. Therefore, it can be helpful for each person to acknowledge and respect the others’ reactions even if they differ from their own.
You mentioned that your daughter doesn’t display outward signs of distress. This might be a defense mechanism whereby she doesn’t allow herself to feel upset. Or it could mean that she’s making an attempt to put up a positive front so as not to upset you. Or it could mean that the situation simply doesn’t bother her. The burden of finding her a high school is largely on you. Your daughter’s perspective may be that you will eventually find her a school, so she doesn’t need to worry about it.
Although each person has his inimitable way of reacting emotionally, one person’s reactions can affect those of another. If your daughter appears unconcerned, this might decrease your anxiety. Alternatively, this might increase your anxiety because you may place more focus on your own feelings.
Children often take emotional cues from their parents. If your daughter is for the most part unconcerned, seeing you upset might cause her to feel that there is something to worry about. If your daughter gets the sense from you that things will work out regardless of the outcome, she is more likely to go with the flow and to adopt the attitude that life will go on.
If you have reason to believe that your daughter is distressed and that this experience may detrimentally affect her self-esteem, you can make it clear that she should feel comfortable speaking with you (or someone else) about her feelings. You might find that her concerns are very different from yours, and that you can alleviate them. If you are projecting your feelings onto your daughter, recognizing that she is not as upset as you think can also help to ease some of your anxiety.
August 11, 2017
After my last baby, I was feeling very sad and not myself. I thought it was just because I was very tired but people said I was depressed and I had what they call the baby blues. Now I am...expecting again and I want to know what steps I can take to prevent this from happening again. I would appreciate any advice you can offer.
What used to be known as postpartum depression is a very common. Though many people refer to it as the “baby blues” regardless of severity and duration, I would differentiate between a mild episode lasting up to a couple of weeks and an episode that is more severe or lasts longer.
Most women feel tired for some time after childbirth. Many feel some sadness. This is what most people likely mean when they speak of the baby blues. These feelings most often dissipate over a couple of weeks. When these feelings persist or the new mom has constant crying spells, feelings of guilt, loss of interest in regular activities, insomnia, hypersomnia (excess sleep), or other serious symptoms of depression, it’s considered a depressive disorder.
The symptoms of depression after giving birth are thought to be due to hormonal changes due to the birthing process combined with the emotional effects of a major life event. Symptoms can occur after miscarriage and stillbirth as well. Women who have had some form of depression in the past are more likely to experience feelings of depression after giving birth.
It is important to monitor your feelings as you near the end of your pregnancy. If you begin to feel sad or have any depressive symptoms, you should speak with your doctor. Your doctor can recommend treatment, which may include medication or therapy to help reduce the symptoms. Beginning a relatively mild treatment early on may help to keep any symptoms under control without the need for more extensive treatment later on. In the event that additional treatment is required, having already begun treatment will likely reduce the severity and duration of the depression.
Another less publicized issue is postpartum anxiety. Racing thoughts, constant worry, fear of being alone with the baby, feelings of dread, and the sense that these thoughts will never disappear are some of the symptoms. As with postpartum depression, it’s important to identify any feelings of anxiety and seek treatment for them early on, so as to prevent an increase in severity and duration.
Eating and sleeping properly and exercising regularly (under your doctor’ guidance) can also help to prevent feelings of both anxiety and depression. It is quite possible that your baby blues was a one-time experience, and hopefully you’re worrying unnecessarily. Regardless, taking care of yourself will likely have positive effects on physical, chemical, and emotional levels.
August 4, 2017
My mother-in-law has been fighting a very serious illness for the last few years. At this time the doctors say that they have no more treatments to offer her. I don't think my husband really accepts the implications of this. My children have always had a close relationship with their grandmother and are always asking when she is going to get better. We have been very positive throughout this but now I am not sure how to approach it with them. I feel like I should prepare them but my husband is encouraging them to daven and telling them that with Hashem's help she will get better soon. Can you please give me some guidance as to how to proceed?
Your question is an important one that will affect many of us at one time or another. It sounds as if your husband and you are both concerned with your children’s reactions to your mother-in-law’s illness. Your husband seems to be taking a short-term approach, worried about the kids’ immediate reaction to news that their grandmother’s illness is terminal. He may also be in denial of some sort. As you mentioned, he doesn’t appear to accept the implications of the situation. This may mean that he has trouble accepting his mother’s impending death.
You seem to be more concerned with the emotional effect that a sudden death can cause. You want to begin preparing them for this eventuality. Also, if your kids sense that the situation is more serious than they are being led to believe, this can lead to more consternation than being told the truth. Fear of the unknown can often be more anxiety-provoking than the reality.
Another concern may be your children’s feelings about being misled. If they may feel that they were lied to, and that they should have been told the truth, they may become quite upset. If they sense the truth and know that they are not being told the truth, it can lead them to distrust you.
On the one hand, kids tend to be more intuitive than we give them credit for. They might have a much better idea of the seriousness of your mother-in-law’s condition than you believe. In addition, children are often more resilient than we expect. Sometimes our nervous anticipation of a child’s response to a traumatic event leads to the anticlimactic emotional equivalent of a shrug. On the other hand, it can be difficult to gauge the effect of traumatic news on anyone’s emotions—and this is especially so with young children. The simple fact that a child doesn’t appear to be bothered by something doesn’t necessarily mean that there is no emotional effect.
Of course, I’m speaking generally. Your decision will be very much dependent on factors like the ages of your children, their maturity levels, the degree to which they seem to recognize more than they are being told, and the types of emotional relationships that they have with your mother-in-law. It might be a good idea to discuss your concerns with someone who knows your family, but can be more objective.
July 28, 2017
Without getting into the gory details, my daughter is currently being treated for a substance abuse addiction. My husband and I are trying to be supportive of her while understanding that it is going to take time. We are being told that we are supposed to view this as an “illness” just like any other mental health or physical illness, such as depression or heart disease. I can’t for the life of me understand how one can compare the two. How will not taking responsibility for her behaviors and blaming an “illness” help her long term? Why is our acceptance such an integral part of her treatment? As sad as it is, she made some terrible choices and is now suffering the consequences. I know it sounds harsh, but like my mother used to say, “You made your bed, you sleep in it.” Thank you for your time.
Many diseases that are high up on the list of leading causes of death have a large degree of self-infliction. For example, if people ate healthfully and exercised regularly there would be an extreme reduction in deaths caused by diabetes and heart disease. According to many credible studies, at least 90% of all cancers are caused by diet, lifestyle, and environmental factors. When putting things into perspective, the age-old “you did it to yourself” criticism is almost no different for addiction than for cancer.
Although we tend to view mental illness as just that, mental without any physical symptoms, this is not the case. Mental illness causes physical changes to the brain’s function. Addiction and substance abuse change brain structure and the way in which the brain functions.
In addition, addiction is in many cases a result of another underlying issue. Many addicts suffer from emotional distress and other mental illnesses. They often turn to drugs as a means of silencing or suppressing emotions with which they do not know how to cope. In many cases, people become addicted due to opioid use that was originally prescribed for physical pain.
Some people have a greater propensity to become addicts than others. While we don’t have a full understanding of the causes, there are a number of factors that influence the risk of addiction. One important factor is genetics. Some people are born with a predisposition for addiction. The second factor is environment. This includes friends and family relationships, economic factors, stress, abuse, and peer pressure. Development can also play an integral role. Since teenagers are still developing their self-control and decision-making skills they are more likely to try something risky such as drugs. That can lead to changes in their brain function, making it more likely for them to become addicts.
As with many diseases, there is no cure for addiction; however, it is treatable. Recovery is the key word. Recovery is generally different for every person but there are a few common factors. In order for an addict to start on the road to recovery, it is imperative that she recognize that she cannot simply control the disease any more than someone can simply control her diabetes. Just as diabetics need to acknowledge that they can’t psychically wish their diabetes away, addicts have to recognize that they also require specific tools with which to fight their disease.
It is naturally easier for a diabetic to change his eating habits when he has the support of his family and friends. This is all the more so for someone with a mental disorder, and often essential for an addict. In addition, if your daughter recognizes that you do not consider her addiction a disease, this might affect her ability to take her first step toward recovery: acceptance. With your understanding and support, your daughter will likely have a much increased chance of success in her recovery.
July 21, 2017
I am a working mother of 6 beautiful children boruch Hashem, and I am dealing with the regular life stresses that come from parnassah, shalom bayis, and running a family etc. A friend of mine suggested something called "mindfulness" as a way to help me ease the stress. I have looked into it and am wondering if this is something that is used by the frum therapists? Also, do I need to actually see a therapist who is trained in this (for which I have no time or money or time) or is this something that I can effectively learn and do on my own?
As far as I know, there is no official “mindfulness” therapy. As such, the term has inconsistent and sometimes vague definitions. Probably the most common form of mindfulness training is mindfulness-based cognitive therapy (MBCT). Since this falls under the umbrella of cognitive-behavioral therapy (CBT) which is a very commonly used modality, it has been used by many therapists including myself.
There are various other forms of therapy that include a mindfulness component. Typically, mindfulness refers to a focus on thoughts and feelings (and sometimes actions), with the goal of better understanding and accepting them. The idea is to help the person separate from emotion-thought-behavior patterns that prevent them from breaking free from the vicious cycles that these create.
Generally speaking, mindfulness is only one of the tools within a particular therapy modality that a therapist would use. Depending on the situation, many additional tools can be used to complement the effects of mindfulness. Additionally, an eclectic therapist might use various modalities, thereby tweaking the use of mindfulness depending on which is being used at the time.
If you have normal stress levels and simply want to manage your stress in a better way, there are many books and online resources through which you can train yourself to become more mindful of your thoughts and feelings. As with many things, repetition is key. Once you find a strategy that works for you, be sure to set aside a specified amount of time on a daily basis to practice it.
If you feel that you can benefit from personalized guidance, a therapist should be able to help you to identify a few areas and strategies that you would practice on your own. This might take only two or three sessions—which might be covered by your health insurance policy.
July 14, 2017
I am worried about how my husband interacts with our children. Most of the time he is great but when he is stressed out he can really be difficult. He yells a lot and on occasion...[spanks]...the kids. He says there is nothing wrong with that and that it was never considered wrong for a father to...[spank]...and is part of...[discipline]. I think it's horrible and will ruin the children emotionally. Can you please settle this issue for us?
Clearly, there are many different parenting styles. Some can appear harsher than others. Depending on the circumstances, there can be a fine line between “punishment” and “abuse.” The location of this line depends on the definitions of these words—and people will define punishment and abuse differently. Some people will refer to both as physical; others define them both as non-physical; yet others identify one as physical and the other as non-physical.
For the sake of this response, I will classify punishment as something that is done carefully, logically, and specifically to help the child to learn an important lesson. I will define abuse as either something that is done for the wrong reason (i.e., out of anger or frustration) or something that can potentially harm the child (physically, emotionally or otherwise).
The simple fact that corporal punishment “was never considered wrong” certainly doesn’t prove that it wasn’t. Nor does the common sentiment, “We all turned out fine” prove anything. In the first place, we didn’t all turn out fine. Many of us have clear emotional scars that were caused by abuse of one sort or another…and many of us have less obvious issues that can be traced back to abusive behavior on the part of our parents. Additionally, times have changed. Although many of us would love to return to the twentieth century, we can’t compare 2017 to 1987. This is not just because laws and norms have changed. It’s also because of how abuse is experienced by the victim.
People are quick to judge an action as abusive. Actions by themselves, however, cannot be abusive. Abusive behaviors do not exist in a vacuum. Abuse can be thought of with reference to its impact. What is abusive for one person is not so for another. One child will think nothing of being casually swatted, while another might be extremely embarrassed, insulted, and hurt. Circumstances will also dictate the degree of abuse. If a teenager is pummeled by his father in a playful way, he might be perfectly fine with it. On the other hand, if he were to be cuffed gently in response to something that he did, he might feel hurt and angry.
