Psychodynamic & CBT: What's the Difference?

As you begin to search for the right therapist and the right type of therapy, you will certainly have come across terms like Cognitive Behavioral Therapy (CBT) and psychodynamic therapy. While these–and other forms of therapy–may feel like word salad at a certain point, it’s useful to understand some of the basic underlying principles of each to best decide on an approach to start with.

Both forms of therapy are evidence-based and can be highly effective, so it’s less about choosing the “better” approach and more about finding an approach, and a therapist, who fit you and what you’re looking for.

What Is CBT?

Cognitive Behavioral Therapy (CBT) is a structured, goal-oriented approach that focuses on the relationship between your thoughts, emotions, and behaviors.

The basic premise is that the way that we interpret situations influences how we feel, what we think, and therefore how we respond. By identifying unhelpful thinking patterns and experimenting by responding with new behaviors that bring about more positive outcomes, people often experience changes in their thinking, leading to improvements in anxiety, depression, stress, and other concerns.

In CBT, sessions often involve:

• Identifying automatic thoughts

• Learning practical coping strategies

• Challenging unhelpful beliefs

• Practicing new skills between sessions

CBT is often a good fit for people who appreciate structure, want concrete tools, or are hoping to address a specific problem, such as panic attacks, obsessive thinking, or social anxiety.

What Is Psychodynamic Therapy?

Psychodynamic therapy takes a different approach. Rather than focusing primarily on changing thoughts in the present, psychodynamic therapy seeks to understand why certain patterns developed in the first place, to better understand why and how they show up now. It explores how past experiences, relationships, emotions, and unconscious processes continue to shape current life.

Many of the ways we relate to ourselves and others develop long before we're fully aware of them. We may find ourselves repeatedly ending up in similar relationships, struggling with perfectionism, avoiding conflict, or feeling responsible for everyone else's emotions, without understanding where those patterns originated or how to change them. Psychodynamic therapy creates space to explore these deeper themes.

Rather than simply asking, "How can we reduce this symptom?" psychodynamic therapy also asks:

• What patterns continue to show up in your relationships?

• What emotional experiences are being repeated?

• How did these ways of coping once serve you?

• Do these responses and coping mechanisms still make sense for you today?

The goal is to understand why and how we arrived at where we are today, to better understand what elements of these responses we want to change and keep moving forward. Psychodynamic therapy believes that greater self-understanding often creates lasting emotional flexibility that allows people to respond differently in their present lives.

Which One Is Right For Me?

Research has consistently shown that both CBT and psychodynamic therapy can be effective treatments for anxiety, depression, and many other mental health concerns, so the best approach often depends on your goals, and what kind of therapist you feel most comfortable with.

If you're looking for practical strategies to manage a specific problem in the short term, CBT may feel like a natural fit.

If you're interested in understanding longstanding emotional patterns, improving relationships, or making deep, lasting changes in how you experience yourself and others, psychodynamic therapy may resonate more.

It is also very likely at this point, that any practicing therapist will incorporate elements of multiple therapy modalities into their work–different issues and moments require different ways of working and approaches. For example, someone experiencing acute work anxiety might benefit from CBT techniques that help manage anxious thoughts and reduce avoidance. At the same time, exploring why achievement feels so tightly connected to self-worth—or why setting boundaries feels impossible—can lead to deeper, more enduring change.

Ultimately, the relationship you have with your therapist is often more important than the specific therapy model they use. You can read more about my approach here, and together, we can determine an approach that fits your goals.

When Reliability Becomes a Trap: The Hidden Cost of Over-functioning

Over-functioning and How It Can Hurt

Over-functioning is the tendency to take on more responsibility than is actually yours–emotionally, mentally, or practically. It might look like solving problems before you're asked, managing other people's emotions, or feeling like it's your job to keep everything running smoothly. In particular, it might feel like helping others is less a choice than an automatic response or obligation, and trying to take a step back brings with it anxiety or guilt.

Often, people who over-function learned early in life that being seen as responsible or reliable earned praise, prevented conflict, or helped create stability in otherwise less stable environments. These patterns may have been developed alongside other ones, such as anxiety or perfectionism, which often develop as a way to increase a sense of control in otherwise uncertain settings.

Over time, it's easy to equate being helpful with being valuable, particularly if it becomes one of the only ways we receive positive feedback. This becomes particularly hard to disentangle because overfunctioning is so often rewarded. At work, reliability might equate to promotions and praise; in relationships, friends might seek out those who they trust to handle crises and make plans. Self-worth becomes closely tied to a sense of being productive, helpful, or needed.

