We all can all agree that the use of various chatbots is at an all time high. Most of us are having all sorts of conversations with these seemingly sentient executive assistants, anything  from how to make a quick and easy spreadsheet to planning a perfect vacation, to even health related questions. While getting a quick answer to what a medical test actually measures can be helpful and super validating in the moment, the chatbot often does not know how to apply the medical research which may or may not be sound, to our particular case.

This is particularly problematic for the treatment of anxiety, OCD, social anxiety, phobias, and  specifically health anxiety. One of the major goals of any anxiety treatment is helping the client gradually tolerate uncertainty and ambiguity, while not engaging in compensatory behaviors like constant validation seeking and reassurance. In fact, one of the most cardinal ways to decrease anxiety is to cut down on accommodations to the anxiety which paradoxically feed the anxiety, sending the sufferer the message that they can not handle being anxious and need all sorts of accommodations. Yet the constant and immediate availability of AI provides just that--immediate feedback, symptom checking, or sometimes even false information that can send the already anxious person spinning. A recent article in Psychology Today speaks to exactly this phenomenon. 

The goal of treatment for most types of anxiety, and particularly health anxiety is not to make anxiety go away, but to recognize that anxiety may be there but that one does not need to constantly react to the signals that our bodies are sending with alarm or even with attention. The theory behind anxiety disorders is that for various reason our bodies do not feel safe and our nervous system is perpetually in a hypervigilant mode, constantly piking up on even the most minute feeling as cause for alarm and further investigation. This, in turn, is keeping our brain in a constant loop of vigilance, validation seeking and alarm. Learning to sit with that anxiety and not get immediate reassurance and validation, or even, attention retrains our brain to eventually stop seeking that feedback from the outside and find the resources needed within to self-sooth and learn to "be ok" with whatever comes our way. The constant availability of a chatbot that will entertain our every anxious thought and provide immediate feedback is training our brain to not only be more anxious and reassurance seeking, but it is taking away our own agency and trust in our own bodies and selves. 

Now recruiting:

Who: Girls ages 12-17 who have been diagnosed with or struggle with ADHD.

When: Weekly time to be determined

Location: Santa Monica

What: An hour long peer support group led by Dr. Inessa Manevich for teenage girls with ADHD who could benefit from having some peer support around friendships, homework, expectations from self and others, shame, guilt, pressure and social, family and academic dynamics.

Cost: $100 per 60 min

More and more adult women are being diagnoses with ADHD, a life-long neurodevelopmental disorder that can present differently in men and women, and yet is diagnosed far more frequently in boys. In order to get an ADHD diagnoses, one's symptoms must have been present in childhood, before the age of 12, and must have caused at least some fictional impairment.  Yet symptoms in girls with ADHD have often been overlooked and dismissed in the past. This is due, in part, to the fact that girls are better at masking their symptoms and often do not present with the same "acting out" behaviors that flag their male counterparts for a more timely diagnoses. (This recent Pharmacy Times article further highlights the differences in how ADHD presents in girls and women)

Unfortunately, a delayed diagnosis for girls  means less interventions, less support, less acceptance, thereby contributing to more internalized sense of shame and self criticism. Additionally, societal expectations of women and girls further contribute to them developing compensatory strategies like perfectionism, rumination and extreme masking,  in order to appear appropriately "productive", "presentable" and "up to par". All of this can be simply exhausting, particularly in combination with the already existing deficits in executive functioning that is characteristic of ADHD.

Furthermore, things can get even more challenging in times of hormonal fluctuations. Moreover, almost 50 percent of adult ADHD diagnoses are diagnosed during or after pregnancy, a particularly vulnerable time for women who may be already struggling to keep it all together. The familial and societal expectation of the mother being able to do it all, the mental load of all that parenting entails, the shifting self-identity, the shifting of the marital dyad, all add up to a population of people who are extremely vulnerable to burnout and even breakdown. Therefore it is imperative that we start paying attention to the girls. It is vital that we continue supporting the moms, while simultatiously questioning our productivity-obsessed societal expectation for both genders, and continue updating the definition of what is a successful and productive life. 

