Dr. Roher Psychotherapy – Blog

“I feel depressed today.” We have all said this, at one time or another of our lives, or heard someone say it. But, what is depression? And, is there one form of depression or are there many?

Feeling blue and suffering from clinical depression are two very different things.

Clinical depression is a condition that affects our moods (we feel down most of the time; we have a bleak outlook of our future, we are not excited about anything, even things we used to enjoy) our thoughts  (we tend to ruminate on the same, negative things, we cannot concentrate, we have difficulties making decisions) our behaviors (we find it difficult to be with people, we are not interested in anything) and our body (we may eat too much or too little; sleep too much or too little; have no energy, no libido, we feel tired most of the time even though we don’t do anything to explain it.)

Mental health professionals differentiate between various forms of clinical depression: Major Depression, Low grade, chronic depression, or Dysthymia, Bipolar Disorder and Adjustment Disorder with Depression. Each of them may be have specific treatments and may have different causes: situational, genetic, histories of trauma, and medical problems.  

According to figures from the National Institute of Mental Health, about 20.9 million people in this country suffer from one form or another of clinical depression. This means 9.5% of all Americans age 18 or older suffer from depression! This is a staggering figure, and seems to be increasing. Major depressive disorder is the major leading cause of disability for ages 15-44, striking people in their most productive years. Of course, depression does not affect only people’s ability to work, but also their social interactions and family lives, disrupting not only those who are depressed, but also people around them. Additionally, depressed people may have other problems as well, such as substance abuse, anxiety, and various medical conditions which may have been the cause or caused by the depression, or are co-occurring with it. Women are twice as vulnerable to depression as men.

According to www.psychologyinfo.com, nearly two-thirds of depressed people do not get proper treatment. There are several reasons why this is so, but I will mention only two here:

1. Symptoms of depression do not develop overnight, but creep up gradually and at first unnoticeably, so people often do not realize they are depressed until they are in a lot of pain and unable to function as they previously did. And even then they may think there is something wrong with them physically, or blame their job, family situation, or other reasons for their symptoms.

2. There is still social stigma about depression. Some people, particularly men, may equate depression with weakness and failure, so they may resist acknowledging their symptoms for what they are and seek help.

What can be done?

The two most used forms of treatment are:

Psychotherapy. Providing support can reduce social and emotional isolation, reduce fears and hopelessness and helplessness and ease the pain. Also it helps reduce pessimistic thoughts and it facilitates the development of positive life goals. Furthermore, it helps assess which areas in a person’s life may be contributing to the maintenance of negative feelings and stress and change them. 70-80% of people in therapy report improvement in 20-30 sessions.

Medication. There are many medications on the market today. You may want to consult with your family doctor or see a psychiatrist to discuss which one may be appropriate to alleviate your symptoms.

There are also things you can do to help yourself: do not see depression as a reflection of who you are. There should be no shame about suffering from depression. Depression affects people of all ages, educational and socio-economic backgrounds. Do not blame yourself. Examine what is going on in your life and make appropriate changes. Exercise, even if you don’t feel like it. Be with other people, even if you want to be left alone. And give it time, as recovery from depression does not happen overnight, but over time. Focus on what makes you feel better and stick to it.

Above all, remember that there is light at the end of the tunnel, even if you don’t see it when you are in the tunnel.

Tags: manage stress, psychotherapy

Just added another post in the “Marriage Story” tab above. Make sure you read it and tell your friends! You are witnessing the writing of a book in progress!

Feel free to make a comment about it by clicking on the comment button below.

Tags: Dr. Roher, relationships

I have decided to give my readers an extra treat on this blog! If you look up at the navigation button at the top of this blog, click on “A Marriage Story.”

I am about to begin a mulitple post “journey” of a recently married couple, Paul and Francesca. We are going to post each week for a total of 52 weeks on this blog.

Please come back often to visit and see how this wonderful story unfolds. I don’t want to spoil the storyline, but I want to tell you that you will thoroughly enjoy it!

Tags: Dr. Roher, relationships

Almost 50% of affairs for women occur with co-workers and more than 60% of affairs for men begin in the office. This is a clear indication that it is people in our daily lives that ignite passion and create situations where lust can be experienced, even if people do not realize what is happening until much later.

More recently, online affairs have become as popular as office affairs, as virtual proximity and accessibility substitutes for physical proximity and daily interactions. We have already discussed the characteristics of online affairs, so here we focus on real time infidelity.

