Tuesday, October 8, 2013

The Effect of Literary Fiction on Mentalization

Almost everyday I start my day by reading/skimming through daily news. A few days ago, as I was practicing my "habit", one headline in the NPR website, caught my attention: Want to Read Others' Thoughts? Try Reading Literary Fiction. (You can read the article here.)

In the NPR article the emphasis was on the effect of reading literary fiction on someone's capacity for empathy. Empathy being considered as an important social skill. First I was very interested in what the article would say, but then I became kind of disappointed since the article was not substantial enough for me and my final reaction was "duhh"!

When we read a novel or a short story, we tend to identify with the protagonist.  We put ourselves in the protagonist's shoes and feel the pain, joy, disappointment, sorrow, triumph etc. That is what makes reading fiction so exciting and fun in the first place. The researchers mentioned in the NPR article implies that this is basically an "exercise in mind-reading and mind construction". This was precisely what gave me the courage to talk about mentalization in relation to reading literary fiction.

Mentalization is a new term in the field of psychology. It is not yet in a regular dictionary. What it means is simply thinking about our thinking and other people's thinking. When we think about what we think and feel in a given moment, we interpret the whole process of thinking-feeling-behaving and see the connections between them. Therefore, mentalization is the basis of emotional regulation and self-control. In impulsive individuals, be it a child or an adult, there is no thinking between impulse and action, which can impair interpersonal relationship. Another important aspect of mentalization is to recognize the fact that other people have their own mind and they might think differently than how we think.

When reading stories or fictions to children, a simple exercise to help them develop their capacity for mentalization could be to stop and ask them what they think the characters in the story might have in mind; what they think will happen next; and why they think so.  That way we are actively engaging them in the process of thinking about other people's thinking, while at the same time encouraging them to form their own mind.

One distinction that needs to be noted here is that mentalization is not about cognitive skills.  It is about understanding our mental state in a given moment and increasing self-awareness as well as awareness about others. These are the cornerstones of emotional intelligence, which is the main ingredient of a successful and happy life. Therefore, when reading a literary fiction, intentionally thinking about characters' thoughts, feelings and actions gives us the opportunity to understand human behavior in general while providing clues to us about how to approach others in daily life.

Friday, September 27, 2013

ADHD: Myths & Facts

I have been working with children for many years now and if you asked me what issues I see them  the most for, my answer would be ADHD (Attention Deficit/Hyperactivity Disorder) and related behavioral problems. The typical age that a child is diagnosed with ADHD is somewhere between five to eight, which means, at the time the behaviors interfere with the child's learning at school. Although there is a lot of information out there about ADHD, some misconceptions still persist. In this post, I will try to clarify some of them.

  • Myth: ADHD is just a lack of willpower. Persons with ADHD focus well on things that interest them. 
    • FACT: ADHD is essentially a mental disorder with strong biological components. It is not a matter of willpower or desire, but a matter of ability. 
  • Myth: ADHD is simply a label for behavior problems; children with ADHD just refuse to sit still and are unwilling to listen to teachers or parents.
    • FACT: Three major symptoms of ADHD, namely "inattention", "hyperactivity" and " impulsivity" cause some problematic behaviors that impede learning, concentration and social interactions. That in return reduces the person's chance for positive experience at home and in school. 
  • Myth: ADHD is a childhood disorder and children usually outgrow it as they enter their teens.
    • FACT: Most people do not outgrow ADHD magically. They continue to struggle with the disorder, however the symptoms might be different. For example, hyperactivity tends to diminish in time. Inattention, on the other hand, may be disabling the adult with ADHD without proper self-management skills in place.
  • Myth: Medication for ADHD is likely to cause substance abuse or other health concerns, especially when used by children.
    • FACT: Research shows that there is no indication that taking stimulant medication leads to substance abuse/addiction. For more information please click here to read an article from ADDitude magazine. 
  • Myth: ADHD does not cause much damage and is not really a big deal.
    • FACT: Untreated, people with ADHD typically struggle in all areas of life. This disorder severly impairs learning, family life, education and social interactions. Many experts agree that an adequate treatment should consist of medication and psychotherapy simultaneously in order for the person with ADHD to learn self-management skills. 
To my observation, a big dilemma for parents with children with ADHD is whether they should "medicate" their kids. This is certainly not an easy call. Some parents first try to manage the situation by structuring their home life, which is quite helpful. In school, they cooperate with teachers to help them find the best behavior management system for their  offspring. However, in severe cases, medication is necessary along with all these strategies mentioned above.  If you closely work with the prescribing physician (your PCP, pediatrician or a child psychiatrist) to find the right type of medication and the dosage, your child will be able to be successful in school, to have a better sense of self and to develop better social skills. However, remember,  it is not the medication per se, but the effect of medication on the child's brain to use his/her executive functions combined with a series of "skill-building" in therapy  that makes the difference. A child with ADHD using medication is more able to listen, take in, observe, make connections & inferences and conclude. Therefore, such a diagnosis is not the end, but rather the beginning of a course of action that you need to consider to take to help your child blossom to be who she/he could be. 

