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By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
My mother criticizes my weight every time I see her. I am overweight, but am well aware. Her comments do not help! How can I deal with her? The answer: Our relationship with our mother can be one of the most complex bonds we have. When the relationship is strong, positive and loving it can be a source of tremendous happiness and validation. When the relationship (or elements of the relationship) are less than ideal it can be a source of sadness, anxiety or even anger. As children, we are of course reliant on our parental figures for food, caretaking, safety and security. As we become older and independent, we no longer rely on our parents for these basic needs. Despite this, our need for acceptance and validation often remains strong, even as adult children. As such it can often be difficult to speak directly or assertively to our mothers about difficult topics. A certain amount of “motherly critique” is a normal part of the mother/child relationship. However, repeat criticisms about weight are both unhelpful and disrespectful, and can be damaging to your self-esteem and confidence. The best advice is to address your mother’s criticisms directly and assertively. Let your mother know that her comments are unhelpful, unnecessary and hurtful. Clearly let her know that you would like her to stop making these comments. Respectfully state the consequences if her statements don’t stop. For example, you could let her know that you need to end your visit with her if she begins to criticize you unfairly. The difficult (but important) part will be for you to follow through with the consequences if her behaviour does not change. Here are some tips for speaking with your mother in an assertive way: – Clearly describe the statements she makes that you find hurtful. Be objective, specific, and avoid being judgmental or criticizing her back. – Express how her statements impact you. Don’t assume that she will necessarily understand what the effect has been on you until you tell her. – Directly state what you need to see in terms of her behaviour change. Tell her clearly that you would like her to stop making comments about your weight. – Assert the consequences if her behaviour does not stop. – Express how much you value your relationship with her, and let her know that you are hopeful that things can continue to improve between the two of you. Remember to be clear, direct and do not make any apologies for establishing boundaries in your relationship with her. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  What is suicidal ideation? The signs one may be thinking about suicide
Suicidal ideation means thinking about or planning suicide or wanting to take your own life. This includes all thoughts from fleeting consideration to detailed planning. If you are thinking about suicide, you are not alone. Many people have thoughts of suicide for a number of reasons and the reasoning behind suicidal thoughts is not wrong. You may feel hopeless and think that nothing can be done to change the situation, but know that having these thoughts does not mean you are weak, or ‘crazy’. Often people think about suicide as a means of escape from their feelings, so just because you are thinking about suicide does not mean that you will act on those thoughts. Due to the stigma attached to mental health and suicidal ideation, those who experience these thoughts often feel as though they need to hide them from the people around them. Know that connecting to others when we are having these thoughts is extremely important and talking about mental health breaks down the stigma. Warning Signs of Suicidal Ideation Warning signs that you or a loved one may be thinking about suicide:
Causes of suicidal ideation Many people might think suicidal thoughts are attached to mental illnesses like depression or bipolar disorder but there are many causes of suicidal thoughts, some of which are circumstantial. As mentioned previously, suicidal thoughts often accompany thoughts of hopelessness, feeling out of control in life and/or feeling purposelessness. The circumstances that often cause these thoughts are relationship problems, trauma, substance use, a crisis of some sort, the pressure at work, a physical health issue, or financial difficulties. Taking Action If you are worried a loved one is thinking about suicide, ask. Asking will not make someone consider suicide if they weren’t already. If you are feeling suicidal, reach out for help. Know suicidal thoughts are common when one is feeling overwhelmed and hopeless, and when there seems to be no way out – but also know those suicidal thoughts won’t last forever, and that help exists. If you or someone you love is at immediate risk of suicide, call 9-1-1. