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Grief, Loss and the Holidays

The approaching holiday season is often a time of celebration, but for those who are grieving the death of a loved one it can intensify the many complex feelings they are having as they go through the grieving process. Even if the loss took place years in the past, holidays and special occasions sometimes have a way of making the loss feel fresh again. As a psychotherapist working with children, adolescents, and adults in the Santa Monica and greater Los Angeles area who have experienced the death of a loved one, I have empathy for just how difficult it can be to discuss the topic of grief and loss.

Difficulty processing feelings about the death of a loved one doesn’t happen just during the holidays. I find the following quote to ring true for many people, “When a person is born we rejoice, and when they’re married we jubilate, but when the die we try to pretend nothing has happened.” Death is not something that is always talked about openly in our culture, and when it happens people may not know how to respond. This can cause people to try to convince themselves or those around them that they are “okay” and “fine” when they are still deeply affected by their grief process. In other cases, some people might even refrain from sharing their loss with others for fear that will make others uncomfortable or that no one will be able to understand what they are going through. Often, this only adds the feelings of isolation, loneliness, and depression that are a typical part of grief and loss.

Seeking help with your grieving process, no matter how long ago it began can be an essential part of the healing process. There are many opportunities for support groups in the Santa Monica and West Los Angeles areas for bereavement and loss, and often finding a therapist or psychologist to help you process your unique experience with grief can decrease feelings of loneliness and isolation. Processing your grief in therapy can create a sense of closure allowing you to hold onto the many positive memories of a loved one without becoming overwhelmed by their absence.

If you need support in your grieving process or if you know someone who has recently suffered a loss and is looking for help, you are always welcome to call my office at (262) 607-2226 or my supervisor Dr. Katja Pohl at (310) 709-4582.

Written by Christopher Marquart, Psy.D. – PSB49022615, supervised by Katja Pohl, Psy.D. – PSY25919

Is this election triggering sexual trauma memories?

This election is like no other and is stirring up concerns all over. Just this morning, at Starbucks, I overheard a woman talking on the phone about last night’s debate and how offended she felt about Donald Trump’s comments about women. Understandably everyone has a strong opinion about each candidate and their remarks. However, as a psychologist who has treated hundreds of sexual trauma victims, I find myself feeling particularly protective of all the women, men, and children that are victim’s of sexual abuse.

As a UCLA Rape Treatment Center on-call therapist I have met with hundreds of children, men and women who recently experienced a sexual assault. They often present with symptoms of acute stress, shame, denial, guilt, fear, sadness, and anxiety. As raw and vulnerable as they are after an assault, they come to the Rape Treatment Center to get support; however, that support includes very personal questions and a medical exam. These children, men and women are incredibly strong and brave to embark on their journey of healing. It is a hard and long journey and the memories will always be part of their story. These memories can be triggered by physical sensations, smells, reminders, places, people, and words such as the ones everyone is exchanging about the Clinton/Trump presidential election.

The recent election controversies can easily trigger a sexual assault victim to be reminded of their assault and how they have felt along the way. Feelings of shame, guilt, sadness, anger, and loneliness can surface and individuals can experience recurrences of PTSD, depression, and anxiety. In my Santa Monica psychotherapy office, where I provide long-term therapy for people who have experienced childhood or recent trauma, I am seeing just that. Women and men, who have endured a great deal of pain and fought for themselves to heal, are being reminded of how painful just words can be. It is so crucial that we as a community are respectful of one another and how we discuss sensitive topics. It can be so hurtful even damaging for a survivor to hear people making comments endorsing sexual assault and sexual battery, as well as questioning victim’s response to an assault. There is no right or wrong way to respond to a major trauma. It is a trauma, which will leave you speechless, confused, angry, ashamed, hurt, frightened and utterly shaken up. And it takes support to heal and recover.

