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By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
My mom is a terrified driver. She’ll stop in the middle of an intersection, paralyzed by fear. She’s recently been involved in a few traffic accidents, although none of these were her fault. She recently ended a 30-year marriage. Are these incidents related? I’m afraid to criticize but I’m concerned for her safety. The answer: Driving-related fears and phobias can be attributed to a number of causes. Some people are just naturally more nervous drivers – individuals who don’t drive often, older adults, and those who have moved from smaller communities to higher traffic-populated areas tend to be less comfortable behind the wheel. It sounds as though you have noticed some recent changes in your mother’s driving behaviour, both in terms of her fear (which I’m imagining she has told you about or you have witnessed directly) and also a higher than average number of accidents over the last short while. Even though the accidents were not her fault, there could be the possibility that she is engaging in less defensive driving behaviours which may indirectly have increased the likelihood of her being in several accidents in a short period of time. If she has recently ended a 30-year marriage she is likely under a higher than average level of stress (even if she chose to end the marriage) and it may be that her elevated stress is manifesting in her driving behaviour. When there is an increase in our baseline level of stress, we tend to have amplification of already existing fears or anxieties. For example, it could be that she was always a slightly nervous driver but the increased stress has now contributed to tipping that nervousness into more concerning fears. Being in a number of accidents over a short while can in and of itself lead to an increased fear of driving, which may from the outside look out of proportion to the severity of accidents that occurred. A number of factors can contribute to quite significant driving-related phobias developing from even minor accidents. Some of the factors include previous number of accidents, physical/emotional health history, other existing stressors, and the nature and circumstances of the accident. Finally, it is important to keep in mind that other changes in her physical or cognitive health status may be influencing her driving-related fears and behaviours. Health conditions that in particular impact one’s cognitive processes or eyesight (e.g., cataracts, stroke, early onset dementia) can also play a role. I can appreciate the concern about not wanting to criticize, but given the safety risks (both to your mother and to other drivers) this is something you need to bring up with her. Take a non-accusatory approach with her. Explicitly state that you don’t want to come across at all critical, but that you have concerns about her safety and have been worried about her recent accidents. Make sure you emphasize that you know they were not her fault, but that you are concerned nonetheless. Be specific and objective about the concerns you have (i.e. give specific examples that lead you to say she is “terrified” or “paralyzed by fear”). Offer to go to her family physician with her. This can be helpful to ensure she has had an examination of her physical function, including eyesight. If it seems that stress-related causes are the sole cause of her fear, the most effective treatment is cognitive-behavioural treatment (which focuses on addressing anxiety-related thoughts and behavioural responses to these thoughts). 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 teen daughter is fat. She’s way over her normal BMI, and I’ve tried talking to her – politely – and asking if she wants to go to the gym together, or work out a healthy meal plan. It just seems to make it worse – she eats way more after our talks. What can I do? The answer: There are two main things you need to consider: the factors that contribute to your daughter’s current weight and the manner in which your concerns have been communicated to her. You say that your daughter is “way over” her normal Body Mass Index (BMI). I will assume that she falls close to or within the “obese” range. By definition, obesity is a medical condition where amount of body fat may adversely and significantly impact health, including increasing the likelihood that one will develop a range of serious health conditions and contributing to shortened life expectancy. For these reasons, expressing your concern and trying to improve your daughter’s health is important. Try to support her to make some changes. For all of us, our weight is the result of many factors – including those that are out of our control (e.g., genetic predisposition) as well as factors that are controllable (e.g., eating habits, exercise/activity levels). Unidentified or untreated health conditions (e.g., thyroid dysfunction) may also play a role. For this latter reason, ensure your daughter has had a recent medical examination. Unfortunately there is considerable stigma in our society regarding weight issues. I wonder to what extent your daughter has dealt with teasing or negative attitudes from family, friends, and kids at school. This could likely be contributing significantly to her feelings of low confidence and self-esteem, including feelings of shame and even low mood or depression. Your daughter may feel hopeless – particularly when kids deal with obesity from a young age, they may develop strongly ingrained beliefs that nothing they do will be effective in terms of changing their situation. You indicate that your daughter eats “way more” after your talks. Many individuals (even those that do not struggle with obesity) engage in emotionally-driven eating and this leads me to think she is likely becoming highly stressed after your conversations. Think about how you are approaching these conversations: it is important to remain non-judgmental, non-accusatory and supportive in your verbal and non-verbal communication. Express to her genuinely why you are concerned about her weight rather than telling her what to do (as this may come across as lecturing and critical). Ask her what her goals for weight/food/exercise are, and if there are ways that you can support her goals. The reality is she may find it too difficult to speak openly to you given history. Offer to help her find a professional (family doctor, dietitian, nutritionist, psychologist) with whom she could speak to openly and confidentially. 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:
