CHILD CUSTODY COACHING

Posted on November 4, 2013 by DrWhitcup

Divorcing is never pleasant.  If you have children, you may be done with the marriage work – but only beginning the difficult family work.

Spouses who participate in nasty prolonged custody battles are, in my opinion,  never fighting about the children.  What they are trying to settle, is the damage from their own childhoods.  This is an awareness  often unknown to the struggling spouses.  It needs to be explored.

I have never met a person, in 33 years of practice, who consciously, willingly, abuses their children – and their children’s futures.  Your relationship now, ends up in their future choice of life partners.

Think about it. This is NOT therapy.  It is conflict resolution beyond your signature on a document.  This is resolution, not agreement.

My training as a Marriage and Family Therapist, and my certification as a Guardian Ad Litem   gives me a unique perspective in which to do this work,

The process is time limited – direct and outcome oriented.

If you love your children – you can find a way, with skilled and caring intervention, to stop the fighting.

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MEDICATIONS AND SEX

Posted on September 11, 2013 by DrWhitcup

Medications and Sex

Derek C. Polnsky MD

There is a constant dilemma for me when considering giving patients of mine medications.  There are many instances where medications are in fact helpful and a careful evaluation is always important in weighing the pros and cons.  When it comes to psychotropic meds, i.e. drugs that are used in the context of psychological issues the potential side effects need to be explained carefully.

First, let me mention the ‘usual suspects’ of drugs and then talk about what they do and what problems might result.

DRUGS FOR ANXIETY:

These medications are known as the ‘benzos’  (which is short for benzodiazepene)  The brand names include Ativan, Xanax, Klonopin, Valium and Librium.  These medications act within 20 minutes and are helpful for people who have moderate anxiety.   They usually do not have sexual side effects.

DEPRESSION and CHRONIC ANXIETY

These are ‘antidepressants’.  There are several different types.  The older drugs were amitryptaline, imipramine, nortryptaline.  They were effective, but the side effects were a problem, Dryness of the mouth, blurred vision, low blood pressure and sexual side effects.  They are not used much today.

“SSRIs”:  Drugs such as: Prozac, Zoloft, Paxil, Celexa and Lexapro.  They have been around for 40 years and are very effective in helping people with depression and with generalized chronic anxiety.  Just giving out pills, though, is not what I do.  I use these medications as a ‘helper’ to the talking therapy.  When combined, they can be very useful.  Patients talk about how they have made a huge difference to how they feel; less anxiety, less obsessive thinking, improved mood and sense of well being.

Effexor, Cymbalta and Pristiq are similar medications, but their chemical structure is slightly different.

Wellbutrin is a totally different antidepressant.   I don’t find it as effective as the others, but use it occasionally when the others have not been helpful, as a means of ‘boosting’ the SSRIs and sometimes to reverse the sexual side effects caused by some antidepressants.

SEXUAL SIDE EFFECTS:

With the SSRIs and the Effexor group the following side effects MAY occur:

1               Lowered sexual interest and desire.

2               Difficulty with orgasm (both for women and men) It may take a longer time to have an orgasm, the orgasm may not feel as good or it may interfere with having any orgasm.  By the way, this side effect is sometimes helpful for guys who come very quickly.

3               Decreased arousal.  For women, they may not get as wet, and for guys, it may take longer to get an erection. There may also be decreased physical sensation.

I always have to balance the side effects with the intensity of the psychological symptoms an individual has.  If the depression or anxiety is severe and interferes with work, relationships, sleep, a combination of medication and talking therapy is what I do.  There are instances where there is a long family history of depression, and here, talking is not that helpful alone.  Exercise, relaxation can be useful, but by and large can not overcome what is a ‘biological’ depression.  In some of these instances the depression is immobilizing and worse than having sexual side effects from meds.

There are many instances where medications are overused, but at the same time it’s unfortunate that people refuse to take meds that could be very helpful with symptoms that have a very negative effect on their lives.

I use the example of insulin dependent diabetes.  Here, one has to take insulin all the time to control the level of the blood sugar.  There is a biological problem with the pancreas, and no amount of good food, exercise, yoga and good thoughts will get it to produce insulin.  In this extreme situation, refusing to take insulin will usually result in coma and death.

MANAGING THE SEXUAL SIDE EFFECTS

It’s always important to describe for my patients what they might be and then see if the individual notices any changes.  There is no way of predicting who will have the sexual side effects.  Some people have none; others have side effects that can be quite intense with effects on sexual functioning.   Sometimes the side effects will lessen over time; and for some, adding wellbutrin may alleviate the difficulties with arousal and orgasm.   For a significant number of women, Viagra (or Levitra or Cialis) may help.  There is increased blood flow in the clitoris and vagina, and arousal and orgasm might improve.

I encourage eople who have been in touch with their sexual feelings, know what feels good and know how to masturbate in ways that are exciting, to make sure they masturbate frequently.  It may initially feel a bit like work, but it can help get over the sexual inhibition.  I have had some women who would almost meditate into sexual arousal, and who described their orgasms as being longer, deeper and more intense.  (Same with some men)

So if you have symptoms that include depression, anxiety, preoccupying thoughts and dread that are having a major impact on your life, medications in combination with talking therapy can be extremely helpful.  It is important in this regard that you find a therapist with whom you feel comfortable, and whom you feel understands and listens.  If you take medications and there are effects on sexuality, discuss this with your doctor and either a dose change or a medication change might make a difference.

