Thursday, February 01, 2024

One Hundred Days: Addressing Our Collective Trauma from this War Against Israel



No words can adequately express our collective sadness and revulsion over the events that occurred in Israel over the last three months. Trauma is defined as a deeply distressing or disturbing experience. Emotional and psychological trauma is the result of extraordinarily stressful events that destroy a sense of security, making an individual feel helpless and vulnerable in a dangerous world. Traumatic experiences often involve a threat to life or safety, but any situation that leaves a person feeling overwhelmed and alone can be traumatic, even if it does not involve physical harm. “It is not the objective facts that determine whether an event is traumatic, but a subjective emotional experience of the event” (Dr. Dawn Apgar).

Initial reactions to psychological trauma can include confusion, sadness, anxiety, and blunted affect. Indicators of more severe responses include continuous distress without periods of relative calm, severe dissociation symptoms, and intense intrusive recollections that continue despite a return to safety (a.k.a. catastrophizing).

Immediate emotional reactions include numbness, anger, helplessness, and denial. Delayed emotional reactions include depression, vulnerability, and anxiety. Similarly, immediate physical reactions include nausea, sweating, shivering, and extreme fatigue. Delayed physical reactions include sleep disturbances and lower resistance to colds and infection.

Trauma can also affect one’s beliefs about the future in terms of loss of hope, limited expectations about life, and fear that life will end abruptly. There are also existential reactions to trauma such as despair about humanity (particularly if the event was intentional as was the October 7th terrorist attack on the citizens of southern Israel). The trauma can also include an immediate disruption of life assumptions such as fairness, safety, goodness, predictability of life, and God’s protection from harm.

Perhaps the worst reaction is hopelessness which is a feeling that the situation will never improve. I recall asking the revered Rabbi Abraham Twerski MD z’l, if he worried about conveying a false sense of hope to trauma victims in his books and lectures and he responded, “I am much more apprehensive about conveying a false sense of despair.”

Seven Ways to Manage Your Feelings and Self-Care

 There is no right or wrong way to react. It is essential that you make space for self-care during this painful time. The triangle-of-health consists of proper nutrition, adequate exercise, and enriching sleep.

The first step is to recognize and accept your feelings as adequate responses to extreme and abnormal circumstances.

Seek support; look for someone who is able to provide a compassionate response.

Limit media consumption. While it is tempting to seek out any information and news, the repeated viewing of tragic and horrifying images is not only extremely harmful but it is slow to fade from memory.

Maintain a regular schedule and take time-out as needed.

Try to avoid getting to a point of feeling overly hungry, angry, lonely, or tired as at those points, you are more at risk for feeling overwhelmed.

Tikkun Olam! Do good things! Give Tzedakah, engage in prayer, and send vital supplies to the IDF or to displaced families. These powerful actions help alleviate trauma. “Remember, if you are having difficulty coping, it is not an indicator of your weakness, but rather a sign of your humanity” (Ohelfamily.org).

Seven Tips to Avoid Catastrophic Thinking

Catastrophizing is when a person fixates on the worst possible outcome and treats it as likely, even when it is not.

1.     Acknowledge that unpleasant things do happen

2.     Recognize irrational thoughts

3.     Say “STOP” to break the stream of thoughts and help change your thinking

4.     Think about a positive outcome rather than a negative one

5.     Offer positive affirmations on a daily basis

6.     Practice cognitive behavioral therapy (CBT), recommended by mental health experts as being effective in this area.

7.     Practice excellent self-care plus stress relief techniques such as: meditation, mindfulness, and journaling (R. Nall, MSN).

  

Phrases That Help Trauma Survivors: Seven Suggestions

This last group of seven tips should assist you in preparing for how to speak with trauma survivors. Your relationship with a survivor can have a positive impact on their recovery, so it helps to know what to say and what not to say.

Instead of “You need to talk about it” try “I’m here to listen if you need to talk.”

Instead of “Things will get better” try “I see and hear that you’re in pain.”

Instead of “It’s time to move on” try “I’m here for you.”