Almost three years ago my partner committed suicide. He suffered from depression. We were only dating for a year, but I find his death still gets to me. It’s especially difficult now for me to date people. I used to be a very patient, happy, joking person. Since it happened, I feel as though it’s a charade I’m putting on so my friends and family don’t notice the change. How can I move on? The answer: The death of someone we love is one of the most difficult life experiences we will ever face . As a society, we are terrible at dealing with and talking about death. We are never taught in schools what to say to someone who loses a loved one, despite the fact that all of us will, at some point in our lives, have to deal with the inevitable losses of those we care about. Dealing with a death that occurs from suicide only adds more layers of complexity, confusion and, in some cases, self-blame that further amplifies what is often a difficult recovery to begin with. Those that are closest to someone who dies by suicide (partners, parents, children) are left with the biggest burden to carry. They are often left with myriad emotions: sadness, guilt, anger. Recreating past conversations, thinking you could have done or said something differently, questioning why you weren’t ‘enough’ for the person to not take their life – all are common thoughts for survivors. Unfortunately so much misinformation, stigma and shame continues to be associated with suicide, making it even more difficult for your support system to know what to do or say, which then further prolongs the grieving process for survivors who are struggling to make sense of the nonsensical. I’ve lost both an aunt and a cousin to suicide – and one of the things that stood out to me so strongly was how uncomfortable so many people were about their deaths. Friends and family that I knew to be caring and otherwise articulate stumbled through awkward conversations. Some avoided the topic altogether, others became visibly distressed, and others made well-meaning comments that were ultimately unhelpful. These are common themes I have heard again and again from patients and friends who have been affected by suicide. When we talk about “moving on” or “getting over” a loss, what we really mean to do is find effective ways to cope. This includes maintaining positive memories and thoughts of your partner, while still getting back to all of the elements that make life worth living – which, in your case, includes dating. It makes absolute sense that it’s difficult for you to date – you are in a self-protective mode, not wanting to make yourself vulnerable to another potential loss. There is no magic formula for how long or what the grief and recovery process looks like, as it is so individual. There is one thing I can say with certainty, however: Not processing your loss – having to present a facade to those that are close to you – will only prolong the ordeal. I would start by opening yourself up to the idea of speaking about your loss, as there is so much therapeutic value in simply talking through the thoughts and emotions you’ll have inevitably bottled up. Consider approaching those closest you: Tell them you don’t need them to say anything, that you just want to talk through what’s in your head. If you feel reticent to approach those you know, I would strongly suggest seeking the support of a psychologist or other registered mental health/grief professional that has expertise in suicide to help you move on. I would also seek support online. Some recommended websites are www.suicide.org, www.survivorsofsuicide.com and www.allianceofhope.org. Have faith that with time and with the support of someone you trust, you will be able to move forward in your life. 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’m in my early 30s and I do want kids – eventually, just not now. I just don’t feel ready, yet as a woman I know the clock’s ticking. How do I prepare myself for what I imagine will be a sea of change in my life? The answer: The short answer? There is no way to fully prepare (ever) for the changes children bring! Now, for the longer answer … Our societal demographics are changing substantively, particularly for women. More women are pursuing higher levels of education. They are putting off co-habitating with partners or getting married (or remaining single by choice). An increasing number are becoming the primary household breadwinners. They are waiting longer to have children, and many are choosing to not have kids at all. As a woman in your early 30s, it is good to hear you recognize that on one hand you realize you aren’t quite ready for kids, yet on the other hand understand that there are some biological considerations you need to be mindful of. Unfortunately, the plethora of images we see in the media, particularly of celebrities who are having children well into their 40s, leads many to have a false perception of the ease with which a woman can get pregnant as she ages. The reality is that fertility starts to decrease as a woman moves into her mid to late 30s. The risk of pregnancy complications and health issues (both for mom and baby) also rise. While it’s true that many women can easily get pregnant and carry the baby healthy to term even well into their 40s, a significant number do struggle and encounter fertility or pregnancy-related difficulties as they age. The question of how to prepare oneself for the significant life changes that come along with having a child (or children) is one I am often asked. The reality is this is almost impossible to do. If you were to ask any parent this question, he or she would tell you the same thing. However, there are a number of life situations you can think about in order to prepare. Are you in a stable, respectful, loving relationship? Having a child to either “save” a failing relationship or in spite of significant relationship issues because of the perceived pressures of the