Derek Polonsky is a psychiatrist in Boston who does individual, couples and sex therapy.

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PREGNANT, PILL-FREE AND PANICKED

Posted on June 24, 2013 by DrWhitcup
Opinionator - A Gathering of Opinion From Around the Web

ANXIETY June 23, 2013

By ALISSA NUTTING

Anxiety

Because I’ve lived so long with anxiety, there were lots of things I figured I’d never, ever do — having children was one of them. In fact, in my 20s, before I’d managed to stumble on the combination of drugs and exercise that allows me to be as sane as I can expect to be, I was so sure I’d never give birth that I got a tattoo of a giant koi fish extending from one end of my abdomen to the other.

Seven years later I found myself hugely pregnant —the koi fish had expanded to a koi whale, stretched out into a giant, fleshy billboard advertising the grand impulsivity of my youth. On darker days, it was a villainous rebuke. Its growing eye stared back at me in the mirror.

At practically the very moment I found I was host to a living being, I realized that that living being could stop living.

To be clear, I did choose to become pregnant, and when I did I found myself in a very ironic situation: my decision to have a child was the result of a sense of stability I enjoyed due to taking an array of anti-anxiety medications that I would be strongly advised by most doctors to stop taking now that I was pregnant.

It was also my medicated, logical brain that reasoned that the possible side effects of the drugs on the baby would be even greater than the anxious thoughts and behaviors that would flood back in when I stopped taking the pills. I can do it! I told myself.

So I stopped taking the pills. And this is what happened.

Ellen van Engelen

My pregnancy was one long, nonfunctional funk, in which I oscillated between the couch and the bed and seldom removed my favorite pair of stained elastic-waist pajama pants. If I had to make a pie chart of my activity during pregnancy, the two largest sections would be “crying” and “apathetically watching ‘Law & Order’ reruns.” I worried that upon birth my child would not recognize my voice or that of my husband but only the gestational background noise she’d heard the most — the sound of a gavel slamming onto wood.

Pregnancy without drugs made it impossible not to constantly entertain the giant, looming questions of mortality all throughout the day. Few things can make one focus on death more than the life-giving process. At practically the very moment I found I was host to a living being, I realized that that living being could stop living. I remembered, that I, too was a living being who could stop living. Whenever I allowed myself the slightest glimpse at the new potential zenith of loss made possible by this gift of a child, I became paralyzed.

The specter of doubt in my head was a convincing one — it took on the form of a wizened voice that brought to mind an elderly philosophy professor in a sweater vest sitting in a rocking chair and thoughtfully puffing away at a pipe. “Just look at you; look at your life!” the voice said. “How exactly would someone like you MacGyver a human baby from the ether of sarcasm, Eggo waffles, and dog hair that is your existence?” It’s true, I thought. It’s enough of a triumph for me to remember to turn off the coffee maker each morning that I’m literally proud when I do it. Did I think I’d actually somehow managed to conjure up — and nurture — another person?This, of course, spawned worries for me that the pregnancy wasn’t proceeding correctly. For example, the “nesting” energy I’d been told about did not kick in and make me want to clean things. A dust ball behind our bedroom door slowly grew to the size of a small cantaloupe. Instead of removing it I manufactured an odd link between the growing dust ball and my growing fetus: I did not pick it up or throw it away for fear that tossing the dust ball would cause me to miscarry. When it grew so large that our dog began to regard it with suspicion — sitting several feet away, trembling, emitting a low growl — I finally compromised by vacuuming it up but not emptying the vacuum into the trash: it was still safe, I assured myself. Encapsulated and going nowhere. I could toss it after I gave birth.

On the bright side, pregnancy actually decreased my anxiety in certain areas — mainly relative to physical appearance. Leaving the house without changing into actual clothing, for instance, would’ve made unpregnant me feel self-conscious, but pregnant me never gave it a second thought. It made going through the McDonald’s drive-thru while wearing a bathrobe at 3:46 p.m. on a weekday feel seven percent less embarrassing than it had before. Ditto for pumping gas in oversized tropical bird patterned pajama pants. When someone at a stoplight recently used their phone to take a picture of me drinking from the mouth of a 2-liter bottle in my car, I was blissfully unaffected. In fact, I had to actively rein in my apathy at others’ judgment of my sloth.

Amazingly, my baby was born without a hitch. And I’ve begun to resume the taking of my beloved anti-anxiety drugs.

But now that I am a mother, I am at the threshold of a whole new set of anxieties I haven’t even allowed myself to contemplate. I’m about to enter a club where increased anxiety is the norm even for people with regular brains — so where will that leave me? When I do allow myself to think about what’s beyond the cliff, it’s the worry that I won’t be able to handle the worry: that no amount of medication, cathartic yoga, or omega-3-enriched, low-preservative-diet food could ever possibly be enough to handle it. I worry about the games and tricks my brain will play on me in its misguided attempt to try to help me cope with the hurricane of what-ifs. But if there’s one thing I’ve practiced to date in my life, it’s anxiety. If anything has prepared me even slightly for what’s about to come, maybe it’s that: maybe my life-long nemesis was just a gateway to motherhood all along.

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