Top 4 Questions Couples Ask Me About Online Couples Therapy


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#1  How Long is this Going to Take?

I am what is called a “brief therapist” which means that I am not interested in making a life long commitment with you.  I am interested in teaching you the skills you need to thrive as a couple so that my job becomes obsolete.  Most happy couples who have graduated from therapy have done so around 20-ish sessions but therapy is not a “one size fits all” approach.

#2  What’s Online Therapy Like?

Couples LOVE the online therapy option.  You get to relax in the comfort of your own home, pet your cat, and I get to sit in my pajama pants in my home office.   Online therapy frees you from the stress of childcare, traffic and parking.

#3  What Kind of Therapist Are You?

I am very hands on and directive in my practice.  You can expect to do some talking to me but my goal is for you to talk more to your partner than to me.  I have a goal to teach with each session and to leave you with learning objectives to practice between sessions.  I am also pretty forward and believe that you came to therapy to get a shake up in your current cycle.  I call it as I see it but always do so with love and respect.

#4  Are You Going to Tell Us to Divorce?

No, but I may think it.  I am committed to your overall health and wellness as well as the children that you may have in your life.  If your goal is to transform your relationship for better, I will help you do that.  If your goal is to split on good terms and with a friendship still intact, I will help you do that.  You identify where you want to go, I will guide you to the destination.

Best, Noah Clyman
http://www.nyccognitivetherapy.com
info@nyccognitivetherapy.com
347-470-8870


NEW virtual CBT skills group for COVID-19 & nine tips


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Coping with Stress and Social Distancing During the Coronavirus (COVID-19) Outbreak

Effective Sunday, 3/22/2020 NYC-CT’s physical office location is closed. All NYCCT services will be conducted via telehealth in an attempt to reduce the spread of the COVID-19 virus.  At this time, we are uncertain when our office will reopen for in-person services. The health and safety of our clients and staff is our top priority and we will notify you of updates as we receive them. If you are a current group client and would like to schedule time to meet individually in order to reinforce the skills covered in group, please let your therapist know and they will assist you in scheduling. Our hope is to continue to provide individual treatment to our clients with minimal disruption.  We are still accepting new clients, and all intake assessments will be performed via video conference or phone.

NYC Cognitive Therapy is starting a new Virtual CBT Skills Group in response to the coronavirus outbreak. The group will provide an opportunity to connect with others in this time of social distancing, gain support on new challenges you may be facing, and learn key CBT skills to help manage worry, stress, anxiety, and loss during this unprecedented time.

The group will meet virtually through video conferencing for 1 hour from 12-1pm (day to be confirmed with final group members). The group will meet for 8 weeks and will consist of 5 to 7 members. Individual group members will be expected to identify goals and complete related homework assignments outside of the group meetings as well. Sliding scale available. NYU insurance accepted.

If you would like more information or want to sign up for the group please e-mail Cara@nyccognitivetherapy.com and provide your name and telephone number. We will then get in contact with you to answer any questions.

Here are 9 tips to help you cope:

1. Know What to Expect
A disease outbreak can be stressful, especially one in which we all need to closely monitor our health, stay home as much as possible, and avoid all unnecessary social (physical) interactions with others. Social distancing and isolation are likely to disrupt your work, your family life, the way you do things and the way you interact with others. This can add to the stress of the situation. Feeling overwhelmed, sad, anxious or afraid, or experiencing other symptoms of distress, such as trouble sleeping, is natural. You can reduce the negative impact of stress by anticipating normal reactions. Stress can affect the way you think, feel, and act. Most of the effects are normal reactions to distressing events and are generally short-lived. Here are some of the effects and symptoms you may experience:
-Physical effects: fatigue, exhaustion, headaches, rapid heartbeat or exacerbation (aggravation, increase, worsening), of preexisting medical conditions
-Emotional effects: feelings of sadness, anxiety, anger, agitation or irritability
-Mental effects: confusion, forgetfulness, or difficulty concentrating or making decisions
-Behavioral effects: experiencing uncharacteristic behaviors such as becoming restless, argumentative or short-tempered, or changes in eating and sleeping patterns.