proverbial clock ticking is almost always a bad idea. Are you in a secure position financially? Can you manage the increasing financial demands a child or children will place on you? Designing a baby budget is a great idea to gauge your position in this regard. Do you feel like there are dreams you have that are immensely important to you that you want to achieve before having a child (e.g., backpacking across Europe for a few months)? If so, plan this into your life. Are you willing to accept that for a fair number of years your primary focus in life will shift significantly and you will have no choice but to sacrifice most things in your life for children? When you think about not being ready, what does that mean to you? Put pen to paper and try to articulate in clear, specific words what your fears are. This may help identify how to best move forward. There is no rule book that can help you prepare for the myriad changes children bring to your lifestyle, and at some point you need to weigh the pros and cons and take a leap of faith. Working toward creating a stable life circumstance with respect to relationship, finances and emotional health is the best thing you can do to prepare. 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 wife is fundamentally against the idea of counseling – she’s depressed, unsatisfied with life and has serious body image issues. But I think she needs to see an expert. How can I convince her it’s a good idea? The answer: It can frustrating and saddening for any of us to see someone we love being unhappy and struggling with life. We can often feel helpless in not being able to improve our loved one’s emotional state, particularly if we feel we have exhausted the avenues we have available to us. Certainly there can be a number of positive benefits that many people can experience from seeing and receiving treatment from an objective, neutral and trained mental health professional. That being said, the first point I would like to underscore is that it is not your role to “convince” your wife to seek out counseling. Your role as a partner is, first and foremost, to serve as a source of unconditional support. I do not mean at all to convey that she does not need or would not benefit from counseling, but the way that you approach this discussion is key. All too often I see well-meaning partners who will “tell” or “try to convince” their partner to seek out counselling, but this message can be interpreted as critical (rather than supportive). I would suggest that you start by have a genuine, heart-to-heart conversation with her. If possible, be mindful of timing this conversation on a day and time when both of you have dedicated and uninterrupted time to speak, free of other distractions. Convey your love and concern for her. Focus on communicating how you feel, and be specific about what you have noticed (e.g., “I feel saddened when I see you looking upset and tearful…”). Avoid making assumptions about how she is feeling (e.g., “I think you are depressed and need help”) as this may come across as accusatory or judgmental. Ask what you can do to help and support her. Focus on directing the conversation toward what she feels she needs, and what she thinks would be helpful. You say she is “fundamentally against” the idea of counseling, and I would try to understand where this comes from. Has she had negative or unhelpful experiences with mental health professionals in the past? Does she feel shame or stigma about having to seek out help? Is she unclear about what role a professional would play? Does she feel hopeless that treatment would not help? This may provide a better understanding of where she is coming from, and may help guide you towards ways that you can more effectively support her. Finally, offer to go with her to an initial appointment, no-strings attached. Maybe she’s afraid and unsure about the process. Let her know that you see this as a family issue, and that if she is feeling unwell emotionally that impacts you. Emphasize that your goal is to help and support her, in whatever way possible. 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 daughter and I are close, but we can’t seem to communicate well. She’s in her 30s, but as long as I can remember we lose our temper or snap at each other over the smallest or biggest things. This starts to get embarrassing when we’re among family or friends and can’t seem to talk politely. I’ve tried to talk to her about it but usually the changes are short-lived. Is it just too late and are we too set in our ways to change the behaviour? The answer: None of us are ever too set in our ways to change our behaviour – we have free will over our actions and full control over the way that we choose to conduct ourselves with others. Now, does this mean that changing the patterns of communication you and your daughter have will be easy or happen overnight? Of course not. Family interactions are often the toughest to change. The dynamics that exist in families are long-standing, and the communication that we adopt is often established at a very young age. The more time that passes, the more resistant to change these patterns become. Interestingly enough, we also tend to feel most helpless or give up the easiest when it comes to changing our family relationships. Strange, isn’t it, when most of us consider these to be among the most important and defining relationships in our life? Start by stepping back and get a big-picture perspective on the reasons your communication is so poor. Is the way you communicate with each other similar to how you interact with others in your life? Does your communication represent a more pervasive style each of you has with others or is it limited to your relationship only? What types of issues trigger conflict? Do you each react to in-the-moment situations, or are there bigger underlying issues that have remained unsaid or unaddressed between the two of you? Keep in mind that there is only one person’s behaviour you have control over – yours. You cannot, no matter how much you wish, force your daughter to act or react in a different manner. Be brutally honest with yourself about the elements you are contributing the situation. Ask a family member or friend whom you trust to weigh in