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I’m afraid of swallowing pills. The size and shape of the pills makes no difference; I either crush pills into food or some other suspension, or avoid taking them altogether. The avoidance strategies I have tended to use are getting harder to manage as I get older. What can I do? The answer: Dysphagia – or difficulties with swallowing – can be related to a range of causes including fear, pain, or some other cognitive, anatomical or physiological problem. Fear and avoidance of swallowing pills is not an uncommon source of anxiety for people. Although it seems like a very simple and easy task to do, many adults and children will struggle with swallowing pills. The gag reflex is a very powerful – and in true danger situations, a biologically adaptive – reflex. Even having one past experience where you felt as though you were going to gag/choke can reinforce that fear. Assuming that there is no physiological basis for your difficulties and that the cause is fully psychological, there are some effective strategies to manage your symptoms: 1. Work on relaxation strategies. The fear of swallowing pills (even in the absence of any physiological problem) can lead to the throat tightening up. Learning relaxation strategies can be very helpful, as reducing your overall level of body tension (and also specifically working on relaxing the throat muscles) can help to lessen the automatic response you get when swallowing. Deep breathing and progressive muscle relaxation skills practiced in the minutes before swallowing a pill can be very helpful. 2. Target your fears/thoughts about gagging/choking. You likely have a number of automatic thoughts related to gagging/choking that contribute to your fear, such as: “I can’t swallow pills”, “I’ll never be able to do this”, “I hate this”, “I will choke”. Increase your awareness to inaccurate/catastrophic thoughts and actively replace them with more realistic thoughts (e.g., “I don’t like swallowing pills, but my doctor has told me there is no physical reason I can’t, and it’s never as awful as I think it will be”). 3. Visualize success. Picture yourself calmly and easily swallowing the pill. Repeatedly visualizing success can have a very real beneficial impact. 4. Gradually build up your tolerance. Teaching yourself to swallow pills is like building up any other skill: you need to gradually build up your tolerance. Start with very small-sized “simulation pills” and gradually build up the size. Be creative here (e.g., using sprinkles, tic tacs). You want to of course ensure you are only practicing with digestible food that won’t cause any health problems (talk to a doctor if you are unsure). 5. Practice, practice, practice! Avoidance of things we fear counter-intuitively increases our fear of those things. So, you need to practice a lot, and not avoid swallowing pills! It can be helpful when you are first building up your tolerance to swallow the pills when someone is around you (e.g., if your worry is about choking). Many people also find eating some food immediately afterward can help with lessening the unpleasant sensation/taste of swallowing the pill. Drink a lot of water before and after (cool or room-temperature) and take the pill during a time of day when you feel more relaxed and can dedicate some time to implementing your relaxation and realistic thought-replacement strategies. Note: It would be important to ensure you do speak to your family physician about this to first rule out whether there is any other contribution, as dysphagia is more common in older adults and could be possibly related to some change in muscle or nerve function. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Recognizing that you are having emotional difficulties can be challenging to admit, but it’s the first step to getting effective treatment. So, good for you for getting there, but figuring out how to get the help you need can be another daunting step as there are so many different types of mental health professionals.
Psychologist vs Psychiatrist Psychologists and psychiatrists are both mental health specialists with expertise in assessing and treating emotional issues. They have approximately the same number of years of formal training. While there are some similarities between psychology and psychiatry, there are also some important differences in their type of training, focus and treatment approaches. We will address each of these topics below. Training
Focus
Treatment and Referral Process
Psychologists and psychiatrists have their own areas of expertise. Some individuals are matched with one or the other and see results, but you may also benefit from seeing both who work together to support you. Speak to your family physician to get some advice and guidance on who can best help you. Your provincial psychological association can also assist with answering questions about how to find a psychologist best suited to your needs. Editor’s Note: This post was originally published as part of a Globe and Mail “Ask the Psychologist” column authored by Dr. Samra, and has been edited and updated. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I have a 17-year-old son who suffers from autism. It can be difficult at times. When he eats, he can unexpectedly start acting up and make awful sounds. He will randomly pick up and turn things over. You can give him instructions as a parent and he decides not to move an inch. I love him, but I find myself struggling not to be angry at him for his worst actions. How can I find ways to cope with behaviour that I understand he may not be able to control? The answer: Raising a child with a pervasive developmental disorder can be one of the most personally taxing and challenging life situations a parent can find themselves in. First and foremost, you need to be gentle with yourself – you are only human, and feeling upset or even angry toward your son is a natural reaction that most parents with a special-needs child will experience. Most parents, however, feel reluctant to verbalize their negative feelings due to fear that they will be reprimanded or judged by others; suppressing these feelings will do nothing but amplify them over time. What’s important is that you get the support you need as you deal with the daily challenges of parenting your son, while of course remaining