Instead of “Let me help you” try “How can I help you?”

Instead of “This made you stronger,” try “This has impacted you considerably.”

Instead of asking “Why didn’t you tell me sooner?” try “Thank you for trusting me”.

Instead of trying to be inspiring and profound, just say nothing. Sit with them in silence (Amanda Gregory, LCPC).

Let us stand united in our prayer for an end to the loss of life in Israel and the safe return of our soldiers and hostages.

Dr. Alan Singer has been a marriage therapist in New Jersey and New York since 1980 with an 80% success rate in saving marriages on the brink of divorce. He is an Adjunct Professor for the Touro University Graduate School of Social Work and is a Certified Discernment Counselor. He blogs at FamilyThinking.com and serves on the National Registry of Marriage-Friendly Therapists and the Beyond Affairs Network. He authored the book, “Creating Your Perfect Family Size” (Wiley). His mantra is: I will be the last person in the room to give up on your marriage!  dralansinger@gmail.com  (732) 572-2707 

Saturday, February 11, 2023

Approaching Healing with Realistic Expectations



Please don't be disappointed if this essay approaches the topic of healing with a measure of skepticism. From my professional point of view, there may not exist the concept of “complete emotional healing”. When discussing trauma with my MSW students at the Touro University Graduate School of Social Work, I begin the semester by quoting Dr. Sue Johnson (creator of Emotionally Focused Therapy) who states that our role as therapists is to help clients who come to us for help with their “current story” leave our offices with a “new and different story”. Sadly, with trauma (which is often caused by horrific and unimaginable events) clients often cannot leave with a “different story.” Simply put, traumatic events are just not fair. One helpful perspective is that time does not heal, rather people heal with time (author unknown).

 

We're in a Better Place

 Often in couple’s therapy, after a couple of months of weekly sessions, one spouse will ask me, “Dr. Singer, we both feel like we are in a better place than when we started therapy with you months ago. We would like to taper down to bi-weekly sessions rather than weekly.” I am gratified to receive this hopeful and optimistic request. I respond by asking of each spouse, could you describe to me what you mean by “in a better place?” Usually this term means some healing has started to take place and continues forward. There are different degrees of intensity regarding the hurt or injury that needs to heal. Couples often describe communication difficulties that begin because one spouse feels talked down to or criticized or ignored. Healing from that type of behavior takes focus, listening, and attunement. It is quite a different story however, to work with couples in which infidelity is the presenting issue. The healing for infidelity, if you would graph it with an X and Y axis, looks like a roller coaster ride, not a straight line. Infidelity closely resembles Post Traumatic Stress Disorder, and the healing is painstaking and slow. Even a resilient spouse who works diligently at forgiveness can turn around one day and simply say, “Never mind, I quit, I'm through.”

 

Optimism: Look on the Bright Side

 You can be optimistic but also be realistic. Infidelity tends to shake a relationship to its very core and render the marriage hopeless. If the betrayed spouse, having spent significant time in couple’s therapy, considers the cheating spouse to be unforgivable, then this marriage is basically over and done with. Bear in mind that forgiveness is not just a feeling, it is a decision. It is a decision to give up your perceived or actual right to get even with someone who has wronged you. Interpersonal healing requires forgiveness.

 

Comparing Emotional and Physical Healing

 A scar is the body's natural way of healing and replacing lost or damaged skin. According to the Johns Hopkins website, there are several dermatological procedures to minimize scars and choosing what is best for an individual depends on factors such as: age, overall health, medical history, tolerance of medications, procedures, therapies, and expectations for the course of the condition. Physical scars usually fade over time. However, the Johns Hopkins web page includes the caveat that explains treatment can only improve the appearance of the scar. It cannot completely erase it. That’s why I began this essay by suggesting that there may not exist the concept of “complete emotional healing”. Wouldn’t you agree that physical and emotional healing appear to mirror each other?

 

Tips for Healing Emotional Wounds

 Sharon Martin (Licensed Clinical Social Worker) cautions that while emotional healing is possible, not everyone returns to excellent emotional health. Martin points to commonalities among people who heal more fully from their emotional wounds and pain.

