Cindy Blank-Edelman, LMHC

A Handy Guide to Relationships

cindy — Mon, 06 May 2013 19:25:54 +0000

Estranged relationship:

Codependent or enmeshed relationship:

Relationship in which there is abuse:

Healthy relationship:

Top Ten Advantages of Liking Your Body As It Is

cindy — Sun, 31 Mar 2013 21:56:30 +0000

You have a lot of mental energy freed up to focus on other things and you can do what you want to do now without waiting until you look better.
You can buy clothing because you like it and not because it hides what you dislike about your body.
You can exercise for enjoyment.
You can have better sex because you’re not worried the whole time about what your partner will think about your body.
You can be a positive role model for your children or other young people instead of teaching them to feel bad about their bodies.
You can eat food that you enjoy and that makes you feel good without obsessing about what to eat, what not to eat, and how much to eat.
You become a more interesting conversationalist because you are not always talking about how much you hate your body and how you are trying to fix it.
You will be refusing to conform to the norms established by a society that values certain kinds of bodies and demeans others.
You can seek out relationships with confidence about your attractiveness.
You will be able to love yourself right now, as you are.

Note: I am aware that this list is more applicable to some people than others. Transgender people, for example, may need to make some changes to their bodies in order to accept themselves.

Beginnings, Middles and Endings

cindy — Mon, 11 Mar 2013 11:40:20 +0000

I often explore with clients what part of their experiences are most easy and most difficult for them — beginnings, middles or endings? I think most of us have challenges in one or more stages. It is useful to be aware of both our challenges and our strengths.

If your strength is beginnings, you might have an easy time meeting new people and socializing at parties. You may do well at applying for jobs and going on first dates. You might be likely to be early or right on time. You are probably good at coming up with new ideas and initiating new projects. You might enjoy the excitement of new relationships.

If your challenge is beginnings, you might have trouble meeting new people, applying for jobs or asking someone out for a date. You may be late sometimes because that allows you to skip over the beginning. You may get stressed out when asked to take initiative or to come up with new ideas. The beginnings of relationships might make you feel very anxious and you might try to skip over the beginning and go right to the middle.

If your strength is middles, you might enjoy the time when you get to the heart of a project. You might like the time in a relationship when you feel comfortable and stable, when you can relax in the routine of the day-to-day life with someone. You might be good at working hard and steadily to move a project along.

If your challenge is middles, you may get bored once you get to the heart of a project or to the comfortable, stable time of a relationship. You may drop projects or relationships once you get to the middle so you can pursue something new and exciting. You might get anxious when you get to the middle of something.

If your strength is endings, you might be skilled at saying “goodbye” to people. You might prefer to end a relationship rather than continue slogging through what seems to be a tedious day-to-day life. You might be good at bringing a project to its conclusion and wrapping things up.

If your challenge is endings, you might get very anxious when you need to say “goodbye” and you may try to just skip the ending. You might prefer to continue a dissatisfying relationship instead of having to endure the anxiety of a break-up. You might have difficulty finishing projects by the deadline, or at all. To avoid saying “goodbye,” you may leave events abruptly or you may have a hard time leaving at all.

So how do you deal with the challenging areas?

Increase awareness. Know your strengths and challenges. Pay extra attention to how you are feeling when you get to a challenging time.
Accept yourself. Everyone has strengths and challenges. It’s not just you. Really.
Plan for the challenge. If you know when things get difficult for you, you can plan for it. Arrange for extra support for your more challenging times. Anticipate what you are likely to do in your challenging time and make a plan for how to deal with it.
Find tutors. If there are people in your life who are very capable in your areas of challenge, talk to them about what they do. Observe them when they are in a time you would find challenging. Ask what they say to themselves that helps them.

And now I’m noticing that I seem to have difficulty knowing how to end these blog posts. There you have it — trouble with endings.

Negative Body Image is Bad for Your Health

cindy — Mon, 25 Feb 2013 20:29:17 +0000

Lots of people have negative feelings about their bodies. It’s hard to find people (at least in the US) who are happy with their bodies the way they are. Specifically, many people are worried about being too fat and dislike their bodies because they are not thin enough.

Aside from the obvious consequence of not liking an aspect of yourself, negative body image has other significant consequences as well.

