10 Inevitabilities of Moving Abroad

Just a few months ago, I relocated to Porto, Portugal from the United States. Coincidentally, it wasn’t my first time moving to Portugal. My parents moved to Cascais, outside of Lisbon, when I was 2. Six years later, we returned to the States with my 5 year old brother in tow.

Apart from a short summer trip in 2021, it was the first time I had been back in the country as an adult. I had previously lived in Mexico City and assumed I would adjust easily—not like all those other expats who complained and were entitled, I would be different.

And of course, oh how wrong I was! There are many stressors that go into a move, no matter how nomadic or well traveled you are, but probably the most tolling is the psychological stress and burden of adjusting to a new place and culture, even if the culture doesn’t initially seem all that different.

Here are a few things I’ve noticed in my very short time here so far:

1. The Why of the Move is Incredibly Important, and Something You’ll Have to Remind Yourself of Often.

   “Why am I here?” is something I’ve asked myself, often, and likely you will too. Did you move because you “felt” something kindred about a place you visited? That feeling won’t necessarily go away but it will be tested. If you have an intuition that you are supposed to be somewhere, the best way to discover if you’ll continue to have that feeling is to stay put. That can be hard when things don’t go how you expected them to (they never do) and the initial fantasy of a place wears off. Did you move for a job? For a relationship? When everything seems to be unraveling at the seams, come back to that decision. It must have been compelling enough at the time for you to uproot your life. If it isn’t anymore, can you find another reason that is?

2. Nobody Cares That You Moved to Another Country.

   Put bluntly, nobody cares that you moved abroad. I’ll let you register that for a moment, now think about it again. Of course, your friends and family miss you and probably had mixed and emotional reactions to your decision. But once the people in your life accept that you are moving away, they likely will not think about it as much as you will. The people in your new city will hopefully welcome you, but you will not receive special treatment or kudos for doing something that immigrants do every day. This is something that I suspect may be particularly challenging for Americans who may expect a pat on the back for braving a new country. The truth is, it will not come. What you can do is take pride in yourself, and remind yourself that you are strong for taking such a leap of faith, because you are.

3. Life in the United States is Not as Bad as We Think It is.

   It’s just not. From tax rates to efficiency to Target to cultural, artistic, and economic freedom, we are pretty spoiled. Our country is now going through the most turmoil it has in what seems like a long time, but in terms of accessibility for people to jobs, economic and social mobility, and education; most Americans are quite lucky. Moving to Europe has revealed two harsh truths about myself if nothing else: One, despite owning The Communist Manifesto, I am a shameless capitalist, and two, I am painfully American. Some prime examples: I expect things to happen quickly and efficiently, and when they don’t, I complain and get frustrated. I expect that if I pay enough money, I will get the service I want. I get frustrated when stores and restaurants aren’t open at the times I expect them to be because I expect to live in an economy reliant on workers putting in 12-16 hour days. The list goes on.

4. You Will Feel Like an Outsider for a Long Time.

   This one I don’t have as much firsthand experience with, mostly I think because I haven’t been in Porto that long, but it is something I have heard consistently from friends who have moved to other countries. Depending on where you go, it can be really difficult to infiltrate the social bubbles and norms of a place. Portugal is a prime example of this, particularly in Porto, which is a small city and one where many people stay their entire lives. There is something ethereal in the air of this moody place, that I can’t quite put into words, but that also seems to inhabit its residents. In addition to the almost spiritual connection that people seem to have to each other and the city itself, there is everything else that can be intimidating or isolating for outsiders; most people have the same friends for decades, send their children to the same schools they attended, families are large and close-knit, and people in general are gravely loyal to one another. Porto is probably one of the friendliest cities I’ve ever lived in, but it’s also an easy place to find reminders of the ways in which you don’t quite belong: yet.

5. Adjusting, Like Grief, Comes in Waves.

   The first two weeks are challenging and anxiety invoking, and then there is a blissful “honeymoon” phase. Around the 3 month mark, where I am now, comes another wave of doubt, insecurity, anxiety, and neurosis. Around the 6 month mark I’ve heard, a sort of acceptance comes. And this cycle seems to continue for a long time. Of course, every person is different and life circumstances may render your experience completely different, but generally I think adjusting to a foreign country pushes people out of their comfort zones and into new psychological spaces. If you are learning a new language for example, your thinking will change. Language dictates meaning, so likely your worldview may shift, your beliefs may shift, you may realize that things you thought you wanted you don’t want anymore. And in fact you are grieving something: your old life, familiarity, being close to family, waking up and hearing your native language spoken before another one. All of these things invoke sadness—why wouldn’t they?

6. You’ll Be Tempted to Blame Your Partner for all Your Problems—Don’t.

   This one I may have learned the hard way. If you moved somewhere predominantly for a person, like I did, be forewarned: your relationship will change. Not necessarily permanently or for the worse, but it will be different, especially in the beginning. Because I had my own hang-ups about what it meant to move to a foreign country “for a relationship”, I found it particularly challenging to face how annoyingly reliant I had to be on my partner for everything. So, I blamed him for a lot of the feelings I was having because I didn’t understand why I was having them. When I wasn’t blaming him I was lost in neurosis and anxiety about all of it. I wasn’t able to see that a lot, if not most of the anxiety I was experiencing was because I was in a new place, living with someone I hadn’t before, learning a language, and uncertain about my future. Rather than allowing myself a grace period to feel all of these things I projected them, which is never good. So, if you’re upset remember: talk about your feelings but don’t blame your partner for all your problems. Especially in the beginning.

7. You Won’t Always Want to but You Should: Eat the Food, Drink the Wine, and Say Yes to Invitations.

   Do I need to say more? If you don’t love going out, find people to do other things with. There are people everywhere who like doing the things you like to do.

8. Expect to Break Down in Public.

   This one I would argue is true for most people, even the most calm and organized. In her first year in Porto, a friend of mine found herself in a screaming fight with a stranger at a dog park—bear in mind, she is one of the most non-confrontational people I know, and in over 10 years of friendship, we’ve never had an argument. Just the other day I had what could probably only be described as a meltdown, trying to buy a phone at the Portuguese equivalent of ATT. Stress, frustration, language barrier, things just not going your way, all of that can add up and when it does, don’t be surprised if you wind up crying to your Uber driver.

9. You Will Feel Discouraged but Oh Well, Learn the Language.

   That’s it, learn the language. And similar to number 2, don’t expect people to construct a parade in your honor because you’re learning the language. In the beginning, people may compliment you for it, but eventually they will expect you to to speak their language. Many people speak English in Portugal, but language is one of the best ways to make stronger connections with people, and I think this may be especially true here. Do not expect to learn the language in a few months, or even a year, or by taking one lesson a week. It will take dedication, time, and effort that likely you will not be able to put in 100% or even 50% of the time. Finally, make sure you actually speak it with people, even if they don’t respond to you in the language you’re learning. Keep trying, and eventually you’ll start to have conversations, which is crucial for developing even the most basic language skills.

10. You’re Going to Second Guess Everything but Don’t Move or Make Any Drastic Life Changes Right Away.

    You may be tempted to move again after a few months, depending on your circumstances. Or you may be tempted to quit your job, change careers, get the pixie haircut you’ve always wanted. Perhaps new haircut aside, those other decisions are likely stemming from the anxiety surrounding all the change that’s happening inside of you and around you. When everything is in flux, it can be tempting to try to gain control back by changing something else. But what will you feel about those aspects of your life in 3 months? Or 6? Before you make yet another major life decision, let yourself reap the rewards of the one you just made, even the scary, unexpected ones. It may take some time before you feel like you can actually enjoy the life you’ve created—don’t jump ship before you know what what kind of boat you’re on.

Is Psychoanalysis Making a Comeback?

Cognitive-behavioral therapy has been the de facto therapy modality of the last two decades. Even The Coddling of the American Mind authors Greg Lukianoff and Jonathan Haidt based their entire thesis for their book on the tenants of CBT. Every Better Help advertisement you hear on a podcast will invariably contain “CBT” or “CBT therapists”. CBT became the de facto therapy because of it’s promising efficacy demonstrated in thousands of studies as well as its huge appeal to insurance companies, since CBT is usually time-bound, prescriptive, and structured.

CBT has shown promising results for anxiety and depression as researchers have shown in a slew of meta analyses. Meta analytic research is essentially research on research, where thousands of articles about a topic are analyzed to reveal if pattern exists. There is certainly a pattern with CBT. It reduces acute symptoms including depressive episodes, worrying, and panic attacks, along with many other uncomfortable psychiatric symptoms. Cognitive behavioral therapy is also used for disorders that are more ego-syntonic, and don’t cause as much subjective distress for the client in question, like anti-social personality disorder.