All else being equal, when a child is punished in a calm and loving manner he is more likely to accept the punishment in a positive way. When a punishment is accompanied by stress, frustration or anger, this can cause the child to be hurt by the punishment—all the more so when it includes a physical component.
Use of corporal punishment has greatly declined over the last generation or two. Because of this, there is a greater sense that physical punishment is extreme. Children, therefore, have a very different response to being spanked than we did a generation ago. Some of us may have taken it in stride and discussed it with friends who had also been spanked. Since children today understand spanking differently, they are more likely to feel that there is something seriously wrong with the situation…or worse, something seriously wrong with them. This is what will, from the child’s perspective, define the action as abusive: the damage caused by the action, rather than the action itself.
Though we may think that we understand the impact of our actions on our children, we can only see a very small part of the effect. We can’t see the impact of our actions on our children’s thoughts, emotions, or self-esteem. Since we don’t know what the effect of our actions will be for each particular child, we need to be extremely careful in how we discipline our children.
July 7, 2017
My 18-year-old son has been going through a very difficult time recently. He has been acting very rebellious and his yiddishkeit [Judaism] is suffering tremendously. We have been advised by many rabbonim [rabbis] and others that the key is for my wife and me to retain our relationship with him and unconditionally love him. Though he has not shown us that he is very responsible, we did not put up a fight and allowed him to get his driver’s license. Now we are really worried about him driving in the mountains over the summer. At the end of the day, it's a sakanas nefashos [danger]. How can I not put my foot down? Still, this will I'm sure cause a huge fight and damage our relationship with him. Can you please give us some advice as to how to proceed?
I’m sorry to hear that you’re experiencing a hard time with your son. As you stated, it’s imperative that your wife and you retain a positive relationship with him. Unfortunately, there’s no cut-and-dried answer that will give you peace of mind with regard to his driving upstate. Although your question is specific to upstate driving, the more general issue is the sometimes delicate balance between discipline and a positive relationship. Although these often appear to exist on opposite ends of the spectrum, they can work in sync with one another.
I don’t know the history of your relationship with your son or how he responds to conversations or directives. Teenagers tend to test boundaries. What this generally means is that they will push the boundaries as far as they can possibly go. Once the parents give in, the bar has been set higher for that particular boundary—and often in general—until the next time the boundaries are tested. Parents often accept these circumstances out of fear that their child will become angry and do something rash. Since the child knows this, he is in control of the relationship.
If this sounds familiar, you may be in a situation where your son clearly recognizes his power over you. (In this case, the unspoken understanding may be: “If you don’t let me drive upstate, I’ll become even more rebellious.) His rebelliousness can have a variety of sources, but he may well be using it as a powerful bargaining chip. With regard to the relationship, I cannot give you specific advice, but I would recommend that your wife and you speak with a therapist about moving the relationship to a more reciprocal one.
At this time, however, it seems that your relationship with your son is lopsided. Since he has much of the power, you feel that your hands are tied. On the one hand, your son has not demonstrated the level of responsibility that might make you more comfortable with the idea of him driving upstate. On the other hand, you’re afraid that a fight might harm your relationship with him.
The ultimate decision, of course is yours. However, if you decide to allow him to drive in the mountains you can make it clear that this is a privilege that can be taken away. You can give him very specific parameters and rules that he must follow in order to keep this privilege. You might limit his driving to certain times of day, and to certain areas. You could let him know that each time he takes the car he needs to return it by a preset time. You can make it clear that if he receives a ticket (regardless of whether it’s “his fault”), he forfeits his driving rights. Consequences for violating these rules can be rigid or time-limited but should be made very clear from the beginning. Creating this kind of accountability can help your son feel that he has some control—as well as some responsibility.
June 30, 2017
My 13 year old son is very busy with how he looks. He is my oldest so it's hard for me to get a sense of what's normal for this age. My friends say it's just a stage but I am worried about it becoming a problem. He has taken up exercising and dieting and is very into it. He spends quite a bit of time each day getting dressed. He has made a few cracks to my husband about how he looks. I would appreciate any guidance you can give me as to how to manage this.
There are a number of external factors that can affect a teenager’s actions with regard to his appearance. (Yes, you now have a teenage son!) These include school, community, peers, and media. In addition there are often emotional needs that manifest as fastidiousness in areas related to appearance. Since you didn’t mention a specific concern, I’ll speak to a few areas that can relate to your son’s interest in his appearance.
A relatively rare example is body dysmorphic disorder. People with BDD are obsessed with a perceived flaw in their appearance. They spend an inordinate amount of time avoiding others or attempting to “correct” the defect in their appearance. A more common—and more general—problem is obsessive compulsive disorder. Although those with OCD can obsess about pretty much anything, including fear of illness, contamination, and loss of control, the need for perfection is often an underlying factor.
Likely the most common cause of the need for perfection is low self-esteem. Since most of us don’t have a truly good intrinsically-based sense of self, we base positive (and negative) feelings about ourselves on external factors. Our sense of identity is usually based on things like family, career, accomplishments, and possessions. At different periods of our lives, we focus on different things to help define ourselves.
Teenagers are generally in the stage that psychologist Erik Erikson referred to as “Identity vs. Role Confusion.” During this stage, according to Erikson, teenagers struggle with their sense of identity, and may feel uncomfortable about their bodies until they resolve this struggle. As such, many teenagers become concerned with their appearance. This is a concern that usually fades as they begin solidifying their sense of identity. More often than not teenagers’ focus on their appearance is something that fades as other areas demand their attention.
Generally speaking, when considering whether someone else has a problem it’s important to ask yourself two questions. The first is whether their actions are causing problems for them, or if you‘re the one who has an issue with their actions. The second question is whether the person is acting largely due to a need (emotional) or a want (logical). If, for the most part, your son simply enjoys dressing well and looking good, this is likely a normal, healthy form of expression. If, however, his actions are based mostly on an emotional need, he might have a harder time developing a clear sense of identity.
June 23, 2017
My wife and I began seeing a therapist a few months ago. After a few weeks the therapist suggested that my wife begin seeing a therapist by herself (in addition to together with me) to help her with her anxiety. Now our therapist has suggested that in addition I begin seeing another therapist to deal with some issues of my past. It's not like we started this because of a massive issue; we just had some things we needed to work on as a couple and now we are going to wind up paying 700 dollars a week for therapy?! Is this standard practice? Is this the only way to work this out? Please tell me there if there is a more effective way to go about this.
We’ve all heard that communication is crucial in relationships. Of course this is true in a general sense. However, in addition to having basic conversations about things that are important to us, it is vitally important that we step back and take an objective approach to things that bother us. Of what does communication consist? The obvious response is that communication relates to how we speak with one another. Tone, body language, and facial expressions are a close second. However, there is a much deeper form of communication within relationships that is often ignored. I’m referring to the way in which we understand the other person’s intentions.
One cause of problematic communication is that we tend to assume that other people think and feel the same way that we do, and that others have similar triggers and insecurities. Even in instances where we can intellectually recognize that this is not the case, we frequently project our thoughts and feelings onto the other person—especially when we are feeling emotional. In addition, we assume that the other person’s actions were caused by something that would cause us to act in that manner. For instance, if my wife raises her voice and tells me that I did something stupid, on some level I immediately ask myself what would cause me to say what she did in the way that she said it. If I’m the type of person who doesn’t show anger unless I despise the other person, I instinctively transfer this sense onto my wife, and assume that she despises me. It’s only when I analyze the situation that I realize that my wife might be acting angry because she feels hurt.
Unfortunately, in many cases, this becomes a vicious cycle. If I react to my wife’s anger by becoming sullen and withdrawn, this can trigger a negative feeling in her for a similar reason. This can escalate her anger response, thereby causing me to further isolate myself. Over time, this can lead to major arguments, which continue to exacerbate the problem and increase the sense that my wife despises me and doesn’t care for me.
Without specifics, it’s impossible to determine your need, or your wife’s need, for individual therapy. Although you began therapy to deal with marital problems, individual issues often arise. In fact, marriage counseling often separates into three parts: relationship matters, his issues, and her issues. Some therapists may opt to deal separately with each person’s issues, then to apply them to the relationship. Some sessions would be dedicated to helping the husband identify his needs, triggers and insecurities, while other sessions would focus on the wife’s. The understanding of how these affect the relationship would then be integrated into the way in which the couple interacts with one another.
When a therapist follows this strategy, there are a number of factors that can help to determine whether individually focused sessions should be conducted together with both spouses or alone with each identified spouse. There are instances where one spouse or both spouses have issues that call for separate individual therapy in order for them to acknowledge, communicate, and work on these. For instance, there may be individual issues that are hampering the efficacy of the joint sessions. Perhaps there are deeply embedded issues that negatively affect the relationship, and that require more intensive therapy. If a therapist believes this to be necessary, his reasoning should be discussed with his clients so that they fully understand his position. If you’re not clear on the reason for your therapist’s suggestion that you each see your own therapist, you should ask for clarification.
June 16, 2017
I have tremendous anxiety from the news, especially nowadays when there are so many videos of terror attacks and other terrible things. I saw a video of a terror attack and I think about it all the time. I had this problem a few years ago but it didn't bother me again until recently. Whenever I go to Manhattan I am so afraid of something terrible happening. Please give me advice on how to deal with this.
There are various types of anxiety and a number of techniques designed to deal with them. If you have general anxiety that tends to be exacerbated by specific news stories, you may be focusing on the obvious, more intense anxiety. However, if your general anxiety is an underlying factor, decreasing this can reduce the higher anxiety that is triggered when you’re affected by a specific event. It’s easy to blame your anxiety on the fear of a terrorist threat. You seem to recognize, however, that your level of fear is greater than the actual threat level calls for. This likely means that something is happening, without your conscious awareness, that is causing you to feel anxiety. These unconscious emotions can be much more powerful than your conscious efforts to logically eliminate the fear. Although you may tell yourself repeatedly that your fear is not warranted, your unconscious mind continuously tells you to be afraid.
Working on general anxiety can seem complicated. You would first need to discover whether you actually have general anxiety. If you acknowledge that you do, you would then work on its history, underlying fears, triggers, and many other factors. Although this may seem daunting, a proficient therapist can help you to identify and work on these. Decreasing this core anxiety can go a long way toward decreasing more obvious fears that appear closer to the surface. For instance, if someone grows up afraid of being bullied, this can lead to a general sense of timidity and fear in adulthood. When this old fear is triggered by news of a terror attack, it can force the childhood emotion to the surface. Working on resolving the childhood fear can reduce the general anxiety as well as fear that is related to specific triggers.
Another approach would focus directly on the fear by focusing on its emotional aspect. This approach would ignore the instinct to avoid the issue or to remind yourself that there’s nothing to be afraid of. It would focus instead on what you are afraid of (even if it doesn’t seem to make sense). For instance, thinking about how a terrorist attack might occur, how it would affect you, and how you would react can help you to focus on your logical thoughts about it—instead of simply feeling afraid. Identifying and challenging your specific fears intellectually can help to decrease them.
June 9, 2017
I have been seeing a therapist for the last few weeks. Recently, while I was waiting for my appointment in the waiting room, I overheard him discussing another patient on the phone. The door to his office was wide open and he knew I was there because he had buzzed me into the waiting room. Since then I just don't feel comfortable speaking with him because maybe he discusses me when there are other people listening. The problem is that it was so hard for me to come and tell him so many things and I just don't have the strength to start again with someone else. How do you suggest I approach this?
It sounds like it took you a long time to muster up the courage to see a therapist. It’s great that you were able to overcome your trepidation and open up to someone who can help. It can be difficult to acknowledge that we can use help with our issues, and it can be very difficult to admit this to a stranger. Once we do recognize our issues and speak with a therapist, creating change can be challenging.
