The Power of Group Psychotherapy.

When I first got out of graduate school I was fortunate enough to have the opportunity to work at an agency in Miami called The Journey Institute (originally Project Resolve). I co-facilitated groups for survivors of sexual abuse. A very heavy and difficult issue for group members to have the courage to face and as a new therapist very scary for me too. The reason I feel so fortunate to have been a part of that agency not only had to do with the very courageous and amazing women who were members of the group. I learned so much from each of them. I always wondered if I had lived though those experiences if I could have been as insightful and openhearted. I also learned more than I ever learned in graduate school co-facilitating a group with very experienced and wonderful therapists. I came to see that group therapy is not only helpful for those of us who have gone through difficult things that we feel alone in, but is also helpful for most of us who struggle with that thing called life. Something which will always have periods of being difficult at times at times may leave us feeling very much alone. 

Group is powerful because a well run group that has been together for awhile can accomplish what individual therapy simply can't. If you've ever been to individual therapy you know the drill. You tell your therapist what your week has been like, whatever it is you're struggling with and they provide a safe environment where you explore it. This of course is helpful in many ways but the one draw back is that you rely on your own perception of things. And your therapist is not a peer. It is a one-way relationship where you tell them what's going on in your life and it stops there. In group you have the insight of all the members. How you come across to them, how you interact with them, etc. There is also a camaraderie. You are in it together, trying to figure it all out, whatever it is you are struggling with. And you have others who are further along in some things which gives you hope. You may also be further along than others and can feel good about how far you've come and about being that beacon of hope for them. Good co-facilitators keep the group safe and help guide the process of group in a positive way so you can get what you need out of it.

I'm very excited to announce that along with my colleague, Dr. Michael Schenker, we will be forming an ongoing psychotherapy group in our offices in Pembroke Pines. I will be posting more about how this kind of group works. If you have any questions don't hesitate to call the office or send me an email.

When should you call it quits?

If you are in a position where you are seriously thinking about whether you should end a relationship there are questions you can ask yourself to see whether you should continue trying to stick it out.

If you don't have children and you're not married, if you have one of these two serious issues, your relationship may not be worth saving. The two issues I think are critical are trust and respect. If your partner has cheated or you are disrespected or verbally/ physically bullied it may be better to walk away before you get in deeper. Disrespect or anger issues are very difficult to change. For that change to even have a chance of taking place the person must recognize and take full responsibility for their actions. If they blame you or minimize what they are doing they are basically telling you this behavior will continue. And disrespect or aggression in any form is poison to a relationship. Now matter how much love you start out with it will change over time and you will no longer be in love with the person. There is only so many times someone can treat you badly before you call it quits. If you put that together with making a change as big as what you do when you're angry and you have a very tenuous situation. Making any kind of change involves making progress and then slipping up. In this situation slip ups mean further damage to a relationship. Making this kind of change usually means the person with anger problem needs to do this on his or her own.

If there has been infidelity and the person cheating has not taken full responsibility and been completely honest about what has happened then you will not be able to rebuild that trust. If you don't trust your partner you will begin to withdraw. I have had many people come in years after an affair saying they are no longer in love with the spouse who cheated. Over the years they became numb and were unable to fully give themselves to the other person. On the other hand if the person is willing to do everything in their power to make things right there are things you never thought you could get over that you do get past. But when it comes to cheating even if you realize the person wants to change it may still mean you don't end up  trusting them. This is especially true if you are in the first few years of a relationship. If you don't have a history to draw from it is hard to honestly see the person as someone who is basically good but made a mistake. And some version of that is where you need to end up if you are truly going to move forward.

How Jealousy Can Destroy A Relationship

We have all felt jealous at some point in our lives. Maybe it's the way your partner seems to have fun with a mutual friend or when they stare at someone attractive a little too long. It is never a good feeling. When you start to blame these feelings on your partner's behavior you are creating a problem in your relationship. Many times the very same quality that made you fall in love with this person is thing that is now the problem. They have a great sense of humor, are really good  at conversation or are charming. Now they are too friendly or flirting and in your mind you begin to imagine worse. If you do not have knowledge that they have cheated or said or done inappropriate things (sexual or romantic) then you need to find a way to let these thoughts go and not act on them. Knowing where these fears stem from also helps. For many people it is having been cheated on in the past. For others it's a negative belief that all men or women will be unfaithful at some point.

