Systemic Therapy Online

Some women are not able to have anything inserted into their vaginas.  This proves to be problematic when they want to have penetrative sex or when they want to have a vaginal exam.   They fear the insertion of anything into their vaginas.  Clinicians and researchers have speculated as to how a woman develops Vaginismus.  Some have stated that Vaginismus originates from a bad sexual experience, which could include anything from watching someone having sex and understanding it as painful, to having a painful sexual experience, to being sexually violated.  Others believe that Vaginismus is due to a lack of communication regarding sexual expectations and realities.  For example, in cultures where it is more of a taboo to talk about sex, Vaginismus is more prevalent.  Still some other researchers argue that relationship factors contribute to the existence of Vaginismus, meaning that the quality of the relationship is something to be considered in the treatment of Vaginismus. 

Although there are a variety of hypothesis regarding the etiology of Vaginismus, most researchers agree that it is important to work on the fear of penetration that women have.  Researchers and clinicians have attempted to treat this fear with the following:

• Talk therapy including exploration of past sexual experiences, sexual values, beliefs, messages in order to create alternate sexual scripts.
• Sensate focused therapy where the focus is taken off penetration and is placed on finding pleasure without penetration.
• Exposure therapy where one is exposed to the fear (penetration) in a slow and progressive manner.
• Couple therapy in order to address the relational dynamics contributing to or maintaining Vaginismus.  Couple therapy would also include addressing the communication regarding sexuality.
• Sexual education regarding pain and pleasure and body mechanics.
• Giving sexual permission to embrace a personal understanding and expression of sexuality.
• Pleasure therapy which include constructing alternate understandings of pleasure and to provide opportunities to incorporate more pleasure into one’s life.

If you fear penetration, there are many treatments that are promising.  However, it is best, as with any other form of sex therapy, to address the issue in a holistic manner where the physical, emotional, cognitive and social influences are simultaneously explored. 

In the end, what matters is not whether you can be penetrated or not, but whether you feel secure and competent with your sexuality.  We tend to focus solely on penetration and not on whether we can feel pleasure.

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I came across this simple therapy technique that anyone can master on their own when feeling emotionally, physically, or spiritually distressed. It is based on the increasingly popular energy based therapeutic approaches. “The principle behind energy work is that universal energies surround us and are available to us for alteration purposes. Energy work is a therapeutic method of deep purification that releases old traumas and fears that limit our natural healing capabilities. Through the process of energy work, our chakras open and relinquish heavy energy blockages. By means of energy work, an individual gains mind clarity, understanding, and hightened awareness, from http://www.holisticjunction.com/categories/MPD/energy-work.html”

Working on your body or through your body to release emotional distresses leads to being more able to focus on what you need and what gives you pleasure. Let me know if it words for you!

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1. Avoid the stressor, learn to say no, avoid people and situations which stress you out.
2. Alter the stressor by expressing your feelings, compromising, being more assertive, better time management.
3. Change your reaction by adapting to the stressor, by changing your attitude and understanding of it (look for positive instead of negative), adjust your standards.
4. Accept the stressor by accepting things you cannot change,
   don’t try to control the uncontrollable, let go of control.
5. Make time for relaxation and fun
6. Start relaxation routines

Sources:

http://www.medicinenet.com/stress/page10.htm; www.stress.org; http://helpguide.org/mental/eq2_managing_stress_relationships.htm

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• Death
• Divorce
• Marriage separation
• Incarceration
• Injury or illness
• Marriage
• Job Loss
• Marriage reconciliation
• Retirement
• Poverty
• Discrimination

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• What is Stress?
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Answer these questions to help you measure how in control you are of your stress

1. Do you notice when you are stressed?
2. Do you know what things or people stress you out?
3. When you feel stressed, do you know how to soothe yourself?
4. Do you go to other people to help with the stress?
5. Even after a stressful day, can you go home and relax?
6. If you are feeling exhausted do you know what to do to feel more energized?

