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Conscious and Subconscious Biases
(Hidden Biases of Good People)

Riddle: A man and his son are driving in a car one day, when they get into a fatal accident. The man is killed instantly. The boy is knocked unconscious, but he is still alive. He is rushed to the hospital and will need immediate surgery. The doctor enters the emergency room, looks at the boy, and says, “I can’t operate on this boy, he is my son!” How is this possible? 

 Congratulations if you were able to solve the riddle. We all have biases. Some of the biases are known to us and other biases hide very deep in the subconsciousness of the brain. Because we have all been socialized differently, it is hard to imagine anything other than what we know. 

The socialization process begins when children are in their early years. Because of bias, we often give our children misinformation, missing history, and biased history that leads to stereotypes about any groups whose cultures are different from our own. This information is reinforced by people, systems, and institutions we know, love, and trust, through continued stereotypes and distortions. Some of these institutions are family, neighborhoods, education, media, government, houses of worship, economics, and class. If we do not purposefully interact with, understand, and study people who are not members of our own groups, we carry those stereotypes throughout adulthood, and they become a part of our belief system. 

The way we were socialized can influence our decisions today, producing discriminatory outcomes. How we view others who do not share the same “cultural” norms as we do can interfere with decisions we make. If we are in a position of power to hire employees, we can form opinions about who can or cannot do the job based on subconscious and conscious biases that have not been dealt with, due to the thinking of what society considers as the norm to follow. Who and what influences our social group? People who do not believe or look like us are usually left out of our social circles if we do not get to know people unlike ourselves. The way we were socialized could keep us in our comfort zone, which causes us to make mental judgments about all others who do not “fit” within our social group. 

Mental health professionals cannot afford to take a chance of not understanding their clients or students “whole selves.” Understanding our own biases will ensure we are able to assist with the healing aspect of those whom we serve. 

For mental health professionals and school mental health professionals, cultural competency is the ability to provide mental health services that can acknowledge cultural differences between the client or student and the professional. The more the clinician knows about clients’ or students’ culture, ethnicity, or background, the more likely clients and students will feel comfortable in therapy. When the professional is culturally competent, having prioritized their understanding of a client’s or student’s background, gender, abilities, sexual orientation, ethnicity, religious or nonreligious beliefs, and other factors, and connecting this important knowledge to mental health services, it enables clinicians to accommodate and respect differences in opinions, values, and attitudes. At the same time, it is important to be aware that no group of people is monolithic. 

The book, Blind Spot: Hidden Biases of Good People, written by Mazarin R. Banji and Anthony G. Greenwald, talks about “mindbugs.” These are ingrained habits of thought that lead to errors in how we perceive, remember, reason, and make decisions. The eye receives, the brain registers, and the mind interprets visual and audio information. If we don’t bring these ingrained thoughts to the conscious level, they lead to negative stereotypes capable of oppressing certain cultural groups. For example, mindbugs can get in the way of mental health professionals’ ability to help in a crisis if they are unfamiliar with a client’s or student’s religious or non-religious beliefs. Therefore, mental health professionals must understand their own cultural biases to become culturally competent professionals. 

There will always be differences within the same cultural group. However, culturally competent mental health professionals are continually working on their own subconscious and conscious biases to support all their clients and/or students. We begin to understand the richness and beauty of the tapestry when the world connects, and we get to know and appreciate each other. 

By the way, what was your first thought about the riddle? Remember, we ALL have biases. 

“I only do what I want to do.” That sounds incredibly selfish, doesn’t it? Most of us would feel guilty saying that to ourselves, let alone to another person. Many of us were taught to be self-sacrificing. Do for the other person and not ourselves. People are praised for thinking of others first and putting their own needs aside. Years ago, I found that there was a fallacy in this thinking. As I was doing what others wanted, I did not give myself permission to do what I wanted – and I resented it and eventually resented them.  

The first time that this occurred to me was when I was in my thirties, married with three adolescents, working full-time as a teacher, and going to grad school. Our psychology professor had recommended that if we were going to be in the counseling profession, we should have the experience of seeing a therapist. At that point, I was feeling frantic. It was two weeks before Christmas, and I was finishing the academic semester. The house wasn’t decorated. No gifts were bought. And there were numerous discussions among family members about who was doing Christmas and Christmas Eve dinners.  

I was referred to a young therapist (a doctoral psychology student doing his residency). I remember spewing out my anxiety and confusion. I felt that I was being torn in a thousand different ways and I didn’t know how I could please everyone. After listening to this, he asked me a very simple question. “What do you want to do?” I felt as though no one had ever asked me that question. I am sure I had never asked myself, “What do I want?” It was always about what others wanted from me and for me. The question literally changed my life. I made the decision that seemed reasonable, doable and would make me happy without adding a burden onto other people. Everyone seemed fine with what I chose. I had a great Christmas. Most importantly, I also decided that I would never spend another holiday not doing what I wanted. All of these years, I’ve kept that promise to myself. 

After this, I discovered two things. The first was that, in pleasing myself, there were no resentments. I enjoyed what I was doing and I enjoyed others with whom I was with. Resentments are toxic to a relationship. How many times do we do things essentially to please another person but end up resenting them in the process because this is not what we want to do. For example, if I would have gone ahead and had Christmas or Christmas Eve dinner to please my mother, I’m afraid my resentments would have spilled over into our relationship. We see this in relationships all too often. One party tends to give to the other regularly and eventually builds a wall of resentment. After years of this resentment, the couple finds themselves in a therapist’s office because, in time, this behavior has destroyed the relationship. The less I resent someone or something, the more willing I am to do what others ask of me.