If you need support in your healing process or if you know someone who has been a victim of sexual abuse or assault, feel free to reach out. You are always welcome to call my office at (310) 709-4582 or contact RAINN or the Santa Monica UCLA Rape Treatment Center.

Beating Addiction In The Industry

As a transplant to Los Angeles, it took some time to understand “The Industry” and the life associated with it. It looks glamorous to many but it is a very hard world, with lots of pressures, expectations, very high stress, and often drugs and alcohol. The amount of people struggling with depression, anxiety, and substance abuse in our entertainment industry is concerning and explains why there are hundreds of inpatient and outpatient treatment facilities.

Intensive treatment can be necessary at first and help in getting clean/sober; however, the long-term involvement in AA or a non-spiritual program in conjunction with therapy is ultimately what keeps people clean. Therapy is an essential part in recovery. It provides a place to explore one’s drug, prescription drug and alcohol use, one’s resistance to giving it up, and managing sobriety. It is so hard to accept a drug problem and it is even harder to address it. Recovery takes time, is a very difficult process and often very painful.

Working with a therapist or a psychologist helps you manage the stress of the industry, anxiety of having to perform at such a high level, insecurities, and ways to socialize in the same circle of importance without needing to use.

Please feel free to call with questions or for support, (310) 709-4582! For information on how to find your Los Angeles Addiction Psychologist, please explore this website to see if I am a good fit for you.

 

 

Depressed in Santa Monica

Do you no longer find pleasure in life? Drive through traffic without noticing the world around you? Feel numb, hopeless and alone? Depression can make you feel like a stranger to yourself and make you do and think things that you never thought you would. It takes you over making you feel lost and alone.

You might notice yourself pulling away from those closest to you. Choosing to stay in and sleep rather then enjoy things that you love. Yet, at the same time longing to have someone understand what it feels like.

I have noticed that living in Los Angeles, these types of feelings can be even more common. Between, the hours being stuck alone in traffic, distance between friends and family members, high cost of living and social pressure to fit the “Hollywood” label of success, it can be a brutal world out there.

So many clients that I have worked with have come in feeling “worthless, not good enough, like a failure” the list goes on and on.  When surrounded by thousands of luxury cars, mansions, millionaires and models/actresses on a daily basis, it’s even harder to feel good about yourself. Many people move here in search of “the dream” only to realize it is a concrete jungle of broken dreams, credit card debt and plastic surgery.

This “image based” culture makes it THAT much harder for those going through depression. In a city that is so spread out it can be difficult to make new friendships and maintain connection. Isolation becomes normal and before you know it, you begin feeling like there is no way out.

In my work with clients, I have seen so many people overcome the darkness of their depression and realize that they are more then their pant size, brand of car or number in their bank account. It is in the moments when you feel alone, scared and uncertain that there is the most opportunity to get to know yourself. Being vulnerable and asking for support is so hard when everything inside of you is saying, “suck it up and deal with it on your own.”  The reality is that none of us can do it on our own and sometimes we need to ask for help. Depression is real and it can feel endless while going through it. Please know that you are not alone.

Written by: Sandra Kushnir, Marriage and Family Therapist Intern

Trauma

Going through a traumatic event can be life changing, often leaving individuals feeling devastated and alone. A trauma is defined as an event or threat that causes you to feel in danger of serious physical harm. This includes near death experiences, sexual assault, domestic violence, accidents, child abuse or even being a witness to a crime!  Experiencing a trauma can cause significant impairments and in emotional, psychological and social functioning.  As more research becomes available about the impact that trauma can have on emotional health, it has become clear that effective treatment is vital and can have a significant positive impact on improving overall well being.