Sources:

http://www.medicinenet.com/stress/page10.htm; www.stress.org; http://helpguide.org/mental/eq2_managing_stress_relationships.htm

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Our knowledge regarding what happens to the body when it is distressed is continuously evolving, but researchers have identified some characteristics and processes of stress. The body’s response to stress takes place in the pituitary gland and the hypothalamus. Nerve circuits are involved in this response as they “increase arousal, focuses attention, inhibits feelings and reproductive behavior, reduces pain perception, and redirects behavior”

Job Stress

Researchers have found that “job stress is far and away the major source of stress for American adults and that it has escalated progressively over the past few decades .” Studies state that “80% of workers feel stress on the job and nearly half say they need help in learning how to manage stress”. Americans increase their working hours on an average of 8% per generation to an average of 47 hours per week. “Americans now work almost a month more than the Japanese and three months more than Germans.”

If you would like to measure the amount of job stress you are, fill out this questionnaire.

Stress Signs

Our reactions to stress can be physical, emotional, cognitive and/or social. For example, we can experience chest pain, headaches (physical); depression, anxiety (emotional); lack of concentration (cognitive); or isolation (social). Before reading on, understand that these reactions can be caused by other emotional and physical factors other than stress.

When we experience distressing reactions to stress, it creates more stress on the body and mind, which in turn creates even more stress, creating a vicious cycle.

Sources:

http://www.medicinenet.com/stress/page10.htm; www.stress.org; http://helpguide.org/mental/eq2_managing_stress_relationships.htm

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 Stress is the body’s way of making sure that it is kept safe. Stress is a positive thing when it protects us from harm. If we are being threatened by our surroundings (job, relationships, economic and political circumstances, etc), stress enables our bodies to move into action. If you are being persecuted, for example, your body goes into a stressful mode in order to make it move quickly out of danger.

Our abilities to handle stress are determined by our physical, emotional, cognitive, and social resources. For example, how well we are doing physically (e.g. nutrition, rest, exercise, etc.) will contribute to how well we handle stress.

Stress becomes a bad thing when we feel that it distresses us, or limits our well-being. We cannot determine what or how much of a stress will be distressing for people; everyone has their own definition of what is distressing. Two people can experience the same job stress, for example, but only one person may experience distress. Likewise, one person may find that the stress of a deadline is exhilarating, while another finds it debilitating. In other words, how much stress we need or want in our lives is very personal and subjective.

Stress can be good for in short time frames, but may become bad after long periods of time. In other words, stress is beneficial up to a certain point in time and then it becomes bad. For example, some deadlines at work are beneficial in order to make our bodies do the work, but a prolonged state of deadlines or an excessive amount of deadlines can be detrimental to our well-being. Researchers have reported that “stress of long duration (chronic stress) sensitizes the stress system (makes it more responsive to stress). That is, the system then over responds to new stressors. They also have reported that the administration of certain drugs, such as amphetamines or cocaine, could also sensitize the stress response ”

Sources:

http://www.medicinenet.com/stress/page10.htm; www.stress.org; http://helpguide.org/mental/eq2_managing_stress_relationships.htm

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Dr. Sapolski talks about the importance of grooming someone and someone grooming you in the battle against stress.

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There has been a flury of news in the last couple of days regarding a new study that came out in October, 2009 regarding the benefits of eating dark chocolate for managing stress.  The reports describe a study that concluded that the ingestion of dark chocolate helps to decrease stress.  I like to see the original journal articles, so I searched for it and was amazed by the first thing that I read.  The study was sponsored by Nestle!  I really wanted to have an excuse to eat chocolate, but I have to wonder as to the intentions of a study sponsored by a chocolate manufacturer.  I was disheartened until I thought of a way to have an excuse to each chocolate, regardless.

The alternative is to forget about how the chemicals in chocolate can reduce or not the stress in our lives and to embrace the pleasure of eating chocolate.  It makes sense that engaging in pleasurable activities, be it chocolate eating or something else, will reduce stress.  The more pleasure I have in my life, the less stressful it will be.  Maybe someone should research that correlation.  Having stated that, I am on my way to find me some chocolate!