Interestingly, all of that can also said be said for psychodynamic therapy, though it does not get nearly as much attention. In fact, one of the most cited and important meta analyses on treatment efficacy published in the last 10 years found that therapeutic modality did not matter nearly as much as the relationship itself between client and therapist. This idea is actually germane to both psychoanalysis and CBT but as the modality has developed and evolved, psychotherapy became less about the relationship between client and therapist and more about results, technique, and outcomes. This is in part why companies like Talk Space and Better Help were able to emerge and why they chose CBT as the therapy they advertise. If your therapist is actually just a faceless person texting you, the relationship becomes much less relevant and becomes more about the “services” they provide which are supposed to be quick, efficient, and useful. While not convenient, good outcomes from therapy rarely come from simply teaching someone a tip.

Cognitive-behavioral therapy as its core hedges on the assertion that most dysfunction arises from beliefs and negative thought patterns. There is certainly much more to the theory, but put succinctly, CBT therapists believe that if they can teach you how to think and speak to yourself in ways that are more realistic, adaptive, and positive, you will begin to feel and behave more positively. For example, a common question a therapist will use when utilizing CBT is “when x happened, what was going through your mind?” or “what was the thought you had before you had the panic attack? During? After?” This type of technique is actually much more difficult than it sounds, and a good example of why CBT actually requires more training than simply going to graduate school. Most therapists who say they practice CBT are not certified, and while CBT is a major facet of the counseling skills we learn in graduate school, it is rare that students graduate knowing the ins and outs of cognitive behavioral theory and practice which, as it was originally was intended, is complex and requires structured homework assignments after every session.

The reason why these questions don’t always work in of themselves is that it is actually very hard to remember what you were thinking exactly when you felt anxious. And as soon as your therapist asks you to do this, your attention immediately leaves the room and it is harder to attune to how you’re feeling in the moment, which is almost always necessary for any kind of progress in psychotherapy. The theory behind the question is that in order to reduce depression or anxiety, the client must isolate whatever negative thought occurred, and link it to a belief they have about themselves. For example, the thought may be “I don’t want to get out of bed because doing anything is pointless” and the core belief attached to that thought may be “I’m bad, or I’m lazy.” The therapist then challenges the core belief after doing some investigation of where it came from (a critical parent or an early shameful experience) and asks the client to challenge it with them. The usual script goes something like “Tell me all the reasons why you aren’t lazy (looking for evidence to counter-act the belief) and why you’re good.” In actuality Aaron Beck who founded CBT was quite direct, provocative, and pragmatic. He did not actually argue that negative core beliefs are always wrong, but he did argue that repeating them or dwelling on them, was futile and furthered distress. Furthermore he argued, it is just as important that one focuses on the positive about themselves while ignoring or putting less emphasis on, the negative. The problem is that as CBT as evolved, it has become less confrontational and more validating. What if someone who also experiences depression has learned lazy habits and struggles to counteract them? Does this person need to be told they are in fact not lazy, or do they need to be encouraged to value their time more, and challenged to try different habits? For psychoanalysts of course, the question would not be “how do I help this client be less lazy or depressed” but “what does laziness or depression mean for this client?” and “why are they behaving this way?” “What conflicts are present for this client that render them paralyzed from time to time?”.

In the years I have spent practicing psychotherapy I have found that almost every time someone is in distress, the why is more important to discuss than the how. For one, with the proliferation of information online, most clients can find psycho-education materials quickly and easily, which they do. A therapist who simply offers information or suggests solutions is likely wasting time. Of course, there are instances when this approach is appropriate, and I use psycho-education as a technique often, in conjunction with other techniques. Furthermore, the risk in solely taking this approach early on is that invariably when it fails, the onus of failure is placed on the client. Likely the client in the first place did not just need a suggestion that he or she start journaling, or a circumscript analysis of his or her thoughts, but a therapist who is genuinely interested in understanding them and the source of whatever issue they are coming in with. It is not rare that I meet clients who are simply interested in personal development and improvement, but it is rare that these clients stay in therapy for more than a few sessions. For those clients, coaching may be a better overall fit than psychotherapy.

So is it at all that surprising that psychoanalysis seems to be a making comeback? The practice has received heavy criticism over the years for its exclusionary history and high costs. Sessions can cost hundreds of dollars and are recommended multiple times a week, at least for traditional Freudian analysis. The therapist is a ‘blank slate’ and usually only asks questions, with the patient facing away from the therapist (a la the famous couch). Psychoanalysis as a discipline is historically European and upper class—everything about it seemed to, and perhaps still does, scream white, bourgeois, and self-indulgent. However, traditional Freudian psychoanalysis is only one form of psychoanalysis. Others, like Lacanian analysis, feature a more active and engaged psychotherapist. And of course there is psychodynamic psychotherapy, which in practice can resemble a sort of mish-mash of psychoanalytic theory and CBT.

Many of the tenants of psychoanalytic theory hold up today—the power of the unconscious, the importance of discussing transference and counter transference in therapy, the function of defense mechanisms. These ideas, at least for me, have helped me understand people so much more than simply asking them what thoughts make them feel anxious. This is perhaps why students still study psychoanalysis and why there seems to be an uptick in practices that offer it. More therapists are now describing themselves as “psychodynamic” which as described, combines modalities and theories.

CBT isn’t going anywhere anytime soon and will likely remain one of the most popular therapeutic modalities in the history of psychiatry and psychotherapy and it is not the only effective form of psychotherapy. Perhaps we were too anxious to write off psychoanalysis—dare we forget the invaluable impact Freud had just in our linguistics and arguably our collective consciousness. The Freudian slip, the Oedipal/Electra complex, defense mechanisms, the subconscious; these constructs are used in every day conversation. They have arguably shaped, at least in the West, how we think about ourselves and others. Perhaps it is time we return to the source of those ideas, and see what other worthwhile lessons we can find.

What is Toxic Positivity and How Does it Effect our Friendships?

Peruse your Instagram or Facebook for more than 15 minutes, and there’s a good chance you’ll encounter the following sentiment: Say goodbye to toxic people and friends in 2021. The phraseology usually looks like: If someone ever makes you feel bad, that’s on them, and that’s not the kind of energy you need in your life. Sometimes you’ll find this advice summarized in a aesthetically pleasing text-box post on a therapist Instagram page above: ways to promote self- care or resolutions for the new year. Other times you’ll see it described in a front-facing monologue from life coaches, therapists, and celebrities alike. You might even hear it from a friend you are close to or used to be close to: “I don’t have time for negativity.”

These sentiments trouble me for a few reasons. The vagueness of “toxic” and “negative” often appear to disguise what is really being described: emotional suffering. Depression and anxiety—something we all have experienced to some degree—are increasing at clinical levels. Suicidal ideation has been on the rise for years. People experiencing depression often feel alienated and isolated, in part, due to self-blame and self-directed anger as a result of thoughts that promote self-loathing (i.e. nobody likes me). The other reason? We are increasingly alienating our friends and family members who are struggling.   

 We all have experienced sadness and hopelessness at one time or another—and yet, the messaging that we consistently get is that we should be happy, all of the time.

In the last couple of years working as a therapist I’ve noticed one consistent theme that continues to come up in sessions. What I realized was: so many of us don’t know how to tolerate distress anymore. We especially don’t know how to tolerate it when the distress is triggered by our friends. Relationships are not just about celebrating wins and offering validation. If they were, we’d never be able to make meaningful connections with anyone.

Codependency takes active work to battle for many people and in many scenarios it is appropriate to end relationships. For people of color, opting to end racist relationships can be an exercise in self -protection and is necessary for avoiding compounding trauma. We may choose to end relationships because a family member or a friend is consistently and intentionally harming us, if we are being abused, or the other person is unable to recognize and respect our personal boundaries after we’ve communicated them. These decisions however take time to think through and process. There is a social and emotional cost to ending a relationship or friendship. When the decision is arrived at impulsively, it is not unlikely that we may find ourselves in a similar relational pattern down the road with someone else. I’m not advocating remaining in relationships that have lost genuine connection, mutuality, and respect.  What I am asking is: How realistic is it to hold friendships to a higher standard than even our romantic partners? More importantly, what do we lose when we cut off a relationship because someone upset us?  More and more, clients don’t come to me asking for help processing a recent confrontation. They come to me asking how to deal with the repercussions of not being able to confront a person who hurt them.

 Next time you find yourself in an impassioned argument with a friend consider the following questions before you leave the relationship:

1.     Do I think and feel that this person probably won’t change?

2.     Do I want them to change?

3.     What am I bringing into this dynamic? What are my expectations of how the other should act?

4.     How do I feel most of the time when engaging with this person?

5.     Am I simply uncomfortable when confronted by this person or am I feeling anxious, distressed, lonely or scared?

Take some time to sit with some of these questions and consider what they bring up for you. Sometimes the healthy choice is to leave. Often however, it is to be honest and open about what we’re feeling. If someone says something that makes you uncomfortable or defensive, sit with it for a while. It may lead you somewhere important. It’s usually not wise to make any big decisions in our lives based on our comfort alone. The same applies to our relationships.

