Fear of Flu Shots and Other Medical Interventions

Medical procedure anxiety is the fear a person feels in anticipation of a medical intervention. It can involve any procedure, from vaccines to surgeries, and it is very common—especially with kids. If you have ever sat in line at a drive-thru pediatric flu clinic, you have likely witnessed someone experiencing medical procedure anxiety. It is no fun for the child or the parent, but adults can help. Strategies include distraction and self-soothing techniques, both of which can help increase a child’s distress tolerance.  

How To Help Your Child Before a Vaccine Appointment

One way to help your child build distress tolerance is to teach them how to prepare. You don’t want kids dreading the appointment for weeks, but a 24-hour heads-up can help. Kids (and grownups) like to know what to expect. Depending on your child’s age, you can help them prepare by reading a “social story,” acting out the visit with a stuffed animal, or making a plan with your child for what will happen and how you will help them. 

Make a Plan

When making a plan with your child, give them choices so they feel more in control. Maybe they can choose which arm to use, or pick out a special band-aid to bring from home. Perhaps they can choose a fun outing you can do together after the appointment. Choices can make kids feel more invested. But remember, only give them choices on things that they can actually control!

Know Your Kid

Like so many other parenting moments, there is no one-size-fits-all approach. The best strategy for your child may be different than the best strategy for another. Some children like to have choices to feel a sense of control. Other children feel overwhelmed by having to make a decision when they are feeling afraid. Follow your kid’s preferences, and reassure them that you will help them through this.

Be Direct But Not Alarming

When talking with your child about what to expect, be direct while using non-threatening language. Instead of telling them it won’t hurt, we can tell them that we will help them find ways to make the hurt go away. If they ask us directly if their shot will hurt, we can say something like, “Different bodies feel things differently. When I got my last shot, it hurt for a little bit, and then I used an ice pack, and it felt better quickly.” Remind them of the ways that they can make it feel better.

At the Appointment

Once you and your child are at the appointment, distraction techniques can help a lot. Blowing bubbles not only distracts them but also encourages kids to breathe deeply, which helps with relaxation. Other kids like listening to music, a favorite story, or a new joke. Some pediatrician offices offer a buzzer or an ice pack to use before the shot. You can also apply ice packs after the shot to help with discomfort.

When It’s More Than Just a Shot: Supporting Your Child at the Hospital

Sometimes kids need more intensive or more frequent medical interventions. Researchers have found that distraction techniques can be less effective when a child undergoes frequent medical procedures because the child becomes used to the distractor. In these cases, parents can seek out new distractors or focus on growing their child’s distress tolerance through other coping strategies. Ask the medical team whether a Child Life Specialist is on staff, or whether they have a topical anesthetic they can use to reduce your child’s discomfort. 

Familiarity Can Bring Comfort

You can also help your child by building rapport with their medical team. If you feel comfortable with the medical staff, that can help your child feel more comfortable too. The same goes for equipment. Ask whether your child can try out some of the equipment necessary for the procedure beforehand. If your child needs to get an MRI, he will need to wear equipment like earplugs, headphones, or a belt. You can have them try on similar equipment ahead of the scan. Many children’s hospitals also have videos that show the equipment and explain the procedures to kids. 

Another common strategy for building up distress tolerance is through gradual exposure. If a child is afraid of band-aids, for example, you can start addressing that at home by picking out band-aids with your child’s favorite character. You can play with the band-aids by pulling some out of the box, taking one out of the package to look at, or putting one on a piece of paper or on an adult. Just like the distraction techniques that can lose their effect over time due to overexposure, feared items or procedures can start to feel less scary over time as well. We can support our children by giving them opportunities to practice in a calm, safe place. If problems are persistent, consistent, or highly distressing, child and family therapists can also help.

The Bottom Line

Guiding our children through medical procedures can be challenging. You know your child best, and the medical team will benefit from your partnership and expertise. We can help our kids manage their distress by making a plan, bringing fun distractions, rehearsing what will happen, and reaching out to team members for connection or assistance. And don’t forget: these strategies for building up distress tolerance can work for grownups, too!   

Sources and Further Reading

Clinical Practice in Pediatric Psychology

UCLA Health – Making Flu Shots Easier

Mayo Clinic – Tips to Help Parents

Posted by Erin Ker, MSW Intern

Erin Ker, a Clinical Social Work intern at Jonah Green and Associates, LLC, offers therapy for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.  