While there are clear benefits to overfunctioning, constantly carrying more than your share keeps your mind and body in a state of vigilance. Rest can feel undeserved, and asking for help can feel uncomfortable or impossible. Eventually, that type of chronic stress can lead to anxiety, burnout, and emotional exhaustion. Ironically, the more consistently you take on everything yourself, the fewer opportunities others have to step in and support you, leaving relationships and situations feeling increasingly one-sided.

How Therapy Can Help

If you've spent years being "the reliable one," setting boundaries for yourself and others can feel deeply uncomfortable. You may worry that saying no appears selfish, or will drive others away–if your value is that you are always there to help, what happens when you’re not?

Even if you know that setting healthy boundaries is not about caring less, the fear of what happens when you no longer hold full accountability and control for the outcome of a situation can be scary and hard to let go of. Tolerating your own discomfort–at your lack of complete control, at how others’ may feel about you–can be the most valuable way to grow.

This adjustment can take a long time to put into practice, though, since overfunctioning develops throughout the course of our whole lives, often starting when we are very young, and because there can be a tremendous amount of fear about what happens to our relationships and to our value when we stop overfunctioning.

Therapy can support those for whom the costs of overfunctioning are beginning to take too heavy a toll, and need something to change, even if they don’t yet know what. This can look like:

• Setting boundaries and exploring the feelings of overwhelming guilt that accompany them

• Reducing people-pleasing patterns with less fear

• Exploring and building self-worth that is less dependent on productivity or caretaking

• Feeling more expressing a need for support

• Creating relationships that feel more balanced and reciprocal

Being reliable isn't the problem, and the goal isn't to become less caring or less dependable. It's to recognize where the need to over-function developed, and explore whether the factors that might have led us as young children to decide this was the best way to receive safety and praise, really still hold.

Therapy for Children of Immigrants

Mental Health Challenges for Children of Immigrants

Children of immigrants often face unique challenges and dynamics, both within their families and in broader society. While every person’s experience is unique, legacies of loss, grief, and hardship that often accompany immigration may be shared. Children of immigrants often grapple with conflicts around their identities, feelings of extreme pressure and guilt, and face various barriers when it comes to connecting with and communicating with family. In this post, we’ll explore some of those challenges, as well as discuss what kind of support therapy can offer.

Sense of identity

For children of immigrants, or those who moved between countries in their early childhoods, “home” may be hard to define. They may feel torn, navigating between the cultures of a country they have little or no connection to, and a country where they may perpetually feel like an outsider. It’s understandable then, that a core conflict for many children of immigrants is understanding and defining their own identity and sense of self across multiple cultures and worlds. The facets of their identities or personalities they feel most comfortable expressing at home with family may be in conflict with who they are with friends, romantic partners, or at work. This conflict can result in confusion, frustration, and depression as they find themselves constantly having to negotiate between or sacrifice parts of who they are to hold onto important relationships.

Pressure and guilt

Children of immigrants often grapple with immense pressure to succeed academically, professionally, and financially, with the implicit or explicit understanding that they need to somehow justify their parents’ sacrifices and hardships. This may lead to definitions of success that are narrow and restricting, offering little room for exploration or error. Even as children of immigrants grow into adults with more secure lives, careers, and families, the feeling of the high stakes of failure may remain with them, perpetuating cycles of pressure and striving for perfectionism. “Failure” to achieve perfection may lead to intense guilt or shame, as the constant striving may contribute to a belief that one’s inherent value is equivalent to their highest achievement. When the margin for error feels that small, we often see struggles with anxiety, imposter syndrome, and burnout.

Barriers

Barriers come in all forms–generational, cultural, structural, physical, language–and children of immigrants often face all of these, within their families of origin, among their friends and in their closest relationships, and in broader society. These barriers may have felt like their responsibility to overcome as children. They may have felt like they had to act as translators for their families; they may have felt like if they achieved enough, they could “overcome” the impacts of racism, xenophobia, or capitalism; they may have felt like they needed to accept that would never be fully understood by their families, closest friends, or partners. Living with the burdens of these barriers will often lead to overarching feelings of alienation, loneliness, and difficulty connecting in their closest relationships.

How can therapy help?

