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A Digital Age of Therapy: Using Tele Medicine

In November, I presented at the Annual Cystic Fibrosis Conference in Indianapolis, Indiana.  I discussed the use of tele medicine in working with patients with chronic illness and how to best support patients in coping with an invisible disease.  Below, I have included a link to my abstract for the conference.  There is also a clip from my talk.

 

https://ww4.aievolution.com/cff1701/index.cfm?do=ev.viewEv&ev=1085

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An Ode To My Cellphone: How Can I Miss You If You Were Never Really Gone

By Diana Garber JD, LCSW

Cellphones!! Is it always glued to your hand? Whether you are scrolling, texting or tweeting, when you are on your phone,  you are not engaging with other people.  This month, my blog post is about the struggle I personally faced regarding leaving my phone out-of-sight. When I am at home with my family, I want to be present and yet my “to-do list” keeps my phone in my hand.  The people in my life deserve more.

Although this article focuses on the impact my phone has on my young baby, so many people face their issue.  Teenagers texting at the dinner table, friends out to dinner with their phone with their phone by their fork or couples who rarely look up during date nights— these are all examples of times people ignore the person across from them for virtual connections of others.  This blog posts talks about the importance of face-to-face interactions:


Before my baby was born, my husband and I did not really discuss parenting styles. We knew that all of our best-laid plans would be thrown out the window once we were in the thick of it. We also wanted to enjoy getting to know our daughter and not always be thinking about what we “should” do. There was one big exception which was our (mostly my) use of cellphones.  My husband was adamant that cellphones would distract us from spending time with our daughter. I told him I agreed.

Then the bullets started flying. In those early days of late night feeds, backwards circadian clocks and 3 a.m. glider parties, my cellphone became my lifeline. I was able to order food, diapers, research how much spit up is too much and update my photostream all while balancing the phone on my boppy and holding my newborn.  On many days, my phone became my only portal to the outside world. I was lucky to have friends in other cities and time zones who had infants the same age and we sent encouragements, funny pictures and emojis in the dead of the night.  Those one-handed texts from the other side of the country went along way to keeping me sane.

But still I knew my phone had to go even without my husband’s constant reminders.  As those early nights stretched into the first weeks and months, we often revisited this topic.  My husband and I would talk about being present.  Not only had my daughter begun to notice my phone, she also knew when my attention was diverted elsewhere.  Sometimes she was curious as to what I was doing and other times cried. I was convinced this was her way of getting me to put the phone down (no mommy guilt there).

As I head back to my therapy practice this month and my time with my daughter is more limited, I am revisiting the cellphone conundrum. I have so few available minutes that to have my phone at arms reach allows me to get things done. And yet, I have so few available minutes that being present for them is vital. My professional life is built on helping people learn, analyze and strengthen their bonds with those around them and so shouldn’t this be a no brainer? No bond is more important that an infant with a parent. And yet, my phone is sitting next to me as I write this (she’s napping, I promise!)

And so, what are the benefits of leaving your phone in your purse during quality family time?

Multitasking is the socially correct way of saying we aren’t 100 percent focused on what we are doing.

Being on our phones means we are half-listening to those around us. When we are half-paying attention, we often miss cues that our children need us.  In response, our kids will cry louder, bang toys harder, act out more to get our attention. In the long run, children can learn that they have to be bigger and better in order to compete with our devices for time. When we put our phones away, we are more able to be 100 percent invested in our children.  This shows our children that they are important and what they say matters, which ultimately leads to a positive self image.

Eye Contact is SO important.  

Eye contact between baby and parents is crucial from the get-go and allows us to be clued in to what our children need. When we are half-paying attention and half-texting, we can miss our children’s cues. I don’t know if any other parent has had the experience where you turn your head while still feeding your infant only to look back and see they are completely covered in milk. Although we can’t be focused all the time, having our phone out means that this situation happens more frequently.

Kids observe their parents and their behaviors constantly.  

When my neighbor’s son gets cranky, he is best soothed by looking at pics on her iPhone, similar to adults around her who need to “zone out”.  When he was two, he liked to show everyone how he could “swipe like daddy.”  When our heads are constantly looking at a screen, our children see us. These interventions work and preschoolers are incredibly computer-savvy, but are these the traits we want them to emulate?

When I was growing up, my parents did not allow a television in the kitchen.  This created an environment where we would talk to each other and we typically had lively family meals.  Smart Phone usage is the next-generation, high-tech iteration of that same principle.  In the end, we have the opportunity to cultivate an environment that doesn’t allow technology to detract from real “facetime” with our families.

 

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Election Depression Is Real: How to deal with your feelings and talk to your kids

By Diana Garber, JD MSWdepression following 2016 election results

 

This article was going to be about sibling rivalry.  Last week, I sketched out my thoughts and multiple times, I sat down at a blank screen trying to write the words.  It didn’t happen.  Frankly, I just wasn’t there emotionally.  And, I can imagine that many of you feel the same way.