An office co-worker can become attractive for different reasons. These reasons can occur concurrently or individually. The following are some of the most common:

• The friendly ear;

A person can become the friendly ear that listens and empathizes with one’s stories of dissatisfactions and unhappiness. He or she seems to be available when needed, with unlimited patience, interest and empathy. It becomes comforting to get together and support each other. From here, the relationship can grow and morph into something more personal, more special and intimate. 

• The unexpected;

At times at the beginning of an affair neither person plans to get deeply emotionally entangled with one another, but this happens gradually, almost unnoticed. Intimacy develops with increased sharing, a sense of being understood, valued and appreciated. The step from being friends to being lovers is often quite short.

• The sexual allure;

At times a person is seen as sexually attractive and alluring from the very beginning. When this person is around, there is an electricity in the room that cannot be ignored. Thoughts about that person start to creep up even when he or she is not around. Obsessive thinking and fantasizing develop, with increasing intensity and frequency. If the other person responds to this attraction, an affair develops and blooms. This relationship may evolve into a deeper one or remain exclusively sexual. If it remains strictly sexual, typically is short-lived.

• The soul mate;

Often this is the evolution of the friendly year scenario we discussed before. As the couple gets to know each other more intimately, they discover they think the same, they like the same things, they have similar goals and views of life. They seem to be on the same wavelength, so there is little need for words to communicate to one another. This relationship can become sexual, but does not have to in order to become powerfully attractive and highly emotional for both people involved.

• The attraction of youth;

For someone who is reaching middle or late middle age and sees his or her looks change, the allure of a younger person can be quite powerful. These types of relationships typically don’t last for a long time, as differences in age and being at different points in life create a wedge that later on affects the relationship, often dooming it.

• The High School sweetheart;

People look up old friends on line of see them at reunions. These are friends from a time in their lives that felt good, pregnant with possibilities and the whole future still in front of them. When people reconnect, old feelings are at times rekindled. Couples feel they already know each other quite intimately, even if they have not seen each other for over thirty years. This feeling of familiarity provides comfort and encourages trust. Often, when old High school or College sweethearts see each other again, they don’t see who they are today but who they used to be. This experience seems to occur in a time warp, catapulting the people involved to earlier and happier times. It is the wish to recapture this time and the feelings associated to it that makes these relationships bonding because they have deep roots and very intense emotions and enduring.

Can you think of other scenarios that reflect common coupling in affairs? Please share your thoughts and views by clicking on the comments button below.

Tags: Dr. Roher, psychotherapy, relationships

Valentine’s Day, February 14^th, is a celebration of lovers. But, if we go beyond the commercialization of this day, with red roses, fancy dinners and pajama-grams, we can see a deeper, more significant meaning to this day.

Valentine was a bishop who married Romans in secret, celebrating their love for one another, at a time when marriage was forbidden by law. When arrested by the same Roman emperor who had forbidden marriages because he believed they did not allowed men to be valiant soldiers, he chose to die rather than change his views on love. In addition, while in jail he fell in love with his jailer’s daughter and, just before his execution, sent her a “Valentine Note.”

The message we derive from these historical events is: love counts, love needs to be acknowledged, cherished and celebrated. Two thousand years later, we are still acknowledging this day and the person who started it, because we still believes that love counts and is worth celebrating. 

What does this day mean to you?

I hope not only another time to buy a gift and make reservations to a nice restaurant, and nothing more.

I encourage you to go beyond these formalities, and think of ways in which you want to let your loved one know how much he or she means to you.

Valentine’s Day is, in fact, a day of acknowledgment and appreciation. We often don’t let people we love know how much we appreciate who they are, what they do for us, how they make our lives better and richer and how grateful we are for who they are. We may take them for granted, caught as we are in our frenetic lives and daily demands. But, if we don’t tell them our feelings, how will they know that we have them? Particularly if we are in a long term relationship, we may believe Valentine’s Day is only for new lovers, not for people like us. Wrong! Valentine’s Day is for all people who love, and this accounts for a very large part of the human population.

Can you think of meaningful ways of expressing your love feelings? However, you are going to do it – with flowers, a card, a gift, an evening together – remember that what is most important is being close. Hold your Valentine’s hand, sit closer to him or her than you usually do, remember what are the things he or she appreciates and provide them as a sign of your love. Above all, whatever you do, make sure it is special, out of the ordinary, because these special events create memories that make up our love histories together and will be cherished for many years to come. After all, what is our life if not a series of memories that give us the sense of who we are and who our loved ones are?

Don’t wait until the last minute to rush to buy a card, or to pick a bunch of flowers among the ones left over. Put some time and thought in it, it will show.

