good evening and welcome to doctors on call I'm Dina clba founder and CEO of Insight Counseling Deluth I am your host for our program tonight on mental health for couples and families the success of this program is very dependent on you the viewer so please call in your questions tonight or send them to our email address ask at pbsn north.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Jamie milb Scott of bridge family therapy Mary Casey lad of duth family therapy and Dr Corey Duffy licensed psychologist of rooted psychology answering the phones tonight are members of the PBS staff and now on to tonight's program on mental health for couples and families the first time we're having this conversation um I believe and I'm super excited about it um I think and for sure marry all of you but under the umbrella of psychotherapy supporting couples and families is newer it's one of the newer ones it was I mean the focus was individual and now we're inviting partners and families into the space so it's it's exciting and I I was reflecting on how helpful it is too if we're able to support them sooner rather than later so I'm so glad we're having this conversation I remember reading a statistic it's dated but I would say even my anecdotal experience would would concur that uh couples for instance can wait six to seven years to seek help after an issue's kind of become an issue uh so I'm really excited that we're having this conversation to be able to kind of talk about what support is available and and how to get it and last I'll say that I've noticed it's seemed I was just last year starting to get more training and kind of helping those couples who are on the brink of divorce and the moment I started doing some more intentional training all of a sudden now I'm seeing so many couples that that's not the case they're um you know raising young children and maybe seeing them their lives going on separate trajectories or their recent empty nesters are soon to be so uh they're very much in love and just kind of looking for well we'll say the handbook the manual which we're not you know we I don't know I always say like we didn't I didn't get a manual when I got married you know you have the one that you were raised with and and they're beautiful and imperfect and um so yes let's let's start this conversation there's so much that we were talking about um in the green room so I don't know how we're going to do this in 30 minutes to start let's I mean Blended families couples who have divorced um how how do do what what are your recommendations about how to um Jamie can we start with you as far as co-parenting I mean kind of under all of that yeah well I think I would start with um as a parent get your own help and support so that you have somebody that you can talk to because the best outcomes for the children are when the parents get along well and they don't hear their parents badmouthing them or talking about them and and leaving the adult problems to the adults and not involving the children thank you Mary you well and I think exactly what Jamie is saying is so important is that um as somebody trained in Family Therapy that what we were taught to really have an understanding about is um watching how oftentimes children get caught in the marital conflict and um and then children often times will will act out some of that pain that they're absorbing and so um being very intentional both for couples who are still together to um to just really um watch how sometimes the children will try to try angulate and get in the middle and how important it is um to be intentional as parents about not allowing that and um and and especially I think in in families where there's contentious divorce that is really really a highrisk factor for kids it is thank you yeah Corey anything yeah absolutely I think that um you know what we really know is that it's not divorce that causes poor outcomes for kids it's confli conflictual relationships between the parents and that's true whether they're married or divorced and so we know that if the the best thing that you can do as parents for your kids is to work on your own relationships which of course means working onself working on your own emotional regulation so that you can engage with with anybody in a really healthy way love that thank you Corey just with that too what would you say that you're seen and I believe you see primarily couples um less families so what are some of the the issues some of the presentations that they're bringing in today well I'll tell you the main thing that I hear when people are coming into coup's counseling is that they need to work on their communication and I I think that that is a really actually very powerful statement because communication is that space in between where we are figuring out how to negotiate our relationship with other people and so you know they're not wrong that they do need to work on their communication but what I always tell people is we have to take a step back because before we can communicate with somebody else we really need to understand what's happening for our own selves and we really need to be able to you know turn down the volume on that emotional disregulation in order to be able to know what we think and then be able to communicate it effectively appreciate that and that space being safe yes right that felt sense of safety to be able to to do that and I just I mean we're biologically hardwired to also be you know survival Instinct and and have some protective factors which thank goodness however they can become problematic in the adult relationships when we haven't you know spent some time around some insight to run with happening thank you Mary how about you how would you say you've been supporting couples and families lately what have you been noticing the um in the 70s when I was under training one of my supervisors