<![CDATA[My Site - Blog]]>Sat, 30 Sep 2017 13:56:46 -0700Weebly<![CDATA[Infertility and Perinatal Loss: How Couples Journey Through]]>Fri, 29 Sep 2017 20:05:16 GMThttp://yourcouplestherapist.com/blog/infertility-and-perinatal-loss-how-couples-journey-through
By Robin Smith
​Updated 4:56 PM ET, Fri Sept 30, 2017

This Pain Feels Too Great to Bear

"I can't believe this is happening to me." How do couples cope with a loss that is invisible to the rest of the world? When we lose a grandparent or a pet, society has given us rituals of mourning, venues to express our pain, cultural normalizing takes its cue. But not all losses are equal. People who experience infertility and pregnancy losses all too often suffer in silence. Sadness, shame, guilt, loneliness, all experienced in isolation. This article is for all of the families impacted by such losses, and should be shared with the greater community at large to raise awareness of issues that remains under discussed and under studied. October marks another pregnancy and infant loss awareness month. Let's all do our part to raise our society's collective awareness around these issues. 

To Miss a Person We Have Never Met

"This was supposed to be easy, what is wrong with me and my body?" "What did I do to deserve this?" "I feel like my body is betraying me." Women who have trouble getting pregnant often blame themselves. As adults going through this, the stories we told to ourselves as children or teenagers of one day becoming a parent, the stories of self and how things were "supposed to go" gets rocked - decorating the nursery, picking out names, parenting, this all needs to get expanded now that the ideal has seemed to go off track. In the context of couples trying to get pregnant, we need to remember that infertility is a relational issue. The relationship can become so focused around the infertility. And each partner's pain can go unnoticed by the other. Those experiencing complications around fertility are at risk for developing depression, anxiety, and in some cases PTSD.

What exactly constitutes as infertility? Infertility is the inability to achieve or maintain pregnancy after 12 months of regular unprotected sexual intercourse. In the U.S., 1 out of 8 couples have trouble getting pregnant. Couples facing this challenge often find that much of the joy and spontaneity around sex gets lost. Being physically intimate has now become "results driven", "we're on the clock", and feeling that pressure can be so difficult. This element in a relationship that is so fundamental to a couple's intimacy is now painful or even absent. The act of sex itself can be a source of grief and emotional pain for the couple for what is represents - "we're not a fertile couple." It is so important for couples who feel like they just need some space and distance from sex to be able to remain physically and emotionally close. If couples take intercourse off the table, they still have affectionate touch, playful touch, and sensual touch available to them.

I Held You in My Dreams

When couples who have been trying to get pregnant for some time are able to achieve pregnancy, they can feel a whole host of mixed emotions. What they have been longing for has finally happened. And, not all pregnancies will be successful. About 1 in 5 clinically diagnosed pregnancies will be lost; Here we're not including those pregnancies lost prior to a medical doctor's confirmation. Perinatal loss includes miscarriage, stillbirth, and neonatal death. This may be new ground for a lot of readers, particularly because our culture doesn't talk about these losses, so let's get our terms defined first before we move ahead.
  1. Miscarriage is a loss that is less than or equal to 20 weeks gestation.
  2. Stillbirth is a loss that is greater than 20 weeks gestation.
  3. Neonatal loss happens from birth to up to 28 days of life.
1.
There are a lot of misconceptions and myths around miscarriage that should be covered here. First, the myth that miscarriages are rare has already been addressed, but it's an important one to dispel since believing it can lead many women to feel shame and isolation. Women may believe that it's their fault, that they did something to cause it, "I drank too much coffee", "I could have prevented it from happening." This is simply untrue. Most miscarriages are caused by a developmental problem with the embryo. The myth that this only happens to women over 35 still has traction. The silence around miscarriage in our culture only serves to perpetuate these misunderstandings and sends an implicit message that we should feel shame. Worse yet, well intentioned friends and family members can end up saying incredibly hurtful things like, "Everything happens for a reason" or "Well, you can always try for another one."

How Old Would They Be Now?​

2.
26,000 stillbirths occur every single year in the U.S. That's an unbelievably painful statistic to reckon with. That is 68 stillborn babies every day or 1 in every 160 births. Again, there is scant literature out there that addresses treatment for the couple after suffering this type of loss which further implicates our cultural aversion to the issue. This baby had a heart beat. In many cases, the mother felt it moving. It may have been given a name, which gives him or her even more form, more identity, and gives the partners more emotional pain. The couples that face this loss are grappling with the paradox of wanting to hold on to their loss while at the same time trying to let go of it. There is no birth or death certificate given to the parents of a child that dies in utero. For the couple, their loss is real, and yet they are missing some of the symbols and rituals that others have when they are in mourning. It is very important for these couple to not let themselves or their family narrative be defined by the loss. They will never forget, but they can begin to write the next chapter in their story.

3.
The most frequent cause of neonatal death is premature birth. Parents have the choice of holding their baby after death, and for different people, for different reasons, this can help the grieving process or it can stunt it. All of these losses can be traumatizing. Loss triggers previous loss. It is not uncommon for partners to be out of sync in their own grieving process. People go in and out of grief, and this back and forth can feel like an emotional rollercoaster, especially when one partner feels ready to try again for a  baby and the other partner is nowhere near being ready, or may even resolve to not try again because the thought of going through this again is unbearable. There is an incredibly powerful article about one mother's story and the death of her infant in the New Yorker written by Ariel Levy called Thanksgiving in Mongolia. Please get your tissues ready before reading. 