The second thing I learned was that I could make choices for myself as long as my behavior didn’t negatively impact the other person. For example, in the case of the Christmas events, I told my mother that I would have a very difficult time doing Christmas or Christmas Eve dinner because of the time crunch, but I would love to do New Year’s Day dinner with my family and my cousins, whom I really enjoy. Everyone seemed pleased and we had a great holiday. If I had offered no solution to the Christmas dinner dilemma, it wouldn’t have been fair to the other family members. My rule of thumb is that as long as my decisions do not negatively affect others, it is my choice to make. For example, if I go dress shopping with a friend and she insists that I buy a dress that I’m not really happy with because she loves the way it looks on me, I have the right to say that I appreciate her opinion but I much prefer the other dress. If I were to buy the dress that she chose, it would be to please her and not myself. 

Realistically, however, there are many things that we do that we feel we should do. I would suggest that if we could take the word “should” out of our vocabulary we would be much happier. We all have activities in our life that we don’t particularly want to do, but we know we need to do them. Very few of us enjoy mopping the kitchen floor, washing clothes, or paying bills. I may not enjoy these activities, but I know they are necessary in living an ordered life. I do want the peace of mind that comes when I’ve taken care of daily living activities, so I choose to do these things. I do not enjoy going to the Funeral Home, but I choose to pay my respects to my friend’s husband. While I may not enjoy doing this, it is something that I choose to do. This is not a “should” but rather a “want.” It is made out of an expression of choice.

The key word in this theory is “want.” What do I want? Many of us have spent much of our lives doing what others expected of us. We live and make our choices based on what others want. Many of us either have never asked the question of ourselves or, if we have, we don’t know the answer. Sometimes we don’t know because we’ve not allowed ourselves the question. This is either because of the guilt in putting the emphasis on what we want or no one was ever really interested in what we wanted. We didn’t know we had the option.  

I find that asking clients what they want is a key factor in helping their emotional growth. When they can’t identify these wants, we concentrate on what they feel. We can start by asking ourselves what is important to us. Is this activity worth my time or energy?  Is this something that I would choose to do? If they can start identifying their feelings, they’ll soon come to a recognition of what they want. Most of my turmoil that Christmas was that I knew what I didn’t want, but I hadn’t asked myself what I did want. I honestly didn’t know that that was an option.

What I’ve discovered through these years is that I have more choices than I thought. In some cases, when I no longer enjoyed an activity that I regularly participated in, I found ways to eliminate it from my schedule. I have also found that having a conscious awareness of the people that I value in my life allows me to be more proactive about spending more time with them. Acknowledging what I want allows me to make more definitive choices in my life. It has also forced me to look at how my choices affect others. All in all, knowing that I have the freedom to choose has given me the opportunity to experience a well-lived life. For that, I am very grateful.

Marriage through matchmaking was the original form of courtship, recorded as far back as the Bible, but the concept of finding a loving partner and getting to know them through dating before marriage has only been in existence since the late 1800’s to early 1900’s. This shift from parental and community decisions about who we spend our lives with to allowing freedom and exploration has never been as apparent as it is in this current era with online dating.

Dating online has had an interesting journey from the humble beginnings of paying for matchmaking services through match. com to its current state of freedom, hype, and confusion. Back in 2001, when match. com merged with love. aol, individuals paid $24.95 per month for a membership to take a survey and be matched with other singles with similar interests and values. Now people can hop onto one of countless, free “dating” apps, which all provide different ends. Most dating apps advertise as a way to help singles meet and find a life partner, but anyone who has ever explored them discovers they often have very different purposes. Certainly, there are a few people who meet their partners through these apps, but the more prevalent experience is that the apps provide some users with false hope and others with stories of frustration and even violation. 

For many Gen X-ers, Gen Z-ers, and other millennials, it has become obvious that the transition from meeting people at school, work, clubs, and bars to meeting them on the smartphone has had deleterious effects on the way we interact with potential partners. People are not only utilizing apps more, but they are becoming more averse to the “old fashioned” way of meeting others. Many younger people talk about the great risks inherent to meeting people at public places and saying things such as, “Well, they’re a complete stranger. Who knows what they may be like? I’d rather get to know someone first [via online chatting].”  

This change has impacted our public interaction in a way that has almost encouraged social phobia. The mentality that we can only feel safe meeting a potential partner if we text them for weeks in advance has led countless people down the rabbit hole of endless conversations that never led to an actual in-person experience. Contrarily, this behavior pattern has led many others down a dangerous path of false security with individuals who are pretending to want a connection when all that is desired is a sexual experience, are presenting as one person when they’re an entirely different individual, or the all-too-friendly bot profile which tries to trick app users into sending cash. 

In addition to these hazards, dating apps have enabled those who suffer from social anxiety to fully envelop themselves in a world where they never truly need to take social risks. They can gain the minimal social interaction they desire by interacting through apps, without ever actually meeting another person. They may feel socially fulfilled, but what they are truly doing is enabling their anxiety. Those who experience social phobia fear the scrutiny of others through social interactions, like meeting unfamiliar people, being observed while eating or drinking, performing in front of others, and acting in a way that is embarrassing. Meeting unfamiliar people, eating and drinking together, and risking embarrassment through personal exposure are all key elements of early dating. As exposure therapy has evidenced, engaging in behaviors that make one nervous, over time, lessens anxiety. Therefore, engaging in dating behaviors, safely and appropriately, inherently will help a socially anxious person gain control over that aspect of life and have more fulfilling life experiences. 