Why You Should Stop Arguing on Social Media

A couple of months ago I impulsively sent a message to a friend on social media after she posted something I felt was insensitive. I didn’t think my message through. I ruminated about the anger it brought up and pep-talked my way into convincing myself that sending the message was the right thing to do, but I didn’t take a second to think about what I was actually feeling or what my intention was in sending it. The result was that the other person became defensive, which made me feel defensive, and it took a while and a lot of introspection to work out. This exchange still sits with me months later.

The phenomenon of social media has changed the way we communicate forever. It doesn’t have to be for the worse if we can learn how to adapt social media to human exchanges rather than adapting to it. Have you sent a similar text message or DM to someone? What happened? How often do you look back at the messages you sent while you were feeling angry or upset and think “yeah, I’d do it again the exact same way.” You probably wouldn’t. The reason? You were in distress in that moment and when we are in distress it is difficult to communicate our feelings. It’s even more difficult to communicate them when we are restricted to typing out our feelings on tiny screens.

Distress tolerance refers to a therapeutic intervention created by Dr. Marsha Linehan, the psychologist who developed Dialectical-Behavioral Therapy. It sounds simple but is actually more complex than you might think. Distress tolerance is hard. It is not easy to sit with uncomfortable and negative emotions. More and more we are learning to use short- term distractions to manage these feelings. Ultimately however, these strategies fail us.

 Think about the last time you felt upset with a friend. Likely you texted rather than called them, or texted someone else about the conflict. You might have even posted about it on your social media account. You’re feeling hot. Your face is flushed. Many of us are flooded with these or similar physiological reactions when we’re feeling hurt, angry, embarrassed, ashamed, confused, or misunderstood.

When we’re facing these emotions it can be enticing to utilize a distraction that is available to us 24/7: Instagram and Facebook. Usually however it is never a good idea to use social media to offset negative emotionality. Why?

Social media limits our ability to remain present and therefore process emotion

Reactions are inherently heightened because communication is rapid and terse

We cannot empathize properly on social media

Research has shown that within electronic communication dyads, our capacity for empathy is limited. When we attempt to ameliorate our negative emotions through posting a story on Instagram or even texting a friend and not calling, we cheat ourselves out of fully processing our emotions and allowing for full and empathic communication. Instead, we impulsively send a text, turn to social media, and immediately receive an influx of stimuli that triggers more emotional flooding. We are validated by strangers and friends alike, which usually looks like some variation of: you’re right, and you’re the better person. These momentary jolts of dopamine are unmatched however by any negative feedback received that triggers what was likely insecurity and defensiveness in the first place. And so the cycle continues and the end result is that you likely never confronted the person you had an issue with in the first place. Your emotions and reactions were never fully processed, and now you may be facing a rupture or end to a friendship.

Before social media, even texting, when we had issues with a friend or a peer, we had little choice but to face them. Remember those awkward encounters in school or work when you had no choice but to deal with uncomfortable conversations? Now we turn to our phones for validation that we are right, and that the other person doesn’t deserve our time and energy. In the end, we’re more isolated than we were before. Try calling a friend or meeting face to face next time you’re upset. I can guarantee that most of the time you’ll find yourself feeling much better than if you had sent a quick message or DM.

How to Handle Betrayal in a Relationship

Many couples and individual clients come to therapy after experiencing a partner betrayal; it is more common than we like to acknowledge and occurs even between the “happiest” of partners. Why does this happen? And what can we do about it?

For many if not most of the clients I have worked with, more often than not betrayal or cheating behaviors manifest online. This could be recently related to the pandemic—pornography use for example has increased tremendously. Even before the pandemic however I often found myself working with an individual or couple wherein one partner had not actually carried on a physical relationship with someone else. While the betrayal may have only involved texting or sending videos/pictures to one another, the impact on the other partner remains the same and can be tremendously harmful.

At this time you are probably feeling a variety of intense and overwhelming emotions. To make matters worse it can feel daunting to open up to others for fear they will demonize your partner and encourage you to break things off. So, what now? Here are some helpful tips based on my experience as a therapist. These are simply suggestions and are certainly no replacement for therapy; below I have included the best ways to find the right therapist for you and your partner.

1.     Communicate with your partner actively around the betrayal. Scream, yell, fight. That’s all okay. During this period of time express and communicate everything you feel rather than putting on a pretense or using passive aggressive communication. If you’re noticing yourself really leaning into the sarcastic and biting comments—or noticing attempting to “get back” or jab at your partner in passive ways, take a second and take a breath. Notice what emotion is coming up for you. If its anger? Get mad. Let yourself feel and communicate what you’re feeling.

2.      Talk to friends and family and set boundaries while doing so. You may want to leave your partner, you may not, or you may feel torn about what to do next. All of those reactions are valid and common. Your friends and family will want to give you advice and they will blame your partner for hurting you. Just be mindful to let others know how you’re feeling. Sometimes it may be helpful to say something like “Right now I just need you to hear me” or “I haven’t made a choice one way or the other if I’m going to stay in the relationship and what I need is for you to just hear me out. I want to hear your opinion, but I also need to know you’ll be there for me either way.”

3.     Think about what you want, rather than focusing on what others will think. Cheating and infidelity in our society are treated with scorn and so it is likely that at some point, someone will tell you to leave your partner. You may feel judged by others for staying and feel belittled about your choice. There is nothing “weak” about remaining with someone who has hurt you, in fact it is often the more difficult choice. What is most important is not isolating yourself. Talk to loved ones, a therapist, or even a community online. Explore your feelings as much as you can and give them space.

4.     Remember that you don’t have to make a decision right now. You don’t. Neither does your partner. It’s ok to be for a while and see what happens. Take some time for yourself, or yourselves, and notice where your emotions take you. At this time it also may be helpful to contact a professional for couples counseling.

5.     Be honest with yourself about your expectations of your partner. A common result of cheating in a relationship is that one partner will try to find safety and solace in controlling the other one. There are strategies that can feel helpful and connecting for both of you (for example, increasing quality time, checking in throughout the day, communicating more often). If, however, you find yourself checking your partner’s phone constantly, checking your partner’s location/GPS, or restricting your partner’s time with others— try to check in with what you’re feeling. Does the checking behavior really reduce your anxiety? More importantly, is it a realistic and sustainable expectation that your partner can meet all of the time? If no, put a cap on it. Give yourself some time to ‘scratch the itch’ and work on letting go. If your partner is happy to participate in any of the above, talk together about the future and when the expectations will change. You cannot control your partner and truthfully, the only way through is with trust. This requires vulnerability which for you means relinquishing control eventually.

6.     Find a couples counselor. As I mentioned, seeking professional help is always a good option. You can simply search “infidelity betrayal therapy” or “cheating therapy” on Google and likely find someone in your area. You can also find EFT-certified and Gottman certified therapists at https://members.iceeft.com/member-search.php and https://www.gottman.com/couples/find-a-therapist/. Finally, you can reach out to me directly at www.isoldesundet.com/getstartedotday. I practice Emotionally-Focused Couples therapy which helps partners explore their underlying emotions and communicate better.

Is My Partner a Narcissist?

Many of my clients worry that their partner, parent, close friend, or boss is a narcissist. Having a narcissistic personality in your life can be taxing, exhausting, and confusing. So how can you determine if someone in your life is truly narcissistic and furthermore, what are your options in coping with this relationship and navigating many of the issues that may come with having a ‘narcissist’ in your life?

A helpful first step is understanding what subclinical narcissism is vs. the psychological disorder that is diagnosable. Narcissistic personality disorder is a personality disorder and it is rare. Narcissism however as a personality trait or construct, is common. In fact healthy narcissism refers to the degree that we all are narcissistic; evolutionarily speaking, it is beneficial for us to worry about ourselves.

When narcissism is malignant or when someone truly suffers from NPD, their actions can have a profound effect. If you have ever dated someone with NPD you may have felt belittled, ignored, gaslit or manipulated. You also may have felt inextricably drawn to this person. People who are narcissistic tend to attract those who want to elicit closeness from them. You may have felt elated and infatuated with you partner during some periods, only to feel isolated and lonely in the relationship the rest of the time. If you suspect your partner may suffer from NPD, consult the clinical definition of the disorder below. The DSM-V or Diagnostic Manual of Statistical Disorders is what therapists, psychologists, and psychiatrists use to diagnose personality disorders. There are 9 traits associated with narcissistic personality disorder and to be diagnosed, a person must meet at least 5 of the following criteria and they must be present consistently for at least one year. Finally, it’s important to remember the limitations of this diagnosis. For example, the majority of research on this personality disorder has been conducted with young, white, college students.

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

4. Requires excessive admiration.

5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).

6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).