The post It’s Flu Shot and Sick Day Season! How To Support Children Experiencing Medical Procedure Anxiety appeared first on Jonah Green and Associates.

Winter can be a magical time of year. Between the holidays, family gatherings, cozy sweaters, snowfall, and delicious comfort foods, there is plenty to celebrate!

However, winter can also bring challenges. Shorter days, colder temperatures, less sunlight, and reminders of loved ones we have lost can make this season particularly difficult.

If you notice yourself feeling less energetic, more irritable, or simply not quite like yourself during the colder months, you are not alone.

For some, seasonal changes produce “winter blues.” For others, symptoms may persist and affect daily life. This may be a sign of Seasonal Affective Disorder (SAD), a form of depression.

Why does winter affect our moods, and what can we do to make the colder months a little brighter?

Why Does Winter Affect Our Mood?

Winter can affect our physical and emotional well-being for several reasons.

1. Less Sunlight

Sunlight regulates our body’s circadian rhythm. With less daylight, sleep-wake cycles can become disrupted, impacting energy, sleep, and mood. 

2. Discomfort

Colder temperatures can contribute to stiff joints and sore muscles. Cold air can irritate lungs and narrow blood vessels, increasing blood pressure and straining the cardiovascular system.

3. Missing Loved Ones

The holiday season emphasizes family, traditions, and togetherness. For individuals who have experienced loss, it can bring reminders of lost loved ones. Grief, loneliness, and changes in family traditions can lead to low mood.

The takeaway? Winter can affect both our bodies and minds. Recognizing these changes is the first step toward supporting our emotional well-being.

Winter Blues or Seasonal Affective Disorder: What Should We Look For?

It is normal to experience occasional sadness or lower energy during the winter. However, when these feelings become persistent or interfere with everyday life, it may be time to seek support.

Signs of Depression and SAD in Adults

Symptoms may include:

• Persistent sadness: Feeling sad, anxious, or “empty.”
• Loss of interest: No longer enjoying activities or hobbies.
• Low energy: Feeling unusually tired, sluggish, or unmotivated.
• Increased irritability: Becoming frustrated or overwhelmed more easily.
• Negative thinking: Feeling hopeless, guilty, or worthless.
• Difficulty concentrating: Struggling to focus or make decisions.
• Changes in sleep or appetite: Sleeping or eating significantly more or less than usual.
• Social withdrawal: Wanting to stay home or avoid others.
• Thoughts of self-harm or suicide: Thoughts of hurting oneself or not wanting to live.

Winter-pattern SAD is particularly associated with increased sleep, increased appetite, low energy, and social withdrawal.

Signs of Depression and SAD in Children

Children do not always express sadness the same way adults do. Sometimes, what looks like defiance, anger, or a lack of motivation may actually indicate that a child is struggling emotionally.

For children, symptoms may include:

• Mood changes: Increased crankiness, frustration, or emotional outbursts.
• Negative self-talk: Becoming more self-critical or saying things like “I’m not good at anything.”
• Changes in sleep: Sleeping more or less than usual or struggling to wake up.
• Changes in appetite: Eating noticeably more or less than usual.
• Difficulty concentrating: Having trouble focusing or completing schoolwork.
• Withdrawal: Losing interest in friends, hobbies, or enjoyable activities.
• Changes in school performance: Difficulty attending school or staying engaged.
• Thoughts of self-harm or suicide: Expressing thoughts about hurting themselves or not wanting to be alive.

A helpful reminder for parents: Behavior is often a form of communication. If your child suddenly seems more irritable, withdrawn, or emotionally reactive, consider what they may be experiencing beneath the surface.

Rather than focusing only on the behavior, try opening a conversation about how they have been feeling.

SAD vs. Major Depressive Disorder (MDD): What’s the Difference?

One of the biggest distinctions is the seasonal pattern.

Major Depressive Disorder (MDD) can occur at any time of year. Symptoms may worsen during winter, but they are not necessarily connected to seasonal changes.

Seasonal Affective Disorder describes depression that follows a recurring seasonal pattern. It is commonly diagnosed as Major Depressive Disorder with a seasonal pattern.

For individuals experiencing winter-pattern SAD, symptoms typically begin during the fall or early winter and improve during spring or summer. Clinicians generally look for this pattern over at least two years.

The important thing to remember: Whether symptoms are seasonal or year-round, depression deserves attention, compassion, and appropriate support.