This is not to say that dating apps are all bad. They have merit in connecting others in ways unimaginable to past generations. If a single person wants to date and find a partner for life, dating apps can certainly be one option. However, users can be mindful not to spend too much time chatting online. Connect with a potential partner, find a safe public place to meet, and meet them. Daters can get to know potential partners in real life and make sure to set clear expectations for what is wanted out of the relationship. In short, today we can use technology to enhance dating, not to replace it.

Other options exist besides dating apps, though. It’s still possible to use more traditional routes of meeting a partner. If meeting at bars feels scary, singles can try connecting with a classmate or coworker – someone we can take our time getting to know, flirt with, and develop something special with in a structured environment. This may lead to building social skills, such as boundary setting, empathy, and cooperating, as well as reducing social anxiety. 

Finding a significant other in the real world can boost confidence. Real-life dating partners can see us for who we really are, not merely our internet identity, and this can feel incredibly validating. On the internet, we have time to come up with clever responses and confident self-statements, but in person we may be awkward and fearful that people will not take the time to get to know the real person that we are; this is understandable. But as we worry about deficits in our competence, we likely also under-appreciate what virtues and talents we actually possesses that may be attractive to a partner. By avoiding in-person relationships, daters can make ourselves inaccessible to growth opportunities, preclude further maturation, and becomes more dependent on the apps.

As daters, whether we choose to try dating apps or to engage with the people in our everyday lives, we must put our personal boundaries and respect first. To be sure, some people will be inappropriate partner options; they just aren’t the right fit. Others may actually be manipulative, deceptive, or simply unkind. But this does not mean we are unlovable or deserve mistreatment. Dating requires that we find the qualities in ourselves that make us unique and bolster them; bring them to the surface and show them proudly to the world. If we choose, we can promote this self-expression first through dating apps and maintain it throughout the process of making a real-world connection. Dating takes courage. Finding someone we want to spend our life with can take time – but this is OK. Though social media comparisons make us feel like there is a timeline for life, there is no rush.

I recently listened to a podcast in which a doctor referred to Attention-Deficit/ Hyperactivity Disorder, or ADHD, as a gift that needs to be unwrapped. As we come out of the holiday season, it’s hard to imagine such a gift being as popular as the ones that arrived from Amazon deliveries or trips to the mall. It’s certainly not a gift that anyone places on their list. But it’s important to remember that ADHD isn’t gifted only to those who were naughty rather than nice. It’s a gift that does not discriminate – despite prevailing myths, such as, “Only kids get it,” “People just need to try harder and get organized,” and “I don’t have it because I can stay focused for a long time when I watch my favorite shows on Netflix.” The true gift in realizing that you have ADHD is in the knowledge that you can do something about it to help you better control its effects on your life. 

What exactly is ADHD, and what does it look like? 

Attention-Deficit/Hyperactivity Disorder is a neurodevelopmental disorder. It’s caused by genetics and other biological causes, not bad parenting, too much screen time, or food additives. Not enough dopamine is produced in the prefrontal cortex, which leads to problems with executive functioning, impulse control, and emotional regulation. According to the DSM-5, there are three types of ADHD: inattentive, hyperactive-impulsive, and the combined type. 

Features include problems with paying attention, impulsiveness, and overactivity. Other traits include poor executive functioning, difficulties with organization, and struggling to stay on task or pay attention in meetings. Then there is cognitive hyperactivity, meaning that the mind has trouble winding down. You might have a difficult time relaxing and feeling that you’re always on the go, in overdrive, restless and impulsive. 

ADHD may also manifest itself through poor activation, or procrastination. You may get easily overwhelmed and shut down, especially when the activity is not in your wheelhouse or else seems hard or boring. Other ill effects include a poor working memory, a struggle to shift focus (especially when hyper-focused on something interesting) and poor emotional regulation – that is, frequent outbursts due to low frustration tolerance. 

Some gift! So now what do I do?

Remember, knowledge is the gift! If you identify with any of these behaviors and think that ADHD could be the reason, don’t panic. A good place to start is with your primary care physician. Along with assessment, lab work is often ordered to rule out thyroid disorder. Often, doctors recommend psychological testing to help rule out other possible causes of your symptoms.

If the diagnosis is clear, you could ask a psychiatrist to do a psychiatric evaluation to clarify the need for medication. Stimulant medication, such as Ritalin or Adderall, is not recommended for everyone, but is often worth trying, when you have a doctor that you trust to work with you to find the right medication and dosage. There are also many non-medication treatment options available, such as behavior modification, nutritional recommendations, and therapy, to name a few. A therapist who specializes in ADHD can help individualize a treatment plan that targets decreasing problematic symptoms, while increasing more positive habits and practices.

Treat yourself to this gift!

Without treatment, negative messages such as, “You can’t pull it together,” or “You’re such a bad parent!” can continue to imprint on your mind, leading to feelings of inadequacy, low self-esteem, anxiety, and even depression. So get help if warranted and “unwrap the gift” of knowledge about your attention deficit. Realize that your brain works in a different way, and with it come strengths, including the ability to think outside the box, be creative, multitask, be laser focused on what you’re passionate about, and be empathetic.

