Loss of A Beloved Pet

March 23, 2016

The loss of a pet can be devastating.  Animals love us wholeheartedly – something that we can not find often in human relationships.  The connection between a human and an animal is profound.  We feel connected and loved.   Losing that relationship can be an agonizing experience and often the loss is not validated by others who simply have never had a pet or who just don’t understand the significance of the loss.   The grieving process is the same as if one has lost a significant other – a spouse, a family member, a close friend.   Losing a pet can result in one feeling alone and isolated – misunderstood.

EMDR can be helpful when one has lost a pet – particularly if the loss is experienced intensely as is often the case.  The combination of supportive counseling and EMDR is ideal in helping the individual manage the intense grief.  Another option is participating in a group specifically focused for people who have lost their beloved pets.

In addition, individuals who are dealing with illness of a pet or an aging pet often struggle with anticipatory grief.  A group that consists of others in the same situation can be very helpful to lessen the anxiety that accompanies the dread of losing one’s animal.

Death is a part of life – we all know that intellectually.  However, when we lose someone significant – a person or an animal who we have loved and who has loved us, we mourn. Grief is normal but we don’t have to do it alone.



Mind Body approach to Fertility

December 15, 2015

Struggling with infertility is truly one of the most difficult challenges  a woman can face.  It seems that everyone around her seems to be having babies easily, yet she continues to struggle with no success.  Infertility is not validated or discussed much in our society.  Often people feel awkward with the delicate nature of the issue and this can create a feeling of isolation for the woman who needs support more than ever.  In addition,often people, through their insensitivity, ask invasive questions like ” Hey, when are you going to get pregnant?”  Parents who want to be grandparents can unknowingly cause additional stress and pressure.

Mind body approaches to fertility are enormously helpful to the woman who is experiencing fertility issues.  In my 10 week psychoeducational program, we focus on learning deep relaxation, meditation, mindfulness and learn ways of working with negative thoughts that hold one back from living a quality life.   Members of the group support one another but it is NOT a support group. Rather, this is a group that helps women go through the fertility process much easier and facilitates pregnancy as supported by much research.

Over the years, the majority of women who choose to learn and practice mind body approaches find joy once again in their lives and go on to be mothers.









EMDR: What is it and How can it help you?

October 27, 2015

EMDR, or  Eye Movement Desensitization and Reprocessing, is a non-invasive therapy approach in which early memories or incidents that are held in the nervous system are processed.  The therapist and the client identify a difficult or traumatic memory or incident that is still impacting the client in the present and the memory or incident is then processed using eye movements.  The processing of the memory allows the release of the memory and a more positive state of mind is achieved.  EMDR has the potential to achieve results in much less time than it might take in “talk therapy.”  The American Psychiatric Association identifies EMDR as the #1 treatment of post traumatic stress disorder.  Although very effective for PTSD, EMDR is also effective for many issues including panic disorder, anxiety, depression as well as many other clinical issues.

Talking back to the What-ifs

June 2, 2012

Fear can be a paralyzing emotion.  The What-ifs play a big part in fear.  One scenario might be that you are considering a new job which will take you to a brand new place where you do not know anyone.  You feel excited and you think you want to take that job. You visualize starting a brand new life, finding new friends, exploring new areas and you begin to feel your pulse quicken. Very quickly, the what-ifs come into the room and take over.  They say things like what if you don’t like it there , what if you find yourself isolated and you don’t meet anyone, what if the job turns out to be not at all right for you and you’ve given up what you had?  Soon you could find yourself in the land of extreme self-doubt and fear and all of those wonderful, exciting emotions have been replaced by worry, anxiety and fear. Trust your instincts. Step out of the fear and take a chance. Listen to that excitement and start dancing. Life is calling.

Loving kindness: A powerful practice

March 31, 2012

Loving kindness or metta is an ancient Buddhist practice of giving compassion to oneself and others. Sounds simple?  Not really. Giving compassion to oneself is not what most people do.  In fact, there is a billion dollar industry built on books on self-improvement. If we stroll down the self-help section of a Barnes and Noble, we find shelves of books on how to be better human beings, how to look better, how to prevent aging, how to achieve the perfect body, how to have better relationships etc.  We get the message that whoever we are or whatever we’ve done in our lives is clearly not good enough.