What Can Couples Do When They're in Hell?

One of the more effective treatment models in psychotherapy for couples or families who have suffered through infertility, miscarriage, stillbirth, and/or infant loss is Narrative Therapy. In this framework, couples are encouraged to externalize the loss. This loss is not "who you are", it does not define the couple, rather it is a challenge that you both are going through. This is not the woman's problem, the couple is sharing this struggle. Often times partners lose parts of themselves when they're in hell. It is important the be able to reclaim these parts of self. Again, you do not have to stay in this chapter. Remember the previous chapters of your life, and get back to who you are fundamentally as a person. Get back to those intrinsic things that define you. Acceptance does not mean that you are forgetting about your child. Couples recovering from this kind of loss are encouraged to expand their ideas around pregnancy, parenting, and identity. How will the couple integrate this chapter with their larger family story. If becoming a parent is still a part of that story, then perhaps adoption is looked at as one option.

​This article is only a surface visit to these issues. If you are struggling with any of these types of loss, you are not alone. You do not have to remain alone. Professional help is one phone call away. If you know someone who is going through, or who has gone through a version of this unimaginable pain, please share this article with them.

"I carry your heart with me (I carry it in my heart) I am never without it."
-e.e. cummings
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[Ask an MFT #2]]>Fri, 01 Sep 2017 02:20:24 GMThttp://yourcouplestherapist.com/blog/ask-an-mft-2
By Robin Smith
​Updated 11:09 PM ET, Thu Aug 31, 2017
Ask an MFT is an opportunity to answer questions from my followers on social media who would like some insights into the world of marriage and family therapy on many different topics. I want to reassure my readers that their identities are protected. While I get many questions, not all of them are useful for the general public so I can only respond to a select few each time.

Q: What can I do if I don’t want to go to therapy, but I know that my relationship needs work?

Robin: The first thing I would recommend you do is to explore and write about what is going on in your relationship that needs to change. Therapy can be a very powerful experience to bring about change, but it is not always needed. Most research-informed therapists will tell you that the change that comes about in therapy is roughly 70% attributable to the client. You are the one doing the work, you are the one making active changes to the ways in which you are thinking about your life and the ways in which you are taking action to bring about change. Here are several questions to get you started:
  • What specifically “needs work” in the relationship?
  • Do you and your partner have an agreed upon “shared view” of the events that led to the state of things in your relationship at present?
    • If not, how do you account for the difference in perspective?
    • Are differences in subjective reality respected and honored?
  • Have you and your partner sat down and had explicitly clear conversations about expectations in the relationship around:
    • Communication
    • Conflict resolution
    • Family and friends
    • Gender roles
  • Are your expectations realistic and flexible?
  • Do you know what influences the relationship both positively and negatively?
  • What self-initiated actions are you taking to enhance your relationship?
  • How do you stay attuned and recognize when your partner needs comfort?
  • How do you tune into recognizing your own needs and go about expressing those needs in a gentle, non-blaming way?
These are but a few of the myriad questions that many marriage and family therapists explore in therapy with their clients. There are couples out there who are able to change the way they are currently doing things without the guidance of a therapist. There are many resources out today and self-help books that people find to be effective. Two books that come to mind are Hold Me Tight by Sue Johnson and the Seven Principles for Making Marriage Work by John Gottman and Nan Silver. I hope this is helpful!
Q: My primary care physician told me I could go on medication for my anxiety but the thought of taking meds is really off-putting. What else can I do besides taking meds?

Robin: With anxiety specifically, there are many different neurochemical changes that you can make to your brain starting today that does not involve medication. For example:
  • Are you sleeping too much or too little? This can affect your mood; Making sure you are taking care of yourself in the domain of sleep can help to reduce anxiety.
  • Are you exercising regularly? Developing and sticking to a consistent exercise regimen can have profound changes on your neurochemistry that can help stabilize your mood (i.e., reduce anxiety), improve concentration, increase libido, and regulate your eating and sleeping behavior.
  • Are you getting all of the vitamins and minerals that are in a daily multivitamin either via a daily multivitamin or better yet, through healthy eating? Are you drinking enough water to stay optimally hydrated throughout the day? Are you putting shitty foods into your body? Your brain chemistry is affected by the things that you eat, when you eat, and how much you eat (not to mention what kind of self-talk you may engage in, in direct response to what you are or are not eating). Making sure to avoid sugary beverages like soda and fruit juice is a good first step to balancing your diet. When your diet is healthy, in conjunction with healthy sleep habits, and a healthy weekly workout routine, you can experience reduced levels of anxiety.

I know that a lot of people share your concern about taking medication. When I discuss the idea of beginning medication with my clients when it comes up, I like to first consider the possibility that it is a short-term intervention. In other words, yes, there are people who are on meds, and they will (likely) be on meds for the rest of their lives. You need not jump to this conclusion at the first mention of medication. Many clients have reported that they found it helpful to be on an anxiolytic or antidepressant for a short period of time in conjunction with psychotherapy to help them get over a mental hurdle they have been facing, and that proved to be just the thing that helped them find progress and change in treatment.


