Category Archives: General

What is Executive Functioning?

Executive Functioning has become a catchphrase in psychology, parenting, and, increasingly, education.  Executive functioning is mediated by the frontal lobe. You can think of it as the conductor of the orchestra. Or the chef of a bustling kitchen. You can have very talented musicians, but the orchestra doesn’t do so well without the guidance and direction of the conductor. Similarly, even in the most delicious or skilled restaurant settings, the head chef is required to pull together all of the stations, to make and serve the perfect meal.

We use executive function when we perform such activities as planning, organizing, prioritizing, self-monitoring, strategizing, and paying attention to and remembering details. People with executive function problems have difficulty with planning, organizing, processing information, and managing time and space. They also show weakness with “working memory” (keeping information in your mind while working).

Why is executive function important?
In school, at home or in the workplace, we’re called on all day, every day, to self-regulate behavior. Normally, features of executive function are seen in our ability to:

  • make plans
  • keep track of time
  • keep track of more than one thing at once
  • meaningfully include past knowledge in discussions
  • engage in group dynamics/interactions
  • evaluate and analyze ideas
  • reflect on our work
  • change our minds and make corrections while thinking, reading and writing
  • finish work on time
  • ask for help
  • wait to speak until we’re called on
  • seek more information when we need it.

These skills allow us to finish our work on time, understand if we are doing it right, ask for help when needed, manage our time, and seek more information.

Problems with executive function may be manifested when a person:

  • has difficulty planning a project
  • Frequently procrastinates
  • has trouble comprehending how much time a project will take to complete
  • struggles to tell a story (verbally or in writing); has trouble communicating details in an organized, sequential manner
  • has difficulty with the mental strategies involved in memorization and retrieving information from memory
  • has trouble initiating activities or tasks, or generating ideas independently
  • has difficulty retaining information while doing something with it; e.g., remembering a phone number while dialing.

How do we identify problems with executive function?
There is no single test or even battery of tests that identifies all of the different features of executive function. Educators, psychologists, speech-language pathologists and others have used measures including the Wisconsin Card Sorting Test (Berg, 1948), the Category Test (Reitan, 1979), the Trail Making Test (Reitan, 1979), and the Progressive Figures and Color Form Tests (Reitan & Wolfson, 1985) to name a few.

Careful observation and interviewing are invaluable in identifying, and better understanding, weaknesses in this area. It’s often helpful to receive information from another person who observes the behaviors, such as a parent, coach, spouse, or teacher.

Strategies to improve executive function.
There are many effective strategies one can use in when faced with the challenge of problems with executive function.

Here are some methods to try:

  • Take step-by-step approaches to work; rely on visual organizational aids.
  • Use tools like time organizers, reminders, computers or watches with alarms.
  • Prepare visual schedules and review them several times a day.
  • Ask for written directions with oral instructions whenever possible.
  • Plan and structure transition times and shifts in activities.
  • Create checklists and “to do” lists, estimating how long tasks will take.
  • Break long assignments into chunks and assign time frames for completing each chunk.
  • Use visual calendars to keep track of long term assignments, due dates, chores, and activities.
  • Use management software such as the Franklin Day Planner, Palm Pilot, or Lotus Organizer.
  • Organize work space.
  • Minimize clutter.
  • Consider having separate work areas with complete sets of supplies for different activities.
  • Schedule a weekly time to clean and organize the work space, including your desk, work bag or backpack.
  • Make a checklist for getting through tasks and assignments. For example, a student’s checklist could include such items as: get out pencil and paper; put name on paper; put due date on paper; read directions; etc.
  • Meet with a teacher or supervisor on a regular basis to review work; troubleshoot problems.
  • Doing chores at home has been shown to improve executive function for young people. Sequential tasks facilitate frontal lobe development. For example, learning to do laundry includes sorting clothing by fabric or color, learning how to put the correct amount of clothing into the washer, putting in laundry detergent and softener, learning stuff how to pick the correct settings, taking clothing out in a timely fashion after it’s completed, putting clothes in the dryer, the correct setting for the dryer, removing clothing, folding, putting items away.

Nine Tips for Dealing Calmly with Criticism

We can have a very hard time being criticized, corrected, or accused – even of the smallest mistakes. One client succinctly said: “it feels like an attack on my character, my very person”. Here are some of the strategies to use to accept criticism.