It’s so easy to be critical of ourselves and others. Loving kindness is acceptance. A loving kindness meditation I practice and teach is:

May I be filled with loving kindness

May I be well

May I be peaceful and at ease

May I be happy

When you practice meditating on loving kindness first for yourself and then for others, you begin to develop more compassion and acceptance. It doesn’t happen overnight but gradually, the message gets through. We can stop trying to improve and love and accept ourselves just as we are. We also learn to accept and love the other people in our lives.

Antidepressants: Do you really need one?

March 18, 2012

CBS Sunday Morning this morning aired a piece on the rampant use of antidepressants in the United States. An astounding 30 million people in our country  take antidepressants. Yet, as pointed out in the program, we are not all walking around deliriously happy.

Why is that?  There are several explanations for the overuse of antidepressants. One thought  is that people are often prescribed an antidepressant when they are only mildly sad or slightly depressed. Primary care physicians prescribe antidepressants along with antibiotics and many other medications, and since they have not been trained in psychiatry, too often they write a prescription based on the patient’s report of feeling a bit depressed.

Pharmaceutical companies advertise directly to consumers. A commercial for Cymbalta sends this message: “Not feeling like yourself? You could be suffering from depression. Cymbalta can help.”

Antidepressants are very helpful if the diagnosis is truly depression.  People who suffer from moderate or severe depression benefit from medication. Individuals with mild depression or sadness do not respond to antidepressants. A recent JAMA study shows that the effect of antidepressants in this group are only slightly more effective than placebos.

If you feel that you are suffering from depression, seek the help of an experienced psychiatrist or psychiatric nurse practitioner for a complete evaluation and assessment.

Beginning a meditation practice

March 5, 2012

I remember when I first started a meditation practice. I had been diagnosed many years ago with a left bundle branch block—a benign rhythm problem in the heart that thankfully does not require treatment. I had always enjoyed good health, and I felt alarmed. As soon as the words “you have a bundle branch block” came out of the cardiologist’s mouth, I felt anxious and totally unprepared for a diagnosis of any kind. I immediately sought the help of a psychologist colleague who began to teach me relaxation and meditation to cope with the anxiety. Every day, as I now teach my patients, I spent 20 or 30 minutes just sitting quietly and repeating a comforting word silently. When my mind wandered, which it always does for everyone, I tried to bring my mind back to the focus of the word I was repeating silently. Although it was tempting to look for results, I avoided that temptation since all the books I was reading about meditation counseled me to stay in the moment. Over time, I began to feel calmer, more focused, and generally more content. I would designate the early morning for my meditation practice where I would sit in a comfortable chair in my living room and simply meditate and spend time with myself and my mind, which never seemed to tire of finding silly things to think about.

You don’t need any special equipment and you don’t need to ponder what word you are going to repeat to yourself. Attempting to find the “perfect” word is simply a form of distraction. All you need is a comfortable chair where you can sit upright in what I refer to as a “posture of dignity” and the absence of any noise or distractions. You can start at 10 minutes if you like and work toward 20 and eventually 30 minutes. Try not to be discouraged by your mind wandering since this this is totally normal. You will notice that the mind does not necessarily wander to brilliance but rather thoughts like “I need to go to the dry cleaners” or ” I should call Susan” or “What do I want for dinner tonight?”—just everyday thoughts that arise. Simply notice the thought and let it go as best you can. I frequently refer to seeing the thought as a beautiful fluffy cloud on a lovely summer day, and I watch it merely drift on by. By all means, be kind to yourself. This is a new practice that could change your life.

What exactly is a Psychiatric Nurse Practitioner?

February 23, 2012

I am a Psychiatric Nurse Practitioner, but many people don’t know what that means. For example, many are surprised to hear that I prescribe medications. A statement I frequently hear is ” Wow, I had no idea you can prescribe!  I thought only doctors do that.”