This is also a time when some couples choose to make important decisions about their lives together. Some men propose on Valentine’s Day; some couples marry. To all of them we wish they will be able to maintain these feelings for one another throughout their lives together. To those and all love couples who celebrate this day, we wish a celebration that takes heir love relationship to a higher level of closeness and intimacy.

HAPPY VALENTINE’S DAY!

Tags: Dr. Roher, relationships

Only 35% of couples with marital infidelity stay together. Hurt, humiliation, disappointment are very powerful feelings that often lead to blaming and attacking. Depression, anxiety and fear can occur following the betrayal. Trust is gone. There is a deep feeling of loneliness and shame, and concern about the future. Partners often don’t know how to deal with these intense emotions that create havoc in their lives. The very person who used to provide comfort and reassurance is now the very person who is now causing the pain. This situation is not very different from incest where the incestuous parent, who is supposed to provide protection and safety is actually breaking these rules making a child feel unsafe and alone.

Women in general tend to want to see if there is a way of repairing the damage caused by the infidelity. However, they tend to have a very difficult time with trust and with re-engaging in sexual activities with their partners. Men, on the other hand, are more likely to want out of the relationship if it is the woman who was unfaithful. Women are more likely to get depressed in these situations, whereas men are more likely to get angry (Spring.)

Forgiveness is what needs to take place for the relationship to survive in the infidelity. Forgiveness benefits both partners and can take the relationship to a deeper level of intimacy.

However, forgiveness is not an act but a process that requires certain elements to be in place in order to occur. These elements are:

 1) EMPATHY.

The person who had the oaffair needs to become aware of the full emotional impact of his or her actions on the other partner and feel what the other is feeling. Up until that point he or she might have minimized this impact, assuming that what is not known does not hurt. However, without open communication, the injuring partner won’t be able to achieve a full understanding and own responsibility for his or her actions. Once the two partners develop an honest way of communicating their feelings, they need to give each other all the time required to process the emotional impact of the affair. The length of this process vary from couple to couple, as a lot of specific elements may speed it up or slow it down. This part of the work requires patience, staying with the feelings, even and particularly when they are uncomfortable and, for the injuring partner, being emotionally available to the injured partner.

2) REMORSE.

There needs to be a reasonable expectation that this behavior won’t occur again in the future. I say “reasonable” because none of us has 100% security about what another person will or will not do in the future. However, it is important for the partner who was betrayed to begin to feel safe again in the relationship. And this is possible only if the person who had the affair becomes a changed person, fully aware of the seriousness of his or her actions and willing to do whatever it takes to change. Forgiveness applies only to those actions that occurred in the past, not to those occurring in the present or possibly happening in the future. It is only when the partner who had the extra-marital affair can provide reassurance that he or she is a changed person that the injured partner can start to rebuild trust. The injuring partner needs to feel and express regret and remorse and communicate these feelings appropriately to the injured partner.

Feel free to make your comment here on affairs by clicking on the comments button below.

Tags: Dr. Roher, psychotherapy, relationships

Internet affairs have become a new way of reaching out to people outside one’s marriage for companionship, love and sex. In this article we discuss the differences between these affairs and real time affairs. 

Internet infidelity is an issue of endemic proportions not only for the sheer number of people involved in them, but also because of the endless possibilities at one’s fingertips that cyberspace contacts offer.

I see the following as some of the main differences between cyberspace and real time affairs:

1. Anonymity. This encourages people to share more personal and intimate parts of themselves; to verbalize fantasies and wishes that might be more difficult to discuss with someone in real time, and to be bolder and more experimental with specific desires and interests.
2. Containment. Lack of physical and sexual contact online makes people feel less at risk of exposure. They don’t have to be afraid to be seen; they don’t have to worry about explaining to a partner where they spent the last few hours, or where they have been, and they don’t have to worry about safe sex. This feeling of safety is illusory and misplaced, however. 50% of people who meet on line progress to communicating with one another over the phone, and 31% end up having sex with one another at some point in the course of their relationship. Other people, however, prefer to maintain a virtual-only relationship, and resist meeting and getting to know each other in real life.
3. More room for fantasizing. Because the person at the other end of the screen is not a person in flesh and bones, she or can easily become an image onto whom all kinds of fantasies can be projected.
4. Unlimited pool from which to choose the person who meets one’s fancy and desires. This almost unlimited pool is available twenty four seven, across the globe.
5. Dissociation from reality. This element contributes to secrecy, compartmentalization and denial. All affairs, including those in real time, are kept somehow dissociated from reality. However, online affairs are even more so. A large proportion of people who engage in Internet infidelity do not even believe they are having affairs. This belief reduces their guilt and responsibility about what they are doing, and discourages them from stopping these behaviors.
6. Easier to begin intimate relationships. Fears of being rejected, of being inadequate, unattractive and socially awkward are greatly reduced in online affairs, due to the lack of physical contact, at least at the beginning.
7. Relationships become intimate much faster than real time ones, due to lowered inhibitions and ease of communication by text only, rather than face-to-face interactions.
8. Easier to end relationships, without awkward explanations, guilt and repercussions. The concept of “de-friendling” used in some social networks is an example of the ease with which people on line end relationships.

