Inessa Manevich,Ph.D., Clinical Psychologist
310.804.6339
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Growing Throughout the Lifespan

12/19/2014

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It is not uncommon for people to get nervous when they notice that some of the hobbies, interests and even friends that once meant so much to them, are no longer of significant interest. This can be a very confusing time, as the things that we do and the people that we do them with are often the very benchmarks by which we identify who we are. But what if who we are is constantly changing? What if we are not supposed to stay still, but are meant to keep moving, changing and evolving? 

Most people do not think of development as occurring after one has reached adulthood, in part because these topics are rarely given their due attention in popular culture. After all, it is not terribly exciting to go see a movie or a show about people who want to go out less and prefer to spend their weekend nights on the couch with their partners and/or pets, instead of having one night stands and meeting new and fabulous people. While some stages of adulthood may not be as commercially thrilling as those encountered in late adolescence, adulthood is defined by many interesting and fulfilling stages that when left unacknowledged can lead to disappointment, frustration and stagnation. 

Dr. Erik Erikson described this very idea in his 8 stages of psychosocial development. According Dr. Erikson, humans pass through various stages from infancy to late adulthood and interface and hopefully master new challenges. The theory posits that if these age-approprate challenges are mastered successfully at the appropriate times, they are less likely to appear as problems in the future. As the saying goes, "every age has its beauty". However, accepting that the beauty we seek today, may be quite different from the beauty we seek tomorrow will surely contribute to a more fulfilling psychological and social development. 


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Treating Depression Before Postpartum

10/23/2014

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Over the last decade, postpartum depression has received a lot of attention in the media, making women fear that this form of depression is something that naturally happens to many women after they deliver their children. In this recent NYTimes article, David Bornstein dispels some of the myths surrounding postpartum depression, and underlines the importance of treating the symptoms of depression during, and preferably even before pregnancy. 

One of the most important points that Bornstein makes in this article is that only a small percentage of postpartum depressions have something to do with "natural" hormonal changes. In fact, this article states that most postpartum depressions are not isolated forms of depression, and at least some of the symptoms may be present during the life span years before and/or after pregnancy, indicating that delivering a baby may not be the underlying cause of the depression. Furthermore, the risk factors for postpartum depression are the very same as for any type of depression, namely a history of depressive episodes, past and current life stresses, a history of trauma and abuse, interpersonal conflict with primary support group, lack of social support and poverty.

Because only a small number of women get treatment for their depressive symptoms before their baby is born, even when the symptoms are present during the pregnancy, it is important for people to understand that treating depressive symptoms early can mitigate, and hopefully prevent subsequent suffering. The good news is that there are a number of ways to treat the various symptoms of depression during and before pregnancy, and not all of them mean having to take a pill. Studies show that non-pharmacological treatments such as exercise, mindfulness practices, increasing one's support network, and psychotherapy can all decrease depressive symptoms. It is also important to keep in mind that if one's depressive symptoms are such that pharmacological interventions are indicated, there are currently a number of medications that have been approved for use in pregnancy.

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Emotionally Abusive Friendships

9/22/2014

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While most of us have at least some familiarity with the warning signs of emotionally abusive romantic relationships, emotional abuse in a platonic relationship  may not be as readily detected. This may be because being a friend is inherently a weaker relational connection than that of a romantic partner or family member, and the abuse may not be as obvious or seem as serious to the outside observer.

While emotional abuse may, on the surface, look a bit different in platonic relationships than it does in romantic or family relationships, any type of abuse typically follows the very same relational dynamics. In every abusive relationship one of the members appears to have all, or most of the power. The person being abused is typically held emotionally captive by the abuser, by ether fear of some sort of criticism or punishment, self-harm or public embarrassment. This constant fear is what typically keeps the abused friend feeling like they are never good enough and may even deserve the kind of treatment that they are receiving.

Abusive friends, like abusive partners, at times, can seem very charming, charismatic and even caring. However it is exactly this duality and unpredictability that keeps their abused partners plugged into the relationship. The abused friend may see their friend acting in a caring manner and think to themselves that their abusive friend is clearly "not all bad". They may then begin to believe that the friend is only abusive to them, and hence their negative behaviors may somehow be their fault. The abused party may then begin to think that if only they themselves were somehow a better friend to the abuser or could provide the perfect circumstance for them to not "go off", then the abusive friend would surely turn into the “good” friend that others see and stay that way. 

Clearly, every type of emotional abuse is harmful. Emotional abuse impacts people’s self esteem and feelings of power, worthiness and agency in their lives no matter who is doing the abusing! Friends of emotional abusers may feel more and more depressed and less and less worthy as human beings, since their needs, wishes and desires are always squelched for those of their friends. It is important then to recognize when the abuse is happening to us or to those around us and to take measures to ensure that everyone has the knowledge, recognition and power to choose better. 


This PsychCentral article provides a thorough list of the various signs of emotional abuse in any relationship.

