What Do YOU Think About It All?

One of my favorite holidays is New Year’s Day.  It’s a contemplative, peaceful  day for me, and I typically spend time reviewing the past year, and setting my intentions for the new year.  This year I’ve been thinking a lot about the quote “Other people’s thoughts are not your business”, ascribed to everyone from the Buddha to Marcus Aurelius to Lisa Nichols, Regina Brett, and Steve Harvey to name just a few!   

Regardless of the original source, there is wisdom in this concept. From a cognitive-behavioral perspective, one of the reasons it holds up is because other people don’t have “all of the data” included in your life and decisions, so how can they accurately judge your situation at any given moment? And with the hundreds of people we encounter in the world each year, there are just too many people we encounter to give each of them that kind of influence. We simply can’t afford our perspective to be pulled in every direction possible by someone else’s thoughts or perspective.

And I don't know about you, but the opposite is also true: I wouldn't want all of MY thoughts to be made other people's business arbitrarily!   

People pleasing is one of the ways we make other people's thoughts our business.  At its  core, people pleasing simply means “I let go of my center, needs, and  perspective in service of what I assume are your needs and perspective”. The motivations for people pleasing can range from hoping other people will like us or take care of us more if we please them, to misperceiving people pleasing as a form of true caretaking.   But regardless of the motivation, excessive people pleasing ultimately becomes an impossible task because frankly, there are simply too many people to please them all.  And most importantly, people pleasing pulls us off of focus because we are no longer paying attention to our own perspective, needs, and values. In this way, people pleasing disrupts intimacy as it prevents others from actually knowing us.

One of my intentions for 2024 is to not expend ANY energy on mind reading or adjusting to people’s unexpressed thoughts, concerns, or opinions.  That doesn’t mean I won’t consider other people’s expressed opinions, with the caveat that they come from someone who has earned my trust. But in order to take better emotional care of myself in 2024, I will remind myself daily that other people’s thoughts are truly none of my business.  

Hidden In Plain Sight: The Female ADHD Experience

Between 2020 and 2022, the population of adult women diagnosed with ADHD nearly doubled.  Often considered a “boys disorder,” girls are significantly less likely than boys to be diagnosed with ADHD. But this is by no means saying there is a lower prevalence of attention disorder in girls or women. Instead, girls with ADHD tend to present differently than boys and teachers and practitioners often overlook their symptoms. 

From a young age, women face difficulties receiving a diagnosis of ADHD. Disorders that go hand-in-hand with ADHD in girls, like anxiety and depression, can overshadow ADHD symptoms and lead physicians to misdiagnose their young female patients. Inward behaviors, like inattentiveness, are more common in girls with ADHD than outward behaviors, such as hyperactivity. In the classroom, hyperactive boys are noticed and dealt with by teachers, while inattentive female students remain ignored because their behavior is manageable. As a result, women learn strategic coping skills for their ADHD throughout their lives, further mitigating the external appearance of their disorder. Researchers Arcia and Conners (1998) determined that the self-perception of adult women with ADHD is poorer than that of men with ADHD or women without an ADHD diagnosis.  Learn more

Studies have shown differences in dopamine release, cognitive function, and sensation seeking between men and women in response to stimulant drugs like amphetamine, often used to treat ADHD (Quinn & Madhoo, 2014). The effects of amphetamine in women vary based on their menstrual cycle, with greater euphoric and stimulating effects observed during the follicular phase, when estrogen levels are higher, compared to the luteal phase. This research suggests that the response to ADHD medications might need to be adjusted throughout the menstrual cycle for better symptom control for women.

Cognitive therapy can be a helpful tool in your ADHD arsenal. Some cognitive therapists specialize in working behaviorally with clients to improve executive functioning skills which may be helpful for aspects of ADHD. While we here at CTWPS do not specialize in executive functioning coaching, we do support our clients in managing the anxiety and isolation that often surrounds their ADHD experience.  If that is something that you’d like to explore more in depth, reach out to us to learn more!

References

Arcia, E., & Conners, K. C. (1998). Gender Differences in ADHD? Journal of Developmental & Behavioral Pediatrics, 19(2), 77. https://journals.lww.com/jrnldbp/Abstract/1998/04000/Gender_Differences_in_ADHD_.3.aspx

Quinn, P. O., & Madhoo, M. (2014). A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls. The Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/pcc.13r01596

Russell, J., Franklin, B., Piff, A., Allen, S., & Barkley , E. (2023). Number of ADHD Patients Rising, Especially Among Women. Epic Research.