Because of all these characteristics, online affairs paradoxically tend to be deeper and more intimate and at the same time more superficial than real life ones. In internet intimate relationships, the sense of time is skewed; the normal progression from superficial to more intimate knowledge of each other is different, as couples can become very intimate right away, while in other areas they may continue to be total strangers to one another.

The biggest danger of online affairs is the illusion that what is happening is real, when in fact it is walled off from reality, and totally dissociated from it. These walled off experiences represent an altered reality that is often maintained isolated, unintegrated from the rest of one’s life and secret. Its presence prevents people involved in it to deal with the problems they face in real time relationships. Instead of addressing real life challenges, people retreat in opportunities and fantasies provided by access to the internet, maintaining two realities that don’t communicate nor interact with one another.

Give us your views on this topic by clicking on comments below.

Tags: Dr. Roher, psychotherapy, relationships

Brain Chemistry and Affairs

Is there a correlation between the levels of some brain chemicals and vulnerability to extra marital infidelity? Research in this area indicates that, while physical tendencies may be changed by our ability to think and reach logical decisions, our brain chemistry can influence our behaviors and choices. Of these chemicals, three in particular affect sexual and romantic behaviors in men and women. These are: Testosterone, Dopamine and Oxytocin. Elevated levels of these chemicals contribute to the development of lust, romantic love and attachment, all elements that play a role in intimate relationships and thus in affairs as well, separately or together.

Testosterone is a hormone associated with lust. While men tend to have higher elevations of testosterone than women, women can also be affected by this hormone’s levels. In women, lust waxes and wanes according to their menstrual cycle, typically reaching a peak during ovulation – the second week of the menstrual cycle – which is also their most fertile time (Havelick.)

Studies indicate that people with high circulating levels of testosterone tend to have more affairs and higher divorce rates than those with lower testosterone levels. And, while some people may have inherited high testosterone levels, certain situations can also elevate or lower them. For instance, single men have higher testosterone levels than married men. In married men, when marriages are in trouble, levels of testosterone raise (Booth and Dobbs), making affairs more likely to occur.

Dopamine, our most powerful stimulant, is a neurotransmitter that becomes elevated in addictions, and is also elevated when we are in love, contributing to hyper-focused attention, exhilaration, obsessive thinking and increased levels of energy (Fisher.) Research found that novelty (like in an affair) can trigger the release of dopamine and promote romantic love. Dopamine, in turn, stimulates the release of testosterone, which increases one’s sexual drive.

Oxytocin is called the “cuddle hormone’ because of the role it plays in intimacy. The role of oxytocin in affairs seems to be particularly important when we consider affairs women engage in. Women, in fact, tend to have affairs because they are looking for a soul mate, someone they feel emotionally connected to, and with whom they can share their innermost feelings (Spring.) Men, on the other hand, are more likely to look for a playmate, someone with whom they can engage in activities and pursuits they both like and enjoy, including sex.

As we can see, “Love is a symphony of feelings with many notes and chords,” as author Helen Fisher tells us in her book “Why we Love.” There are many elements – we discussed the psychological, environmental and physiological ones – that contribute to making it as exciting, attractive and irresistible as it is, at all ages and under all kinds of circumstances. But, while its elements have been the same throughout history, new technological developments have created circumstances and opportunities for the development and expression of lust and romantic love that are completely new. Internet affairs are examples of such new circumstances, providing hitherto new and fantasy rich romantic and lustful encounters for both men and women.

In the following blog post we are going to address Internet affairs, and discuss the similarities and differences between them and more traditional ones.

