O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

Archives for March 2013

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Amour: Keeping Marriage Strong After a Stroke

How Marriage Can Survive Health Problems

The French film Amour is a touching, realistic window into the world of a committed marriage in which one partner has suffered a stroke.

The elderly couple are music lovers, their apartment chock-full of music books, records, and CDs, plus a concert-size grand piano. Yet the film has no musical score, just the mundane sounds of everyday life. The couple’s need to cope with change is so profound that the music of life fades, replaced by the clinking of forks against plates, sweeping away crumbs from the kitchen table, or shower noise as a caregiver washes Ann’s back. The story gently unfolds, depicting the couple’s commitment and love as the outside world shrinks, startlingly magnifying their life lived in three rooms. There is no shaking of fists at their plight, no angry outbursts from either partner.

How Stroke Affects Marriage

When giving talks on how stroke affects marriage, I say, “When one partner has a stroke, both partners have a stroke.” The stroke survivor grapples with loss of bodily function, speech, and often dignity, and the caregiving spouse must come to terms with the magnitude of the change in their lives.

A stroke can alter two people’s lives in an instant. For the person with the stroke, simple tasks suddenly become difficult or impossible. For the person’s partner, life revolves around the stroke survivor’s needs, requiring many adjustments.

And while stroke (like any chronic medical problem) affects marriage, it can also open a gate to improving communication and building and strengthening skills that were taken for granted.

Empathy on both sides is needed for the marriage to survive. Learning new ways to communicate fondness and appreciation serve as protective factors. Building new rituals of connection and remembering the positive aspects of your marriage before the stroke are necessary to keep your relationship healthy.

Coming to Terms with Suffering

While stroke can create strain, frustration, and distance in your marriage, coping with its effects is an opportunity to reset your priorities and goals. You may be able to strengthen your marriage as you and your spouse work together on common problems you will face. It is by accepting the limitations that life imposes on us that we can overcome them. As we learn to carry our burdens well—in the yielding and in the striving—we become whole.

Viktor Frankl was a psychiatrist who survived the Holocaust; his parents, brother, and pregnant wife did not. In his remarkable memoir, Man’s Search for Meaning, he discusses how people face unavoidable burdens. Why did some crumple beneath the horrors of the death camps, while some comforted others and gave away bread?

“When a man finds that it is his destiny to suffer, he will have to accept his suffering as his task; his single and unique task. He will have to acknowledge the fact that even in suffering he is unique and alone in the universe. No one can relieve him of his suffering or suffer in his place. His unique opportunity lies in the way he bears his burden. . . . The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified, and unselfish. Or in the bitter fight for self-preservation, he may forget his human dignity.”

I do not mean to minimize the great accommodations that must be made in marriage when a stroke occurs. But there is a phenomenon seen in marriage counseling that often predicts good prognosis; therapists term it “glorifying the struggle.” This describes a couple that comes to therapy with a crisis, but they can talk about how they see the struggles that they have gone through as ways to grow and that they can grow together. The likelihood of that couple being able to keep their marriage whole and strong is better than when there is bitterness and resentment toward their marriage struggles.

Of course, sometimes caregivers can’t look after a stroke survivor at home. In Amour, the husband was the caregiver until he could no longer tolerate bearing her pain for her. In the United States, if a caregiver is no longer available and/or funds have run out, the best option is a skilled nursing facility (or SNF in the medical jargon). But in many families, life must go on: living together, but with tremendous challenges for both partners.

Ways to Cope When Stroke Strikes

Here are some issues to consider in coping with the aftermath of a stroke.

1. Spousal support: This is a powerful aid to stroke recovery for several reasons, including a spouse’s ability to improve the stroke survivor’s mood and increase physical and social activity levels.

2. Role changes and division of labor: Most couples must change their usual division of labor. Tasks and duties that were previously performed by one spouse may need to be reassigned. Outside help should be considered when possible.

3. Emotional support: High levels of emotional support lead to the best possible recovery after a stroke, and support is most effective when it is seen by the stroke survivor as meeting his or her particular emotional needs. Empathy—your ability to see things from the other person’s perspective—is important for both partners. Even a stroke survivor with speech problems (aphasia) can still listen. To truly listen is a great gift, even when your replies are non-verbal.
4. Counseling and group support: Both partners can benefit. There are many great agencies that offer classes following a stroke, and ongoing groups to help maximize coping.

In the best of circumstances, marriage is challenging. When couples face chronic medical problems such as stroke, the marriage vows -in sickness and in health are tested to the limit. Compassion by both partners for each other, as so tenderly shown in the film Amour, is imperative to preserving love.

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10 Things Parents can do to Help Their Kids Engage in School

 

Helping your child in school
Monday can’t come fast enough!

My daughter posted this photo and comment on her Facebook page after purchasing her textbooks for winter term. She is a full-time senior at a university and works part-time at an independent bookstore. Yet she can’t get enough of reading and learning. Her twin is equally passionate about learning. After seeing my daughter’s Facebook post, I reflected on what we did to encourage and support their love of learning.

