Category Archives: General

Cumulative grief

Cumulative grief is what happens when you do not have time to process one loss before incurring another. In an ideal world, you would get a chance to metabolize and heal from one loss before you are tasked with facing another.With cumulative losses, painful emotions which come from the initial loss bleed into the experience of the next one. As you accumulate losses or traumas, processing the grief from each one becomes harder to handle. For example, during the pandemic, a person may have suffered grief from impaired health, loss of financial security, role or job loss, death of loved ones, and prolonged isolation, often overlapping or in rapid succession.

The complexity of multiple losses includes a mix of painful and sometimes contradictory emotions. You may feel angry, numb, have bring-you-to-your knees sadness, loneliness, and even relief. I often state there is no timeline for grieving and loss is not linear. I have written elsewhere about mourning the living; where the person you are grieving is alive but there has been a permanent rift or rupture, so they are physically alive, but gone.

Over time, the wave of hurt that is sharp and distracting may move to one where it is quieter and softer. Anniversaries of loss can send us right back to the raw place.  Clinical psychologist and grief researcher, Dr. Katherine Shear, writes about characteristics of Integrated Grief, what I refer to as metabolized loss in my practice:

– We accept the loss.
– We adapt to a new world with the absence of the person or situation we are grieving.
– We begin to believe again in a positive future.

Imprisonment and mental illness.

Happy Bastille Day, Le Quatorze Juillet, 7/14

Most people are familiar with Bastille Day, a national celebration of independence in France, and the beginning of the French Revolution. It was marked by the storming of the Bastille in 1789, a medieval fortress that became a prison and place of torture, in eastern Paris.

Ironically, on the day of the storming of the prison, there were only seven prisoners present.

The symbolism, however, is crucial. The prison was used by the Paris police with immunity to do what they wanted for countless years. It housed many political dissidents, including the writer Voltaire. In addition to those who went against the callous rulers Louis XVI and Marie Antoinette, what is less known is that the Bastille was used to house the chronically mentally ill, often family members of the elite. Most prominently, schizophrenics and developmentally disabled individuals. On the day of the storming of the fortress, of the seven prisoners being held, two met the diagnosis for schizophrenia based on current medical knowledge.

For centuries, mental illness has been treated as criminal, dangerous, punished, and hidden away. Today, many homeless individuals and those who are incarcerated suffer from major mental illnesses.

Brain Lies: Internalized Negative Thoughts

Your brain can be a trickster. Depression and anxiety create automatic negative thoughts that can become our internal dialogue. They are obstacles that influence our everyday life. Therapy is useful for identifying and giving voice to these internalized beliefs. And actively combating them.

Some examples of negative thoughts that can be harmful:
– All or nothing
Binary thinking. If you stick to your exercise plan for a month, you think you think you are the most disciplined person on the planet. If you miss a day at the gym, you think you have no discipline and give up and go back to being a coach potato. Being able to hold multiple opinions and thoughts, often contradictory ones, is mental flexibility.

– Catastrophizing
Jumping to the worst possible conclusion, usually with very limited information or objective reason to despair. When a situation is upsetting, but not necessarily catastrophic, we may still feel like we are in the midst of a crisis.

– Shoulding
Our “shoulds” come from internalizing others’ expectations and comparing ourselves unfavorably. This is the hallmark of regret, the what if, the opposite of living in the moment.

– Overgeneralization
You see a single negative event as a never-ending pattern of defeat. These thoughts make you see only the negative aspects of situations and make you more inclined to give up on your efforts.

– Labelling
When you call yourself or someone else names or use negative terms to describe them. A lot of us do this on a regular basis. You may have said one of the following at some point in your life; “I’m a loser”; “I’m a failure”; “I suck,” or “I’m lazy.” The problem with repeatedly calling yourself names is that your brain starts believing them.

– Personalization
You see yourself as the cause of some negative external event, which in fact you were not responsible for. For example, you see someone scowling as they walk down the hallway. You automatically assume that they are angry with you, when they could’ve actually had a really bad day.

– Assuming
When you make assumptions, you’re usually filling the void of the unknown by imagining an undesirable outcome. In reality, a number of good things are often also possible.

– Fortune-telling
Predicting an outcome, usually negative, even though you don’t know what will happen is the hallmark of fortune telling. These thoughts disregard data.

– Mind reading
When you think that you know what somebody else is thinking even though they have not told you, and you have not asked them, it is called mind-reading. Listen carefully to the other person instead of trying to predict what they have to say. See also Active Listening.

– Blame
Blaming others for your problems and taking no responsibility for your own successes and failures.
Also see How to Practice Self-Compassion.

