Self-Care for the Holidays

Ah, it's that time of year again.  You may have started your holiday planning and shopping, RSVPing to various events, and/or getting ready to host.  For most of us, the holidays are a mix of excitement, gift giving and receiving, and spending time with the ones we love.

On the flip side, it may also involve running harried, stretching ourselves too thin, dealing with competing demands, and family drama.  Relationships may become (more) strained.  Whereas some level of increased stress is to be expected, the holidays can also bring out additional difficult feelings, such as grief and loneliness.

The need for self-care and boundaries is higher than ever at this time of year, although ironically we likely have less time to do so.  Here are some things to consider:

• Be kind and gentle with yourself.  When multiple demands compete for our energy and attention, it becomes increasingly difficult to stay in the present and enjoy the moment.  
• Identify now how you want to take care of yourself.  For some, this means scheduling time with a dear friend.  For others, it could be unwinding with hot tea or cocoa at night and sticking to an exercise routine.
• Notice when you become reactive.  When you notice having a shorter fuse, for example, take a long and gentle moment to reflect on what is really causing it.  What may initially feel like annoyance with slow moving lines or traffic, might really be about pressure to keep up, or feeling taken advantage of, or having familiar buttons pushed by a family member.
• Holiday stress may get acted out in relationships.  This may create a wish to withdraw from others or engage in various escape fantasies.  Be careful not to entirely give in - spending meaningful quality time with others usually leaves us feeling better. 
• Be aware how you respond to interpersonal conflict.  Do you pursue or withdraw?  These patterns may get exacerbated with holiday stress.  Just being aware can help you modify your responses to others.
• Be a clear communicator.  Let others know what you're willing and able to contribute, and also communicate what you are not able to do.  Read this post about assertiveness skills.
• If you are spending the holidays alone, plan quality time for yourself as well as some time to be around others.  Joining a community that has meaning to you, religious or secular, is good for mental health.  Volunteering and giving back during the holidays can be immensely rewarding.  Shifting focus from inward to outward can help put difficult feelings in perspective.  Plan your participation early as volunteer opportunities on holidays fill up quickly.
• Take note of what you are grateful for.  It helps put things in perspective.

Happy holidays to you and yours!

Relationships: When Cultures Clash

Every person is a cultural being.  And therefore, we each bring our own story, family history, and cultural background into our relationships.  Unlike 20 or 30 years ago, in today's globalized world, we are more likely to interact, make friends, and fall in love with people from cultures other than our own.

Whereas intercultural romantic relationships, like any romantic relationship, are based on mutual love, respect, openness, and sincerity, they also present with unique challenges that may only become apparent after the initial honeymoon period has passed.   Common challenges faced by intercultural couples are differences in family culture and expectations, religious and political differences, language barriers, and decisions around cultural practices, such as how to celebrate holidays and eating habits.  Down the road, these challenges may also play a role when the question of how to raise children may arise.

Other unique challenges and decisions faced by intercultural couples are:

o Response to stress & conflict

o Response to illness

o Sexual behavior

o Values

o Place of residence

o Friends and interpersonal relationships

o Finances

o Cultural and society’s acceptance of the relationship

o Parental/family approval

o Gender roles

o Cohesiveness of family

o Emotional expressiveness

Factors For Success
Facing all these challenges together as a couple takes much energy, patience, acceptance, and most importantly, the willingness to "go back to the drawing board" as often as necessary.  A first important step is to identify which cultural differences may cause stress and conflict in the relationship.  In this process, it's important not to make any assumptions about the other's standpoint.  Remember, differences are merely differences - they are neither good nor bad.  They are honest expressions of personal and cultural values.

As humans, we assume too quickly, and can accomplish much more if we are curious about each other.  Also, don't assume that understanding each other better necessarily means agreeing with each other.  Living with cultural differences takes constant work.

For additional relationship advice, see these blog entries:
Improving Relationships Through Vulnerability
Managing Expectations In Relationships
Are You In An Abusive Relationship?

I am a Houston psychologist who specializes in working with intercultural couples.  Please visit my webpage for more information.

Understanding Depression

A startling finding: The World Health Organization has determined that depression is the most burdensome disease in the world today. It robs adults of more productive days of life than AIDS, cancer, or heart disease.