2. Stay Informed
Use credible sources of information about the disease outbreak to stay up to date on what is happening, understand the risks and know how to best protect yourself. Avoid sharing unconfirmed news or acting on rumors, as this adds to misinformation, fear and panic. For information about COVID-19, visit cdc.gov/coronavirus.

3. Limit Screen Time and Exposure to Media
Too much time on the phone or computer, or watching or listening to news reports 24 hours a day, seven days a week, can increase anxiety and fear. Seek updates and guidance two or three times per day.

4. Keep Connected and Reach Out
Stay connected with family, friends and your social networks using communications such as email, social media, video conference, telephone, FaceTime or Skype. Consider calling a neighbor or older adults and people who live alone that you know to see how they are doing and show you care.

5. Maintain Daily Routines
Keeping routines gives us sense of control and can reduce anxiety. Try as much as possible to keep daily routines or create new ones, if needed, to help you cope with the changes.

6. Stay Positive
Focus on things you are grateful for and things that are going well in your life. Get courage and inspiration from positive stories of people who are finding ways to cope and remain strong.

7. Be Proactive About Your Basic Needs and Financial Stressors
Advocate for yourself to make sure you have what you need, such as food and medication, and to be safe and comfortable. If you are unable to work, contact your employer and discuss any options for leave. Contact companies that send you monthly bills and request different payment arrangements.

8. Be Thoughtful and Sensitive
Avoid assumptions and blame about who has the disease because of the way they look or where they or their families are from. There is no connection between race/ethnicity and infectious diseases. Speak up when you hear false rumors or negative stereotypes that encourage or promote racism and xenophobia.

9. Seek Help
An infectious disease outbreak such as COVID-19 can be stressful for you, your loved ones, and your friends. As mentioned, it is natural to feel overwhelmed, sad, anxious and afraid, or to experience other symptoms of distress, such as trouble sleeping. To lower your stress and manage the situation contact us. We offer individual, couple, and group therapy.

 

Best wishes, Noah Clyman, LCSW-R, ACT, noahclyman@nyccognitivetherapy.com


Overcoming social anxiety through group therapy


Worried about what others think? Feel tongue tied when you try to speak? Do you hold yourself back from career opportunities to avoid public speaking?

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Image credit: Sara Petterson/Getty Images

You may have social anxiety. Social anxiety disorder is quite common – roughly 12% or 15 million Americans will experience social anxiety that impedes their typical functioning and goals within their lifetime. Cognitive Behavioral Therapy, and group CBT in particular, have been proven to be effective in treating social anxiety, helping individuals to better understand the nature of their fears and thoughts in social situations, and also to develop and strengthen social skills through hands-on practice and behavioral experiments.

What is social anxiety?

Social anxiety disorder is marked by intense anxiety and fear of social interactions, particularly the fear of judgment and scrutiny from others. Those with social anxiety not only fear negative evaluation from others, but also that others will see how nervous and anxious they are. As a result, such individuals typically avoid social interactions or engage in other safety behaviors, such as speaking softly, avoiding eye contact, or pre-planning questions and conversations.

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Image credit: Berger & Wyse

How does group CBT help social anxiety?

It may sound counter-intuitive to join group therapy if you deal with social anxiety. However, it is this group setting that contributes to the effectiveness and lasting results of treatment. Group therapy provides the opportunity to meet, interact, and relate to others with similar experiences. The social interactions that are built into the structure of the group provide ample opportunities to act out behavioral experiments, test out beliefs, and share constructive feedback in real-time.

Group sessions will be structured in a way that encourages participation from all members. Topics covered will include:

  • Changing perceptions and learning to identify the thoughts that contribute to your social anxiety

  • Mindfulness practice to help develop awareness of your distressing thoughts and turn your focus back to the present moment

  • Assertiveness and problem-solving skills to bounce back when social situations don’t go as intended

  • Experiments to test the skills learned in session and practice new behaviors in your daily life

Is group therapy right for me? What are the advantages of CBT groups for social anxiety?