Eating disorders. In an effort to change their appearance, people starve themselves (anorexia) or binge and purge (bulimia). In addition, being overly focused on appearance can lead people to lose their natural abilities to regulate their eating, as hunger and pleasure are denied attention in favor of “willpower” and “self-control.” Compulsive dieting can thus lead to compulsive eating.
Unhealthy methods of staying thin. I have heard people say that they would like to quit smoking but won’t do so because they are afraid of weight gain. I wonder also about how negative body image is a factor in other addictions, such as crystal meth use.
Reluctance to seek medical care. People who worry they are too fat don’t want to go to doctors and hear doctors tell them that they are too fat. It is not easy to talk back to medical providers about weight issues even when you feel OK about your body. It’s easier to just avoid the doctor’s office altogether. When you don’t feel like you can go to the doctor, you don’t get screened regularly for high blood pressure, diabetes or cancer. You don’t investigate your health problems until they become bad enough to outweigh the discomfort of being negatively judged by your doctor.
Avoidance of exercise. We all need exercise to be healthy. Some people who dislike their bodies feel too self-conscious to exercise at a gym or in front of any other people. It’s hard enough to get yourself to exercise without the worry that you are going to be judged by other people because of how you look. So people with negative body image can miss out on the positive feelings that come from different kinds of exercise.
Depression and other medical problems. Feeling bad about your body is depressing. Also, many people decide to not take antidepressants because they are concerned about the side effect of weight gain. Some psychiatrists I have encountered are reluctant to prescribe certain antidepressants for this reason as well — even when clients are very depressed. It seems clear to me that choosing to stay depressed to avoid weight gain is unhealthy. There are many valid reasons that people decide to not take medication, but this should not be one of them. Similarly, some people with diabetes avoid treating their diabetes because it sometimes results in weight gain (which they are then judged for by their doctors).
Avoidance of other significant problems. Instead of addressing the cause of their anxiety or stress, people “take charge” of their lives by going on a diet. The diet requires their attention for a while, they get a temporary boost in self-esteem when they feel like they have accomplished something, and then they gain all the weight back plus more and are back where they started — no closer to figuring out what is really making them unhappy.

Ironically, the solution that many people (including many therapists) would offer for these problems are for you to lose weight, thereby reinforcing the negative body image you have in the first place. So you keep dieting and gaining weight and feeling bad about yourself and dieting some more and gaining weight and feeling bad about yourself and on and on.

Get yourself out of this negative body image cycle. Try pondering these questions instead:

What would help you to feel better about your body exactly the way it is?
What would help you love yourself and your body enough to take good care of it?
What would help you feel more alive and happy in the long term even if your body stays the same?
What could you add into your life that would make it more fulfilling and meaningful?

And, if you are looking for a psychotherapist, find one who will accept you and your body exactly the way it is.

How To Say “No”

cindy — Sun, 10 Feb 2013 08:20:42 +0000

Many of my clients have struggled with the question of how to say “no” to others.¹ Too often, people find themselves overcommitted and resentful and doing things they don’t like.

Let’s use an example of a colleague’s asking you to be in charge of a project. You are in charge of several projects right now and you are not interested in this one. Your supervisor said it was up to you to decide. Here are some ideas for how to say “no”:

Thank you, no. “Thank you for thinking of me for this project! I need to say no to the idea of being in charge of it, but I do appreciate the offer.”
I’m sorry, I can’t. “Oh, I’m so sorry. I can’t do that right now.”
No, unless/Yes, if. “Yes, I’d be glad to take on that project if we can make it doable for me. Here is what I would need in order to agree to be in charge of it….” [eg. someone to take on some of the other work, an extended deadline, extra help, etc.]
No, I don’t want to. “No, I’m not interested in doing that.”
No, I can’t do it because… “No, I won’t be available to work on that project because I’m working on another important project.” Note: While this is a helpful way to say “no” sometimes, it does invite people to argue with you and try to convince you into doing what they want. If that happens, you probably will need to go to another kind of “no.”

What do you do when you’ve said “no” but the person asking you persists or asks you to justify your decision? In some cases, you may need to provide reasons for your decisions (to your boss, for example, or if your partner asks for something important). But in many situations, I find the most helpful approach is the “broken record” method. If anyone aside from me remembers actual record albums, you know that if there was a scratch in the record then the record would “skip” and get stuck playing the same piece over and over again. When the asker does not respect your initial “no,” then you keep saying “no” in a similar way (like a broken record) until the person stops asking. For example:

You: Thank you for thinking of me for this project! I need to say no to the idea of being in charge of it, but I do appreciate the offer.