objectively. What nonverbal behaviours (tone, posture, facial expressions) change for you when you are around your daughter? Are there hot-topic buttons that you purposely or inadvertently push? How do you respond when she gets snappy? Once you have identified the verbal and nonverbal behaviours you bring to the mix, have a discussion with your daughter. Express to her that you want your style of communication to change. Let her know what you will work on adjusting (be specific and detailed). Ask her what else you can do that would make things better for her (there are likely things you do or say that trigger her that you may be unaware of). Be mindful of not reinforcing her behaviour. For example, if she gets short with you, do not engage or escalate your response – simply stay silent or walk away (assuming the behaviour does not violate a personal boundary or become abusive – in which case you would need to establish parameters). Even if your daughter is unwilling to take a look at her contribution, it is almost impossible for her behaviour to not naturally start to change once you truly commit to changing yours. After all, communication is inherently bidirectional, and our responses are shaped significantly by the responses of those we are interacting with. 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 recently started checking and rechecking certain things, such as making sure that I’ve turned off the stove or locked the door, sometimes four or five times. Is this normal? The answer: Virtually all behaviours – obsessive and compulsive behaviours included – exist on a continuum of severity level, and most people will experience mild forms of most “psychological” symptoms at some point in their life. Checking and rechecking behaviours are very common, and not necessarily of concern unless they take up a significant period of your time, get in the way of you being able to do other things in your life, and create ongoing distress or anxiety. Only about 2 per cent of the adult population will experience clinical levels of these symptoms that would constitute a diagnosis of obsessive-compulsive disorder (OCD). True OCD has some very clear markers. First, there are persistent, repetitive and intrusive/interfering thoughts (obsessions), behaviours (compulsions) or both.
Try to identify other stressors in your life at the current time, and work to resolve those. It can also be very helpful to actively set limits on the number of times you check or re-check (e.g., setting a maximum limit of 2 or 3 times) as this can effectively reduce the behaviour. If you find your symptoms may meet criteria for a diagnosis of OCD, speak to a family doctor, psychologist or psychiatrist. There are very effective treatments for OCD. For most, a combination of cognitive-behavioural therapy (incorporating a treatment approach called “exposure/response prevention”) and medication treatment can lead to very positive improvements in symptoms. 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 wife is inconsolable after three miscarriages. What can I do? The answer: There are a number of things that may be help your wife through this difficult and understandably emotional time. First, resist the tendency to problem-solve. Let her know that you love and care about her, and that you want to support her as best as you can. Acknowledge that you don’t fully understand or appreciate what she is experiencing, but communicate that you want to understand. Then listen to her. Many men have a tendency to want to try to problem-solve or find a solution, but many women feel that they just need the opportunity to express what they are feeling. Being overly positive (e.g., “don’t worry, next time I know things will work out”) may feel invalidating to her. Ask her what you can do that would be helpful. We all cope in different ways and need different types of support from our loved ones. Ask her what you may be inadvertently doing or saying that is unhelpful. Ensure that you are present for any appointments that she is attending with respect to managing her health post-miscarriage, and also in terms of appointments moving forward to investigate causes of the miscarriages. Although the rates of having one miscarriage are quite high (15-20 per cent, with the bulk of these miscarriages occurring within the first seven weeks of pregnancy), the rates do increase with previous number of miscarriages and concerns your wife may be having about the viability of future pregnancies may be a realistic yet also saddening or frightening thought. Many women may experience a grief reaction, where they go through a number of emotional stages before they get to a stage of acceptance. These stages may include: denial that the loss has occurred; anger at having to deal with multiple losses; bargaining for the situation to be different; and sadness or depression. Keep in mind that you may be also experiencing your own emotional reactions to this, and ensure that you are getting the support you need as well. A number of factors impact the manner in which a woman copes with pregnancy loss: how early in the pregnancy the miscarriage occurs; the woman’s age; whether there are previous children; and the number of previous losses. These factors impact the bond a woman starts to make with her child (which is qualitatively different and often much stronger than the bond a father makes in early stages of pregnancy) and may amplify other worries, concerns or anxieties the woman has both about her fertility and the viability of having another child. At some point you both may benefit from speaking to a mental health professional, who can address if she is experiencing any clinical levels of depression or anxiety. 