How Can Adults Support Their Mental Health During Winter?

The good news is that there are several ways to support our mental health during the colder months.

1. Recognize It

Awareness is the first step! Notice changes in your mood, sleep, energy, and motivation. Recognizing patterns can help you identify when additional support may be beneficial.

2. Build Your Winter Wellness Toolkit

Different strategies work for different people. Consider incorporating some of the following into your routine:

• Light Therapy: A specially designed light therapy box may help reduce SAD symptoms.
• Breathwork: Deep breathing and relaxation techniques can manage stress and regulate emotions.
• Sunrise Alarm Clocks: These clocks gradually increase light in the morning, mimicking sunrises.
• Daily Movement: Walking, stretching, dancing, or exercising can support mood and overall well-being.
• Natural Sunlight: Spend time outdoors during daylight whenever possible.
• Therapy: Therapy can help you develop coping strategies and navigate seasonal challenges.
• Medication: For some individuals, medication may be an appropriate part of treatment.

3. Keep the Conversation Going

Sometimes, one of the most helpful things we can do is simply talk about how we are feeling.

Create opportunities for honest conversations with friends, family members, or trusted supports. You do not have to wait until things feel overwhelming to ask for help.

How Can Parents Support Their Children During Winter?

Just as adults benefit from additional support during winter, children may also need some extra care, consistency, and connection.

Here are six ways to help your child navigate the colder months.

1. Recognize Changes in Behavior

You know your child best! Watch for changes in mood, energy, sleep, appetite, and behavior.

Try asking open-ended questions such as:

• “I’ve noticed you’ve seemed a little more tired lately. How have you been feeling?”
• “What’s been the hardest part of your day recently?”
• “Is there anything you wish felt a little easier right now?”

2. Maximize Natural Sunlight

Encourage your child to spend time outside during the day. Whether it’s playing at recess, taking a walk, or visiting a playground, movement and sunlight can support overall well-being.

3. Maintain Strong Routines and Predictability

Children thrive on consistency! Predictable routines can help children feel safe and supported, especially when their energy and mood fluctuate.

Maintain consistent bedtimes, wake-up times, mealtimes, and opportunities for family connection.

4. Explore Light Therapy With Professional Guidance

Light therapy may help some children experiencing SAD, although research in children is more limited than in adults. Consult your child’s pediatrician or mental health provider before beginning.

5. Consider a Sunrise Alarm Clock

Waking up when it is still dark outside can be difficult! Sunrise alarm clocks gradually brighten the room, which can make morning routines feel a little easier.

6. Make Space for Feelings and Consider Therapy

Children need to know that all feelings are welcome, even the uncomfortable ones.

Create opportunities for your child to express sadness, frustration, worry, or loneliness without judgment.

For some children, therapy can provide a safe space to explore emotions, develop coping strategies, and build emotional regulation skills.

Finding the Sunshine in Winter

Winter can be challenging, but it can also bring wonderful moments: warm meals, crisp weather, cozy evenings, and family traditions. The goal is not to love every moment of winter or force ourselves to feel happy all the time. Instead, it is about recognizing when our loved ones or we might need a little extra support.

By understanding the signs of seasonal depression, maintaining healthy routines, and creating opportunities for connection, we can make the winter months feel a little more manageable.

Remember: Even when the days are shorter, there are still ways to bring a little more light into our lives.

A Little Extra Support Can Make a Big Difference

If you have noticed changes in your child’s mood, behavior, or emotional well-being during the winter months, you do not have to navigate these challenges alone.

At our practice, we provide a safe, supportive space where children, adolescents, and families can explore emotions, develop healthy coping strategies, and build tools they need to thrive.

Reach out to our team to learn how therapy can help you and your family find a little more sunshine, even during the coldest months of the year.

If you or someone you love is experiencing persistent symptoms of depression, consider reaching out to a licensed therapist. For mental health support, call or text 988.

-Posted by Marci Hameroff

Marci Hameroff, a therapist at Jonah Green and Associates, LLC, offers therapy for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas. 

Sources and Further Reading

• National Institute of Mental Health 
• Mayo Clinic — Seasonal Affective Disorder
• Cleveland Clinic — Light Therapy
• University of Utah Health — Helping Kids Cope With SAD
• American Heart Association — Cold Weather and the Body

The post Why Are We S.A.D. in the Winter? appeared first on Jonah Green and Associates.

You don’t have to love everything your partner loves. But it can mean a great deal when you make an effort to understand.