Colleague: Well, I really do think you are the best person for the project. You are really the one who should do it.

You: That’s so kind of you to say. Maybe in the future I’ll be able to take on a project like this, but I need to say no to this one.

Colleague: Why can’t you do it?

You: I can see how much you want me to do it and, again, I appreciate your thinking of me, even though I’m not going to take it on.

Colleague: If you won’t do it, then who will? This is ridiculous. You really need to step up here.

You: I know, it is so stressful finding someone to take the lead on projects like this! I’m sure you will be able to figure something out. I am confident I’ll be able to help out on some future projects.

What you will notice in the above example is that there was no attempt to justify or even explain the “no.” Therefore, it is difficult to argue against the “no” — there is nothing to argue about.

It occurs to me as I write this post that although many adults have difficulty saying “no” to each other, adults seem to say “no” to children all the time. What is that about, do you think?

Others have difficulty saying “yes,” but that’s for a future post.

Therapists and Friends

cindy — Thu, 31 Jan 2013 01:54:14 +0000

Top Five Things Your Therapist Can Give You, But Probably Not Your Friends

Education on different topics relevant to you. “Homework,” when appropriate.
A diagnosis and information about what it means.
Attention completely focused on you at a time set aside for you each week.
Tissues. (OK, your friends can give you tissues, but are not as prepared to offer them at any moment.)
Strong legal and ethical commitment to confidentiality.

Top Five Things Your Friends Can Give You, But Probably Not Your Therapist

Hugs and physical affection.
Practical help, eg. going with you to the gym, lending you money.
Their own stories of life experiences similar to yours.
Alcohol, food or other things to help you escape temporarily from your worries.
As much time as makes sense for your friendship, free of charge.

Top Five Things You Can Get From Both Therapists And Friends

Support and validation.
Another perspective on your troubles.
Appreciation of your strengths.
Someone to laugh with you and not at you.
Constructive criticism.

Secrets and Lies in Therapy

cindy — Tue, 05 Jun 2012 17:35:42 +0000

I am often surprised by how many clients there are who tell me that they have lied to past therapists. Clients usually tell me this as if they are confessing to a past sin. Then it is their turn to be surprised by what I tell them.

I tell them that if they need to lie to me in therapy, that’s OK with me.

I suggest that they try to be aware of what they are doing and to be intentional about it. I also suggest that they consider telling me that they have lied during a session or not been completely truthful even if they don’t want to tell me what the lie was about. And I suggest that if they feel the need to lie in response to a question I ask, they try saying “I don’t want to talk about that” instead.

Clients often say in response that they don’t want to be dishonest, that they want me to know the truth about them so I can help them. I appreciate their ability to even discuss the issue of dishonesty in therapy.

From my perspective, if clients choose to lie to me, they are doing so in an effort to protect themselves in some way. Perhaps they never had anyone they could really trust as a child. Maybe they were punished or hurt in the past when others found out something about them. Possibly, they are ashamed of an aspect of themselves and would rather make up a story that is more pleasing to them (or, they imagine, to me). People have good reasons for doing the things they do.

In any case, I just assume that clients are telling me the truth and I work with what they tell me. In my opinion, if clients are lying to me then it points to a major challenge they face in their lives. For whatever reason, they feel like they can’t be honest about who they are. Sometimes, the lying happens outside of therapy also. Some people have felt judged and mistreated by past therapists, which is what led them to lie in the first place, leaving a wound that needs to be healed.

Lying is just one of many behaviors that interrupts people’s contact with each other. As such, it’s just another issue to explore with curiosity in therapy. I think one of the ways therapy is valuable is that it allows for clients to experiment with relating to someone else (the therapist) in different ways. One of those ways is lying.

Does lying complicate the therapy? Yes. For example, if a client is talking about difficulty in a current relationship but lies about his sexual orientation because he feels bad about being gay, then that issue — which may be the key issue — can’t be explored in therapy. If a client reports everything is “fine” when she feels like her life is falling apart, she may not get the support she needs. Essentially, when clients lie in therapy, the dishonesty in the therapy relationship is the main issue that is being worked on. That’s fine with me, but it may not meet the client’s goals.