7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

8. Is often envious of others or believes that others are envious of him or her.

9. Shows arrogant, haughty behaviors or attitudes. 

Look out for a following post in which I’ll discuss ways to cope with a narcissistic personality. If you are worried that your loved one is narcissistic, you can always seek therapy for yourself or couples therapy to help your relationship. You can head here to schedule an appointment with me, or you can consult the following websites to find a therapist in your area: zoc doc, psychology today, zencare.

So You Want to be a Forensic Psychologist…

What is involved in becoming a forensic psychologist and/or psychotherapist and what do I need to know and do to become one? For starters, the only difference between a “forensic psychologist” and a “psychologist” is what kinds of clients you treat and where you work.  The title of “forensic psychologist” is not regulated or official, so theoretically anyone can call themselves a “forensic psychologist” that is a licensed psychologist. Generally, what this title refers to is experience and training that someone received either in their program or in clinical work post-graduation. The same applies to forensic counselor/therapist/psychotherapist/clinician.

Ph.D. vs. Psy.D.

A psychologist is someone who has a doctorate degree in the following areas: clinical psychology, counseling psychology, school psychology, community psychology, and health psychology. The main programs you will see are Ph.D. programs in clinical and counseling psychology. You will also see Psy.D. programs in clinical or sometimes even “forensic” psychology. What is the difference between a Ph.D. and Psy.D.? A Psy.D. can do all the same things a Ph.D. can do. The difference is in prestige and cost. Psy.D. programs will still award you with a doctorate degree and the ability to get licensed with the added inconvenience that the vast majority are infinitely more expensive and there are rare opportunities for funding. Due to lack of funding, they are much less competitive than Ph.D. programs; a cohort in a Pys.D. program may include 100 students whereas a Ph.D. cohort will average about 5. Two exceptions (and they are still pricy) are Rutgers University and Baylor University; both are renown Psy.D. programs. To the contrary, most clinical Ph.D. programs are fully funded and offer teachers assistantships to doctoral students. While you certainly will still have to live off a measly stipend, you also won’t be forced to take on hundreds of thousands of dollars in student loan debt.

Psy.D. programs emphasize clinical training over research. If you want to work as a professor or publish research in the field of forensic psychology or criminology, a Ph.D. makes more sense to pursue. Contrarily, if you want to work as a prison psychologist, pursuing a Psy.D. may be the more prudent option.  With both degrees you can still become a licensed psychologist as long as you attend an APA accredited program. It is possible to get licensed after attending a program that is not APA accredited, but it will be more difficult.

Counseling Psychology vs. Clinical Psychology

Within the PhD. world, you can opt between clinical and counseling psychology.  Counseling psychology Ph.D. programs are newer and generally there tends to be more emphasis on environmental factors and social justice. They are mostly fully funded and can be equally as competitive as clinical programs, though some counseling Ph.D. programs may be slightly less competitive. Many counseling Ph.D. programs are school/education focused. Some schools offer both degrees. For example, Teachers College at Columbia University offers both counseling Ph.D. and clinical psychology Ph.D. tracks.

A Ph.D. in clinical psychology is generally considered the most rigorous trajectory and they are extremely competitive (7% or less acceptance rates in most programs). Many people with Ph.Ds. in clinical psychology work as psychologists, researchers, and academics.

Working as a Forensic Psychologist with a Ph.D. or Psy.D.

Forensic psychologists can work as psychologists or clinical directors in jails and prisons. Many work in private practice and complete evaluations for the court. These evaluations include psychosexual evaluations which are generally used to determine risk for sex offenders, competency evaluations (to determine if someone is mentally fit or competent to stand trial/take a plea), or custody evaluations to determine suitable guardianship. Many forensic psychologists testify in court and are hired by either the defense or the prosecution. Sometimes they are subpoenaed by the judge directly if, for example, one of their clients re-offends while in treatment. Other forensic psychologists solely publish research. It is important to note the distinction between forensic psychologists and “psychological profilers.” The vast majority of profilers start out as FBI agents to my knowledge, and it is a vastly different career trajectory with different requirements.

Forensic Counselor/Psychotherapist

You don’t need a Ph.D. or a Psy.D. to work with offenders but if you want to testify in court and/or work in evaluation/assessment, it is better to have a Ph.D. or Psy.D. (Texas has an exception to this with what is called a Licensed Psychological Associate license). If you want to do clinical work with offenders in a jail, prison, or clinic, your best option is pursue a master’s degree and subsequently licensure. There are many options here. You could pursue a social work degree and get licensed as a LMSW/LCSW or you could pursue a master’s in counseling degree and get licensed as a licensed professional mental health counselor. What can you expect from working as a ‘forensic counselor’? There are many different career trajectories or jobs available. One benefit is that you will always be in demand. At least for the foreseeable near future, there will always be jobs available in prisons, jails, and with mandated clients in community mental health settings. It is important to consider that working in this field (as a psychologist or a therapist) means that 90% of your clients will be mandated. They will be required to go to therapy by a judge, lawyer, or even warden if they want to stay on a certain prison unit in a correctional facility. A lot of your job will be spent exploring why someone does not want to be there and demonstrating how and why treatment is helpful. A good deal of your time will be spent facilitating group therapy. Groups have been shown to be more clinically effective for mandated clients than individual work, and make up the bulk of treatment in most clinics, agencies, jails and prisons.  Some groups will be manualized unfortunately, but if you find the right clinic or agency, you will have the opportunity to provide more “process” oriented group therapy (wherein there is no manual and you’re working more clinically than didactically). You can also work in an agency or clinic that specializes in sex offender treatment, domestic violence treatment, or criminal rehabilitation. 90% of the therapists will be masters-level and you may work with one or two psychologists and/or psychiatrists on a treatment team. The clinical directors are more likely to have doctorate degrees, though this is not a requirement necessarily and there are clinical directors with masters degrees. As a masters level ‘forensic’ counselor, you will likely get to administer some evaluations or assessments, but not many, and most of them will be under the supervision of a licensed psychologist. You will not be able to make a living (for the most part, there may be rare exceptions) as an expert witness. You will have the option, once you’re licensed, to open your own private practice, where you can see mandated clients if they’re approved by their lawyer, probation officer, or whoever is overseeing their mandated therapy requirement.

I worked for 3 years in an agency treating and, in some cases, performed assessments with people who have committed sexual offenses. Prior to my work with sex offenders, I worked as a mental health liaison and advocate to a criminal court and prior to that I worked as an intern at Rikers Island Correctional Facility. I still work with people who have committed offenses in private practice though it is no longer the bulk of my clinical practice. If you have any questions about my experience and training, or just general questions about this kind of work, please feel free to reach out to info@isoldesundet.com .

What to do When You Want to Cheat on Your Partner

To preface: fantasizing, having a crush on, or flirting with someone who is not your partner is not the same thing as an affair. In my opinion, fantasizing or understanding your relationship to, what sex and relationships expert Esther Perel calls “the third” is healthy. At the point that these thoughts and feelings grow strong enough that you are noticing them impacting your relationship however, it may be wise to examine what is happening. For those of you who are thinking about or have had sex outside of your ‘primary relationship’ and are feeling conflicted about your actions, the goal here is to understand yourself and your desires better.

Ask yourself the following questions and try to practice honesty and openness to your reactions, whatever they are.

Do I want a monogamous relationship with my partner?

For most people who think about sex with others or have strayed outside of the primary relationship, the answer is yes. If the answer is no, it may be time to reevaluate what you want from your partner. Whether that means staying together in a non-monogamous partnership or separating, at the very least communication about needs is paramount.

What is involved in my fantasy of the other?

If you are thinking about cheating on your spouse/partner: what specifically is involved in this fantasy? If it is purely sexual, what or who is involved in that sexual fantasy? If it is sexual and emotional, or purely emotional, what would it feel like to receive attention from someone else? It may be helpful to consider: do I want to feel wanted by someone else independently? Or perhaps do I actually want my partner to know that I am desirable to someone else?

When do I feel the most fulfilled/’alive’?

Sometimes the desire for sex with someone who is not your partner is indicative of a deeper desire for novelty, overall, in life. Think about the times in your life when you felt the most joyful, carefree, and invigorated. Likely these moments involved doing something you love or being with the people in your life that you love the most. Will sex—independent of anything else—fill this craving or desire? Maybe, or maybe not. At the very least it is important to consider what it is that you are hoping to accomplish, or what it is you are hoping to feel.

Once you get clear on the answers to the above questions, consider how you might feel after straying outside of your relationship as well as how you might feel if you choose not to. It may be helpful to really sit with whatever thoughts and emotions come up. It’s not helpful to judge yourself for whatever internal response you have—remember thoughts and feelings are just that, thoughts and feelings. Often they have nothing to do with what we actually want to do, or what we choose to do. The goal here is not to assume that our thoughts and feelings dictate our desires, though they will inform you about what is going in the present moment. Now that you have considered how you would feel in both scenarios—consider how long this feeling would last. Maybe you identified that if you spent time with someone else outside of your relationship you would anticipate feeling excitement, feeling alive, feeling desired. Now consider: how long would that feeling last? If you have already initiated a relationship—how long might these feelings continue to last?