Sunday, September 8, 2013

Neuroscience and Play Therapy

Neuroscience sounds like a big word. However, simply put, it is the science of the brain, or more specifically, of the nervous system. Of course, we can not ignore the complexity of this vital organ. The brain consists of many parts and systems, which orchestrate the whole body and mind.  Although the term "neuroscience" was coined in 1960s, the research on brain, nervous system and behavior goes back to antiquity. 

So, what did we learn from the modern neuroscience that is relevant to the title of this post?

To me, the most striking information is the neuroplasticity of the brain, which means the brain is not a physiologically static organ. It has the capacity to change throughout life based on experience. What that means is environmental changes could alter behavior and cognition by modifying the connections between existing neurons and also through neurogenesis (birth of new neurons).

Exposure to trauma/traumatic events affects brain functions. Which part of the brain is affected the most depends on the developmental stage of the individual at the time of traumatic experience. If a person was socially-emotionally traumatized during the first year of life when the development of the brainstem is in full-swing, we might see problems in metabolism, hyperarousal or sensory perceptual problems rather than cortex or limbic based issues of guilt, identity, personal awareness, coping skills, etc. Although regions of brain that are immature and developing slowly are less likely to be severely affected by an early trauma, the affected lower brain structures often lead to inhibition of higher level brain function. Therefore the earlier, the worst.

The good news is that the damage of social-emotional trauma on brain is reversible thanks to neuroplasticity. This is of paramount importance for mental health professionals. The intervention strategies must be carefully tailored according to the brain region affected and the developmental level of the child at the time of trauma.

Brain regions respond to specific types of sensory input. Cognitive and insight-oriented interventions will have limited effect for a person traumatized very early in life. Non-verbal modalities such as sand play, art, movement therapies could provide alternatives to access low brain regions in order to modify connections in existing neurons.

At the end, psychotherapy of all kinds is a process of "corrective experience". All we need to do is to access the specific brain region through specific types of sensory input. Sometimes it is "words", some other times it is "kneaded, squeezed or cut-into-pieces of clay" that is worked in the presence of a quiet witness. As the neuroscientist Bruce Perry suggests, the bottom line is to use the neuro-developmentally appropriate therapeutic activities for the specific brain region affected. 

Adopted from Play Therapy V. 5, Issue 4 p.18-20 December 2010

Monday, September 2, 2013

A Book Review: "How to Hug a Porcupine" by Julie A. Ross

I consider myself an avid reader. This is both because I simply LOVE reading and also because of the field I work in; psychology/psychotherapy is one of the disciplines with very vast literature choices, which sometimes feels like falling into an endless well. If you read one book, that makes you curious about five others and your to-read list increases exponentially.

Since I work with children and their parents, a good parenting book that offers parents practical tools on how to deal with daily parenting issues is like a treasure to me. Here is a little bit about How to Hug a Porcupine by Julie A. Ross.

What struck me first about this book is the title. I haven't come across any better description for the tween years. Please notice the humorously illustrated child on the cover. I personally found it quite funny and "telling".

What Julie A. Ross tells parents in a very reassuring and empowering way is: 
  • If you have a tween, anticipate the earthquake. Say to yourself, " This is normal and to be expected."
  • What you say and what "she/he" hears can be quite different. For example, a simple question like, "Is your homework in your bag?" might be heard by your child as " I don't trust you."
  • Become aware of the communication blocks and recognize your contribution to the negative cycles.
  • Change your communication style and consider this as learning a new language, which means, practice, practice, practice, until you don't sound phony.
  • Use encouragement (not praise) to boost self-esteem and to promote a healthy level of independence.
  • Raising kids is like planting seeds. Patience, faith and appropriate support are essential elements.
This short review doesn't do the book justice. If you read the book, you will find tons of practical techniques and advice as well as anecdotes from real parents and as a result you won't feel "defeated" and "alone" with your struggles anymore. Whether you deal with defiant behaviors, the computer "addiction", sibling rivalry or the push for independence, you will find valuable information and tools to handle your "porcupine".