What is depression?  What is it not?  We all know the feeling of being sad or "blue" after experiencing a loss or disappointment.  It may last a few days or a few weeks.  But when do we start talking about an actual "depression" in clinical terms?
Common signs of clinical depression include:

• Frequently feeling sad and/or guilty
• Eating more or less (including significant weight loss)
• Sleeping more or less
• Loss of interest in things you usually enjoy
• Low energy, fatigue
• Irritability
• Difficulty concentrating and making decisions
• Thoughts about death and suicide

While the above signs are more common, everyone is different.  The following may also indicate depression for some people:

• Increased use of alcohol and drugs
• Anger
• Difficulty envisioning a hopeful future
• Helplessness
• Increased aches, pains, or bodily ailments

Depressive episodes can be situational - that is, they occur after a stressful event or events (for example, death or loss of a loved one, diagnosis of severe or terminal illness, children leaving home, divorce, persistent stressful job conditions, academic stress/difficulty, job loss, and other extremely stressful situations).  Or, it can happen for what appears to be no reason at all, literally out of the blue.  Research shows that clinical depression can also occur when stressors in the environment combine with a genetic or biological disposition.  If depression runs in your family, you are likely more vulnerable to also being depressed.

Depression is a complex and serious illness, comparable to diabetes or heart disease.  You can't just "snap out of it" by pulling yourself up by your bootstraps or thinking happy thoughts.  People with depression need professional treatment, just like people with diabetes and heart disease do.

What helps?  Talk therapy can help individuals determine what life circumstances may contribute to their depression and how to address them.  Therapy can also teach important skills to lower stress and address recurring negative thoughts that happen with depression.  Antidepressant medications can help normalize chemical imbalances in the brain that contribute to depression.  A helpful analogy to consider when thinking about antidepressants:  Just like insulin can help a person with diabetes whose pancreas no longer produces it, antidepressants can help a person with depression whose brain may be low on certain chemicals, or neurotransmitters.  More and more novel treatments are being researched and becoming available for people with recurring and treatment-resistent depression.

Only about one-third of individuals with depression seek treatment.  It is quite common for someone to live with depression for years, even decades, before deciding to seek help.  The sooner a person can get treatment, the higher their chances for recovery.  

If you know someone who is depressed, offer a supportive, non-judgmental, and listening ear.  Then offer your support in getting the person professional help and treatment.  Remember - depression is an illness that can linger, worsen, and/or recur if left untreated.  Remember, there is hope and there is help.

 I am a Houston psychologist who specializes in treating depression.  Visit my website for more information on my services.  

Please click here for an inspiring article in the New York Times on new approaches of treating depression in developing countries, impacted by war, famine, AIDS, natural disasters, and other trauma.

You and Your Shadow

 "To confront a person with his own shadow is to show him his own light." ~ Carl Gustav Jung

Strong, negative emotions can catch us by surprise, and can be incongruent with who we know ourselves to be.  Feeling irritable for no apparent reason, or catching an unexpected frown on our face in the mirror, are perfect examples.   Wouldn't it be so wonderful to have a magic way to make fearfulness, anger, and insecurity disappear for good?  

We all have a "dark side", or shadow.  The shadow is represented by deep mental grooves that lead to negative feelings and behaviors.  Besides triggering strong feelings, it may result in unwanted habits, such as being habitually late, self-sabotaging, or spreading gossip about others.  Other examples are stretching the truth, erupting at the ones close to us, or masking insecurity with pride and boastfulness.  The shadow is the person you'd rather not be.  It personifies the selfish, unpredictable, primitive, egocentric, and violent aspects of yourself.  These undesirable aspects of self have often been dis-owned by consciousness, nicely packaged and filed away deep in the unconscious.  

As painful as these aspects can be, they have important lessons to teach us once we bring them into consciousness.  Let's take the example of Nora*, an administrative assistant at a medical office.  Nora took pride in being a conscientious worker and "always going the extra mile" for her supervisor and patients.  Over time, she found herself having resentful feelings towards her boss, the medical director, whom she perceived as neglectful and irresponsible in patient care.  She became irritable with him in meetings and found herself frequently rolling her eyes around him.  After meeting with a therapist and exploring her feelings and behaviors, Nora became aware that her judgment about her boss mirrored her judgments and fears about herself.  She herself was insecure and afraid of seeming "incompetent", which she covered by over-functioning in numerous ways.  When Nora became aware of the harshness of her inner judge, she was able to let go of the resentment and judgment of her boss.  Their relationship subsequently improved.  More important, Nora was able to feel more compassion for herself.

Raising awareness for one's shadow is important.  Getting to the root of these feelings and behaviors can be liberating and improve our relationships to ourselves and others.  So how do we do this?  Here are some tips:

• Listen to feedback from others about your behaviors (eg, about being habitually late, having a short fuse, etc.).  
• Notice when an encounter with a person leaves you feeling emotionally charged.  Look at your reaction to people you feel strongly negatively about.
• Recognize that the "dark" qualities you react to in others may be feared or unacknowledged aspects of yourself.  
• Consider what (harsh, unrealistic) expectations you have of yourself, others, and the world.
• Consider talking to a counseling professional to gain perspective and depth of understanding.