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Some people eat more when they are stressed, while others eat less.  However, according to a study conducted at the University of California-San Francisco, those under chronic stress report more often eating fatty foods to relieve stress .  Reports such as these make a lot of sense if we understand the connection between body and mind.  However, the effects of stress are also influenced by other things such as worldview, culture, and historical time.  A group of people may face the same stressors, but will be influenced, mind and body, differently depending on what they believe about the stressor.  If they believe the stressor to be unimportant, then the stressor will not affect them.  If they believe that the stressor is somehow important given a greater goal in life, then the stressor will not affect them in the same way as someone who gives the stressor importance to how their life will unfold.  What I am saying is that stress is part of life and only becomes hurtful when our minds, given our goals, priorities, approaches make it be extraordinary.  I’ll always remember the day I spoke with a woman whose child died as a result of the fighting between her husband and herself.  I asked her if she was devastated, and she replied that she was not because the death had to occur for the violence to stop.  Now, for you and me, this may be convoluted thinking, but for her it relieved her of the stress and emotional distress that occurs from the death of a child.

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A study has validated the use of aromatherapy in the management of stress.  This study tested the effects of lemon essential oil on both physical and psychological stress.  They found that the particular components of lemon essential oil do indeed aid in the management of stress.

Fukumoto, et al. (2007).  Effect of flavor components in lemon essential oil on physical or psychological stress.  Stress and Health, 24(1), 3-12.  

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Small everyday stressors, or hassles, impact our emotional well-being.  Hassles are defined as ‘irritating, frustrating, distressing demands that to some degree characterize everyday transactions with the environment.’  Examples include getting cut off in traffic, standing in line, having an argument with a bank teller, etc.  Studies have shown that these everyday and seemingly benign stressors, are sometimes even more harmful than major stressors such as death of a family member.  Hassles that are experienced as a result of relating to another person are shown to be more stressful than hassles not involving human interaction.  Everyone has their own ideas as to what experiences are considered to be hassles.  Someone may think that commuting is a hassle, while another may find it relaxing.  In the referenced study, results showed that the “for all types of hassles, the amount of negative emotions that a hassle evokes is the strongest predictor of stress.”   In conclusion, it may not be about the type of stress we experience, but rather how we make sense of that stress, or how we experience the stress emotionally. 

McIntyre, K., Korn, J., Matsuo, H. (2008).  Sweating the small stuff:  How different types of hassles result in the experience of stress.  Stress and Health,  24(5), 383-392.

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The Journal of International Society for the Investigation of Stress reported research results indicating that high stress levels lead to night time eating, or NES (Night Eating Syndrome).  The article stated that stress leads to night time eating because we use “bad” coping strategies when experiencing stress.  Some “bad” coping strategies may include avoidant rather than active problem solving, or focusing on solutions rather than the problem.  Another study showed that for unemployment stress, for example, solution focused coping would include applying for more jobs, learning new skills and problem focused coping would include taking out a loan, joining a group of fellow unemployed workers.  In other words, the study is not stating that stress in itself leads to night time eating but that stress with the combination of maladaptive coping strategies leads to night time eating.  Hence, it is not the fact that we have stress in our lives that leads to night time eating, but rather that we are not coping with the stress in positive ways.  These results shed light on why college students gain so much weight.  These findings can help us increase our awareness regarding our night time eating habits and its relationship to stress.   In addition, if we have stress in our lives that is affecting our eating habits, we may want to learn to handle the stress more effectively by using “good” coping strategies such as facing the problem and finding solutions.

Wichianson, J., Bughi, S., Unger, S., Sprunijt-Metz, D., Nguyen-Rodgriguez, S. (2009).  Percevied stress, coping and night-eating in college students.  Stress and Health:  Journal of International Society for the Investigation of Stress, 25(3), 235-240.

Bennett, N., Martin, C., Bies, R., Brockner, J. (1995).  Coping with a layoff:  a longitudinal study of victims.  Journal of Management, Nov-Dec.