Now you’re faced with another hurdle related to your relationship with your therapist. Once again, there is something that is uncomfortable for you to address, but you recognize that it should be discussed with him. Although this can also be daunting, there are a few things that can help you feel more comfortable bringing it up.
The obvious difference between discussing your problems and addressing the current issue is that this issue lies with your therapist and is something that he needs to change. Remind yourself that this is something that he should be addressing and that it’s not your problem. A professional therapist would want to know that he is inadvertently breaking confidentiality. He would also want you to discuss anything that makes you feel uncomfortable with the therapy process. It’s his job to create a safe and comfortable atmosphere. He will likely be thankful to you for bringing this to his attention.
If you’re concerned that your conversation will seem confrontational, you can emphasize the fact that you felt uncomfortable. Although this isn’t your problem, and you shouldn’t have to soften the message, doing so can make it easier for you to broach the subject. Speaking about it from your point of view, while at the same time recognizing that it’s not your issue, can make the discussion seem less like a confrontation. That being said, your therapist will likely be apologetic, and thankful to you for pointing out something of which he should be aware.
May 30, 2017
I know someone who has a sibling who is in his early 20's and is holding down a job. However, he is socially awkward and can really benefit from therapy. However, this person will get highly insulted after being told this and may resent the person who told him. How can he be told (by a relative or professional) that his behavior calls for therapy? Can it be said straight out? If so, how should it be done? On the other hand, is finding the right words and presenting the facts the right way to go?
It’s easy to point out problems with someone else’s behavior. However, we often define problems based on our own preconceived notions and sense of appropriateness. For instance, if this person seems loud and inappropriate, is this his problem or yours? The determination as to whether he should be in therapy depends on a number of factors. Perhaps the most basic question to be answered is: Is he happy? After all, isn’t happiness the goal that we all strive for? If he’s happy despite his social awkwardness, and is likely to continue being content, does he need therapy? If his social awkwardness causes you to feel uncomfortable, perhaps this is something that you should be dealing with.
On the other hand, if the person is unhappy, or is having clear life issues relating to his trouble socializing, a therapist can help him to identify the causes for his unhappiness. This might be the key to understanding how to approach him. I don’t think that “presenting the facts” would be the best approach. If his inappropriate behavior is the focus of the conversation, he might easily be insulted by the insinuation that there is something wrong with him. We don’t like others telling us what’s wrong with us, and we don’t like being told that we need to change.
On the other hand, focus can be placed on his subjective feelings. If someone close to him can talk with him about the things that are bothering him, he will likely be more open to looking at the causes. This can achieve two objectives. Firstly, it will allow him to identify his own issues and goals rather than having someone else tell him what he needs to work on. It can also help him to recognize that there is in fact a problem that he will want to resolve. This will give him a stronger incentive to address the issue.
May 19, 2017
I am wondering if you can help with the following question that I frequently wonder about. Why is there more of a need for therapists today than a generation or two ago? Somehow we managed fine in the past. I am not, chas v'shalom [G-d forbid], against therapists, especially those who follow Da'as Torah [torah knowledge]. I am just seeking to understand.
Your question is one that bothers many people. It can be viewed from a theological, psychological, philosophical, ideological, or pragmatic perspective. Of course, these and other perspectives often overlap. For instance, one might point to the loss of community insularity (and the resulting almost universal access to enormous amounts of information) as a cause of more increased mental health issues. Because of this, someone might feel that we are being punished for the way in which we access and use this information. The person may then question this and ask himself whether an underlying sense of guilt is leading him to feel that anything bad that occurs must be a punishment for something that he did. A more logical analysis can then lead him to a clearheaded decision about how to respond to the problem. He would thus have begun from an ideological view, transitioned to a theological one, moved on to a psychological perspective, and finally ended with a pragmatic understanding.
I am not a philosopher, a theologian, or an ideologue. However, like many people I have given this topic some thought. Your question is based on the assumption that there is a greater need for therapy in this generation than in generations past. This is likely true to some degree. Recognize, however, that in previous generations people didn’t talk about their issues with the openness with which they do today. If someone had an issue, he often suffered in silence. In addition, people who were depressed might have been identified as morose; those with ADHD were considered to be difficult or multi-taskers; and anxious people were viewed as dramatic or simply annoying. This makes it very difficult to compare the incidence of mental health issues in the past with that from today.
The fact that we are a more open society today can be a double-edged sword. Certainly there is much greater acknowledgment of problems that can be improved through therapeutic intervention. We have many more resources to help people identify issues and to educate them as to treatment. We have referral agencies, teachers, physicians, and rabbis who are much more knowledgeable and understanding about mental health issues. We have a vast array of therapies and techniques with which to help people to overcome their problems.
A possible negative aspect of the more open nature of our society is the increased tendency for people to identify normal feelings as mental health problems. For instance, more kids today are open with their parents and discuss issues that most children in past generations would never have discussed. This can lead parents to believe that their child has a major issue that needs to be dealt with professionally. When parents give their kids the sense that their feelings are problematic, this can itself lead to emotional problems. The sense that “abnormal” feelings need to be “corrected” can in turn lead to increased discussion about “problematic” feelings, thus continuing the vicious cycle.
Those of us who grew up in past generations often point to the fact that most of us didn’t need therapy as children. What we fail to recall is that we had similar feelings and insecurities, but that we didn’t necessarily discuss them with our parents. We often normalized our feelings and dealt with them on our own. Although this may not have always been the best solution, it tends to give us the impression that previous generations were more emotionally healthy.
There are many factors that likely contribute to an increase in the incidence and severity of mental health issues. In the 1940s, Abraham Maslow proposed what he termed a “hierarchy of needs.” Basically, his theory was that people tend not to focus on higher needs like self-esteem and self-actualization (essentially feeling good about oneself) until they have met more basic needs like physiological and safety needs (putting food on the table, paying bills, etc.).
In past generations, most kids were given chores. They were expected to be responsible for many of their own basic needs. If a child wanted something done, he often tried to do it himself. If he wanted to buy something, he would work to earn the money necessary. Today’s parents often try to insulate their children from adversity and hardship. Many kids are not being given a sense of responsibility and a chance to develop responses to their more basic needs. In effect, these kids are often forced to contend with higher needs at an age when they are not mentally prepared to do so. This can lead to frustrations and insecurities that were less common among the children of past generations.
May 12, 2017
Around a year ago I went through something very difficult (I am not comfortable providing all the details). I have found that the passing of time since the event, keeping busy so that I don't have time to think about it, as well as writing about it, have helped but would appreciate any other suggestions that you might have. Someone I spoke to said it was a “trauma” and that something called “EMDR” is used to treat trauma. What are some of the things that are done during EMDR? Is that the best and only way to treat trauma? Do all therapists provide the same type of treatment and if not how do I know which type would be best for me? I have been able to do all my responsibilities and be there for my family, but feel like I am always very alert—worried about danger—and can't concentrate as well. How can I get back to my former self?
Trauma affects different people in different ways. Some people are generally able to get back to normal function and emotion relatively easily after a traumatic experience. Others generally have a difficult time dealing emotionally with traumatic events. Type of trauma, individual background and triggers, coping skills, and support systems are some of the factors that can affect a person’s response to trauma.
There are a number of therapeutic processes that can help someone deal with trauma. These include CBT, psychodynamic therapy, DBT, exposure and desensitization, and EMDR. Depending on many factors, one or more modalities can be utilized. Factors include age at which trauma occurred, number of traumatic events, duration, amount of time that has passed since the trauma, and emotional reaction, among others. EMDR is a treatment protocol that is designed to help people to identify and change the way that they process traumatic events. EMDR uses eye movements along with aspects of other treatment modalities, like CBT.
A therapist can help you to identify some of the specific factors that affect your ability to effectively process your recent trauma as well as traumatic events in general. The appropriate modality or modalities would be identified. A good therapist can shift focus and modality as needed to properly address issues and needs as they are discovered.
If the traumatic event that you experienced is not associated with other past experiences (as from early childhood) a few sessions can often help you to work through the negative effects. It can be difficult, however, to verify that there is no unconscious, connected early emotion impacting on your current reaction. This is something that a therapist can help you to determine.
May 5, 2017
I am a 12th grader in what is considered a very chosuva mesivta [prominent high school]. There are some things that I would like to discuss with someone. They cause me a lot of worry but I do not feel comfortable discussing this with a rebbe [rabbi] or mashgiach [dean] in yeshiva. I think that maybe a therapist would be the right type of person to discuss this with. The issue is that my father doesn't hold of therapy. I am not sure how to bring this up with him and I don't want to get pressured to share something that I am not really comfortable discussing. I am really stuck. Can you give me advice as to how to move forward? Thank you.
A generation ago, fewer people sought the help of a therapist. Those who eventually went for help often did so because they had reached the point where they were no longer functioning normally. This had the effect of creating the impression that therapy was only for people who had severe issues. Over the years, however, it has become clear that working on problems in their beginning phase can help to avoid more severe future problems.
Fortunately, over the past generation or so, the general population and the yeshiva world in particular have become much more open to the concept and importance of therapy. However, as you point out, there are many people who feel that therapy does not help. Worse yet, there are those who secretly recognize that therapy can help and is often necessary, but they refuse to avail themselves of it due to fear of stigma or other emotional reasons.
It sounds like you could use a third party who can help to convey your message to your father without the necessity of going into details. The question is whether this third party should be a family member—like your mother—or someone who is impartial. Either way, this would need to be someone who will not pressure you for information, and who can persuade your father not to pressure you.
The fact that much of the yeshiva world has come to embrace therapy as a great asset in many areas can help you to convince your father that seeing a therapist is the right thing for you to do. If there is a rav or rosh yeshiva with whom you feel comfortable discussing the issue—and whom your father respects—he can help your father to understand how therapy works, and can help to dispel any negative associations that your father has with regard to therapy. If you don’t feel comfortable discussing the specifics of your issues, you can simply explain that you want to help your father feel more comfortable with the idea of you speaking with a therapist.
If there is no one in your life with whom you feel comfortable discussing your feelings, there are many well-known and respected rabbonim who are quite familiar with mental health issues, and who would be happy to help educate your father about the process. This can help him to feel more comfortable with the idea, and can help him to recognize the efficacy of the therapy process. If you would like a recommendation for a rav who might be able to help you, feel free to call or email me.
April 28, 2017
I am 21 year old Bochur just back from Eretz Yisroel. Can you please explain to me why some people have such a hard time waking up in the morning? This is something I constantly struggle with and I never am able to beat it. Oversleeping is something that is constantly getting in the way of my aliyah. It also really annoys my parents and rabbeim. I wouldn't say it just has to do with going to sleep late because I have friends who go to sleep really late and still somehow always make shachris. People tell me I am just lazy and should just get up, but if so I don't know how to stop being lazy. Can you please give me some advice as to how to deal with this endless problem?
The ability to wake up (and rise) early is reliant on many factors. You speak of “a hard time waking up.” If you mean that you literally do not awaken despite the use of an alarm clock or others attempting to rouse you, you should probably be tested for a vitamin deficiency—like an iron deficiency. Mental health issues like ADHD and bipolar disorder can also create for a need for longer and deeper sleep.
Your circadian rhythm (commonly known as your biological clock) helps to regulate your need for sleep. Every person has their own individualized rhythm with specific sleep requirements. In addition, your circadian rhythm changes as you age. This is the reason that children generally require more sleep than adults. There are also a few sleep stages through which you cycle a few time every night. If the time that you try to awaken coincides with a deep sleep stage, it can be very difficult to do so.
At the age of 21, you might still be in the late adolescent-early adulthood phase at which you require an average of 9 ½ hours’ sleep on a nightly basis. In this phase, your body may also be biologically set for a late bedtime, further complicating the issue. Proper sleep is critical. If you are not getting enough sleep, this can affect your general level of alertness and memory, and can lead to weight gain. Over time, it can also contribute to mental health problems, like depression.
