Saturday, December 6, 2014

The need for attachment

Science is showing that the need for attachment begins even before birth. The in utero environment can impact a fetus's developing brain. After they enter the world, you attach to your baby by making eye contact, holding, cuddling, cooing, feeding and other ways of otherwise nurturing and letting your baby know you are there for them.

Once the "baby stage" ends, they enter toddlerhood. The often tumultuous, emotional time where children want to be both "big kids" and babies all at the same time. This can be frustrating for both parents and children, who do not understand the process that kids are going through developmentally. Watch the video below, which does a much better job than I can of demonstrating the attachment needs of toddlers:

As anyone who has survived the twos, threes and fours of early childhood, it is a no-brainer how challenging and tiring it can be at times for your child to need so much of your energy. It can be overwhelming some days, and not make sense on others. It can feel like a breath of fresh air for kids to become school-aged, and not need those frequent attention and check-ins. Or so it seems...

I have a nine year old daughter who plays hockey. Last weekend, at her hockey game, I had a light bulb moment where I was reminded that this need for safety and security does not end after toddlerhood. My daughter plays goalie- which is a really tough position to watch your child play, BTW- and I noticed that after someone scored on her, she would look up to the stands where we were sitting, needing to check in and make eye contact. I would give her some kind of sign to let her know "It's OK! Keep going!" and she would turn back to the game. I then observed her block a puck, and I was hoping she would look up to me with the excitement I knew she was feeling. But she didn't. I noticed this pattern throughout the game- check in if a goal went in, but stay focused on the game if it didn't. And it occurred to me that she was checking in, just like in the video, seeking reassurance ONLY when she was disappointed, worried, in need of reassurance. A sign of her secure attachment was not seeking out our connection when she was successful- likely because she knows we are proud of her.

As kids get older and become adults, they will continue to search for safety and security. The need to attach to loved ones, to find that secure base, never ends. It just changes.

Wednesday, October 1, 2014

Can I take it or not?

There've been a lot of articles in the media recently about whether it is safer not to take medication during pregnancy or while breast-feeding. It can be very confusing and scary to those reading to know what the "right" thing is to do. You may hear different information from your OB/GYN, your psychiatrist and the pharmacist. And then, when you finally do get the nerve to decide to take the medication, you read something different. I have had some clients who finally make a decision to try a medication, only to have it filled and be told by their pharmacist that they "can't" take that medication while nursing.

Taking medication is a very serious step. In some cases, medication may not be warranted. However, especially when there is severe depression, anxiety, bipolar, or psychosis, medication may not be a choice, but rather a necessary decision in order to be out of, or prevent, a crisis.

The good news is that there are credible resources that you can look to for information, so that you can make the most informed decision. The other good news is that it does not mean that you cannot breast-feed or that you will (for sure) cause damage to your baby by taking certain medications. The harder news is that information is not always black and white. There may be risk involved. There may be a time where you are not 100% sure, but it is clear that the benefits will outweigh the risks. Here are some resources where you can find research-based information:

http://www.mothertobaby.orga service of the non-profit Organization of Teratology Information Specialists, is dedicated to providing evidence-based information to mothers, health care professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding. (Copied from their website). This website has a ton of information, as well as toll-free numbers to call for more support.

http://www.infantrisk.comBy educating healthcare professionals and the general public alike, we aim to reduce the number of birth defects as well as create healthy breastfeeding relationships. This website provides great information, and also has forums online for questions. this website has a page for both parents and providers. It also has several various toll-free helplines not only about medications but also about things like morning sickness and substance abuse. I really really really like LactMed. However, the information (A medication database) can tend to be more scientific, so if that makes your brain feels like mush, then don't use this website. It does have an app that you can also download onto your smart phone or tablet, so that may come in handy.

The decision to take medication during pregnancy or while breast-feeding can be very daunting. Knowledge is power. If you must read other information aside from what your doctors provide to you, make sure that it is coming from a reputable source. All of the above, in my opinion, fit that bill.

Friday, August 29, 2014

What to expect when you start therapy

Making the decision to go to therapy can be intimidating for some, and downright scary for others. If you have never been to therapy, you may have no idea what to expect. And even if you have been to therapy, starting over with someone new... they may have a completely different style from other therapists.