Therapy may be hard for any first- and second-generation immigrant to approach, as the idea of mental health may not have been championed or even accepted in their families of origin. However, examining the narratives under which we grew up and formed our earliest relationships and experiences of attachment can be a critical component toward leading more authentic, connected lives.

Among other things, within the therapeutic setting, we might: explore and rewrite parts of the narratives of our upbringing and the roles we have played within our families; examine our values and attitudes toward things like success, guilt, and shame, and reconstruct them to better suit us now; clarify more deeply what meaningful relationships could look and feel like for us, and move toward them.

What is IFS therapy?

What is Internal Family Systems therapy?

While Internal Family Systems (IFS) as a therapy modality has gained increased recognition recently, the concepts underpinning it have long been used by therapists to support clients in exploring internal conflicts they have with themselves. For instance, one moment a client may be extremely motivated to address a problem; and the next, they’re depressed or experiencing intense procrastination. This internal tug-of-war can be confusing, but IFS therapy offers a framework to understand these conflicts.

IFS views the mind as a system made up of various sub-personalities, called "parts." These parts can be managers (critical or controlling parts), firefighters (parts that react impulsively), or exiles (parts that hold past pain).  Each part has a role to play, often stemming from past experiences, and works hard to fulfill what that role believes is best for you.

The goal of IFS therapy isn't to get rid of these parts, but to create harmony within the system. Therapy works to help you identify your “self”--the calm, compassionate center of your being, from which you can understand your various parts with curiosity and without judgment.

IFS therapy may help you to:

• Increase self-awareness: By identifying your parts and their roles, you can understand why you react in certain ways.

• Reduce emotional reactivity: When you see your parts as fulfilling certain learned roles, it becomes easier to manage overwhelming emotions.

• Build self-compassion: IFS teaches you to see your parts as trying to help, even if their methods are misguided.

• Embrace your wholeness: By integrating your parts, you move towards feeling more whole and fulfilled.

IFS therapy can be helpful for clients dealing with issues of anxiety, depression, addiction, relationship issues, and past trauma.

Understanding Relational Therapy

Therapists may use all types of terms to describe the type of therapy they practice. When I describe how I work, I often start by saying I work from a “relational” and “psychodynamic” lens, and while you don’t have to know what they mean to benefit from them, it can be useful to have a general sense of how your therapist might want to work with you. 

Building on Relationships

Relational therapy, also known as relational-cultural therapy, emphasizes the importance of our connections with others. It's based on the idea that a lot our traumas and pain occur in relation to other people, and that strong, healthy relationships are essential places for our healing and emotional well-being. Therapists using this approach explore how your past and present relationships shape your current thoughts, feelings, and behaviors in relationships, especially if you find that you are attracting the same type of partner, or encountering the same conflicts in relationships. Relational therapy also considers how your cultural background and social environment influence your interactions with others.

Similar Goals, Different Focus

While both relational therapy and behavioral therapies, such as Cognitive Behavioral Therapy (CBT), aim to improve your overall well-being, they may take different approaches at time.

Behavioral therapies tend to be more focused on you as an individual, versus in relation to others, and might involve identifying unhelpful thinking patterns and developing new coping mechanisms to address them. Relational therapy, on the other hand, might delve deeper into the dynamics between you and others. It might explore how your communication styles, attachment patterns, and past experiences all play a role in your past and current relationships.

The role of the therapist

One unique aspect of relational therapy is how the therapist works with the client-therapist relationship itself. In relational therapy, the therapeutic relationship becomes a model for healthy connection. By working together to understand your needs and build trust, the goal is that a client can experience what a secure and supportive relationship can feel like within therapy, which can then translate into your interactions outside of therapy.

Is Relational Therapy Right for You?

If you're struggling with relationship issues, family conflict, or feelings of loneliness, depression, or anxiety, relational therapy can be a powerful form of therapy for you, as these issues can often be rooted in relational challenges. Read more about how I work here.

Attachment Styles and Relationships

We’ve been hearing the term “attachment styles” more frequently, and we have come to understand that they can impact the “big stuff” in relationships, as well as the everyday moments–like feeling anxious if your partner doesn’t text back right away, or feeling like your partner doesn’t understand how you desire intimacy. These struggles might be attributable in part to your attachment style, a concept that was developed by psychologist, John Bowlby, that explores how early relationships with our caregivers share how we seek connection with others in adulthood.

Bowlby described three main attachment styles:

• Anxious: Those with anxious attachment often crave reassurance, or worry excessively about being abandoned. In a relationship, they may be more likely to take on a “pursuer” role in conflicts.