Three years ago this summer, Embolden Psychology went from a dream to fruition. We emerged at the beginning of a mental health pandemic, of an enormity never seen before in my profession. In the summer of 2020, the US Census Bureau wrote that the levels of clinical depression in the United States had never been recorded as any higher since they began record keeping. Anxiety disorders, substance abuse, trauma, and domestic discord were close partners.

After being the clinical director for almost 18 years for a DC and MD-based mental health practice headed by my mentor, Dr. Neil Schiff,  I worked as a contractor all over Washington DC before deciding to pursue opportunities that were not available under any one roof. Neil helped me develop a model that emphasized inclusion, flexibility, and diversity as essential in providing psychological services.

Throughout the pandemic, which is far from over, Embolden provided low fee and Pro Bono support for front line medical and emergency providers, the service industry which was devastated, and individuals nationally experiencing severe financial hardship and family problems.

Our motto is Mental Health Is For All

This requires a tricky combination, constantly being fine tuned:

Community mental health, volunteer services, crisis management, neuropsychological assessment, psycho educational work (teaching and consultation), writing about mental health in a way that’s accessible to as many people as possible, cultural competency and training, individual and family-based therapy services, and some very enjoyable creative opportunities that I’ve had a chance to collaborate on, including film, graphic novels, podcasts, and meditation classes. Lots more to come. Stay tuned. ❤️


Empathy is a Ferrari

LaFerrari Aperta, 4.7 million dollars. Top speed 218. Early Fall, 2017

Her: I wish I wasn’t so empathic. It hurts so much because I see and feel a resemblance of myself whenever I see anyone in pain. I have to do something about fixing them. And I don’t have a routine that works to control it. I don’t have an off switch.

Me: Think of empathy as a high end Ferrari.
It’s absolutely amazing, has a high cost, requires maintenance and care, and very few people have it. Other people notice it and think it’s beautiful. They want to go for a ride, because experiencing empathy feels wonderful, but they may not fully appreciate it or understand it. Empathy is very sensitive and requires skilled handling.

Treatment goals :
– You don’t have to drive 200 mph, even if you can.
– It is OK to avoid curvy cliff roads.
– Ferrari maintenance and care is crucial. Don’t ignore it.
– Watch the gas gauge, because empty happens.
– A high level of driving skill is required and can be practiced.
– It is not the only car in the garage. Because snow and ice.

Mental Health and Our Elders

The Loneliness in Older Persons study, published in 2012 (Journal of the American Medical Association; JAMA), studied 1,600 adults with an average age of 71. The results concluded that among participants who were older than 60 years, loneliness was a predictor of decline and premature death. This study also concluded that loneliness can lead to depression, cognitive impairment, and coronary artery disease.

Harvard Medical School conducted a study in 2015 featuring a similar conclusion; the key to healthy aging unequivocally is relationships. What our aging parents need most from us is our time. It does not matter how many expensive gifts you have delivered to your parent’s doorstep or how many cards you send to their mailbox; what they need most is your presence.

Essentially, a portion of the power is in our hands to increase the longevity of parents’ lives. The importance is not placed on what you do together, but the fact that you are spending time together.

Here are a few reasons why spending quality time with your folks can be good for mental health, theirs and yours.

Make up for the Lost
If either of your parents weren’t around much when you were growing up, there’s no better way to make up for lost time than being there for them as they get older.

Learning Ancestry
Spending time together now allows you to get to know each other more, and you start seeing them in a different light. There is still a lot that you can learn from your parents even once you are an adult, vital life skills and ancestral knowledge and traditions that only a parent can share with their child.

Mend Broken Relationships
Maybe you missed out on a lot of the parent-child relationship because you frequently clashed. Reach out to them; don’t miss out on spending the last few years with your folks because of pride. Past mistakes cannot be undone, but you can patch things up. This does not mean that toxic relationships should be swept under the rug. Not everyone can mend; but for many relationships, it is possible.

The following are simple ideas to alter the scenery for when you visit your parent/parents:
Visit them in their home. If they live by themselves, consider baking them goods to bring over, bringing a delicious treat they would not normally indulge in, or buying magazines or books for them. It’s healthy to have your parent looking forward to something new each day, no matter how small the surprise may be. Novelty pings our brain. It also keeps them in touch with the outside world, if they aren’t able to leave their home often.

If their physical health permits, try a new bakery or restaurant. The idea is to pick a place where you can speak to one another, within a new environment.
Maybe your mother enjoys scrabble. Or your father finds a chess game to be exciting. Engaging in a game is a distraction for themselves, and provides them the outlet to keep on thinking strategically.

