On April 9, 2020, Governor Wolf announced that PA schools will not re-open until the Fall. With this in mind, I will continue sessions by tele-therapy until further notice. I have adjusted my schedule to accommodate the competing demands of my practice and my family. You may receive an email with a rescheduled appointment time in the next few weeks. I am trying to spread appointments evenly throughout the week. If you receive a new time that does not work for you, please write me back and we will work it out!
When we first began to shelter at home, I was not taking new patients, thinking that I would rather meet new families in person. Seeing that this might be quite a while off, I will be taking a limited number of new patients "remotely." Please fill in the new patient information form and we can discuss further whether tele-therapy is appropriate for your family.
Please let me know if there is any desire for some zoom therapy groups. I was thinking about parent support groups; groups for kids whose parents work in the healthcare field; and groups for kids whose senior year of high school or college has abruptly ended. Sharing these experiences with others in the same boat can be very comforting. Drop me a note to let me know if these groups interest you: firstname.lastname@example.org.
Please stay well, and let me know how I can best support you!
Dear Patients and Families:
Due to the COVID-19 pandemic, I will be seeing all of my patients remotely until further notice.
You can make and change appointments using my online system as usual. I might be in touch to change appointment times in order to best balance work and family commitments.
I have added a consent form for telepsychological services to required patient forms. Please complete and email back to me - or alternatively, snap a picture of the completed form and email back to me.
This is an anxiety provoking time for everyone. If you already suffer from an anxiety disorder, this time of uncertainty might be heightening your symptoms. There are many available resources that you might find useful:
More to come!
Send me your questions or requests for online support/psychoeducation groups and I will try to make them happen :)
Originally published at adaa.org.
When a baby arrives, gifts are most often given to the new little bundle of joy rather than to the new parents. Parents might find their homes heaped with adorable onesies, brightly colored chew toys, and board book editions of childhood favorites. What do new parents need? I suggest some wisdom of cognitive-behavioral therapy (CBT) from a book, a supportive friend, a group for new parents, or maybe even some sessions with a skilled therapist.
Why is CBT such a natural intervention for new moms?
The Mismatch Between Expectations and Reality
From the day of birth, many moms experience a stark discrepancy between what they expect from birth and new motherhood and what actually happens. Many moms create a formal birth plan, or at the very least, spend nine months imagining what their baby’s birth will be like. As they say, “best laid plans!” Events outside of one’s control might change many facets of this carefully thought out event, including of course how the baby is delivered (e.g., cesarean section instead of a natural birth).
Another mismatch can be how woman imagine that they will feel the moment they meet their baby and how they actually feel. We all hear about immediate love and bonding. But, what if it doesn’t happen? Many women first hold their newborn after hours of painful labor; no food, drink, or rest; and stressful moments pertaining to both mom’s and baby’s health. It is no wonder that when moms finally meet their babies, we are often totally exhausted and frankly, pretty out of it! And before we can even say hello, or examine all of the baby’s precious little fingers and toes, there is pressure to learn to nurse (which does not come as naturally as one might expect) and an influx of visitors (some wanted, and some not so wanted). Is it any wonder that many women do not feel an immediate bond, but rather feel a flood of all sorts of emotions – some on the more negative end of the spectrum?
A helpful strategy to embrace is acceptance. We cannot change how our birth experience goes. We cannot change how we feel in those first few hours or days of motherhood. Rather, we can look at this personal narrative without judgment. “This is different from what I expected and that’s okay,” “I feel different than I thought I would and that’s okay.”
New moms should also recognize the impermanence of their feelings. In any given hour, let alone in those first days and weeks, new moms will experience a whole range of feelings, from positive to negative. We can recognize these feelings with interest, rather than with judgment.
Research into unwanted thoughts has also taught us that the more we try to suppress thoughts, the more we have them. Therefore, new moms should be encouraged to let in all thoughts and to share their thoughts and experiences with others. The more we do this, the less scary our thoughts become. And by sharing experiences with others, we often find that other are feeling the exact same way.
As the weeks of new motherhood progress, negative self-talk can go along with it. This is especially true when people are sleep deprived and when hormones are raging. There is a lot of time to think when you have a new baby, especially because new babies are not great conversationalists!