Reflect on these questions and your desire for monogamy with your current partner. If your dissatisfaction is really more about you than your partner, as it is for many people, it may be helpful to consider what you can change in your life that doesn’t involve secrecy. Perhaps this means expanding solo/independent activities and expanding your sense of self confidence and agency outside of your partner. It may mean traveling on your own for example—not to have an affair, but to reestablish your independence and yes, desirability outside of your relationship—physically, intellectually, and emotionally. We all want to be desired by others who are not our partners and simultaneously most of us do not actually have affairs. What may seem contradictory is actually complimentary—it is the act of choosing our primary partners every day while also acknowledging our own desires, needs, and fantasies that defines intimacy. The goal is to be able to effectively communicate our needs to our partners.  

Sometimes the desire may be for the relationship to end, or for the freedom to pursue a relationship with someone else. For some people affairs reflect a deeper, at times even irreparable conflict in the primary relationship. Returning to the question of what you want and how you feel about what you want, is one of the first steps in understanding desire, motivation, and ourselves, better.

What is Co-Dependency, Really?

Like ‘gas-lighting’ co-dependency is one of those terms that can take on a myriad of different meanings depending on who you’re talking to.

In pop culture and in every day conversation “co-dependent” is often exchanged for “needy” and is incorrectly used to describe relationships that are actually enmeshed, not co-dependent.

Codependency as a psychological term originated in alcoholism and addiction treatment when counselors began noticing a trend with people seeking help for substance abuse. The people struggling with addiction tended to be married to or in relationships with people who were not alcoholics or addicts. Within these relationships, the non-alcoholic often took up the role of caretaker. Subsequently, a theory emerged that the non-alcoholic was essentially ‘addicted’ to the role of being the one that the alcoholic depended on, hence the term co-dependence.

Researchers began studying co-dependency as a behavior and also as a personality construct. Some researchers posited that people who are co-dependent share similar traits. Partners and spouses of alcoholics tended to be quite functional themselves. Many were successful, high-achieving, and described as “having it all together” at least in the eyes of the people around them. They also tended to struggle with identifying their own feelings, while at the same time demonstrated an uncanny ability to understand and attune to the emotions of their partners. Sometimes they enabled their partners through attempting to mitigate the harms that arose from drinking and using (covering and/or lying for them for example) and sometimes they made no such effort, and condemned the addict’s behavior, while remaining in the relationship. Despite describing the relationship as one that was ultimately disappointing, most stayed. Many talked about wanting more from their partners, who could be unreliable or emotionally unavailable. Others felt manipulated or abused but also struggled with ambivalence around leaving their partners.

The interesting quandary for people in co-dependent relationships is: why stay? For people who are co-dependent, there is often a (usually unconscious) avoidant attachment style. The partner’s addiction makes it very difficult for them to reciprocate emotionally, physically, financially, and this power differential can feel familiar to someone who is uncomfortable with intimacy, struggles to ask for they want directly in a relationship, or who fears that closeness will inevitably cause hurt.

Co-dependence is about “fixing” the other so that we may avoid our own feelings. Some people who gravitate towards the role of co-dependent experienced alcoholism and/or addiction in their own families. People who grew up with an alcoholic parent or guardian sometimes find themselves in romantic relationships with partners whose behavior mirrors that of the authority figure from their childhood. Like personality structure, human behavior tends to remain relatively consistent throughout the lifetime, and is shaped by early experiences. If early on we learned to adapt to a parent that was inconsistently emotionally available, when we enter adulthood and meet partners who can’t meet our needs the instinct is not to leave, but to enter a relationship that may feel disappointing but may also feel familiar, connecting, or even safe.

If you feel you would benefit from learning more about co-dependency, or are currently in a relationship with an alcoholic or addict, head to Al-Anon (https://al-anon.org/) and Adult Children of Alcoholics and Dysfunctional Families (https://adultchildren.org/) to learn more and find support groups in your area.

Social Anxiety on a Date

Now that dating often means meeting complete strangers in public, more and more clients come to me looking for help coping with social anxiety on dates. Social anxiety is a specific form of anxiety that refers to a fear, discomfort, or pervasive worrying when socializing or being around other people. Typical social anxiety symptoms include worrying about how one looks while eating, or feeling so anxious that conversation can feel next to impossible. Here are some suggestions on what to do the next time you feel socially anxious on a date:

1. Beware Your Thoughts—They are Not Fact

   Social anxiety is driven by our thoughts. Thoughts like “I sound stupid”, ” I’m awkward” or “They’re not going to like me.” These thoughts inhibit good risk taking behaviors and suffocate personality. It’s really hard to be yourself—even your “first date” self, when your brain is shouting mean things to yourself, about yourself. Step one: notice your thoughts and vow to silence them as best you can while on your date.

2. Focus on the Other Person

   It sounds simple but active listening is harder than it seems. If you’re experiencing anxiety and having trouble shutting down negative thoughts try to focus intently on what your date is saying. Notice how they carry themselves, how they’re dressed, or any interesting idiosyncrasies in their behavior. When we focus on someone else we ultimately find something that interests us, which in turn spurns connection.

3. Don’t Think About the Future Just Yet

   People who struggle with social anxiety while dating often become distracted during dates thinking about the probability of a second. Ruminating about what the other person may or may not do is futile. As soon as you start noticing these thoughts redirect to focusing on what is happening in front of you. With the goal of remaining present, put your phone away. Try other simple actions like taking time to notice your surroundings. If you’re in a restaurant, what is the decor like? What does the food taste like in your mouth? Noticing what’s happening in the here and now keeps you in the present and ultimately will help you redirect your attention to your date.

4. Tell the Other Person You’re Nervous

   Leading with vulnerability is one of the easiest ways to soothe any tension real or imagined. Very few people feel NO anxiety on dates. Some nervousness is normal and should be expected—it speaks to our humanity rather than to weakness. Tell your date you’re nervous and see what happens. Social anxiety is common and talking about it helps people connect.

5. Overwhelmed? The Bathroom is Your Friend

   If your social anxiety is causing physical symptoms or simply becoming overwhelming, respite awaits in the bathroom. If you’re sweating for example, take some deep breaths and utilize the hand dryer. Deep breathing is one of the best ways to regulate your temperature and heart rate and will immediately bring some relief. Once you’re calmer, remind yourself that the worst has passed and all that’s left is some food and a conversation. Remember to take the pressure off of yourself. The ultimate goal of dating is to connect, and it is difficult to connect when feeling internal or external pressure.

How to Find a Therapist

Step One: Write Down a List of Criteria

Write a list of what you’re looking for. Preferences do matter. Do you want someone in-person or virtual? Do you have a preference for gender, race, other identity? Or, are you looking for someone with a particular speciality? Write down whatever comes up for you and use this as a roadmap.

Step Two: Insurance, Private Pay, or Out of Network Benefits

Decide: Are you going to use in network Insurance, pay out of pocket or utilize your out of network benefits? Some insurance plans reimburse patients after meeting a deductible for out of network providers. Call your insurance company and ask about out of network (OON) benefits or go to https://headway.co/insurance/form to determine what kind of coverage you have. If you decide to pay out of pocket, what is your budget? Decide on a number or a number range, and go from there.

The single largest barrier that folks encounter when looking for a therapist is insurance and payment. More and more therapists are refusing to take insurance due to low reimbursement rates, making it very difficult, particularly in larger cities, to find a therapist who takes your insurance. If you cannot afford private pay, consider asking potential therapists if they have a sliding scale. A great resource is www.openpathcollective.com which is specifically for clients looking for therapists with sliding scale openings.

Step Three: Schedule Consultations

Schedule at least 2 or 3 consultations, even if certain websites don’t make it easy. Rather than booking an appointment, try to find the therapists contact info (if you can’t find it google it) and reach out for a consultation. Almost all therapists offer free consultations before scheduling sessions. You can do this using the following websites and companies that match therapists to clients:

www.zocdoc.com

www.zencare.com

www.headway.co

www.helloalma.com

www.psychologytoday.com

Step Four: Go to Your Consultation with Questions

Remember it is really important that you like your therapist and feel comfortable talking to your therapist. It’s also important to understand the type of therapy your counselor offers as well as logistical considerations. For example, if you have a busy work schedule, does your therapist offer other times to re-schedule during the week of your appointment? Here are a few sample questions to bring in:

1. If you are looking for a therapist with a particular speciality, ask! What is their experience?

2. What kinds of people do you see? Who are you passionate about working with?

3. What is your cancellation policy?

4. What has your experience been like in working with people on x?

5. What would you consider to be good goals given what I am looking for help with?

It is vital that you and your therapist agree on what the goals of therapy are. Sounds simple, but more often than one might think, what we call ruptures (significant disagreements or impasses in therapy) occur because therapist and client may have different ideas about what progress looks like and how to get there.