Your friends might have an easier time waking up due to many factors. They may simply need less sleep than you do. However, if they are not getting the amount of sleep that their bodies require, this can cause long-term issues related to sleep deprivation, despite their apparent ability to easily awaken.
If you’re getting enough sleep and actually wake up but still have trouble rising in the morning, you can try two things. The first is to set your alarm for the latest time that you want to get out of bed. This can eliminate your tendency to hit the snooze button and fall back asleep. The extra few minutes of sleep can do more harm than good since they will likely interrupt then restart your REM sleep, (arguably the most important sleep stage, which helps to you to focus), thus keeping you in a fog throughout the day. The second thing that you can try is rising slowly from bed. First sit up, then breathe deeply a few times, then slowly rise to your feet. This can help to alleviate the shock of switching suddenly from a deep sleep to being fully awake.
April 10, 2017
I have struggled for years with overeating and dieting. I was put on a diet at a young age (I was not overweight; it was purely for aesthetics) and as a result I have spent over 20 years yoyo dieting. I mostly maintain a normal to slightly large physique, so my health is not in great danger. But I cannot seem to get beyond this. I use food to cope and to relieve any emotions I cannot handle. I basically wake up and crash whatever diet plan I concocted the day before. Then I feel full, bloated and guilty and come up with a new plan for the next day! I have tried OA but found it too extreme a diet. I also tried intuitive eating, just trying to eat healthier or just eating whatever I want in an attempt to put my eating issues at rest. I never seem to be able to do anything but binge. I am a mom of a busy house and I just don't know how to get over my food issues.
Overeating is a very common problem that often has numerous causes. Reasons for overeating include poor meal scheduling, possible physiological issues, and emotional needs. You suggest that your overeating is a direct result of the emphasis that was placed on dieting when you were a child. In fact, many people with eating disorders (ranging from anorexia and bulimia to binge eating) trace their eating issues to problematic childhood messages.
When a child is given the sense—intentionally or otherwise—that their value is linked to their body image, this is given a disproportionate significance in the child’s life. This can lead to poor eating habits. In addition, this sense often causes anxiety, which ironically can lead to the use of food as a temporary solution to the anxiety. Thereby a vicious cycle is created, in which the person feels anxious with regard to food, causing her to overeat to relieve the anxiety, which in the long run actually increases the food-related anxiety.
It is important to identify the emotional triggers that make us crave food. Two common childhood beliefs are that we are good only if we are thin, and that food is bad. Acknowledging these and other erroneous beliefs, and identifying current impulses similar to those that we experienced as children, can help to slow the cycle. We can thus stop and challenge the reasons that we are eating instead of simply eating emotionally without questioning whether we are actually hungry.
It can be very difficult to work on unconscious needs and impulses on your own. A therapist can help you to explore and identify these, and can help you to change your eating habits. Support groups can also be helpful. They allow you to discuss your feelings in a non-threatening and non-judgmental environment.
Perhaps the reason that you found Overeaters Anonymous to be too extreme is that you didn’t properly identify your emotional need to eat. Overly restrictive diets can trigger the very anxiety that sets an overeating cycle in motion. Intuitive eating also ignores the underlying needs, thereby causing you to fall back on childhood emotions and eating patterns. If you can begin to identify your particular emotions and your insecurities related to body image and food, you can begin changing your emotion-food-emotion cycle.
March 31, 2017
I am a 17 year old girl and one of my closest friends is constantly saying very depressing things. I'm not always sure if she is serious or just doing it to get attention. I don't know if anyone else is aware of this but she definitely does not want me to tell anyone. Point is, I'm not really sure what to do about it. It's getting to be a bit much for me but if I don't listen to her and take her seriously I don't think she will have anyone else to go to. Can you please give me some advice as to how to deal with this situation?
There appear to be two parts to your question. On the one hand, you want to know whether your friend is in need of help. On the other hand, it sounds like you’re becoming overwhelmed with your friend’s issues, and want to know if there is a better way that you can handle your emotions with regard to them.
As you suggest, people will oftentimes say things for attention. This can be especially so if your friend recognizes that her comments will go no further than you. However, this can also be the case when there is a real concern; your friend may feel safe discussing her true feelings with you because she knows that you will keep them to yourself.
Unfortunately, it can be very difficult to separate fact from fiction without knowing more about the situation. People can speak about depressing things for various reasons. Depending on the types and frequency of comments, reasons can include a psychiatric disorder, attention-seeking, situational problems (like an ill relative), and changes in mood due to a medical issue (like a thyroid condition).
The most obvious psychiatric possibility is depression. There are different types of depression. As an example, dysthymia (a general type of depression that is often mild and chronic) is marked by feelings of sadness, and loss of interest in daily activities. Other symptoms include: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.
If you believe that your friend is depressed, remaining silent may not be the best choice. Although you understandably want to keep her confidence—and don’t want her to lose the only person in whom she confides—you are not qualified to help her. Regardless of the reasons for your friend’s comments, she is placing you in an unfair position. She is naming you her confidant, but not “allowing” you to seek help for her. Though this may be her intention, it is also possible that her negative comments may be her way (conscious or unconscious) of asking you for help. Either way, you should not be put in this untenable position where you want to help but feel that your hands are tied. At the very least, you should encourage your friend to seek professional help, stressing the fact that therapy is confidential.
March 24, 2017
I recently graduated from college and began a job in an accounting firm. Although the job is working out well and I get along with everyone there, I have been feeling increasingly anxious as time goes on. I can't put my finger on what is bothering me because nothing else in my life has changed.
In school I was always a relaxed, happy, popular person. I have good relationships and I am happy with my career, but I can't seem to shake the anxiety. What can I do to help pinpoint the cause?
Very often, anxiety is an unconscious process whose causes can be difficult to identify. It is this type of anxiety that is so frustrating. When we can pinpoint a clear source for our anxiety, we can question our emotional response, challenge it, and otherwise analyze it to help reduce our problematic feelings. When an emotion appears to make no sense, it can continuously intensify due to our inability to deal with it.
Sometimes, we point to a stressor that “should” be causing anxiety. For instance, I might be feeling anxious for an unknown underlying reason, but will decide that I’m stressed out because of my job or my marriage. When this occurs, we often spin our wheels trying to resolve the identified problem. This can lead to resolution of the identified stressor—only to discover that the anxiety remains, or has increased. Or worse, we can get trapped in the minutiae of the “cause” of the anxiety, leading to a major decision like divorce (once again discovering that the anxiety hasn’t been resolved).
In your case, you haven’t identified any stressor that can be causing your anxiety. With the limited information at hand, I cannot identify for you a specific cause for your anxiety. However, I can point to two general sources of emotional upheaval that might help you to begin the process of identifying the root causes of your feelings.
On a surface level, life changes can create for feelings of anxiety and/or depression, even when there appears to be no reason for them. When you first went to summer camp, did you feel some trepidation? When you enrolled at a new school, were you nervous for a time? These feelings are normal, and generally evaporate over time. At the beginning of a new venture, regardless of its positive nature, there are many unknowns. Will I make friends? Will I like it? Will I get along with my boss and associates? Even if these issues aren’t legitimate concerns, they can persist until we feel comfortable in our new environment. If these issues begin to dissipate over time, they will likely disappear in the near future.
On a deeper level, let’s understand the reason that we have these concerns at all. Self-esteem is an underlying factor with regard to many emotions. When I have no real concern (like losing my job) why will it hurt me if I don’t make friends, or if I’m not liked at work? The general answer is: if I have the sense that I’m not liked, it can make me question my own value as a person. If my self-esteem was always grounded in being popular (or smart, funny, athletic, etc.), moving to environment where this factor is unimportant can reduce this artificial sense of self-esteem, thereby causing me to feel anxious or depressed.
I will not elaborate here on the importance of building an authentic sense of self-esteem based on intrinsic qualities, which can be the long-term solution to your anxiety issues. On an interim basis, identifying the external sources of self-esteem that are no longer being sustained can help you to put your finger on the cause for your anxiety and to begin building one that is more viable in your current environment.
March 17, 2017
I have an older (half) brother who has a serious mental condition. I'm not sure exactly what it is but he has often had to go to the hospital for a few days till he gets "stabilized". My parents don't really like to talk about it and I try not to bother them with it. I think there are also some other people in my mother’s family who have mental issues. My question is: People have told me (and I have also read online) that these types of things are in the genes and that I could also have these issues. As I get older I am more worried about it. Can you please clarify if this is true? And is there anything I can do to prevent it?
The “Nature versus Nurture” question has been hotly debated for generations. Strict proponents of the nature argument dismiss the notion that there are factors other than inborn ones that contribute to mental illness, while those who argue for the nature side insist that genetics have no role in the manifestation of mental illness. Although strict proponents of either side will probably always exist, research continues to indicate that mental illness is typically caused by a combination of psychological, biological, and environmental influences.
There are many factors that can contribute to mental illness, including family dysfunction, physical trauma, psychological trauma, death in the family, divorce, and low self-esteem. In addition, each factor impacts on the others. For instance, though we are born with all the genes that we will ever have, interactions between experiences, maturity, medications, illnesses, and many other factors determine whether or not particular genes are expressed.
Having a genetic predisposition to cancer and high blood pressure will not necessarily cause a person to develop these diseases. However smoking, alcohol use, and being overweight can turn the predisposition into an illness. From this perspective, we can recognize that although genetics can make us susceptible to a disease, they are in no way a clear predictor of that disease.
The psychiatric illnesses that appear to have the most research showing a genetic component are OCD, schizophrenia, bipolar disorder, and depression. Again, this means that genetics can play a role—not the only role—in the development of these disorders. With regard to age of onset, schizophrenia is most often diagnosed in late adolescence or early twenties. Bipolar disorder most often presents around age 25, and OCD typically manifests by age 25.
More information about your brother’s symptoms and diagnosis can help you to better research possible issues and symptoms. Awareness of these can help you to identify and deal with them early on should they appear.
March 10, 2017
I was wondering what your opinion was regarding taking anti-depressants. I have been feeling extremely tired and fatigued recently and when I went to my doctor thinking I needed some blood work he prescribed me an anti-depressant. Is this an advisable course of treatment? Do you think it would be more beneficial for me to see a therapist in addition to, or perhaps instead of, medication?
I’m not a psychiatrist and do not dispense medication, so I cannot speak to specific medication issues. However, if your only symptoms are tiredness and fatigue, there are certainly various medical, lifestyle, and other issues that should be ruled out. If your doctor prescribed an anti-depressant based simply on these two symptoms without ruling out other possibilities, you would do well to seek a second opinion.
Some of the many medical causes of tiredness and fatigue are: Anemia, Chronic Fatigue Syndrome, Kidney Disease, COPD, Diabetes, Emphysema, Heart disease, Hyperthyroidism, Hypothyroidism, Inflammatory Bowel Disease, and Sleep Apnea. I don’t know why your doctor didn’t do blood work. You could ask him, in order to get a better sense as to his thought process.
Possible lifestyle causes of fatigue include: use of alcohol or drugs, excess physical activity, lack of physical activity, lack of sleep, certain medications (like antihistamines and, cough medicines), and unhealthy eating habits. If your tiredness and fatigue began recently and are of short duration, other factors—like work stress or relationship issues—can be the culprits.
Once medical and other issues are ruled out, and it is determined that there is no physical cause for your tiredness and fatigue, you might want to consult with a mental health professional to help you deal with your symptoms and their root causes. A psychotherapist or a psychiatrist can help you to determine whether there is a mental health concern. A therapist can work with you to identify possible triggers and problems, and a psychiatrist can help ascertain whether medication is necessary and, if so, which one makes sense for you.