Symptoms of trauma include:

  • Recurrent and unwanted memories of the trauma
  • Flashbacks and/or nightmares
  • Severe emotional distress or physical reactions to reminders of the event
  • Avoiding places, people or reminders related to the trauma
  • Low self-esteem, shame and guilt
  • Feeling numb or hopeless
  • Isolation and losing interest in activities that once were pleasurable
  • Memory problems
  • Irritability
  • Substance abuse
  • Hypersensitivity to sounds and ones environment
  • Trouble concentrating
  • Trouble in interpersonal relationships
  • Disassociation

Often when working with clients, I hear a theme of profound struggle and pain that comes from living with these symptoms. The impairments caused by experiencing trauma can be emotionally draining and at times feel hopeless. It is important to remember that these responses are, “normal reactions to an abnormal event.”  Many people become flooded with feelings of guilt and shame following a trauma and hide their symptoms in fear of judgment from others. This makes it even more important that we address the stigma surrounding mental health and become we become educated about the impact that untreated trauma can have.  There is a clear link that has been found between substance abuse, eating disorders, self-harm, suicide and trauma.

Trauma can also impact relationships and leave individuals feeling alone and isolated at a time when connection to others is needed most.  Leading to co-occurring depression, anxiety or other mental health issues. Research has found that talking about the trauma with a safe and trustworthy person can actually decrease and even eliminate symptoms.  Taking the first step is difficult; but life changing!

Written by: Sandra Kushnir, MFTI #85116 – Santa Monica Intern Therapist

References

Goff, B., Reisbig, A., Bole, A., Scheer, T., Hayes, E., Archuleta, K., . . . Smith, D. (n.d.). The effects of trauma on intimate relationships: A qualitative study with clinical couples. American Journal of Orthopsychiatry, 451-460.

Levine, P. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley: North Atlantic Books.

Litz BT, Engel CC, Bryant RA, Papa A. A Randomized, Controlled Proof-of-Concept Trial of an Internet­ Based, Therapist-Assisted Self-Management Treatment for Posttraumatic Stress Disorder. Am J Psychiatry. 2007 Nov;164(11):1676-84.

Watson PJ, Shalev AY. Assessment and treatment of adult acute responses to traumatic stress following mass traumatic events. CNS Spectr. 2005 Feb;10(2):123-31.

 

Rape Myths

A woman tells her friends before her date that she plans to have sex with her boyfriend that night. He is taking her to a campus party, and she dresses in a very skimpy halter top, short skirt, and heels. To get ready for the date, she takes several shots before the night begins. When she arrives at the party, she proceeds to consume many more alcoholic beverages, as well as an ecstasy pill, and asks her date to take her to his room. She initiates kissing and takes off her clothes. Her date follows her lead and the couple begin making out on his bed. After a few minutes, however, the woman changes her mind about sleeping with her date. He inserts his penis, and she tells him that maybe they should slow down. He says, “Come on, I know you want me too.” Her body has become physically aroused. She says, “No,” but does not physically attempt to stop him. Tears roll down her cheeks, and she feels defeated.

Many of us have heard stories such as these and some may have even made judgments about the rape victim. Those judgments are called rape myths. Rape myths are defined as false beliefs about rape, which are influenced by the individual’s prejudices and sexist beliefs (Burt, 1980; Lonsway & Fitzgerald, 1994; Ullman, 2010). It is important to abandon rape myths because they serve to ignore and justify male sexual assaults against women (Lonsway & Fitzgerald, 1994). Examples of rape myths people may believe about the example above are:

 Rape myths
• It is not really rape if the victim has previously had sex with the perpetrator
• If a woman originally consents to sex, it is not rape

 In fact
• Consent must be given during each sexual encounter
• California Law states that consent can be revoked at any time, including after penetration (California State University Los Angeles University Police, 2012)

Belief in rape myths hinders victims from seeking out resources after being raped (Fisher et al., 2000; Hayes-Smith & Levett, 2010; Norris & Cubbins; 1992; Olson, 2004; Ullman, 2010). In reality, it is not the victim’s fault even if she: was drinking, using drugs, going out alone, talking to strangers, staying out late. If a victim blames herself for the rape, then she is less likely to seek legal ramifications for the attack, which in turn means that the perpetrator will not be punished, and may continue to assault other women.