Sunday, August 18, 2013

Is Psychodynamic Psychotherapy for you?

Many people enter therapy at their wits' end with the expectation of a quick relief. There is this widespread belief that the therapist has magical tools to help them fix the problems or see the world anew, happy and peaceful. Well, the magical tool here is the uninhibited and honest talking of the client. For this particular reason, psychotherapy is also known as the "talking cure".

In psychodynamic psychotherapy, everything is essentially in the client's talking. The well-trained therapist's role is to listen non judgmentally; to make links between the past and the present symptoms; and to interpret what he/she thinks is going on with the client in order to increase the latter's awareness. The rest is almost all up to the client: Is he/she able to think about therapist's interpretation? Can she/he agree/disagree with the therapist? Does he/she have enough ego-strength to face the pain of the process? We can add several other  questions to this list to show the essence of psychodynamic psychotherapy. The questions above also show why most people quit prematurely.

Take a look at the list below to decide whether this kind of in-depth therapy is for you.
  • You realize troublesome patterns in your relationships or behaviors.
  • You want help with feelings/ issues that have bothered you for a long time.
  • You want help for a problem that is unclear to you.
  • You tried other type of therapies in the past or medications that didn't help as much as you had hoped.
  • You are curious about yourself and open to explore your feelings.
  • You are open to a less structured, collaborative exploration, which would not require "homework", exercises or worksheets. 
If you answered "yes" to most questions above and are ready for a long-term therapy process, which will lead you towards a less defensive and more courageous life,  psychodynamic psychotherapy might be for you.

Thursday, August 8, 2013

What is Wrong with My Middle-Schooler?

In the literature of Developmental Psychology, adolescence is considered as the second most drastic period of individuation; after the “toddlerhood” and before the “midlife crisis”. Parents of children roughly between the ages of 10-15 notice sooner or later that there was a golden decade of peace, love, and understanding that is common in the early years of parent-child relationship. They come to realize that the little sweet girl or boy that they once had has become a moody door slammer, who seeks refuge in her/his room, in music or in friends. In her book My Teenage Werewolf, Lauren Kessler says, “ I am in mourning for the old days, not the days of diapers but the days of being part of everything they did, of calming their fears and taking away their hurts, of teaching them to read and ride bikes, to swim, to dance”.  Many parents experience a sense of grief for the loss of the “little child”, as well as for the loss of their all-influential role in the life of their children.  
This is the situation for many parents whose children reach puberty. I think the first thing that parents need to do is to allow themselves to “mourn for the old days” and at the same time to realize that this is a transitional time where family members’ roles need adjustments. 
What happens during early adolescence that shakes the family structure so profoundly? Last year I attended a seminar and the speaker started her presentation with this question: “Has anyone seen something more obnoxious than a 7th grade girl”? The question was answered with a loud laughter from the audience. The rest of the talk was about the brain development during adolescence. We are all aware of the physical and hormonal changes and their outcomes during this phase of life. However, the story is more complex than that. Recent neuro-scientific studies shed light on our understanding of adolescents’ behaviors that often puzzle us adults. The researchers explain this with the development of brain parts; the front part of the brain, the frontal lobes is the seat of rational decision-making, emotional and impulse control, and moral reasoning. As Kessler puts it, this is the “cop” part of the brain that would stop a person from talking back, lashing out, slamming doors and so on. The bad news is that the frontal lobes are the last part of the brain to reach maturity, often not until the early twenties. I do not suggest here that parents should excuse all rude, disrespectful, disruptive behaviors because of the discoveries in neuroscience, however, this information helps us understand how "teen's brain" function and put things in perspective.
Beside the brain development, adolescence is a time of massive changes. In search of their identity, teens become more and more distant from their parents, both physically and emotionally. They prefer to spend time with peers or alone, rather than with families. Their relationship with peers provides them with a miniature community in which they “rehearse” various roles and identities. With this regard, it is essential for teens to have this opportunity. Many parents fall into the trap of taking this “distance” personally and as rejection.  We need to keep in mind that this separation, displaying itself as a strong preference for peers and privacy, serves a developmental need in becoming a healthy, independent adult. 
Risk-taking is another major behavior change that one can observe in adolescents. Young people are naturally very curious about life and that curiosity shows itself in experimenting “adult-only” activities (alcohol, smoking, sex etc.) Risk-taking and experimenting are both normal and frightening and one study shows that periodic acting-out behavior during adolescence –as long as the child is not diagnosed with Oppositional Defiant Disorder- may actually reflect a normal, healthy adolescent personality. (Phelan, 1998) As parents, we need to realize that experimentation is normal while at the same time trying to discourage its dangerous forms. 
Another important characteristic of young adolescents is self-consciousness. Self-consciousness always goes hand in hand with egocentricity, which translates into a “13 year old girl spending hours in front of a mirror before going out”. The adolescent feels like the whole world is watching and everything revolves around him/her.  That also brings a huge fear of failure and sensitivity for being criticized. It is important for parents to empathize with their teen’s self-consciousness and take the time to remember their own teenage years. 
The purpose of this post is to give parents a brief account of what they might observe in their pubescent/young adolescent child. Of course, there is a variation among teens and not all teens follow the script. No matter where they are in the spectrum, parents should expect to face some challenges. It is not unusual to feel discouraged, however, bearing in mind that children/teens are “work in progress” may bring a sense of peace. Our primary role as adults, during this phase of “rebirth”- as Richard Frankel puts it- is to guide them without being too intrusive. 