March 3, 2017
I'm really enjoying your column, and I'd love to hear your take on my problem. I am eighteen and I've always suffered from anxiety, and in times of stress also insomnia, but since I graduated from school last year and started working it’s gotten a lot worse. These days, I barely sleep and I am constantly in a state of sleep deprivation and exhaustion. I've tried melatonin, but it doesn't really help much. It basically only makes me drowsy, and if I'm successful in calming myself down enough, then it works, but a few short hours later I'm up again for the rest of the night. I'm not too keen on the idea of sleeping pills because they're addictive. What course of action would you recommend?
You refer to your issues with anxiety, since you have clearly associated this with your insomnia. Your question, however, is with regard to the insomnia. Despite your recognition that your trouble sleeping is closely linked with your stress levels, your question focuses on how to treat the insomnia. I don’t know whether you’re currently dealing with, or looking to treat, your anxiety. If you are, your insomnia should be included in the treatment of your anxiety. As a symptom of anxiety, trouble sleeping can be improved by reducing the anxiety that lies at the center of this and other symptoms. As an example, symptoms of Generalized Anxiety Disorder can include restlessness, difficulty concentrating, fatigue, irritability, and headaches, among others. Rather than treating each symptom individually, it usually makes sense to treat the source of all the symptoms.
You mentioned that you tried melatonin and are averse to sleeping pills due to their addictive properties. I am not a medical doctor, so I can’t speak to specific pharmacological treatments. There are, however, non-addictive options for the direct treatment of insomnia. In addition, if you’re willing to consider the use of medication for the treatment of the underlying anxiety, there are many non-addictive choices for that as well.
Since you have “always suffered from anxiety,” you likely know that changes and new situations can often trigger a fear response and feelings of stress. The transition from the insulated and often comfortable world of school to the relatively exposed, unfamiliar realm of the workplace can be intimidating and anxiety provoking. You may have had a similar experience upon entering high school after many years of acclimation to elementary and middle school.
There are various psychotherapeutic methods that can help to reduce anxiety, both generally and with regard to specific situations, stressors, and triggers. A competent therapist can help you to identify the method or methods that will best work for you. You can learn to decrease your anxiety, which will help to reduce all of the symptoms associated with it, including your insomnia.
February 24, 2017
I have a son who would like to see a therapist to deal with some issues. I think it would be beneficial for him but I am concerned that therapy might damage his relationship with my wife and myself. Every parent makes mistakes and I am sure we have as well, but I am worried by the sentiment I hear expressed that therapists "estrange" children from their parents. Can you please clear this up for me and perhaps give me some ideas as to how to make this a positive experience that will enhance my relationship with my child. Thank you so much for your time!
I think that it’s great that you’re considering these types of concerns. Too often, parents leave their children’s issues at the door of the therapist, assuming that they no longer need to be involved in the response to their children’s needs and issues. The fact that you’re concerned about the effects of therapy tells me that you’re considering therapy a part of your son’s approach to his issues, not the entirety of it.
There are various schools of thought with regard to the parental role in the cause of mental illness. There are those who contend that many mental illnesses are caused by bad parenting. There also those who vociferously argue that parents consistently get a bad rap. The concept of the “schizophrenogenic mother,” the mother who “causes” her child’s schizophrenia, was much-vaunted in the middle of the 20th century and still has its proponents. On the other hand, there are many groups that help parents to recognize their blamelessness within the context of their children’s mental illness.
The reality, of course, is that this issue is much too complicated to be painted with broad strokes. Naturally, children are significantly affected in many ways by their parents. Therefore, many problems can be exacerbated by the actions of parents, just as many problems can be minimized or eliminated through the actions of parents. No competent therapist will make assumptions about parental roles within a particular issue. A proper therapist will help their client to understand the issues and causes, beginning from their client’s perspective, in order to properly help him to become happier and better adjusted. This goal is generally in the best interest of all involved.
I wonder whether you have reason to believe that therapy might drive a wedge between your son and you, or if you have simply heard others associate therapy with parental estrangement. Perhaps you know someone whose relationship with his child changed for the worse while the child was in therapy. On the other hand, if your relationship with your son is already strained and you’re afraid that a therapist might reinforce your son’s notion that his problems are due to his parents’ actions, perhaps a few family sessions are in order. The parent of a teenager who is unconsciously trying to maintain complete control over his child’s life can feel threatened by the idea of a third party who can influence his child to become more independent—this despite the parent’s intellectual recognition that more independence is exactly what his child needs.
You speak of a concern that therapy might detrimentally affect your relationship with your wife. This leads me to believe that the two of you differ with regard to your approach to your son. Perhaps one of you feels the need to maintain control and has trouble letting go, while the other believes that your son needs to begin (or continue) his quest for independence. Maybe one of you reacts more strongly to your son’s perceived rebellious actions. If there is discord between the two of you, there can be a fear that a therapist may side with one parent over the other, or that the therapist will help your son to follow his own ambitions.
With regard to the therapeutic relationship, one of the factors that should be considered is your son’s age. Often the age of the client is what determines the extent of the parents’ involvement in the therapy process. For a young child, the parents often meet the therapist during the initial session, and have regular discussions with the therapist. Aside from imparting important information to the therapist, this helps to give the parents a clear sense of the goals and plans of therapy, and can help to alleviate concerns relating to the therapy process.
Older children, however, often want their relationship with their therapist to remain confidential. When this is the case, it is crucial for this expressed wish to be adhered to, in order to allow for a trusting and effective client-therapist relationship. For a parent, this can be hard to accept, since we want to be involved in our children’s lives with regard to important issues. This is especially true when our child’s wellbeing and his relationship with us (or with the entire family) appears to hang in the balance.
It’s important to recognize that a good therapist will want to focus on all aspects of a problem, including the effect on their client’s family relationships. In addition, although the therapist might not be able to share information with you, I believe that most therapists are happy to listen to your ideas and concerns, in order for them to best help your son. Periodically checking in and discussing your feelings about your son’s progress can keep you more involved, and will help the therapist to identify any relationship issues that might arise. Remember that the therapist’s primary concern should be your son’s best interest. That being said, this should take into account his wellbeing with regard to his relationships.
February 17, 2017
Thank you for your column. Since parnassa [money] pressure is something we all face, I hope you will print my question. I am the mother of a growing family, BH, and like most women today, my income is essential. Perhaps my husband is learning and I am the primary breadwinner. Or perhaps my husband is working, but his income covers basics while mine pays the tuition.
Either way, the pressure that I am feeling to increase my income as more of my children enter school is crushing. The truth is that I am not cut out to be a working mother. Far from meeting my needs for outside stimulation, my job drains the life out of me, physically and emotionally. When I come home, I have no strength left for my family, and wish everyone would just go away so I could rest or have some time to myself. After my kids are in bed, I have paperwork to complete or students to tutor at home. At that point, I have no strength left for any household tasks or phone calls, because I need time alone to unwind. (I know this is not depression, because Yom Tov [holidays], maternity leave, and even sick days are a different world. That is when I finally feel alive.)
I would appreciate your REALISTIC advice! My family needs their wife and mother back!
Move to backwoods Mississippi! Seriously though, I have spoken with many people who are dealing with this issue. We live in a society in which a family needs to earn what is considered an upper middle class income just to pay the bills. A very large portion of the frum community seems to be feeling the pressure to work inordinately hard in order to keep from drowning in debt.
I have heard from many a parent that they feel like they are being sucked dry by the stresses of life, and that they have no energy for their families. To some extent, it comes down to priorities. Should we work that much harder to afford that new watch or vacation, or should we take time off to be with the kids? Unfortunately, however, many people find themselves in the position where they need to work extraordinarily hard simply to afford the necessities.
I don’t have a suggestion that will completely change your life and allow you to feel energized after a difficult day at work. That being said, there are some things that you can try that might help you to relax both generally and after a long day. It can help to schedule tasks for specific times. For instance, instead of doing paperwork whenever you have time, try scheduling it for a specific time and for a specific amount of time (i.e., from 8:00pm to 8:30pm). This can help you to avoid the sense that you are always working. It can also help you to begin scheduling time for relaxation. If you know that your obligations are time-limited, and you can look forward to relaxation time, this can make you generally feel more calm and in control.
It can also be helpful for you to schedule time away from your house. Try to find some time to spend with your husband or with a friend or friends. Always being in the same places (home and work) can lead to feelings of being overwhelmed and the sense that you are always “on duty.” Getting away, even for just a couple of hours a week can help to reduce that sense.
February 10, 2017
I am a pre-school Morah in the local Yeshiva. There is a boy in my class who never talks above a whisper. This has been going on since the beginning of the school year. While the parents insist that the child is just shy I am convinced that this is more than that. Can you please give me an idea of where the line is between shyness and a more serious problem? I would also appreciate any strategies you can suggest in convincing the parents to go for help.
Without further information, it is difficult to guess at a possible cause for your student’s tendency to whisper. Depending on the circumstances, this can be related to feelings of anxiety, depression, social phobia or other social issues, adjustment problems, agoraphobia, or separation anxiety to name just a few. There could be family or social causes, including abuse, bullying or learned behavior.
Although the parents insist that this boy is just shy, my first question would be, “What is shyness, and why are some people shy?” Is this boy shy because he doesn’t feel comfortable within himself (low self-esteem), or does he feel neglected and uncared for, sensing that others don’t listen to him? If he is indeed “just shy,” what is behind the shyness, and will it become more problematic going forward?
You didn’t describe the reason for your sense that this is something more than “normal” shyness. In fact, you may not have clearly identified the reason for this sense. If this is based on your observations with regard to other actions on the boy’s part, acknowledging these can help you to get a better handle on the problem. For instance, perhaps he isolates himself, doesn’t initiate conversation, only speaks with one other boy, makes repetitive motions, or appears afraid of a particular person. If you can identify more specific concerns, this can help you to better formulate your concerns, and to communicate these to his parents.
February 3, 2017
I go through periods of time when I am consumed with worry about my health. I will be OK for a few months but then I wind up spending all day convinced that I have some sort of horrible illness. I wish I would be able to function normally. Why is this happening to me, and what can I do to stop it?
There can be numerous triggers for fears related to health. From a clinical perspective, Illness Anxiety Disorder requires that a number of criteria exist, such as avoidance of triggers and continuous high levels of anxiety and preoccupation with a possible illness, despite little or no physical symptoms. This disorder is a chronic condition in that it needs to be present for at least six months.
You may not have enough of the qualifications to be diagnosed with Illness Anxiety Disorder. However, as with most emotions there is a spectrum with regard to the level of anxiety experienced. In the past, I have defined anxiety (in my non-clinical vernacular) as feelings of stress that don’t logically match the situation. Using this definition, people on the lower end of the spectrum feel little to no anxiety, while those on the upper end of the spectrum feel constant anxiety. People on the lower end will are often able to adapt to stressors and changes very well. Those on the upper end usually need help dealing with the curveballs that life throws at them. It’s the people in the middle part of the spectrum who are generally okay but may, at times, need some help dealing with stress and triggers.
If you are on the lower-to-middle part of the spectrum, there may be specific triggers that cause occasional fear of illness. Direct triggers can include hearing a news report about a health issue, finding out about someone else’s illness, experiencing a minor ache, and thinking about a past illness. Less direct triggers can be hard to pinpoint, since they are often unconscious. They can range from seeing a person from your past with whom you associate a particular illness to a holiday or season that is somehow associated with not feeling well.
If your anxiety is mostly manageable, you can try to identify your particular triggers, both obvious and subliminal. This can help you to do two things. To the extent that it makes sense to avoid the clear triggers, doing so can reduce the frequency and severity of the anxiety response. As far as unconscious triggers are concerned, the more that you understand and analyze their origins the less likely it will be for them to affect you.
January 27, 2017
One of the panelists recently mentioned that “the source of the problem needs to be uncovered and healed” in order to really feel safe and secure. I’ve been wondering for a while how this is actually done in therapy. I’m married in my twenties with some kids and have been struggling with general anxiety. I’ve been seeing a therapist for a couple of months now and she’s really helped me a lot on the “uncovering” aspect through looking at my childhood. I now know that it’s not a surprise that I have insecurities as an adult. But how do I get to the healing aspect? She says that talking over and over about those childhood experiences eventually ends up healing the subconscious. I don’t see how that works. Are there specific tools or steps to get there? What do therapists typically do to "heal" the subconscious?