• Avoidant: People with avoidant attachment often prioritize independence, and might struggle with intimacy. In a relationship, they may be more likely to take on a “withdrawer” role in conflicts.

• Secure: People with secure attachment experience comfort with both intimacy and independence. The goal is that they are more able to trust their partner and communicate openly.

Of course, no one term fully encompasses someone in every scenario, but understanding your attachment styles can help you gain awareness and foster a deeper connection with your partner. Couples therapy can help partners both move toward a more secure attachment, by:

• Identifying Stuck Patterns: Therapy can help you identify how your attachment style shows up in your interactions. Do you constantly seek reassurance from your partner (anxious), or shut down conversations to avoid intimacy (avoidant)? Recognizing these patterns is the first step towards healthier communication.

• Building Empathy: Couples therapy can help each partner better understand what the other partner is experiencing, and why they exhibit certain behavior. Better understanding each other can help to build empathy and create opportunities for more emotional connection.

• Navigating Conflict Resolution: Attachment styles can often lead to unhealthy conflict patterns. Therapy can equip couples with tools to navigate disagreements more productively, focusing on problem-solving and emotional understanding.

Couples therapy that incorporates an understanding of attachment styles can help you build stronger, more resilient connections, and equip you with the tools to navigate these aspects of a relationship more effectively.

Job Anxiety: How It Affects You and How Therapy Can Help

Work anxiety, the “Sunday scaries”, or whatever we call the persistent fear and anxiety associated with one's job, can significantly impact both professional and personal life. If you find yourself feeling overwhelmed, fixated on work, or paralyzed with procrastination even while you’re stressed, therapy can provide valuable tools to help you manage and alleviate these anxious feelings.

The Impact of Job Anxiety on our Lives

Intense anxiety around your job rarely stays focused just on work. We often feel its impact in other areas of life, where it can:

• Impair relationships. Chronic stress and anxiety can strain relationships with family, friends, and romantic partners. Being preoccupied with intense anxiety can make you irritable, withdrawn, or less present in your relationships.

• Contribute to physical and mental health problems. Work anxiety, and the chronic stress that accompany it, can lead to various physical symptoms, such as headaches, digestive issues, and poor sleep. These symptoms in turn may also contribute to poorer mental health – both general anxiety and depression, as well as a sense of hopelessness or overwhelm.

• Lead to burnout. Chronic or sustained work anxiety can lead to burnout. Though this term is used quite often now, we may experience it as a state of general emotional, physical, and mental exhaustion that decreases the overall quality of our lives.

The Role of Therapy

Therapy offers a safe and supportive space to explore how work anxiety is impacting you today, as well as understand its connection to other parts of our lives. Increased understanding of our anxiety helps us to develop ways of coping with it and interacting with it differently. In therapy, we might:

• Explore past experiences. Your past experiences, including how you were brought up, the messages you learned about how you need to achieve, as well as past professional experiences, can all play a significant role in your current anxieties. Examining these past experiences in a safe and non-judgemental environment may help you understand how they’re influencing your current feelings and behaviors. 

• Address connected, underlying issues. As you begin therapy, you may discover underlying–often unconscious–factors that may be contributing to work anxiety. These often include things like negative core beliefs you hold about yourself, unresolved conflicts, and defense mechanisms you’ve used in the past, that may no longer be working. Therapy provides a forum to explore and adapt.

• Build resilience. By exploring and identifying more of your past, and related drivers of anxiety, you can build a stronger sense of self, and begin to develop healthier ways of coping with stressful situations, that don’t fall back on negative patterns, like self doubt, negative self-talk, or feelings of paralysis.

Seeking support for work anxiety is often where the work starts, but not where it always stays or ends, because of how connected these core issues may often be to other areas of our life. It can also be a sign of strength and readiness for things to change. Book a free consultation here to get started.

How to Manage a Relationship with Loved One with Borderline Personality Disorder

Borderline Personality Disorder (BPD) can be a confusing diagnosis and one that is often misunderstood. Though we may have come to hear the term “borderline” more frequently in daily language to describe people who seem to have extreme reactions to things, it can still be hard to recognize the symptoms of BPD, especially in those we are close with, whose symptoms we may have been managing without wanting to or realizing we have been for awhile. People with BPD tend to have volatile relationships, where seemingly minor interactions set off outbursts or reactions that can feel irrational or extreme to the person on the receiving end. BPD also often presents alongside other conditions, such as depression, anxiety, or substance use disorders, further adding to the difficulty in understanding what someone may be presenting with or experiencing.