*Nora and her example are purely fictional for illustrative purposes of this article.  Any resemblance to actual people is purely coincidental.

Third Culture Kids

A home away from home.  Caught between cultures.  A foreigner in your own land.  These phrases all describe the experience of a third culture kid.  The term "third-culture kids" refers to children who spend a significant amount of developmental or formative time outside their (parents') home culture.  Children of military, missionaries, or other expats are good examples.  This results in an interesting phenomenon - these children, caught between two cultures, create a culture of their own.  

Spending one's formative years in another country means that third culture kids internalize that country's customs, culture, and language, while also retaining their home culture and language.  At the same time, however, they are perceived as foreigners in their host country.  They create a "third culture" to deal with this tension.  This usually means spending lots of time with others who experience the same situation - usually other third culture individuals, who can bond around the same shared experience.  Often, third culture kids have multiple stays abroad, at times in multiple countries, therefore repeating this process over and over again.


Here are some interesting positive trends observed in Third Culture Kids:

• They usually do well academically (40% have postgraduate degrees or doctorates) and usually grow into successful professionals.
• They adapt to new situations quickly and are skilled at navigating culturally diverse social situations.  
• They develop excellent communication and diplomatic skills, and pick up new languages quickly.
• They have good self-confidence.

Some challenges faced by Third Culture Kids are:

• They may have difficulty immersing themselves completely in the host culture.  As adults, they may often feel like perpetual outsiders, regardless of their environment.
• Making new friends and saying goodbye becomes routine, often creating an out-of-sight-out-of-mind attitude.  It can be hard to maintain close friendships and relationships.
• Returning to one's home country after many years can lead to "reverse culture shock".  Third culture individuals are expected to remember how to behave at home, which can be hard when you've internalized other cultures.  Peers in the home country have moved on within their own cultural customs.  This, too, can lead to feeling like an outsider.
• For the third culture kid, the home country can prove to be more foreign than previous host countries, and many of them create and retain their own, separate identity as a third culture person.  Many move abroad again as adults, and will work and raise their family in a foreign country.

Support for third culture kids is crucial.  Their adjustment usually depends on their personality, the duration of the stay abroad, their age, the parent-child relationship, family support and circumstances, and parents' attitude.  Giving third culture kids a sense of stability and consistency is important.  Parents should encourage safe and supportive dialogue around cultural and social issues.  Parents are also encouraged to support safe immersion in the host culture and promote learning of the host language(s), and interaction with locals.  And when returning home, parents should expect their children to experience reverse culture shock, and be supportive and available in this process.  Finally, parents of third culture kids may need to get their own outside support to help cope with these challenges.

Resources for Third Culture Kids:

TCK World

Denizen Online Magazine

Book:  Third Culture Kids: Growing Up Among Worlds

What to Expect in Therapy and Counseling

Psychotherapy and counseling serves many purposes.  It can provide relief from anxiety, stress and depression.  It can help you work through a personal or professional crisis and productively address conflicts in your life.  It can help you navigate numerous life transitions.  It may help uncover reasons behind recurring patterns in relationships or unproductive behaviors.  It can make it possible for you to change those things you are able to change, and can help you bear those things that can't be changed.  

The decision to enter therapy or counseling often arises from challenging circumstances.  So what is it about therapy that works?  Research has shown that the most consistent aspect of therapy that promotes healthy change is a safe and trusting therapeutic relationship.  It's therefore important that you find a therapist with whom you feel comfortable to be yourself.   Powerful insight and change often happens as a result of a positive relationship between therapist and client.  This doesn't mean that your therapist won't challenge you or at times disagree with you; however, in order for this to happen effectively, there has to be a trusting relationship first.  The therapeutic relationship can be a great model for a healthy relationship.  Your therapist should be attentive and you should feel that they have your best interests at heart.   It may be a good idea to "interview" a few potential therapist candidates over the phone before making a decision about who is right for you.


The first step of the process should involve a thorough evaluation of your concerns and life history. Your therapist will collect factual information about you, including the nature of the problem that prompted you to seek help, a history of past and present emotional and psychological concerns, any medical issues and medications you're taking, and your past and present use of drugs and alcohol.  Your therapist should also ask about your family and social history.  This process is very comparable to first seeing a medical clinician, who gathers your medical history to arrive at a diagnosis and treatment plan.  After the information gathering process is completed, you and your therapist will design a plan for your therapy and establish realistic goals.