First, take baby steps. Dramatic changes are often unsustainable. Making small incremental and manageable changes creates a feeling of success, hope, and encouragement which are vital to carry an individual through their healing process.

 Second, bear in mind that an individual does not need to heal 100% to improve the quality of their life. It is not all or nothing. Even a modest amount of healing will improve the quality of a person’s life. Taking one step at a time will enable the person to notice improvements in their mood and in their ability to cope with triggers, relationships, and self-esteem.

 Third is to have realistic expectations. If we aim too high, we end up disappointed or frustrated - often at ourselves - which does not help us heal. One common unrealistic expectation is expecting progress to move consistently forward. Progress is more often two steps forward and one step back.

Fourth is to prioritize self-care and self-compassion. Work on emotional healing takes considerable energy, time, and sometimes money. Pay attention to the physical sensations in your body such as tight muscles, headaches, and fatigue - because these are your body's way of telling you what it needs.

Fifth is to ask for help! Healing is not meant to be done in isolation. It isn't easy but reaching out for help has many benefits including: emotional support, guidance, and the ability to break down shame. Seeking help is another form of self-care.

In conclusion, Martin suggests some helpful healing “meditations;”

I will seek help from trusted people who can give me guidance, encouragement, and love along this journey.

I am healing one day at a time.

I am learning to let go of what other people think and to honor what I think and feel.

I am learning to make time for rest, fun, and pursuing my own goals.

(And my personal favorite) I am learning to put myself on my To-Do List.

Dr. Alan Singer has been a marriage therapist in New York and New Jersey since 1980, with an 80% success rate in saving marriages of couples on the brink of divorce. He serves as an Adjunct Professor for the Touro University Graduate School of Social Work. He is a Certified Discernment Counselor, coordinates reconciliation for family estrangement, blogs at FamilyThinking.com, and is author of the book, Creating Your Perfect Family Size (Wiley). All counseling sessions use ZOOM. His mantra: I’ll be the last person in the room to give up on your marriage.  dralansinger@gmail.com  (732) 572-2707 

 

 

Sunday, November 13, 2022

Safe Relationships Facilitate Family Well-Being

Hollywood has led us to believe that the fundamentals of a good marriage are: love, passion, infatuation, romance, and chemistry. In my professional opinion, those are the tier two fundamentals. The vital tier one fundamentals are: respect, empathy, friendship, forgiveness, trust, and safety, which is the focus of this essay.

www.Shalomtaskforce.org

Back in the early days of domestic violence awareness and prevention, safety in relationships meant there would be no physical abuse. I had the honor of serving as executive director of Shalom Task Force (STF) for three years. The mission of STF is to combat and prevent domestic violence and foster healthy and safe relationships in families. It is a blessing that from 1994 to 2012 the rate of domestic violence declined by 63% in the United States. Sadly however, according to the CDC, one in four women and one in seven men will experience physical violence by their intimate partner at some point during their lifetime. While most events are relatively minor (i.e. grabbing, shoving, pushing) there are tragically fatal injuries as well.

Early in the DV prevention movement, domestic violence referred only to physical abuse and was defined as any intentional act which causes or threatens injury or trauma to another person by way of direct contact. STF brought attention to three additional types of abuse: 1. verbal and psychological abuse – using words to control, devalue, insult, or criticize another person including yelling and humiliating, which destroys the self-confidence of the victim. 2. Emotional - mistreating a person through use of words or gestures aimed at affecting a victim's self-esteem and frightening and isolating them.

3. Financial abuse is using power to control a partner by withholding money. Examples include restricting access to bank accounts and threatening to withhold money if a partner leaves the abusive relationship.

Digital Abuse

In recent years, STF added several more categories of abuse to raise awareness for the general public. Digital abuse is the use of technology assert control and manipulation by stalking, intimidating, bullying, or controlling a person via a social networking platform. Examples of this include stealing a person's digital passwords, threatening to post inappropriate photos on social media, or mocking on social media.

