Online counseling sessions can be just as intimate, if not more so, than in-person therapy sessions. The first week or two of tele-therapy were an adjustment to the technology for both client and therapist. Over the past few weeks, I've noticed that the sessions have become much more rich. Meditation and other contemplative practices have long been an excellent adjunct to therapy. Now that there is no more commute to our offices, I've been recommending that the extra time be used to create a special ritual. Below is a list of what I've been recommending. Repeat this process every week to provide a sense of grounding and to take your therapy process to a deeper level.
If you hurt me, you hurt yourself.
---my husband’s response when I said something mean
This profound statement reveals how intertwined our lives are when in a relationship.
I was halted. My anger wanted to do damage---and then walk away unscathed, feeling catharsis, feeling right.
This kind of gratification does not exist in a relationship. Hurting him would not lead to my happiness.
In a relationship, every action has a reaction.
Each day, we make choices that have consequences. Thousands of banal micro-choices that have a significant effect on another person; a dish left unwashed, a critical comment, a seductive overture unnoticed, looking at social media while someone is talking to you.
Your partner has an experience of your choices. Their experience is filtered through layers of their past experiences. They make myriad interpretations; I am loved, I am not loved, this person is selfish, I can’t depend on this person…… Profound interpretations---of your banal micro-choices-- are happening inside this person, in their silent, internal dialogue about you.
Your partner now chooses an action.
Perhaps, they fall quiet. Recoil from your touch. Snap at you. Avoid you.
These perceptions, choices and actions form patterns that repeat over time.
The content of the fighting may change, but the pattern remains the same. Couples feel stuck and often, partners blame each other. Our internal narratives, or stories about the relationship, are often epic tales with great villains and tragic victims. As a couple’s therapist, I’ve found that there are rarely clear victims or villains; more commonly, I see a series of cycling actions and reactions with mutual input. The truth is, whatever situation you’re in right now, you probably co-created it.
To say couples are interconnected is not a new concept, yet this notion still proves difficult to execute. In truth, awareness is mental labor. You would need to interrupt your own mental dialogue to consider the experience of your partner. You would need to ask yourself, ‘How will they feel about this banal micro-choice?). It’s fairly common to be self-focused, and rest assured, it is not necessarily clinically narcissistic. I’ve noticed that most people’s infractions were not intentional or malignant, but a benign blindness; an act of omission.
Shelter-at-home has turned our homes into relationship crucibles. There is an increase in domestic violence and a rise in relationship tension, irritability and conflict. However, it’s not easy to get distance from our partner or to break-up. What we can change---is how we fight.
The first step in un-packing a pattern, is identifying your conflict style. Here are some simple questions to get you started.
What is your Conflict Style?
How do I express anger and resentment?
How do I ask for what I want? Do I make demands or requests?
Do things need to be done ‘my way’?
Am I open to other perspectives on what is a ‘right way’?
Do I give my partner space to say no?
Do I ask about my partner’s perspective?
Am I able to tolerate different perspectives?
If not, do I get angry or need to convince my partner toward my perspective?
Am I able to compromise?
Do I tend to persuade or manipulate to get my way?
Do I put my partner’s wishes ahead of mine?
Do I assert my point of view when it’s different?
Do I ask for what I want?
Do I communicate my expectations out loud? Or expect the other to ‘just know’?
Do I teach my partner how to love me?
Do I try avoid my partner’s anger?
Do I change my behavior if I believe my partner will be disappointed?
Do I guess how my partner will react to situations rather than asking directly?
Do I share when I am upset?
Is it hard for me to tolerate differences?
Is it hard for me to tolerate tension?
Am I defensive when my partner expresses feelings?
Do I tend to attack rather than investigate and ask questions?
Do I prepare my next attack while my partner is talking?
Do I use criticism to get what I want?
Do I use criticism to express how I feel?
Do I avoid vulnerability statements? ( i.e. ‘I am sad,’ or ‘I am disappointed.’)
