Counselling & Psychotherapy

/Counselling & Psychotherapy

Couples Troubles

Many couples enjoy the change of pace that summer brings. Vacations, musical festivals, cottage getaways with family and lots of outdoor BBQs are occasions to enjoy life and create happy memories. But these can also be times when relationship troubles are camouflaged, then dealt with later.

Is this you? Sad but true, a time to away, meant to grow as a couple, can also be a time of deepening relationship distress. Couples Therapy is an effective way of overcoming a communications impasse.

A recent report on BBC.com states that people between the age of 16 and 44 are having less sex than ever before. Is there something about life today? Are there new ways to hide problems?

Some modern indications of unhealthy couples behaviors include:blog-fighting-loving

  • Excessive smartphone/tablet use/social sites
    • Often in the presence of their partners
  • Excessive organized family activities
    • E.g. not enough free time for individual interests
  • Excessive amounts of time viewing adult web sites (Pornography)

These are ways to fill time and maintain distance when unspoken issues lie beneath a superficial calm. Couples unconsciously collude to maintain the status quo of parallel lives – like railroad tracks going in the same direction but never intersecting.

The issues below are still the ones most often involved in couples’ communication breakdowns:

  • Money
  • Sex
  • Parenting
  • In-laws

These issues are caused and often complicated by values that you and your partner may not always share. Values are personal perceptions about the right way to live your life.  For example, you may believe that it’s better to enjoy life while you have the freedom and resources to do so. Your partner may argue that it’s more important to save money for a nest egg as the priority. Issues become more entrenched when they conceal emotional issues such as insecurities about money or phobias that lead to recurring impasses of communication.

Despite the summer distractions, if you and your partner are stuck in a communication breakdown, it is a good idea to consult a psychologist trained in couples therapy to help you accomplish your goals together.

 

Dr Eva Fisher is a registered psychologist trained in Ottawa, Canada with training in couples and family issues.

Headaches and Medically Unexplained Symptoms

Headaches and Pain

Dr. Eva Fisher D. Ed., C. Psych

It’s upsetting to go to your family doctor for help with headaches, or any pain, and to be told that there is no obvious cause or medical reason for them. You might consider seeing another doctor, only to hear similar conclusions.  Since the headache (or pain) feels real, why can’t doctors find a “real” cause or fix for it?

The fact is that psychological pain can feel just as real as physiological pain, only the cause cannot be found by standard medical testing such as X-ray/MRI or other imaging technologies. It can be additionally frustrating that in many cases, pain medications help little, if at all.

If you are  provided with a referral to a psychologist with training in psychotherapy for medically unexplained symptoms, you may have found new hope for a solution.

A new field of treatment, called Intensive Short Term Dynamic Psychotherapy, or ISTDP, is re-visiting the relationship between emotion suppression and pain. Psychiatrists working in this area have determined that psychological or emotional issues may indeed be implicated in symptoms of headaches, as well as back pain and digestive disorders.

If you or someone you know suffers from unexplained medical symptoms, it may be helpful to schedule an appointment with a psychologist with training in ISTDP.

Dr Eva Fisher is a clinical psychologist with ISTDP training, in private practice located at 436 Gilmour St., Ottawa, Ontario, Canada.

Post-traumatic Stress Disorder

Cory, a veteran police officer, draws his gun just as a bullet whizzes through his hair, grazing his scalp.

Emma, a bank employee freezes when a gunman holds her hostage for several hours in the safe room.

Anthony, a military officer in Afghanistan, runs through crossfire to retrieve the corpses of his buddies.

 

These images are all too familiar to TV audiences, but nothing can simulate a near-death experience like the ones described by Cory, Emma and Anthony.

They all suffer from Post Traumatic Stress Disorder.

Posttraumatic Stress Disorder (PTSD) occurs after someone is exposed to a life-threatening traumatic event. Commonly this happens after coming back from a war zone, but it can happen after any traumatic or life-threatening event.

Although many people experience very disturbing things in war or security situations, not everyone will develop PTSD. Both the Canadian Department of National Defence, and the United States Department of Veterans Affairs that 11 to 24 percent of veterans from the Iraq and Afghanistan wars have PTSD.