Written by: Rebecca Rodriguez, M.A.

References

Burt, M. R., & Albin, R. S. (1981). Rape myths, rape definitions, and the probability of conviction. Journal of Applied Social Psychology, 11, 212–230.
California State University Los Angeles University Police (2012). Annual security and fire safety report [PAMPHLET]. University Police, California State University: Los Angeles.
Fisher, B. A., Cullen, F. T., & Turner, M. G. (2000). The sexual victimization of college women (NCJ 182369). Washington, DC: U.S. Department of Justice, Office of Justice Programs.
Hayes-Smith, R. M., & Levett, L. M. (2010). Student perceptions of sexual assault resources and prevalence of rape myth attitudes. Feminist Criminology, 5(4), 335-354. doi:10.1177/1557085110387581
Lonsway, K.A., & Fitzgerald, L.F. (1994). Rape myths: In review. Psychology of Women Quarterly, 18, 133-164.
Norris, J., & Cubbins, L. A. (1992). Dating, drinking and rape: Effects of victim’s and assailants alcohol consumption on judgments of their behavior and traits. Psychology of Women Quarterly, 16, 179-191.
Olson, L.N. (2004). The role of voice in the (re)construction of a battered woman’s identity: An autoethnography of one woman’s experience of abuse. Women’s Studies in Communication, 27(1), 2-33.
Ullman, S. E. (2010). Talking about sexual assault: Society’s response to survivors. American Psychological Association. doi:10.1037/12083-000

The Love Lab: John Gottman’S Research

Many couples enter therapy for the first time hoping that they will learn better ways to communicate and their relationships will improve. A “common complaint made by couples is that the communication between them has eroded or at least negatively changed over time” (Mahafeey, 2010 p.  45). Healthy communication between couples has a high correlation with satisfaction and happiness in the relationship. Research has found that “lack of communication, distressed communication, and negative communication have all been linked to couple distress…conflict, and psychological distance within the relationship” (Mark & Jozkowski, 2013, p. 414).

Leading researcher in couples counseling John Gottman (1999) proposed that relationship satisfaction is not dependent on whether a couple fights but rather how they fight. In his research, Gottman found that couples that reported being happy and satisfied with their relationships have a five-to-one ratio of positive interactions for every negative interaction (Gottman & Silver, 1999). Therefore, one of the goals of therapy should be to help couples change destructive conflicts into constructive and reparative communications opportunities. 

Gottman discovered that couples that reported being less satisfied with their marriage, often began their discussions with “harsh start-ups” such as, criticism of the partner or sarcastic remarks. He also observed that these couples had more criticism, contempt, defensiveness and stonewalling during their interactions. The negative interactions became known as the “four horsemen of the apocalypse” (p. 27).  Through his research on couples he has been able to predict with 97.5% accuracy the longitudinal course of relationships (Gehart, 2013).

The Four Horsemen

The presence of the four horsemen during an interaction between couples can predict divorce with 85% accuracy (Gottman, 1999). The four horsemen are: a) criticism, b) contempt, c) defensiveness, and d) stonewalling. Criticism is a statement that attacks character and implies that there is something inherently wrong with the partner (e.g. “you always do everything wrong”). Contempt is expressed when one partner sees themselves as superior to the other (e.g. “you don’t deserve to be with me”). Defensiveness is protecting oneself from attacks by the partner (e.g. “This is all your fault… You always mess everything up”). Stonewalling is withdrawing from the interaction emotionally, mentally, or physically (Gehart, 2013, p. 302). Flooding, or the feeling that a partner’s negativity is so overwhelming that it leaves the other shell shocked, also was a common element discovered in couples that reported being dissatisfied in their relationship. Finally, the greatest predictor of divorce that Gottman found was failed repair attempts. Failed repair attempts are “efforts that a couple makes to deescalate the tension during a touchy discussion” and in “unhappy marriages… [It is] harder to hear and respond to a repair” (Gottman, p. 40). Therefore, distressed couples have more attempts at repair then happy couples because these attempts are unsuccessful at ending or deescalating the argument.