What does an equitable conflict style look like?
This is the starting point for unraveling toxic patterns. A good couple’s therapist will not shame you for using one of these conflict styles. A good couple’s therapist will not take sides. Your therapist would map out your problematic pattern, teach different approaches, and allow you to practice with role-plays. With guidance and support, you and your partner can grow and establish new, unifying patterns.
It is possible to do couples therapy over tele-health and if you’re feeling the heat now, it’s better to get started remotely before the situation escalates. Couples therapy works best when there is still some good will and faith that your partner can change with you.
What is Trauma?
Trauma is a term used to describe a person’s emotional response to a severe, distressing event that shatters one’s sense of security and safety. Highly frightening events such as assaults, car accidents, combat, or natural disasters typically contain an overwhelming amount of stress that disrupts mental health, nervous system and neurological functioning.
According to the American Psychiatric Association (APA), approximately one in eleven people that have survived or witnessed a traumatic event will develop posttraumatic stress disorder (PTSD) in their lifetime.
The term trauma is often used beyond the criteria for PTSD and refers to relationship traumas, reactions to a crisis such as the ongoing pandemic, and other acutely distressing experiences.
Trauma symptoms can be acute or chronic. It is important to address PTSD symptoms early, so you can start the healing process, and get your life back on the track.
What are the Symptoms of Trauma?
The most common symptoms of post-traumatic stress disorder are:
After the traumatic event, the brain keeps the memory of the event in the short-term memory (stuck in replay) rather than moving it into long-term memory. Having the trauma sit in the immediate, short-term memory (which is normally reserved for day to day functions), keeps people constantly hyper-vigilant for danger and the entire nervous system is constantly on guard as a result. This experience would be exhausting and obviously distracting, making it hard to get work done or feel normal in social situations.
As a result, people experiencing trauma symptoms often socially isolate or feel uncomfortable in social situations---even around friends and family. They tend to report feeling “not like myself,’’ joyless and ‘off in space’ (dissociation). Some people are overtly emotionally disturbed---they may experience crying spells or violent outbursts. Others become numb, foggy-minded and emotionally flat. Substance abuse is a common secondary issue. There is a real domino effect on all areas of people’s lives.
Other atypical signs of trauma may include body pain, severe migraines, sexual dysfunction, eating disorders, and a rapid weight loss.
These unusual signs and symptoms of PTSD may lead to inaccurate diagnoses. It is, therefore, particularly important to understand the signs of trauma, so you can get the appropriate trauma treatment.
What are the Benefits of Trauma Treatment?
The good news is that trauma treatments have research to support their effectiveness. There are several popular treatment approaches used by therapists. Traditional talk therapy is less effective than a specialized treatment protocol. I will outline the types of trauma treatment below. None of them are superior to the others; they are all excellent and have research to support their efficacy. We have therapists on staff with certifications in each of these trauma treatments. I’ve personally had great results with the Cognitive-Behavioral/Mindfulness protocol.
What to Expect from a Trauma Therapy Session?
Processing emotion, neurologically, biologically, and cognitively, is essential in trauma recovery and healing. The goal of trauma therapy is to reduce symptoms and teach skills to manage triggers. Many people experience a full recovery. The intrusive thoughts and feelings will subside as the brain moves the traumatic event out of your short-term memory and into your long-term memory.
Therapy sessions will be more structured than traditional talk therapy. The therapist will be focused on symptom reduction. As the symptoms become more manageable, therapy will focus on creating meaning and restructuring thought patterns.
Many patients feel scared of re-experiencing their trauma in therapy. In fact, avoidance of directly talking about the event is a hallmark of PTSD. It’s true that therapy does expose people to the anxiety, but therapists are well trained to incorporate anxiety management into the session and use exposure to the trauma in small steps. The sessions should feel emotionally evocative but tolerable—and you should walk away with a sense of learning and mastery. It’s wise to surround yourself with extra support when embarking on trauma treatment. Journaling and meditation are great adjuncts to therapy.