said to me the worst phrase that we've heard in our culture is the phrase of I have to tell you how I feel and when I when I heard him say that I thought what you know Sam what are you talking about and he said people say that when they're now what we call flooded when they're emotionally um really charged not in their wise mind but in a really reactive part of their brain and it is a time when people can say just the cruelest and meanest things to each other so I think that it is very difficult when people are in that angry State who want to be heard and want their point to get across um that they have to recognize that there's a time when you need to be able to take a break step away which is very very difficult for us to do when we're in it to step away to cool down and to be able to re-engage in a way as you said Dena when it feels emotionally safe right yeah that being trained by the G mens you know they they said they even put a little monitor on the fingers to monitor heart rate right and if it goes above 80 then we're going to be soothing because nothing productive happens right your um yeah executive functioning is is challenged yeah how about you Jamie what are you seeing yeah we talked about you've got some you yeah please talk about that well so there's a lot of things that that bring people in but um I think both of these ladies have spoken to um just how the big emotions come right and we don't always recognize why they're there but they come and they come out looking like anger but underneath all of that is hurt disappointment pain all kinds of things um and so I'm helping couples get to the root right some of those deeper emotions and meanings that we make of um what our partners do like if your partner leaves the pizza on the counter what does that mean and and how they're interpreting that that is they think I'm their maid and they're disrespecting me they don't care about me and really yes right and they go right to that instead of he got busy and he left the pizza on the counter right and it's not about the pizza it's about what's going on at a deeper level and then and then it gets into this cycle of conflict right and you were talking about disregulation with all those those heavy emotions coming we have to learn how to regulate and Bruce Perry he's just phenomenal his work but he talks about how when we're disregulated we're back here in the back of our brain you know and we're not doing any thinking back there we're doing the surviving like you said the reacting to things because we're wired to survive then up here is where we can relate and then in the front is where our skills lie for the thinking and everything so before we can learn to communicate with the skills we have to be able to regulate our bodies first and then relate and then reason thank you um and I think yeah I'd love to talk a little a little bit about some of the ways that we do it if you could just pick one modality that you've been using lately um and I'm going to call on the PCI parent child interaction can you talk about that a little bit yeah so my work with um parents is just a little bit about it is um it's called parent child interaction therapy I teach parents how to do play therapy with their children so that they are building the relationship with their child instead of me I do it through the internet so I get to see them at home and they're in their natural environment so sometimes they know I'm there and but they forget that I'm there when they're playing with their parents and then I coach the parent in the in an earbud in their ears they're playing and I'm reinforcing these beautiful therapeutic techniques and so what you see in the first phase of treatment is behaviors just dramatically going down because parents have to then practice five minutes a day just five minutes a day those skills and it changes kids' behaviors and it creates this warm beautiful attachment and if you're already H having this warm beautiful attachment it enhances it even more and in the second phase of treatment we then teach the parents now that you've calmed him now that you've grown closer now what do you do when he doesn't listen or she what do you do when she doesn't listen and we teach you what to do exactly all these steps it it takes the guesswork out of it and it helps parents to it empowers them really to be the parents they want to be in soad the parents that we become when we're overwhelmed and we're stressed and we have nothing left to give right right all of us human yeah yeah and the important thing Jamie about what you're doing which is very different for a lot of people who were trained to do children's therapy is that you're more in the background as the parents coach and that the the focus isn't on the child forming a relationship with you but you helping the parents reestablish the trusting relationship with the child and um and there are so many child therapists in my um in my experience who don't it's like they have not been trained to involve the parents in the therapy they consult with them before the session or after the session but that Focus about that that your job is to help that parent and that child strengthen that bond which needs to continue after the therapy's done yeah absolutely yeah uh if you're just tuning in we're having a great conversation on mental health for couples and families uh Mary a favorite modality and you've taught me so much over the years which one would you pick no it's like I I and you won't be surprised Dina to hear me say that I can't say that I have a favorite because um I when I I started training in 1972 as a family therapist and the field has changed and evolved so much over those years and um and so it is you know for me it's about being able to have the exposure to some incredible clinicians and theorists and um and to kind of adapt and borrow so much I would say