Life would be so much easier if everyone just got along, but at some point, each of us encounters individuals who behave in a manner that evokes anger, fear, humiliation, or a sense of powerlessness. This is especially challenging when the person is a colleague, supervisor, neighbor, client, or family member with whom we have to interact on a regular basis. Of course, behaviors that one person may find difficult may not be such a big deal for another. Whereas one person may have a strong negative reaction to an individual who behaves in a pushy, bossy, critical, or intimidating manner, another may get stirred up talking to someone who expresses strong religious or political beliefs with which they disagree. We may be able to sometimes avoid or decrease interactions with these individuals, but it helps to increase our ability to effectively navigate them.

Goal Setting

Our goals and objectives for challenging encounters depends on the nature of the relationship and what we want to accomplish. For a one-time interaction with an individual who is known to become volatile, our objective may simply be to communicate something important and obtain compliance without making the situation worse. With a family member who expresses very different viewpoints in a manner that makes us upset, our goal may be to remain calm, grounded, and curious, and to express our beliefs without expecting endorsement. We do not have to like the other person, we do not have to agree, and we do not have to change their mind or elicit an apology. We should try to resist the urge to judge or put the person in a single category according to something like politics or religion, because that can make things worse. Sometimes our goal is to acknowledge to the difficult person that our own view may be but one legitimate viewpoint among many. At other times, our objective may simply be to remain quiet, redirect, or distract rather than confront, or to restrict interactions with the person.

Planning Ahead

If we anticipate that a person will act in a provocative manner, it is important to choose the right time and place for conversations, and troubleshoot potential challenges in advance. Ensuring physical and emotional safety, maintaining the person’s privacy, and treating him/her with maturity, dignity, and respect are very important. Encounters can be planned to ensure built-in opportunities to take a break if needed. It may be important to ask a co-worker, supervisor, friend, or family member to be present during an interaction as an observer or participant, to increase our comfort level and assist if needed. It may be necessary to plan interactions in public areas, or keep our back to the door in case we need to exit quickly. During the conversation, it is OK to end a meeting quickly in a polite and respectful manner. We should avoid trying to reason with someone who appears to be under the influence of a mood-altering substance. Emotional abuse, including deliberate humiliation, threats, or derogatory name-calling, should not be tolerated. If at any time we feel unsafe, we should consider involving law enforcement, Human Resources, or other authority figure who can ensure safety.

Self-Awareness

It may be helpful to increase self-awareness of why a certain person evokes strong emotions, and what we may be inadvertently communicating to that person in our response. Sometimes an individual reminds us of a previous painful relationship when we felt the same fear, anger, shame, or sense of powerlessness. In situations where a person is difficult because he/she has very different viewpoints, it may help to remember that it is natural to have a strong preference for our own values and belief system because they help define our identity and what is important to us. Sometimes it is hard to acknowledge the different ideas of others in part because our strong emotions may interfere with logical or rational thinking, in the same way they may block reasoning for the other person. Talking about contentious issues in our highly polarized social environment is incredibly hard and complicated. Seeking support from a trusted confidant to process thoughts, feelings, and reactions, can help in gaining perspective.

Strengths-based interventions that increase our self-confidence may also lead to improved relationships. For example, making a list of our interpersonal strengths, coping abilities and past successes in interacting with difficult people, may help empower us. We can recall an experience in which we handled a challenging interaction in a way that made us feel courageous and self-confident, and then soak in and savor those pleasurable feelings immediately before we have to talk with an angry customer or co-worker.

If an interaction leads to us feeling rejected, criticized, or disrespected, these feelings may be reflected in our tone of voice, facial expression, or body language. We may avoid eye contact, scowl, or display irritation on our face, perhaps leading the other person to think we do not like him/her. We can increase awareness of how we come across to others and learn to modify our responses so they do not contribute to worsening of an individual’s provocative behavior.

Interpersonal Skills

Active listening, without being so overly focused on our rebuttal that we miss the message, gives people a sense of being seen, heard, and understood, which can be calming. As we listen, we can re-state the individual’s main point and validate his/her viewpoint or feelings. Validation simply means that we recognize and acknowledge where the person is coming from, even though we may not agree. Our instinct may be to try to calm the other person down by telling them to lower their voice, putting our arm on theirs, or some other similar gesture that may be appropriate in other contexts. But if someone is already upset, it may be better to avoid directives or physical touch, as it might be misinterpreted. Also, telling someone who is upset to be quiet and calm down may make the person angrier. Allowing some degree of ventilation as long as the person does not become emotionally abusive, may be helpful.

There are many considerations to help make decisions around when to avoid conversation, change the subject, or stand up for what needs to be said. It is helpful to build coping skills for tolerating distress and managing strong emotions so they do not cloud our thinking or interfere with our response. To delay responding immediately to an angry person, we can focus on taking slow, deep breaths, or using a mindfulness strategy of shifting our attention away from negative thoughts to the here and now.

Assertiveness skills such as asking for what we want, setting boundaries, and saying no when appropriate, help us take care of ourselves while effectively communicating our needs. Utilizing these skills during interactions with someone who exhibits bullying or intimidating behavior can be very challenging and requires practice. It is OK to limit conversation duration, frequency, and content, or to say, “That’s an interesting idea and I’d like to hear more but I have to leave now.” In some circumstances, it is preferable to use messaging or email communication, rather than face-to-face, although one has to be careful with wording, to prevent misinterpretation. At any time, after weighing out the pros and cons, it is OK to end the relationship.