The prevalence of PTSD in the general population is about 7 to 8 per cent.

What are the signs?

Fight or flight is an instinctual human reaction in the face of extreme danger, when you have milliseconds to decide whether to run away to safety or to fight to defend yourself. After a traumatic event, this ”flight or fight” reaction in the body is damaged and the person freezes up when sensations, images, or feelings they had at that time recur in the here and now.

Physiological signs of fear, like rapid heartbeat and profuse sweating activate emotions of acute fear and strong normal responses to threatening situations often appear in PTSD sufferers in situations where there is no danger present.

PTSD usually develops within three months of the traumatic event, but can occur much later in life.

Flashbacks

Some of these symptoms are referred to as Re-experiencing symptoms. These include flashbacks of the event, which can bring extreme stress on not only the mind, but also the body in terms of sweating or a racing heart. Bad dreams and frightening thoughts are also typical. The traumas from the past become torturous again, in the present.

Avoiding Triggers

The next category is Avoidance symptoms. This is when the sufferer goes to extremes to avoid reminders of the traumatic event. This can cause people to change their clothing, hair, and even to quit their job to avoid things that trigger memories and to have deep feelings of shame or guilt.

Hyper-vigilance 

The last category of symptoms is called Hyper-arousal symptoms. This is when a PTSD sufferer becomes very easily stressed or fearful for their safety, such as checking that doors and windows are locked, feeling suspicious of parked cars, strangers and anything they used to consider benign.  This effect of being easily startled can also lead to angry outbursts, constant vigilance for possible signs of danger, and difficulty falling asleep or staying asleep. These symptoms make people more vulnerable to overuse of drugs and alcohol.

Consequences

Unfortunately there is still a stigma surrounding PTSD. Because it can be such a terrifying and disruptive mental state, sufferers can be labeled as “crazy,” “dangerous,” or “violent.” Other stigmas are general beliefs that since in today’s wars people chose to go to combat, in a sense they brought it on themselves.

Many PTSD sufferers reported that they avoided early treatment because they did not want to be considered to have a mental illness. However, PTSD can be cured through different forms of therapy.

Group treatment programs for PSTD are delivered over 6 to 12 weeks, while individual therapy is customized to each person’s needs.

What happened to them?

Cory was in psychotherapy for 11 months, and eventually retired from the force  to work as an investment advisor. He sometimes remembers the trauma, but can now deal with stressful feelings realistically.

Emma was off work for six months before she was able to step foot in the bank again.  With the help of a psychologist, she eventually felt strong enough to return to her job.

Anthony was released from the military after intensive individual and group psychotherapy.  He still has survivor guilt. He works part-time as a security guard.     

A psychologist can help you learn more about PTSD and its effects, deal with explosive anger, and help you become aware of the signs leading to a recurrence.

If you or someone you know is struggling with post traumatic stress it would be a good idea to schedule an appointment with a registered psychologist.

 


Patients in this story are a fictional composite of people who have sought help for this issue. Any resemblance to real persons, living or dead is purely coincidental.

Dr. Eva Fisher is an Ottawa psychologist who has been providing psychotherapy for a variety of issues for over 20 years. Follow her on Twitter @drevafisherFacebook or Instagram @dr_evafisher. Blog writing assisted by freelance journalist Alyssa McMurtry.

Written by Dr. Eva Fisher C Psych
All rights reserved. Copyright protected.
Photo Credits: www.flickr.com/photos/copsadmirer/5141029384 Oscar in
the middle
http://www.flickr.com/photos/alancleaver/4446487398 Alan
Cleaver

Gender Differences in the Therapy Room

Talking about gender differences is sure to result in strong opinions and feelings, and there are times when arguing about gender differences will even result in a call to a psychologist.

In the early days of living together, Nina and Andrew looked like poster children for New Millennium relationships. Theirs was a relationship of equals – both had professional degrees, earned high salaries and held jobs in upper management. They divided the housework chores equally; that is, until their new baby’s arrival disrupted their carefully structured lives.