Here are some examples of negative self-talk:
• If the baby is crying endlessly and can’t be soothed
--“The baby doesn’t like me.” “I don’t know how to help him.”
• If breast-feeding isn’t going well,
--“I am a failure at this.” “This is supposed to be natural. Maybe I shouldn’t have even had a baby.”
• If there are moments of negative thoughts or emotions like boredom or loneliness or anger,
-- “I shouldn’t be feeling this way.” “I should be grateful to even have a baby”
Cognitive therapy teaches us to ask, “Is there another way to look at this situation?” Another great way to approach negative thoughts is to ask, “What would I say to my sister or best friend if she believed this?”
This might lead us to the following calming thoughts:
• “Babies cry. Sometimes for no reason. And that is okay.”
• “My job is to feed my baby. There are lots of ways to accomplish that task” or “The baby and I are learning a new skill. Any new skill takes time and practice.”
• “All feelings are valid. Some moments will be happy or funny and some will be frustrating or boring. I can notice these feelings, but I don’t need to judge myself for them.”
• “I have no idea how other moms are feeling. Chances are many other moms are feeling the same way as I am.”
Falling into the Baby Blues or Post-Partum Depression
Being home with a new baby can take on an aimless quality. Babies do not adhere to a schedule and planning things around them can be awfully hard. While a lot of women are used to holding down challenging jobs, they might have a hard time adjusting to days where it is difficult to even find time to shower or do laundry. Women who have a perfectionistic streak might fall into the trap of avoidance rather than doing things less than perfectly. For example, a new mom might choose to miss lunch with a friend if she doesn’t have time to shower first or might stop cleaning the house because she can’t do it as perfectly and completely as she did before baby. Days at home with a new baby can lead to feelings of loneliness, sadness, anger, and anxiety.
Many new moms will find it helpful to draw on the lessons of behavioral activation, making a schedule to bring some structure to each day. These daily schedules should include some very manageable items that bring them a sense of mastery (e.g., clean one room in the house, rather than the whole house; write two thank you notes) and a sense of pleasure or fun (e.g., get together with a fellow new mom; watch a fun TV show while baby naps). Each week should include some social activities (I’m a big fan of having new mom friends) and, after the first 6 weeks or so, some activities that a woman used to enjoy before becoming a mom (e.g., resuming an exercise class; meeting a friend for a coffee). While the schedule will need to be somewhat flexible due to the needs of a new baby, moms should also be mindful that they might need to change their own expectations of what they should accomplish in a day or how they should look or feel before going out.
Suggested resources for new moms:
• This Isn’t What I Expected, by Karen Kleinman & Valerie Raskin
• Becoming a Calm Mom: How to Manage Stress and Enjoy the First Year of Motherhood, by Deborah Ledley
• Motherhood Sessions podcast, Alexandra Sacks (and also her book with Catherine Birndorf What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood)
*Although I have referred mostly to new moms in this post, the lessons of CBT are relevant to all new parents.
Looking for some excellent back to school reading? Pick up a copy of Middle School Matters by Phyllis Fagell. I follow Phyllis on Twitter and had pre-ordered this book as soon as she began tweeting about it. It arrived last week and I have been eagerly reading every word between doing camp laundry, buying school supplies, and driving my daughter to pre-season sports. Despite this book being about Middle Schoolers, I am finding so many gems for a much wider range of kids, from the upper elementary ages to new high schoolers. As a mom of an incoming Middle Schooler and High Schooler this year, and a psychologist who works with kids, I am highlighting like mad!
Here are some gems so far -
-"on different days, the same kid may present as thirteen going on thirty or thirteen going on three."
-because of the underdeveloped prefrontal and frontal cortices of teens, smart kids can do stupid things. We should expect mistakes - some pretty frightful! Turn these into teachable moments rather than "life sentences".
-Friendships change immensely over the course of middle school. One study actually showed that only 1% of friendships formed in 7th grade were still intact by 12th grade! As parents, we need to expect this, understand that it is part of growing, and not catastrophize these changes (e.g., assuming a tough social period in 7th grade will mean lifelong social disaster).