In recent years, abusers have used apps on their smartphones that are connected to internet-enabled devices in their homes. These apps remotely control everyday objects in the home. These can be used to watch and listen in or just to scare and show power. Even after the partner leaves the home, the devices often remain and continued to be used to intimidate and confuse the remaining parties. Examples of this include a woman who turned her air conditioning to a cool setting, only to find it switched off in the middle of the night for no reason. Another victim said that the code numbers on the digital lock on her front door changed daily and she couldn't get into her house. A third victim told an abuse hotline that she kept hearing the doorbell ring at all hours of the night and no one was there (NY Times 6-23-18).

Religious and Spiritual Abuse

This category involves the practice of someone in a dominant position creating a toxic culture using the bible or religion to control, harass, ridicule, shame, or intimidate another, preventing the partner from practicing their religious beliefs, or using their partner’s religious or spiritual beliefs to manipulate or shame them.

Sexual Abuse: any sexual act or unwanted touch performed without a partner's consent. This includes forcing a partner to send sexually explicit photos or distributing sexually explicit images of one’s partner.

Immigration Abuse: abusers exert power and control over their victims because of their immigration status such as preventing the victim from learning English or communicating with family and friends. Intimidation includes destroying legal documents needed in the U.S. such as passports. Economic abuse - getting the victim fired from their job by falsely reporting that the victim is undocumented.

                                University of Denver’s Four Safeties 


Dr. Scott Stanley, a research professor at the University of Denver, conducts studies on marriage and romantic relationships and develops materials that help people in their relationships. Together with colleagues H. Markman and N. Jenkins, he heads up the team at the renowned PREP (Prevention and Relationship Education Program) which produces materials used in pre-marital and relationship education.

Dr. Stanley and colleagues have delineated four primary areas of safety that are necessary in a healthy relationship. 1. Physical Safety is the bedrock requirement for a healthy marriage. There should be no threat of being physically harmed, nor should either spouse be physically or emotionally intimidated by the other. Domestic violence experts agree that fear of being hurt or controlled by one's spouse or fear that others will be hurt is a red flag in a relationship. The most dangerous patterns involve aggression that leads to injuries and/or ongoing control and intimidation. 

2. Emotional Safety: the comfort to be oneself and feel connected to their spouse. When this is present in a relationship, each spouse can raise concerns and express vulnerabilities without fear of rejection. Scores of studies document that those couples who struggle in marriage and are most likely to divorce, are those who have more frequent and intense conflicts. ‎It is fairly easy to recognize when an argument is escalating or when one spouse is demeaning or showing contempt for the other. It becomes more complex when those patterns wear away at what people deeply desire in marriage. Emotional Safety: being able to be yourself and feel connected to your spouse. When a couple has this, each spouse can raise concerns and express vulnerabilities without fear of rejection.  

Commitment Safety should also be prioritized.

Couples in thriving healthy marriages do not merely have a solid day-to-day connection. They share an abiding sense of having a future together, a sense that provides a secure attachment that is beneficial for spouses and for children. Security about the future is crucial because most people do not invest in something, whether a financial asset or a relationship, without some reasonable confidence in its ability to last.

Community Safety unlike the above three, is not in the sole control of the couple. Rather, it refers to the context of the marriage. Is the environment safe? Are there sufficient resources? Jobs? Healthcare? Is there stress from poverty or anxiety about crime? Are transportation and healthy food accessible? These are far from academic questions for many families and they highlight how important context is for marital health. Think of a couple like a plant. All other things being
equal
, the plant with better soil, nutrients, and mix of rain and moisture...thrives!  Shalom Task Force Hotline: 718 337-3700. National Domestic Violence Hotline: 800 799-7233.