Some of the most successful PTSD therapy treatments involve Cognitive Behavioral Therapy (CBT) for trauma, Eye Movement Desensitization and Reprocessing (EMDR), and the Trauma Resilience Model.
In short, the main aim of CBT therapy for trauma is to decrease symptoms by using strategies to relax the body while introducing small amounts of exposure to the symptoms, then incorporating various interventions in the moment, then returning to relaxation at the end of the session. The goal is to work on the trauma but keep the client’s nervous system within a window of tolerance. The goal is to train the brain that the person is no longer in immediate danger so it will stop sending false alarms through the nervous system. Many bio-based interventions are used to calm and retrain the nervous system.
Eye Movement Desensitization and Reprocessing
EMDR therapy focuses on disturbing emotions and thoughts that result from a traumatic event rather than on trauma itself. This therapy approach can be used in all stages of trauma treatment, from the beginning to the end of treatment. Three stages of the recovery process for trauma include:
Trauma Resiliency Model (TRM)
The Trauma Resiliency Model is rooted in research on resilience. This is a skill-based treatment that teaches people about the neurology and biology of trauma and how to bring the body and mind back into balance.
I'm pleased to announce that my book "The Women on My Couch" made it to BookAuthority's best Psychotherapy books of all time!
BookAuthority collects and ranks the best books in the world, and its lists are featured on CNN and Forbes. I'm honored to receive this kind of recognition. Thank you to all my readers for your support!
The book is available for purchase on Amazon.
Should I Stay in this Relationship?
15 Smart Questions to Help You Decide
(Hint: How you were loved shapes how you love.)
.Are you contemplating a break-up or divorce? What kind of information do you need to make a good decision?
Perhaps you’re listing your partners infractions or looking at the frequency of conflict or assessing your alignment on values and goals. As a couple’s therapist, I’ve had the opportunity to witness hundreds of people make decisions about whether to stay or go. I’m interested in the way people make these life-changing decisions. What is the evidence? What is it based on?
We can all make lists of our partners failings. There is conflict in every relationship (even if you don’t fight). There are differences in every relationship. I’ve learned that differences and conflict are often not the real deal-breakers. At the core of most people’s decision-making is the experience of love; feeling loved in the way you need to feel it.
Here are some questions to take you on a deeper dive into the nature of who you are—and who your partner is-- in a relationship.
Go through these questions with your partner. Take turns listening deeply.
Repeat 3 times; once related to your mother, father and one significant relationship from your past.
1. How did your mother/father/significant past person express love to you? (Choose the ones that apply below)
2. What was your reaction to her expressions of love? Describe your felt experience both in feelings and physical sensations (choose any that apply or add others).
3. On a spectrum, did their expression of love feel like it was a good fit, too much, not enough? If overstimulated by a parent’s love and attention, did you feel irritable, strong desire for freedom, or angry. If the love wasn’t enough, did you feel longing, sadness, emptiness, loneliness, or anger. If their love was exploitive, did you feel shame, anger, controlled or manipulated. Was love safe or unsafe? Was love consistent or inconsistent?
4. How did you behave in response to their love style?
5. In what ways did you feel deprived? What was missing for you?
6. How did you react to not getting what you wanted?
7. How were your thoughts and expectations changed? (i.e. People are like this…men are like this…women are like this….)
8. Did you believe you were worthy of love? Valued in the family? Worthy of attention? Worthy of being heard?
9. Did you feel ignored? Unworthy of being seen or heard?
10. As a result of these experiences, do you believe you can count on/depend on others?
11. Do you feel comfortable letting others see your need for love (i.e. being vulnerable and open)?
12. Is it easier for you to receive or give love?
13. What fears do you have around giving love? What feels safe and what feels too vulnerable?
14. What is your fantasy partner? If you could waive a magic want and have your partner love you in a way that is perfectly designed for your needs, what would that look like?