Step Five: Schedule (and go) to a Session

The final step: schedule a session! Remember, it’s okay to have a session or a couple of sessions with a therapist and return to the drawing board if you still feel like the relationship is not right. Check in with yourself: Do I feel comfortable with this person? Do they challenge me? Am I hopeful about therapy? All of these honest questions will help guide you find the best therapist for you.

How to Cope with an Avoidant and Anxious Attachment Style

Do you strategize about how to keep your partner close? Do you feel anxious when things are going well? Over-analyze your partner’s behavior to the extent that it makes it hard to feel present in your relationship?

The above may indicate an anxious attachment style though many people with “secure” attachments and even avoidant attachment styles experience abandonment anxiety associated with closeness and intimacy. If you overthink, contemplate disaster, and feel anxious in relationships, it’s likely that what you are actually fearing is loss. Intense fear of loss and separation is often associated with a history of neglect and/or abuse in childhood. Even if your experience does not include a history of trauma however, it is likely that you are familiar with the gut-wrenching dread that comes when we feel rejected or abandoned.

In the early stages of a relationship ambiguity can easily be interpreted negatively. Fear of abandonment involves thinking the worst. Rather than imagining a relationship growing closer and more fulfilling, people who fear abandonment contemplate all the ways their attachment to their partner could be destroyed.

In working with many folks with anxious attachment styles, I have compiled a list of some of my go-to coping responses when feeling anxious in relationships.

Learn to Regulate Yourself

This is one of the most powerful tools for handling anxiety in general, and I have found it particularly helpful to remind clients to do this when feeling anxious in relationships because the go-to is often to approach your partner for reassurance. Before doing so, ask yourself what you can do to regulate your anxious response in the moment. Go for a walk, call or text a friend, exercise, anything to help distract you from ruminating and doing something impulsive.

Own Your Feelings as Your Own, Rather Than Projecting

It’s easy to assume that our partners are feeling the same way we are and often that can propel feelings of anxiety and discomfort. Many of the couples I see in therapy project their emotions on each other without realizing it. If one partner is feeling anxious in the relationship it is common for that partner to accuse the other of being non-committal or distant. “I’m feeling anxious” translates to “You are trying to leave me.” Accusations breed defensiveness, which breeds conflict. Understand that your emotions are valid, and while you may not be alone in experiencing them, your partner is not responsible for your emotional well-being. Your partner is responsible for regulating their own emotions which will hopefully result in treating you with care and consideration.

Imagine the “Worst-Case” Scenario

Often the worst case scenario I hear from people is “I would lose my partner” or “we would break up.” Truthfully however most of us have gone though a breakup, or experienced a loss, and got through it with the support of people in our lives. For a moment, picture what life would be like without your partner. Where would you live? How would you spend your time? What would you do? How would you feel? Construct a narrative around the possibility. Did the world end or did you cease to exist? Probably not. Remember, there is a difference between imagining the worst case scenario intentionally and ruminating. The goal here is to be as realistic as possible and then remind yourself that the worst case scenario does not have to equate to doom and most importantly, that you are capable of surviving it.

Talk to Your Partner and Get the Response You Want

One of the best ways to cope with fear of abandonment is to have an open conversation with your partner. It is vitally important that you understand your intention in broaching the subject, as well as contemplate your expectations before you do. It is not appropriate to expect your partner to respond the way, say, a therapist might. Think about what you are hoping to gain from this conversation. If you are looking for reassurance, be explicit in requesting that from time to time you need to be reminded that your relationship is on steady ground. If it is emotional connection, provide positive feedback when your partner is open and vulnerable. It’s also okay to not expect or even hope for a particular response. Sometimes it feels comforting enough to verbalize anxiety and move on.

What I Learned Going to Therapy as a Therapist

n therapist jargon we have something called “self-disclosure.” Self-disclosure refers to the therapeutic technique of the therapist disclosing something personal in session. The goal is often to build rapport, or universalize a client’s experience. Other times it’s to help clients who struggle with emotional connection to build empathy and compassion. When done incorrectly however it can make clients feel awkward or worse, unheard.

Years ago when I worked for a private practice one of the things a client shared with me when I left is that while he felt our work together was very helpful, he had realized in our last session that he had “no idea” who I was as a person. Since then I have tried to bring more of my personality into the room with clients. My hesitation is partially due to fear of alienating clients but also a learned occupational hazard—most of my clinical training took place with mandated clients where strict boundaries were necessary.

In my own practice I have found myself sharing similar self disclosures with clients. I have disclosed that I myself was in therapy and recently, found myself sharing experiences with that therapist that I found helpful. I have realized that sharing what I learned in my own experience as a client, and contextualizing what I learned, has been a powerful thing.

I’ve been pondering my relationship with my therapist—who is also a colleague—and how our relationship ended. I think one of the hardest things to do is end a therapeutic relationship, even if the time has come and there isn’t much more to explore in therapy. Personally I detest goodbyes and have a hard time letting go of people and the way I left therapy is a clear reflection of that. I discovered a relationship pattern of mine that played out in real time while I was in therapy and that I did not want to face at the time. I’ve learned that anything my therapist said that really bothered me, or that I felt was wrong, had at least a kernel of truth in it. This is not to say therapists are always right (because a lot of the time they aren’t) but my therapist did see things that even I was reluctant to admit to myself. Even if I was misunderstood by her, it was nearly impossible for me to articulate this in a way that was direct and made sense. That’s the other thing I took away from therapy. That so much of relationships are about simply stating what it is that you want and what you feel regardless of how the other person reacts. I feared her judgment but more importantly, didn’t trust my own. She taught me again and again to trust myself.

I learned its pretty hard to get anything out of therapy if you’re not consistent. I learned that avoidance takes active effort to combat and that no therapist, no matter how astute, can read your mind or know what you want more than you do.

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The Problem with Dating Apps

I talk about dating apps with my clients about once a week, sometimes more. Most of my clients live in New York City or Austin, TX and many of them are single and braving the world of online dating. Interestingly I hear the same complaints from my clients who are looking for serious relationships as my clients who are interested in more casual relationships which is: I’m not satisfied.

We all have married friends who have met on Tinder, Bumble, Grindr, or Hinge. Niche apps that target a specific audience are becoming more and more popular. Raya is the “exclusive” app that at least in the past, attracted celebrities and influencers. Jdate helps Jewish people find relationships. Match.com is for our parents, and LOOSID is for people who don’t drink. Of course the idea behind these apps isn’t really new. Black People Meet and Farmers.com are websites that have been around for decades. But while dating websites have existed for years, dating apps have taken off in the past 10 years and now are probably as common as owning an iPhone or using Instagram. Even if you’re currently not using an app, at some point you probably created a profile.

I’m not against dating apps. I’ve used them. I encourage clients to get on them just as much as I encourage clients to get off of them. To explain what I mean: I encourage the use of dating apps often for folks who are avoidant, or tend to be judgmental of others. Dating apps is a great way for some people to work on their social anxiety or meet people after moving to a new city.

What I have noticed is the probability that something gets lost when we only meet people online. Expectations become baked in for short encounters with strangers. Approaching every first date with the thought could this be my person? gives everything and everyone such gravitas, and not always in a good way. Suddenly the date becomes more about our own feelings and experience than getting to know the person in front of us. Filtering on apps eliminates the chance that it will be anything close to organic. I used to think people were being judgmental and short-sighted when they would write someone off after looking at a profile or going on a date. Now I wonder if their judgment is simply astuteness. If we’re only going on dates with people who are around our age, live in the same city and even the same neighborhood as us, use the same dating app, attend similar colleges and do similar activities, maybe our sense of familiarity is earned. Familiarity can be great but it can also make things that much more disappointing when we walk away feeling empty.

My practical advice is to do a bit of everything. Meet people who aren’t like you. I encourage many clients to join a sports league , go on an adventure , or do something solo. Dating is hard enough and doing it online has made it both more convenient and excruciating simultaneously.

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How to Cope with a Panic Attack

Keep in mind, not everything on this list will work for you or is necessarily your best go-to coping skill. Take the ones that you think will help and disregard the ones you don’t.

• Call a trusted family member or friend and tell them what’s going on.

• Text someone and ask them to tell you something funny or intersesting to distract you.

• Take 10 really deep breaths in a row.

• Notice everything around you that starts with the letter A, then continue with the alphabet. Name at least 5 things.

• Do an inventory of your senses. What are you seeing/hearing/touching/smelling/tasting?

• Take a shower.

• Listen to a podcast that brings you joy.

• Do your makeup or get ready, even if you’re not going anywhere.

• Make some food. Go out to get some food.