Communication between couples is an important factor in determining each partner’s satisfaction in the relationship and is linked tightly to relationship outcomes (Johnson & Bradley, 2009). Being able to communicate in a calm and respectful way can help couples learn healthy ways to handle conflict and improve their relationship. Couples therapy can help couples learn these tools and has been found to be highly effective in decreasing the “likelihood of divorce and improving individual and family well-being” (Tambling, Wong & Anderson, 2014, p. 29).

 

If you are interested in reading more about John Gottman’s research you can check out his book: The Seven Principles for Making Marriage Work.

 

** This blog is an excerpt of an academic paper written by Sandra Kushnir, MFTI. 85116

 

References:

Gehart, D. (2013). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. (2nd ed.). Belmont,  CA: Brooks/Cole.

Gottman, J. M., & Silver, N. (1999). The seven principles for making marriage work. New York: Crown Publishers.

Johnson, S., & Bradley, B. (2009). Emotionally focused couple therapy: Creating  loving  relationships. In J. H. Bray, M. Stanton (Eds.) , The Wiley Blackwell handbook    of family psychology (pp. 402-415). Wiley  Blackwell.   doi:10.1002/9781444310238.ch27

Mahaffey, B. A. (2010). Couples counseling directive technique:  A (mis)communication   model  to promote insight, catharsis, disclosure, and  problem resolution. The Family Journal, 18(1), 45-49.   doi:10.1177/1066480709355037

Mark, K. P., & Jozkowski, K. N. (2013). The mediating role of sexual and nonsexual  communication between relationship and sexual satisfaction in  a sample of college-age heterosexual couples. Journal of Sex & Marital   Therapy, 39(5), 410    427. doi:10.1080/0092623X.2011.644652

Tambling, R. B., Wong, A. G., & Anderson, S. R. (2014). Expectations about couple therapy: A qualitative investigation. American Journal Of Family Therapy, 42(1), 29-41. doi:10.1080/01926187.2012.747944

7 Myths about Living with Trauma

Experiencing a traumatic event is more common than most people think. However, there are several common misconceptions about living with trauma. It can be hard for people who have survived a traumatic event, and for people who seek to be supportive to survivors, to understand why their mind and body reacts as it does. Here are seven common myths about living with trauma.

 Myth #1: You have to be physically hurt to experience trauma

Trauma results from an experience of intense fear (American Psychiatric Association, 2013). Physical violence may have occurred but it may not have. Trauma can occur when the person feels like their life is in danger or when their sense of safety is threatened.

Myth #2: Everyone who experiences a traumatic event will develop Posttraumatic Stress Disorder (PTSD)

About 8% of the American population will develop PTSD in their lifetime (Kessler et al., 2005). However, PTSD can only be diagnosed when symptoms persist more than a month after the traumatic event (American Psychiatric Association, 2013). When symptoms similar to PTSD occur within the first month of the trauma, a person may be diagnosed with Acute Stress Disorder.

Myth #3: People who get PTSD are weak

There is no evidence that people who develop PTSD are weaker than those who do not. There are several factors that affect whether someone will get PTSD after experiencing a traumatic event. Research suggests that there may be neurobiological factors that predispose certain people to developing PTSD (Keane, Marshall, & Taft, 2006). Other risk factors include past history of trauma, age at time of the traumatic event, type of trauma, and duration of trauma. Also, people who felt that they were supported by their friends and family were less likely to develop PTSD after a traumatic event.

Myth #4: PTSD isn’t a real thing

Studies on the brain show measurable differences in a person’s brain after they have developed PTSD (Bremner, 2006). This means that PTSD actually changes the way your brain works and how it responds to your environment.