The Awkwardness of Authenticity

When we try something new in front of other people, we tend to worry about judgment or other negative consequences. And we tend to feel awkward because the experience between us is novel and unpracticed.  But the feeling of awkwardness doesn’t mean we actually are awkward (thankfully!).  But feeling awkward typically goes hand in hand with feeling vulnerable. 

We are often unaware that feeling awkward and taking emotional risks in front of other people eases them.  

Why? Because vulnerability cues other people that your communication is authentic and sincere.  It also cues other people that they too could be awkward, vulnerable, and authentic in safety.  That they too can try something new in front of others. 

No one can authentically connect with others without some vulnerability. If you have a hard time believing this, consider whether you have ever felt safely connected to someone who never displayed at least some vulnerability with you.

So even when it might feel initially awkward for you,  it might be time to reframe vulnerability and awkwardness as the necessary starter ingredients for authentic connection. 

Motherfectionism

Motherfectionism:  the cultural and intrapsychic insistence that mothers be perfect vessels of love and nurturance; responsible for, and in control of, all aspects of her child’s behavior and outcome.  

OK, so I made up my own word.  But it’s probably about time because it describes a process mothers often experience, and that I am witness to in my private practice and personal life. There are more examples of motherfectionism than I can count because women still bear the lion’s share of the emotional, logistic, and physical labor of parenting. And any form of perfectionism is first and foremost a coping strategy. 

Why am I framing the challenges of motherhood through this lens? Because I believe that our role as women’s mental health psychologists is to consciously not reinforce perfectionistic, unrealistic standards for mothers.  Indeed, there is a whole parenting advice industry that serves to replicate these standards, replete with two minute TikToks of confident, easy wins with our kids. I can’t tell you how many therapy sessions I have shared with mothers who feel confusion and shame in their parenting in the reflective glare of TikTok advice.

I believe our role as women’s mental health psychologists is to acknowledge the complexity of parenting,  and to shore up resilience within our female clientele for the emotional and pragmatic complexities - and labor - of motherhood. While we can offer parenting advice if needed, our job is to support you with all the flexibility and creativity that parenting requires.  Just like we do with every other important area in your life.

Schemas of aging: how they might actually impact how we age

If I were to say “close your eyes and picture a college dorm,” what image would your mind paint for you? You’d probably visualize a pretty nondescript room with twin beds, posters on the wall, a desk with a computer sitting on it, etc. But what if I were to say “close your eyes and picture a person in middle age.” Or, “picture a person in their 70s.” Now what do you see?

For a lot of us, thinking about aging usually evokes images and beliefs related to loss. Loss of mobility, health, beauty, or of feeling care-free. These beliefs and images are called “schemas,” and they can have a very powerful impact on how we move through life. Sometimes these schemas can be useful; like when my dorm room schema pops in my head and reminds me to buy the right sized sheets before move-in day, for instance.  

But what effects might these loss-heavy age-related schemas be having on us? Well, as Dr. Becca Levy details in her book “Breaking the Age Code,” research shows a significant relationship between such schemas and medical illnesses like high blood pressure, Alzheimer’s dementia, and heart disease (to name just a few). Simply put, those who endorsed more fatalistic beliefs about aging were statistically much more likely to experience actual health problems in older age.

In contrast, Dr. Levy found that those with more favorable attitudes towards aging were also more likely to recover from disability at a quicker rate, have better memory performance, and yes, even live longer. In other words, these individuals are living a self-fulfilling prophecy that is actually fulfilling!

How did they do it, you ask? According to Dr. Levy, this process involves three stages:

1. Developing a greater awareness of harmful aging schemas- as they exist in both ourselves and in our external environments.

2. Tracing these schemas to their original source: a society that conditions us to fear aging as a means of profit. ($75 wrinkle cream, anyone?)

3. Disrupting and replacing these beliefs the moment they pop into our heads

If this process sounds familiar to you, you might either already be a patient at CTW, or at the very least have read some of our previous blog entries. Because what Dr. Levy describes here is at the very heart of the work we do in our therapy sessions. 

