An Analogy

I am still thinking about the different ways our culture responds to assaults on property and (sexual) assaults on person. Consider the following situation:

A woman takes her purse and goes shopping, perhaps with the intent to buy something. Or maybe she is just window shopping. Maybe she hasn't made up her mind yet about whether or not she wants to buy. She goes into a store and looks at the things for sale. Maybe she takes something from the shelf or off the rack and looks at it. Perhaps she even carries it up to the shopkeeper at the checkout counter and takes out her money.

But then she changes her mind and decides she's not going to buy the item after all. The shopkeeper grabs her purse away from her and steals her money.

He's completely justified, of course:

1. She shouldn't have been shopping if she didn't want to buy.
2. She went into his shop, didn't she? Doesn't that mean she wants it?
3. She had her purse right out in the open where everyone can see it--a definite signal of intent to buy.
4. Once she's in the shop with her purse, after she's examined the merchandise, and especially after she's taken out her money, too late! Nobody could expect the shopkeeper not to grab the money at that point. He's way too far into the sale to quit now, even if she changes her mind. Sellers can't be expected to control themselves then.
5. It's just she said/he said what really happened anyway.
6. And we all know how these shopping women are--basically asking for it.

Tell me how "date" rape is different from this.

The Stages of Change

Here is a good article by Marc F. Kern about Prochaska's Stages of Change model for overcoming bad habits, addictions, and compulsive behaviors. The 12 Step program is the gold standard, but for some people (and some problems) a harm reduction approach rather than a total abstinence approach may be more effective. I'm not a specialist in chemical dependency or substance abuse, and won't get into that battle, but this model seems a common-sense way to navigate the almost inevitable mistakes and relapses involved in overcoming a long-standing habit.

The idea behind the SCM is that behavior change does not happen in one step. Rather, people tend to progress through different stages on their way to successful change. Also, each of us progresses through the stages at our own rate.
....The stages of change are:

• Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed)

• Contemplation (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change)

• Preparation/Determination (Getting ready to change)

• Action/Willpower (Changing behavior)

• Maintenance (Maintaining the behavior change) and

• Relapse (Returning to older behaviors and abandoning the new changes)

....Transcendence

Eventually, if you “maintain maintenance” long enough, you will reach a point where you will be able to work with your emotions and understand your own behavior and view it in a new light. This is the stage of “transcendence,” a transcendence to a new life. In this stage, not only is your bad habit no longer an integral part of your life but to return to it would seem atypical, abnormal, even weird to you.

When you reach this point in your process of change, you will know that you have transcended the old bad habits and that you are truly becoming a new “you", who no longer needs the old behaviors to sustain yourself.

I read once that to successfully kick an addiction the average person goes through rehab seven times. I don't know if that is true, but it speaks to the difficulty of change, and to the importance of self-awareness and honesty about where one is in the change process.

Postpartum Depression

I am doing a presentation today on Postpartum Depression, and I thought it would be helpful to include some of the best links to resources here. Clinically diagnosable Postpartum Depression occurs during an estimated 10% of pregnancies and childbirths.

This is a serious disorder which can have lasting negative effects on both mother and child. The American Academy of Family Physicians reports that

Infants as young as three months of age are able to detect the affective [emotional] quality displayed by their mothers and modify their own affective displays in response to it. Cognitive skills, expressive language development, and attention have been adversely affected by maternal depression.

The AAFP lists these warning signs of the disorder:

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• Persistent feelings of sadness and crying.
• Having little desire to eat.
• Significant weight gain or loss.
• Irritability, anxiety and restlessness.
• Inability to find pleasure or interest in life.
• Feeling exhausted or having no motivation to get things done.
• Insomnia.
• Feelings of hopelessness, worthlessness or guilt.

More serious symptoms include:

• 
  

Thoughts of hurting the baby.

Thoughts of hurting yourself.

Not having any interest in the baby.

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These more serious symptoms indicate the likely presence of Postpartum Psychosis, according to The National Women's Health Information Center. Postpartum psychosis

...occurs in about 1 to 4 out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Women who have bipolar disorder or another mental health problem called schizoaffective disorder have a higher risk for postpartum psychosis. Symptoms may include:

• Seeing things that aren't there
• Feeling confused
• Having rapid mood swings
• Trying to hurt yourself or your baby.

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If you or someone you know fits this description, please seek medical help immediately. This is a medical emergency requiring URGENT care.

Also call your doctor if:

• Your baby blues don't go away after 2 weeks
• Symptoms of depression get more and more intense
• Symptoms of depression begin any time after delivery, even many months later
• It is hard for you to perform tasks at work or at home
• You cannot care for yourself or your baby

Your doctor can ask you questions to test for depression. Your doctor can also refer you to a mental health professional who specializes in treating depression.

Some women don't tell anyone about their symptoms. They feel embarrassed, ashamed, or guilty about feeling depressed when they are supposed to be happy. They worry they will be viewed as unfit parents.

Any woman may become depressed during pregnancy or after having a baby. It doesn't mean you are a bad or "not together" mom. You and your baby don't have to suffer. There is help.