  1. Listen to what a critic is saying. Really listen, try to understand that point of view, don’t just nod while you formulate your retorts.
  2. Don’t be defensive. This is the toughest step for me. With my writing, for example, I always have to take a deep breath and remind myself, “I welcome criticism. This person is helping me. I want to hear how to improve my book/article/post.”
  3. Act the way you want to feel. It’s really uncannily effective; acting friendly and eager to learn makes me feel friendlier and more eager to learn.
  4. Don’t fire back by criticizing your critic. Your comments will just sound defensive, and you’ll escalate the exchange. This urge is very difficult to resist, because the impulse to justify and attack is strong when you feel criticized, but it isn’t helpful, and it certainly isn’t effective.
  5. Delay your reaction. Count to ten, take a deep breath, sleep on it, wait until the next day to send that email…any kind of delay is good. I find it’s much easier to apply this rule when I’m responding in writing. I’ve trained myself to think long and hard before hitting “send” or “enter.”
  6. Explain honestly the reason for your actions. Sometimes it’s tempting to re-characterize your actual feelings, actions, and motives. Usually, though, that just complicates things more. It becomes impossible to have an honest exchange.
  7. Admit your mistakes.
  8. Explain what you’ve learned. If you can show a critic that you’ve learned something, you prove that you’ve understood the criticism and tried to act on it. That, itself, usually mollifies critics.
  9. Re-frame the issue entirely to embrace criticism. Fact is, trying new things and aiming high opens you to criticism. You wanted to grow, and accepting criticism can be part of the process.

A Year of Growth

Just 14 months ago, my vision of a company providing multi-tiered mental health services for the widest range of people in the DMV came to life.

Since that time, we have opened two offices, with a third location on the way next year, served the community through psycho-education and consultation for teens in Fairfax County public schools; taught meditation to youngsters in middle school and high school; provided services to the restaurant and bar industry through mental health screening and seminars/outreach; aired a West Coast podcast on minority mental health; used social media to write blogs and post articles of interest for timely topics in psychology; been a contributor to local news sources for psychology; led mental health discussions at faith based and secular groups; given talks at local professional organizations such as the Maryland Psychological Association; partnered as a consultant for some of the most innovative private schools in the area; and established working relationships with other mental wellness professionals, including coaches, trainers, physicians, educators, attorneys, hospitals, advocates, activists, artists, writers; and so much more. 
Grateful.

Most important, I have had the great pleasure of working with a huge range of clients for testing, psychotherapy, and consultation, greatly individualized.

There is so much more to learn and do.
Mental health is for all. Stay tuned.

Q & A with Dr. Hoorie Siddique

Occasionally I’m asked to do Q&As by people interested in psychology as a field and/or the practice I’ve developed with Embolden Psychology. What follows are the questions and answers from a brief interview I did recently with an actor who was researching a role.

1.) What fascinates you about psychology?

So many things, but what comes to mind are two important but different levels.

First,  studying human behavior is something we all do. From trying to figure out our friends and family to people watching, it’s all about psychology. In my belief, we have an inherent need to understand others that’s part of our wiring. The field of clinical psychology takes it to a level of science and research, combined with empathy and treatment/healing.  My doctoral program emphasized what is called the scientist practitioner model. This basically refers to having an understanding of social science, psychological, and medical research and how to use this knowledge in ways that are helpful to your clients.

Second, in clinical psychology practice, you actively strive to meet another in their experience, with empathy, acceptance, and a genuine desire to understand all that has brought them to this place and time. This has been described as a “corrective emotional experience” for clients, Meaning an acceptance and openness to the uniqueness of that individual that may not necessarily be present in other meaningful relationships with family, friends, and partners.

2.) What do you love about your job?

I love seeing people find satisfaction and joy in their lives. I also love, on a personal level, how much I learn just from talking to hundreds of people every year.  I’ve had the privilege of hearing thousands of stories of courage, pain, and triumph. Although psychologists go through many years of education and training, the education we receive from being with our clients is the highest echelon.

Another wonderful thing about psychology is the broad range of work and learning it makes possible. Psychologists were the original consultants for the advertising industry, as seen in Mad Men. Psychologist are professors, researchers, therapists, consultants, and scientists, just to name a few roles. For example, I received advanced training in neuropsychology, mindfulness-based therapy, and psychodynamic psychotherapy after I completed my formal doctoral program. The field of psychology is dynamic and growing.