15. What did my gender, sexual orientation, religion and culture teach me about my lovability and how to love others?
Make a list of what you’ve learned about yourself. You may notice that you’ve developed feelings, thoughts and expectations about what love feels like, should feel like and even your capacity to give love. Your most salient experiences shaped how you view your present reality---and often result in misinterpretations of reality. As a couple’s therapist, I’ve learned not to take anyone’s story at face value. Any event being discussed in couples therapy has two distinct perspectives. There is no shared subjective experience.
We all project our past onto our present partner. Rather than seeing them as they are, we see them through the lens of our past. As a result, we make faulty assumptions about other people (this principle extends into other relationships as well).
I’ve observed that these distortions change over the course of time. In the early stages of a relationship, we often project idealized fantasies on to our partner; feelings are positive and loving. In middle stages, disillusionment sets in as we realize this human being is not our fantasy; here, anger emerges then grief sets in. Years into the relationship, deeper, childhood pain re-emerges, and more intense emotions show up.
At the intersection of reality and projection, my job as a therapist is to witness how people make meaning out of both perceptions. I’ve noticed themes across their narratives; assumptions about the partner or a situation. These are some common assumptions:
“I can’t depend on you.”
“You don’t really care about me.”
“You are trying to control me.”
“You are selfish/neglectful.”
When said out loud in session to the partner, “ I don’t think you care about me,” and the partner is able to respond, it usually becomes clear that it was not the partners intention. As we work through each of these deep assumptions over the course of therapy, a heaviness is lifted and the couple begins to talk about these assumptions with levity or in a constructive way that allows them to correct their behaviors and reach for a better way to love.
In order to make a wise decision about staying in a relationship, you want to use evidence that is grounded in reality and not distortion. Once you're able to let go of your assumptions, you will see your partner more clearly. His/her infractions will be contextualized. Your differences and conflicts will take on new meaning. If you want to stay together, use the information that you’ve learned about each other to craft new ways of interacting; specifically-tailored to your deprivations and longings----not in a way that keeps you trapped in your past, but in a way that allows you each to overcome the past and grow. Seek to create a corrective, healing set of patterns.
Your deal-breaker question: Are you willing and able to create a brand new love?
If you are not both willing and able to learn and grow, then perhaps you should part ways.
People are drinking more during the quarantine.
The Washington Post reported that alcohol sales increased by 55% in mid-March and the San Fransisco Chronicle reported an increase of 42% in the first week of the city’s stay-at-home order.
How do you know if your Tiger King drinking games or Zoom drinking games are all in good fun or if your alcohol consumption is becoming a problem?
Here are some early signs and symptoms:
Many people associate alcoholism with drinking daily or all day or no longer being able to function. The truth is that addiction is an insidious, slow-developing process. These stereotypical ideas about what alcoholism looks like are actually later -stage symptoms. The line from recreational drinking to the neurological condition of addiction had been crossed much earlier. It’s wise to take seriously the earlier, more subtle symptoms described above. These symptoms are often fleeting which makes assessing yourself difficult. Your alcohol intake can seem controllable one day and out of control on another day.
So how can you tell if you’re developing a problem with drinking? Start by noticing what is happening in your body and mind. Drawn from the techniques of mindfulness, you can learn some mastery over your internal experience.
Here is a research-supported practice that will help you to develop a better awareness and some control over urges. ( the ability to ‘control’ urges is a neurological function that is impaired in addiction).
Close your eyes.
Step back into your observer mind and watch how you experience an urge.
Notice where you feel it in your body.
Note the level of intensity.
Note the thoughts about drinking.
Now, imagine urges are like ocean waves: they swell, crest, and fall.
If you fight against them, you can exhaust yourself and be carried away, eventually getting pulled under.
If you stay above them and ride the wave, you will safely make it to shore.