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Most victims of domestic violence find it hard to decide to leave their abusers because their partners are not always abusive and are at times caring and loving. This is what some people refer to as the cycle of violence. The cycle of violence starts with a honeymoon phase where the barterer is sweet, charming, and loving.  The cycle moves into a phase where the barterer starts to build tension and the victim does everything she can to keep her partner from exploding, but the cycle turns into just that, explosion. After the explosion (the abuse), the perpetrator comes back to make up with his victim and the violence starts all over again.

The cycle of violence involves an element of time restructuring, meaning that the time between the honeymoon and the explosion become shorter and shorter the longer the relationship lasts. At first the barterer presents as very charming, loving, and totally dedicated all of the time.  Many times the relationship with the barterer at the beginning is described as passionate, intense, and fast. Most often, the barterer gives his all and makes a commitment quickly.

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The Psychoanalysts believe sexual abuse happens because children want to have sex with their parents. Some of the myths behind this explanation are that women cry about rape, children lie about incest, children are sexually provocative, incest is not harmful, and mothers collude with the perpetrator.

The Victim Precipitation Approach states that women ask for it. Myths for this approach include that only young, stereotypcally attractive women are raped, and that women can avoid being raped by not walking on the streets, choosing different clothing, etc.

Others believe, that sexual abuse is a family dysfunction; that it only occurs because a family is dysfunctional. This is yet another myth. Finally, the psychological approach believes that men who abuse cannot control their sexual urges. This is also a myth or a belief that can be contested.

The truth is that sexual abuse occurs when there is a great difference in power, where the perpetrator has more power than the victim. This power may be physical, monetary, social, legal, etc. It is believed by others that sexual abuse occurs because we are socialized into particular ways to be a man, where male dominance and parent dominance reign; that our system is set up to support and encourage this domination and rarely is truly complicit with the victim.

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What happens after sexual abuse depends on many things. Some of the things it depends on are the length of the abuse, the intensity and frequency of abuse, and the use of force. However, the major determinant for the severity in the consequences to sexual abuse are how those who are close to the victim respond to the disclosure. If family and friends do not believe that the abuse occurred, as is frequent, the victim will fare worse. There are things that will help to overcome sexual abuse, aside from support from family and friends, such as the resiliency of the individual, the age of the victim, the perpetrator’s confession of the abuse, a mentor or supportive environment. Some of the symptoms and effects of sexual abuse include the following:

Dissociative experiences
Suicidality
Sexual problems
Self-destructiveness
Difficulties in intimate relationships
Hopelessness
Using or abusing of substances
PTSD symptoms (anxiety, depression, nightmares, flashbacks, hypervigilance)
Eating disorders
Personality disorders
Sexually risky behaviors
Sexualized behaviors
Agression

It is important to understand that these behaviors or experiences are functional to the victim while the abuse is happening and after the abuse has ceased. These behaviors protect the victim from being killed physically and emotionally devastated. It also protects them from being further abused. For example, dissociation is a way to remove the person from the body as it is abused; The soul is saved while the body is taken.

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There are many different ways to treat sexual abuse. The important thing to understand is that it is a difficult process and recalling the abuse can be re-traumatizing. A key consideration is choosing carefully who you will involve in your recovery. Most often it is good to find a therapist, but it needs to be a therapist who understands and knows a lot about sexual abuse as well as a therapist who you feel you can trust and who can nurture your process. Don’t let anyone tell you that it is crucial that you remember or retell the abuse, that is not true. It often helps, but is not necessary, especially if you do not feel you want to or can do so. Groups are also a good way to approach healing as they consist of many other women who are sexual abuse survivors. Some ideas on treatment which have not been explored in great detail are body centered work. I believe this is an effective way to treat the frequent dissociation that is felt from the body in sexual abuse survivors.

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Sexual abuse can be many things that are not merely penatration such as sexual discrimination, marriage rape, sexual favors, unwanted touch, unintentional touch, sexual comments, etc. The important thing to remember is that most often sexual abuse involves some form of power over the victim. Sexual abuse happens because the offender has power over the victim. This power can be monetary, legal, emotional, etc. Sexual abuse also involves some form of deception and breaking of trust.