Your Experience with a Loved One with BPD

While it can be important to remember that those living with BPD are themselves experiencing a tremendous amount of pain–their destructive or seemingly erratic behavior is a reflection of the inner turmoil they are experiencing–maintaining a relationship with a loved one with BPD comes with its own pain, as well.

Everyone’s experience varies, but some common experiences you may experience when in a relationship with someone with BPD are:

• Having to be cautious about how you approach them: Since people with BPD often experience extreme emotional reactions, it can feel like small things can unpredictably set off someone with BPD. You might realize you are walking on eggshells for fear of triggering that emotional response, and learn to hide what you’re thinking or feeling in an effort to maintain peace.

• Being praised and devalued frequently: Those with BPD often have a hard time living with the reality that people, including themselves, can contain parts that are both “good” and “bad”. As a result, they may only be able to experience you as either all good–a perfect friend, or partner, or family member, or all bad–a selfish, uncaring person.

• Feeling stuck or manipulated during interactions with them: The emotional extremes that people with BPD experience may mean that they will behave in accordance with how they feel, and that can include volatile, sometimes even scary or dangerous, behavior. To try and maintain a sense of safety, those in relationship with someone with BPD may find themselves feeling stuck, fearing what will happen if they leave or cut off contact.

What Can You Do

There is not necessarily a handbook for what will work with everyone with BPD, but given the emotional volatility and fears of abandonment, or rejection those with BPD often encounter, these are some recommendations for what can help:

• Validate their feelings: While it can be tempting to want to talk someone out of how they’re feeling, particularly if it does not seem to reflect reality to you, it can be effective to validate the feelings and thoughts of someone with BPD. They are already experiencing intense emotions, and may feel alone in these moments, so, while difficult, it can prove helpful to express sympathy for them about how they’re feeling, rather than to try and explain why their feelings seem extreme.

• Maintain calmness: When people with BPD are experiencing intense emotions, especially anger, directed at you, it’s natural to tend to defensiveness or anger in response. However, in these moments, it’s important to remember that the anger they are experiencing then, even if intense, is only one element of what they’re feeling. Remaining calm in the face of this, may help them move to other elements of their emotions, rather than exacerbating the anger.

• Set boundaries: Setting boundaries with someone with BPD can be difficult and daunting at first. However, the slow, calm introduction of boundaries–i.e. When you will and will not be available for communication, what type of behavior you will or will not accept–presented without anger or accusation can benefit both you, as well as them, over time.

• Recommend therapy: This can apply to both the person with BPD, as well as for yourself. Therapy for someone with BPD can be difficult, but there is evidence of symptom improvement over time, particularly with certain modalities like Dialectical Behavior Therapy. At the same time, it can be stressful and difficult to manage a relationship with a loved one with BPD, and it’s important to also provide yourself the opportunity to reflect and process the relationship.

Why is it so Hard for Us to Receive Compliments?

We can all picture the scene – someone pays us a compliment, and for some set of reasons, our immediate instinct is to disagree, minimize, or deflect the compliment with one of our own. While we can often ruminate on and believe any criticism about ourselves, whether explicitly stated or imagined, we have a much harder time accepting or tolerating receiving a compliment. While it may feel like a sign of modesty, there are a host of reasons it might be hard for us to accept compliments comfortably.

Common Responses to Compliments

We’re all guilty of disagreeing with compliments at times. Someone tells you that you look great, and you tell them “Ugh, no way, I feel so ugly today.” Maybe that is genuinely how you feel, maybe you want to demonstrate your own modesty by rejecting the praise, but either way, you have disagreed with someone’s compliment, which can create awkwardness since you’ve now inadvertently stuck them in the role of having to argue for you to accept their praise.

Another common response is to minimize a compliment. Someone tells you you’ve done a great job on a work presentation, and you tell them, “Thanks, I’m glad it was alright,” minimizing the degree of praise from “great” to just “alright”, even though you spent hours of preparation to make the presentation appear effortless. While in this case, you’ve technically accepted the compliment, you rejected the actual sentiment behind the person’s compliment.

At other times, still, we may deflect the compliment back to the person giving it to us. I’m so funny? No, you’re the funny one. This is the response that we may feel is most generous, and again, could be wholly sincere on our end, but still shifts the focus away from the compliment and overemphasizes our own modesty in the moment.