The therapy process depends on your therapist's theoretical orientation.  Nowadays, most therapy and counseling consists of a series of interactive conversations.  Most therapists will not present as cooly detached observers, but rather ask questions, make comments, and offer suggestions.  For example, as a therapist, I consider one of my main missions to help each client uncover the best answers and solutions that are uniquely right for them.


As a result of therapy and counseling, you should hopefully understand yourself better, have more positive feelings, and increase healthy behaviors. For more information about my therapy services, please  visit DrGortner.com.  

Simple Ways to Boost Your Mood and Confidence

Positivity and confidence are important building blocks in life.  Often they are the prerequisite for other positive changes.  They keep us moving forward (instead of looking backwards) and connected to others.  Here are some simple ways to build mood and confidence boosters into your everyday life:

• Evaluate your choices:  Take inventory about what is currently going on in your life:  in your relationships, workspace and environment.  Determine the aspects of your life that you can change positively, then focus on them.  Also acknowledge the things that you cannot change, and move on. Make sure to only invest energy in the things that are worth your while.  It may help to write them down.
• Eliminate negativity:  If there are people and situations that leave you drained and grumpy on a regular basis, re-evaluate their place in your schedule and your life.  For example - a friendship should leave you energized, rather than drained, most of the time.
• Stop blaming yourself:  When something doesn't go as expected, don't dwell on it.  Rather than beating yourself up about human mistakes, take a deep breath, regroup, and figure out your next steps.
• Make time for exercise:  This helps burn off stress hormones and leaves you feeling relaxed and refreshed.  Exercise is also known to counteract mild to moderate depression and improves confidence.
• Get social support:  Make time for dates with friends.  This helps reduce stress, improves health, and gives you something to look forward to.
• Learn something new:  Novelty is good for the brain and the soul.  Pick up a new hobby, craft, skill, or language.  You will improve your confidence and may meet new people that share your passion.
• Reward yourself:  Break down your goals into small, manageable benchmarks.  When you reach a benchmark, reward yourself with something healthy.  For example, after you finish cleaning a room, make time for a healthy snack or a phone call to a friend.
• Nurture your mind:  Surround yourself with positive music, entertainment, and art.  Avoid movies or TV shows that leave you feeling stressed, anxious, and negative.

Make self-care a priority in your life.  If this is consistently hard for you, you may wish to consult with a licensed mental health professional for support.  Check out my website for information on my services.

Are You Feeling Taken Advantage Of?

It's a nagging, uneasy feeling - when you feel like another person crossed a boundary and you feel used.  Sometimes these situations are hard to pinpoint, and you notice much later how you actually feel about it.  Other times it's immediately apparent.  A boss asks you to stay late for the third time in a week, a friend doesn't pay their share on a tab, a family member asks for repeated favors that start to take up much time and energy.  These are just a a few examples that may cause you to feel taken advantage of, and this in turn may cause anxiety, stress, anger, and resentment.


Often our needs and opinions will differ from another person's.  We can only guess what another person's intentions may be behind their requests or demands.  However, we can be in full control of how we respond to these requests.  Lots of people, especially women, struggle with assertiveness. Assertiveness is the very essential skill of communicating clearly with others, while respecting your own rights and feelings as well as the rights and feelings of others.  

What causes people to avoid being assertive?  Often it's for fear of displeasing others and of not being liked.  However, this leaves you vulnerable to being taken advantage of over and over again in the long run.  Acting assertively is not acting aggressively, passively, or passive-aggressively.  It means being direct, honest and open about your feelings, opinions, and needs.  It also means:

• Stating reasonable requests directly and firmly.
• Stating your goals and intentions in a direct and honest manner.
• Stating your point of view without being hesitant or apologetic.  
• Being able to say "no" without guilt to unreasonable requests.
• Asking for help when you need it
• Asking for clarification when you're confused.
• Respectfully volunteering your opinions even when they're different from others.
• Using assertive body language - face a person squarely, straight upper body, good eye contact, being calm but firm
• Taking your time ("Let me think about that").

Here is a basic script for setting a boundary with someone, aka guidelines to saying "no" to a request.

1. Acknowledge the person's request by repeating it.  This shows respect for the other person's rights and needs.
2. Explain your reason for declining.
3. Say no.
4. (Optional) If appropriate, suggest an alternative proposal where both your and the other person's needs will be met.