That’s all for now! I try to keep these short and sweet. I look forward to the next Ask an MFT segment!
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[How Do Religious Beliefs Affect Our Health and Well-Being]]>Fri, 28 Jul 2017 13:53:36 GMThttp://yourcouplestherapist.com/blog/how-do-religious-beliefs-affect-our-health-and-well-being
By Robin Smith
​Updated 10:16 PM ET, Mon July 31, 2017

The Connections Betweens Our Beliefs and Our Overall Health

In a nutshell, being religious is strongly associated with better overall mental health and well-being. The devoutly religious have fewer symptoms of anxiety and depression in addition to having a better ability to cope with stressors. A 2005 study on adults in their 60s and 70s in the U.S. found that religious beliefs buffered against depression associated with poor physical health. And for those of you thinking, “well sure, people who are religious tend to enjoy the benefits of social support by attending weekly services at various houses of worship,” the buffering effects of religion was present even after controlling for social support. In a 2013 study, researchers found that patients who were being treated for depression and self-harm responded better to treatment if they believed in God. Of course, these results do not show causality.

Dr. Harold G. Koenig, director of the Center for Spirituality, Theology and Health at Duke University Medical Center, found that more religious people had fewer depressive symptoms after conducting a meta-analysis of 93 studies between 1872 and 2010 on religion and health. According to Koenig, "People who are more involved in religious practices and who are more religiously committed seem to cope better with stress. One of the reasons is because [religion] gives people a sense of purpose and meaning in life, and that helps them to make sense of negative things that happen to them."

What's the Downside of Religious Beliefs on Health?

Negative religious beliefs are associated with harmful outcomes such as higher rates of depression and lower quality of life. To make sense of all of this, the American Psychological Association sat down with professor of psychology at Bowling Green State University and an expert on the psychology of religion and spirituality, Dr. Kenneth I. Pargament. According to Pargament, if people perceive God as have a loving, kind disposition, they seem to experience psychological benefits; However, we also know that the God of Abrahamic religions has a darker reputation. If a person tends to see God as punitive, threatening or unreliable, then that takes a negative toll on one’s health.

If one is willing to be open to the facts, one has to recognize that some beliefs do indeed threaten a person’s health. Let’s consider the idea that people are, right now, refusing medical treatment for themselves and for their children because of their deeply held religious beliefs. People will refuse to get 21st century medical treatment because it is either prohibited by their faith or because doing so would demonstrate a lack of faith in God, when instead, according to their faith, they should be relying on the Creator to answer their prayers. This idea opens up the whole libertarian can of worms of an individual's personal rights; but when minors, when children - who by the way, aren’t old enough to make informed decisions about many other choices in their lives - are needlessly suffering and dying because their care was left to the rational and ethical choices of their parents, this is an obvious threat to health and raises a far more interesting question.

The scope of this article attempted to explore how religious beliefs affect an individual’s health and well-being.How do religious beliefs affect human societies’ health and well-being? This sounds like a blog post idea for another day.
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[The Child Inside: How Your Childhood Affects Your Parenting]]>Fri, 30 Jun 2017 19:24:23 GMThttp://yourcouplestherapist.com/blog/the-child-inside-how-your-childhood-affects-your-parenting
By Robin Smith
​Updated 4:42 PM ET, Fri June 30, 2017

NEWS FLASH: Your Childhood Influences the Kind of Parent You Are

With the kids out of school, many families are going on vacations, sending their children to summer camp, and of course there are those families whose schedules don’t change a bit other than having to figure out alternative arrangements for childcare. For many parents, the summer months can actually bring on more stress around the house because of having to adjust to a different routine from the previous nine months. As a parent it’s important to recognize that’s it’s not just the adjustment itself that brings about a stressed out family, but indeed, how you as a parent respond to the stressors that are presented to you.
 
What could be triggering this response in you, you might wonder? Think back to your own childhood and how you felt around your parents when summer came along and you were rushing to the airport, or going off to camp, or sitting at home in a very unstructured environment. The experiences (good and bad) we had when we were children get brought forth and influence the way we parent. Often, when these experiences have not been fully processed they can lead to unresolved issues that influence how we respond to our own children’s behavior. And as parents, we are especially vulnerable during times of stress to act on the basis of our unresolved past issues.

Raising Healthy Children Begins With Self Care

Let’s look at the classic example of a mother who sneaks out of the room without saying goodbye because she didn’t want to hear her child cry at the separation. I hear about this happening all the time at pre-schools and daycares - and by the way, I will admit, I’ve rationalized doing this as well; I was wrong. The child’s sense of trust gets broken when they look around for their mother and they get upset at her absence. The child feels insecure, betrayed, and uncertain about when she will return. If it turns out that this resembles what you experienced as a child, separation experiences might be challenging for you in your role as a parent. Your own sense of abandonment might affect the decisions you make when leaving your own child.
 
When parents don’t take accountability for their own emotional baggage, they miss an incredibly important opportunity to further their own self-development and become better parents in the process. Our unresolved “stuff” gets in the way of responding to our kids in the ways they need us to. Instead we become stuck in our life story and the reactive responses from our past wins out. We seemingly forfeit our ability to choose how we respond to our children when our limbic system hijacks the higher order neocortical processing of the brain.