The decision as to whether “the source of the problem needs to be uncovered” can depend on many factors including desired length of the therapeutic relationship, short-term and long-term goals, and type, severity, frequency & progression of symptoms. A therapist who uses various therapeutic modalities can help clients to determine whether they have a need or desire to focus on the root of an issue.
Once a decision is reached to indeed work on the underlying childhood emotions and insecurities, there are different ways of going about this. Although later neo-Freudians changed and added to Sigmund Freud’s concept, “pure” Freudian psychoanalysis basically focuses on a cathartic (healing) experience through which a person can theoretically be helped and "cured."
The unconscious mind is extremely powerful; it has an effect on our every waking (and sleeping) moment. It constantly affects how we feel and how we react emotionally. Since our unconscious minds were largely formed in childhood, the signals that it sends to us are based on childhood beliefs, feelings and insecurities. Many of us go through life largely unaware of these signals, simply incorporating them into our conscious thoughts. However, it is when we have strong emotions that seem inexplicable to the logical, conscious mind that we often begin wondering what may be occurring under the surface.
Many therapists use psychoanalytic techniques to help clients to better understand early sources of their symptoms, essentially making their unconscious impulses conscious. For many people, reliving problematic childhood experiences (more than simply talking about them), leads to the healing to which you referred. Other people require the therapist to be more involved in interpretation and the understanding of mental associations. However, if after a number of sessions you are experiencing no progress (or stagnation) in this area, you should begin asking whether the psychoanalysis is being done properly, whether the therapist should consider incorporating other techniques into the therapy to enhance the results of the psychoanalytic process (like cognitive techniques to help incorporate now-conscious impulses into your normal though process) or generally whether psychoanalysis is right for you.
January 20, 2017
I have been enjoying this column in the Yated very much. I was wondering if you would be able to help me out. I’m going through a very hard period. I’m only 28 years old and I’m realizing that I have an issue in retaining information that I learn. I’m realizing it now because I got a job and it’s really affecting my job. I am slowly getting very very down on myself and I no longer have any interest in talking to people. Is there anything you would suggest? Thank you.
There are a number of reasons that you might be having trouble retaining information. If you have always had trouble retaining certain types of information, this could be due to something simple, like lack of interest in the material. If this is the case, you can identify those areas in which you have trouble retaining information. Once you have a clear recognition of these, you might try and schedule your study of these for a time when you are better able to focus—or you could ask someone for help in these particular areas. If this is not possible, knowledge of the areas in which you do retain information and those in which you have trouble can help you to choose a job or career in which you can excel.
If the problem is more general, and you have always had trouble retaining different types of information (regardless of interest or other obvious factors), it could be caused by a learning problem, like a processing disorder. Although processing disorders and learning disabilities are usually diagnosed in children, people have often gotten through school without a disorder being identified, only to have trouble later on in life. Most programs seem to be dedicated to children, but there is certainly help available for adults as well.
If you haven’t always had memory problems, or if they are becoming progressively worse, there are many factors that can be contributing to this. Some possible medical causes of memory loss include alcohol use, some medications, physical inactivity, high blood pressure, diabetes, obesity, smoking, Vitamin B-12 deficiency and Hypothyroidism. There are also various mental health issues that are associated with problems in focusing and memory retention. A few that come to mind are ADHD, depression, anxiety, OCD, and Bipolar Disorder. If you’re experiencing other symptoms along with memory issues, you should discuss these with your physician or a mental health professional.
January 13, 2017
I am in my low 20's and have OCD and Anxiety. Baruch Hashem, I am more or less stable as I am in college, and holding down a job at the same time. My question is: In a Shidduch, do you think I should look for someone who’s similar to me- someone who also has Anxiety or some other disorder, or should I rather look for someone who’s "regular" without those kinds of challenges? (Honestly, I would prefer someone who doesn't have any of those challenges but I don't know how realistic that is). I would appreciate your suggestions/advice.
There are a few aspects inherent in your question. First, I’d like to speak to the more general question of choosing a spouse. I’m often asked if people should look for someone with a personality similar to theirs, or if the old “opposites attract” adage has validity. The truth is that it’s difficult to generalize because people are complex and have differing feelings and needs. That being said, although it’s true that opposites often attract, this is often true only in the initial phase of the relationship. It can be exciting to experience a new perspective and interesting new concepts. Indeed this can be a positive thing when it broadens our horizons.
When it comes to personality traits, however, it’s important to choose someone who shares your basic values and life view. By personality traits, I’m referring to healthy feelings and viewpoints with regard to important areas in life. For instance, if you’re a thoughtful, spiritual, caring, inquisitive person who has a sharp sense of humor, you might initially be attracted to someone who has a devil-may-care attitude, appears not to care what others think, is off-the-cuff, and has a cutting sense of humor. These personality traits can seem invigorating and thrilling. In the long run, however, the disparity in basic beliefs and values can become a source of incompatibility and strife.
To more directly address your questions, you can begin by separating your healthy personality traits from any issues and mental health concerns. Although you might have a certain level of anxiety that is problematic, part of what you identify as OCD or anxiety might be an appropriate interest in doing things properly. If you are able to clearly identify this, you can recognize this as a part of your personality that you appreciate, and which you might similarly appreciate in a spouse.
It seems clear that you would rather marry someone who doesn’t have a disorder, as would most people. Fortunately, today people are much more aware of, and educated about, mental health issues and treatment. This continues to increase open-mindedness within the frum community with regard to shidduchim and marriage. Most people have, or know someone who has, a mental health disorder. Therefore it is becoming increasingly more likely that a person without a mental health disorder will marry someone who does.
Although you would like to marry someone who has no disorder, you have personal experience that shows you that these can be well-managed. In addition, the fact that someone has no overt history of mental health problems is no guarantee that they will have none in the future. Recent statistics from the National Survey on Drug Use and Health (NSDUH) have the percentage of adults in the US who experienced mental illness each year from 2008-2014 consistently hovering in the 18% range. In fact, those of us who have less obvious issues, which are not being acknowledged and addressed, can be less functional than those of us who properly identify and address our problems.
January 6, 2017
I was involved in a car accident 2 months ago. Although I fractured my arm I am BH ok. The driver of the other car was more seriously hurt and needed surgery. My friends tell me I am “traumatized” and that I talk about the accident too much. I think it's normal to be shaken up by going through such an experience. I do have trouble falling asleep at night but I don't know that it's related to the accident. Am I traumatized? Do I need professional help?
I think that most people would classify your accident as a traumatic event. People experience and react to trauma differently. Although some people having gone through the same experience might mentally shrug it off, most would feel at least a degree of nervousness or fear and might replay the event in their heads. In addition, some people having a normal reaction to an event deal with it by talking about it with others, while other people prefer to deal with it alone. In general, some people are more open and forthcoming than others. In fact, it’s quite likely that the support of your family and friends will help you to move on more quickly and easily.
There are two factors that can give you a sense as to whether you have a problem (and neither one involves someone else’s opinion of what a “normal” reaction should be). One factor is the severity of the emotional response; the other factor is the progression of the emotional response. If you felt shocked and shaken up shortly after your accident and had significant trouble falling asleep but these problems continue to progressively dwindle over time, you likely have nothing to worry about. On the other hand, if you have felt highly anxious for an extended period of time or the problems don’t seem to be decreasing, you should probably seek help.
Posttraumatic stress disorder (PTSD) is a serious condition that can have long-lasting effects. Symptoms include reliving the event, avoiding similar situations, and excessive emotion (like anger, irritability, trouble sleeping, trouble concentrating, and startling easily). Early treatment can significantly decrease or even eliminate feelings these along with feelings of guilt, helplessness and fear. If you, or someone you know, has symptoms of PTSD, psychotherapy and/or medication can be a source of significant relief.
December 30, 2016
I am a tenth grade Rebbe in a local mesivta. I am concerned that one of the bochurim in my shiur may have OCD. He is a very good bochur and does very well, but is shy and seems very anxious about his grades. I noticed recently that he spends a very long time putting on ( and taking off) his teffilin. At least 10 minutes. He is constantly adjusting them during davening. He also takes a very long time davening. How do I know the difference between dikduk bamitzvos and unhealthy behavior?
OCD (Obsessive-Compulsive Disorder) is basically comprised of two aspects: obsession and compulsion. Although some people have obsessive thoughts without compulsive behavior, the two often go together. Until recently, OCD was classified as an anxiety disorder. Indeed obsessive thoughts are often caused by, and in turn cause, much anxiety in people who suffer from this disorder.
Since OCD is largely diagnosed based on a person’s thoughts, ascertaining whether someone in fact has OCD (or another disorder) should not be based simply on observable behavior. A few of the criteria for OCD are that the thoughts are intrusive and unwanted, that the person feels driven to the behavior, and that the actions are aimed at eliminating or reducing anxiety.
One person might simply feel very strongly about davening and tefillin, and wants to fulfill them on a higher level. If there is no anxiety related to this, and the person can easily abstain from the action if he wants to (as when he has a pressing appointment), this is likely fine. Another person can feel the need to do the very same action in the very same way to reduce anxiety based around his obsessive thoughts.
In order to get a sense of what the case is in your situation, you might want to speak with the bochur to find out whether his thoughts about davening and tefillin are appropriate, and whether his actions are based on anxiety and an attempt to reduce it, or based on a healthy deliberate decision to be careful about these particular mitzvos. If it becomes clear that he has a problem, you can try to help him to acknowledge that his thoughts and actions are hurtful to him. The earlier that he goes for help, the more likely that treatment will be relatively short and effective.
December 23, 2016
How do I deal with my husband’s first family?
Both I and my husband are married for the second time after losing our first spouses.
My kids, who are all married, accept my new husband with open arms.
Half of his children, on the other hand, who are married with children and grandchildren, reject his remarriage and stopped talking with us and prevent his grandchildren, even those few who are already married, from having contact with us.
Our rav tried to intervene but they refused to mitigate. Any thoughts on the matter?
Unfortunately, there are often conflicts when various close-knit groups, with their individual needs, insecurities and idiosyncrasies, are thrust into a new social situation. When a couple marries, it is difficult for those two people to adjust to one another’s personality; it is all the more difficult for entire families to adjust to a changing dynamic.
I obviously cannot offer specific advice without having significantly more information. I don’t know why your husband’s children reject your marriage and are not speaking with you. They may have realistic concerns, or they may feel threatened in some way. Although you might feel entirely justified in your perspective, your husband’s children probably do as well. As long as each side continues to focus only on the sense that they are in the right, the other side will tend to do the same. This will continue to polarize the two sides, making it continually more difficult to repair fractured relationships.
There is likely little to nothing that you can do to directly change their viewpoint. You can only work on changing your side of the issue. One way to begin defusing a contentious situation is to remove the righteousness, indignation and anger from your part of the equation. I imagine that your husband’s children recognize that your marriage will not dissolve simply because they are not happy with it. Their goal, therefore, is not to change the actual situation. Perhaps they simply want their father (and possibly you) to validate their fears and insecurities. For instance, if they’re afraid that you are trying to replace the memory of their mother, they may be looking for their father’s reassurance that this will not happen. If they’re concerned that they will become less important to their father, they may require similar validation of these feelings. If you can identify and address their emotions, you have a good chance of bringing the families closer.
December 16, 2016
My wife has always been afraid of flying. The last time she flew, around a year and a half ago, there was some turbulence mid-flight and she got hysterical and wasn't able to calm down until we landed (thankfully this was on the way home). We have a family bar mitzvah on the west coast at the end of the month and she is already very apprehensive about going. I have tried to talk with her about the safety of flying but that just gets her upset. I would appreciate any techniques or suggestions that you have to help make this easier.