There is a very big difference if your partner has been unfaithful. If you are in this situation then these thoughts and feelings are a signal that you still do not trust your partner and need more from them to help you get past whatever happened. If they have done everything they can to regain your trust it may be a matter of you taking that leap of faith and again letting these feelings pass and not acting on them. If on the other hand there has been no cheating then you have to realize the damage you are causing by accusing your partner when they have done nothing wrong. This usually pushes the person away from you and causes a viscous cycle. You accuse them, they get angry and become more withdrawn. You feel the distance and this makes you anxious which in turn makes you more suspicious and you again make accusations which further push them away. Despite your anxiety and certainty that they are doing something wrong, you have to first and foremost stop acting on these feelings. The impulse to lash out and accuse is the first place to start. Along with this beginning to examine your assumptions is crucial in stopping this cycle.

Keeping the "good stuff" in your relationship

Most people come to couples therapy looking to change what's wrong in their relationship or marriage. Of course that's always what stands out for us. It's how bad you communicate, the fact that you're not having sex as often or that there has been a major betrayal. And when there is a crisis you do have to take care of that first. I consider disrespect and a breech of trust to be "crisis" issues that must be taken care of immediately. But if neither one of you has cheated and arguments don't spiral into name calling and curse words, then focusing on making more of the interactions with your spouse or partner positive is definitely worth the effort. 

I have to admit this is where it gets tough for most of the couples I work with. It is really hard to reach out to each other if things have been bad for a long time. It's easy for most people to slowly fall into the habit of keeping to themselves, waiting for the other person to make a move which only makes you build more of a case against things working out if they don't. Yet according to the research of John Gottman, if the interactions in your relationship aren't at least 80% good to 20% bad you are headed for trouble. And you can stop arguing as often, have more peace in your home, even learn to negotiate and communicate better in general but if there isn't enough "good" it makes it more likely that any change is merely temporary. That is because that good will, kindness, appreciation and affection is a buffer to the unavoidable difficult moments in every relationship. And make no mistake there will be difficult times in every marriage. That is why it's important that you make a conscious choice to reach out to your partner in a way that makes them feel good about the two of you.

Again reaching out is not easy. You make yourself vulnerable when you reach out. You take the risk of being rejected. And habit in and of itself makes it easier to keep the status quo. Ask any seasoned couples therapist and they will tell you it is much harder to make a change in a couple that is disconnected and not fighting a whole lot than it is to make a change when you fight all the time but have that connection. Our habits are usually automatic and unconscious. The longer they've been in place the harder they are to change. With all of our busy, hectic lives setting aside time at the end of the day to relax together is usually at the end our long list of things to do. Our marriage or relationship is also the heart of our lives and the foundation of our families once we have kids. That is why focusing on this is so important and really needs to be at the top of our list. So if you want to know one thing you can do to make you relationship stronger it's making sure there is a lot of good.

The most stressful time in a marraige

Barring terrible, traumatic situations the most stressful "normal" milestone in a marriage is becoming a parent for the first time. Friends will often ask me this question, thinking it's the seven year itch or when the kids all leave or maybe even the first year of marriage. But research actually supports that it is when you become parents. Why is this? You would think it would be an exciting time, you become a family and have this new baby you both love. What could be so bad about that?

Many things make this a difficult time. First of all on a practical level neither one of you is sleeping much when you have a infant. Sleep deprivation does all kinds of things to us, including affecting our mood, our concentration, our ability to function in general. Add to that the fact that I don't think you can be prepared for how much your life changes in every possible way when you have your first child and you have a recipe for a great deal of stress. Of course, it is a wonderful time filled with this immense love for your child. That is the part most of us remember when we think back to the birth of our children. The stressful parts are the getting up every two hours, indefinitely (which is really stressful, if you had a time frame it would be so much easier!), not having any time when you are not worried, attending to or doing something for the baby and both of you feeling the weight of caring for this new life and doing everything right. Of course, you are not going to do everything right. None of us ever does. But that pressure is there when you are out of balance, sleep deprived and stressed. 