Understanding Difficult Behavior

Using negative labels such as “arrogant” or “idiot” to describe a difficult person can narrow our perspective and contribute to emotional distress. It is more helpful to focus on the behavior and resist the urge to cast judgment with negative labels. There are great variations in the reasons why people behave in a provocative manner. The individual may have a mental health or substance abuse problem, or be reacting to life stressors such as loss of a job, divorce, death, financial setback, or other events. They may have a history of painful life experiences such as being bullied, victimized, rejected, or abandoned, and have developed a sense of having been wronged and a desire to blame others for those wrongs. 

Our understanding and empathy for how a person reacts to life experiences does not mean we are making excuses for bad behavior. We may still need to prioritize holding the person accountable for his/her behavior. But understanding can increase our empathy, compassion, and forgiveness, if those are our objectives. Forgiveness does not have to interfere with the pursuit of justice if harm has been done. However, it may help us to stop obsessing about past wrongs so we feel less angry or bitter about the other person.

Sometimes it is helpful to identify goals or interests that we share with the person, such as a sports team, a hobby, or type of music, which are all great neutral topics to discuss. Finding something we can agree on is a better place to start than jumping right into a disagreement or difficult topic. Acknowledgement of mutual goals can help build rapport and resolve conflicts, even if each of the parties have different ideas of how to achieve those goals. For example, an angry and volatile parent may share the same goal as a teacher: for the child to do well in school. Maintaining this focus during interactions may dilute the intensity of a challenging interaction.

Closing

Getting along with a difficult person often requires extraordinary effort and emotional energy, but can be managed successfully. Seeking therapy or consultation from a professional counselor can help you identify thoughts and feelings, gain perspective, build coping skills, and implement a plan for managing a relationship with a difficult person. If you are interested in getting connected with a compassionate and experienced therapist, please contact West County Psychological Associates at (314) 275-8599.

I’ll be honest…I put off writing this article. I, along with many helping professionals in the senior care field, have been feeling drained. There is so much to do and not enough hands to help. There is the ever-present time struggle to balance providing good care and documenting everything to satisfy insurance and licensure requirements. There is the physical, mental, and emotional energy we try to restore after work, yet we often enter personal caregiving situations for our families in addition to playing catch-up with paperwork or preparation for the next day.  

While this problem is not necessarily new – staffing has been an issue for a long time in healthcare – there are two new twists which are compounding the issue. First, never before has a generation aged into the need for care like the baby boomers are in line to do. According to the Population Reference Bureau (PRB) Aging in America Fact Sheet, “The number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65-and-older group’s share of the total population will rise from 16 percent to 23 percent.” The other new facet of this problem is that there has never been a shortage of caregivers like there is currently in the U.S. An article published in November by AARP, “Caregiver Shortage Felt by Older Adults,” reports that “3 out of 5 U.S. nursing homes have limited their admissions due to staffing shortages and nearly 3 out of 4 are concerned that they may have to close their facilities due to staffing problems.” These concerns are echoed by many in-home care agencies who are trying to staff the hours their clients need to stay safely at home.

The knowledge that the work we do is necessary is both reassuring and weighty. We have watched many colleagues leave in the past two years for employment that isn’t as taxing and pays the same, if not better, than what we make. So, why stay? Then again, why leave? We love what we do. We often can’t imagine ourselves in any other line of work, and the feeling that comes with a patient getting better is unlike any other. We are passionate about this career, and we have deep connections to our clients and to each other. In what other line of work would we get to listen to the stories of each patient or have the opportunity to witness some of the best parts of human nature?  

The main question is, if we continue to stay, how can we prevent ourselves from burning out in a system that is experiencing so much turmoil? Lately, I have been practicing the concepts of taking in the good and moment meditations. These ideas don’t take a great deal of time and can be done anywhere. Psychologist Rick Hanson has focused much of his career on mindfulness and the neuroscience of contentment.  He emphasizes the benefits of fostering a sense of gratitude and creating small habits to improve our outlook. At first, this may sound frivolous, but I have noticed a genuine improvement in my outlook when I practice these concepts. Let me share how I have implemented these ideas and habits in minor ways. I notice if I skip them too often, my days do not feel as productive and I feel more anxious.  

The first part of any good day of mine takes several minutes of preparation the night prior. Before I go to bed, I program my coffee maker so that I can wake up and go to the kitchen with a fresh pot of coffee ready. In the morning I get up, head to the kitchen and intentionally choose a mug. I take a moment to appreciate the mug I’ve selected (most mugs in my collection are a gift from someone special, a memento from a trip, are a color I enjoy, or contain a fun graphic). I pour my coffee, smell the aroma, and take a sip. I turn to look at the side of my fridge where I have a collection of holiday and birthday cards, birth announcements, inspirational sayings, and silly magnets. I take it all in and reflect on the good people in my life. In total, this practice from start to finish takes about two minutes. Then, I run around to get myself and family ready for the busy day ahead. The beauty of it is, I know I will have this calm moment again tomorrow, the day after, and so on. It’s my built-in moment of gratitude and mindfulness to start the day off well.

A second practice I do throughout the day is to try to give myself two options, no matter how small the decision may be. This helps me feel grounded and reinforces a sense of security within me. For example, I keep two different scented soaps in the bathroom to choose from, I ask myself if I want to return a call or check my email when I have a few minutes between clients, and so forth. I am choosing to write this article now (you may recall I put it off previously) rather than write up a treatment plan. We have many opportunities to choose small paths throughout our day, and it is important to remind ourselves of the power we have to choose. These small moments do add up.