With anxiety in general, and with phobias in particular, logically explaining why fears are not warranted is usually not very effective. Among the reasons for this is the fact that the person is most often well aware of the fact that her anxiety is not logical, and she has likely tried telling herself many times exactly what you’re trying to tell her. Despite this, the anxiety persists.
Although we all feel certain levels of stress, anxiety by definition is emotional. Think of this in terms of levels of stress vs. anxiety. On a scale from 1-100 (where 1 represents no stress/anxiety and 100 reflects the highest possible level of stress/anxiety), if a particular stressor shouldlogically rate a 20, but your stress level is 60, your “effective anxiety” is 40—the difference between the “normal” stress level and your actual stress level. This means that two thirds of the stress is emotional. This anxiety will not respond to logical reasoning because it is not logical.
There are various techniques that can help your wife to reduce her fear, including identification of the original source of the fear and its subsequent reinforcement. A simpler strategy is to help your wife to focus on the emotional aspect of her fear. This means abandoning your instinct to explain why there’s nothing to be afraid of; focus instead on what she is afraid of. For instance, allow her to recognize her fear that the plane will take a downward plunge, causing it to break apart, leading to a crash, etc. This will allow her to begin to correct her emotional assumptions with facts, like the existence of air pockets, the expertise of aviation engineers, and the miniscule possibility of a crash. If she can acknowledge her specific fears (despite their illogic) and begin to challenge them intellectually, this can help to decrease her fear.
December 9, 2016
I am a regular frum girl, 15 and in high school. My parents never got along well and recently told us kids that they are getting divorced? Is my life finished? Will everyone look at me with pity? Will I be able to do a good shidduch? Does the fact that my parents divorced make it more likely that I might get divorced? Any information or chizuk that you can give me is appreciated.
Please remember that you’re a person, not a statistic. No person or situation has the power to affect your life more than you do. At age 15, you are still learning to experience your own independence and autonomy. It may still seem as if the people and circumstances in your life can shape your future far more than you can. Optimally, as you grow older you will recognize more of your individuality, and learn to increasingly view yourself as the master of your own destiny.
The fact that your parents never got along doesn’t mean that you will have the same experience. Your parents’ decision to get divorced does not resign you to a life of misery. People who know you might feel sorry for you, but they will likely view you based on who you are as a person rather than as a child of divorce. Remember that you are a person, not just to yourself but to others as well. Your friends and acquaintances should see you for who you are, not as a consequence of a particular circumstance.
Though we are usually very good at judging others, it can be very difficult for us to see ourselves from a realistic perspective. It might be easier to look at this from an objective viewpoint. Imagine a friend going through the same situation. How would you view her? Would you feel that her life was finished? Would you look at her with pity? Would you assume that she would be unable to get a good shidduch? Would you assume that her parents’ divorce would cause her to get divorced herself?
If your responses are more positive with regard to your friend than toward yourself, recognize that this is likely how others will see you as well. Regardless of your responses, remember that your value lies within yourself, not in others’ perceptions of you. Anyone who might refuse to see your value is not worthy of you.
December 2, 2016
My son's Menahel called us in for a meeting. He said that while our 7th grade son is smart and has friends, he acts chutzpadig and doesn't listen to authority. The menahel said that he thinks our son has ODD and gave us the number to a (costly) therapist. Do we really need a therapist for.this? Isn't this a regular kid who misbehaves that for generations parents and schools found some way to deal with. Must everything become a label and a diagnosis?
Without knowing the details of your son’s behavior in school, it’s difficult to determine the necessity of bringing in a therapist. Very often a child’s behavior at home does not reflect his behavior in school. Some kids are models of good behavior at home, while in school they act out (or vice-versa). This can be due to various factors, like respect for parents, fear of being punished at home, or some issue in school.
Regardless, in his capacity as your son’s principal, the menahel should not be suggesting diagnoses. If he has a problem with your son’s behavior, that is what he should be discussing—the behavior, not his theoretical diagnosis. As to his recommendation of the costly therapist, this may be due to his experience with this therapist’s results.
My suggestion is to have another meeting with the menahel once you have prepared the questions that you feel are important to have answered. Some of these questions might be: “When did the chutzpadig behavior begin?” “Is there a specific time of day or week that my son exhibits inappropriate behavior?” “Is there a particular member of the faculty to whom this behavior is addressed, or is it more general?” “Is there a common factor associated with the behavior, like being among a specific group or being in a particular situation?” “What are the specific types of problematic behavior?” “What steps has the school taken to address the problem, and what have the results been?” “What made you recommend this particular therapist?”
Assuming that the menahel is able to properly answer these questions, you should then have a much better understanding of the situation, and some of the issues that you raised might be resolved. You would then be able to make a more informed decision as to whether more can be done in school or at home, or whether a therapist is a good idea. If you do decide to have your son see a therapist, there are referral agencies, like Relief Resources, that can help you to decide which therapist would be right for him.
November 25, 2016
I am in my 30s married with kids and work part time. Since before my marriage (about 15 years ago) I have always been somewhat moody, but I not exactly sure why. At times I just want to go under the covers and don't want to have anything to do with anyone. Other times I am full of energy. Winters are particularly hard. A friend said that I might have bipolar disorder, but I am doing ok as a wife and as a mother and holding down a job. My life is not falling apart. Do I need to see a professional?
No professional should diagnose or rule out a diagnosis sight unseen. There are many factors that go into a diagnosis and treatment plan. Also the process of diagnosis and treatment is generally not a linear one. Rather, it often follows an indirect path depending on the person’s background and the information being offered.
You speak of having been “moody” for many years. You also mention that there are times that you feel depressed and other times during which you energetic. Without further information, it’s difficult to get a full understanding of the issues that you face. That being said, I will make a couple of assumptions and base my response on those.
It sounds as if you are describing your moodiness as intermittent feelings of depression. I will assume that your reference to moodiness is simply that. When you say that there are times that you are full of energy, I will assume that you are describing energy as simply a lack of depressed feeling, rather than manic (or over-the-top) feelings of euphoria, hyperactivity, and impulsivity. In other words, there are times that you feel depressed and times that you don’t.
Based on these assumptions, it doesn’t sound like Bipolar Disorder, though of course even notwithstanding these assumptions there may be other factors that will not be addressed in this response. One diagnosis that I would consider is Pervasive Depressive Disorder (previously called “Dysthymic Disorder”), which is essentially general depression. Your mention of increased symptoms in the wintertime would have me consider Seasonal Affective Disorder, which causes depression during a particular season. This occurs most commonly in the winter. In fact, SAD has been called “winter depression.”
No one should have to live with constant feelings of depression. There are various clinical approaches that can help alleviate depressive symptoms. It sounds as if you could benefit from psychotherapy to address your symptoms and their causes. A good therapist could help you to better deal with and reduce your feelings of depression.
November 18, 2016
What is the balance between getting what you want, sometimes being pushy.., and letting go? Example, I called doctor to get an appointment for one of my children, they were overbooked and only let him come for culture. The culture was negative and my son was complaining about his ears... so I was a little pushy, and the nurse did let me into a room. Now I am not sure that my son saw a good example... luckily, the nurse came to tell me, “'it's good you were pushy, that’s how you get things in life. Other mothers give up too fast, you were pushy so you got what you needed.” I used to be weaker, but have learned that I am the only one who can take charge of my life... just don’t know when I may 'try my luck' to get what I want and when to give up. Are there any general guidelines by which I can gauge if I’m pushing the boundaries too far?
There can be a fine line between being a pushover and being too abrasive. Unfortunately, in our society, not being assertive is often viewed as a sign of weakness, while being assertive can be seen as aggressive or antagonistic. Unfortunately, there is also something of a double standard with regard to gender, where a man is more often viewed positively when asserting himself while a woman may be perceived as strident and annoying. (As an example, compare many people’s response to Hillary Clinton’s assertiveness and their response to Donald Trump’s. Though Trump may be considered brash and aggressive, Clinton is often seen as shrill and irritating.)
It’s important not to allow yourself to be led by your emotions or insecurities. If you’re afraid of how you might be perceived by the people around you, it can be difficult to properly assess the situation and come to an appropriate decision. Similarly, if you have an unsubstantiated fear of being taken advantage of, this can lead you to act against what your logic would dictate.
On the other hand, if you can step back and view each situation based on logical thought, you will likely gain clarity on the proper course of action. First, it’s important to identify any emotions or insecurities that might be getting in the way of your decision. Once you have a clear sense of how these are impacting on your view of the circumstances, it will be easier to view the situation from a more objective standpoint. Once you’ve done this, you will likely find that you are less uncertain of yourself and of your decision.
November 11, 2016
I am working on myself to rid myself of childhood trauma that has affected my behavior. I am aware of triggers, and that certain reactions are not healthy or acceptable. I would like some guidance on how to change bad habits that have become ingrained in my personality. While I’m aware that they can be unhealthy, some behaviors have become so much a part of me that I don’t know another way to behave.
There are numerous forms of therapy that can help in changing unhealthy and unwanted behavior. Some emphasize the behaviors themselves, others focus on the thought processes leading to the behaviors, and yet others try to identify underlying emotional issues and triggers.Though individual needs and responses vary, the best results are often achieved when a combination of approaches are used.
You appear to have good insight into both your problematic behaviors and their causes. This is an essential first step in working on changing behaviors, thoughts, and emotions.
A typical process often involves a trigger (i.e., someone glaring at you) causing an emotion (i.e., anger), leading to a thought (i.e., “I need to defend myself”), ending in an action (i.e., yelling at the offender). In many instances, we are consciously unaware of one or more of these steps.For instance, someone might find himself yelling without knowing the reason.Sometimes, other “reasonable” explanations are identified, like the person convincing himself that he was yelling to teach the other person to be more respectful.Though you seem to be aware of your triggers and actions, it might be helpful to identify any emotions and thoughts that exist.
Once problematic thoughts are acknowledged, you can begin challenging inaccurate thoughts and beliefs. You can work on dispelling myths that tell you that your thoughts—and possibly therefore your actions—are appropriate.In a similar vein, once you identify specific emotions you can ask yourself if these feelings accurately reflect the situation or if they might be related to other issues or past situations.
With regard to direct behavior modification, it can be helpful to isolate related factors like when and where each behavior occurs (and when and where it specifically does not occur), and detailed, specific mechanics of the behavior (what you do and how you do it).Once you have a better recognition of these related factors, you will likely be more alert to problematic behaviors, and be better able to change behaviors as they begin.
Often, the sources of our triggers are deeply embedded in childhood experiences and insecurities. Allowing yourself to recognize early instances of an emotion can help you to put the emotion into perspective.For instance, you might recall that you used to feel angry when teachers glared at you, reminding you that this made you feel hurt and worthless.This could help you to recognize these same emotions in the current situation, allowing you to focus on the differences between childhood and current experiences.In addition to helping change behavior, this can also help to reduce the power of the trigger.
November 4, 2016
My daughter is 6 1/2. Last year the school brought to our attention that she is displaying possible signs of ADD and they recommended an evaluation. Our pediatrician suggested that since preferred reputable specialists don’t take my insurance, and it’s a very costly evaluation, and being that my daughter is still very young, we can wait until after first grade when we’ll have more information on which to evaluate her. Additionally, he said it is not recommended to start medication at this young age.
However, I am concerned that if she needs help why not be proactive and get her the help now. She has a very healthy self-esteem and I don't want she should lose it if she does poorly in her school work.
When is the right time to evaluate for ADD?
Is there a benefit of having a diagnosis if I won't be medicating her until we have exhausted all other options?
What’s the benefit of having a diagnosis if I won't be medicating her until we have exhausted all other options?
Who would be suggesting other options, the doctor or do I have to search for them myself?