Suppose your partner is passionate about baseball, while you couldn’t care less about sports. You might listen politely when they talk about a game, but you don’t really understand what they’re saying. After a while, you might stop asking.

Now imagine you learn the names of a few favorite players. You understand why a particular rivalry matters. You even remember that there’s a big game coming up and ask how it went.

You haven’t necessarily become a baseball fan. But you’ve communicated something important: I care enough about you to learn a little about something that matters to you.

And that can be a surprisingly meaningful expression of love.

Curiosity Is a Wonderful Beginning

In couples therapy, we often encourage partners to become more curious about one another.

Rather than assuming we already understand what our partner thinks or feels, we can ask questions. We can listen with genuine interest. We can try to understand experiences that are different from our own.

But curiosity becomes even more powerful when we follow through.

If your partner loves gardening, you might learn the names of a few favorite flowers. If they’re fascinated by history, you might become familiar with a period they especially enjoy. If they practice yoga, you might learn what they find rewarding about it.

As we become more familiar with your partner’s world, it becomes easier to be curious about it. We can ask better questions, appreciate new developments, and sometimes even discover that we enjoy aspects of it ourselves.

Building “Love Maps”

Couples researchers John and Julie Gottman popularized the idea of Love Maps: the knowledge we develop about our partner’s inner world.

A Love Map includes the important people in our partner’s life, their hopes and dreams, their worries, their favorite activities, and the experiences that have shaped them.

The Gottmans have even developed Love Map cards, with questions designed to help partners continue learning about each other.

I particularly like the idea that these maps are never finished. People change. Their interests evolve. New concerns and aspirations emerge.

The better we know someone, the more opportunities we have to show them they matter.

We can also extend the Love Map idea beyond knowing what interests our partner to understanding something about those interests.

Knowing that your spouse loves classical music is a beginning. Learning which composers move them, and perhaps listening together to a favorite piece, can create another opportunity for connection.

A Little Effort Can Mean a Lot

Of course, none of this should become another obligation or test in a relationship. Time is limited, and it’s perfectly healthy for partners to pursue interests independently or share them with friends. The goal isn’t to become involved in everything our partner does.

Instead, take small, occasional steps into their world.

You might ask your partner to explain something you’ve never understood. Read a short article about a subject they love. Watch part of a program together. Or remember something they mentioned and ask about it a few days later.

Sometimes the most meaningful gesture is simply bringing up the subject yourself.

That communicates not only that you listened, but that you remembered.

What Makes It Meaningful

Ultimately, what makes your interest in your partner’s interests is what those efforts communicate. When someone we love takes an interest in something that matters to us, we may feel appreciated and understood. And when we make that effort ourselves, we sometimes discover new dimensions of our partner—things we might otherwise have missed.

We don’t have to share all our interests to share our lives. But every so often, learning a little about something our partner loves can be another way of saying:

I want to keep getting to know you.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy for children, teens, couples, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

The post Taking an Interest in Your Partner’s Interests appeared first on Jonah Green and Associates.

It’s good advice. But in my work as a couples and family therapist, I’ve noticed something more complicated: Not every sentence beginning with “I feel” really functions as an I-statement. And even some genuine feeling words can be surprisingly hard for the person we love to hear.

This matters because couples and families in distress are often trying hard to communicate better. Sometimes a small shift in language helps a partner or family member hear the underlying feeling we’re trying to express, rather than an accusation we never meant to make.

Anger Is a Feeling—But It May Not Tell the Whole Story

Words such as angry, frustrated, irritated, and annoyed are genuine feeling words. Sometimes anger is exactly what we’re feeling, and there is nothing wrong with saying so.

But in close relationships, anger can be difficult to hear—particularly when both people are already upset. Sometimes it helps to pair the anger with the more vulnerable feeling or wish underneath it.

“I’m angry, and I’m also really hurt.”

“I’m frustrated because I miss feeling close to you.”

This isn’t about replacing anger; anger may be an important part of the truth. But others may often hear us better when we express more of the truth. When someone can hear not only our anger but also the hurt, fear, disappointment, loneliness, or longing connected to it, there may be more room for understanding.

When “I Feel” Still Sounds Like “You”

Sometimes it is fairly obvious that “I-statements” are not really statements about personal feelings at all. “I feel that you don’t care about me” or “I feel like you’re being a jerk” are thoughts, judgments, or conclusions with “I feel” in front of them.