Dr. Alan Singer has been a marriage therapist in New York and New Jersey since 1980, with an 80% success rate in saving marriages of couples on the brink of divorce. He serves as an Adjunct Professor for the Touro University Graduate School of Social Work. He is a Certified Discernment Counselor, coordinates reconciliation for family estrangement, blogs at FamilyThinking.com, and is author of the book, Creating Your Perfect Family Size (Wiley). All counseling sessions use ZOOM. His mantra: I’ll be the last person in the room to give up on your marriage.  dralansinger@gmail.com  (732) 572-2707 


Sunday, April 18, 2021

My Fear That You Won’t Seek Help for Estrangement


                Estrangement is commonly defined as the intentional choice by one or more relatives to end contact because of an ongoing negative relationship. Primarily based on emotions, not facts, estrangement can bring unimaginable heartbreak to families.  

I implore you to seek help if the above describes you, as the numbers are staggering. Twenty-seven percent of Americans eighteen and older have cut off contact with a family member: 10% parent/child, 8% siblings, 9% extended family (i.e. grandparents and cousins).  

A woman living in the Midwest has not spoken to her son and his wife for seven years because she asked her daughter-in-law to bring a specific dessert to a family gathering. The daughter-in-law deliberately brought the same one that the woman had baked. The mother-in-law interpreted the dessert as a symbol of total disrespect (Catherine St Louis, Dec. 2017). 

Another story describes denying access to grandchildren reflecting estrangement from adult children who act as the gate-keeper “middle” generation. Dr. Pat Hanson had been seeing her granddaughter monthly until she was four years old, when her mother separated from Dr. Hanson's son. The mother halted visitation and stopped answering phone calls. Dr. Hanson does not even know their address. She has composed hundreds of letters to her granddaughter (now seventeen), and they are kept in a wooden box. She holds on to the hope that "One day she will want to search for her roots and will look me up" (Paula Span, July 2020).  

Are these cut-offs driven by the expectation that parents, not children are primarily responsible for maintaining the parent-child relationship? Perhaps. Some of the stressful experiences and circumstances that contribute to parent-child estrangement include: psychological abuse/neglect, poor parenting, betrayal, parental incarceration, drug abuse, disagreements, politics, and matters relating to business, inheritance, and money. Other factors include: feeling a lack of support, acceptance, or love from the estranged family member. Sometimes there are differences in values and the feeling that a family member’s behavior is toxic (Lucy Blake 2017).     

Cornell Sociologist Dr. Karl Pillemer adds these pathways to estrangement: harsh parenting, parental favoritism, and parental divorce. Another discovery of Pillemer is that long simmering family feuds may culminate in a "volcanic event". Often when this occurs, one family member declares "I'm done.” People who are estranged feel deep sadness and long for reconnection. Oh, how they wish they could turn back the clock and act differently to prevent a rift. 

Desperately, parents try to maintain contact by making phone calls that are not answered and sending letters, texts, and emails that are ignored. Cards and gifts that are sent for life cycle events are returned to the sender unopened. A common theme for both parents and adult children is loss. Parents lose their voice as they cannot apologize and try to make things right or find out why the estrangement happened in the first place. Adult children feel the loss of family and miss the emotional, financial, and practical support.  

Why try counseling with a licensed therapist? For starters, if you currently have no relationship whatsoever with a given family member, and the goal is to regain “some type of connection”, go for it. The goal is not "all is forgiven"; whatever steps you take to forgive will lift a burden from your shoulders. Dr. Janis Spring explains there are degrees of forgiveness; it is not a black or white decision.   

One goal is to take positive steps toward opening a line of communication. Here is the model that I use when coordinating reconciliation for family estrangement. I firmly establish with the family members that my office is a blame-free zone and a shame-free zone. Anyone who makes disparaging comments or raises their voice will be muted on the Zoom call. Repeat offenders will be placed back in the Zoom waiting room until they calm down. 

Next, I use the principles of Discernment Counseling, which combine solo time with joint-session time. The primary goal is not to fix the issues, but rather to determine if the issues are fixable. I suggest to the person who calls me that they should reach out to their estranged family member with this message: "I’m inviting you to explore the idea of opening communication between us with Dr. Singer acting as a moderator to create a safe space and I will pay for the session. Can the three of us meet via ZOOM and talk about positive change?"