• Lay down and think about a scene or a memory that makes you feel relaxed.

• Accept that you are feeling anxious right now and that it will eventually pass.

• Go for a walk.

• Masturbate.

• Text someone to meet up for a walk, drink, movie, etc.

• Exercise.

• Go to a yoga class.

• Just go outside.

• Plan a vacation/plans for the next weekend.

• Get a massage.

• Sleep.

• If you have a dog, give it a bath.

• Play loud music.

• Go to you favorite restaurant or bar, even if you’re alone.

• Go to your favorite Instagram page.

• Watch stand-up comedy.

• Play a video game.

• Call a crisis line to talk to someone.

• Call your therapist.

• Read.

• Go sit in a church.

• Pray.

• Meditate.

• Write a letter to yourself or someone else.

• Journal.

• Download Duo Lingo and start learning a new language.

• Go get your nails done.

• Get your hair done.

• Make a list of 10 things you would like to do before you die.

• Online shop.

• Go to a store.

• Go to a museum.

• Google free things near you and decide which one you would like to do.

The goal of these coping skills is not to eradicate all of you distress, it is to make the negative feelings less overwhelming. If you can distract yourself enough to get some relief from the intensity of the pain you’re in, you will be able to process your emotions easier and work through them.

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Is it OCD or an Intrusive Thought?

What is OCD?

If you’ve ever wondered if you are living with obsessive-compulsive disorder, you are not alone.

Almost all of us use the term “OCD” colloquially in conversation and yet few people understand the difference between having an intrusive thought or a strong penchant for cleanliness and living with a diagnosable condition like OCD.

Obsessive-compulsive disorder is a condition that can manifest differently depending on how symptoms present and are experienced by an individual. For someone to meet criteria for diagnosis, they must experience either obsessions or compulsions or both. Furthermore the obsessions and/or compulsions must be significantly time-consuming and as is the criteria for any psychiatric diagnosis, must cause clinically significant distress and/or impairment in crucial areas of functioning (think work, school, relationships). If a person does not experience impairment in any functional areas, subjective distress (i.e. feeling anxious, depressed, or fearful as a result of symptoms) must be present.

Some people who have OCD only suffer from obsessive thoughts, images, or impulses and don’t experience compulsions. Other people experience both. Compulsions are behaviors associated with OCD that feel out of one’s control and are repetitive and ritual-like in nature. Sometimes compulsions can manifest as mental acts. For example, a compulsion can include something like hand-washing, but also encapsulates behaviors like counting, repeating words, or checking to see if an appliance is working. Often compulsions are related to obsessions. For example, an impulse may be to imagine a specific scenario (even if the person does not want to do so) and a related compulsion may be to imagine that scenario a certain number of times while simultaneously repeating specific words.

Sometimes obsessions or impulses are sexual in nature and for many people, include sexual taboos or images that cause significant distress, ranging from imagining a family member engaging in a sexual act to imagining harming children or animals. These thoughts foster intense shame for the very reason that they are unwanted, and yet many people assume these thoughts reveal a buried desire or conflict, which only further entrenches feelings of shame and alienation. While it is natural to wonder if our thoughts are clues to some unconscious desire, more often than not intrusive thoughts have nothing to do with our actual desires or intentions. OCD is an ego-dystonic disorder which means that symptoms are often at odds with desires, goals, and wishes. Subsequently, the emotional toll that comes with OCD is often deeply distressing and exhausting. Thankfully, there are many evidence based treatments for OCD that are extremely successful and that I will outline later.

What differentiates an intrusive thought from OCD?

Have you ever had an impulse to jump in front of a subway before your morning commute? Most of us have experienced some version of that thought or impulse, however fleeting. For an individual living with OCD, the thought or impulse does not simply go away when the subway arrives. The thoughts or impulses remain, and the desire to push them away increases just as intensely. So what characterizes an intrusive thought? As I mentioned in the subway example, most people have experienced some form of an intrusive thought. Intrusive thoughts tend to increase when anxiety and/or depression is present. Anxiety in particular is often accompanied with intrusive thoughts or images, like imagining a perceived faux pas. Thoughts can range from self-flagellating like “my friends hate me” or they can also have a taboo or distressing nature—like violent images. What differentiates these thoughts from obsessions however is that they eventually subside. For individuals who do not meet criteria for OCD, intrusive thoughts can manifest due to stress. If you notice experiencing more anxiety and intrusive thoughts than usual, or even for the first time, reflect on any major life stressors that may be impacting you. Stressors like burnout, fighting with a partner, caretaking for a family member, financial hardship, an upcoming exam, or even anticipating a significant shift in your life (like going to college for example) are all stressors that can trigger unwanted thoughts or impulses.

How to Cope and Find Relief

If you are experiencing any of the symptoms outlined above, it may be time to contact a therapist for an evaluation and/or treatment. Psychological treatment of OCD is often accompanied with psychiatric treatment, though many people find relief in therapy alone. Cognitive-behavioral therapy (CBT) and exposure/response prevention therapy (ERP) have consistently been found to successfully treat OCD. Both of these specialties are commonly by practiced by therapists with experience in treating OCD. In the meantime, the following strategies may be helpful in relieving the distress associated with intrusive thoughts and symptoms related to intrusive thoughts. Keep in mind that any technique or treatment is always more likely to be successful with the guidance of a professional.

1. Exposure

A professor of mine who worked as a psychologist once shared an example of a patient he treated who was plagued by recurring intrusive images of stabbing his wife. In the first session, after hearing about what was happening, my professor opened a drawer in his desk and took out a letter opener. He walked around his desk and placed it in the client’s hand and reminded him his wife was in the waiting room, and he could easily go do the deed at that very moment. In that moment the client realized that in fact not only did he not want to hurt his wife, but that he would never be able to do so. The intrusive thoughts immediately began reducing in frequency and intensity and after a short time in treatment, he reported that they were gone. Try to confront the impulse and image head-on. Ask yourself: what would really happen if I found myself in the situation I am imagining?

2. Practice acceptance

 Many techniques for OCD, and anxiety disorders in general, initially appear counter-intuitive. That is because the goal is to create new associations for your brain and challenge the anxious thoughts themselves. One of the most helpful techniques to try when in the midst of experiencing an intrusive thought is to practice acceptance. Instead of pushing away the distressing thought or feelings of anxiety, welcome them in. If the thought or image is replaying in your mind—let it. This is most helpful when sitting down, or in a quiet environment where you aren’t distracted. Allow the thoughts to enter and begin to practice breathing as you let them. Often this helps alleviate anxiety which in turn allows you to better focus on something else.  

3. Focus on something that demands your attention.

Watching television or looking at social media is something many people try to do to alleviate obsessions but often find that these distractions are not helpful. That is because they tend to not require very much focus at all. Something that demands your full attention like exercise for example, is much more likely to successfully distract you from a recurring thought. Cooking, playing a sport,  riding a bike, singing a song that you know all of the lyrics to, solving a math problem, cleaning, re-arranging a room, and using an adult coloring book are all activities that require focus and attention.

4. Check in with what you are actually feeling

 There are some clinical theorists who believe that obsessive-compulsive disorder manifests when underlying feelings of anger and rage are not expressed. At the very least, when experiencing OCD symptoms or intrusive thoughts, most people feel anxious and stressed. Try to first acknowledge what it is that you’re feeling by allowing for any underlying emotions to enter your consciousness. It may be helpful to check in with bodily sensations to identify what is coming up for you; from there, notice what feelings arise. Instead of pushing them away, allow yourself to sit with and fully recognize what emotions are present.  

5. Remember that you aren’t alone

Intrusive thoughts are incredibly common. In addition to seeking professional help, consider a support group. You can find online and in person support groups for individuals with OCD at https://iocdf.org/ocd-finding-help/supportgroups/ and https://peaceofmind.com/resources/support-groups/.

How to Find Motivation

Recently I was talking to a client who admitted he didn’t have the motivation anymore to do much of anything.

“I guess I just don’t want to” he said, somewhat sheepishly. “Sometimes I think I’m comfortable being depressed.”

The sentiment did not surprise me because I’ve it heard before, many times actually, from clients in my private practice and at the mental health clinic I used to work for. When people utter this statement or something similar they tend to assume that nobody else has ever felt the same way, or that even me, their therapist, would judge them for it.

For my client, his lack of motivation was mostly tied to depression. His perception was that nothing mattered and that if he tried, nothing would change. When something external pushed him to get out of his comfort zone however, he did. And he always felt better. The problem was he continuously had to be pushed to do things that ultimately made him feel better because it was a lot easier to stay home and not do much. In a sense he had become lazy because he had developed bad habits as a result of depression, not because of some character trait that he was born with, as he alluded to in previous sessions.

