Esther Perel Speaksmarri on Intimacy and Affairs

Esther Perel is a world-renowned couple therapist who speaks and writes about relationships and sexuality.

Woman Suffering From Depression Sitting On Bed And Crying

In a recently-begun video series, Perel talks compassionately and non-judgmentally about infidelity, how and why it happens, and how marriages can heal.  She also explains how to help a friend if they have recently discovered their partner has been having an affair.  Follow her video series here: Infidelity Series.

To see more of Esther Perel, check out her book or her famous TED talk.  In her book Mating in Captivity, she talks about the seemingly impossible challenge of maintaining intimacy and passion when you’ve shared a home and a bed with someone for a decade, or two or four. She also has a wonderful and much-watched TED talk on this topic, asking the million-dollar question, “Can we want what we already have?”  Watch her TED Talk here: The Secret to Desire in a Long-Term Relationship.

To make an appointment for relationship counseling at Psych Choices of the Delaware Valley in Drexel Hill, PA, please complete the form on our Make An Appointment page.

Why I Take My Fish Oil Supplements

Fish oil bottle and capsulesEvery time I change health insurance, which surprisingly has been many times over the past five years, I have had to change my primary care physician. What doesn’t change is that each doctor has recommended taking Omega-3s as a supplement.  I run out to the drugstore, buy the largest bottle I can find of fish oil pills, and start popping the suggested number of milligrams two times a day. Then, after a week or so, perhaps after a late night out with friends or before rushing out the door late for yoga class, I forget to take the pills once, twice, three times. Slowly, the huge bottle of Omega-3 pills gets moved to the back of the medicine closet.

Interestingly, I’m super strict with my dental regimen (and my coffee routine). Perhaps that’s because before now I never really understood the benefits of the supplement. Each doctor would suggest Omega-3s and say the usual line about how the fatty acids are good for my immune system and heart. (The American Heart Association recommends one gram per day of EPA+DHA for people with heart disease and/or everyone else who is not eating two servings of fish, specifically fatty fish like salmon, trout and albacore tuna, a week. See below for a delicious salmon recipe if you’d like to increase your fish intake.) Yeah, and so is getting eight hours of sleep.

But, then, my latest doctor tells me that Omega-3s may also help with depression. I’ve had a bout or two with depression. My ears perk up.

I am afraid of looking stupid so I don’t ask questions. I have a hard time processing anything scientific. My eyes start to glaze over when medical terms are used. My only associations with the word “Omega” are either on sorority sweatshirts or my R&R visit to the spiritual retreat of the same name located in Rhinebeck, NY. I go home to do some independent research. Here, in layman’s terms, is what I find:

Omega-3s are polyunsaturated fats that we need for basic body function, such as building the protein and fat-based cell membrane in our brain. There are two main sources of omega-3 fatty acids.  The first source is plants, especially seeds (flax and chia) and some tree nuts, which containt ALA (alpha-linolenic acid).  The second source is fish and shellfish, which contain a combination of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).  Bone marrow and brains also contain this type of omega-3 (sweetbreads, anyone?)

omega 3 foodsThe Omega-3s work in tandem with the Omega-6 fatty acids, which are found in cereals, whole-grain breads, certain oils, and some nuts. Omega-6s, although recently given a bad rap, aren’t bad for you in small quantities. But high levels in the body can cause inflammation and worsen diseases such as arthritis and asthma. The key to good health is to maintain a correct ratio of Omega-3s to Omega-6s. Before our modern day of processed food and unhealthy eating, this ratio was usually 1:1. but now it is more likely to be 1 to 10 or 20, with Omega-6s overpowering the body.

This Omega-3 deficiency, according to researchers, has a direct effect on mental health disorders such as ADHD, bi-polar disorder, and depression. The relationship between Omega-3s and depression is a main point of Dr. Andrew Stoll’s groundbreaking 2001 book The Omega-3 Connection.   Since that book’s publication, other doctors and nutritionists have added many other books on this wonder supplement and Omega-3 infused diet plans.