Why is it so hard?

There are nearly always rational reasons for our responses to things, even if they don’t feel like they always make sense in the moment. Our difficulty in accepting compliments is no different, and may often be grounded in our desire for safety and protectiveness, indirect as that may feel.

Self-esteem

A common factor in rejecting compliments is low self-esteem, and a fragile sense of self. If we believe that we are not actually deserving of good things, of praise, of being held highly in others’ esteem, the compliment not only does not feel accurate, it can create anxiety for us. Rather than feeling lifted by the praise, we become worried that we’ve tricked someone into thinking these things about us, and feel anxious about what they will think once they discover the “truth” that we are not deserving of the compliment they’ve paid us. Maybe they’ll be angry or disappointed, so it feels safer to preempt those possible outcomes by downplaying, or outright disagreeing, with the compliment.

Societal conditioning

Many of us are taught that humility and modesty are virtues, and the idea of letting your accomplishments speak for themselves is viewed as a more principled and desirable way to be. While these can certainly be positive traits, they may at times morph into an inability to acknowledge our strengths and accomplishments. Perhaps we fear that accepting a compliment will make us appear arrogant or conceited, and we’ll actually be negatively judged for having accepted what was freely offered. Even if we want to acknowledge the compliment, some of us may be uncomfortable with the perceived attention that a compliment brings. Being singled out, even for something positive, can feel vulnerable; perhaps we’re worried about being judged more harshly once we’ve accepted praise, and prefer to feel more hidden as a means of feeling safer.

Past experiences

Our past experiences may play a role here, as well. If we have received insincere compliments, or indeed felt more harshly judged upon agreeing to a compliment, it makes sense that we would develop a general skepticism about praise in general. We might assume that the compliment isn’t genuine, or even that there is an ulterior motive in it. This can make us hesitant to accept even well-intentioned compliments.

Overcoming this discomfort takes conscious effort, and may be multi-faceted depending on where the difficulties lie. Learning to accept compliments can be a critical step not just in fostering healthier, happier relationships, but also in easing our own anxieties and stabilizing our sense of self. While easier said than done, the next time someone offers you a compliment, try recognizing the anxiety it provokes for a moment, taking a deep breath, and simply replying “thank you”.

Why do I have Travel Anxiety?

Travel, typically seen as an anticipated, exciting adventure, is often a trigger for anxiety for many. While the underlying reasons behind travel anxiety may vary–fear of flying, navigating unfamiliar environments, or simply the disruption of routine–travel anxiety is a common, shared experience. Understanding more of why this happens, as well as having some strategies to combat it, can improve the experience. 

The Roots of Travel Anxiety

While the experience of anxiety is different for everyone, there are some common themes that frequently underpin the worries. Some of these are:

• Specific phobias: Fear of flying, or of being confined in the tight spaces on planes, can make the experience of traveling intensely distressing. This anticipated distress can make not just the experience of flying itself, but of traveling to the airport, and even packing and planning the trip an anxious one, as even these mundane-seeming activities are associated for the person with the actual phobia itself. 

• Lack of control: Traveling is inherently accompanied by a lack of control. In some ways, that can be seen as part of the joy of traveling, but for individuals with anxiety, that loss of control over their schedules (i.e. flight delays, transportation logistics) and environment can induce feelings of helplessness and anxiety.

• Scarcity: While perhaps less associated with travel anxiety, as it has less to do with the logistics of travel, for some, travel anxiety is rooted in the fear of not doing “enough” with travel time. There may be a sense that travel is rare and indulgent, and therefore there is an obligation to utilize the time in the “best” way possible, when of course that is a subjective measure that varies for every person. Ultimately, this is an anxiety of leaving a trip feeling disappointed in oneself.

Practical Ways to Lessen Travel Anxiety

There is not one set of behavioral shifts or rituals that will definitively help each person who experiences travel anxiety. However, these are some activities that can provide some relief:

• Reframing thoughts: Considered a type of cornerstone of cognitive behavioral therapy (CBT), reframing your thoughts involves acknowledging, challenging, and then modifying negative thought patterns. By identifying and reframing irrational beliefs about travel, individuals can reduce their anxiety. For instance, instead of thinking, "My flight will definitely be delayed and that would be terrible," you could challenge yourself to acknowledge other outcomes, i.e. “It’s vacation, and I’m actually not in a rush to get anywhere.”