Watch one of their favorite films with them. Ask, why is it a favorite?
Cooking their favorite meal for after the movie can be a great way to talk about the movie over food. Positive associations alleviate depression.
Reading your or their favorite books aloud, especially to parents with dementia-related ailments.

Listening to music they loved together. Music is evocative and is a stimulus for memory.

Going through old photo albums with your parent, as you listen to the stories and memories behind each photo. See The Psychology of Nostalgia.

Touch through grooming. Perhaps give them a manicure, brush their hair, put on make up or hand lotion together. The small acts of ADLS can increase connection.

Looking through their letters, files, and memorabilia with them. People save what they value. One patient learned about her mother’s life through shared letters from a lost love: As an individual, not a spouse, mother, or sibling. It was deeply moving for both of them, a peak experience.

Showing them new technology- your parents will always be awed by how far technology has come. And then they will be happy to tell you how such gadgets were not needed to communicate back in the day.

Also see 10 Tips to Support Home Medication Management for Seniors.

On friendship pain

Sometimes it can be hard to tell if a friend’s taking advantage of you, or if you are just being overly sensitive. However, there are some infallible signs to be on the lookout for that will give you answers.

Here are 8 signs that you’re being taken advantage of in a friendship.

1. They don’t listen to you, but always expect you to listen to them.
If your friend expects you to listen to them vent for 20 minutes straight, then they should let you vent to them, too. If you always provide a shoulder to cry on, but they dismiss you or don’t give you their full attention when you have a problem or are feeling down, that’s not a true friendship.

2. They only want to hang out when it’s convenient for them.
If they want your entire schedule to revolve around their appointments or commitments, something is wrong. When making plans in healthy friendships, you should both discuss your schedules and compromise to figure out what dates, activities, and times work best.

3. They’re constantly asking you to do favors for them.
If your friend is sending you out on errands as if you’re suddenly their Personal Assistant, it’s time to reassess the relationship. Sure, friends with healthy relationships will do favors for one another, but if it’s one sided and the person is constantly asking you to go out of your way for them, they’re taking advantage of you.

4. They only reach out when they need help.
This is one of the surefire easiest ways to spot whether someone is taking advantage of you. Does it seem like your friend only hits you up when they need something? It may feel like they’re always needing your help, whether it’s borrowing money, career advice, or “brain picking” with nothing to offer in return, or a place to crash when they’re in town (but they never talk to you regularly throughout the year).

5. They are always making you pay for things.
It’s pretty common for a friend to offer to foot the bill once in a while, and it’s expected that the other friend will get the bill the next time, right? If you notice your friend is conveniently always “missing” when the check comes, they never offer to pay for anything, they’re just taking your money, and it’s definitely time to have a serious talk with them.

6. They’re using you to get ahead.
The sad truth is that a lot of people will use others just to get ahead in life, whether that means to gain popularity in a certain social circle or in a work environment. You don’t have to be rich and famous for people to try to use you and your friendship to their advantage. Manipulative people will keep “friends” just so they can step on you to climb on up to the top.

7. They don’t show interest in your personal life.
Friends care about their friends. Think about it — you want to know how your friends are doing, right? You care about your friends’ well being, how they’re doing, and you’re curious about their daily life. If your friend never asks how you’re doing, doesn’t show interest in your life, and only wants to talk about themselves, you are less than significant.

8. They are not happy for you.
You may have had a major win at work, lost weight, had a great date, or accomplished a personal goal. If they don’t take the time to appreciate your victory, they brush it off or minimize it, or switch the subject to their own life, you do not have a real friend.

Don’t let your “friends” take advantage of you, your kindness, or your time. Your true friends will never want to take too much from you or be manipulative. They genuinely desire your company, through good and bad times. They don’t forget about you when things are going well for them. if you feel like somebody’s taking advantage of you — they are.
Also see Friendships Are Good For Your (Mental and Physical) Health.

When your friends are successful

Best friends – we share life through thick and thin. But what happens when your friend has a major success? Do you feel proud, happy for them… jealous? Even when we love our friends, insidious feelings of unfairness or envy can start creeping in. There are steps you can take so that situational jealousy does not grow into resentment or bitterness.

* Acknowledge your envy
Trying to suppress unwanted thoughts rarely works. In fact, thought suppression can actually increase the frequency of undesired or negative thoughts (Siddique, H.I., Individual Differences in Thought Suppression, 2004). Instead, let yourself feel the feelings.

*Jealousy is a normal emotion.
Feeling jealous does not mean that you’re a terrible friend, it means you are human.

Jealousy can also be a stress response. Make sure that you’re not exhausted, overwhelmed, or anxious. The self-care foundations of nutrition, sleep, and exercise are more important than ever when you have strong feelings. Negative feelings can be significantly exacerbated when you are not in a good place, physically or emotionally.