What You Can Do Right Now

Keep a log tracking your emotions – you can do this daily or weekly whatever works best for you. Whenever there is an event that rubs you raw, pay attention and notice where in your body you feel movement. Observe what thoughts begin to bubble up into consciousness. There is no need to change your response at first, just practice strengthening your awareness muscle. You may notice that there are certain behaviors that your child engages in that are more likely to trigger these emotional reactions. Take note of these patterns and write them in your log. Being mindful of your thoughts and feelings is a crucial first step towards growing with your child, and becoming the parent you want to be.
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[Is Our President Actually a Tyrant?]]>Wed, 31 May 2017 21:36:27 GMThttp://yourcouplestherapist.com/blog/is-our-president-actually-a-tyrant
By Robin Smith
​Updated 2:32 PM ET, Mon June 5, 2017

How Can Democracies Fail?

After listening to an episode of The Waking Up Podcast with Sam Harris, I felt compelled to share the important message that his guest Timothy Snyder was speaking on. Timothy Snyder is an American author, historian, and professor at Yale University whose latest book On Tyranny: Twenty Lessons from the Twentieth Century is becoming more and more relevant, especially if you’re an American. Snyder argues in his book, “We have to spread out our political imagination and have a broader sense of what’s possible. The danger is that we just go day by day and then every day seems normal, even if today is much worse than yesterday; We’re very good at getting used to today, and then tomorrow the same thing happens.” This article will give you a taste of what Snyder’s book is all about. Can our democracy’s constraints contain our President? And, what can we do to make sure those constraints *do* contain our President?
Americans today are no wiser than the Europeans who saw democracy yield to fascism, Nazism, or communism in the twentieth century. One advantage is that we might learn from their experience. Now is a good time to do so.

​One of Trump’s populist messages on the campaign trail was very effective in resonating with people who have been struggling to make ends meet or find employment. Trump convinced his voters that globalization was one of the most important problems of the 21st century that needed to be addressed. Many Americans felt themselves the victims of globalization. Politicians from the 20th century, especially in the fascism and national socialism movements willingly ignored the inherent complexity of globalization and instead would attempt to simplify the challenges by blaming a particular group for these problems. Trump is doing the same thing. We've seen a similar reaction to globalization. The problem as Trump sees it is that globalization has a face, a Chinese face, a Mexican face, a Muslim face. So rather than addressing the multifaceted challenges of globalization, Trump has us chasing after the supposed members of these groups. The Muslim ban gets us into the habit of seeing Muslims as a source of our problems. The VOICE program gets us into the habit of denouncing our neighbors. You know the George Santayana quote, “Those who cannot remember the past are condemned to repeat it.”

Do Not Obey in Advance

Most of the power of authoritarianism is freely given. In times like these, individuals think ahead about what a more repressive government will want, and then offer themselves without being asked. A citizen who adapts in this way is teaching power what it can do.

​Snyder says that this lesson is number one for a reason. At the very beginning, authoritarian leaders require consent. The people have the power to resist, at the beginning. If you blow lesson 1, then you can forget about the rest, because if you can’t do "Don’t obey in advance", then the rest will become impossible, because the rest will seem psychologically senseless to you. If you normalize and drift, things which would have seemed abnormal to an earlier version of you, will start to seem normal now, and the point to start doing anything will never seem to come. You’ll keep saying, “tomorrow, tomorrow, tomorrow,” and in fact, internally you’ll just be adjusting, adjusting, adjusting, and psychologically you become a different person. Synder says that, “In America, in Spring/Summer of 2017, if you’re doing nothing, you’re actually doing something. You’re helping regime change come about.”

Defend Institutions

Institutions do not protect themselves, they fall one after the other unless each is defended from the beginning.

​Snyder uses Nazi Germany as an example and points out an editorial from an Austrian newspaper in 1933. From the perspective of German Jews, “We do not subscribe to the view that Mr. Hitler and his friends, now finally in possession of the power that they have so longed desired, will implement the proposals circulating in Nazi newspapers. They will not suddenly deprive German Jews of their constitutional rights, nor enclose them in ghettos, nor subject them to the jealous and murderous impulses of the mob. They cannot do this, because a number of crucial factors hold powers in check, and they clearly do not want to go down that road. When one acts as a European power, the whole atmosphere tends towards ethical reflection upon one’s better self and away from revisiting one’s earlier oppositional posture.” Snyder comments on this piece of history, “Such was the view of many reasonable people in 1933, just as it is the view of many reasonable people now. The mistake is to assume that rulers who come to power through institutions cannot change or destroy those very institutions, even when that is exactly what they have announced they will do.”

Beware the One-party State

The parties that remade states and suppressed rivals were not omnipotent from the start. They exploited a historic moment to make political life impossible for their opponents.

​Snyder points out the story that Americans tell themselves that we’ve had democracy for 200 years, and we’ll just keep having democracy. Really democracy is as old as the Civil Rights Act, and we've been drifting away from democracy since then. Allowing unlimited money into politics, gerrymandering, and voter suppression laws have chipped away the visage of a true democracy in our country. 31 out of the 50 State Houses are Republican because gerrymandering has become so unsettlingly precise. Snyder argues in this lesson that when we slip into a one party system it’s not just unhealthy for democrats, but it’s unhealthy for Republicans, and above all, it’s very hard to get out from under that again.