The verdict is still out on the link of Omega-3s and depression, but several recent studies support the theory. In 2009, researchers at Beer Sheva Mental Health Center in Israel found that after taking Omega-3s, many patients’ depression was reduced, with no significant side effects. In 2011, twenty women who had major depressive disorder related to menopause were given two one-gram capsules of a omega-3 a day for eight weeks. The results were impressive – their depression scores were reduced by half, and there was an unexpected bonus: fewer hot flashes. Well, I’m not quite at that dreaded age of menopause, but when my time comes, pass me those pills.

With limited side effects and studies praising its positive results, it seems silly not to take Omega-3 supplements. I’ve diligently taken my prescribed milligrams of Omega-3s for two months. If it’s made a difference, I can’t yet tell.  But I have nothing to lose. (Now if it did help lose pounds, that would really be a magic pill.)  Omega-3s are also being investigated for Alzheimer’s prevention, ADHD regulation, and reversal of age-related loss of brain function.  One study found Omega-3s can help reduce the symptoms of schizophrenia.  A 2007 study, published in the journal Neuroscience Letters, even went so far as to say that the intake of Omega-3s increased the volume of the brain’s gray matter, specifically in the areas associated with happiness. Perhaps the marketing tag line on the Omega-3s supplement bottles should be changed from “heart healthy” to “Happy Pill.”

Adding Happiness to Your Diet

salmon & quinoaOne way to increase Omega-3s in your diet is by taking daily supplements of fish oil or algae. A more natural alternative is to include Omega-3 rich foods in your everyday diet. Want a quick fix: Sprinkle some chopped walnuts, flaxseeds or chia seeds on a bowl of plain yogurt or munch on a bowl of salt-sprinkled edamame. Here’s a quick and tasty recipe perfect for a mid-week dinner when you want something healthy but don’t have a lot of time or energy. The salmon and the edamame are full of Omega-3s, the quinoa and chickpeas are packed with protein, and the turmeric contains curcumin, which has been tested for its antidepressant qualities.

Broiled Salmon on Turmeric Quinoa Salad

4 salmon fillets (about 1 pound) (wild has more Omega-3s than farmed raised)
juice of 1 lemon
1 tablespoon of olive oil
Preheat oven to broil, medium temperature. Rinse and pat dry the salmon fillets and place on the broiler pan. Mix the lemon with the canola oil and brush on the fillets. Broil, on medium, for ten minutes. Increase temperature to high and cook for two additional minutes. The fillets should be crispy but not charred.

Turmeric Quinoa Saladquinoa dish
1 cup of quinoa, rinsed
1-3/4 cup of vegetable broth
1 tablespoon of turmeric
1 teaspoon of cinnamon
1/2 cup yellow raisins
3/4 cups of chickpeas, drained and rinsed
2 cups of frozen, shelled edamame, cooked in microwave for three minutes
1 yellow pepper, cut into 1/2 inch pieces
2 lemons, juiced
2 tablespoons of honey
1/2 cup of olive oil
Salt & Pepper to taste

Bring broth to a boil in medium saucepan; add turmeric, cinnamon, and quinoa. Cover, reduce heat to low and simmer for about 15 minutes. The broth should be absorbed. Remove from heat, and fluff with a fork. Let cool to room temperature and pour into a big mixing bowl.
Add to the quinoa, the yellow raisins, chickpeas, cooked edamame, and chopped red peppers and toss. Whisk together the lemon juice, honey olive oil, salt and pepper and toss with the quinoa mixture.

Serve the quinoa with the salmon on top, and add a handful of arugula, if you wish, on the side. Enjoy and be happy!

 This article does not constitute medical advice. Please discuss all supplements with your doctor.  To consult a holistic psychiatrist at Psych Choices of the Delaware Valley, see our Make An Appointment page.