Sexual abuse is very common and is experiened by 1 out of 3 women. Although sexual abuse is common, most of it is not reported (less than 10%) to the legal authorities and if reported, most are unsubstantiated. The lack of reporting is most likely due to the fact that most sexual abuse acts go unpunished and because the laws do not protect the victim. Most of the time, victims have to prove that they have been abused and are often considered to be “making stories up”. This is especially the case when it comes to perpetrators that do not fit the stereotype of “creepy outlaws.” In the case of child abuse, the majority of the perpetrators are people whom the victim knows and trusts.

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The chart below shows some ways in which children are affected by domestic violence.

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• Domestic Violence

Does your partner… 

1. Constantly criticize
2. Ignore or interrupt often
3. Call names
4. Swear
5. Humiliate
6. Make the you ask permission to spend money
7. Prevent you from going to work, school
8. Display extreme jealousy
9. Yell or scream often
10. Frighten you
11. Drive recklessly on purpose
12. Threaten suicide
13. Threaten with violence
14. Throw things
15. Break objects
16. Punch walls
17. Break doors or windows
18. Destroy valued possessions
19. Threaten to hurt pets
20. Hurt pets
21. Push you
22. Restrain you
23. Hit you with hands
24. Punch you
25. Slap you
26. Hit you with objects
27. Kick you
28. Grab you by the throat
29. Choke you
30. Burn you
31. Cut you
32. Threaten with a weapon
33. Use a weapon
34. Has the abusive partner ever been arrested for assault?
35. Make you have sex when you did not want to
36. Pressured you to have sex or to do things sexually that embarrassed or offended you
37. Forced you to perform humiliating or bizarre sexual acts to prove love
38. Used physical force or the threat of force to have sex

Answering these questions and talking to your friends, family, or a professional will help you. Remember that you must feel safe in talking and do not do so unless you are safe.

If you need to speak to someone you can call the domestic violence hotline. They will help you get the help you need.

1.800.799.SAFE (7233) 1.800.787.3224 (TTY)
Anonymous & Confidential Help 24/7

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• Domestic Violence

The first question that comes to mind regarding domestic violence is, “Why doesn’t she leave?” The reality is that women attempt to leave many times, usually 7 times before she can actually rid herself of her perpetrator. We must remember that a person experiencing domestic violence is terrorized by her partner. Many times the threat of death is real. Women know that they cannot count on the legal process to protect them and leaving can endanger them, and even lead to death.

Victims are made to believe that the violence is their fault and that if they could only change, their partner would not batter. But, batterers abuse regardless of what their partner does. He will find a way to exert his power, regardless of what his partner does or does not do. Battering is a choice. What’s more, domestic violence victims want to keep their family together because the media in our country has hammered in the idea that children will be damaged by separation from their fathers.

Lastly, the victim feels an emotional attachment to the perpetrator because the man who is abusive is also tender, kind, and attentive. The woman is faced with two different men, one that is abuse and one that is kind.  When our partners are kind, we want to believe that the abuse was a mistake, that it won’t happen again.

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Domestic violence is common in the world. In the United States 1 out of 3 women experience some form of domestic violence. 50-65% of clients wanting therapy report some form of domestic violence. Domestic violence is about power and control, meaning that the motivation for violence is power and control.

Physical Abuse includes scratching, pushing, shoving, throwing, grabbing, biting, choking, shaking, slapping, punching, burning, use of weapon, and the use of restraints against another person.

Sexual Abuse includes marital rape, forcing sexual contact, and sexual contact without consent.

Psychological Abuse includes constant criticism, name-calling, damaging one’s relationship with one’s children, undermining one’s sense of self-worth, and humiliating.

Economic Abuse includes total control over financial resources, withholding one’s access to money, and forbidding employment.

As you can see, there are many types of violence that are not what is typically thought of  but are nevertheless damaging, dangerous, and devastating. Domestic violence renders the victim to isolation and fear. Most of us think that domestic violence occurs to only certain types of people, but the reality is that it cuts across all social and economic domains.  Many incidents of domestic violence remain unreported due to the inadequacy of the legal structure to protect the victim and the fear that the victim feels.

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