How do you get through this time? Being realistic about it and having other parents who you can talk to about how hard it is  and who are honest with you about how hard it is really helps. Being compassionate with each other is absolutely necessary. A husband who asks his wife what she did all day when she is home with a baby can't wonder why his wife is angry. And a wife who expects her husband to work all day and then get up every night with the baby is also setting up a bad situation. You each have to keep in mind how hard it is for the other person and try to be partners in making this huge transition easier for each other. It is a lot of work for both of you. Having a contest about who has it worse doesn't do anyone any good. When you both appreciate the contribution of the other that is when you have partnership. You giving that understanding and appreciation to your spouse is what you can do to get your marriage going in the right direction.

What's normal when you're going through a tough time

Don't we all wish life could be smooth sailing all the time. Everyone knows that's just not realistic. We all go through difficult times in life. And it's normal to have strong feelings if things are not going the way you wanted them to. If you're going through a break-up or realizing a relationship isn't working,  its normal to feel sad. If you got fired from your job or aren't doing well in school and don't know what direction to go in you're going to be scared and anxious. If you've lost a loved one you will be grieving. If someone betrayed you or something unjust has happened to you, you will be angry. Feelings are there to guide us, have us pay attention and maybe motivate us to make changes. 

So how do you know when normal emotions become something more, something to worry about? A good baseline to look at is if there are no ups and downs to your feelings, you're just always down, for two to three weeks. Now when you've gotten hit with something big like your spouse just left you or you just got fired, immediately afterwards it will feel like a constant sadness or anxiety. But if you really look at it you might see you had a moment where you felt a little better, didn't think about it for that hour or even laughed with a friend. This doesn't mean the feelings won't come to you again, they will and that is normal. But if as time goes by you can see you're having less of those really bad moments and more of the moments that feel a little better, you are moving through the situation in a normal way. This also means that with time you will probably be okay. It helps if you have close friends and family that you trust to talk to. It helps to talk to someone so you don't feel so alone and also to figure what, if anything, you need to do to get through the situation. Often time and the love and acceptance of those around is all you need. Sometimes you actually need to make some changes and whatever the situation is helps to clarify what those changes are.

On the other hand if weeks and months are going by and you don't feel any better, maybe you're actually feeling worse, then there may be more going on. And if there isn't anything that's happened to cause you to feel depressed or anxious to the extent that you do then you really should speak to a therapist or psychologist about it. Depression can have a very physical component where you actually feel run down and maybe even have aches in your body. The lack of energy, everything feeling and looking gray and negative is also a part of depression. All of this makes it very difficult to get out of bed and do the most basic things like go to work or school. It also makes it difficult to do anything that might make you feel better, like go out with friends and family or exercise. If you're feeling like you're going into this black hole you can't climb out of this is also a sign that it's something more. And of course, if you are having suicidal thoughts, including thoughts of not wanting to wake up or having something happen to you so you're not here, that is a very serious sign and you need to speak to a professional. If you are having more detailed thoughts of how you plan to kill yourself that makes it even more serious and dangerous. You need to get help right away. Even if you have moments where you feel better, suicidal thoughts indicate something more serious is going on.

It is hard to reach out and ask for help. It always makes you feel vulnerable and usually means facing something  that isn't easy to face. Therapy is not only for people with serious disorders. Talking to an unbiased person, who is trained and experienced in how to guide people through difficult times in life helps many people. We all have blind spots that keep us stuck. By definition a blind spot is very hard or impossible to see on your own. It does take courage to admit the difficulties you may be facing. And yet seeing things for what they are is a first step towards things getting better, whatever your situation.

How do I know if bad experiences from my past are affecting me today?