Lost That Lovin’ Feeling? 6 Ways to Jump-Start Desire

young african american couple kissingAs a sex therapist, the most common problem I’m asked about is the loss of sexual desire.  Usually couples come in after years of infrequent or absent sex, and usually they can remember that when they first got together, they were both passionate.  But then something changed.

It is completely normal for sexual frequency to diminish after the first year or two in a relationship; it’s a natural stage of couple development.  But sometimes the problem is severe enough to cause conflict and suffering.  One or both of the partners may be seriously considering divorce.

I find that about 2 out of 3 times, it’s the female partner (in a heterosexual couple) who loses desire first.  About 1/3 of the time, it’s the male.  But in either case, if the problem persists for some time, the higher-desire partner usually reports that he or she has also lost interest.  “I can only take so much rejection,” they will report, “and after a while I just gave up.”  Their partner’s lack of interest may have led to their own loss of confidence.  They respond by shutting down their own sexual desire.

Here are some of the suggestions I usually offer to couples struggling with this problem.

(1) Try to talk about your feelings.  If your partner tells you “It’s not you, it’s me,” consider taking them at their word.  Often stress, exhaustion, depression, or medical problems can cause one or both of you to lose interest in sex. A history of sexual abuse or trauma can complicate the situation.  If any or all of these factors are true in your relationship, try to address them directly.  Individual and/or couple therapy can make a difference.

(2) Remember the good times you had with your partner in the past, and try to re-create them.  For example, did you honeymoon romantically by the sea? Consider a weekend away at the Shore for just the two of you.  Don’t bring your computers.  Turn your cell phones off (at least for an hour or so!)  Enjoy dining out and possibly a glass of wine, but don’t eat or drink so much that you dull your senses.  Pay attention to each other.

(3) Plan regular times for intimacy.  Many couples tell me “We don’t want to schedule sex, it should be spontaneous!” Please remember that when you were dating or in the early days of your marriage, you did in fact plan for sex, though it may not seem that way: it was usually on the agenda for both of you, because you kept it front and center in your minds.  Once you live with someone, daily life often gets in the way.  Work, family, housework, and different sleep schedules make “spontaneous” sex nearly impossible.  Try to set a time to be alone together, preferably without distractions, about once a week.  That might not seem like much compared to your early days together – but if it’s more than you are having now, it’s a good start!

(4) Try to meet in the middle.  If you are the partner who wants more frequent sex, set the bar lower, and accept the fact that you may need to take care of your own needs some of the time.  Yes, masturbation may help your marriage, if you use it to help reduce pressure on your partner.  Pressure is often a big part of the problem.  Meanwhile, if you are the partner who has less interest in sex, try to build up your own interest by fantasizing.  Take the time to purposely imagine or remember exciting sexual scenes.  This is an activity that high-desire people may experience naturally all day long, while low-desire individuals may rarely have a fantasy.  You can learn to fantasize!  Try reading or viewing erotica, if you like, to help jump-start your interest.

(5) Plan intimate interactions that are sensual and romantic, but don’t include intercourse.  A sensual massage can help set the stage for sexual intimacy at a later time. Consider shopping together for lingerie or sex toys.  Watch a romantic or erotic movie together.

(6) If conflict or emotional distance is part of the problem, consider getting help.  In addition to regular relationship therapy or couple sex therapy, you might consider a couples’ retreat. Three such resources to consider:

Marriage Encounter is a long-established program of weekends for married couples that originated in the Catholic church but is appropriate for spiritually minded couples of all Christian backgrounds.  According to the website, a Marriage Encounter weekend “gives spouses an opportunity to grow in their marriage through open and honest communication, face-to-face sharing, and heart to heart encounter in a comfortable, relaxed setting. National Marriage Encounter invites and encourages married couples of all ages and faith expressions to share in this experience and to become an integral part of this journey.”