If you find that you can’t be honest with your therapist, consider the following questions:

What do you think would happen if you were honest with your therapist?
How honest are you able to be in your other relationships? How are those relationships affected by your honesty or dishonesty?
How do you feel about your dishonesty in therapy?
How is lying a way you protect yourself, in therapy and elsewhere?
Is there a small truth you could tell instead of the lie? For instance, you could try, “It’s hard for me to talk about some things with you,” or “You know, there are some important issues I haven’t been able to tell you about yet,” or “At some point, I’d like to be able to be more authentic with you, but I can’t talk about this now.”

It is a powerful, healing experience to be accepted just as you are, to have someone see all your flaws and pains and fears and still care about you. If you can be honest with your therapist, you may be able to have this kind of experience.

And if you are my client and you decide to lie to me, I accept your need to do that and I still care about you. Maybe some day when I’ve earned your trust you can try relating to me in a different way that allows you to be fully seen and cared for as you are.

Developing A Supportive Community

cindy — Tue, 03 Apr 2012 13:49:05 +0000

Therapists like me provide a lot of support to clients. But, in my opinion, support from a therapist is not enough to create the kind of meaningful, peaceful, connected, vibrant life that most of us want. Even support from a therapy group is not enough.

We need more. We need community.

A supportive community is a group of people who will help you through difficult times and celebrate with you in happy times. It is a group of people who have a commitment to you and who are there when you need them.

For some people, their nuclear and extended families¹ serve as their supportive communities. If you have a family like this, you are truly fortunate. While you may still benefit from adding some friends into your support network, you already have much of the support you want.

For others, their families are not providing the kind of support they want and need. Many people have never experienced feeling fully supported and connected, not even as children. When I talk to clients who have this kind of history, they often say that they don’t know how to find the kind of support they want outside of therapy.

How can you develop a supportive community for yourself? Here are some ideas to try:

Start with one friend or acquaintance and build from there. If you have anyone in your life whom you like, that person can be the start of your supportive community. Work on building your relationship with that one friend. Schedule regular times to get together. Then, when you meet another person you’d like to get to know, do the same with that person. If it’s doable, introduce your friends to each other and do things with both of them together. Then add another person. And another. And so on.
Offer support to others. If you are already part of any group of people, look for opportunities to support other people. Do a favor for someone. If someone is sick, bring her some soup. If someone is sad, offer to listen to him. Organize celebrations of people’s birthdays or other special occasions. When you offer support, you help to build community for everyone, including yourself.
Join an already existing community. Find a political group you can support, join it and start going to meetings and events. Volunteer for a cause you believe in. Find a religious or spiritual community and start going to weekly services. Look on-line for opportunities to connect with others who are like you in some way (try a Meet Up in your area, for example). Join a sports team. Find a community chorus. There is something out there for everyone, you just have to find it.
Use social media to help build community. If you already use Facebook or Twitter or other social media, use your on-line connections to help you create a community off-line. Look through your on-line “friends” and see whom you’d like to know more. Then invite them to get together with you in person. Social media can be very useful in this way, but I don’t think it’s an adequate substitute for having a community of people you see in person. E-hugs are not the same as real hugs when you need them.

Developing a supportive community for yourself requires time, effort and commitment. Try to be patient and allow your community to develop gradually. It takes a while to find the right people and to develop trust with them. If you find you have difficulty building a supportive community, or that others are not responding to you in ways you would like, you may benefit from improving your communication skills or exploring your problems in relationships. Psychotherapy might help you with that.

While a spouse or life partner can certainly be a source of support, I don’t think it’s possible for one person to provide all of the support that another person needs. It puts way too much strain on the relationship.

Dieting and Control

cindy — Wed, 29 Feb 2012 22:37:12 +0000

When people suddenly start to talk about wanting to lose weight when they haven’t been talking about it before, I wonder what is going on for them. Frequently, what I find out is they are feeling powerless. It seems to me that dieting¹ is often a way for people who feel powerless to assert some control over an aspect of their lives: their bodies and the food they feed to their bodies. It is understandable that people would want to assert control in their lives in this way.