One simple test is to remove “I feel that” or “I feel like.” If what’s left is essentially a statement about the other person—“You don’t care about me”—it probably isn’t an I-statement in the sense we’re talking about.

But sometimes it’s much subtler.

Consider:

“I feel criticized.”

Compare that with:

“I feel hurt.”

“Hurt” describes something happening inside me. “Criticized” also says something about what I believe you did. To the listener, “I feel criticized” may sound a lot like “You’re criticizing me.”

The same can happen with words such as blamed, controlled, judged, or attacked.

That doesn’t mean these words are wrong. But sometimes it helps to separate our feelings from our interpretation:

“When you said that, I felt hurt and embarrassed. I heard it as criticism, although I’m not sure that’s how you meant it.”

That gives the other person more room to understand our experience without first having to defend against an accusation.

Some Words Live in Both Worlds

Other words are more ambiguous.

“I feel trapped.”

“Trapped” may genuinely describe an internal experience. But a partner may hear: “You’re trapping me.”

“I feel unwanted” may express real loneliness and insecurity while sounding to the other person like: “You don’t want me.”

Words such as rejected and abandoned can work similarly. They may describe something deeply felt while also seeming to claim something about what another person has done or feels.

Sometimes a little more vulnerability makes the message clearer:

“I’m feeling lonely, and I’m starting to worry that you don’t want to be as close to me.”

People often find it easier to understand others who express sadness, fear, or longing directly than when they hear statements that can sound like an accusation.

When a Feeling Sounds Like a Verdict

Then there are words like hopeless.

Imagine hearing:

“I feel hopeless about our relationship.”

“Hopeless” isn’t an accusation. It isn’t even an angry word. It may be a completely honest description of someone’s experience.

Yet I’ve seen how powerfully a word like this can affect a conversation. A partner may hear:

Our marriage is doomed. You’ve given up on me—nothing I do matters. You’re going to leave.

The speaker may be describing a feeling. The listener hears a conclusion about the relationship.

The same can sometimes happen with words such as done, defeated, or detached.

This is where it can help to become curious about our own language. What do I actually mean when I say hopeless? How much of that feeling is about the relationship itself, and how much comes from how hurt, frightened, or disappointed I feel right now?

Perhaps you’ve truly lost hope for the relationship. If so, that deserves an honest conversation.

But perhaps what you mean is:

“I’m terribly hurt by what happened. Right now I’m so discouraged that I can’t see how we find our way back to each other.”

Those are different messages. The point isn’t to talk ourselves out of what we’re feeling. It’s to understand our feelings well enough to say what we actually mean, in a way others can hear.

Helping Each Other Hear What Matters

None of this means couples or families should search anxiously for the perfect word or avoid saying difficult things. Close relationships require us to hear things we don’t always want to hear. And sometimes someone we love will become upset no matter how thoughtfully we speak.

The goal isn’t perfect communication. It’s to give someone we love a better chance of hearing the heart of what we’re trying to say.

So before “I feel criticized,” we might wonder: What am I feeling when I experience this as criticism?

Before “I feel unwanted”: What is happening inside me that makes me afraid I’m not wanted?

Sometimes:

“I feel hopeless about us”

can become:

“I care so much about us that this really hurts. Right now I’m scared and discouraged because I can’t see how we get from where we are to where I want us to be.”

The second statement isn’t necessarily softer because the problem is less serious. It’s softer because it lets the other person see more of us.

Over my years as a couples and family therapist, I’ve come to believe that some of the most important moments in relationships happen when people can get beneath the anger, accusation, conclusion, or defensive reaction and find what they were struggling to say in the first place.

Often, underneath it is something quite tender:

I’m hurt. I’m scared. I miss you. I want this to be better. And I’m trying to find a way back to you.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

The post When Even “I-Statements” Sting: Choosing Words That Help Others Hear You appeared first on Jonah Green and Associates.

But learning doesn’t happen only when trainees play the therapist. They may learn just as much by inhabiting the experience of a parent, child, teenager, or partner—feeling what it is like to be misunderstood, defended, challenged, or genuinely understood by a therapist. They also learn by observing role-plays and noticing the small moments when a conversation becomes safer, more defensive, more vulnerable, or more connected.

This experiential approach has reinforced something I have come to believe after many years of working with children, adolescents, couples, and families: good family therapy is not primarily about teaching people to communicate correctly. It is about helping them communicate more fully.