Imago Relationship Weekend Workshops  offer a way for couples to communicate and understand one another on a deeper emotional level.  This form of treatment, developed by Dr. Harville Hendrix (author of the bestseller Getting the Love You Want), typically involves a group of couples from many backgrounds learning together.  It is spiritual only in a general sense.  An Imago Workshop resource local to the Philadelphia area is Self Expressions Counseling in Malvern.

For a very special vacation, consider Intimacy Retreats.  Offered in Siesta Key, Florida, and sometimes in other vacation spots, these retreats are led by a couple therapist and her husband, who together coach groups of couples interested in a Tantric approach to sexuality.  There is no nudity or sex in the group setting, but it does include explicit instructions and exercises that enhance sensuality as well as verbal communication.

A few books that may be helpful:

Getting the Sex You Want by Tammy Nelson.

Intimacy and Desire by David Schnarch.

The Sex-Starved Marriage by Michele Weiner Davis.

Reclaiming Desire by Andrew Goldstein and Marianne Brandon.

To make an appointment for couple therapy or sex therapy at Psych Choices of the Delaware Valley, call our Intake Coordinator at 610-626-8085, or use our Make An Appointment page.

Healing a Lonely Heart

Lttle BearFor the fortunate among us, Valentines Day means a romantic dinner with a new flame, or a special evening with someone they’ve loved for decades.  For parents of young children, it’s a time for buying or making sweet treats and hanging paper hearts.  For the cynical, it’s just a “Hallmark Holiday” pushed upon us by the greeting card, flower and candy industries.

But for many people, Valentines Day is a time of sharply aching loneliness.  Especially for those who may have recently ended a relationship, who are recently widowed, or for others who have been alone for years or for a lifetime, Valentines Day really seems to rub it in.  It can be very depressing to be surrounded by hearts and flowers when you have no one to give them to.

If you’ve read this far, you may be looking for ways to feel happier and less alone on Valentines Day and afterward.  Here are a few suggestions:

Think of someone you haven’t seen in some time, perhaps an elderly relative, a distant cousin, an old friend, or someone you know who may be even lonelier than you.  Reach out to that person in a personal way.  A phone call is better than an email, a visit better still.  Find out how they are doing, bring them a gift of food or invite them to see a movie or go shopping with you.  Mail or better still, personally deliver a hand-written card.  A “gratitude visit,” to tell someone how much they have helped or inspired you, is especially powerful as a way of lifting your spirits and changing your perspective.

Express yourself in creativity.  Even if you don’t usually think of yourself as the creative type, you may find that painting, crafting, building, or baking can lift your spirits.  For those who enjoy words, writing your feelings in the form of a poem, song, or writing a journal may help you move through the feelings of loneliness and feel a sense of release when you get your thoughts on paper.  Or you may feel a sense of pride and satisfaction in a creating a batch of cookies to share with co-workers or neighbors, a craft project to display in your home or give away, or even rearranging your furniture creatively to give you a new perspective.

Improve yourself. Now might be a good time to re-start an exercise program, to take up mindfulness meditation, or to begin to explore, with the help of a therapist, any of your own traits that may have been a partial cause of your loneliness.  Then again, more superficial self-improvement can work wonders for many of us: a new hairstyle may be exactly what we need for Valentines Day.

When all else fails, treat yourself.  You’ve probably heard by now that chocolate is good for you; buy one of those heart-shaped boxes for yourself, just for today.  Get a pedicure.  Take yourself to a movie or play.  Don’t make the mistake of waiting for someone else to come along before you can do something fun – plan a vacation for yourself or with a relative or friend, join a hiking club, sign up for golf lessons or tap dancing class.  Being single doesn’t have to mean being sad.

Why your therapist can’t be your friend – not even on Facebook

Therapist listening to her talking patientIf  you have been in therapy, then you may have experienced the special kind of intimacy that occurs when you open up your most painful thoughts and memories to another person.  You probably felt your therapist’s genuine concern and empathy for you, and you likely felt safe within the sanctuary of your therapist’s office.