The problem with trying to feel some control via dieting is that it only works in the short term and it doesn’t usually help in the areas of life which are feeling overwhelming. If you are feeling overwhelmed by a bad relationship, dieting doesn’t help the relationship, it just makes you temporarily smaller. If you are feeling overwhelmed by anxiety, dieting doesn’t get to the root of the anxiety, it just temporarily distracts you. In my opinion, dieting is usually a way for people to avoid dealing with something else.²

So, if your life is feeling out of control, instead of going on (yet another) diet or making a “lifestyle change” that makes you feel deprived, try one of the following coping strategies instead:

Meditate. Sit quietly, close your eyes, and pay attention to your breath. When your mind wanders, as it always will, just notice it with a smile and bring your attention back to your breath. When your anxieties about your life arise, as they will, just notice them, be aware of the feelings, and bring your attention back to your breath. Guided meditation CDs can be very helpful as well. I particularly like the ones by Tara Brach.
Take one very small step towards improving one of the areas of your life that seems overwhelming. For example, if your finances are a mess, one small step might be asking some friends if they know any good financial planners. Or it might be creating a file system for your financial papers. Or it might be setting the goal of saving a small amount of money every week for emergencies.
Write it down, paint it, sing it. Creatively express how your life feels out of control right now.
Call a friend. Talk to someone who cares about you about how difficult your life is at the moment. Cry on someone’s shoulder.
Ask for help and guidance. Pray, if that is meaningful to you. Talk to a therapist. Find a mentor. Have a frank conversation with your partner about what you need.

Of course, this is not an exhaustive list, just the coping strategies that occurred to me at this moment. The point is to do something that doesn’t encourage you to avoid the difficulties or to numb out about them, but to acknowledge and address them. This is all easier said than done, I know — but dieting isn’t any easier.

And eat healthily and with pleasure. Treat yourself well and accept your body as it is.

I am including here the kind of dieting that people label “lifestyle changes” while still having the goal of weight loss.
When people eat compulsively, and it is not a reaction to having been recently starved by dieting, then compulsive eating is also an avoidance behavior, just like alcohol, drug use, gambling, etc. I just put “dieting” in that category as well.

“Behavioral Health” or “Psychotherapy”?

cindy — Thu, 23 Feb 2012 16:38:05 +0000

The new popular term for the kind of work I do as a psychotherapist seems to be “behavioral health.” This is a term often used by health insurance companies and, as a result, by agencies providing therapy services.

I don’t like it.¹

What I don’t like about “behavioral health” is that it implies that psychotherapy is all about changing behavior. In my opinion, while behavior change is included in most people’s goals in psychotherapy, it is only a part of what psychotherapy is about.

I suspect that the emphasis on “behavior” originates with health insurance companies’ wanting to know that their money is being well-spent on improving clients’ health. Therefore, they insist that clients have “measurable, behavioral goals” on their treatment plans. These goals are things like “eat three meals per day” or “find gainful employment” or “reduce panic attacks to once a month or less.” There is nothing wrong with these goals. But, in my opinion, they are insufficient.

Yes, my psychotherapy clients want to be more functional and able to pursue their goals. But essentially, they want to feel content and at peace with themselves and the world. Contentment and peace are hard to measure. So often, therapists have to write treatment plans with goals like, “Client will report feeling content on most days of the week.” Because reporting is a way to measure how much you have improved the behavior of feeling content.

To me, this just seems silly. It demonstrates a problem with needing to get approval from insurance companies for psychotherapy: therapists have to change the way they describe their work. While it is nice to think that describing therapy as “behavioral health” is just a semantic change that doesn’t have to affect therapists’ approach with clients, I think our language does end up affecting our work. It subtly pushes therapists to focus on clients’ behaviors instead of focusing on how clients feel about themselves and their lives. This is fine for therapists who choose a mostly behavioral approach (which is a valid kind of therapy if that is what you choose to do).

As for me, I prefer the term “psychotherapy” to describe what I do. From Wikipedia:

Psychotherapy is an English word of Greek origin, deriving from Ancient Greek psyche (ψυχή meaning “breath; spirit; soul”) and therapia (θεραπεία “healing; medical treatment”).

Healing your spirit. Learning to breathe again. Healing your soul. That is what I think of when I think of psychotherapy. Changing behavior is a part of this healing. But just because we “behave” in a “healthy” manner (whatever that is) doesn’t mean we are at peace, able to breathe, or able to have spirited lives.

Healing the spirit is a really big goal. I’m not sure that we can completely achieve that goal in our lifetimes. My goals as a psychotherapist are to help clients with some of their healing, to allow them to renew their souls and have space in their lives to breathe. My hope is that we all find people in our lives to help us with those goals.

I am not the only one who has wondered about the use of “behavioral health.” See, for example, this post from the Psychology Today website.