Family Therapy Begins With Safety

One of the first things I teach therapists is that before we can help a family address difficult problems, we need to create enough emotional safety for family members to talk about them.

Families may come to therapy in part because they are having trouble communicating effectively. But communication problems are not always simply a matter of lacking the right skills. Family members may have important things to express but find their conversations quickly become organized around defensiveness and self-protection. Parents may criticize when they are worried. Teenagers may withdraw when they feel misunderstood. Partners may press one another for answers or retreat when they feel overwhelmed. Family therapy can help people communicate more effectively while also helping them understand and express the feelings, needs, and concerns driving these patterns. 

The family therapist’s first job is to help create a conversation in which people feel understood well enough to become curious about one another again.

One principle we emphasize in training is: When you feel yourself losing empathy for someone, become more curious about their experience.

That doesn’t mean agreeing with hurtful behavior or pretending everyone’s behavior is equally helpful. It means working to understand each family member’s experience—especially when someone’s behavior is making that understanding difficult. When someone in a family feels that the therapist has already decided that they are the problem, meaningful family therapy becomes very difficult.

Role-play makes this lesson especially vivid. A trainee playing a family member who is angry, guarded, or hard to reach may feel isolated when the therapist seems aligned with everyone else in the room. Conversely, a therapist’s small gesture of curiosity or understanding can make it safer to listen, reflect, and participate.

Helping People Communicate More Fully

Family therapy often helps family members communicate more effectively—using “I-statements,” listening without interrupting, and finding ways to express strong feelings without using hurtful words. These skills can make difficult conversations safer and more productive. But good communication involves more than how something is said; it also involves helping people discover and express more fully what they are trying to say.

In training, I encourage therapists to listen for what may be emerging underneath the words.

A teenager who says, “You never trust me,” may also be saying, “I want you to see that I’m growing up.”

A parent who says, “She doesn’t care about anything,” may be expressing fear: “I’m scared that my daughter is struggling, and I don’t know how to reach her.”

A partner who complains, “He’s too needy,” may also be acknowledging, “I know I’m not giving him the closeness he wants from me.”

Family therapists learn to listen for these hidden feelings, needs, hopes, and acknowledgments. We may reframe an accusation, slow down an interaction, or help someone find words for a more vulnerable feeling underneath anger.

The goal is not to replace a person’s authentic language with “therapy language.” It is to help people say more of what they actually mean.

Helping Families Move From Anger Toward Vulnerability

Anger can tell us that something important has happened or that an important need is unmet. But when families get trapped in anger, they can lose sight of the more tender feelings underneath.

Behind criticism may be disappointment.

Someone may withdraw because of fear of disapproval.

Controlling behavior may be a result of anxiety.

Repeated demands for attention may represent loneliness and longing.

One skill we practice in our family therapy training is helping therapists listen for these deeper emotions without dismissing the anger that brought the family into the room. When family members begin to recognize the hurt, fear, love, hope, or longing beneath one another’s defenses, the conversation can change.

The person who seemed unreasonable becomes easier to understand. And once people feel understood, they often become better able to understand others.

This is another reason experiential training matters. Playing the role of a family member can help a therapist feel from the inside how anger and defensiveness can coexist with love, fear, or longing. Observing a role-play can also make visible what is harder to notice during a difficult conversation: how one person’s self-protection can trigger another person’s self-protection, creating a cycle neither person intends.

Finding Strengths Helps Families Go Deeper

Family therapy should also help families remember what is working.

This does not mean minimizing serious problems or trying to make everyone “look on the bright side.” Families who come to therapy may already feel discouraged, ashamed, or frightened about their ability to repair their relationships. If therapy focuses exclusively on everything they are doing wrong, that discouragement can deepen.

So therapists also look for competence, affection, resilience, good intentions, successful exceptions, and moments when family members have already solved a small part of the problem.

Sometimes family therapists emphasize strengths not instead of going deeper, but in order to go deeper.

A family that begins to recover a sense of hope and dignity may become more willing to examine painful patterns, acknowledge mistakes, hear difficult feelings, and take emotional risks with one another.

Helping the Whole Family Work Better

Family therapy also focuses on more than individual family members’ feelings. We pay attention to what happens between people.

Who gets pulled into arguments? Who withdraws? Which family member tries to keep the peace? Does a child end up carrying tensions between adults? Can parents work together effectively? Does everyone have a voice? Are boundaries clear enough that children can be children and adults can take responsibility for adult problems?