There is so much more to expand on here. If you've enjoyed this article, I highly recommend you buy the book. It's more of a booklet; you could read it in an hour or so.
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[Reduce Stress in Your Life: It Just Takes a Little Practice]]>Sat, 29 Apr 2017 19:55:12 GMThttp://yourcouplestherapist.com/blog/reduce-stress-in-your-life-it-just-takes-a-little-practice
​By Robin Smith
​Updated 4:32 PM ET, Sat Apr 29, 2017

What Is Mindfulness Meditation?

As April comes to a close, we raised our collective awareness of Autism, Sexual Assault, and Child Abuse Prevention here in the United States. April is also Stress Awareness month, and it could certainly be said of all awareness months, that we shouldn’t limit our acknowledgment of these causes or issues to just one month. And of the many things in our lives that contribute to or compromise our well-being, stress is an incredibly pervasive and potent adversary. That is why I feel no hesitation or regret from piling on to the mountain of articles, blog posts, and books that make the case for mindfulness meditation as an effective tool to mitigate stress. If you have no idea what I’m talking about, don’t worry, because you are in good company. Here in the U.S. only about 6% of the population practices meditation according to the 2012 NHIS Survey. Mediation is on the rise, and for good reason. 
Couples who practice mindfulness have a higher ability to identify their emotions and communicate them to their partner in more functional ways that de-escalate conflict. These couples are simply less angry and less anxious.
Mindfulness practice is beneficial for both therapy clients and therapists. I actually didn’t begin to practice mindfulness until I began training as a psychotherapist. Research on mindfulness mediation has revealed its benefits:
  • Reduced rumination
  • Boosts to working memory
  • Improved focus
  • Less emotional reactivity
  • Increased cognitive flexibility
  • Enhanced self-insight, morality, intuition, and fear modulation
  • Reduced stress
  • Higher relationship satisfaction
Source: APA Journal Psychotherapy 2011, Vol. 48, No. 2, 198 –208
 
While there are many good reasons to get into the practice of mindfulness mediation, for the purposes of this article, we’ll focus on how it strengthens our ability to reduce stress.

How Does the Practice of Mindfulness Meditation Protect Us from Stress?

Mindfulness is the practice of self-observation. When glance at the phenomena of consciousness, the thoughts, sights, sounds, and other body sensations that are experienced within us, we are neurologically disengaging automatic pathways that would otherwise disrupt our present moment input. Have you ever been lost in thought? Yea, that’s the stuff I’m talking about here. When we are mindful, we are no longer lost in thought, but rather clearly aware of any present sensations that arise in consciousness. And this way of thinking helps us to be less emotionally reactive, and respond to negative situations with a faster recovery to our baseline calm state of being.

Regular mindfulness practice (*after just 8 weeks) can alter the ways in which emotions are processed in the brain. Many mindfulness practitioners have quite literally changed the neural architecture of their brains, and this allows them to cope with stress in more adaptive ways. As a marriage and family therapist, this is particularly evident to me with the couples I treat in therapy. Relationship stress is simply a subcategory of overall stress. Couples who practice mindfulness have a higher ability to identify their emotions and communicate them to their partner in more functional ways that de-escalate conflict. These couples are simply less angry and less anxious.
*Premed and med students reported less anxiety and depression symptoms after taking an 8-week mindfulness based stress reduction training compared to the control group.

Staying in the Present Moment

When we are focused on the present, we can’t also be focused on the past. Mindfulness works because it shuts down brain activity associated with rumination. It shuts off activity associated with thinking about possible realities that haven’t happened yet. Practicing mindfulness for just 10 minutes a day can have profound beneficial effects on your life. There are many guided mediations out there, videos on YouTube, and apps that you can download on your device that make it easy to practice mindfulness wherever you are. If you decide to begin, or start again with your mindfulness practice, I suggest you do it at the same time of day each day. And it’s even more likely to become a habit that sticks if you do it in the same place, at the same time, each day. One unforeseen benefit I have personally experienced, in addition to stress reduction, is that knowing how to be mindful affords me the ability to never feel boredom again. That alone is life changing.
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[Retraining Your Brain for Improved Sleep: Part 2 - Good Habits Consistently]]>Thu, 30 Mar 2017 17:09:51 GMThttp://yourcouplestherapist.com/blog/retraining-your-brain-for-improved-sleep-part-2-good-habits-consistently
Make Lifestyle Changes for Improved Sleep
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By Robin Smith
Updated 12:24 PM ET, Fri Mar 31, 2017

STOP: Read Part 1 First and Then Come Back to This Page

Now that you understand how the Wake-Sleep system functions and you've downloaded your Sleep Diary, it's time to learn about healthy sleep habits and what you can do right now to begin the process of retraining your brain for better sleep. Notice that the Sleep Diary is for 6 weeks. Retraining your brain for improved sleep will not happen overnight. You will need to commit to practicing these good habits throughout the next 6 weeks, and then you can personalize which habits you feel were helpful and worth keeping as life long habits.