*It’s not binary
Success is not a limited resource. Just because your friend has a major success, does not mean you will not. In fact, social psychology research shows that when we have friends who have achieved a major success through their efforts, it can be motivating and inspiring for those around them to work on their own endeavors.

*Remember the backstory
No one is on the same timeline.As a friend, you, more than others, know the struggles and challenges they had to overcome to achieve success. What you can learn from them can be valuable in your own endeavors.

*Recognize and honor your vulnerability
Acknowledge that you fear you will be left behind. Many friendships do blossom under times of travail, but that does not mean that they will not continue to grow in good times. Also read What Is Abandonment Anxiety.

*A win for all
What does your friend’s success mean for your community, friend group, the greater good? Chances are, if you are close friends you share similar values and goals. Instead of feeling competitive, realize that you are on the same side. Their achievement moves everyone forward.

*Embrace change
Change involves not just letting go of how things used to be, but looking for new things to build upon together. Your friend may not have the same schedule to just hang out, but you can seek out new ways to remain close. What are some ways that fit for both of you?

*Communicate your needs
If you miss them, let them know. If you are lasting friends, genuineness is already part of the relationship. Not having a dialogue while you have jealous feelings simmering will eventually get in the way of closeness.

On Friendship and Mental Health

Connecting with true friends is one of the best things we can do for our health and happiness. The research unequivocally shows that having true friendships is good for our medical and mental health, decreases stress, helps manage depressive and anxious symptoms, and contributes to overall life satisfaction. Friends help us live longer: Seniors with a strong connection to a network of social support live longer and healthier lives.

Like any powerful relationship, friendships can hurt and harm.

Transactional friendships
Some people are friends with you because of what you can do for them. Red flags include friends who repeatedly try to sell you something, ask to borrow money, ask your help to buy things or services, or keep tabs on favors. These friends routinely cross the line between friendship and business. Unlike business, friendships can emotionally hurt you, because what you regarded as care or love was actually convenience.

Narcissus friendships
This friendship works great, initially, because you have a common factor: you both adore the narcissist. As long as you are both on the same page, aligned on the superiority of one, you get along well.

When needs become mutual, the relationship breaks down. The relationship might also be more subtle — they may love you back when you consistently admire them, and they validate you with heart emojis. In return you get a shot to your self-esteem.

Mutually unhealthy friendships
In 2007, a study in the New England Journal of Medicine tracked the spread of obesity through a “deeply interconnected social network” of more than 12,000 people, underscoring that social ties link to health behavior. Healthy (or unhealthy) habits can circulate within any friend group, too. For instance, unhealthy psychological habits like a tendency to put each other down, self criticize or denigrate, or to complain constantly can spread from friend to friend. Over-eating, substance abuse, and even overworking can become an acceptable and approved part of a friend group.

Emotional labor friendships
This is where you do all the emotional work — talking them down, shoring them up: “Of course you’re amazing. Sure, let’s talk about all the ways you rock. Again. Tell me about your terrible week.“ If you’re doing all the work in the relationship, you’re an employee, not a friend. Of course, over time the balance will shift back and forth — you will inevitably have a major life crisis at the same time your friend gets a promotion or falls in true love, but good friends are there to share in your successes and your struggles. You should feel sure in your friendship; winter, spring, summer, or fall, all you have to do is call.

Historical friendships
Historical friends are those who have stayed in our lives as we’ve grown up, for whatever reason. They are not necessarily the closest friends we have, but they have stood the test of time. These are the friends we usually meet in school. We bond with them and the bond may fade but never disappear. We may meet up with these friends only once in awhile, but when we do, we fall back into the rhythms of the relationship in no time at all. Then after the meeting we all go ou own way until our paths cross again. But historical friends make up a piece of our identity. Lifestyles, interests, and values may have drifted apart, but it’s OK to hold them in your heart without having to force time together.

True friendships
Your “friends of the heart” are the people you can call at two in the morning when you have a problem. They listen to you, give you their full attention, and are on your side no matter what. They know everything, or almost everything, about your life. With them, you feel confident and don’t need to hide your true self because the foundation of your friendship is acceptance.

They make time to be with you. You may disagree, even argue, but neither one of you exits the relationship. They tell you when you have messed up, and pull you up at the same time. Research on friendship indicates that most people generally only have between four and six ‘true’ friends, because friendship requires dedicated commitment, time, communication, and growth.Our brains are only dedicated to a special few people.

Also see:
Nine Reasons Why Cross-Cultural Friendships Are Great for Your Brain
The Ingredients of Friendship

Embolden Psychology

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.