You may be surprised to find that I, and many other therapists I know, take the first couple of sessions not just to get to know you, but to "get back to basics". Many people who struggle with anxiety, depression or any other mental health difficulties have let go of the things that we KNOW we should be doing, but lack the energy or motivation to do. Part of my job is to help get that back on track before diving into deeper emotional concerns, like trauma or emotions.

The top four:

Sleep:  Anxiety and depression can really impact your sleep. You may find that you can't sleep, or are waking up at 2-3 am and toss and turn until the sun comes up. You may find that all you want to DO is sleep, and struggle to get out of bed, or nap several times a day. Or you may find that staying up late is the answer to getting things done around the house, catching up on Breaking Bad episodes, or playing Words With Friends on the iPad.
Why this matters: Sleep deficiency can cause many issues- poor driving, poor decision making, difficulty losing weight, mental deficiencies... and just feeling tired and crabby. This makes you not only uncomfortable in your own skin, but usually not very fun to be around. It also means that you likely don't have energy for exercise, relationships, or hobbies (the other important self-care items).
What to do: Create a sleep schedule, committing to be in bed by a certain time, and that time should be relatively consistent. Cut out the use of screens before bed, and stop using caffeine after 2 pm in the afternoon. Consider meditation or deep breathing/relaxation to help ease you into sleep. If your pets or kids sleep with you, and this is interfering with sleep, consider a new plan.

Can't... stay... awake....

Exercise: Before you think I am sadistic, I refer you to a previous blog post where I talk about how much I HATE exercise. There. Now we are on the same team.
The reality is that many of us are not getting enough activity, whether that is because we are overtired, we work full time, the kids take too much of our time, etc. etc. etc. Or we just hate to exercise, and nothing sounds fun. Again, small amounts can make a big difference. Start with a ten minute walk around the block. Park your car farther away when you work or shop. Take the stairs. Play in the yard with your kids. You don't need to be able to afford exercise equipment or a gym membership in order to get exercise.
Depression, especially, takes away any motivation or interest in exercising. So you will have to make yourself do it. There is no simple answer, unfortunately... I'm sorry. However, you will likely feel better after you do something, and that I know is true.

Exercising with a friend is always more fun

Diet: Please don't hate me. When  I use the word "diet", I do not necessarily mean "going on a diet". Although sometimes that is the case, the healthier approach is making small changes in the daily ways that you eat, or don't eat. Drinking more water. Not skipping breakfast. Eating less carbs.
Depression and anxiety can make people crave carbs and junky foods. Then they have an energy crash which does not help anything. Or it can completely rob you of your appetite, leading you to skip meals and either lose weight or binge/make poor choices later in the day.
So again, start small. If you are skipping breakfast, have a hard boiled egg, a piece of fruit or a smoothie for breakfast. If you go several hours without eating, have healthy snacks available that you can reach for rather than something processed from the vending machine. Or keep a full water bottle nearby so that you remember to drink more water. Cut out one serving of caffeine, particularly if it is the afternoon. Focus more on how you feel rather than the number on the scale.
Nom nom nom....

Socializing/Hobbies: Finally, a big one. When you work full time, or are a new parent, or have young kids... friends and hobbies seem to be the first thing to go. Then, add a mental illness that can either sap you of any motivation to socialize, or cause you a lot of anxiety or panic attack to think of engaging in. Often, this are seems to take more time for me to get clients to buy into. They say, "Nobody wants to be around me right now" or "Everyone will think I'm stupid/fat/weird". "I don't have time/money/space to engage in my hobbies".
There are many approaches we can take in counseling to address these thoughts or low motivation, and also find some ways around any concerns to help you get reinvolved in your life. I promise, you will feel better when you do.
Again, start small. Think of something that used to bring you pleasure, and do it for 10 minutes. Go to the library and get a book. Go to an art museum. Grab your camera and go outside and take pictures. Call up a friend and commit to talking for a short period of time, or send an email to someone you haven't connected with recently but would really like to. Ask a co-worker to join you for lunch. As daunting as some of these things feel, you are in control of what you do and for how long.

This looks fun, right?

I share this information in the hopes that it will encourage you to reach out for help if you are struggling. Don't try to figure things out alone. Have a professional who is non-judgmental and is there to offer support and encouragement as you get back on your feet. Ultimately, when you are struggling with anxiety or depression (or any other of it's close friends), you feel very out of control. Self care is something that you do have control over, and small changes can add up. Pick one small thing to try, and start doing it.