Tags: Dr. Roher, psychotherapy, relationships

Emotional disconnection and Infidelity

As we saw in the preceding blog on the psychological traits that make people more vulnerable to extra marital infidelity, it is the emotionally disconnection from their romantic partners – whether because one or both are insecurely attached, or because external circumstances weakened their emotional connection with one another – that makes some people more likely to get involved in extra marital affairs. Most cheaters (over 90% in a survey of over 4,300 people) confirm this when they state that the primary reason for cheating is emotional, not sexual (Layton-Tholl.)
 
When this lack of emotional connection and closeness with their mates gets married (no puns intended) to the pull of desire, as well as the excitement of the new and forbidden and the fantasy that, with another person, they can achieve the intimacy they want and need, we have a perfect storm for an affair to happen.

However, not all insecurely attached individuals develop affairs. However, insecurely attached people may tend to be more impulsive, as the sense of security in the relationship with their mate is not there to anchor them. Impulsivity facilitates the shift from thinking about doing something to actually carrying the thought out in reality. Impulsive people focus entirely on the present moment and their present needs and block out any thought about the repercussions of their decisions. Impulsivity also blocks out any thought about how a certain behavior may impact people who are going to be affected by these decisions. Of course, impulsivity does not exclusively occur in insecurely attached people, but insecure attachment creates an added vulnerability.

Some other psychological elements may increase the chances of people having extra marital affairs. In an earlier blog we discussed that people in the high drama professions are more at risk for extra marital infidelity. Psychologically, people who choose these professions tend to thrive on excitement and high drama. While their tolerance for routine is quite low as they get easily bored, they are attracted to unpredictability, exhilaration and constant stimulation. Affairs, to these people, are highly appealing and tempting because they feed their need for excitement and risk. These are also people who tend to live in the present, and don’t worry too much about the repercussions of their actions in the future. So, they don’t think about what will happen to their primary relationships as a consequence of their affairs, or to their lovers, often until it is too late. In such cases, impulsivity gets coupled with by an exaggerated sense of entitlement and being above rules that apply to everybody but not them.

In our next blog post we continue discussion of the traits that contribute to making some people more vulnerable to affairs. Please join us as we continue this discussion.

Tags: Dr. Roher, relationships

Elements that make people more vulnerable to extra marital infidelity.

In addition to the general situations created by being in long term intimate relationships, there are specific elements that make affairs more likely to occur.

When people live in marital situations where there is a lot of hostility, for instance, an affair may be a way of getting back at a spouse seen as insensitive, uncaring and rejecting. At times they are ways of getting out of the marriage. These affairs are called “exit” affairs.

Going through a life transition, like entering middle age, may also increase chances of one partner getting involved in an affair. The unconscious purpose of the affair here is to deny reality by engaging with a partner – typically younger – who finds us sexually attractive and givers us the attention we crave.

Losing one’s job, recovering from a life threatening illness or getting through the birth of a baby are transitional times where usual patterns of connecting with one’s mate have been altered by these events. Because of this, these emotional connections no longer provide the comfort and security they might have provided in the past. These times also force some people to see their lives differently and reflect on what they want. Consequently, they may develop different priorities and different goals for themselves. Some may struggle with these changes, conflicted about who they used to be and who we are now. Extra marital affairs may both contribute and reflect these changes.

People who are better off economically and have higher levels of education tend to get involved in extra-marital affairs more often than people with lower incomes and lower educational levels. Further, people in occupations with high levels of stress, like working in an emergency room, being a firefighter or a soldier in a combat zone, have higher incidence of affairs than people in professions with less drama. People in the entertainment business are extremely susceptible to getting involved in affairs, because they have the financial means and lead lives full of excitement and high drama. This is also true for surgeons and politicians, as they operate in high visibility and high drama professions.

Gender Differences. Do men and women act differently when it comes to extra marital infidelity? Current trends indicate that the gender gap is closing, as more women are likely to engage in affairs, particularly younger women. We can speculate on what are the reasons for these changes. I think one of the main reasons is the more open attitude about sex and women today, versus the past. Also, most of women in long term relationships now work out of their homes.They are thus in daily contact with other people, exposing themselves to the same risks and vulnerabilities as men. Earlier we talked about the fact that most affairs develop in the office, where both men and women are in daily contact but without the stresses of living together.

Women, today, are also quite aware of their needs and are more assertive in verbalizing and meeting them, rather than passively accept their situations.

There also seems to be a correlation, in women, between age of first intercourse and infidelity later in life. The earlier the first sexual experience, the more likely women are to engage in extra marital sex later in their lives.

In the next blog post we will discuss some of the psychological elements that make some people more vulnerable to extra marital infidelity. Click on the comments button below and give us your thoughts!

Tags: Dr. Roher, relationships