Here are some other helpful tips

• Rest as much as you can. Sleep when the baby is sleeping.
• Don't try to do too much work or try to be perfect.
• Ask your partner, family, and friends for help.
• Make time to go out, visit friends, or spend time alone with your partner.
• Discuss your feelings with your partner, family, and friends.
• Talk with other mothers so you can learn from their experiences.
• Join a support group. Ask your doctor about groups in your area.
• Don't make any major life changes during pregnancy or right after giving birth. Major changes can cause unneeded stress. Sometimes big changes can't be avoided. When that happens, try to arrange support and help in your new situation ahead of time.

• 
  

Treatment for Postpartum Depression can include psychotherapy or antidepressant medication. Sometimes a combination of the two is best.

Unfortunately, major depression affects 15 to 25 percent of adults in the US each year, and women are twice as likely to experience depression as men. Here is a self-help resource for those experiencing the "Baby Blues" to begin using proven techniques for dealing with depression.

But remember, Postpartum Depression is a serious condition which most often requires professional help for recovery.

Pardon the random dots and spaces. I'm still learning how to copy quotes with bullet headings. Any suggestions?

Challenging Unhelpful Thoughts, Simplified Version

I keep trying to come up with simpler ways to use some of the well-researched techniques for countering depression and anxiety. Here is a 4-step system that may work even when you don't have your therapy notebook nearby:

1. I feel [bad, sad, angry, frustrated, discouraged, panicky, hopeless, etc.]

2. because [identify or describe the situation in a few words].

3. I've been talking to myself about it this way: [describe typical unhealthy and/or unhelpful thought patterns--note that while what you're thinking may be technically true, it just isn't helpful].

4. More healthy and/or helpful thoughts would be: [brainstorm a list of thoughts that are also true and which have a positive effect].

Repeat this process whenever you feel your mood deteriorating, and specifically tell yourself the thoughts you come up with in #4 several times per day. This exercise depends on the assumption that a) you are able to identify your unhealthy and/or unhelpful thoughts, and b) you can come up with positive alternatives. Some people need a therapist to even begin the process. But it's worth a try.

Bitterly Funny

While perusing the feminist blogosphere, I ran across these rules for rape prevention. I almost didn't post them for fear they could be a trigger for my clients who are rape-survivors, but the rules are so tiredly true, and yet so often overlooked, I couldn't resist:

Sexual Assault Prevention Tips Guaranteed to Work!

1. Don’t put drugs in people’s drinks in order to control their behavior.

2. When you see someone walking by themselves, leave them alone!

3. If you pull over to help someone with car problems, remember not to assault them!

4. NEVER open an unlocked door or window uninvited.

5. If you are in an elevator and someone else gets in, DON’T ASSAULT THEM!

6. Remember, people go to laundry to do their laundry, do not attempt to molest someone who is alone in a laundry room.

7. USE THE BUDDY SYSTEM! If you are not able to stop yourself from assaulting people, ask a friend to stay with you while you are in public.

8. Always be honest with people! Don’t pretend to be a caring friend in order to gain the trust of someone you want to assault. Consider telling them you plan to assault them. If you don’t communicate your intentions, the other person may take that as a sign that you do not plan to rape them.

9. Don’t forget: you can’t have sex with someone unless they are awake!

10. Carry a whistle! If you are worried you might assault someone “on accident” you can hand it to the person you are with, so they can blow it if you do.

And, ALWAYS REMEMBER: if you didn’t ask permission and then respect the answer the first time, you are commiting a crime- no matter how “into it” others appear to be.

Building Close Relationships

It is discouraging that the people we are closest to--spouse, family members, partners--are often those with whom we have the most difficulty. One reason is that these relationships matter so much. Another is that these people are with us much of the time, through good times and bad, seeing us at our worst as well as at our best. Here is information on emotional intelligence which gives ideas for developing aspects in ourselves to improve these vital relationships.

Here and here find further info on a slightly lighter note. (Remember to take internet advice with a grain of salt).

Some things to consider if you are thinking of marriage counseling. Here is a frequently updated blog about relationships and counseling.

Don't give up yet! Your relationship is likely worth working on.

Posttraumatic Stress Disorder (PTSD)

Part of the human condition is dealing with trauma. We are usually resilient enough to cope with the after-effects and move on. Some people have had to deal with exceptional trauma in their lives, however--whether it is childhood abuse, sexual or physical assault, combat situations, witnessing death or injuries, or other terrifying single or prolonged events--and they may find themselves experiencing symptoms of Posttraumatic Stress.

Here is the list of diagnostic criteria for this disorder.

Here is a good summary of the various types of treatment.

Here is a forum to talk with others with the diagnosis, get information, support, and advice from people dealing with similar issues.

As always, use your good judgment and don't take everything you find online to be the best information for you. But there are many resources out there, and the support you find may be worth sifting through others' hypotheses and testimonials. If you are not yet meeting with a therapist, or you are otherwise unhappy with your treatment situation, don't hesitate to pursue better care. Therapy is highly individualized and it may take a while to connect with the best therapist for your particular personality and situation.