Instead of fighting the urge, use your breath as the “surfboard” and ride the urge through its rise, cresting, and inevitable fall.
As you feel the first urge to drink rise within you, stop what you’re doing, and focus on your natural, unaltered breathing. As thoughts come up, observe them non-judgmentally--let them come and go as you remain connected to your breathing.
You’ll notice that as the urge rises, it also grows stronger and may even begin to feel impossible to ride out. Don’t let it fool you. It will crest, and from that point forward, the urge will fall and dissipate.
Notice a more peaceful feeling.
As urges arise again, repeat the practice.
This practice works best pre-emptively. Do it early in the day. Do it more than once if possible.
Finally, record what you noticed happening in your mind and body in a journal.
We know that the mental health effects of COVID-19 are extraordinary; an emerging grief as we all stand at the precipice of a great loss, the depression that comes with isolation, economic anxiety, trying to ward of restlessness and despair, and the anticipatory anxiety of getting sick.
Our therapists are ready to provide support. We are open and even accepting new clients. Our therapy sessions will take place via tele-health. Tele-health, or tele-medicine, is therapy done over video or phone. Most insurances are now covering tele-therapy sessions.
Research tells us that the relationship between therapist and client is as healing as the interventions we employ. Video therapy continues to offer the deep understanding that comes from eye-contact and the intimacy of her exploring the layers of your emotions through facial expression and subtle body movements. We look forward to getting back into the room together soon. For now, let's stay connected. We're all in this together.
Last year on Halloween, my father passed away. Upon hearing the news, I felt like I was transported to another planet - a cruel new reality where the people you love the most have suddenly vanished.
Grief alters reality. ‘Grief brain’, a fog that sets in after experiencing a loss, can feel disorienting. Suddenly, time has no boundaries and mortality demands most of your attention without your consent. One year later, here are a few of my reflections on the process of grieving.
I’ve learned that the depth of the pain can seem boundless, an empty and bottomless ache, but little by little, pain and love find a way to coexist.
I’ve learned that grief cannot be alleviated but it can be carried. It can be held.
I’ve learned that the experience of grief is as unique as the experience of love in any relationship.
I’ve learned that there is no timeline, no stages, no pattern. Grief is not linear. Waves of tears, numbness, warm feelings of love and even joy may show up at any time.
I’ve learned that overtime, the loss is integrated, not overcome.
Grief can be lonely, but it doesn’t have to be. A support system and a safe space has helped me explore this new, uncharted territory.
One year later: I’ve learned the importance of embracing whatever brings me joy. At this point in my life, I feel inspired to live in the moment and surround myself with others who know how to do the same; appreciating experiences of all forms. I’ve learned that there is so much beauty and comfort in connection. Filling that lonely space from the inside out has been such a humbling journey.
Staff therapist: Stephanie Sandoval, AMFT
"Creating meaning and a narrative about the relationship and its ending helps people get closure,” Dr. Engler says. “You don't need the partner for closure—you can do it on your own.”
- Dr. Engler in Women's Health Magazine, "13 Ways To Get Over A Crush Once And For All"
“I hear all day from couples that they harbor a sense of disconnection that they often don't say out loud," says Brandy Engler, Psy.D., a relationship therapist in Los Angeles. "These kinds of questions help people put words to what they want and how they want to feel—it taps into your core longings.”
- Dr. Engler in Women's Health Magazine, "8 Questions That Provide The Ultimate Compatibility Test"
Dr. Engler's Articles on the Huffington Post:
Should You Get Pre-marital Counseling?
Women's Health Magazine interviews Dr. Engler on the factors to consider.
Why Moving in Together Kills Your Sex Life, and What to Do About It.
Men's Health Magazine interviews Dr. Engler about how to improve your sex life, and reviews her book, "The Men on My Couch."
11 Things That Actually Surprised This Sex Therapist.
BuzzFeed reviews Dr. Engler's new book, "The Women on My Couch."