mindful of not inappropriately displaying your frustration to your son. Autism spectrum disorder (ASD) has the hallmark feature of impaired social interaction and is characterized by impairments in communication and repetitive, stereotyped behavioural patterns. Although there is no “cure” in the traditional sense for autism, symptoms often improve with age and treatment, with Applied Behavioural Analysis (ABA, a skill-oriented behavioural intervention that is highly structured and intensive) being the most strongly supported by research. This would be an avenue I would suggest exploring if you have not already. It’s important to keep in mind that repetitive or perseverative behaviours are not unique to individuals with autism; particularly when under stressors, many people will engage in some element of repetitive behaviours (e.g., nail biting, pacing, obsessive cleaning). Given your son’s age, I would guess you have spent countless hours over the years trying to understand and manage as best as you can your son’s behaviours. Over time, however, and given the number of years your family has been dealing with his autism, it’s natural to lose objectivity in understanding patterns that may exist, and there may be value in revisiting this. Specifically, pay attention to the days when the repetitive/perseverative behaviours are less frequent: What elements that occurred earlier in the day – and particularly in the hours leading up to mealtime – could account for this? Try to replicate the elements that seem to be associated with a reduction in his repetitive behaviours, and reduce or eliminate those that seem to play a role in exacerbating his symptoms. Most importantly, actively work to manage other stressors in your life that you do have control over. Pay attention to the usual factors that may reduce our threshold for stress; get adequate amounts of sleep, regularly exercise, eat healthy and minimize alcohol use. You can also join a support group in your community where you can get the emotional and logistical support that other parents with autistic children can offer. And make sure you schedule some “non-parenting time.” Don’t be shy to ask for help from your partner or family members, or you can implement external caretaking support if you are financially in a position to do so. Take the time away from parenting to do things that you enjoy: Meet a friend, go for a run, watch a movie – anything that provides you with much-needed relief from your responsibilities, for a little while. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth
The question: There’s a group of us who hang out, and we are pretty sure that one of our friends is gay. We don’t care, we just wish he wouldn’t hide it if that’s the case. Should we ask him outright? The answer: Coming out is a deeply personal process that can be immensely difficult and challenging. I’m happy to hear that among your group, your friend’s sexuality is irrelevant (in a good way) and a non-issue when it comes to how you view him. It sounds like you will accept and support him when he does choose to come out. Whether you should ask him outright is a tricky issue. On one hand, there’s something to be said for communicating to him that you accept him regardless of his sexuality. However, you need to balance that openness with the need to not put him in a position where he’s forced to come out when he’s not ready. Asking him outright may put him in awkward position, and you need to respect that he will come out when he feels he is personally ready to do so. He may also feel that it’s important that he first comes out to certain people in his life – like his family – before anyone else, even your group of friends. Consider the myriad challenges your friend may be facing. He may be going through the personal challenge of accepting his own sexuality before he comes out to others. He may be unsure how to tell those close to him. He may not be sure what reaction he will get from family and friends – those that he cares about and whose opinions matter to him. The best thing you and your friends can do is ensure that you are mindful of actions that may inadvertently create an unsupportive environment. Pay attention to the language you use and the jokes you make. It often stuns me how frequently people, just in day-to-day conversation, with no malicious intent, use words that can alienate someone who is gay. Also, take some time to learn more about the experiences people have when they first come out, so you can better understand what your friend may be going through. PFLAG Canada has links to a range of resources and support agencies that you may find helpful. Pay attention to your friend’s behaviour: It may be indirect communication he is giving about his sexuality. Think about your responses to him. Not uncommonly, people “test the waters” with those close to them before they come out, by observing how people react to seemingly neutral situations or stories. Whenever the opportunity arises, let your friend know what he means to you and what qualities you value in him. If it is appropriate and not awkward, try to convey that you would accept him no matter what. When he does come out, offer to support him however you best can in coming out to other friends, family or coworkers. And, most importantly, let him know how you feel – which is that his sexuality makes no difference to how you view him and your friendship. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