We survived the homework battles and our daughters are now months away from finishing their undergraduate degrees. It wasn’t always easy. We didn’t have many of the challenges that some families face, like those with ADHD, depression, anxiety, or medical problems, but over the years we found ways to support them in school.

In his February 15 New York Times editorial, David Brooks commented on President Obama’s agenda for getting kids better prepared to start school by providing early educational opportunities before kindergarten. Brooks wrote:

Today millions of American children grow up in homes where they don’t learn the skills they need to succeed in life. Their vocabularies are tiny. They can’t regulate their emotions. When they get to kindergarten they’ve never been read a book, so they don’t know the difference between the front cover and the back cover. . . . This is rude to say, but here’s what this is about: Millions of parents don’t have the means, the skill or, in some cases, the interest in building their children’s future. Early childhood education is about building structures so both parents and children learn practical life skills. It’s about getting kids from disorganized homes into rooms with kids from organized homes so good habits will rub off. It’s about instilling achievement values where they are absent.

The Importance of Reading

These are lofty goals in a world where there is much inequity in income, lifestyle, and education. Raising kids is challenging in the best of circumstances; just getting dinner on the table after work can be exhausting. But even families from affluent homes struggle to find time for family when screen time takes over or heavy work schedules make direct parental attention scarce.
A good story is captivating even to unpracticed readers. A friend of mine volunteers at a juvenile hall a couple of times a week, reading books for incarcerated teens. Many of these kids have never been read to. She tells me that in the five years she has done this, no kid has complained. Many are there for weeks at a time and so they hear bits of the stories and look forward to the reading even without the benefit of continuity of the story.
David Brooks is saying something important: raising kids who possess the necessary skills to find jobs or go to college requires not only affordable educational opportunities but family involvement as well.

What can you do to help your child in school?

1. Read to them every night. Start when they are very young, and continue until they ask to read out loud to you. They will stumble over words, one page taking a long time to finish, but stick with it and try not to show impatience. (In the long run, it’s a lesson in more than just reading.)

2. Talk about what you read. Discuss what the characters might have been feeling or doing.Reflect on the stories together.

3. Continue reading as a family; take turns reading aloud to each other. There are many young-adult (YA) books that are great for adults—look at the worldwide popularity of Harry Potter among readers of all ages. My daughter’s bookshop holds an adult book group that meets monthly just to read YA titles.

4. Download books or borrow the audio CDs from the library and listen to them on car rides and in place of video games, movies, or TV.
5. Make a place for study and homework (this could be just the kitchen table) that is a dedicated quiet area: TVs and smartphones off.

6. Limit and monitor all screen time, including texting, gaming, and Facebook. Screens can consume inordinate amounts of time for all family members, but just as in marriage, turning away from preoccupations and toward your child in little and big ways every day will help them feel loved.

7. Make a family plan about how much is okay and stick to it—adults, too. Some families do well by limiting TV/screen time to one hour a night once all schoolwork is complete, but not too close to bedtime. Save the hour before bed for quiet time—reading or listening to books—or talking about the day together.

8. Keep growing and learning through hobbies, reading, classes, or learning to play music. Follow your own passions and your child will see that learning throughout the lifespan is valued.

9. Never let your kid have a TV in their bedroom. This will surely lead to nighttime TV, inappropriate shows, or staying up late—leading to trouble getting up for school the next day.

10. Eat together several times a week. Having dinner conversations that are not forced or stiff is a skill. Don’t just talk to your kids but to your partner as well.

We weren’t always perfect but we tried to follow these guidelines, and now we are enjoying our daughters as they graduate from college—entering the next chapter in their lives. 

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Mindfulness in Everyday Life: Letting Everything Become Your Teacher

Mindfulness in Everyday LifeSometimes we can’t ignore external signals to be mindful. My puppy is a reminder. When I am absorbed in a task, usually at the kitchen table on my laptop, she will quietly move into position next to the chair and nudge my leg with a toy. If I ignore her attempts to get my attention in this gentle way, she will increase her efforts by pressing the toy into my leg more forcefully. If that doesn’t work, whimpering will. Recognizing the need for a break, I take the stuffed toy outside so she can chase it. I am reminded that life exists beyond the computer screen. Sometimes it takes a puppy to nudge us toward mindfulness.

In Peace Is Every Step: The Path of Mindfulness in Everyday Life, Buddhist monk Thich Nhat Hanh writes: “In my tradition, we use the temple bells to remind us to come back to the present moment. Every time we hear the bell, we stop talking, stop our thinking, and return to ourselves, breathing in and out, and smiling. Whatever we are doing, we pause for a moment and just enjoy our breathing.”

In mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) we practice both formal and informal meditation. Formal practice is sitting and lying-down meditation, or a guided body scan. In these practices, the focus is on the breath, or—in the body scan—the area of the body we are focusing on in a guided meditation. When our mind wanders, we bring it back to the breath without judgment, doing this over and over again for the duration of the meditation. Minds will wander off the focus of the breath a million times, but the instruction is to bring the mind back to the breath a million times.