3.) Rewards? Challenges?

The rewards are having a job where you can genuinely help alleviate suffering, do something different every day, work with multiple colleagues (I believe in a team approach), and continue to grow and learn as a person. For example, we have to to keep up with continuing medical education credits, so staying on top of advances in our field is extremely important and required. Education never stops.

The challenges parallel the rewards. On a daily basis, we hear some of the most painful things, and sit with people who are suffering. Self-care is paramount to prevent burnout. Most mental health health professionals have participated in personal counseling/therapy, which is highly recommended, and in my belief crucial, to help us understand our own concerns that might affect our work. Having a strong social support network, healthy routines, and personal activities to destress are essential. I have an incredible network of colleagues and close friends who are so helpful in this regard. For me, being outdoors, being with my dogs, and spending quiet time (reading, writing, meditation) are tools that help me replenish.

Lastly, I have to add that I believe that psychology has a social justice and advocacy component that is relatively new to the field, at least “officially”.  Not until 2017, did the American Psychological Association add to their ethical guidelines that examining systems of oppression and environment are factors that we must actively address as psychologists.

On Grief and Grieving

Loss is a universal experience. Grieving takes many forms.

Many people truly want to help a friend or family member who is experiencing a severe loss. Words often fail us at times like these, leaving us stammering for the right thing to say. Some people are so afraid to say or do the wrong thing, they choose to do nothing at all. Doing nothing at all is certainly an option, but it’s not often a good one.  While there is no one perfect way to respond or to support someone you care about, here are some good ground rules.

Grief belongs to the griever.
Grief is personal.  You have a supporting role, not the central role, in your friend’s grief. This may seem like a strange thing to say. So many of the suggestions, advice and “help” given to the griever tells them they should be doing this differently, or feeling differently than they do. Grief is a very personal experience, and belongs entirely to the person experiencing it. You may believe you would do things differently if it had happened to you. We hope you do not get the chance to find out. This grief belongs to your friend: follow their lead.

There is no timeline.  And grief is not linear.
Everybody has their own time frame for grief. There are no rules and there is no need for them.  Some people describe waves of pain. Some people don’t think about it until there is a reminder. Often, there are anniversary reactions on important dates that elicit memories.  As a therapist I have found that many people have a deep fear of forgetting.  When they want to speak about their loss or their relationship with a loved one, give them the space to do so.

There is culture, and there is personal culture
From wanting to be quietly alone, to craving the presence of loved ones. Wanting to talk. And not.  Crying, or not.  Wanting to talk about spirituality and loss is also personal.  There is no formula.

Stay present and state the truth.
It’s tempting to make statements about the past or the future when your friend’s present life holds so much pain. You cannot know what the future will be, for yourself or your friend — it may or may not be better “later.” That your friend’s life was good in the past is not a fair trade for the pain of now. Stay present with your friend, even when the present is full of pain.

It’s also tempting to make generalized statements about the situation in an attempt to soothe your friend. You cannot know that your friend’s loved one “finished their work here,” or that they are in a “better place.” These future-based, omniscient, generalized platitudes aren’t helpful. Stick with the truth:  this hurts. I love you. I’m here.

Do not try to fix the unfixable.
Your friend’s loss cannot be fixed or repaired or solved. The pain itself cannot be made better.  Do not say anything that tries to fix the unfixable, and you will do just fine. It is an unfathomable relief to have a friend who does not try to take the pain away.

Be willing to witness searing, unbearable pain. 
To do so, while also practicing  the above is very, very hard.

This is not about you.
Being with someone in pain is not easy. You will have things come up — stresses, questions, anger, fear, guilt. Your feelings will likely be hurt. You may feel ignored and unappreciated. Your friend cannot show up for their part of the relationship very well. Please don’t take it personally, and please don’t take it out on them. Please find your own people to lean on at this time — it’s important that you be supported while you support your friend. When in doubt, refer to #1.

Do not impose your personal spirituality or religious beliefs on another.
I believe in prayer and spirituality.  My beliefs are highly personal. Telling somebody that you will be reunited in a better place and how a loved one is in a better place may not be helpful. Let them guide you.