So, I would like to explain more about my profession.  In terms of education, a nurse practitioner has graduated from a Master’s program in Nursing. I received my degree from Columbia University and then went on to do post-graduate training in Family Therapy and Mind Body Medicine.  I also completed a Fellowship in Pain and Palliative Care at Memorial Sloan-Kettering Cancer Center.  Nurse practitioners are called mid-level practitioners.  That means that we don’t function as doctors or nurses.  Many psychiatric nurse practitioners like myself establish private practices where we see patients for psychotherapy as well as medication management.  In my practice, I often see patients for initial evaluations in order to determine if medication is appropriate.  Often, patients are referred to me by other mental health professionals but are also referred to me by other patients with whom I have worked.

How does a psychiatric nurse practitioner differ from a psychiatrist?  To begin  with, our education and training are somewhat different.  In nursing education, health is stressed rather than illness.  Everything that has an impact on someone is important to the nurse practitioner.  A person’s living environment, relationships (or lack of relationships), health habits, genetic history, family influences, financial status, and job-related and personal stresses are all taken into consideration when an evaluation or assessment is done.  All of these factors contribute to a person’s well-being or lack of well-being.

Psychiatrists are medical doctors who decide to specialize in psychiatry, and although medical education is changing, the focus has been primarily on the disease and illness medical model rather than on a model of health.  Psychiatrists in the 21st century mostly function as psychopharmacologists; a patient comes to them specifically for medication, and in a short 15-minute follow-up visit, the patient’s medications are the sole focus of the visit. Psychotherapy is typically handled by other mental health professionals, including social workers, nurse practitioners, marriage and family therapists, and psychologists.

What can a psychiatric nurse practitioner offer someone who is seeking help? The answer is comprehensive care that takes into account all aspects of the person’s life.  When seeking the help of a psychiatric nurse practitioner or a Psychiatric APRN (advanced practice nurse in psychiatry), inquire about whether the practitioner is board-certified.  Board certification means that the individual has passed a certification exam that tests for competency and thorough understanding of psychiatry and psychiatric care.

When and how to take anti-anxiety medications

February 18, 2012

Benzodiazapenes or anti-anxiety medications are very effective in treating anxiety.  Xanax, Klonopin and Ativan are the most commonly prescribed medications for panic disorder and generalized anxiety.  However, all of these medications, while effective, are only to be used on an “as needed” basis.   They are best used for the relief of acute anxiety and not for chronic use. While anti-anxiety medications are not physically addictive, people can develop a psychological dependency on the medication and not make a choice to cultivate and learn other ways to cope with anxiety.  Approaches like a daily practice of relaxation techniques, yoga, mindfulness  and meditation, when practiced on a regular basis,  are excellent ways to deal with chronic anxiety.  In working with patients and teaching relaxation and meditation, I have seen that medications are often not needed at all anymore.. We are reminded once again with the recent death of Whitney Houston that, although the cause of her death is still unknown, it is known that she struggled with prescription drugs as well as other substances and that she may have combined anti-anxiety medications with alcohol – a truly dangerous and potentially fatal combination.  When used properly and with caution, these medications have a place in treating anxiety for short-term use.

How do I know if I need an antidepressant?

January 27, 2012

One out of six people in the United States have experienced clinical depression.  However, only 50 % of people seek treatment – thinking they can “tough it out.”  So how do you know if you are depressed and need treatment? The typical signs and symptoms of depression include sleep difficulties -typically,  sleep interruptions during the night, changes in appetite, lack of libido, difficulty concentrating, irritability, feelings of worthlessness, guilt or hopelessness.  The good news is that depression is treatable by the use of  antidepressants and psychotherapy.  An antidepressant can be prescribed by either a psychiatrist or a psychiatric nurse practitioner and there are many effective antidepressants to choose from. Most of the newer antidepressants are well tolerated with few if any side effects.   The combination of medication and psychotherapy has been shown to be the best treatment approach for depression.  The good news is that help is available and you will be feeling significantly better – there is no need to suffer.