I know many are dealing with intense feelings, struggling to manage them while also being a parent.  I know many parents are wrestling with what to say to their children.  Here are my thoughts on how to do both:

  1. Your emotions are real. Many of my clients this week have shared feelings of loss akin to losing a loved one or being laid off.  Many have felt unheard, despondent and helpless.  Living in San Francisco, I have noticed these pervasive feelings among neighbors, colleagues and family.  Try to acknowledge these feelings.  Many people are afraid that when they admit a feeling, it will intensify it.  The opposite is actually true.  Giving words to your emotions can lead to a sense of relief because you aren’t ignoring that gnawing feeling and pushing sadness away.
  1. Laundry can wait. Many people who experience intense feelings try to jump right back into routine and push the feelings aside.  It is ok to have a quiet weekend–or two.  Grief and depression are a little like a hole in a dam.  If you acknowledge that the feelings are there and deal with the problem, the dam will be just as strong as before.  However, if you ignore the hole, at times, a crack or another hole can form, creating a bigger problem down the road.I know many feel that there is a lot to “do.”  Feeling your emotions and even slowing down your pace for a few days is not contrary to that.  I believe acknowledging feelings allows many to be more connected and eventually make more thoughtful and productive decisions.  So when you do act, it’s thought out and not reactive.
  1. Don’t neglect all aspects of your life. Many people struggle with acknowledging negative feelings because they are afraid those feelings will overtake them.  Remember, feeling a certain way is not being a certain way.  Most of the time, acknowledging and leaning into negative feelings for a short while will allow you to re-calibrate to your normal state more quickly.If you notice that you are neglecting your daily life for an extended period and continually feel overwhelmed, please reach out for additional support from friends, family or mental health professionals.
  1. Seek out small things that bring you happiness. This weekend my husband and I are pouring hot apple cider into giant mugs and carving pumpkins with our neighbors.  We knew that while we did not want to take on too much this weekend, we needed some event to let go of the heaviness of the week, if just for an hour or so.
  1. Focus on family and friends. Seek out people who you feel understand you, who can validate your feelings.  We generally feel stronger when we connect with others.  Spend quiet and quality time with the important people in your life.  The upcoming holidays can be a perfect time to recharge.

Understanding and processing personal emotions can allow parents to clearly express themselves to their children.  Here are some points to consider during those conversations:

  1. Explain your feelings to your children. Children from a young age are very perceptive.  They hear snippets of conversation whether it be from the news, other kids or adults.  Most importantly, children are attuned to their parents’ emotional states and can sense feelings of sadness or uncertainty.For that reason, it is important to acknowledge your feelings to your children.  Tell them a little of why you are having this reaction.  Acknowledging that you are having an emotional time teaches children that emotions are real, it is ok for you, and ergo them to have such reactions.
  1. Remind your children that they are safe.  Remind them that our basic liberties are secure.  Remind them that your job as a parent is to protect them.
  1. This can be a great opportunity to talk about your family values.  Many children, especially school age, have some awareness that the country has chosen a person who has said negative things about certain people or groups.  Their confusion is totally understandable.  Talk to them about what you believe in.  Reiterate that these core values haven’t changed.
  2. After the hard conversations, lighten the mood.  Take your children to the park, on a hike, out for ice cream.  Try to help them put this week’s events in context, especially after talking to them about safety and values.

And next month, I’ll share my thoughts on sibling rivalry.

 

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How to Promote Emotional Development in Toddlers

 

Promoting Emotional Development in Toddlers

By Diana Garber JD, MSW

My recent blog post for San Francisco Mom’s Blog talks about how important emotional growth is for toddlers. However, emotional development often gets overlooked as children learn physical and verbal skills.  It is easy for parents to overlook how important it is for toddlers to try to solve and manage problems are important as children gain independence.  Learning how to regulate emotions and develop a sense of self starts at a young age.  My article talks about how parents can promote emotionally skills along with more traditional toddler growth:

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Last month I was lucky enough to spend a whole week with my 16-month-old niece. Besides taking credit for teaching Mallory the words “Di-Di” (a variation of my name that I pushed HARD) and “yes” (you can thank me later), I loved seeing how much she had grown since the winter.  Mallory had become much more mobile since I last saw her and was eager to show me how much she could do on her own.  For much of one afternoon, Mallory buoyantly pushed her shiny “Frozen” car from one side of the house to the other.  She was unstoppable—until she hit a literal and then figurative wall.

With the car wedged against the door, Mallory looked up at me with hope in her eyes and gestured for me to turn the car around.  Instead, I sat next to her and said, “this is so hard, isn’t it?  It seems that the car is stuck.”  And then I encouraged her to try to move the car.  My little niece looked annoyed (at the car, the wall and definitely me).  My response didn’t change and Mallory’s frustration became re-purposed into energy to experiment with different angles between the animate and inanimate object.  I saw the pure joy in her eyes when she realized the car could move backwards and she could continue driving without any physical help from me.