An example:  Let's say another person asks you to help them move, but you have already made plans or have an important deadline.  You may respond: "I understand you need some help moving (acknowledgment).  I'd like to help out but I promised my boyfriend we would go away for the weekend (explanation), so I'm not going to be available (saying no).  I hope you can find someone else."    Again, assertiveness means being direct, honest, and respecting your own rights and needs as well as theirs.

For a latest follow-up post on assertiveness on my blog, click here.

Assertiveness is a very important subject affecting our lives every day.  It takes awareness and lots of practice.  It is hard to be assertive for many of us.  If you find yourself being passive, aggressive, or passive-aggressive instead of being assertive, and this is pervasive in several areas in your life, talking to a trained licensed professional, such as a psychologist, can help.  I offer assertiveness training in my practice, as well as the opportunity to explore what may make it difficult for you personally to be assertive.  Feel free to visit my website www.DrGortner.com for more information.

Food and Emotions

We need food to sustain and nurture ourselves.  And food is intricately linked to both positive and negative emotions for almost all human beings.  For example, many cultures embrace the use of food for celebration or to provide comfort in times of sadness or emotional distress. It’s normal for us  to associate food with our emotions.


But how do we know when we are feeding an emotional, rather than a physical, hunger?  And when does this become a problem?  "Emotional Eating" is a behavior that is dictated by the way you are feeling at the moment. Whenever you experience pain, frustration, depression, or boredom, you turn to food to fill the void and satisfy your emotional hunger. While you feel fulfilled during the process, afterwards you’re often left feeling worse than before. It becomes a problem when emotionally driven food habits take over from healthy eating and result in uncontrolled weight gain.  Emotional hunger has been tied to many eating disorders such as bulimia and binge eating. 


Here are some ways to distinguish emotional and physical hunger:

Emotional Hunger:

Is sudden
Is for a specific food
Is urgent
Is paired with upsetting emotions and situations
Involves automatic or absent-minded eating
Does not respond to fullness
Comes with feelings of guilt

Physical Hunger:

Is gradual
Is open to different foods
Is patient
Occurs out of a physical need
Involves deliberate choices and awareness of the eating
Stops when full
Realizes eating is necessary

The most common feelings that trigger emotional eating are stress, anxiety, boredom, loneliness, anger or frustration, and sadness.  The next time you’re going through an emotional phase, instead of reaching for snack food, you may want to try some of the following:

• Stop and evaluate your feelings. Become aware of what is happening and know that if you can ride it out, it will eventually pass.  All feelings are temporary.
• Take time out to write what you are feeling down. 
• Release your feelings.  If you need to cry, do so.
• Develop new mood regulation strategies.  For example, when you are anxious or stressed, try exercising, taking a hot bath or have a hot beverage.  Or call a friend you trust to talk about what is bothering you.
• Food issues can be very complex and often involve messages we received from our families.  Awareness is key.  Often talking to a licensed professional, like a psychologist, can help.

Improving Relationships Through Vulnerability

A universal and very human struggle is how we can feel less alone and more connected to others.  Attachment is hardwired into our brains.  Like it or not, we are all social creatures in need of connection.  It's a basic need for survival, dating back to when we are newborns and are so utterly dependent on another human being to continue life.


In a now famous lecture on TED.com, Dr. Brene Brown spoke about the important concept of worthiness.  The fear that we are unworthy, she says, keeps us from fully connecting to others in our lives, and keeps us isolated and afraid.   Dr. Brown's research shows that people with a sense of worthiness believe they deserve love and belonging, have self-compassion, and possess the amazing courage to be imperfect.  People who have a strong sense of worthiness are also willing to take more interpersonal risks - they are willing to make themselves vulnerable in relationships while being comfortable with the idea that there are no guarantees and certainties in relationships.  They allow themselves to be seen and known by others while embracing their imperfections.


As a society, we are obsessed with perfection.  This also means obsession with appearing not-vulnerable.  Perfection can mean an unhealthy preoccupation with trying to make all the uncertainties in life certain - a futile quest.  When we realize that we are indeed vulnerable human beings, we tend to try to numb this often scary feeling - by acquiring material goods and overspending, turning to food and drugs, avoiding responsibility and blaming others (just to name a few examples).


Dr. Brown says we all have an immense fear of disconnection from others; she calls this the definition of shame.  This fear is part of being human.  She suggests that in order to improve relationships and have that real connection, we could consider making ourselves vulnerable:
- To let ourselves be seen by others as we truly are
- To love with our whole hearts even though there's no guarantee
- Practice gratitude and joy in everyday life
- Embrace the belief that we are enough, that we are worthy of love

The power of vulnerability - what a concept!
Dr. Brown's full lecture is available here.