Practicing Mindfulness

Informal practice means performing a routine activity mindfully. By being fully present in a mundane activity that we often do thoughtlessly, we change the experience. Eating a meal mindfully, without watching TV or reading—noticing the food, sensing the texture, the flavor, the smell, the colors, and really tasting the food—is one informal meditation practice. Usually, we eat with numerous distractions and wolf down food so that before we know it, we are done eating and don’t remember having tasted our food or even having eaten.

Practice doing any routine activity mindfully. Brushing teeth, folding laundry, washing the dishes, and getting dressed are all ways to practice mindfulness. We often use distraction when performing mundane activities to prevent boredom. Yet by bringing awareness to a puppy’s prompting or a child’s insistence on playing one more game of Chutes and Ladders, we find them surprisingly interesting. As Jon Kabat-Zinn says in Letting Everything Become Your Teacher: 100 Lessons in Mindfulness, “If you are cultivating mindfulness in your life, there is not one thing that you do or experience that cannot teach you about yourself by mirroring back to you the reflections of your own mind and body.” It is in the stillness of focus that we observe where our minds wander. Later, we use this information to know ourselves more deeply.

Bringing Awareness to Daily Life

When a child or a puppy interrupts you, you can use the opportunity to notice your thoughts and your breathing. Being attentive to what you are doing in the moment invites inner stillness and reflection. By bringing awareness to aspects of life that otherwise may slide by, it is possible to wake up from automatic pilot and connect more intentionally with the present. If you have been living life on automatic pilot, as most of us do, then taking these opportunities when they present themselves opens up experience. If you are fully aware of thoughts, feelings, and sensations in your body, you can change the experience; you have more choice, more freedom. And this can have a profound effect on feelings of depression and anxiety. In a recent MBCT group, several participants commented that being mindful allowed them to stay focused without judging when family tensions arose. Being able to experience difficult emotions knowing that they will pass brings equanimity in the face of challenges.  

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Sleep and Romantic Relationships: How a Good Night’s Sleep Keeps Relationships Romantic

 

Research conducted at the University of California, Berkeley, showed that poor sleep hurts relationships. “Poor sleep may make us more selfish as we prioritize our own needs over our partner’s,” according to Amie Gordon. Gordon concluded that when partners feel unappreciated, the hidden culprit is sometimes poor sleep.

Sleep is a Cornerstone of Mental Health

Sleep is the cornerstone of mental health. One of the most common symptoms of emotional distress is sleep disturbance. People with depression complain of early-morning awakening, fragmented sleep, and inability to get back to sleep once awakened. Anxious people frequently report difficulty getting to sleep due to worry, rumination, and replaying or anticipating the day. Having children is another culprit in poor sleep. Nightly feedings, diaper changing, and generalized worry keep new parents awake well into toddler-hood. Getting a good night’s sleep is important—anyone who has been through periods of insomnia can attest to that. But what was interesting about this study is that it demonstrates that a partner who is sleep deprived is less likely to express fondness and gratitude. As Gordon notes, “You may have slept like a baby, but if your partner didn’t, you’ll probably both end up grouchy.”

How Sleep can Affect Romance

When Jack and Anne came to my office recently, Jack had been through a particularly stressful experience with his father. His emotional distress increased tension in his neck and back, intensifying his chronic pain. The combination of physical and emotional tension cascaded over several days, resulting in a sleepless night. The next morning, when his partner made a gentle bid for contact by pointing out an interesting article in the newspaper, he snapped at her. Or as they more vividly described it, “It was somewhere between a growl and a scream.” The walls went up, and both partners retreated in silence.

When bids for contact are not acknowledged, or your partner turns against rather than turning toward your bid, it leads to accumulated tension, often turning to resentment. Over time, this resentment leads to distress-maintaining thoughts about your partner (such as “my husband is such a jerk”) become toxic to the relationship. We know from research on marriage that expressing fondness and admiration is important for the health of the relationship. Once Jack was able to identify that his grouchiness was due to his poor sleep, he could make a repair to Anne by saying, “I’ve been preoccupied lately with my father, and that made me lose sleep. I’m sorry I overreacted this morning.”

Poor sleep can lead to the chronic use of sleep aids. From over-the-counter Benadryl to prescription sleeping pills, these medications can help for short-term insomnia, but when someone is depressed or anxious for an extended period of time, nightly use of these medications changes sleep architecture, making deeper, restorative sleep scarce. If disturbed sleep lasts for months—or years, as it often does—the missed opportunities to express loving tender thoughts to your mate accrue, leaving both partners feeling deprived of affection.

Because sleep problems are a symptom of something else, such as depression, anxiety, sleep apnea, or chronic pain, it is important to understand the reasons behind poor sleep and address those directly. As sleep improves, grouchiness diminishes, making room for hugs and kisses.