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’ve been seeing a therapist for 8 months. I’m unhappy with my life and feel like I’m not the best mother I could be. The thing is, I don’t feel like therapy is helping at all. My situation and my outlook hasn’t improved. Do I just need to be patient? Or does seeing a psychologist not help some people? The answer: At the risk of sounding biased, I firmly believe that we can all benefit from the support, perspective and guidance of an objective, competent, and specialized professional for various issues at different points in our lives. This is true for any area of life with which we are struggling – physical health (physician), our taxes (accountant), selling a home (realtor), or our emotional health (psychologist/psychiatrist). Although I don’t have enough information on your difficulties and history to provide you with a sense of how long you may need treatment for, I can let you know that the research indicates that individuals with the most common types of psychological concerns (i.e., uncomplicated depression, anxiety, and relationship difficulties) experience significant benefit after an average of 12-16 treatment sessions. Individuals with more complicated histories or concerns (such as childhood history of trauma or chronic suicidality) experience benefit with about 24 sessions. Certainly 8 months is a long enough period of time for you to have started to experience some significant benefits from therapy. It is wise of you to pay attention to the feeling you have that your current therapy is not helping you, as that is giving you an important message that you need to do something different. The beneficial impact of therapy is dependent on a number of important factors. Here are a few considerations: 1. As with any other relationship with a professional, a good fit between you and the service provider is important. I believe this fit is even more important to the success of a psychologist/patient relationship than others, given that patients are having to expose themselves emotionally and are addressing issues such as fears, insecurities, and other core vulnerabilities. Ask yourself whether you feel there is a good fit with the psychologist you are seeing in terms of their approach, style, and personality. 2. You describe feeling unhappy with life in general and with respect to your parenting style. Does the psychologist you are seeing have expertise in dealing with depression and mood issues? Parenting issues? 3. In every single profession, individuals range in terms of their competence levels. Ensure that the psychologist is up to date on advances in treatment approaches, and takes an evidence-based treatment approach (which means providing treatment techniques that research has shown are effective). Ask the psychologist directly about the types of treatment approaches he/she uses and the rationale for such. 4. Finally, have you communicated with the psychologist about how you are feeling about treatment not being effective? A good psychologist will not get defensive, and will openly address your frustration with the lack of progress. He or she should suggest a different treatment approach, or suggest an alternate type of treatment and/or alternate professional. If, after considering the above and after having a candid discussion with your psychologist, you feel that there are still no shifts or improvements, I would suggest seeking out another psychologist. 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 daughter gets excellent grades and wants to be a doctor. She’s been accepted for pre-med at several schools with full scholarship. But now she’s talking about taking a year off before university. I think she’s scared that things won’t be as easy for her as in high school, but I’m worried that a year off will only deepen her anxiety and knock her careers plans off course. What should I do? The answer: As a parent, one of the most important things you want is to see your children be happy, healthy and thrive in their lives. The desire to protect your children and navigate them toward the best decisions is deeply ingrained. So it’s natural that this situation is creating some distress for you. First, congratulations on raising not only an intelligent, but what sounds to be an insightful daughter. The reality is that university is a very different playing field than high school, and her worry is not unwarranted. Worry or anxiety is not a bad thing; we have it for a reason. It mobilizes an action or a response to deal with a stressful (or perceived stressful) situation; it indicates to us that we value the thing we are feeling worried about; and it communicates to those around us that we may need some support. Your daughter’s response is a normal reaction to a coming and significant transition in her life. There are a few things I would suggest you do: Try to understand the depth of your daughter’s anxiety. Find out whether her desire to take a year off is fully precipitated by anxiety or if other considerations are playing a role. Give her reassurance about her ability to successfully cope with the transition. And openly communicate your concerns to her. Start by saying how proud you are of her and that your desire as a parent is to see her succeed and excel in life. Convey that you understand she is worried about things being harder at university and that she is right that things may be challenging. Let her know that you have confidence in her skills to adjust. Ask her what is motivating her to take a year off and what she wants to do in that time. Then listen. You indicate that you think her decision is motivated by fear, but this may be a very small part of it. She may be thinking that if she is going to take a break from school, now is the time before she starts to undertake a decade-plus of additional schooling. The reality is that it will be much more difficult to consider a year off once she begins her studies. Perhaps she is thinking of travelling, or working and making money. If she continues to live at home, establish some motivating parameters. For example, let her know that if she is not attending school she is expected to work and pay rent, and that she needs to increase her contribution to the household (through cleaning, cooking and so on). To calm your worry, remind yourself that for most young adults, a year of working in the real world at what will likely be a low paying, less than ideal job actually has the opposite effect of motivating them to go back to school sooner. Ultimately, you need to trust your daughter’s decision as she is an adult, and also have confidence that you have raised a young woman who will make the right decision. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. |
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