My best friend is getting a divorce – and I’m ecstatic. His husband never treated him properly, and I think it’s long overdue. Do I have to act sad because my friend is? I’m trying to enforce the silver lining, but maybe I should just pretend to be devastated? The answer: The strongest friendships are based on a number of core elements: love, respect, trust, unconditional support and acceptance, and honesty. It sounds like you are struggling with knowing how to achieve a good balance between these different components of your friendship, all of which you value. On one hand, you are happy (and I suspect relieved) that your best friend is ending his relationship due to genuine concerns that you have had about him not being treated well. Your heart is in the right place here. You are making efforts to have him see the positive in the situation, which can help him to remain optimistic and hopeful despite his difficult current situation. On the other hand, you’re likely worried that your real feelings may not be perceived by your friend as supportive. Acting disingenuous never works out well in our close relationships. Inevitably our true feelings will come out, and there can be a negative impact on a relationship that can be difficult to repair. That said, you have to be sensitive and empathic to what your friend is going through. The most important thing right now is that you are the most supportive friend that you can be. Bite your tongue slightly on your true feelings (e.g., saying you feel “ecstatic” likely will not serve any useful supportive function, may come across as hurtful, and may be interpreted by your friend as a “I told you so” type of response). But you do not need to completely “act” in a way that is at odds with how you truly do feel (e.g., convey that you felt his husband did not treat him well). Your friend will likely read through any efforts you make to pretend that you feel otherwise and, as you are best friends, I would guess your friend already has a sense of how you feel about his situation. Ask your friend what he needs from you: tell him you love him, that you want to be supportive, and that you want to know what you can do that best help him. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I have a friend who I’ve known almost my whole life. A while ago, he asked me to wire him money because he “lost his wallet” – and not a small amount. Then he dropped out of sight. It turns out his life was nosediving because of alcohol and he wound up homeless. Now he’s getting back on his feet again. I’m happy for him, but now I’m unemployed and want my money back. How do I approach him? The answer: There is some wisdom in the old adage that money and friends don’t mix. More often than not, mixing the two can create rifts in a friendship and add an awkwardness that wasn’t there before. Now, in your situation, you did what a good friend does – in fact what a great friend does: You supported your friend when he needed it. Although you later realized that he was struggling with substance use and likely myriad other difficulties, you put your trust in him and gave when you thought he needed it. It is your friend’s turn to now support you. The best way to approach him is clearly and directly. Here are some tips you can follow when making your request: Describe the past situation: “You may remember that in [month/year] I lent you [x dollars] when you had called and let me know that you lost your wallet. I really wanted to help you out, so was happy to do so. I know you’ve gone through a lot since that time, and I am really happy that you are getting back on your feet again.” Describe your current situation (not necessary but it may help to give context): “Unfortunately, I recently lost my job and am struggling financially.” Make your request (be specific, and provide timelines): “So, I need the full amount of what I lent you back, ideally by the end of the month.” Be reasonably flexible and allow your friend to respond: “I realize that this is likely not something you were planning for. What are your thoughts on being able to get the full amount back to me within that time period?” Then negotiate a reasonable resolution that is acceptable to both of you. Be specific. Ask yourself what you are willing to accept and convey that clearly to your friend. For example, if you need the money within the month and he proposes to pay you six months down the road, let him know that won’t work for you and why. Tell him that you do not want money to get in the way of your friendship and that you are hopeful you can arrive at a resolution that works for both of you. Do not apologize (as that dilutes the request) and do not be overly wordy. If your friend is not willing to give your money back or work to get it to you within the limits he has, unfortunately, it may be that you just have to learn a very valuable lesson from this and decide how, or in what capacity, you want to keep this friend in your life moving forward. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth  Managing Suicidal Thoughts: How to prevent them in the future
Suicidal ideation, plans and attempts are common: conservatively, 1 out of 10 adults will consider suicide as an option at some point in their life. Despite how common suicide thoughts are, there are effective, evidence-based approaches to managing suicidal thoughts and reducing their frequency in the future. Managing Suicidal Thoughts