Myth #5: If I force myself to stop thinking about the trauma, it will go away

People often want to avoid thinking about the trauma and avoid anything that could remind them of it as well (Herman, 1997). This avoidance doesn’t stop the experience of pain and can severely limit a person’s life. People living with trauma may begin to socially isolate themselves or stop doing things they used to enjoy. Some survivors may also resort to drugs and/or alcohol to cope with the pain. The most effective way to overcome trauma is to talk about it.

Myth #6: I am going crazy

Many people coping with the aftermath of trauma feel like they are going crazy.  Their mind and body may react in unpredictable and uncontrollable ways. It is important to realize that this is normal for anyone who has survived a traumatic event. These reactions are often due to internal and external triggers, which make the memory of the trauma resurface (Tull, 2014). Internal triggers may be anger, fear, memories, or physiological cues like a racing heart or muscle tension. External triggers come from the environment such as people or places that remind you of the event, smells, anniversaries, or noises.

Myth #7: I’m going to feel like this for the rest of my life

Living with trauma is painful and for some people the effects are long lasting. The good news is that some people will recover from trauma over time, especially those who feel that they can rely on friends and family for support. There are also effective therapies out there for treating those who develop PTSD. A new area of research is showing that out of trauma can come posttraumatic growth, which is when trauma gives birth to positive changes (Joseph, 2014). For example, the mothers who lost their children due to drunk driving and formed Mothers Against Drunk Driving (MADD), an organization that aims to stop drunk driving and support victims.

Written By: Kaitlyn Masai, MA, PSB 94020891

Supervised By: Katja D. Pohl, Psy.D., PSY 25919

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 1 June 2013]. dsm.psychiatryonline.org

Bremner, J.D. (2006). Traumatic stress: effects on the brain. Dialogues Clinical Neuroscience, 8(4), 445–461.

Herman, J. (1997). Trauma and Recovery: The Aftermath of Violence–from Domestic Abuse to Political Terror. New York: BasicBooks.

Joseph, S. (2014, February 8). What doesn’t kill us: The new psychology of posttraumatic growth. Retrieved from http://www.psychologytoday.com/blog/what-doesnt-kill-us/201402/posttraumatic-growth

Keane, T.M., Marshall, A.D., and Taft, C.T. (2006). Posttraumatic stress disorder: Etiology, epidemiology, and treatment outcome. Annual Review of Clinical Psychology, 2, 161-197.

Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593-602.

Tull, M. (2014, August 29). How to Identify and Cope with Your PTSD Triggers. Retrieved from http://ptsd.about.com/od/selfhelp/a/CopingTriggers.htm

ONLINE RESOURCES

Are you having a hard time finding the information you need? Here are a few good websites and resource pages for mental health concerns. Please feel free to contact me for information on local resources or more in-depth information.

GENERAL INFORMATION ON MENTAL HEALTH

SUBSTANCE ABUSE AND ADDICTION

SUICIDE PREVENTION

SEXUAL TRAUMA

 

New Year’s Resolutions

New Year’s resolutions can be for fun, minor improvements or they can be much needed changes in one’s life. In Santa Monica and Los Angeles some of the most popular New Year’s resolutions are:

  • Finding a soul mate
  • Losing weight
  • Improvement in one’s career and income
  • Quitting smoking
  • A healthier diet
  • Better relationships
  • Traveling
  • Getting sober

As a clinical psychologist I often hear about goals for the New Year and with it come the questions of “how do I do it”. According to Norcross’ research, only 50% of people state they achieved their New Year’s resolution. It begs the question, what leads to success and what leads to ones failure in achieving goals.

Some factors that lead to success:

  1. Be realistic with your goals and the time needed for change to occur
  2. Divide the process into smaller steps and time intervals
  3. Be compassionate with yourself and how difficult the process of change can be
  4. Share your goals with family and friends
  5. Ask for help in achieving your goals