-Help kids find activities that interest them, that introduce them to kids with shared interests, and that play to their strengths. I.M.O., this is a very different approach from picking activities that will help kids get into an Ivy League school! Fagell writes, "When children are young, they find friends based on proximity. As they get older, they find friends based on similarity. This transition is one of the fundamental challenges of middle school..."
So much more to share! But really, buy this book and read it for yourself. It's super!
I am pleased to be offering a new group at my office called COLLEGE-BOUND.
Beginning in May, this group will meet weekly and is open to students beginning college in Fall 2019 (or returning to college after time away).
All potential group members must meet with me for a one-hour session prior to joining the group to assess suitability and discuss confidentiality.
Groups will be led by Dr. Ledley with a segment dedicated to teaching valuable COLLEGE-BOUND skills and a segment reserved for group sharing and discussion.
Topics will include:
-Dealing with roommates and making friends - with students often selecting their own roommates, kids are going into college assuming this relationship is going to be a perfect, life-long friendship -- but it often doesn't turn out that way. We will discuss how to deal with disappointment if roommate choice does not work out; how to resolve conflicts with roommates; and how to make friends around campus.
-Academics - Students tell me that it is very hard to adjust to the academic independence of college after the hand-holding of high school. We will discuss what to expect in college, how to manage independently, how to choose classes, how to stay organized, and how to seek help and speak to professors.
-Drinking - Many patients who I work with have made the decision to NOT drink or to drink minimally in college and have found it challenging to find like-minded friends. We will discuss this issue, as well as how to deal with substance use problems in roommates and friends, and how substances are often used to manage emotions.
-Managing emotions away from home & Homesickness -- Kids are very connected to their parents these days and that has its definite plusses - except when kids are texting their parents at all times of day and night because they are having difficulties managing the day to day challenges of life away from home. We will learn valuable emotion regulation skills designed to foster independence.
-Finding resources on your campus - Despite the time we take selecting a college, students often don't know about the resources available to them when they need them. We will discuss how to know if you need help and where to find that help (academic, medical, emotional). Each group member will build a list of these resources to take to school with them.
-Life skills - These days, so much time in high school is spent on school work and on building one's resume that college comes and kids don't know how to pump gas, cook eggs, or do laundry. Not knowing how to do these basic skills can add to stress in college and maintain reliance on parents. We will discuss and work on these skills throughout our group.
-Managing Your Anxiety Disorder - Kids are going to college with social anxiety, OCD, panic attacks and so forth. We will discuss how these disorders can impact college life and what we can work on in advance in order to be ready for these challenges. We will also discuss how to get ongoing help at college if needed.
Please contact me to get involved in this valuable and fun group! email@example.com
Last night, I cooked a nice dinner and we began discussing New Year's Resolutions. Let me tell you that even psychologists can have bad parenting moments - or at the very least, ones we question!
My kids, ages 11 and 13, contributed some ideas for their New Year's resolutions. The 13-year old wanted to eat fewer chips. The 11-year old wanted to annoy his big sister less often. Okay, nice resolutions guys.
And then, we got into the mix. We just couldn't let it rest. My husband and I started giving the kids New Year's resolutions. We believe that one of our kids really needs to work on "emotion regulation skills" (yes, I am a psychologist!) and the other needs to focus on building reading and writing skills.
Within the few minutes, the kids started giving US New Year's resolutions. Mommy should work on being less snappy. Daddy should work less. And so on. The conversation degenerated quickly. The kids felt criticized and the parents felt --- well, we also felt criticized and, perhaps, like the children were talking about things they didn't really understand.
So, who should be setting kids' New Year's Resolutions?
The answer? I am not sure!
All good psychologists know that motivation is strongest when it comes from within. If my daughter really believes that it is important to cut back on chips, then she will likely succeed at this goal. A win-win - she is healthier and feels good about accomplishing a goal she set for herself.
Yet, as parents, our job is to guide and teach and our kids might not have the ability to frame or verbalize the things that they need to work on. It is hard to hear about weaknesses (I know this firsthand, since I was told last night that I need to be less snippy!), but if we only tell our kids how wonderful they are, they won't grow and they will also sense a lack of genuineness in all this praise.