They were in my office on a gray Monday morning after a weekend of arguing over issues that began at a dinner party with close friends. When the talk had turned to gender differences, Nina, referring to Andrew in the third person, had commented that his porn surfing was a contradiction of his so-called belief in gender equality; leaving Andrew feeling criticized and humiliated. Trying to save face, he countered with a parody of Nina’s nightly stress headaches that left him sleeping on the couch on many nights

The power politics of gender equality are played out in the lives of modern couples when issues come up about children, money, family loyalties and sex. Nina and Andrew didn’t know that neurobiological gender differences could override their best efforts at stepping back from the brink when arguments needed to be resolved.

Recent neurobiological studies of differences between men and women looked at differences in brain structure when men and women process feelings. Cahill and co-author Lisa Kilpatrick reported differences in the emotion- processing centers of the brain, reporting that although both genders have the same fundamental brain structures, men and women are wired to process incoming information in different ways. In other words, although both have the same basic hardware, men and women have different software that influences them to react differently to the same event.

Same-sex relationships whether men or women, tend to be more egalitarian than heterosexual ones. Gay and lesbian couples have about the same rate of conflict as heterosexual ones, but they are better at defusing arguments and avoiding confrontations. A study cited in the New York times2 found that same sex couples were better at seeing the other person’s point of view, lending support to the finding that different emotion-processing centers in heterosexual couples makes it more difficult to see the other person’s perspective when arguments occur.

Nina and Andrew were responding differently to the arrival of their new baby. Nina became vigilant about the baby’s feeding and sleep schedule while Andrew began planning finances to pay for nannies and private schools. The disruptions in their routine made them both anxious in different ways – Nina cried more easily, and Andrew became irritable more quickly, both of them unaware that their neurological software was leading them to process the same events through different emotional pathways.

Men are socialized (and perhaps neurologically wired) to achieve, to compete, to know how things work, and to fight to protect their family and property, while women are socialized to nurture, to display vulnerability, to attend to their own and others’ feelings while suppressing jealousy and envy, to attract powerful men, and to obtain their own power in indirect ways.

Skilled therapists pay attention to gender differences knowing that women respond better by talking about upsetting events and exploring the processes leading to an unwanted outcome while men are more inclined to identify the problem and brainstorm various ways to resolve it.

Look for a psychologist who is attuned to gender differences when you are ready to explore therapy options for yourself or for you and your partner.

1. Sex-related difference in amygdale activity during emotionally influenced memory storage. Cahill,L., Haier, R., White, N.S., Fallon J., Kilpatrick, L., Lawrence, C.,  Atkin, S.G., Alkin, M.T. Neurobiology of Learning and Memory,  Volume 75, Issue 1, January 2001, Pages 1–9

2. http://www.nytimes.com/2008/06/10/health/10well.html? r+0


Patients in this story are a fictional composite of people who have sought help for this issue. Any resemblance to real persons, living or dead is purely coincidental.

Dr. Eva Fisher is an Ottawa psychologist who has been providing psychotherapy for a variety of issues for over 20 years. Follow her on Twitter @drevafisher, Facebook or Instagram @dr_evafisher. Blog writing assisted by freelance journalist Alyssa McMurtry.

Written by Dr. Eva Fisher C Psych
All rights reserved. Copyright protected.
Photo credit:
gagilas
via photopin cc

Anxious Moms, Anxious Kids

“Your children are not your children, they are the sons and daughters of life’s longing for itself”

-Kalil Gibran

From the moment they realize they are pregnant, women often shift from being “me” to being a “mom-and-child”. This is re-enforced through the early years, and most mothers feel both pride and pangs of separation when their little ones go off to school.

Unfortunately there are moms who find it impossible to let go at any time.  These moms share and peer into every corner of the child’s life and act as if their child’s life is their own.  They cannot see the child as a separate person; they see their child’s identity as being one with theirs.

Moms who interfere with their child’s normal attempts at independence have anxieties of their own, that are triggered by the child’s growing away from her – really just growing up. Unconsciously they see their kids as an extension of themselves, and constantly feel the child doesn’t really know what’s best and so she must intervene.  In reality the child’s existence must make up for their own childhood failures and deprivations.  And so they relentlessly plan, schedule, car pool, push and prod their kids into a facsimile of “mini-me”.