Anticipate, don’t ask.
Do not say “Call me if you need anything,” because your friend will not call. Not because they do not need, but because identifying a need, figuring out who might fill that need, and then making a phone call to ask is light years beyond their energy levels, capacity or interest. Instead, make concrete offers: “I will be there at 4 p.m. on Thursday to bring your recycling to the curb,” or “I will stop by each morning on my way to work and give the dog a quick walk.” Be reliable.

Do the recurring things.
The actual, heavy, real work of grieving is not something you can do (see #1), but you can lessen the burden of “normal” life requirements for your friend. Are there recurring tasks or chores that you might do? Things like walking the dog, refilling prescriptions, shoveling snow and bringing in the mail are all good choices. Support your friend in small, ordinary ways — these things are tangible evidence of love.

Please try not to do anything that is irreversible — like doing laundry or cleaning up the house — unless you check with your friend first. That empty soda bottle beside the couch may look like trash, but may have been left there by their husband just the other day. The dirty laundry may be the last thing that smells like her.  I have a strand of hair from a loved one from years ago, carefully wrapped.   Do you see where I’m going here? Tiny little things become precious. Ask first.

Tackle projects together.
Depending on the circumstance, there may be difficult tasks that need tending — things like casket shopping, mortuary visits, the packing and sorting of rooms or houses. Offer your assistance and follow through with your offers. Follow your friend’s lead in these tasks. Your presence alongside them is powerful and important; words are often unnecessary. Remember to bear witness and be present.

Run interference.
To the new griever, the influx of people who want to show their support can be seriously overwhelming. What is an intensely personal and private time can begin to feel like living in a fish bowl. There might be ways you can shield and shelter your friend by setting yourself up as the designated point person — the one who relays information to the outside world, or organizes well-wishers. Gatekeepers are really helpful.

Respect privacy and boundaries.
In the event of loss, and faced with our own mortality, one of the first questions we ask is: what happened?  We have a need to search for and find meaning. Again, this is not about us. What someone chooses to tell us, or others, is up to them.

Educate and advocate.
You may find that other friends, family members and casual acquaintances ask for information about your friend. You can, in this capacity, be a great educator, albeit subtly. You can normalize grief with responses like, “She has better moments and worse moments and will for quite some time. An intense loss changes every detail of your life.” If someone asks you about your friend a little further down the road, you might say things like, “Grief never really stops. It is something you carry with you in different ways.”

Love.
Above all, show your love. Show up. Say something. Do something. Be willing to stand beside the gaping hole that has opened in your friend’s life, without flinching or turning away. Be willing to not have any answers. Listen. Be there. Be present. Be a friend. Be love. Love is the thing that lasts.

Sources and resources:
https://www.refugeingrief.com/blog/
https://suicidepreventionlifeline.org

Mentors Are A Gift

In 1999, while completing my doctoral program, I joined forces with one of the best people in my industry. Initially, we worked together by phone: as a doctoral intern, I was seeing young patients at the eating disorders clinic and adolescent medicine center at Children’s National Medical Center and he was working with their parents. His dedication and integrity were clear. He eventually asked me to come work with him, and actually paid for my remaining credit hours as a doctoral student at an expensive private university.

Over the years, Dr. Neil Schiff and I created a practice, with multiple offices, that was dedicated to supporting the overall community of DC and, in particular, helping the neediest citizens.

So, one of the most gifted family therapists in the entire country became my mentor. He trained with Jay Haley, one of the greats, and owned it. We worked seven days a week, frequently bringing our Labs, Asia and Riddle to work with us. I felt unbelievably blessed. He became a great friend and confidant. We could network our way through anything. He knew all my flaws and strengths and still loved me.

We worked together for the department of state, where I repped the East Africa sector, medevac, and eventually consulted for virtually every office in the DC government. We could make eye contact and know it was time to leave an event. He was not prone to mansplaining, even though year after year he was voted one of the top therapists in Washington DC. He almost never told me what to do, but when he did, it was time to listen.

Tragically, years later he became ill with advanced Parkinson’s, initially misdiagnosed. He had every possible side effect and complication you could possibly experience. He lived in excruciating pain, but always had time to share a glass of champagne, kept chilled for me, and a conversation of substance.

I closed the last office we created together as mental health providers serving the DC community. this past weekend. I lost him as a colleague, never as a friend or loved one. I will love him forever.

May we all be mentored well.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.