Meanwhile, I work toward acceptance that we operate in an imperfect system for the time being. I remind myself that I will continue to do the best I can for the clients and families that are in my care. I will show up, assist where I can, and appreciate the many beautiful people I work with each day. I will continue to consult with my colleagues for the well-being of my clients, as well as for my own mental health. I hope these ideas help you as you continue your wonderful work. Please reach out to us at WCPA, (314) 275-8599, if we can help you or your team gain additional support.

Caregiving for an aging loved one is difficult at any time of the year, but the winter months bring a unique set of physical and emotional challenges for caregivers and their elderly loved ones. Winter’s cold temperatures, ice, and snow not only increase the risk of injury and illness, but often lead to depression and anxiety. Additionally, winter holidays and more frequent isolation can elicit feelings of grief for losses of loved ones over the years and wistfulness for winters past. So, how can caregivers and their elderly loved ones stay healthy and positive while facing the challenges of winter?

Older adults are greatly impacted by “the winter blues.” Freezing temperatures and fewer daylight hours contribute to increased feelings of isolation and depression. It is more difficult for older adults to safely navigate the community they live in and, as a result, many opt to stay at home rather than risk facing potential hazards outside. During this time, I commonly hear clients ask themselves, “How did I get to the point where I can’t rely on myself to get what I need?” They may find themselves grieving for their former healthy selves in addition to grieving for lost loved ones they could rely on during difficult times. Furthermore, many older adults who do not have a consistent caregiver in their lives feel that they are left to fend for themselves during the winter, ultimately leading to increased feelings of hopelessness and helplessness.  

Similarly, caregiving in the winter is particularly demanding. Not only do caregivers perform their routine responsibilities for their loved ones, they also have to make accommodations for weather issues. Taking a loved one to a doctor appointment often becomes more stressful and time-consuming due to winter-related factors such as additional driving time, potential mobility issues for their loved one when getting to and from the car, and working to keep their loved one calm under these circumstances. Caregivers also tend to worry more about their loved ones in winter when risks for illnesses such as pneumonia, heart issues, and falls increase. These pervasive worries over time can further compound caregiver stress. When we combine these caregiver stressors with increased rates of Seasonal Affective Disorder (a type of depression related to the changes in season) in the winter, it is no wonder that many caregivers often feel exhausted and depressed.

With all of these challenges, how can older adults and caregivers overcome the “winter blues?” First, it is essential for caregivers and their elderly loved ones to rely on their support systems as much as possible during these months. Strong support systems not only help us fulfill our responsibilities, they also foster a sense of connectedness and reduce isolation, often alleviating depression. Asking a friend or family member to help with something such as frequent short phone calls to check in on a homebound loved one can make a positive impact on the older adult’s mood and help ease a caregiver’s mind. Additionally, coordinating an older adult’s transportation schedule among family and/or friends can help the older adult access what they need during winter (such as trips to the grocery store or pharmacy). This coordination can take stress off of one caregiver who is juggling multiple tasks.

It is also imperative to practice good self-care during the winter months. Eating well, staying hydrated, exercising, resting, and staying up to date on doctor appointments are important for overall well-being of both caregivers and their loved ones. It is important to remember that good physical health of a caregiver makes for better quality care of their loved one.  

Another way to combat the” winter blues” is through therapy. If caregivers or elderly loved ones continue to experience symptoms of depression or anxiety, counseling often provides relief. Counseling offers the opportunity to talk through the difficulties in life, process grief and loss, and discover how to move forward. Experienced therapists at West County Psychological Associates offer on-site counseling to relieve older adults and caregivers of the often difficult task of transportation during the winter months.

Since the winter months are commonly a struggle for caregivers and their elderly loved ones, it is essential for caregivers and older adults alike to practice good self-care, stay connected to social supports to reduce isolation, and ask these social supports for help when needed. Sometimes, even when practicing these “winter blues” survival essentials, depression, anxiety, and isolation can become unmanageable. A counselor can be a valuable asset to help process through these difficulties and move toward a warmer future. 

Disclaimer and Trigger Warning: The author is a Licensed Clinical Social Worker, not a registered dietitian nutritionist (RDN), and mentions of Binge Eating Disorder occur.

I always enjoy as the holidays come around each year, and I again have an excuse for doing more of one of my favorite hobbies: baking. In the winter months, I’m flooded with warm memories from my childhood of the one day each year my family and I would come together to bake and decorate cookies. For me, the sweet smell of chocolate chip cookies and the dusting of powdered sugar everywhere is a treasured memory. (In all honesty, it meant a lot to me because it was the one day a year my mom didn’t mind when the kitchen got messed up.)

Yes, the holidays can be a joyous time, but for many of us the season also invokes a great deal of stress and anxiety related to family, finances, and finals. For someone struggling with Binge Eating Disorder, holiday stressors may lead to feelings of genuine distress.

Binge Eating Disorder is defined by having three out of five of the following symptoms, that have lasted at least three months:

1. Feeling that you’re unable to control your eating.
2. Eating large amounts of food, even when you’re full or not hungry.
3. Rapidly snacking during emotional episodes.
4. Eating without focusing on your food.
5. Frequently eating alone or in secret.

Eating can be hard around the holidays, especially when family members feel entitled to make comments on your appearance or the size of your dessert plate. While yo-yo dieting around the holidays or watching your weight may seem normal in our hyper-fixated eyes, it’s important to know the difference between making healthy choices for ourselves and restricting. The billion dollar diet industry has created a narrative telling us to cut down on carbs and that sugar is the enemy. The industry says that the latest diet fad is the best and that our calories should be tracked; that dessert should be a sometimes-treat (but, truth be told, food should not be looked at as a reward, because food is fuel.)