In fact, even when the “kids” are forty-year-olds, these moms may still be like this, and still be anxious about their children making the “correct” decisions in every part of their lives.  These moms are “micro-manager moms”, and in trying to control every aspect of their children’s lives they create unnecessary stress for themselves and immaturity and dependency in their offspring.

Paula, a 13 year old, was referred to a psychologist by her pediatrician for anxiety and self-esteem issues. In therapy with children, confidentiality is most important to give the child a place to think and express  things that may be taboo at home.

She was brought to every appointment by her mother, although Paula could easily have walked there after school.  After a few sessions, Paula confided her fears that she might be gay and how these doubts affected her self-esteem. The following day, the psychologist received a call from Paula’s mother who was incensed that the psychologist had discussed sexual matters with her daughter, demanded a thorough summary of each Paula’s sessions, and promptly cancelled future appointments.

Paula’s mother illustrates the micro-manager mom’s issues with boundaries and respecting confidentiality.  She had intruded into her own daughter’s therapy, effectively destroying Paula’s attempt to establish her own identity and raising Paula’s post-treatment anxiety even higher than it was before.

As children grow up and see their mother’s worrying and micro-managing approach, they may take on this behavior themselves as they grow up. If they are used to their mom always interfering, asking details, criticizing, and saying how they should feel and what they should say or do in every life scenario, such behavioral copying and low self-trust becomes endemic. The results can become generational, almost like a family habit.

Anxiety is serious, and the best way to treat anxiety is with psychological treatment by a trained professional. This is particularly important with anxious families and micro-managing moms, as these are serious external influences affecting the anxiety in the child.

Anxiety can really degrade the quality of living as a result, and addressing it with a professional is an important and effective investment of time and money.


Patients in this story are a fictional composite of people who have sought help for this issue. Any resemblance to real persons, living or dead is purely coincidental.

Dr. Eva Fisher is an Ottawa psychologist who has been providing psychotherapy for a variety of issues for over 20 years. Follow her on Twitter @drevafisherFacebook or Instagram @dr_evafisher. Blog writing assisted by freelance journalist Alyssa McMurtry.

Written by Dr. Eva Fisher C Psych
All rights reserved. Copyright protected.

Back to School Parenting 2015

It’s always surprising when, in the middle of summer, big-box stores suddenly display stacks of back-to-school supplies on their shelves.  They remind us that lounging afternoons with friends and enjoying summer BBQs will soon be replaced with back to school preparations.

For parents Back to School 2015 means getting tighter with kids’ bedtimes and routines, and starting to talk about the upcoming changes that will soon be upon us. Now is a good time to star reminding children about their responsibilities, and preparing for some push-back from kids who want to convince you that the end of summer is still a long way off.

Parenting is different today: modern parents believe kids need guidance and rules laid out in small bite-size doses to protect their self-esteem and emotional health.  Today’s kids also feel entirely within their rights to negotiate these rules with you. And as kids get older that’s where you may need help.  Perhaps lots of it, because your own parents didn’t treat you that way. You may find you’ve entered uncharted parenting territory.

Raising emotionally stable children in the new millennium is often difficult and can be exacerbated with the multitude of stresses that working parents face. Between kids’ activities and time deprivations across the board, combined with warp speed changes in technology that affect social norms and all family members, the modern world can be pretty complicated.

Don’t be afraid to seek help from a professional psychologist if this all becomes overly stressful and simply seems too much. You are certainly not alone. A qualified psychologist can assist both parents and kids in understanding their family situation and creating harmonious family relationships.  Any underlying children’s issues can also be uncovered and treated.

children1

In the meantime, here are a few planning suggestions to help with back to school transitions.

  • Make a list of chores to be completed and routines to be established and obtain agreement from all family members regarding them. (But remember, you and your partner are still the uber-bosses.)
  • Divide chores into manageable chunks, for example things to be done 3 or 4 items a week
  • Develop schedules for guidance – such as homework, other activities, and also family fun times.
  • Begin bedtimes 15 minutes earlier each week before the time to return to school and the bedtimes to be observed then.
  • Insert pleasant memories about school friends, activities, teachers into conversations, and discuss how they might look forward to the new school year.
  • Organizing your time and their time using a planning calendar is also showing your kids that a planned family environment works better.