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Relationship-Based Social Skills Groups

9/16/2014

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Currently offering relationship-based social skills psychotherapy groups for TEENS and YOUNG ADULTS with Asperger's Syndrome and High Functioning Autism and Social Anxiety! 

*         Learn, Practice and Implement Valuable Social Skills.

*         Form Enjoyable Lasting Relationships with Your Peers.

*         Get Professional and Peer Support with Organizational/Practical Life Skills.

*         Talk About Your Particular Experiences and Interests with Peers.

Members:                 Teens and Young adults with ASD's and Social Anxiety

Fee:                            $85.00 per one hour groups session 
                                   * (services may be reimbursable by your insurance)

Where:                      1150 Yale St, Suite 2, Santa Monica, CA 90403

If interested in joining or learning more about this group, please contact Dr. Inessa Manevich at 310.804.6339 or at dr.imanevich@gmail.com to set up an initial assessment 
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On Social Media

8/25/2014

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The recent news that Facebook had conducted a psychological experiment on unsuspecting users in order to see if it was possible to alter the emotional reactions of users by manipulating content, has undoubtedly sparked people to think about what role, if any, social media plays on people's emotions. Yet perhaps it is the very hope that social media might influence one's emotional state, and perhaps even one's sense of self, that drives so many people to be so invested in it's use, and others, to opt-out.

If one is to assume that friendships are, at least in part, utilitarian in nature, and that each party gets what they need or want from the other, it makes sense to assume that one's on-line connections are also serving some sort of inter-psychic need. While most people certainly use social media in order to get information, stay in touch with friends and for professional networking, it seems to reason that we are also using our on-line selves in order to attain peer validation, support, as well as project the exact version of ourselves that we want to be at the moment.

Take the profile picture for example--is it not exactly the visual that we would like for others to associate with the idea of who we are? Is it not a highly-produced version of our idealized selves, or at the very least, some version of the person that we would like to be? And as we continually update our profile pictures and updates, are we not asking our network whether or not they "like" us, thereby seeking the approval from those who typically have limited real-time knowledge of our "real" lives, and are not necessarily in the best position to provide that validation? It certainly appears that by happily sharing our lives on-line we are also choosing to put some version of ourselves in front of a large number of people who we may or may not really know, in order to see whether or not they like us. Or, more accurately, if they like who we are trying to be. 

Perhaps not wanting to put oneself in the position of being judged by others has something to do with why some folks are so staunchly opposed to social networking. Or it may have something to do with simply wanting to avoid the myriad of feelings, ranging from joy and sympathy to jealously, competition, and even contempt that being privy to the accomplishments and failures of the "produced" lives of one's friends and acquaintances may engender.




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On Working with Russian Immigrants

5/21/2014

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It is important for mental health professional treating diverse populations to understand that open self-disclosure in psychotherapy is very much dependent on one's culture. For example, when working with Russian immigrants, the clinician may find some initial distrust and reluctance to "open-up" and to "trust" the psychotherapy process. Instead of acknowledging their psychological stressors and subsequent problems and disorders, research and practice show that both Russians and Russian immigrants are more likely to express their psychological distress in somatic concerns (Brod & Heurtin-Roberts, 1992; Kohn, Flaherty, & Levav, 1989).

Newhouse (2005) explained that “historically, the traumas that befell Russians and Russian Jews were so overwhelming, and strictures on personal expression so unrelenting, that people kept their emotional and psychological pain to themselves and presented a stoic front” (p. 705). He goes on to explain that disclosing personal pain and family problems was often seen as a betrayal to the family system, even if the disclosure is made to a mental health professional. Additionally, although emotional pain and difficulties in adjusting to life in the Former Soviet Union were so prevalent among its citizens (Smith, 1990), talking about this pain was regarded as a sign of weakness, as well as a dangerous statement against the political system. Clearly then, the Former Soviet Union was not a place where psychotherapy was often utilized and valued (Leipzig, 2006), a belief system that may be difficult to disown even after immigration.

Yet studies indicate that immigration, particularly from a totalitarian, repressive society such as the Former Soviet Union, can be a traumatic process, frequently leading to family dissolution, problems with separation and individuation, and mental illness of various kinds (Beckerman & Corbett, 2008; Hsu, Davies & Hansen, 2004; Markowitz, 2003). Likewise, epidemiological studies have documented relatively high levels of depression in different primary care settings in this immigrant group, as compared to the community samples (Hoeper et al., 1979; Katon, 1987). Yet when these immigrants do find themselves in a crisis, usually having to do with a family member’s illness or a child’s problems or a somatic manifestation of their psychiatric distress, they will, though reluctantly, seek the help of a therapist (Newhouse, 2005). It may be crucial then for mental health professional treating this population to understand their historical reluctance to disclose personal information, and be able to provide the patient with “a combination of solid credentials, personal warmth, and a proactive approach” (Newhouse, p. 701). 