  • Less expensive than individual treatment
  • Opportunity to identify with others who share similar experiences and problems and feel less alone
  • Provide support and be supported by others, which tends to feel good and help one another make more rapid progress 
  • Collaborate on in-session and homework experiments with other group members 
  • Make friends with people who share a common therapy experience, which is a good way to keep making progress after the group is over 
  • Groups serve as a safe “laboratory” to explore how we relate to others and to experiment here-and-now with new ways of relating in a safe setting
  • Changing underlying attitudes and beliefs about the self and the world in order to adjust perceptions of ourselves and others in social situations

When and how often will the group meet?

The social anxiety therapy group is a structured, intensive, 20-week CBT program. Groups are made up of 6-9 members who are at least 18 years of age. The groups meet weekly for 1.5 hour sessions on Monday evenings at 6:30pm, starting December 9th, 2019, for five months.

How do I join? 

If you would like more information or want to sign up for the group please e-mail Cara@nyccognitivetherapy.com and provide your name and telephone number. We will then get in contact with you to answer any questions.

Cost is $175 for the private intake session and $80 per group session, NYU insurance accepted.


How do you fix a shy bladder?


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  • Do you experience anxiety or fear using public restrooms when others are around?
  • Do you worry about what other people are thinking when you are trying to urinate?
  • Are you concerned about being humiliated or embarrassed by problems passing urine?
  • Has your doctor ruled out a physical cause for your difficulty urinating in public rest rooms?
Millions of Americans suffer from an anxiety problem that few know about and even discuss. This social phobia is paruresis, or shy bladder syndrome. At some point, almost everyone has difficulty urinating, most commonly as a result of a medication when recovering from a surgery, or when giving a urine sample at the doctor. But this temporary condition is not paruresis. People who suffer from paruresis almost always have trouble using the bathroom if other people are around, even in their own home. Paruretics experience a consistent pattern of “freezing up” and avoiding public restrooms. The condition often develops from a traumatic event. The triggering event can range from a simple remark (“Will you hurry up and go” spoken to a child going to the bathroom) to chronic bullying.

Over the past few years, I began assessing for shy bladder with all my clients and discovered that many people struggled with it, but didn’t bring it up on their own either because they didn’t realize it could be helped with therapy, or felt too self-conscious to bring it up on. The good news is the treatment for paruresis is simple: Since some event, or series of events, triggered the inability to urinate in public, the method to overcome the disorder is to relearn how to urinate in a safe environment. The best evaluated treatment is referred to as graduated exposure therapy, essentially, doing what you fear in a step-by-step fashion and the exposures occur gradually, often, and for prolonged periods of time. For paruretics, since avoidance of urinating in public restrooms is the phobia, the “do what you fear,” involves gradually and repetively attempting to urinate in the presence of others, in situations ranging from those that are “safe” to more challenging situations.
Here’s an example of one of my patients who agreed to share his story. At the beginning of treatment he said, I am a 31 year old male who has had this problem for as long as I can remember. I can’t urinate if I have even the slightest idea that someone might come into the bathroom. I have severe anxiety about it…, it isn’t rational, but it seems to be the way things are right now.
Here’s a summary of some of the tools we used to help my client conquer his shy bladder:
1. We started with “fluid loading.” This means, drinking a lot of water until he felt like he was about to burst. (This idea of fluid loading goes against one of the main coping strategies that patients use, that is controlling the intake of fluids in order to control the “when” and “where” of needing to urinate – e.g., avoiding drinking fluids before going out to a restaurant).
2. Working with a therapist as a buddy. My role was simple. I would stand at various distances from the patient (whatever his comfort threshold would allow), in various bathroom environments, as he attempted to urinate. The patient would give me directions on where to stand, and we would always discuss the plan beforehand as a team to make it clear and specific; the patient was in charge of all plans.
3. Developing the behavioral plan. The goal was after loading up on fluid, for the client to allow the flow of urine for approximately 3 seconds and then stop the flow of urine. Then zip up, then go back and repeat. The reason for the 3 second limit is to save urine for repeated exposure attempts in the same session. When he was initially unsuccessful (which is normal and part of the process), we had him wait by the stall for 2 minutes; if he was still unable to go, we took a 3 minute break and tried again. If still unsuccessful, we would reduce the intensity of the exposure (e.g., I would stand outside the bathroom, instead of inside).
3. We worked on a range of exposure challenges, and repeated each one until it became easy for him, before moving on to the next one:
*Urinating at home alone, standing up, while imagining people are standing next to him.
*Urinate in a single person public restroom (a single commode with a locked door) with therapist standing outside the restroom.
*Urinate with therapist standing in the bathroom a few feet with patient.
*Urinate with therapist standing behind patient while therapist makes noise or impatient comments (this helps the patient feel more prepared for any rude behavior they might encounter in a public restroom).
Outcome:
After several successful trials in isolated public restrooms with me present, the client graduated to practice on his own. Attempting to urinate with others present at stalls and at other urinals, then a more crowded restroom. My client varied the context which helped build his confidence even further – urinating at the mall, a busy airport, a sporting event, a concert, and the theater.
After 12 weeks of intensive exposure practice, both in session, and between sessions, he sent me the following email, Dear Noah, I had the most incredible experience. Last night a friend and I went out to dinner. We went to a restaurant we have been to at least 100 times before. I had to go to the bathroom even before we got to the restaurant, which used to produce a lot of anxiety for me. However, not this time. The restaurant was very crowded, and I walked into the bathroom and went. When I got back to the table I realized something, that for as long as we have been going to this restaurant I had never even walked into the bathroom!