• Calming and mindfulness techniques: For those who are afraid of flying, before any type of reframing of thoughts can occur, it may first be necessary to calm yourself down in order to even acknowledge what distinct thoughts you are having. One way to do this is to slow down your thoughts through mindfulness & calming techniques, such as deep breathing (breathing in for five seconds through your nose, holding the breath for two seconds, breathing out through your mouth for five seconds) and meditation before travel, if possible.

• Managing physical symptoms: While anxiety may be an emotional, mental hurdle, preparing for travel by ensuring you are physically in as sturdy a place as you can be can support you in keeping the anxiety to more tolerable levels. This could look like making sure you are as well-rested as possible before travel, not feeling rushed or running late as you head out for travel, ensuring you have eaten enough, etc. all in an attempt to ensure that you feel as healthy as possible before potentially being emotionally activated.

• Slow exposure & desensitization: For a specific phobia, such as flying, it can be possible to utilize the technique of systemic desensitization, which essentially involves gradually exposing yourself to situations that ignite that fear, in small, measured ways that challenge, but do not overwhelm, you. For instance, you could start by first visualizing being in an airport setting and boarding a plane, and then progress to visiting the airport you are likely to fly out of, and eventually take short flights.

Why (and When) to Go to Couples Therapy

Similar to individual therapy, there is an emerging belief – both among couples and within the clinician community – that “any couple can benefit from couples therapy.” This is not to say that every couple should start couples therapy right away, but increased understanding of our partners and ourselves in relation to them, is an outcome of couples therapy that can support the couple at any stage, and in nearly any state.

What Does Couples Therapy Do

Just like with individual therapy, couples therapy will look different for every couple, based on what the couple comes to therapy with, how the clinician practices, and what the couple’s goals are. But conflict is an inherent part of being in relation to another person, and better understanding that conflict–what emotional responses become activated in us, what our defensive actions in response to those emotions activate in our partner–is a central goal of couples therapy.

I often frame the first phase of couples work as one of collectively slowing down and examining the conflict dynamic that exists in the couple today–i.e. “I bring up something that bothers me, and then she shuts down, which just makes me more upset, so I yell, which just makes her shut down more.” Understanding the emotional needs and attachment wounds that have taught us to respond the way we do (more yelling, more withdrawal) is something that all couples therapy should be able to support with. From there, what a couple chooses to do may vary; for some couples, understanding that dynamic and having language to speak to it, is itself a good amount of work and sufficient for them to take it and run with it; they’re able to confront new conflicts with improved patterns of handling them. Other couples may continue with couples therapy, wanting support in applying this understanding to new areas of their relationship.

Benefits to Therapy Earlier in the Relationship

The conflict pattern couples often present with in therapy are not new ones. In fact, they’re usually quite well-trodden and the conflict can almost occur on autopilot because of how often it’s occurred. It’s very common for a couple to express a sentiment along the lines of: “It doesn’t matter what we’re arguing about, we seem to end up in the same place no matter what.” Given this, there are tremendous benefits to starting couples therapy with a partner, before the relationship feels like it’s in a dire state.

What can hinder the process of understanding, and ultimately shifting, the conflict dynamic is underlying resistance from one or both partners, due to resentment and unresolved hurt or anger. These emotions can be, of course, a part of any relationship, but for couples who have been together for a long time, the interactions and conflicts that have created these patterns may be even more deeply entrenched.

While we sometimes hear people wondering, “Is it too early in my relationship to go to couples therapy,” I might reframe the question as: “How bad would you like it to be before you go to couples therapy?” Couples therapy, like individual therapy, rather than signaling that something is deeply wrong about a person or a relationship, could instead be understood as one of several tools available to people to help them feel more connected and understood. There’s no time that feels too early for that.

Couples Therapy After Infidelity

The discovery of infidelity in a relationship is accompanied by a period of intense emotional turmoil and uncertainty, for all people involved. Regardless of the state of the relationship before the discovery, a shift occurs when couples have to now contend with both the pain created, as well as make a decision about what comes next. The goal for every couple at this moment can be different–processing confusion and hurt, trying to make sense of what has happened, reconciliation, or figuring out how to separate with the least harm done–but for any of these goals and more, couples therapy can be a useful resource:

• Providing a structured space: One primary way couples therapy may help after infidelity is by creating a safe, structured space for communication, particularly at a time when any communication may feel especially fraught and contentious. While the therapist is not a referee, they can serve as a more neutral facilitator, allowing both partners the opportunity to express their feelings, fears, and perspectives in a more contained space. The containment may allow for each partner to hear the other more clearly, as well as feel heard themselves, with less defensiveness or judgement.