If I could turn back time on last night's dinner, here's what I would do. I would have each family member set one resolution for themselves, and be open to one suggestion from another family member on something they might consider working on. I would then check back in a week on how each family member has made sense of that suggestion and articulated it for themselves. Rather than harping on the kids for their weaknesses, I hope that they would come to see why they might want to work on these goals for their own benefit.
What did you do with resolutions with your kids? Any thoughts or suggestions to share?
With school starting all over the country, I've decided to repost a favorite post from last year!
I've had a really busy week with clients preparing to start a new grade in elementary school or make the transition to middle school, high school, and college. Although each of my clients is so unique, the concerns they tend to share at this time of year are very similar. The boil down to the Three L's:
-Who will I sit with at LUNCH?
-How will I get into my LOCKER?
-Will I get LOST (and as an addendum to that one, will I be LATE?)
For anxious kids, I think these fears point to a few very important lessons to be learned:
-All adjustments take time. Every kid is going to have a hard time getting into their locker the first week of school. Everyone is going to get lost on their way to class in the first few weeks of school (and might even be late). Every student is going to feel uncertain about who to sit with at lunch. I tell kids that by the end of two weeks, they will feel pretty good. With respect to friendships, it will take longer. For college freshman, it might take several months to find a group of like-minded kids who really make you feel at home in your new surroundings. All of this is normal and should be expected.
-The only way to succeed is to ask for what you need. If you can't get into your locker, ask a friend or teacher for help. If you are lost, ask an older student. If you are alone at lunchtime, ask to join some kids who look nice. What is the worst thing that might happen? Test out this fear. In all likelihood, this fear will not come to pass. For example, if you fear that someone will laugh at you if you ask where your next class is, test it out. In all likelihood, the student you ask will point you in the right direction or even walk with you to help you find the way.
-Anxious kids often fear doing the wrong thing and getting in trouble. Ask yourself, "What's happened in the past for me?" or "What would happen if this happened to another kid?" For example, in the first week of school very few kids get in trouble for coming into class late. Remind yourself that when you've made a minor mistake in the past, the world hasn't ended - you haven't even got a detention! These is generally wiggle room for kids to make little mistakes, and even if a teacher says some sharp words, you can handle it!
Good luck with the new school year - and send me any questions or concerns you'd like me to address!
I was happy to be quoted in the Chicago Tribune recently on a situation we have all been in....haven't we?
What do you do when a stranger tries to parent your child in public? (Photomondo / Getty Images)
Christen A. Johnson Chicago Tribune
Q: A stranger tries to parent or critique your child in public. How do you deal with the person without becoming irate?
The first inclination is to give a dirty look or nasty retort. These public put-downs can eat away at us for hours, or even days, after they’ve happened. They can make us question our capabilities as parents or the goodness of our kids.
Ask yourself if you value what this person thinks of you. There are many people you care about who give parenting feedback and whose advice you will take to heart.
The stranger in the playground or the neighborhood restaurant? Not so much. You don't know the person’s values or parenting skills. So be prepared for these situations with a set response. "Sorry he's bugging you. We were all kids once, right?" Or a simple, "I've got it, thanks."
Care about the people who do matter to you, and be able to dismiss the people who just pass through your life momentarily.
— Dr. Deborah Roth Ledley, author of “Becoming a Calm Mom: How to Manage Stress and Enjoy the First Year of Motherhood”
Today's New York Times is a must read: nyti.ms/2yYp7cn
Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?
captures what I do on a daily basis - the kids I see, the issues they face, the reality of treatment (what it can achieve and its limits). I encourage all parents to read this wonderful article. And, please leave your comments here.
Using Cognitive-Behavioral Strategies to Treat Perfectionism Across the Anxiety Disorders in Children and Adolescents:
Learning to Live by Values Instead of by Rules
Friday October 27, 2017, 10am-2pm
Deborah Ledley PhD and Lynne Siqueland, PhD
Continuing Education Information: The Children’s and Adult Center for OCD and Anxiety is approved by the American Psychological Association to sponsor continuing education for psychologists The Children’s and Adult Center for OCD and Anxiety maintains responsibility for this program and its content. Participants will earn 4 CE hours for completing this workshop.
Please contact Lynne Siqueland for more information and to register: firstname.lastname@example.org
I am a licensed psychologist working with kids, teens, and adults with anxiety disorders.