The 20-20 Rule: 20 Minutes in Bed, 20 Minutes Away From Bed

This is one of the most important habits for retraining your brain and it addresses stimulus control. As mentioned in Part 1, people who get poor sleep have associated their bedroom and bed as a place where they can expect to struggle falling or staying asleep. The 20-20 rule is simple in theory, but an ordeal in practice, and it works! When you get in bed, it is fine to spend anywhere from 10-20 minutes engaging in a relaxing activity. After about 20 minutes you'll want to turn the lights out. Once lights are out, the 20-minute countdown has begun. You now have 20 minutes to fall asleep (remember, do not clock watch). If you have not fallen asleep within 20 minutes, it is now time to leave the bed, and leave the bedroom. Yes, you read that correctly.
Improve sleep by changing your habits
Staying in bed to toss and turn will only further associate the bed and bedroom as a place of stress. You must now spend 20 minutes away from the bedroom to engage in a relaxing activity in darkness or in low lighting, no blue light from screens! I prefer to listen to a guided meditation for 20 minutes, but find whatever is right for you. Even if you feel drowsy after the first 10 minutes outside of the bedroom, you are not to return until the full 20 minutes are over. This is when the clock restarts and you now have another 20 minutes to fall asleep. Repeat this step for as long as it takes until you are asleep. Yes, it is an ordeal, but it works. You will no doubt be tired the next morning, and just as any other poor night's sleep, it is important to make up for lost sleep by catching a nap anytime during your day so long as it is before 1pm, and so long as it is no longer than 30-minutes. Once you're over the 6 weeks of "retraining mode" it is fine to nap later than 1pm, in fact, the ideal time to nap is around 2pm-3pm after lunch. But while you are retraining your brain, do not nap after 1pm or else you are delaying the time that your Wake System will wind down, and therefore, delay when your Sleep System is gearing up.
Even if we get stressed out during our workday, the remaining cortisol levels in our bloodstream can affect our ability to relax at night time, which can be disruptive to our sleep.

Change Your Negative Thoughts About Sleep

For many people, one of the things that gets in the way of falling asleep is turning off the mind. Do your thoughts race when you turn out the lights? Do you think negative thoughts about not sleeping, or perhaps how you will feel or perform the next day because you aren't getting the recommended 8 hours? It will reassure you to know that this 8 hour rule is a myth! For a more in-depth understanding of this, read The myth of the eight-hour sleep. In fact, getting 6-7 hours of sleep each night, instead of the standard 8 hours may lead to a longer life. Many sleep experts agree than at minimum, getting 5 - 5.5 hours of sleep is "enough" to function the next day. Knowing this can help (if you'll pardon the pun) put to bed the concerns or negative thoughts that "I won't be able to function tomorrow at work." Letting go of the 8 hour sleep myth, and reassuring yourself that 5 hours will be "good enough" can be powerful cognitive tools to help you relax and catch Z's.

Improve Relaxation Skills for a Better Night's Sleep

It is helpful to practice relaxation skills throughout the day and night time. Here's why:
  • When we're stressed, the hormone cortisol enters the bloodstream and can stay in the bloodstream for many hours
  • This means that even if we get stressed out during our workday, the remaining cortisol levels in our bloodstream can affect our ability to relax at night time, which can be disruptive to our sleep
  • Practicing relaxation skills throughout the day will help to regulate cortisol levels in the body; Practicing relaxation skills at night will help the body and mind to fall asleep more easily
Progressive muscle relaxation exercises can do wonders to mitigate the impact of stress on the body. Tension-relaxation exercises leave the body feeling a wave of relaxation that can run from head to toe.

Make Lifestyle Changes For Improved Sleep

There are many different options to make adjustments to one's lifestyle to improve their quality of sleep. Often times when we are making changes, it can be helpful to start small and choose something that you feel you'll be more likely to follow through with. Choose any from the following list:
  • Set a regular sleep-wake schedule (even on weekends)
  • Avoid alcohol close to bedtime
  • Finish eating dinner 2-3 hours before bedtime (and restrict liquids close to bedtime)
  • Avoid caffeine at least 6-8 hours before bedtime
  • Avoid activities that will arouse you before bedtime (arguing, paying bills, etc.)
  • Avoid medicines that may disrupt sleep
  • Establish a regular routine of relaxation before bedtime
  • Avoid exposure to bright light before bed time (use blue light filters if you must use screens, and set the lighting to low)
  • Regular cardiovascular exercise will help you get a better night's sleep, so long as it is done at least 3 hours before bedtime
  • Make sure your bedroom is dark, cool, comfortable, and quiet (to the extent that you can control this)
It is strongly recommended that you consult your physician first to make sure you understand the cause of your sleep problem and treat it appropriately. The importance of sleep cannot be overstated. Sleep deprivation for just 6 weeks can lead an otherwise healthy person to develop clinically significant depressive symptoms. A good night's sleep is a vital part of a healthy lifestyle. It is my hope that you found some use in this article. Good luck catching those Z's!
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[Ask an MFT #1]]>Wed, 01 Mar 2017 02:47:23 GMThttp://yourcouplestherapist.com/blog/ask_an_mft_1
By Robin Smith
Updated 10:05 PM ET, Tue Feb 28, 2017

Ask an MFT #1

Ask an MFT is an opportunity to answer questions from my followers on social media who would like some insights into the world of marriage and family therapy on many different topics. As I begin this platform, I want to reassure my readers that their identities are protected. While I get many questions, not all of them are useful for the general public so I can only respond to a select few each time. Ok, let’s dive in!
 