Lazy is a bit of a taboo word in therapy where really, there should be no taboo-anything. No therapist is ever supposed to call anyone, much less their clients, lazy, and in fact we aren’t supposed to buy into the idea with our clients that there is even such thing as laziness. At least that’s what I’ve gathered from years of practice myself and hearing about other therapists from my clients and from my colleagues. I started to think about this—why do we ignore the question: “Am I lazy or am I depressed?”

Likely we ignore discussing laziness for fear of offending clients or propagating shame. ‘Lazy’ is a hurtful description because it insinuates something is bad or wrong at the character level. There is a moral implication to calling someone lazy because laziness and selfishness are related traits. People don’t say “I did lazy” and they rarely say “my behavior is lazy.” It’s usually “I’m lazy.” Maybe sometimes “I feel lazy.” Laziness becomes a death sentence and also a fulfilling prophecy. Once someone has labeled you lazy it’s hard to prove to them or yourself otherwise because no one can be productive 100% or even most of the time. Therapists generally do not want to reinforce a belief that is incorrect, self-shaming, or that perpetuates a behavior someone is trying to stop engaging in. Unfortunately what this can do is make clients in therapy feel even more alienated. If someone does feel lazy, why argue with them that they’re not engaging in lazy habits? For my client, his habits were spurned by depressive episodes but they were maintained for years at a time, during periods when he was not feeling depressed. He had learned certain habits, though of course they did not define him. Once we were able to identify those habits, then we could start talking about how he could change them.

So how does one find motivation again?

Our behaviors are directly tied to the neurological network that is associated with reward, which is why addiction takes such an intense toll for many people. Even if you are struggling with motivation in more than one area of your life, there are daily activities that involve motivation that you do every day. First, identify what those activities are. Maybe you’re motivated to take a shower every day and wash your hair; what would be another step you could take in on personal hygiene that could also double as a self care exercise? Maybe you’re motivated to see your friends but not to work. Maybe it’s time to forge closer relationships at work, or if its the work you don’t like, asking to be moved to a different project or exploring something new altogether. Maybe you don’t feel motivated to do much of anything other than sleeping. What is one thing you used to look forward to that you don’t do anymore? Maybe it’s making yourself a cup of coffee or buying one at a cafe. Or taking a walk, or texting a friend, or exercising. Until you experience the reward associated with those activities, you won’t be motivated to do them, which is where will comes in. Doing those things won’t feel good until they do.

The concept of “finding motivation” is therefore non-sensical. Motivation has to be cultivated, and the only way to do that is through changing our behavior.

Is Your Partner Busy or Avoidant?

Is your partner busy? or avoidant?

We’re all familiar with the specific anxiety of waiting for a text or a call. The intensity of the anxiety is always proportional to how much we like the other person, and why does it always seem to be the slippery ones that hold our attention most aptly? The crush, date, or partner whose interest in us seems ambiguous is also the same person we want the most. But what if you feel simultaneously secure in the relationship as you do anxious? While you’re frustrated with the communication style of your relationship/situationship partner, you also feel with almost eerie certainty that they are into you, maybe even more than you are into them.

Your confidence, or maybe a better word would be trust, is not delusional. Maybe this person tells you things that you haven’t heard from others; that you’re special. More importantly, you’re special to them. Maybe you share a strong connection with this person that manifests in great sex, feeling safe, or simply having a lot to talk about. These factors are indications that things are going well, so when your partner pulls back, it’s only sensible to question what you are doing wrong rather than question their interest or commitment.

We’re all familiar with the (gendered) cliches around men. “If they want to, they will” for example, is one. An entire episode of Sex and the City and romantic comedy “He’s Just Not That Into You” is based the idea that men are more simple than women assume they are, and that when they want to commit to a relationship, they will do so with gusto. Apart from the hetero-normative aspects of these pieces of media, there is truth in a dynamic that often plays out between all partners. One person is unequivocally more committed, or more interested in commitment, than the other.

To return to the method of communication of our time: texting, what do you do when you feel secure with your partner most of the time but painfully anxious the rest of the time, because your partner’s behavior drastically shifts when you’re apart? Perhaps they don’t respond to texts or calls for days, make plans and flake, or deliver promises that ultimately feel empty. Barring blatant manipulation and lying which eventually will become clear, it is likely that your partner wants closeness and commitment sometimes. The rest of the time what they want, or what they are likely familiar with, is distance. The dance between a so called “anxious” partner and “avoidant” partner is illustrated in depth in “Attached” by Amir Levine and Rachel Heller. Ultimately, Levine and Heller argue, unless an avoidant partner experiences some kind of life altering change or epiphany, they will always be limited by their capacity for closeness. The implication? That the anxious partner accepts these limitations or leaves the relationship to search for a secure partner. Avoidant people have quite a poor reputation in self-help and relationship books, and for logical reasons. Categorizing an avoidant person as all-avoidant or totally detached, however, misses what makes relationships with these folks feel so confusing.

If you feel both secure and anxious in your relationship, consider how much you are willing to give to this relationship, as well as consider how much you have already. If someone is ignoring your messages, it is likely they are doing so for a reason. Perhaps their inclination is to withdraw as you get closer, and if their behavior follows this pattern, it is likely they are avoidant. Consider now how prevalent this behavior has been—if someone has showed avoidance consistently and from the beginning of a relationship, likely the behavior will endure. If, for example, your partner who is “bad at texting” also has traveled with you, showed consistent thoughtfulness, and demonstrated actions that make you feel secure and appreciated, there may be room for growth and change.

What “to do” if your partner ignores messages or calls? Remain curious, but remember to interpret actions literally and communications with more nuance. If someone is attempting to show you who they are or what they are capable of right now, take it at face value.

Anxiety vs. Depression

“Co-morbidity” refers to the incidence of overlap of two or more medical conditions and/or psychiatric conditions. When disorders are co-morbid they are co-occurring—one doesn’t necessarily cause the other but we know that they tend to show up together. Alcohol addiction for example, is often co-morbid with anxiety, but does anxiety cause alcoholism or vice versa? There isn’t a causal explanation but we know that it is likely that at the very least, there is an interaction happening that strengthens the relationship—and so the more someone drinks likely the more anxious they feel, and a cycle emerges.

Depression and anxiety are one of those classic duos in modern day psychiatry. If you consult with a psychiatrist for anxiety there is a fair chance he or she will prescribe you an SSRI that is commonly used for depression. Even at the medication level, what works for depression often works for anxiety. So what does this mean exactly when we know that the experiences of depression and anxiety are fundamentally different? As constructs they certainly have their own set of characteristics that set them apart. Anxiety often feels like a more manic, intense emotional state and depression often feels slower, more fatigued, and in a state of stuck-ness we can’t get out of. Some people genuinely struggle with both though what is increasingly common is anxiety at the idea of being depressed, or an increase in anxiety because there are deeper, unexpressed emotions that remain dormant.

Subsequently people often mistake anxiety and depression for one another. They often describe feeling anxious because they are depressed or feeling depressed because they are anxious. It’s particularly difficult to admit to oneself I’m feeling depressed. Though the term “mental health” (which has become oddly synonymous with mental illness) is thrown around more frequently as stigma is supposedly challenged, there is a character weakness that we associate with psychological pain. Many times what people are actually saying is that they feel depressed—or there is an inner conflict that is causing distress—and they don’t want to be, because confronting one’s sadness is difficult. Furthermore anxiety, for whatever reason, seems to hold a more positive valence than depression or sadness. To be anxious can still mean being a high-achiever. “I have anxiety” doesn’t carry the same negative implications as “I have depression.” Recently Kendall Jenner appeared in a series of Youtube videos where she discussed her anxiety with a psychologist. Would the campaign have been as popular if she talked about feeling depressed? To many, one is a cop-out or an excuse to not work hard, though truthfully many people function very well with depression. The other—anxiety—is somehow more easily accepted; why wouldn’t we all feel nervous in our treacherous pursuit of success?

Ironically, anxiety can be extraordinary crippling. Even moderate anxiety often renders people unable to make decisions efficiently. When you’re feeling anxious you’re likely over-thinking everything and ruminating over outcomes. When you’re depressed, you’re likely feeling confused or sluggish, unable to take the first steps to make a decision that you know will benefit you, but aware at least of what you need to do.

Of course, depression and anxiety can and often coincide with one another, though they may have different psychological roots. If you’re feeling depressed for example, and are self medicating with drugs or alcohol, there is a high chance that at least intermittently you will feel anxious. Or, if you’re go-to coping mechanism for depression is unhealthy (i.e. binge eating) you will certainly feel anxious as a result because now there is a new stressor added to the overall state of malaise and emptiness that you are likely already feeling.

Begin with considering what you’re doing that is exacerbating symptoms and what you’re doing that is ameliorating them. Depression for example, is highly unlikely to change until something is consistently added to your life that involves effort and reward. Adding one small activity (for example taking a walk after work) and reducing one unhealthy coping mechanism (i.e. high sugar in your diet or getting off social media) can work wonders for your mental health.