Improving sex & intimacy: What we know from research


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We all want to keep our relationship passionate and connected, and there are ways to both create and destroy your connection that all take place out of the bedroom. What’s most important is not to let sex become the last item on a very long to-do list, the final obligation you turn to when you’re both exhausted. There are concrete ways to ensure you have a great sex life.

 

In a study of 70,000 responses from 24 different countries, Christianne Northrup and Pepper Schwartz and James Witte, in their book, The Normal Bar, reported the results of their extensive study about love and sex. Couples who have a great sex life:

 

  • Say “I love you” to their partners every day, and mean it
  • Buy one another surprise romantic gifts
  • Compliment their partner often
  • Have romantic vacations
  • Give one another back rubs
  • Kiss one another passionately for no reason at all (85 percent who love sex also kiss passionately)
  • Show affection publicly (hold hands, caress, kiss)
  • Cuddle with one another every day (only 6 percent of the non-cuddlers had a great sex life)
  • Have a romantic date once a week that may include dressing up, dinner out, massage, and lovemaking
  • Make sex a priority and talk to one another about sex comfortably
  • Be open to a variety of sexual activities
  • Turn toward your partner’s attempt to connect with you

 

Furthermore, the more couples do these things, the better their sex life is. The champion countries were Spain and Italy. The bottom line: Great sex is not rocket science. It’s very doable, but you have to talk about it and you have to make it a priority in your relationship. CBT can help.

 

Practice exercise #1:Re-read the list above and identify 2-3 items you could do for your partner. Set an intention to do them this week.

 

Practice exercise #2:Pick 2-3 items you would like your partner to do for you. Share the list, and ask them.

Noah Clyman, LCSW-R, ACT

Academy of Cognitive Therapy (ACT) Diplomate & Fellow
Certified Trainer/Consultant & Credentialing Committee Member
Clinical Director, NYC Cognitive Therapy
347-470-8870, x700
Fax: 347-470-8870

Improve your love relationship by talking about sex


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Noah Clyman LCSW-R & Drs. Julie & John Gottman

I recently had the pleasure of attending a 3 day workshop with couples’ therapy experts Drs. Julie & John Gottman who are world renowned for their work on marital stability and divorce predictions. You may recognize them as the authors of the New York Times bestseller, The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert. I learned their innovative theory about how to make relationships work, along with research based skills for a great sex life, improving friendship, and resolving conflict. There are so many pearls of wisdom and this blog post will touch on the importance of talking about sex.

According to Drs. Gottman, there is no more stable and replicated result in the sex field than this: being able to talk comfortably about sex is strong related to satisfaction. Not just with sex, but with the whole relationship. And the results are not weak, they are dramatic. Quantity as well as the quality of the talking about sex, are strongly correlated with a couples’ happiness. Statistically speaking, only 9% of couples who can’t comfortably talk with one another about sex say that they are satisfied sexually, as well as satisfied in general with their relationships. On the other hand, over 50% of couples who can (and do) talk with one another openly about sex are satisfied sexually and are satisfied in general with their relationships. That’s a difference of forty-one percent! Amazing.