*A portion of this blog post was taken from Manevich, I. (2010). The Changing Patterns of Self-Disclosure in Soviet Immigrants.


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Process Group for Teenage Girls

4/25/2014

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Now offering a process group especially for teenage girls! 

This group focuses on helping adolescent girls have a safe place to process the various issues in their lives, and attain valuable feedback from both peers and professionals. This group is designed to help girls work through self-esteem issues, relationship issues, anxiety, depression, and anything that may be facing teenage girls today!

Members: Girls age: 15-18

Location:  Group meets weekly in Santa Monica

Fee:*  $80.00 per one hour group session 
* (services may be reimbursable by your insurance)

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On Antidepressant Medication.

4/4/2014

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After recently reading this NYT magazine article about the over-prescription of antidepressant medications in the U.S., I thought it might be helpful to expand on this often-debated issue. Being a psychologist, it is not my job, nor my wish, to prescribe medication. However, it is very much my responsibility to notice when an appropriate medication consultation may be necessary. For example, if a client's presenting symptoms are significantly interfering with their daily life, making it nearly impossible for them to initiate change, it may be a good idea to obtain a medication consultation.

I often hear the fear that once begun, one will have to remain on the given medication indefinitely. While people with certain diagnoses, such as bipolar and psychotic disorders, are proven to fare much better if continually medicated, others may have a different course. For example, some individuals, particularly those with presenting symptoms of anxiety, adjustment disorders and mild depression, may initially need a little extra pharmaceutical help in alleviating the severity of their symptoms in order to be able to make the necessary changes in their lives. However, once these folks are able to make and maintain certain behavioral, cognitive and even affective changes, they may be able to lower the dose of their medication or even discontinue its use, advisably, with the consent of the prescribing medical doctor.

As mentioned above, in addition to treating the primary symptoms of depression, anti-depressant medications are often used to help manage symptoms of anxiety as well, and are often prescribed for people who experience frequent panic attacks, persistent worry and nervousness, as well as obsessive thoughts. While these medications do not cure the underlying anxiety, they can certainly alleviate some of the bothersome symptoms and can help patients be calm enough to effectively work thought their worries.

It is important to keep in mind that there are a number of highly effective and non-invasive options to treat symptoms of depression, adjustment and anxiety that have nothing to do with pharmaceutical intervention. For example, while exercise certainly has not received as much press and endorsements as psychopharmacological treatments for depression and anxiety, studies show that regular exercise may be a viable medicine against certain psychological problems. Likewise, regular meditation, yoga and mindfulness approaches may be extremely helpful in reducing symptoms of anxiety and  depression. Finally, while talk therapy can sometimes be a difficult and time-intensive process, it often results in lasting, sustainable change that rarely has the kinds of side effects that are unfortunately all too common with pharmaceutical interventions.

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Social Skills Groups for Teens and Young Adults!

3/27/2014

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In addition to offering Relationship-Based Social Skills groups for teens and young adults with Asperger's Syndrome, I am now also offering social skills groups for teens and adults with Social Anxiety.

* Learn, Practice and Implement Valuable Social Skills.

* Form Enjoyable Lasting Relationships with Your Peers.

* Get Professional and Peer Support for Overcoming your Anxiety and Enjoying Social Activities.

Members: Teens and young adults with Social Anxiety and Asperger's Syndrome

Fee: $80.00 per one hour groups session 
* (services may be reimbursable by your insurance)

Where:  Groups offered weekly in Santa Monica.

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The Pressure of the Ticking Clock

3/11/2014

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If you are a woman in your thirties and do not have children, you have undoubtedly been exposed to the omnipresent familial and even societal pressure to hurry up and have babies. These "well-meaning advisors" are often not too concerned about whether or not one is emotionally and psychologically ready and willing to have children, but are far too concerned that these young women are running out of precious time. 

About a year ago, Jean Twenge wrote this fascinating article in The Atlantic about how the information that most people use about fertility and age are based on "statistics from a time before electricity, antibiotics, or fertility treatment". Furthermore, the article points out that these studies are not only based on relatively small, homogeneous samples of women from 1670-1830, but that these studies are also poorly designed. In this article, Twerge thankfully sites a number of modern, well-designed studies that paint a far more optimistic picture about female fertility and age.

Clearly, it would behoove everyone, particularly the aforementioned "well-meaning advisors" to read up on the current statistics on fertility and age. It would also be helpful to understand that what may feel like helpful advice (which, seems to be based on dubious data) might put unnecessary pressure on a woman who may already be struggling to define her place in society, in the workforce, and as a self-sufficient and whole human being.  Not to mention that being pressured into making a decision that is as life-altering as having a child is likely the least beneficial way to make it.


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    *Information in this blog is for educational purposes only and should NOT be used as a substitute for professional therapy*

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1150 Yale St, Suite 1 | Santa Monica, CA 90403 | 310.804.6339 | dr.imanevich@gmail.com
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