For those wanting to change their relationship with food and their body, intuitive eating can be one good strategy. Tune in to what food your body wants and what sounds unappealing. People who restrict foods, as with dieting, often find themselves on the road to a restrict-binge-repeat cycle. Restricting calories leads to feeling deprived, because your body is not receiving what it needs nutritiously, which beelines to feelings of guilt and shame, binging and using food as a coping mechanism. Thus, the cycle repeats itself. 

Instead, tune in to your body to gauge accurately the differences between your hunger and appetite. Hunger is when you feel your body needing food and appetite is the desire to eat. While this may seem simple, for some people it can be challenging to differentiate, due to our busy lives, being checked out on our phones or even just missing that healthy window of hunger. Practicing mindful eating by shutting down all distractions in order to fully enjoy what you’re eating; this can help you feel more satisfied. Slow down your eating in order to allow your stomach to send signals to the brain that say you’re full. 

Other suggestions are to try “eating the rainbow” by getting a variety of fruits, veggies, protein, carbs and fats throughout the day. Remember, there’s no need to restrict any food groups unless there are health reasons to do so, despite what diet gurus and influencers may tell you. Skipping meals can lead to a lack of impulse control and overeating as a whole. Another tip is carrying a snack bag in your car to use for emergencies, such as when you are stuck in traffic, have no time to prepare food ahead of time, or need a food option that’s on the run. Items in the snack bag can range from bananas to granola bars to Flamin’ Hot Cheetos. Yes, read that again. I did say Cheetos – because I don’t restrict and sometimes I want Cheetos.

Changing your relationship with food can be hard, but it’s a journey worth taking. Your body deserves to be nourished and replenished throughout the day. After all, it does so much for you. Don’t let others tell you what you can and can’t put into your body, because at the end of the day, you know yourself better than anybody else. So enjoy the holidays and focus on the fun, not the food.

If you or a loved one is struggling with a Binge Eating disorder, keep in mind that help is available. Individual therapy with a trained professional can help change the negative thoughts and behaviors that impact your relationship with food. An individualized treatment plan starts with raising one’s awareness of what happens before, during and after binging, while self-soothing and overcoming barriers to eating in moderation.

One of my adolescent clients recently had an epiphany during our session: social media is not real. As we discussed all the ways she felt her peers were surpassing her academically and socially, she stated, “You know what I just realized? What people post on social media is not a real representation of their lives. People are only posting the best version of themselves.”  I excitedly agreed with her. I encouraged her to pursue this train of thought. She furthered that people do not post every time they try something new. They only post when they have finally succeeded at something, whether it is academic, like a standardized test, scoring in sports, or starting a new relationship. My client appeared relieved to understand this phenomenon.

I have since discussed this warped perception of social media with others, who have all agreed that this issue extends beyond our youth. In our 20’s, we hear sensational stories of strangers meeting online and it being kismet, while we ourselves spend months, sometimes years, talking to other “singles” through dating apps, who end up not actually being single or they ghost us. We can become demoralized by these experiences, blaming ourselves for being unlovable and defective. 

In our later 20’s and 30’s, we begin seeing our peers posting videos of their glamorous weddings and beautiful babies and we start to feel like we are losing time on meeting these milestones for ourselves. In our 40’s through 60’s, we see happy couples with successful children who go on fabulous vacations with them and we lament over our imperfect lives, tricking ourselves into believing that our intimate relationships are toxic, our children are not living up to their potential, and we are simply not measuring up to others. In older adulthood, we see posts by our friends visiting with their grandchildren and we become lonely due to having no grandchildren or resentful to our own families for not giving us enough attention.  

We, as humans, naturally thrive when we connect with others, which has been enhanced by social media. In the not so far past, changing schools, jobs, or communities meant losing touch with relationships we cherished and sometimes struggling to find the time or energy to cultivate new ones. Now, we have access to quick and easy connections through chat rooms, dating apps, and other social media. What an exciting innovation in how we develop lasting relationships!

These conflicting observations are bolstered by research conducted by Akram and Kumar (2017). They propose that technology and social media has granted our population with many positives and negatives in realms of business, education, society, and kids and teens specifically. For societal positives, they report connectivity, education, gaining help from others, obtaining information and updates, advertising small businesses, promoting noble causes, and building communities, which are all beneficial to a great degree. However, they report some severe negatives such as cyber bullying and harassment, hacking, fraud, addiction, and the ability to completely destroy someone’s reputation, whether with factual information or through slander.  

Although there are negatives to social media, it has provided us a global environment from which to absorb information and reach people who we would never have been capable of knowing before. It has also increased the number of relationships we can collect to virtually limitless proportions. Pragmatically, when we only knew 50-100 people, it was not so hard to learn the good, bad, and ugly about most of them. Now that we have hundreds of friends or followers, it is hard to imagine intimately knowing many at all. 

All humans desire acceptance, so when we only have seconds to present ourselves to these infinite others, it makes sense that we would choose to share the most positive representations of ourselves. We want to be perceived as interesting, funny, good students, good parents, etc. But the problem comes when people start to believe that what is presented is reality. Because they never see negative stories, it feels like those negative stories do not exist.

If people shared their lives inclusively, and not just phenomenally, we might begin to debunk this myth that everyone has it better than us or that we are not good enough. Instead of envying others and disliking ourselves, we might learn from each other and grow into people who truly engage with those around them and have healthier relationships and identities. 