Q: What do you recommend I do about my wife’s drinking problem?
 
Robin: There are many things to consider here, and of course, many unknowns. I should probably start by saying that there are specific licensed professionals who specialize in drug and alcohol counseling, and I am not one of those. Having said that, the first question I would have is, does your wife see her drinking as problematic?
If she’s not there yet, there are still things you can do to support her. You can stop buying alcohol. You can stop drinking alcohol (at the very least, stop drinking while you’re around her). You can attend support groups that are just for the family members of people who struggle with addiction.
 
If she does admit that she has a problem, it can be helpful to have her join a support group such as AA or call a drug and alcohol treatment center in your area. There are fabulous programs that are aimed at helping the individual learn how to manage their addiction and begin their journey of recovery.
 
Q: What is the secret to a long and lasting marriage?
 
Robin: I’m afraid there is not one secret. Sorry! There are however, key traits that couples who are in long lasting and satisfying marriages have in common. For instance, the couples who stay together and are truly satisfied in their relationship tend to:
-Have a strong friendship with one another in which they feel emotionally secure to share anything with one another.
-Depend on and rely on their partner, and know that even when things go wrong, they give their partner the benefit of the doubt.
-Identify when a disagreement is starting to become a fight in the very early stages and slow down their communication process to listen for understanding before interrupting with a solution or rebuttal
-Make daily efforts to connect and share appreciation for one another
-Have clearly defined roles in their household for who will do what
-Have a solid understanding of what their partner’s life goals and dreams are
-Have a way to deal with stressors outside of the relationship such that these stressors do not “split up the team mentality” of the couple
-Create and maintain rituals of connection for real intimacy, romance, passion, and of course, great sex
 
As this is the first official Ask an MFT post in what will undoubtedly be a long running series, I’m afraid these two were the only ones that qualified with regards to my criteria for responding. Keep your questions coming!
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[How To Listen During Conflict: Tips From a Couples Therapist]]>Wed, 01 Feb 2017 02:52:28 GMThttp://yourcouplestherapist.com/blog/how-to-listen-during-conflict-tips-from-a-couples-therapist
How To Listen During Conflict
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By Robin Smith
Updated 10:21 PM ET, Tue Jan 31, 2017

Listening, It’s Not as Easy as You Think

What do couples who come to therapy often fail to do in the beginning of their treatment? Most couples therapists will tell you that 95% of their cases involve couples who are looking to improve their communication. As a therapist, it is my job to see what it is that the couple cannot see, that they have a pattern of communicating that ends in hurt feelings, gridlock, and/or withdrawal. My job is to see this, and help the couple see it, and get them to see what it is that they are doing that contributes to this negative pattern, and then change it. Easier said than done right? That’s why they pay us the “big bucks.”

So what do couples who end up in therapy often fail to do? In my 5 years of experience, there are general trends that I’ve noticed, and most paths lead to a failure of expression of needs. We are taught how to ask for what we need (or not ask) in our family growing up. Many times a partner will criticize, or verbally attack their partner which leads to hurt feelings, defensiveness, counter attacks, or withdrawal. Underneath this exchange was an important need that wasn’t getting met. The key here is to recognize what it is that we are needing from our partner, and then express it in a clear and direct way using language that will not put our partner on the defensive.
Why Is It So Hard to Communicate?

Why Is It So Hard to Communicate?

One of the most nefarious culprits that sabotage important couple conversations is threat. This threat that we experience can occur when our partner says something that we interpret as cutting, or disparaging, or blaming, or distancing. When we feel threatened, our heart rate changes, our breathing changes, stress hormones begin pumping into our blood stream, and the beautiful human body system that evolution has given us takes its course. What do we need to know or do when this happens? There are cognitive and physiological answers to this question. For the scope of this article, I’m going to focus here on the physiological interventions one can use.

Belly Breathing, aka, Diaphragmatic Breathing, aka, Deep Breathing, is a technique that can prove effective at keeping ourselves in the conversation and able to have the conversation that needed to happen instead of the fight that buried it. When I ask my clients to use this technique, I remind them not force it, even though they are doing something new, and it will take some conscious control, it is still important to allow the breath to come naturally. When we can engage this technique, we can reverse the effects of stress on our body and on our thinking, and consequently on our role in the conversation.
I am so happy to see Sesame Street is teaching the next generation this important skill!

Notice, Breath, Express

We first must be aware that we are becoming dysregulated in our breathing. Sometimes it can be helpful to pay attention to the temperature of our cheeks and/or forehead, if calf-muscles or shoulders are tense, odds are we are in “threat mode”. Some people who would prefer to not go into their body this way can choose to pay attention to their thoughts. Perhaps they notice that their mind is racing, or looking for the partner’s opportunity to “pounce.” This can clue us into our selves being dysregulated.

Once we notice that we are tense, or beginning to feel emotionally threatened, we can then engage in this technique. Here’s a video of how it’s done:
After we’ve rediscovered the safety of feeling more grounded and centered in our thinking, and after we feel calm to participate in this conversation, now it’s time to express feelings and needs. One helpful tidbit, is that before we express our own feelings and needs, it can be helpful to FIRST reflect back what we see and hear our partner saying, and listen for the feelings and needs in what they are saying. This might sound something like this:

Susan: “All you want to do is spend time with your friends, it’s like you’ve forgotten that I’m even here.”