that one of the most powerful for me was the training that I got in what was called narrative therapy and that we were having an understanding about like what are the stories that have been passed on generationally what are the stories that we tell about why our kid is misbehaving you know it's like one family it was like they were dropped on their head as an infant and you know and the family came to believe that as a truth and so to be able to kind of say well that's a possibility but let's look at some other factors that might go um go into this so this this ability to listen to what the stories are that sometimes times restrict the families from being able to see you know their possibilities or their potential I think is um that that training was very very um impactful and significant and and I couldn't I can then hear as we were talking about as we started that the meaning that somebody attaches or the story that they have in their head about why somebody is doing whatever to me or to other people um again it's a possibility it's not a fact and so we want to we want to create the ability to kind of step back and look at how is it that you came to believe this about your child or about your spouse um what are the factors that kind of led to that and um and let's maybe get a different angle on that so that was powerful for me yeah Corey how about you what have you been doing lately yeah well so this is not so much a modality but the the skill probably that I fall back on the most when I'm working with couples is a skill that's taught pretty much in any type of Coupes therapy training you will take but then I think it's always called something different so I call it mirroring which I got from Harville Hendrick um but basically what it is it's very similar to what you're describing with the parent child interaction where you're teaching the parent to interact with the child in mirroring I'm teaching the couples to interact with each other right so that I'm not having to talk to each of them so much but so what it is is basically somebody one person the speaker says the thing that they want to say to their partner the partner says it back to them almost word for word they're not interpreting they're not putting their own spin on it they're not sharing their opinion about it or anything like that right they're just saying it back and then the Speaker gets to confirm or deny like okay is this what I thought what I meant to say or not do they get it so they can add a little bit to it if they want to they can clarify for the for the partner the partner then reconfirms so you go through this cycle as many times as necessary until the speaker feels understood and that's the metric for whether it's working or not as the speaker says yes you got it I feel understood now and what that does for the space between a couple is so powerful because then all of a sudden everybody relaxes right and it's like okay now we can get somewhere but it's it's so simple it is but it's not easy at all and so it does take a lot of practice but I I find that to be if I could teach couples one skill that would be it I agree with you I mean I've been Imago therapy you know developed by him and uh I mean and it's putting the chairs together so couples are KNE to knee if you have them in the the office with you and sometimes I mean it sounds so simple right and easy but even like couples facing each other sometimes that might not happen at all like I I'll get the giggles you know and I mean it's just it's amazing and Powerful uh I will add that part of that um dialogue you know with the miring making an appointment I have found that to be the gem in some of those steps I mean just because often when we want to comment about the pizza on the C you know it's like things are just moving fast or whatever and to truly be able to hold that space I just I've found so many times like with couples and I'll just say myself personally asking is now a good time to share um my most recent one was I don't feel like it's safe to go on the lake when it's so warm out seriously can I make you know but of course it's fine and exit but it's like it's helpful to make an appointment for something just very trivial but I think we all know some of those just trivial things can be come complex conversations when an emotion or a raw spot gets hit and making the appointment to come to Coupes sessions is sometimes the first date that couples have had for a very very long time I have Goosebumps Mary when you say that how many they will go out to dinner or happy hours something afterwards and they hadn't done that for a long time because the marriage often times gets put on the back burner when the first child is born it's really busy right and I want to say again CU I mentioned uh the and look The Empty Nest so on so forth and I've recently heard the term free birds and I like that too and I've noticed the couples I'm working with like that too were free birds you know still transition ups and downs or whatever but that was kind of a fun way to talk about it so we have uh Karen from Washburn Wisconsin has a question she says how do how do I handle anxious thoughts and ruminations when they come to me at 4:00 a.m. she doesn't necessarily mention couples but I can't help but think that often we are sharing a bed sometimes with someone at 400 a.m. and um so just if we can kind of look at it from that perspective as well how to support each other when we're experiencing anxiety which one of the other questions is about um a partner losing his best friend and um how do I support him so I guess when you know your partner is experiencing whether they're ruminating at night or there's been a loss what do you think um Corey if you want to start what feels like most helpful or some some things that they could try sure well I think you know with the anxious thoughts that's