If you're wondering about this you have probably had friends or family tell you whatever horrible experience you had is why you're acting a certain way. It's usually those we love who get the brunt of it in the form an over reaction. Or you may be the kind of person who keeps things in and does a lot of pretending. Especially if those bad experiences involve family members you may still have to interact with. We feel like we have to keep this past experience where it we want it to stay, in the past. It may feel like something so far removed from your life you don't see how it could possibly be affecting you today. It happened years ago, maybe even when you were a kid, so how could it be affecting you today? You may not even think much about it and in fact do everything you can to not think about it.

If this experience was something traumatic, something where it felt like there was a definite before and after, it is probably affecting you in some way. I say this for two reasons. First of all we are all products of our past experiences, good, bad and in between. This doesn't have to be a negative thing. We all have heard of someone who overcame a negative experience and it shaped their life in a positive way. Think Tony Robbins, Oprah Winfrey, Maya Angelou and the list goes on.  We cannot escape the fact that things that happened to us shape how we see the world, the kind of spouse we are, the kind of parent we are, the kind of friend we are. It is simply a matter of degree. Is our reaction mostly about what is happening now and a little about past experiences or visa versa? The clearer we are on that the more in control we become of the past not getting in the way of today. The second reason I believe this may be true is because of what happens to us, to our brains when we go through something traumatic. That memory is stored differently than a regular memory. This is a protective mechanism. Think cave man days when we lived in the jungle and saw a lion under a tree. The next time you walk by that tree your heart will beat faster, adrenaline will be released just in case you have to run and you will be hyper-vigilant waiting for that lion. That is exactly what happens when we are triggered or reminded of a past traumatic event. This is a physiological response not a thought you have. You may not know why you are having the reaction, especially if it is to something that happened in childhood. But it will cause you to avoid things, react stronger that is normal in a given situation and most certainly affect your life now. If this traumatic event is something recent it will be easier to put together why you're having the reaction.

Most people see no connection between a childhood trauma and reactions they are having today. Many times it is only after these reactions have affected your life in a serious way that you begin to wonder about this. They are connections that are difficult to see because they are so automatic and have been there for most of your life. The more conscious you become of these reactions the more control you gain over them and over your life.  

When does a fight turn into abuse?

Abuse is a heavy word. It can be an accusation that probably feels like an exaggeration if it's ever been thrown at you personally. And yet it's very real if you've ever been on the receiving end of it. That is what is so difficult about this topic. It is common that the two people involved see it very differently. Not always but most of the time. We all can watch a situation and know when the line has been crossed, when it goes from just being angry or frustrated to damaging and scary. When we are involved, especially if we are the angry one losing our temper, it's much harder to see when we are crossing that line.  For the sake of a definition, cursing, pushing, hitting, getting in someone's face, throwing things are all in the category of abuse. This is especially true when one person is stronger, older or has more power than the other. When we have engaged in this kind of behavior the most important thing to do is to be accountable, apologize and not let it happen again. If this person is your partner or spouse whether you are the woman or the man this kind of behavior will affect how they feel about you. If it continues, even if it's only once in awhile, it will change the way the person on the receiving end of it feels about the other person. That is the more obvious bad behavior we all know should not be present in our relationships. And that is the definition of abuse we all agree on.

How about the more subtle forms of abuse? It is easier to label it as disrespect because I think it's easier for us all to identify this and not get caught up in whether it's "abusive" or not. It's a tone of voice, a mean spirited dig at you and a general retaliation or punishment for something you've done. This is also poison to your relationship, it's just harder to label and easier downplay. One way to look at this differently is that if your partner feels personally attacked, put down or controlled by you, it doesn't matter whether you think they shouldn't feel this way. They do and you are in a relationship with them. That should be enough to make you stop engaging in the behavior. If instead you spend your energy defending why you're right and telling them that they should just get over it you are compounding the problem. You are telling your spouse you don't really care how they feel and you are missing an opportunity to know and respect their point of view. I am sure if they did or said something you thought was disrespectful you would want them to take it seriously and try to at least understand you. This is where you have to start if you want to repair things. The quicker you stop defending yourself and accept that whatever you did feels bad to your spouse the quicker your relationship will get back to being okay. 