Research on sexuality strongly points to the importance of being able to talk intimately with one’s partner to enhance the quality of sex in your relationship. Yet having these conversations is very difficult for American couples from an African, Anglo-Saxon, or East European cultural background. Drs. Gottman–who have been analyzing videotapes of couples talking about their sex life in their “Love Lab” for decades–found that most couples have a great deal of trouble being clear and specific about what they want and don’t want in the bedroom. There’s an enormous fear of rejection which comes from a lack of trust and openness with each other.

Interestingly, this isn’t true of many heterosexual couples who are Latino and haven’t been made to feel guilty by strict religion. In some ways, these cultures support direct and frank non-defensive conversations with one’s partner about sex, romance, and passion. (This is not to say that all Latino couples are comfortable talking about sex. Many are not). Drs. Gottman discovered these facts about Latino cultures in America during a national survey they designed for Readers Digest. They also found that the same was true of gay and lesbian committed couples, in a 12-year study they did with Robert Levenson. Generally, Latino and same-sex couples didn’t make assumptions about eroticism. They considered it their responsibility as lovers to know what their partner did and didn’t find erotic.

To facilitate the process of conversation about sex, romance, and passion for couples who may feel uncomfortable with these intimate topics, it is important for couples to learn how to how their partner basic questions about sexual preferences, and then remember the answers. Remember: if you know your partner’s preferences, you will be able to create more excitement and pleasure for your partner. I look forward to helping couples improve their relationships from resolving conflict, to deepening friendship, to having great sex.


8 tools to defeat your ‘workaholic’ ways


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I am a workaholic. While on vacation last week, I became cognizant of the benefits of r&r and was inspired to write a blog that might help my fellow workaholics to address this issue. Do you find it difficult to disengage from work? An imbalance between your work life and your personal life may be behind of myriad of other problems, such as anxiety, depression, or insomnia. Are you obsessed with working to the exclusion of other things in your life? Some people work as though they were addicted to working. Have you convinced yourself that you have to work harder than everyone else? At your place of work, are you always the first to arrive and the last to leave? Has anyone ever accused you of being a workaholic or a perfectionist? Do you feel as if you are addicted to work? Work and your professional identity may be overly tied to your self-esteem so that you over-allocate time to work pursuits. Do you feel badly about yourself when you are not doing work? Do you view non-work activities as a waste of time? Do you believe that any idle time should be filled with some useful activity towards a goal? Have you come to devalue activities done for the sake of leisure or rest? If so, here are some cognitive and behavioral therapy techniques for you to try:

 

  • Ask yourself, Why am I the exception to the rule that human beings need rest and relaxation? In other words, challenge the idea that you do not require rest or pleasure in your life—all human beings do.
  • Imagine what would happen at work if you were incapacitated in some way. Would the business cease to exist, or would it find some way to make up for your absence? Challenge your tendency to overestimate your importance at work. Paradoxically, people who take breaks and recharge are often more productive at work.
  • Experiment with putting some rest and pleasure into your life and taking away some of the time currently allotted to work. For example, if you are working more than eight hours a day, commit to leaving work at an earlier time this week. Spend extra time doing something enjoyable.
  • Shorten your to-do list this week to essentials only.
  • In your own personal currency (i.e., in your mind), consider increasing the value of moments of pleasure and decreasing the value of accomplishments.
  • Create a “Buffer zone:” about an hour before getting ready for bed, begin to transition away from your “active self” by restricting your activities to those that are relaxing and enjoyable to you.
  • Say no to at least one request this week.
  • Think of the needs of people who currently depend on you. Now think of your own needs. Is your list of needs shorter? If so, why? How are your needs different from theirs? Why are you an exception? What is missing from your list of needs? Add to your list of needs and make time to de-stress and unwind every single day.

 

In summary, like any other human being, you need time for rest and relaxation. Far from being wasted time, making a conscious and consistent investment in “self-care” will help you be happier, more self-aware, calmer, and more productive throughout your days.