In sessions, I do my best to offer practical advice. I suggest to family members that they should not expect their relative to change to meet their expectations. It is their expectations that may need to change.  

Pillemer believes that time spent waiting for an apology is time that is wasted. He concludes: "Focus on building a new future that can eclipse the past!" Those who are able to reconcile have one main strategy: to abandon the need for the estranged relative to accept their version of the past and apologize. They focus on the present and future of the relationship. They adopt realistic expectations about the other person rather than trying to change them. Reconcilers come to understand their own role, i.e. engaging in self-examination about their own level of responsibility.   

Even unsuccessful attempts to reconcile sometimes lead to greater peace of mind. How so? According to Dr. Pillemer, most individuals felt much better after the reconciliation even if it was not perfect. There was a sense that it might be difficult, but they weren't carrying that "backpack" around anymore; a substantial weight was lifted off their shoulders.  

The Prophet Malachi (3:23) best expresses the hopes of Israel: “Behold, I will send you Elijah the Prophet before the coming of the great and awesome day of God. And he shall turn the hearts of the parents to the children and the hearts of the children to their parents.”

Dr. Alan Singer has been a marriage therapist in NJ & NY since 1980 with an 80% success rate in saving marriages of couples on the brink of divorce. He coordinates reconciliation for family estrangement, is a Certified Discernment Counselor, blogs at FamilyThinking.com, and is author of the book, Creating Your Perfect Family Size (Wiley). All sessions use ZOOM. His mantra: I’ll be the last person in the room to give up on your marriage. dralansinger@gmail.com (732) 572-2707

Thursday, December 17, 2020

Dr. Alan Singer Achieves Certification As a Discernment Counselor


Discernment counseling is a protocol for treating mixed-agenda couples where one is leaning out of the relationship and is reluctant to work on it in therapy, and the other wants to save the relationship. Studies suggest that as many of 30% of couples presenting for couples therapy fall into the mixed-agenda category, and they present a significant challenge for couple’s therapists because our models assume a basic willingness to try therapy and to stay in the relationship for the time being. Discernment counseling is intended for couples who once made a lifetime commitment, whether legally married or not. It’s not for couples considering whether to commit.

Goal: greater clarity and confidence in their decision making about the future of their marriage, based on a deeper understanding of what’s happened to their marriage and each person’s contributions to the problems.

2. A clear distinction between discernment counseling and couples therapy. No couple interventions occur in discernment counseling and no experiential enactments during sessions. The “deeper” work occurs during one-to-one conversations with each partner.

3. Distinctive structure: • Short term: 1-5 sessions. Preferably weekly. A decision made each time whether to meet again. • Two hour opening session. 1.5 hour follow up sessions. Both partners come for all sessions. • Session flow: first part with the couple, then separate conversations with each partner followed by a brief sharing of something learned during the individual time, and then couple together at the end. Confidentiality guideline for individual conversation: the discernment counselor does not share the specifics of what each spouse says, but is free to share impressions and reactions to each spouse when talking to the other. • Insist that both spouses come for each session, even though they each spend part of the session in the waiting room.

4. Focus on decision making about three paths: the marriage as it has been (path one), separation/ divorce (path two), or a six month reconciliation period with an all-out effort in couples therapy (and using other resources), with divorce off the table—and then a decision about the long term future (path three)

5. Use different approaches with leaning in and leaning out partners • Leaning out: Help them make a decision based on more a complex understanding of the marriage and their own role in its problems and potential future • Leaning in: Help them bring best self to the crisis, not make things worse, get what the other spouse is saying, and work on self. 

6. Outcomes: Path three: launching couples therapy (usually but not always with the discernment counselor); Path two: move towards divorce; or Path one: stay on hold for now—neither divorce nor start couples therapy 

7. Study of 100 consecutive discernment counseling cases: 48% chose path three, 42% path two, 12% path one. About 40% of the total sample were still married two years after discernment counseling. Ref. Doherty, Harris, & Wilde (2016)