Kids complain, use all sorts of “logic” to get their way, resist, but behind it all they know that rules and structures show that you care about them and love them.

Dr Eva Fisher is a registered psychologist with training in family and parenting issues.

Sexual Arousal and Desire

Sexual arousal and desire in long-term relationships are always hot topics.  Everyone has different needs, wants, likes, annoyances and patterns which can be fragile and hard to talk about or even understand. Individuals in couples have to deal with not only their own complicated sexuality, but also with that of their partners and synchronizing the two.

Sex is something which is incredibly important to many relationships, however, the more fundamental aspect is desiring and being desired.

What happens when you are strongly attracted to someone, fall in love and decide to move in together?

You have great sex, you talk and laugh together, and you’re happy doing anything together. You have a feeling of being complete, that you complement each other perfectly. When you’re apart, you long to be together and when you are together again, you do all kinds of things you never thought you’d ever do.   You experience yourself differently – like trying new foods, new activities and new ways of behaving.

In his book, The Erotic Mind, Dr. Jack Morin describes the building blocks of eroticism. These include longings when you’re apart, excitement and taking risks, new discoveries, and idealizing your lover.

Falling into the familiar

Over time, though, your closeness settles into familiar routines. The realities of everyday life like taking out the trash, laundry or child-care can’t be ignored.  Where there once was an illusion of closeness, the reality that was always there appears –that you are separate but together, with different ideas, habits, and ways of seeing the world.

Routine can be good but isn’t necessarily the sexiest thing and, as Lori Gottlieb wrote in a recent New York Times article, “marriage is hardly known for being an aphrodisiac.”

The article touches on how more equal marriages may even lead a less sex-filled marriage because new power roles in relationships, while quite positive in logical, daily-life, don’t work for some people in the bedroom.

Although it is somewhat paradoxical, Esther Perel a couples therapist who wrote a book called “Mating in Captivity,” said, “most of us get turned on at night by the very things that we’ll demonstrate against during the day.”

And where eroticism, if not diminished, has disappeared.

This predictable path always comes as a surprise to the couples who come to my office for help with lost sexual desire. The partner most upset by this outcome – usually the one with the higher desire – may have realized that they are powerless to make their partner want to have sex, while the lower desire partner complains that the higher desire partner only wants them for sex.

A recent study reported in The APA Monitor, found that couples where one partner has “avoidance-motivated goals”  such as a woman accepting her boyfriend’s desire for sex  to avoid conflict or disappointing him, or a tired man responds with sex because he feels guilty refusing, tend to have lower sexual and relationship satisfaction.  Surprisingly, both the reluctant partner and the initiating partner reported sexual dissatisfaction in these encounters.

Wanting sex, and wanting a person, can create vastly different experiences when it comes to sexual arousal and desire.  Both partners feel different when they feel personally wanted – for who they are – and not just for sex.

Let’s go back to Dr. Morin’s cornerstones of eroticism.

They all encompass the single idea – the feeling that you are with the most wonderful, special person who also makes you feel special and unique. Great sex is the bonus that goes with these feelings – you want to be with that person, and and when you’re having sex together, both of you feel it.

Looking to self-help books that suggest sexual toys, costumes, lingerie, date nights, won’t resolve the gridlock between couples who want to feel wanted.

Sexual arousal and desire problems are primarily feelings of wanting and feeling wanted.

If you are having problems with sexual arousal and desire, speak to a psychologist with training in this area. Your couple is worth it.


Patients in this story are a fictional composite of people who have sought help for this issue. Any resemblance to real persons, living or dead is purely coincidental.

Dr. Eva Fisher is an Ottawa psychologist who has been providing psychotherapy for a variety of issues for over 20 years. Follow her on Twitter @drevafisherFacebook or Instagram @dr_evafisher. Blog writing assisted by freelance journalist Alyssa McMurtry.

Written by Dr. Eva Fisher C Psych
All rights reserved. Copyright protected.