There are a number of questions that should be addressed. Which member of the school’s faculty contacted you?Was that person reporting first-hand information, or was he simply relaying information obtained from another source?What are the “possible signs of ADD” that concern him?Do you observe similar signs at home?Is your pediatrician very familiar with mental health issues and local specialists, or is he only assuming that there are no competent practitioners who accept your insurance?Is he qualified to determine the appropriateness of ADHD medication?
There can be various reasons for many of the symptoms associated with ADHD. For example, symptoms like trouble focusing and distraction in school can be due to ADHD, or they can be indicative of high intelligence, which can cause the child to be easily bored.Kids who grasp concepts more quickly than others often lose interest when the lesson becomes repetitive for them.Regardless, it’s important to identify the problem, rather than focusing on a label, like ADHD.
It’s important for you to meet with the people who interact with your daughter on a daily basis to get a clear sense of their specific concerns. Once you understand the potential problem, possible causes can be discussed.If you determine that a professional should be consulted, an ADHD specialist can help identify causes and possible corrective action.There are some very good specialists who accept insurance.A mental health referral agency like Relief can help to guide you in choosing the right professional for your daughter.A proper evaluation should give you a sense as to whether there is a clinical cause for concern or, if not, what corrective action can be considered.Depending on the issues and causes, solutions can range from medication to therapy to classroom modifications or accommodations.
Once alerted to a possible diagnosis, parents sometimes become overly vigilant in identifying behaviors and assigning labels to them. Although your daughter may have problematic symptoms, be careful not to attribute typical behaviors (like normal disinterest in homework or the occasional careless mistake) to a disorder.
Remember to focus on the problem—not the label—in order to ascertain whether it requires intervention, and if so which specific intervention is appropriate.
October 16, 2016
My wife and I are married for five years. My wife is the youngest in her family and often her mother gives her opinions or makes requests that she feels that she can't decline. She is also very often the person who has to take care of family events. She would like to stand up for herself and be able to decline, how she can do that in a way that won’t offend. I also feel that, while I respect my mother in law, she sometimes oversteps her place, in areas where I feel that I should be the one to make decisions.
In families, individual roles are tend to be defined in childhood and continuously reinforced as the family matures and changes. Roles can include the responsible child, the scapegoat, the rebel, etc.These roles are generally shaped based on the perceived needs within the family.This perception can be that of the child, or one created by multiple family members or by the family as a whole.
When a role becomes too rigid, this is often due to a variety of factors, which usually reinforce the child’s needs. Examples of these needs include the alleviation of guilt, a sense of responsibility to keep the family from becoming chaotic, and building a sense of self around the role.Even once the original family members are married with their own families, these roles often persist.Depending on many factors, including the original needs, personal development, and roles within the current family, roles can be reinforced to the point that they seem unchangeable.
If we do not identify the causes and development of our roles, we tend to assume that they are the result of current issues, family obligations, or legitimate needs. These often erroneous beliefs can be continuously supported by original and/or current family members.If we don’t recognize these needs and unhealthy relationships, we tend to assume that our roles are a part of our personalities or simply ingrained habits.It is only once we acknowledge possible underlying needs that we can begin separating appropriate actions and beliefs from those rooted in childhood insecurities.
I don’t know what your wife’s role was as a child (responsible; scapegoat; easygoing) or if that role has continued or evolved. Your wife can ask herself if her mother is generally demanding and overbearing, or if she acts this way only with her.If their relationship issues are related to old, unhealthy family roles, understanding the original needs and the development of her role can be very helpful to your wife in beginning to change her childhood beliefs.
I imagine that logistically your wife can figure out how to respond to her mother—it seems that her siblings are able to effectively decline their mother’s requests. If there are underlying needs, resolving them will make it easier for your wife to appropriately deal with her relationship with her mother.Either way, it is important for your wife and you to work on a concerted strategy to begin changing the relationship and roles.Though there may be fear of resentment and anger, doing so in a considerate yet firm manner can lead to a healthier, mutually respectful relationship.
October 2, 2016
I have a teenage son who I noticed was acting out of sorts. I attributed it to be a “stage” and did not make anything of it. A few weeks ago, I got a call from my son’s menahel telling me that my son was involved in some things that required help from an outside source. They would provide the “professional” and make sure my son was taken care of with the best care. I felt that cooperating with the yeshiva was the best route to take and I adhered to all the measures that were to be taken. Among them were paying for the “professional” and not informing my son that I was aware of his circumstances. It has been a few weeks now and I am keeping up my end of the deal. I pay for each session and my son has no idea that I know about the situation. However, when I ask about the progress of my son and for some details on new developments, I am told “it’s handled” or “under control.” This is my son. Until when do I cooperate and not fight for information? Until when do I sit back and allow my son’s life the good and the bad, accomplishments and failures be “handled” by his yeshiva and not by me; his father? Please give me some insight on how to continue on with this situation. Thank you.
There appear to be two issues here: confidentiality vs. parental involvement; and school policy vs. parental involvement. There are legal, ethical, and relationship concerns that play into both of these issues. My understanding is that generally minors do not have the right of confidentiality. That being said, ethics often dictate that a therapist withhold information from parents in order to foster trust, independence, responsibility, and other qualities. When a school is involved, they may have reasons of their own to handle certain issues within school guidelines.
Without knowing the school’s position, I wonder whether they discussed their reasoning with you as to why they would prefer to handle the situation on their own. Sometimes this can be a school’s way of maintaining control; other times they have concerns about how a particular parent generally deals with problematic situations or how the parent responded to the current issue. If your son’s menahel has not been forthcoming with regard to the reasons for his reticence, the first step might be to discuss this with him. If his temperament, your relationship with him, or some other factor precludes this, you should consider involving a third party like a rav or another professional.
That being said, it’s important not to allow your emotions or your ego to be involved in any part of your decision. If your son is doing well, and his acting out continues to improve (and your only concern is that you are being wronged), you need to remind yourself that your only concern should be the welfare of your child—especially if your involvement might hamper the process. On the other hand, if you are not seeing positive results and you have a legitimate concern about the efficacy of the current treatment, there should be a dialogue about how best to approach the situation. In this regard as well, be sure to separate any emotional or ego concerns from your decision and from your response, keeping constant focus on the goal: your son’s ultimate welfare.
September 23, 2016
My 18 year old daughter has been having issues with frumkeit, and seems to be moving in the wrong direction. She has had trouble with anxiety and trust issues in the past and seems generally unhappy. My other kids are being affected by her constant anger and comments. My husband and I find ourselves constantly arguing over the proper way to handle the situation, and we feel that there’s no one to whom we can turn for help. How can we properly deal with this as a couple and as a family? How can my husband and I help my daughter deal with all of her issues while respecting her choices even if we don't agree with them?
Very often, a significant portion of a parent’s emotional reaction to a child’s behavior is due to the parent’s sense that she must have done something wrong, or that she is being judged by others as based on her child’s actions. It’s important to recognize that your situation is not at all unusual. Though it’s easy to feel that you’re alone in this and that everyone else seems to have kids, families, and lives without major issues, this is in no way true.
When we have strong feelings about something important to us, we often get the sense that we would clearly see such strong emotion in others if they were going through something similar. Therefore, if we don’t see these emotions, we assume that all is well with others, and that we’re the only ones dealing with these kinds of issues. Even when we intellectually recognize that someone else has a particular problem with one of their kids, since we don’t see or feel their pain—and we don’t judge them—our level of emotion with regard to the problem is significantly minimized. We can therefore see the issue much more clearly.
If your husband has considerable insecurities related to the situation and you don’t, or vice-versa, or you each have different insecurities (i.e., one of you wants to be seen as open-minded and the other wants to be seen as perfect), this can lead to substantial differences in your responses. This could also lead to one or both of you feeling that the other is uncaring or unsupportive. In addition, when parents are in constant disagreement about something so important, the children pick up on this (even when the parents believe that they are being surreptitious about it). Often, the negative impact on the family and children is caused or exacerbated by the parents’ reactions rather than those of a particular child.
Sometimes I will ask a client to imagine a close friend confiding in them about the exact same predicament that they are experiencing, and to imagine their own response to their friend. The result is often that they much more clearly identify an appropriate response, and sometimes are quite adamant about it. When this occurs, they can more easily separate their situational concerns from their own insecurities, and focus on the former. Your husband and you can try doing this together in order to isolate the actual problem and to appropriately deal with it. No one knows your daughter better than you do. Once you’re able to focus on the issues with less emotional interference, you might find that you know exactly what to say and do in order to help your daughter.
If your daughter feels that her role in the family (and perhaps in the community and in life) is being defined by her family’s sense that she is a rebel or a maverick, she can easily accept that label and allow it to become a large part of her sense of self. If your husband and you are on the same page, it’s likely that your daughter’s actions within the family will moderate, and you might find her being less obviously angry.
If she feels that your husband and you are reacting from a logical place without emotional judgement, your daughter’s anxiety and trust issues can also improve. That being said, there may be a deeper source for her issues with trust and anxiety. If you believe that this may be the case, it would be a good idea to broach with her the subject of seeking professional help, bearing in mind her level of sensitivity to her sense that she is being judged as problematic.
With regard to your daughter’s issues with frumkeit, there are many rabbonim who have experience in these matters, and who can help you to handle the situation with sensitivity so that neither your daughter nor you feel like you’re being judged.
September 16, 2016
This past summer I had an anxiety attack. It came as a surprise because last year I was depressed but at the beginning of the summer I made it my business to get out of the rut. And since then I’ve been very busy going to classes and having a very small business which allows me to express myself. I’ve been in therapy for about a year now and I really feel like I’m on the road to recovery, being emotionally aware and stable. How and why is it that at this point I suffered from an anxiety attack. I’ve had four since the summer. Maybe I need a different form of therapy. How can I know when and if it’s time to change tactics or therapists? I can’t go on like this, I feel like it’s holding me back and inhibiting me tremendously.
I’m not sure what you mean when you refer to an anxiety attack. Although this is a commonly used term, there are many different forms of anxiety and levels of severity. A “panic attack” is a sense of terror, along with a physical reaction, which leads to yet higher anxiety. Physical symptoms can include profuse sweating, weakness, dizziness, tingling, numbness, heart palpitations, fear of having a heart attack, and subsequent fear of another panic attack. Panic attacks can be frightening in the extreme. If you are having panic attacks, a therapist can help, but you will likely want to see a psychiatrist who can prescribe something to alleviate the symptoms until you learn to decrease the frequency and severity. Educating yourself about panic attacks can help to decrease the fear associated with the attacks.
Often, however, when people speak of anxiety attacks, they simply mean that they have a constant level of anxiety that began at a particular point, or that they experience waves of anxiety. These can range from a general feeling of concern to many specific fears, and can fluctuate or remain at one basic level of severity. It sounds like you may be having waves of recurring anxiety without a specific identifiable cause or fear.
One thing to bear in mind is that the very lack of an identifiable fear often exacerbates the anxiety. This may be part of what is causing your anxiety. Learning to acknowledge possible underlying fears—even if they make no logical sense—can help to change this dynamic.
There are a number of forms of therapy that can help to address this form of anxiety. An eclectic therapist is capable of utilizing various therapy modalities either individually or concurrently to achieve the maximum benefit. If your therapist mostly uses only one modality (i.e. cognitive therapy or psychoanalysis), and you are no longer seeing gains, this should be discussed with the therapist in order to ascertain whether she can continue to help you with the particular issue that you’re experiencing.
Sometimes, the therapist-client relationship becomes stagnant and, if not addressed, the therapy process can get stuck in a continuous loop. This can be due to many factors. If this issue is addressed, an honest and competent therapist can help you to decide whether she is the proper professional to help you achieve your goals.
Yehuda LiebermanLCSW-R, QCSW, DCSW1438 East 26th Street 1011 Nameoke St
Brooklyn, NY 11210 Far Rockaway, NY 11691 Entrance on Cornaga Ave