• Understanding underlying issues: While the discovery of fidelity may be the initial betrayal wound that brings couples to therapy after infidelity, it is nearly always a symptom of other underlying dynamics that have existed within the couple before this moment. Therapy can help the couple understand their own conflict dynamics better, as well as each of their own attachment wounds that led to one or both of them seeking connection outside of the relationship.

• Reconciliation and rebuilding trust: For couples interested in reconciliation, rebuilding trust is both a priority and a major hurdle. It is a gradual process that requires honesty on both partners’ parts, as well as consistency, and an understanding that the relationship will be different after this infraction. In the best outcome, the relationship is an improved one–one that carries the wounds of its own history, alongside the understanding that the ability of the relationship and of the couple to adapt to its new reality creates a resilience that is necessary for the new stage of the relationship. 

• Managing emotions: Even if the goal is reconciliation, the healing process after infidelity is rarely linear. There will be setbacks, moments of intense pain, and challenges in navigating forgiveness. Couples therapy can help the couple acknowledge and manage these difficult emotions, and develop coping mechanisms when they arise. 

• Ending the relationship: In cases where couples decide to end the relationship for any number of reasons–either because the betrayal feels too deeply stung to overcome, or because the increased clarity of the moment tells one or both people that they are seeking something different–therapy can provide a supportive framework for the couple to navigate separation with dignity and minimize further pain.
  

Shame and stigma around infidelity can prevent a couple from seeking support at their most fractured, painful moments. Infidelity, like so many other sources of disconnection and harm in a relationship, does not have to define the couple. Reach out to understand how couples therapy can support you.

What is Anticipatory Grief?

Grief is a complex, deeply personal journey, often associated with the aftermath of a loss. But there are times when grieving begins before the loss has actually occurred. This is the experience of anticipatory grief, a unique and often overlooked facet of the grieving process.

What is Anticipatory Grief?

Anticipatory grief is the emotional and psychological distress experienced when you understand that a loss is coming. More than just a feeling of sadness, anticipatory grief is a full-fledged grief process that may mirror in many ways what we more traditionally understand as grief. It is commonly experienced by caregivers and family members of people with a terminal illness, dementia, or other progressive conditions, but can also be brought on by impending life changes, such as a relationship coming to an end, a job loss, or a major move. It’s the process of grappling with the future absence of something or someone who is still present, and can look a lot like grief–feelings of sadness, anxiety, fear, depression, anger, and social withdrawal.

Stages of Anticipatory Grief

Just as the stages of grief are unique to each individual and often non-linear, so too are the stages of anticipatory grief. While people may experience a whole range of symptoms, some stages of anticipatory grief that have been identified are:

• Acceptance: The recognition that a loved one’s death, or a major change, is unavoidable, and the feelings of sadness, denial, anger, and depression that come along with this realization.

• Reflection: Processing these feelings, and come to terms with additional feelings like regret, guilt, and remorse as the reality of the upcoming loss sinks in.

• Rehearsal: Preparation for how you’ll feel and think during and immediately after the loss, potentially including practical considerations, such as making funeral arrangements.

• Imagining the future: Visualizing what life could look like after the loss, mentally reorganizing your life and potential identity without that person in your life.

Benefits and drawbacks

In some ways, anticipatory grief offers a unique opportunity for resolution. It allows for a gradual process of accepting the loss and saying goodbye, enabling conversations and experiences that might not happen otherwise. It can also help to prepare for the practical realities of the future, potentially easing the shock of the actual loss.

However, the process of course has its drawbacks, as well. Living in this state of prolonged sadness can be emotionally and physically exhausting, especially in the case where a loved one’s death is drawn out or unpredictable in timing. It can also lead to a strained relationship with loved ones who are still alive, as the grief may cause you to withdraw or become distant. A significant drawback is the potential for guilt, feeling as though you are “giving up” on the person before their time has come.

How Can Therapy Benefit?

Navigating anticipatory grief can feel like walking a tightrope between hope and despair, wanting to be prepared without prematurely retreating into the loss. Therapy can provide a safe, non-judgmental space to process these complex emotions in a contained, honest way. They can help you make sense of your feelings, and develop coping strategies. Therapy can also help you find ways to be present and find joy in the time you have left with your loved one, while also preparing for a future without them.