Since these feelings may also occur with friendship, it’s tempting to think of your therapist as your friend, and even to seek out a friendship outside the therapy session, or after therapy is completed.  However, it’s important to understand that an ethical therapist can never be your friend … no, not even on Facebook.

The guidelines of each one of the professional organizations for therapists (American Psychological Association,  National Association for Social Workers, and others) all specifically prohibit relationships that involve a “dual role.”  A dual role, for example, is when someone acts both as therapist and friend.  For similar reasons, your therapist can’t offer you a job, or hire you to fix her computer.  The American Association for Marriage and Family Therapy states in their Code of Ethics:

Marriage and family therapists are aware of their influential positions with respect to clients, and they avoid exploiting the trust and dependency of such persons. Therapists, therefore, make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client’s immediate family.

So “dual roles” can impair professional judgment – your therapist may not be able to think about you as clearly and objectively if she is counting on your friendship.  If you are fixing her car, and the car still won’t run after you’ve worked on it, how will you feel? how will she feel toward you?  And “dual roles” can increase the risk of exploitation.  If your therapist asks you to watch her children for her, will you feel free to tell her “no”, or would you feel obligated to grant her every request because she has done so much for you as a therapist?

Even Facebook “friending” your therapist can be risky.

Imagine, for example, that your therapist does “friend” you on Facebook.  You will then have access to a good deal of personal information about your therapist. Sometimes this may involve direct violation of the HIPAA guidelines for confidentiality – because you may wonder about other people in her Friend list …are they her clients too? are they wondering about you? Or, on your therapist’s Facebook page, perhaps you will discover that he or she has political views or religious views that you strongly disagree with.  How will you feel about your therapist then? will you continue to be able to confide in her trustingly?  What if you see that she has posted sad news about the loss of a loved one? will it still be possible for you to go to therapy and confide your troubles, without worrying about your therapist’s own grief?  And what if you discover that your therapist is divorcing her husband.  Will you still feel the same about her ability to help you with your own marriage?

Therapy is not friendship.  A therapist can be truly “there” for you, and can be an objective helper, in part because she will never need you to be “there” for her.  A friendship is a two-way relationship where both people give and both receive.  Friendship is very valuable and we all need friends to lean on; but it’s not the same as therapy.  A friend will have an opinion about your life, will have a stake in some of your decisions, will need to count on you when she is down.  A therapist is able to be available for you and dozens of other clients at the same time, but she cannot welcome her clients into her personal life.

Your therapist likely does have genuine caring and concern for you, and perhaps if you had met some other way, he or she could have become your friend.  But once the therapy “contract” is established, that possibility no longer exists.  In fact, most mental health professionals agree that even once psychotherapy has ended, the therapeutic relationship still exists and friendship or romantic relationships are still unethical.  Most of us want our friends to be people we can see as an equal.  Even once therapy has ended, the therapist is someone whom you have turned to for help and guidance, someone you have confided in and who has not confided in you.  The relationship is not “equal” in that sense.  Therefore the therapeutic boundary, for most professionals, must remain in place indefinitely.

When a Spouse has ADHD

Couple Having Arguement At HomeWhat happens to kids with Attention Deficit Hyperactivity Disorder (ADHD) when they grow up?  Like most adults, they get married, or live with a partner.  The partner with ADHD may have many good qualities, including spontaneity, creativity, energy, and compassion.  But when it comes to working together smoothly to run a household, the ADHD symptoms of disorganization, distractibility, poor impulse control and difficulty following through may lead to chronic resentment, anger, arguing and distress for both partners.

If you or your partner has (or may have) ADHD, you may have struggled with these and other difficulties in your marriage.  If so, you may want to check out the website, a website created by Dr. Melissa Orlov and Dr. Ned Hallowell, who specialize in helping the “ADHD Couple.”  This website contains many useful suggestions and resources for both of you.  Dr. Orlov also has created an advice column called “May I Have Your Attention,” where she focuses on help for couples in an “ADHD-Impacted” relationship.