​Now offering two weekly group aimed to help women in the transition to becoming and being mothers of twin children!

​Whether you have just learned that you will be having twins or have recently had twins, this is a space to process this incredible rollercoaster, meet others who are experiencing the same struggles and get some helpful practical and psychological tips to make this journey as easeful as possible.

*Because it is quite challenging to participate in a group while juggling two babies, this groups is for moms only. This group will be a unique space to process and receive care from others who are traveling the same road of caring for two babies while navigating the new identity of being a mom. 

Cost: $100 per 60 min session
Location: 1150 Yale St Suite 1, SM CA 90405
Time: TBD

Your children have grown. Hopefully, if you did a good job, or perhaps in-spite of you, they now have their own families and may need little from you in terms of physical gifts. Yet, you invariably ask them, "what is it that you want for the holidays", because you are a parent and you want to give.

You want to give them something to make them smile like they used to when they were small and needed you for everything. Or maybe you wish to provide something that would lighten their load now that they are adults. Perhaps you may also want to provide something that would protect them and to share your wisdom so that you will continue to be with them long after you are gone.

All of that is great, it truly is. For it is the season for family, and giving and magic...

​Yet the gift that your adult children truly want from you is the enduring belief that life can be good, no matter how old you are. They want to see you handle aging with grace, beauty, whit and wisdom. In our youth obsessed culture, your adult children yearn to see and believe that every age truly has its beauty, because, after all they are right behind you.

So what does that mean in practical terms? What can you really give your adult children? You, dear parent,  are the only one in the unique position to gift them a living example of evolving, dynamic and interdependent enjoyment of your own terrifying and breathtaking life. 

While I rarely share the same post more than once, given that Mother's Day is upon us, the topics herein are so very relevant for many parents that I felt compelled to share it again. 

In a 2011 issue of the Pennsylvania Psychological Association Public Newsletter, the article "Working Women: Take Care of Yourselves" by Rachel Milner, Psy.D., caught my attention as being particularly important any time of year. As children go back to school, working moms are often faced with not only the demanding daily responsibilities of their jobs and housework, but now children's class selections, teachers, specialized learning programs, various therapies, sports, clubs, high school or college applications and other social activities are once again begging for mom's finite time and attention.

According to the article, while the number of  women in the workforce has increased from one in three in the 1950's to more than half of the current workforce in the US, "women continue to have primary responsibility for home and family matters, [and] many forget to take care of themselves and many run the risk of exhaustion, burnout or becoming ill". (Milner, 2011) In order to decrease the likelihood of these negative outcomes,  Dr. Milner suggests taking the following steps:

• Learn to set limits - You cannot accomplish every- thing yourself. Know your limit and set it.
• Take breaks - It is important to take short beaks during the day. Get up and take a short walk, speak with a co-worker, or do some relaxation exercises at your desk.
• Say no - It may be difficult to say no for fear that you will be negatively evaluated. However, if you take on too much you will not be able to give sufficient attention to anything.
• Take days off - It is important to take time away from the office to rest and regain your energy.
• Give adequate attention to your life outside the office. - If you are having problems in your personal life, your work may suffer.
• Work reasonable hours - Everybody needs to come in early or stay late sometimes, but avoid this becoming a pattern.
• Communicate - It is important to communicate with your supervisors and co-workers so that they know what your needs are and when you may need extra support on a project. 
• Recognize signs of burnout - Know the symptoms of burning out, such as having a short attention span, getting annoyed easily, and feeling unmotivated. When you recognize that you are burning out, make some of the changes mentioned in this article. 

Learning how to recognize our needs and learning to take care of ourselves is not only important for our own self-preservation, thus giving us more energy and resources to tackle more of life's difficulties, but it also models to our children the importance of self-awareness, limit-setting, and balance.

Now recruiting participants for two ongoing RELATIONSHIP BASED SOCIAL SKILLS groups for YOUNG ADULTS and ADOLESCENTS!

*Goal: Learn and implement valuable social skills with like-minded peers, in a collaborative and supportive environment.

* Members: Adolescents (14-18y/o) and Young Adults (19-33y/0) living with Social Anxiety and/or Asperger's Syndrome.