I was very tempted to relieve Mallory of her temporary distress and turn the car around myself.  However, as a therapist, I know how important it is for everybody, even toddlers, to learn to tolerate distress and soothe themselves when they feel sad or frustrated.  Many people who enter therapy as a teenager or young adult struggle to do so independently and (sometimes unwittingly) come to therapy to develop these emotional muscles.  There are many theories on parenting and how to nurture children from birth to college (and beyond) and those choices are personal decisions that all parents make for themselves.  However, from a therapeutic standpoint, allowing your child to experience small frustration can be a positive growth experience.  Here are a few things to keep in mind:

  1. It is ok to be frustrated.  Toddlers and little children are learning new skills every day.  It won’t all come easily and this would discourage anyone at any age.  When a child falls down trying to walk independently, she will inevitably be upset and cry out.  She might feel sad, frustrated or angry.  These feelings will pass and when a child is able to stand back up and try again, she begins to learn these feelings don’t last forever.
  2. Learning to tolerate emotions is just as important as learning how to crawl, walk or talk!  Emotions are new and can feel overwhelming to children.  When a child doesn’t get a new skill right away, she will unsurprisingly get upset just like my niece.  When that child tries again, she has grown emotionally.  She has learned that she can have negative emotions and that she can tolerate the distress they caused.  Negative emotions are a part of life. A child who gets the opportunity to practice emotional skills at a young age is well on her way to knowing she can handle bigger more frustrating events as she gets older, such as, not getting an A on a math test or getting the chorus instead of the lead in a school play.
  3.  If your child seems to be in real distress, be there for her.  Exploration is fun and teaches problem solving.  But knowing that you are there if she really struggles enforces the message to your child that she is safe and you can support her if she hit a literal or proverbial wall.

 

 

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No Body is Perfect

teenage body image

 

By Diana Garber JD, MSW

Back-to-School shopping can exacerbate negative teenage body image especially in adolescent girls.  Many parents find it hard to support their daughters during this stage without being shut out.  Check out my post at San Francisco Mom’s blog to discover ways to promote healthy body image during these critical years or read it below:

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In many households, the start of school means new clothes, however, back-to-school shopping can highlight negative body image for pre-teen and teen girls.  Returning to school can lead to feelings of insecurity and anxiety for girls as many teenagers anticipate that their classmates might notice differences in their appearance after the long summer break.

Moms want to encourage teens to feel good about themselves because positive body image helps develop a healthy sense of self.  So how do we encourage our daughters to not get hung up on numbers, to accept their bodies and not say mean things about their shapes?  If you are privileged enough that your daughter still lets you tag along on this yearly ritual, here are a few things to keep in mind:

  1. Change negative self-talk. Being a little self-conscious during middle school and high school is normal. However if you are shopping with your daughter and she starts putting down her body or herself, it’s time to step in.  Trying to get your daughter to refocus can be tricky because you don’t want to tell her that her beliefs are “wrong” or “silly.” Instead focus on how her body supports or fuels her.  Does she love Field Hockey?  Point out how strong she is or how her body supports her athletic goals.
  2. Encourage her to pick clothes that she feels good in.  Your daughter is going to want to buy certain things that her friends are wearing—that’s what teens do. There will be small moments when your teen connects to her own unique interests—non-matching socks? Purple jeans?  Be supportive when she indicates a certain preference and encourage her when she does. This will promote the development of her own identity.
  3. Take a break.  Over lunch, discuss what she is interested in or enjoys doing.  Is she moving from JV to Varsity soccer? Now an editor on the school paper? This will subtly allow your daughter to think of herself as a whole person, not just focus on the clothes she didn’t like on her body.
  4. Be careful about negative comments about YOUR body.  I often hear mothers censure themselves for having extra weight around their middle or refusing to shop until they lose ten pounds.  When you criticize yourself, your children are listening and internalizing the notion that perhaps they would be more worthy if their bodies were more perfect.  Follow the same advice you gave your daughter. Focus on what your body does and what you want it to be healthy for (like an extra hour with her at the mall).

Remember, body image can be a reflection of how your teenager feels about themselves.  Struggling to accept her new body is a part of this age.  However if you notice a change of behavior (not participating in sports, not spending time with friends, odd conduct around meals) it is time to consult with a professional.

Happy shopping

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Millenials are not the Naughts

Millenials are not the Naughts

By: Diana Garber, JD, MSW
Millennials face real struggles when starting their career or when they find they are not on the right professional path as recently reported in the New York Times.  In my private practice, I often work with 20-somethings and 30-somethings that feel “stuck” but are unsure of their next move.  In our work together, we often uncover that strong environmental pressures –family, peer group and financial stressors—make it hard for people to discover what they want, what they love and what works for them.

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