Frankel, R. (1998) Adolescent Psyche: Jungian and Winnicottian Perspectives, New York: Routledge
Kessler, L. (2010) My Teenage Werewolf, New York: Penguin Group, Inc
Phelan, T. W. (1998) Surviving Your Adolescents-How to Manage and Let Go Your 13-18 Year Olds, Glen    Ellyn, IL: Child Management, Inc

Picture credit: © Hurricanehank | <a href="http://www.dreamstime.com/">Dreamstime Stock Photos</a> & <a href="http://www.stockfreeimages.com/">Stock Free Images</a>

Sunday, August 4, 2013

What is Play Therapy?

Those who work in the field of child psychotherapy and psychoanalysis know the name "D.W. Winnicott" very well. Winnicott was an English pediatrician and psychoanalyst whose work with children and mothers led to the greater understanding of psychological development. A central theme in Winnicott's work was the idea of play. Indeed, I owe the name of my blog, "The Potential Space" to him.

(For more information on Winnicott,  click here )

Many parents who bring their children for therapy are puzzled with the idea of "play" in therapy and how it works. Isn't it what their children do all day at home? Actually, not any more-especially since the invention of video games. What we see nowadays are children who are confined within the tiny screens of  tablets, smart phones, DS's and electronics in general, which restrict imagination, creativity, social interaction and exploration inside and outside. But this is a topic in itself.

Now back to play therapy and why it is different than simply "playing at home". Here are a few important aspects of play therapy:

  • It is a proven therapeutic modality. Association of Play Therapy (APT) defines it as "the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development."
  • It is a way of communication. Children do not have the verbal abilities to express complex emotions, thoughts and conflicts. Play therapy allows the child to "speak" to the therapist without words. Toys are used as "words" onto which the child projects feelings, conflicts, the world within their mind.
  • It has a therapeutic power in itself. Children do not have much control in real-life situations. By "pretending" they have power over the world and make reality conform to their wishes. This in return, helps children feel competent and satisfied by the sense of efficacy, which especially diminishes with traumatic events. 
  • It is a learning experience. Play therapy conducted by a trained therapist provides children with the opportunity to process their feelings, to assess their behaviors and to develop appropriate coping skills. Through play, they explore who they are and learn how to relate to their self and others in more positive and realistic ways. 
  • It is a self-motivated activity.  No child between the ages of 3-12 opposes to come to a safe place, where self-expression is fully encouraged by an attuned therapist, whose responses cultivate respect, empathy and freedom with a sense of responsibility. 
  • It is beneficial for a wide range of psychosocial problems including but not limited to: Posttraumatic Stress Disorders, Anxiety and Phobias, Disruptive Behavior Disorders, Mood Disorders, Attention Deficit/Hyperactivity Disorders, Social Skills Deficits, Grief and Loss. 
As an eight-year-old girl put it, "In here, I turn myself inside out and give my self a shake, shake, shake and finally I get glad all over that I am me." (Axline, 1947)

Saturday, August 3, 2013


Hi! My name is Yeshim Oz and I am a psychotherapist practicing in Omaha, Nebraska.  I am currently enrolled in Psychoanalytic training program at Greater Kansas City Psychoanalytic Institute.

 For more information about my practice and services visit www.oztherapyservices.com

The purpose of this blog is to give you a glimpse of the field of psychotherapy and related issues, including information about different therapeutic modalities, answers to questions I often hear from my clients, child development and developmental disorders, strategies that might help in dealing with stress and such. You will also find some writings about Psychoanalysis and related topics.

Thank you for visiting The Potential Space and check back soon for new posts.