Cutting Remarks

It takes a lifetime to learn how to handle disappointment, and being a teenager doesn’t help much when things get rough. I was wondering what would cause a beautiful, smart 15 year old like Briana to get a pack of her dad’s razors and some disinfecting lotion from the medicine cabinet and deliberately carve small evenly spaced slices up and down her arms and legs.

It didn’t help when her mom walked into her room and freaked out either. She couldn’t know that her mom would bring her to see me, and that she’d land up having to talk about what happened which was why she was sitting in my office. She couldn’t tuck herself any more tightly into the corner of the sofa without disappearing completely, trying to avoid my eyes and smoothing the long sleeves of her shirt.

And looking at the floor, she whispered that all she wanted was to escape from the bad feelings when her friends at school had turned against her.

In 1921, Freud proposed the pleasure principle is the instinctual pursuit of pleasure and the avoidance of pain. Maturity is learning to endure the pain of frustrated desires when reality requires it.

Self-Cutting

While many people abuse their bodies while indulging in smoking, drinking or recreational drugs, they can shrug it off the next day by remembering the fun and good times that went with their over-indulgence. With self-cutting, the pleasure principle – meaning, the avoidance of one kind of pain as a way of by-passing emotional pain however, results in bodily scarring and disfiguring while offering emotional relief.

Self-cutting is when the injury is intentional, as when as person makes small cuts with a sharp object that draw blood on the wrists, arms, legs, sexual organs or bellies. Unwanted and potentially dangerous side effects are infected wounds, scars, accidentally cutting too deep or uncontrollable urges that get in the way of daily activities.

Research shows that 90 per cent of people who engage in self harm begin during their teen and pre-adolescent years, however onset can occur at any age, including in elderly people.

In a survey by the Canadian Mental Health Association, approximately 13 per cent of adolescents said the engaged in self-harm activities. However, since this habit tends to be secretive, it is difficult to determine the exact percentage.

There is no single pattern or profile for self-injures, however the Canadian Mental Health Association shows that most are from the middle to upper-class, intelligent but suffer from low self-esteem. Almost all say they were discouraged from expressing emotions, especially anger and sadness.

Why do people self-cut?

There are many different reasons that people engage in self-cutting behaviour, but the primary reason is that it provides temporary relief to feelings of frustration, suffering and emotional pain. The flow chart below, shows two common patterns of why people injure themselves.

cuttingchart

Studies show that incidences of self-cutting are increasing. This may be due to cultural trends, where young people are told it is a normal way to express feelings of frustration, numbness or sadness. However, it is not new, in the 19th century some women in Europe became known as “needle girls” because they would cut themselves with sewing needles. Today, for example, there are many websites that give advice on how to go about cutting oneself. In order to fit in to a subculture, teens may try cutting themselves only to find that it is an addictive behaviour that can spiral out of control.

Contrary to the belief of some, self-cutting is not necessarily a ‘cry for help’ nor is it attempts at suicide. Cutting tends to become an impulsive, secret habit where the pain provides an illogical sense of temporary calm. Many self-cutters are ashamed of this habit and try to hide their scars.

Self-cutting is not a mental disorder but is usually a symptom of underlying emotional problems. There is a whole gambit of psychological problems that can be associated with it, anything from depression to borderline personality disorder to bipolar disorder.

If you or someone you know is self-cutting,  speaking to an experienced psychologist could help.


Patients in this story are a fictional composite of people who have sought help for this issue. Any resemblance to real persons, living or dead is purely coincidental.

Dr. Eva Fisher is an Ottawa psychologist who has been providing psychotherapy for a variety of issues for over 20 years. Follow her on Twitter @drevafisherFacebook or Instagram @dr_evafisher. Blog writing assisted by freelance journalist Alyssa McMurtry.

Written by Dr. Eva Fisher C Psych
All rights reserved. Copyright protected.

  • Individual therapy
  • Couples therapy
  • Family therapy
  • Stress Management
  • Grief & Loss Therapy
  • Career Counseling

Fisher Bloom

436 Gilmour St. Suite 101

Ottawa, Ontario

K2P 0R8

Call:

Email:

Blog Categories:

Fisher Bloom