obviously very common right like people will awaken in the middle of the night with anxiety right and that they can't fall back to sleep because it's it's uh you know hard to fall asleep when your mind's racing but I think that um self- soothing is going to be the key but the trick is how to find something that actually feels like that for you so it's going to be a really individual process I think that um one thing that I think is kind of helpful for people is to think that sometimes it's hard to go straight to the self soothing piece sometimes we need to distract ourselves first from the thing that's stressing us out and so like in bed at night in the middle of the night right like maybe popping in a podcast that's a little bit boring but something that's going to just get your mind off of it so something that can distract you first and then you can kind of refocus on how do I like do some deep breathing how can I um you know try to get my my my body to be more comfortable the other thing that we know about sleep which I'll talk about sleep all day because to me it's the most important piece right but if you are finding yourself laying in bed for more than 20 minutes or so you want to get up out of that bed because otherwise your bed's going to become associated with all these anxious thoughts rather than sleeping and resting so just get up walk around get yourself a glass of water or whatever it is so something like that I mean yeah when it comes to supporting your partner about these things I think you know for the most part just being a listening space for them right I mean you know usually when people are having a problem whether it's anxiety or whether it's losing a friend like there's nothing that you can do about it and so your partner is not coming to you wanting you to solve the problem your partner is coming to you just because they want to again feel Hur and under and so just being able to offer that space I think is such a gift even grabbing holding your hand ABS B go that's beautiful um anything else as far as supporting uh Jamie or Mary did you want to weigh in at all I I agree wholeheartedly with that most people just need support when they're in grief and support looks different for everybody and so you have to learn what your partner needs and it could be a handholding it could be a I want you to know that I care and I'm here I don't know what to say because there isn't anything we can say right um and then on the anxious thoughts one in the middle of the night one of my favorite things that I have my clients do is keep a notebook and P um pen next to the bed have them write it down really quick because then the brain can say oh okay I'll remember this tomorrow and then it can shut back off and go back to sleep sometimes it works and sometimes it doesn't but that's why you want to have a bunch of tools in your toolbox and I've done that and it's amazing how those are not important really most of the that list um Mary what rituals can I develop with my partner to inspire our relationship oh my goodness this is um there's a wonderful resource for this is Evan Ember black wrote a book called rituals for our families and and it's filled with fantastic rituals that um that can help but I think that you know the rituals that are important to develop have to do with what some of your shared interests are some couples I work with they have a ritual of of leaving a note on the the day you know like on the 30th of every month which is a day that they met um which is a little love note or a ritual um a couple friends of mine who had been married for um over 50 years on their anniversary they went up to Grand marray they stayed in the same hotel and they had written a letter to each other about Reflections on this past year um there are you know rituals that have to do with how is it that we play together so are there games activities um or every month going and finding the full Moon I mean so it again it's like the ritual is um an act you know a kind of like a shared belief that really gives meaning to the fact that sharing this with you is different than I just go and look at the the full Moon by myself um or that I listen to this piece of music um and so there are there are ways to have rituals that we where we're celebrating things that are happening in our life but I think for couples it is to emphasize how is it that we stay connected I'm in dialogue right now with um um two young dancers who are opening up their own Studio not in our state and you know we're I'm Consulting with them about how to use dance as that activity that can bring couples together that it can be intimate it can be romantic I say sometimes dance is the best form of foreplay and you know so I think to for couples to um to just really devote some time in reflecting on on what brings us together that feels like it's shared Joy thank you Jamie one tip about how to connect oh mine my favorite is make sure that you have time set aside every week so if it's a weekly date or it's those rituals they can be daily but you have to be setting aside time to connect and my favorite is weekly dates Corey how about you what's well what's coming to my mind is just the the um what we know about the body's physical reaction to hugs and so you know we need to have it's needs to be about 30 seconds for our bodies to get that really Powerful release of hormones that's like helps us to feel better and so this is applicable for your partner but it's also good for your kids too right to know that if we can get um some nice long hugs in there we're all going to feel a lot better 30 second hugs and sixc kisses yes yeah I want to thank I want to thank our panel of um our panelists Jamie Milbridge Scott Mary Casey lad and Dr Corey Duffy please join Dr Ray Christensen next week for our program on upper GI problems thank you again for watching good night