And in the meantime, when we begin feeling bogged down by other people’s posts, we may benefit from taking some time away from our technology and engaging in the experiences all around us, with the people we care about most. Being fully present with our closest relationships can be one of the best deterrents for negative thoughts and promotors of positive perceptions.

“We are all going to depend on something!” “What is that giving you that you are not getting?” The former statement is one a colleague shared with me in a conversation years ago, the latter is a question I often think about when I work with clients who have addictions. They both provide a nice segue into the question, “What is addiction and how should it be treated?”

We have known for years that alcohol and drugs can be addictive and our current opioid epidemic reminds us of the serious nature of drug addiction and its consequences. Our collective consciousness has grown in recent years to understand the many things or behaviors to which one can get addicted, including gambling, sex, food, shopping, social media, video games, and people, to name just some. While addictions look very different on the surface, common dynamics are at work.

All addictions include a loss of control. The person is not able to control the amount they engage in the behavior through their own will. So, for example, the alcoholic may think they can limit their drinking to one beer per night, only to find out that they ended up drinking eight. The individual who binges food may tell themselves they will only have two Oreos, only to eat a sleeve of them. Similarly, the person addicted to video games may think they can limit their play to two hours, only to play all night. 

An inability to stop the addiction through one’s own volition is another hallmark of addiction. The individual may cease the addiction for a certain period, only to pick it up again. Sometimes, one can stop for an extended time, but does not address the underlying problems that fuel the addiction. This is commonly referred to as “white knuckling” and includes hurtful behaviors. 

All addictions are cyclical. They often begin with a preoccupation with the object or behavior and lead to certain rituals and behaviors. For example, those addicted to alcohol will be preoccupied about when and how they will drink, and sometimes, with whom. Those addicted to video games will be preoccupied with when and what they will play, leading to the ritual of playing a certain and predictable game for an uncontrollable amount of time. The preoccupation, rituals, and then addictive behavior are inevitably followed by negative feelings and diminished self-esteem which, in turn, starts the cycle all over again. 

Often, I tell clients that addiction is remarkable and clever, for it is a coping mechanism, a way of trying to deal with feelings and the need for healthy dependency and purpose. Yet, the very feelings it attempts to cope with (shame, guilt, depression, resentment, and anxiety) and an unhealthy dependency are what it creates more of. While it is a survival or coping mechanism, it simply does not work in the long run and creates more problems. 

Addictions negatively impact very predictable areas of one’s life. Because the individual is consumed by the addictive behavior, they are less available to relationships with significant others, friends, family, and colleagues. Legal or job problems can occur due to the amount of time spent in the addiction or its consequences. One’s sense of self is also eroded. The individual’s access to their feelings, hobbies, leisure, and general enjoyment of life are dampened and, sometimes, extinguished. In short, the person’s dependency on the object of addiction narrows all aspects of their being and relationship to the world. Addiction is the negative outcome of the dilemma, “We’re all going to depend on something.”

The only lasting way out of addiction is to work through the feelings one avoids and copes with through the addiction in the context of healing relationships. Yet, to do this one must be in a solid position with adequate internal and external resources. The nature, the progression of the addiction, and the individual’s level of support, determine the appropriate level of care. Some may require a period of inpatient treatment for stabilization and to help them gain the ongoing resources for recovery. Those whose addictions are serious, but do not require the most intensive treatment, often find that intensive outpatient treatment can provide the needed support, education, and resources to help them with their ongoing recovery. Often, therapy and 12 Step groups provide adequate structure for recovery and provide the best prognosis for long-term recovery.

Psychotherapy can provide a healthy dependency to counter addiction. Therapy should facilitate an exploration of healthy and unhealthy patterns, their origins, and the underlying feelings that fuel these patterns. It can support the expression of feelings by being the “container” to hold them without concern for repercussions. 

Sometimes, 12 Step groups are needed – they provide a unique function. These groups provide a safe and non-judgmental place to share with others who struggle to learn that one is not alone with the addiction or its consequences. This can help neutralize the feelings that fuel the addiction. Support from a trusted sponsor in the program, someone who has significant recovery from the addiction, can provide tools and a road map to recovery. Working the 12 Steps can help heal aspects of one’s character that contribute to the addiction. The various aspects of the program can provide the healthy dependency that counters addiction.  Both 12-Step groups and therapy can lead to an experience and recognition of what healthy relationships and dependency are, which, in turn, can lead the individual to create healthy relationships and find purpose and meaning in their broader world. 

There is a dialectical tension between healthy dependency and finding one’s place in the world. The healthy dependency created in therapy and 12 Step programs, as they help rework patterns, character, and underlying feelings, inevitably leads to greater satisfaction in one’s broader world. Recovery from addiction in this way can lead to satisfying relationships, relationships that allow for mutuality in terms of sensitivity to one’s needs and feelings and a commitment to work through conflict to arrive at a deeper understanding of the other. 

Recovery can also lead to a newfound or renewed sense of purpose. Being freed from the addictive cycle and the weight of the underlying feelings leads to greater vibrancy and a new vision in whatever one does: parenting, volunteering, working, etc. This successful outcome is captured in the often-shared statement by those who recover, “I don’t need that anymore (the addiction). I’m high on life.” The mood-altering experience, or high, of addiction is no longer needed, as it has been replaced by a deeper satisfaction with loving relationships and accomplishment. This is the “what” the addiction can never give that can be gained through hard work and the right help.