* Duration: Weekly Hour sessions

* Payment: $85/session *(services may be reimbursable by your insurance)
​
* Location: 1150 Yale st, Suite 2, Santa Monica, CA

It seems that everywhere we look these days, we encounter yet another person or study underlining the various benefits of mindfulness mediation. While to some, the idea of meditation conjures up yogis in a cross-legged positions, spending hours inside their heads, those that have any intimate familiarity with mindfulness know that the practice of mindfulness meditation leads to the exact opposite of being in one's head. In fact, practicing  mindfulness meditation can lead to a more direct and in-the-moment interaction with the world around us.

The idea behind mindfulness is learning to tune in to the present moment, and becoming fully aware of one's inner sensations and the environment, while trying to avoid unconscious or habitual activity. [1] If we stop to think about how much time we spend in our heads, trying to think through, prevent, predict, or understand some sort of event that is either in the past or in the future, we start to realize just how much we may be missing in the present moment. While we may feel that doing all of this mental gymnastics may lead to better outcomes, thereby giving us a sense of control over our day to day lives, many of us know all too well that this type of rumination actually reinforces already established, often negative thinking patterns.

The practice of mindfulness meditation trains our minds to notice what we are doing mentally and physically in the moment, a process that may be so mechanical that it may seem unconscious. By giving ourselves the space to notice what may feel to be automatic, we are actually acknowledging that what we are experiencing is, in fact, under our conscious control, and is most likely learned. And we all know that anything that is learned, with some effort and understanding, can be unlearned, albeit not forgotten.

While there are a number of great ways to start a mindfulness practice, I have found the app "10% happier" to be very clear, helpful and dare I say, "mindful" of a busy schedule.

References:

• ​1. Hyperion Books. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Accessed at http://books.google.com/books?hl=en&lr=&id=QnYBXlX2bPwC&oi=fnd&pg=PR13&dq=mindfulness+meditation&ots=iaiedsPYPb&sig=eUtL03wBBA9CSgxAcmTF7yVi3NM#v=onepage&q=mindfulness%20meditation&f=falseon May 1, 2014.

Individuation is no simple task. In fact, individuation can be seen as one of the most important developmental tasks to work towards in order to attain self-knowledge, self-realization and even personal freedom. Individuation is defined as "a process through which a person achieves a sense of individuality separate from that of others..." (GoodTherapy.org, 2016 ). While this process is certainly ongoing, it can be particularly difficult in young adulthood, when the overarching questions sound something like "who am I now that I am an adult " and, perhaps more importantly, "who do I want to be?"

At a time when most people are faced with mounting personal and professional responsibilities, it can be quite trying to figure out how to manage everything and prioritize that which is important. This is an even more daunting process when one does not know what exactly is important, how to get it and perhaps most problematically, how to feel good about it. Even more challenging, is when one's most salient role models on how to be "a successful adult" have different priorities and very different rules of how to go about attaining them.  

This is where the process of individuation comes in. Namely, learning how to recognize ones' own inner voice and differentiating that from the internalized opinions or values of others. While learning to recognize one's own voice is a crucial step to self-realization, the trickiest part, in my experience, is learning how to trust and be guided by this voice, so that it is heard above those of all others.

While this process is challenging for most people, individuation is particularly difficult for those folks who come from more collectivist cultures, where the opinions of the family, and particularly, of the elders are valued more than the opinions of the self. In this case, choosing one's own path in life, no matter what it is, can lead to feelings of betrayal and abandonment on both sides. Additionally, in collectivist cultures individuating from one's family of origin not only can be seen as a form of disrespect, but is often deemed to be quite unwise. In the words of Otto von Bismark "only a fool learns from his own mistakes, a wise man learns from the mistakes of others".

These powerful messages can be quite difficult to disavow, particularly for those who have been conditioned to please and value the wisdom of the collective, above their own. It is precisely this invalidation of the self that can lead to a grave and debilitating fear of making mistakes, no matter how valuable the lesson within. The process of individuation then, requires tremendous courage to not only recognize, trust and pave one's own path, but to make a few mistakes along the way, in hopes of finding that which is truly one's own.