How about if you are on the receiving end and you are confused about whether you are overreacting or this was the case of a line being crossed? If you feel intimidated, controlled, put down or in any way scared that is a huge clue that whatever happened felt abusive to you. If you have that scared feeling when it's happening or when you think of what happened, whatever happened was probably abusive. Whenever fear enters an intimate relationship it changes the dynamics. You cannot give yourself to someone you in any way fear. Whether we realize it or not we begin to emotionally exit the relationship when this happens. Which is why it's always best to take it at face value whenever these feelings do come up. You feel them period. If the relationship is to continue to grow that needs to be enough.

Taking that leap of faith

In continuing last weeks post on trusting again after an affair, here are some thoughts on what comes next. Let's say your partner has done everything to regain your trust. Through all of the difficult and emotional conversations and fights you feel he or she has been remorseful and tried to make things right. They have been open and transparent, going out of their way to make you see they are not hiding anything and have ended the relationship they had. You feel pretty sure nothing is going on right now and that they wouldn't cheat in the near future. But you don't feel the same way you did before. The way you see your partner is different. And even though it is much more positive than it was right after you found out, things are not the same. The whole experience has changed you and there is no going back to the way it was before. So what do you do? If you really are honest with yourself and step back from the situation there are couple of questions to ask. The first is do you need more time? It takes a very long time to get to the other side of a betrayal this huge. Sometimes years, even when your partner is doing all they can to make things right. It can be tempting to force yourself to be further along than you are. And usually your partner wants more than anything for things to be okay, to be reassured you're going to stay. It may be too soon to give them that reassurance. 

If it has been over a year, or maybe a couple of years, and they have been doing everything that I went over in my previous post, the next question is a tougher one. You have to ask yourself if the trust was too broken and whatever happened may be something you just can't get past. You can forgive your partner but you just can't open yourself up to them the same way. This is a very sad and difficult position to be in. Make sure you have someone you trust to talk through with this, ideally someone who is happily married. If you don't then a therapist or someone in your church or synagogue may be able to help. Part of this question involves being realistic about where you end up in this situation. You're innocence about your spouse never cheating is gone. Replaced by the knowledge that we are all human and fall. That 100% certainty is gone. Which is where the leap of faith comes in. It's you looking at all you know about your partner and making a choice to stay. Knowing you can get hurt again and choosing to be there anyways. In a way it's also trusting in yourself, that you will survive and be okay if the worst happens. And choosing to open your heart to your partner, family and the history you have.

Can you get over an affair?

Most people say to themselves that they would never tolerate an affair. If their spouse cheated it would be over, period. Yet when faced with this situation after having built a life together, possibly a family as well, leaving is not so easy. So is it possible to learn to trust again after being so betrayed? The answer is yes, for most people. Although in order to get through this crisis you need certain things from your spouse or partner. If they are able to give you these things there is a good chance you can recover no matter how unimaginable it seems. For most of us you need four things. The first thing you need is the truth about what happened that makes sense to you. You will never feel 100% certaint that you know the truth because your spouses words may not mean much. That's why the best you can hope for is that what they tell you makes sense and they are willing to give you whatever details you feel you need. Most people who have been unfaithful are very reluctant to reveal details their partner may say they need but I have found over the years that if you really need the details, as painful as they may be, it actually does help. The second thing you need is for the partner who cheated to be willing to do whatever it takes to make things right. Even if they've gone over the same thing a hundred times, even if they feel cornered, as hard as it may be, they are willing to give the wronged person what they need. The third thing most people need after they have been betrayed is transparency. Unlocking phones, access to email accounts, willingness to be open or call if they're late all help to put their spouse at ease. It's important to feel you spouse has nothing to hide. And the final, and in my opinion most important thing, is empathy and understanding from the spouse who cheated. A constant putting yourself in the other person's shoes. Actually imagining if they had done to me what I did to them how would I feel? Can I understand why they would react this way? The reason I believe that last one is so important is because if you don't think they get how you feel about it can you really get over it? Probably not. At best you try an push it away and just have this distance between you. At worst it permanently changes your relationship. Getting through all of this is not easy and can be a long process but the answer for most people is yes you can move on after an affair but only if you get what you need from your partner.