Oscar: “I can see that I’ve really upset you by making these plans. I think I’m hearing that you feel shut out, or maybe even ignored by me, that I’m making others a priority, or putting my friends first. I never meant to hurt you. I guess this conversation means we aren’t spending enough quality time together.

 
Oscar is validating Susan’s feelings, and listened for her unmet need – “I don’t get enough time with you.” Even if Oscar may have thoughts of getting defensive, or is tempted to fight back and talk about how unreasonable Susan is being, this way of listening and reflecting back what our partner is saying can do wonders to any relationship. Once Susan feels that Oscar fully understands where she is coming from, then she will likely be more receptive to Oscar when he expresses his feelings.
 
Of course this is merely a fictional example, and your relationship might benefit from speaking to a trained professional. For more information, I'd recommend beginning at our Frequently Asked Questions page.
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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<![CDATA[Bringing Baby Home: What Pregnant and New Parents Must Know to Build a Healthy Family Together]]>Thu, 15 Dec 2016 15:41:06 GMThttp://yourcouplestherapist.com/blog/bringing-baby-home-what-pregnant-and-new-parents-must-know-to-build-a-healthy-family-together
By Robin Smith
Updated 7:36 PM ET, Thu Dec 15, 2016

You Never Knew You Could Be So Vulnerable

The adjustment that happens when couples transform into parents can be joyous, exciting, and stressful all at once. Neither parent has any clue as to how much work this is going to be no matter how much they try to prepare. Loving this newest little member of your family brings about many emotional and psychological changes. Life goals, values, and priorities shift for new parents. Couples have a new focus of what it means to be a team. And through all of the crazy making, it's important to remember that with this adjustment comes normal responses to stressors. Responses from each new parent such as:
  • Increased stress
  • Increased couple conflict
  • Feeling more irritable (more frequently)
  • More fighting, miscommunication, and hurt feelings
​This barrage of new emotional experiences, both positive and negative, can overwhelm any relationship and drive new parents apart from one another. Expectant and new parents learn so much in preparing for this time, and once they bring their baby home, they need to know what to expect. It's crucial for new parents to learn about what changes will take place, and how to best lay the foundation for a strong relationship which will grow a strong and healthy family for this little one, as well as any siblings that might come along.

John Gottman and his team of researchers have been studying more than 3000 couples since the 1970's, some of whom have been followed for 12 years or longer. The team was able to collect data on couples who were becoming parents, and if you're about to become a new parent, or have just recenty given birth, you are going to want to read on.

​What Does the Research Say About the Transition to Parenthood?

Over 4 million babies are born in the U.S. each year. While this is an exciting time, research shows that within three years after a couple brings baby home, approximately two-thirds of these new families will experience a significant drop in relationship quality and will have a dramatic increase in conflict and hostility. Many mothers experience baby blues and other postpartum mood disorders. This can lead to a severely compromised co-parenting team and a decreased quality in the couple’s relationship. 

Half of all relationships break up in the first seven years. Why? When Gottman and his team studied young couples from the newlywed period through the transition to parenthood they discovered that most of these breakups were because couples became parents. The Gottman group's research showed four common trends among couples when they become parents:
  1. There is a Profound Philosophical Shift - Identities change, roles may become more traditional, views on work, finances, and faith change.
  2. Relationships Change - Conflict increases in the first year after baby arrives, sex and intimacy decline dramatically, communication between partners decreases or becomes more stressful.
  3. Some Fathers Withdraw - This adjustment can lead to withdrawal from mom, from family responsibilities, and from baby; Some dads feel like they need to spend more time working, leading to feeling resentful and some moms to feel like they are parenting alone.
  4. There are Physical and Psychological Changes - Sleep deprivation and exhaustion can make both parents depressed; Parents report increase in stress; Sexual desire may decline dramatically and stay low throughout the first year; Changes in roles, values, and identity can cause a psychological adjustment which for some leads to emotional withdrawal – for others, an increased neediness.

The Greatest Gift You Can Give Your Baby Is a Strong Relationship Between You and Your Partner

Like most couples who are expecting a baby, you want to be good parents and provide the best for your children. However, when such a strong focus is placed on your baby, it can be easy to forget about the importance of the relationship between you and your partner. The Bringing Baby Home Workshops, were created by the Gottman Institute to help these very couples who are about to become, or who have just recently become new parents. These new parents who master the skills and apply the knowledge taught in these workshops are more likely to have a good, satisfying relationship that lasts, which is the foundation for their children's positive emotional and social development as they grow.

These workshops are offered throughout the U.S. and other countries as well. If you happen to live in the D.C. Metro Region, and are interested in upcoming workshops check out the D.C. Area workshop listings here. For a complete list of upcoming workshops throughout the U.S. and beyond, visit the workshop listings here.
Robin S. Smith, MS, LCMFT is a Licensed Marriage and Family Therapist in clinical practice in Bethesda MD, and specializes in relationship issues for couples, families, and individuals, for improved quality of life. His clinical specialties include: transition to parenthood for new and expecting parents, infidelity, sex and intimacy issues, premarital counseling, and trauma. Robin has given talks to various groups including hospital administrators, graduate students, therapists, and child birth educators. He is the primary contributor to Your Couples Therapist Blog.
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