Preventing Suicidal Thoughts But, what can we do to decrease the chances of feeling suicidal in the future? 1 - Get treatment for mental health problems: It is important to get treatment for depression, anxiety, and alcohol and drug problems. Just seeing your family doctor may not be enough. It can help to see a mental health specialist, such as a psychologist or a psychiatrist. You can get referrals from your doctor or learn how to find a specialist from one of the referral lines listed on the last page. If you are already receiving treatment, speak up if your treatment plan is not working. 2 - Identify high-risk triggers or situations: Think about the situations or factors that increase your feelings of despair and thoughts of suicide. Work to avoid those situations. For example, going to a bar and drinking with friends may increase feelings of depression. If this is a trigger for you, avoid going to a bar or seeing friends who drink. 3 - Self-care: Taking good care of yourself is important to feel better. It is important to do the following:
4 - Follow through with prescribed medications: If you take prescription medications, it is important to make sure you take them as your doctor directed. Speak to your doctor if medications aren’t working or if side effects are causing you problems. If you have just begun taking antidepressants, it is important to know that the symptoms of depression resolve at different rates. Physical symptoms such as energy or sleep may improve first. Improvement in mood may be delayed. Speak to your doctor if you are feeling worse. 5 - Structure and routine: Keep a regular routine as much as possible, even when your feelings seem out of control. Here are some tips for creating structure in your life:
6 - Do things you enjoy: When you are feeling very low, do an activity you enjoy. You may find that very few things bring you pleasure. Think of things you used to enjoy doing at times you didn’t feel so depressed or suicidal. Do these things, even if they don’t bring you enjoyment right now. Giving yourself a break from suicidal thoughts can help, even if it’s for a short time. 7 - Think of personal goals: Think of personal goals you have for yourself, or that you’ve had in the past. Some examples are: to read a particular book; travel; get a pet; move to another place; learn a new hobby; volunteer; go back to school; or start a family. Final Thoughts If you’ve been feeling suicidal know that you’re not alone. And just because you’ve felt suicidal doesn’t mean those thoughts will last forever. Taking small steps toward improving your mental wellness can help to prevent suicidal thoughts from returning. And remember there is help if you need it. If you or someone you love is at immediate risk of suicide, call 9-1-1. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I love being single, every day of the year except Valentine’s Day. For 24 hours I feel like I need another person in my life. It’s an awful feeling. What do you recommend I do to avoid this? I can’t do another ‘single’s party’ or first date. It all seems so fake. The answer: Ask yourself this: why does feeling that you need another person seem awful? Think about why you are rejecting any notion of being in a couple. As humans we are social creatures, who both need other people in our life, and need to be needed by others. Think about what this is about for you – do you feel it is a sign of weakness to need another? Is this a barrier for you in terms of actively pursuing or acting on a connection with someone? That said, certain days of the year can feel particularly difficult if you are single – and Valentine’s Day falls at the top of that list. This of course is not surprising given that it is the day of the year that has an explicit focus on couples, relationships and ideas of never-ending romantic love. Other special days such as Christmas, New Year’s and birthdays are also ones that can be hard hitters. Many single people will describe just wishing that those days would hurry up and be over, as they feel particularly lonely on those days, much more than they may at any other time of the year. Making yourself do something to rebel against the idea of Valentine’s Day often doesn’t work. A ‘single’s party’ for example can ironically have the opposite effect and further amplify your single status; and, having a first date just for the sake of a date certainly can feel fake and forced. Instead, think about just doing something for yourself that is a treat or makes you feel special – a massage, an indulgent gift, or a short trip away. Try to understand what it is that you are reacting you – you say that you “love” being single every other day but feeling “awful” on Valentine’s Day. There appears to be a disconnect for me in the intensity of the feelings you are having. You are wishing that your relationship status was different, and perhaps you aren’t loving being single as much as you feel at times. This may be hard to admit or acknowledge to yourself, but may be important information in that it may motivate you to make some active changes in your life that can help you to work on changing your relationship status. For the interim, to get through the day, remember that Valentine’s Day is a day just like any other (also true for the other holidays!). This can be hard to do when we are bombarded by images of flowers, balloons, chocolates and other testimonials attesting to one’s love for another person every which way we look – TV, stores, and even in your office. But it is just one day and there are 364 others that are not surrounded with multiple images of coupledom. Remind yourself that your negative feelings will abate (as they always do) and that the 24 hours will be over before you know it. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. |
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