Dr. Orlov recommends setting personal goals for changes that would improve the marriage.  For example, “Spend more time with my wife.”  Then list specific steps you can take toward that goal, for example, “Set alarm clock to 9:30 p.m. to help me remember to go to bed with her.”  Then after trying a step, go back and evaluate whether it worked, and figure out ways to make it work better.

Another online resource that may be helpful for the ADHD couple – or any couple – is a calendar that helps families create and stick to schedules.  It’s called Cozi Family Calendar, a free resource for couples and families.

If you or your partner has ADHD, you or they may already be in treatment with a psychiatrist or other doctor.  Medications can often help with focus and brain function.  In addition, Dr. Orlov offers the following suggestions:

Exercise: Try to exercise vigorously at least 4 times a week.

Diet: Try to reduce sugar and refined carbohydrates.  Try to eat protein at each meal.

Supplements: Try fish oil capsules, up to 2,000 mg a day.  Also talk to your doctor about taking Vitamin D supplements to improve brain function.

Sleep: Try to keep a regular schedule with a goal of 8 hours a night.

Memory training: For example, you may want to look into the program Cogmed.  Professionals trained in this program can help people learn to improve their working memory, which is key in developing better focus and concentration.  An inexpensive online program which can help working memory as well as other aspects of brain function is

Neurofeedback, or brain biofeedback, is a non-invasive technology for training the brain to focus and improve impulse control.  This is a relatively new field, but there are several ways practioners can become certified to work with this modality.  One way to learn more, and to find a local practitioner, is through the Biofeedback Certification International Alliance.

The ADHD marriage, like any other, can be improved with better communication skills and other tools for improved emotional connection. At Psych Choices of the Delaware Valley, we have psychiatrists who can prescribe medications, as well as 14 therapists, many of whom specialize in working with couples.   To make an appointment, use our Make an Appointment Page or call our Intake coordinator at 610-626-8085, extension 213.

Self Compassion – One of Nature’s Gifts

Bleeding heart flower - Dicentra spectabilis

Self-compassion can be a powerful tool for the relief of suffering. Evolution has designed us both to give and to receive compassion, the urge to relieve suffering. As long as there is not too much interference with our development, we grow up naturally wanting to be compassionate and kind.

Can you remember a time when you were suffering in some way and someone was kind, warm, caring, and non-judging as they tried their best to help you? If you cannot remember such a time, please try to simply imagine being treated with such kindness. As you imagine or remember, take your time. Now notice how you feel inside. Maybe, like most of us, you will notice some type of pleasant sensations. I hope this is true for you.

Now remember a time when you were kind and helped someone else. Visualize the kindness, warmth, caring and non-judging flowing from you as you try to help. Now notice how you feel inside. Maybe, like most of us, you will notice some type of pleasant sensations. I hope this is true for you.

For many people, this activity can help them to connect with what nature has designed within us. Compassion can be cultivated, not only to give to others, but also to give to ourselves. We all are born with a nervous system that feels pain from many kinds of events, both real and present events, and also those we may remember or imagine. Fortunately, in nature’s wisdom, a capacity to find peace and comfort has also been built into our nervous system. Without this capacity, we could not have survived as a species.

Compassion and self-compassion are pathways to connect with that comforting capacity we all have within us. Many psychotherapists, due to their intimate contact with suffering, have become interested in how to nurture self-compassion in those seeking their help.

If you want to learn more, the resources below may be helpful. May this information bring something good into your life.

Self-Compassion by Kristin Neff, Ph.D.

The Mindful Path to Self-Compassion by Christopher Germer, Ph.D.

Mindful Compassion by Paul Gilbert, Ph.D. and Choden

The author of this article, Dr. Fred McKinney, is a psychotherapist at Psych Choices of the Delaware Valley.  To make an appointment with Dr. McKinney or another Psych Choices therapist, click on our Make an Appointment Page, or call our Intake coordinator at 610-626-8085, extension 213.