Together with our patients, CTW psychologists take time to unearth these schemas, explore their roots, and examine the vines they have grown. And if they are found to be the viscous, choking kind, we then work to apply some cognitive “weed killer,” so to speak. We attack them with relevant information (e.g., that it is possible to remain healthy and active as an older adult) and plant more nourishing beliefs (e.g., “being alive for longer gives me more time to explore the world and discover exciting new things about it”) in their place.

Just like actual weeds, these schemas of ours are often pesky and persistent. They sprout easily, demand regular intervention, and are impossible to prevent entirely. But that is no reason to let them grow wild and literally strangle the life out of an otherwise thriving existence. So if you are one of the many people out there who struggle to imagine themselves flourishing with age, perhaps this is your sign to get back in the garden and start digging.

You don’t have to do it alone, either. We are here to help. Contact us today to get started!

The CTWPS Commitment to Women*: Talking about hormones, periods and the full female experience

The CTWPS practice has always been dedicated to addressing the specific mental health needs of women. Our clinicians are passionate about the need for increased understanding of, and compassion for the particular biological, psychological and socio-cultural experiences of women. In our psychotherapy work, we often support women in developing greater insight around the ways in which their womanhood impacts their thoughts, feelings and behavior on a daily basis; and ultimately, how aspects of their womanhood influences their mental health. 

Given my exposure to many women at many different stages of life (e.g. perinatally, postpartum, premenopausal, menopausal) ,over the years, I have developed a wealth of clinical experience that continuously reinforces my belief that there can be close ties between a woman’s reproductive cycle and her mental state. This is not to say that every woman experiences the same fluctuations in mood and mental state at similar points in the reproductive cycle; but simply, each woman responds to the rise and fall of estrogen and progesterone in her body at different points throughout her cycle, to differing degrees, in different ways. Furthermore, the multitude of changes I have observed and tracked with my patients over time are not limited only to the days leading up one’s menstrual period, as popular culture’s interpretation of “PMS” might suggest. A woman’s body, mind and mood is truly influenced by fluctuating hormones throughout the full reproductive cycle - all month long, month after month. Notably and thankfully, these hormonal fluctuations do not always have a negative impact on life! In fact, some women report feeling energized, experiencing greater clarity of thought, and having increased libido at certain points of their cycle. 

Just as I have become more convinced of how tightly woven reproductive hormones are in women’s daily lives, I have also become increasingly aware of how infrequently this topic is brought into the therapy room. As normal as it is, menstruation is, and always has been, stigmatized around the world. Historically, menarche and menstruation has symbolized religious impurity and contamination, been linked to witchcraft and evil, and been blamed as the cause of hysteria, disease and disorder. Unfortunately, to this day, playful words, disparaging metaphors and misogynistic themes persist when describing menstruation, (if it is mentioned at all). These tendencies undoubtedly perpetuate the embarrassment, shame and discomfort many women continue to feel about their body and its functions.

Thus, I and my colleagues at CTWPS make it our business to (gently!) inquire about the menstrual cycle with each of our female clients. We encourage exploration of how each woman experiences her cycle, and actively support the destigmatization of these topics. We help women track and assess changes in their mental state, mood and functioning alongside their monthly cycle, in order to better understand when interventions might be most beneficial to alleviate the negative impact of reproductive hormones. We assist women in developing (and following through with) plans for making lifestyle changes and/or medication changes to address difficulties they experience at different points in their cycle. And of course, we continuously educate our clients (male and female alike!), about the role of reproductive hormones in women’s lives, to encourage increased awareness, understanding and compassion for the full range of female experience.

As a female-focused psychotherapy practice, CTWPS is committed to honoring all that it means to be a woman in today’s world. If you or anyone you know would benefit from our expertise treating menstrually-related mood disorders (e.g. PMS, PMDD, Perimenopausal Depression) or mood disorders that tend to be exacerbated by hormonal fluctuations (e.g. depression, anxiety, OCD, and insomnia for example), please reach out to schedule a consultation. 

* A note about inclusivity: The aforementioned writing uses terms such as “woman” and “female” to reference individuals whose biological sex assigned at birth is female, and who possess female reproductive organs. We acknowledge that some cisgender women don’t have periods due to menopause, stress, disease or a hysterectomy. They may have never started menstruating due to a variety of medical conditions or they may be transgender or intersex. We also acknowledge there are people who menstruate who aren’t cisgender women. They might be trans men, intersex, genderqueer or nonbinary.