A family therapist helps families develop ways of relating that make everyday family life work better.

Sometimes this involves helping parents become more coordinated and confident. Other times, it means strengthening the relationship between a parent and child. Sometimes it means helping family members step out of a repetitive cycle in which everyone’s understandable attempt to protect themselves accidentally makes someone else’s reaction worse.

The goal is not to create a family that never argues. Healthy families disagree.

The goal is to help families better remain connected while they disagree—and to repair their relationships when things go wrong.

Therapists Make Mistakes, Too

One reason I use role-play when training family therapists is that family therapy is complicated. Several people sit in the room, each with different experiences, and the therapist will inevitably misunderstand someone at times.

A therapist can try something, discover that it didn’t land as intended, hear how it felt to the trainee playing the family member, and try again. Observers can notice what helped the therapist recover the relationship. The mistake itself becomes part of the learning.

What matters is what happens next.

If I misunderstand a child, parent, or partner, I want to notice it, acknowledge it, and become curious about what I missed. A therapist’s mistake can become an opportunity to show families something they themselves need: relationships do not depend on perfect understanding. They depend upon our capacity to recognize misunderstandings and repair them.

That may be one of the most hopeful lessons family therapy can offer.

Creating Conversations Families Can Continue at Home

The therapist helps create a different kind of conversation: one with enough safety for people to become less defensive, enough curiosity for people to listen, enough emotional depth for important feelings to emerge, and enough hope for family members to try something different.

Over time, families increasingly learn to have those conversations without us. At its best, family therapy helps family members know one another more deeply, express difficult feelings more honestly, respond to one another more compassionately, and build relationships sturdy enough to withstand the inevitable stresses of family life.

That is much of what I hope therapists learn by doing, observing, inhabiting, making mistakes, and trying again in our training—and what I hope the families we work with will experience in their own relationships.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

The post What Makes Family Therapy Work? Lessons From an Experiential Approach to Training Family Therapists appeared first on Jonah Green and Associates.

The first day of school can bring excitement, anticipation, and… a whole lot of feelings. New classrooms, new teachers, new peers, new routines—and for some children, all of that change can feel overwhelming.

Some anxiety around a new school year is completely normal. After all, anxiety is one of the ways our minds and bodies respond to uncertainty and change.

Sometimes anxiety looks like, “I’m nervous about school.” Other times, it looks like a stomachache, a meltdown, trouble sleeping, or suddenly refusing to get dressed.

Signs & Symptoms of Anxiety in Children

Every child experiences anxiety differently, but you may notice:

1. More frequent outbursts or meltdowns
2. Stomachaches or headaches
3. Changes in eating habits
4. Changes in sleep patterns
5. Avoidance of school, activities, or situations that feel overwhelming
6. Increased reassurance-seeking, such as repeatedly asking what will happen or whether everything will be okay
7. More clinginess or difficulty separating

This list is not exhaustive, and you know your child best. Children don’t always have the words to say, “I’m feeling anxious.” Sometimes, their behavior is how they communicate what they can’t quite put into words yet.

Rather than focusing only on stopping the behavior, it can be helpful to get curious about what the behavior might be telling you. Is your child worried about separating from you? Making friends? Keeping up academically? Finding their classroom? Sitting alone at lunch? Managing a noisy or overwhelming environment?

Sometimes a behavior that looks oppositional on the surface is a child’s way of saying, “This feels like too much for me.”

So, What Can You Do?

You don’t have to eliminate your child’s anxiety. In fact, trying to convince a worried child that there’s “nothing to worry about” doesn’t always help.

Instead, the goal is to help your child feel safe, understood, and supported as they learn that they can manage difficult feelings and new experiences.

1. Create a Schedule

A new routine can be a BIG adjustment. A visual schedule can help make the unknown feel a little more predictable.

Try including things like:

• Wake-up time
• Getting dressed
• Breakfast
• Leaving for school
• School
• Homework
• Dinner
• Something fun or relaxing
• Bedtime

For younger children, pictures can be especially helpful. And don’t forget to include something they can look forward to!

You might even practice the morning routine a few days before school starts. Familiarity can make the first morning feel a little less overwhelming.

2. Check In

If you notice a change in your child’s behavior, gently let them know that you’ve noticed.

Instead of immediately asking, “What’s wrong?” try making an observation:

You might say:

“I’ve noticed you’ve been crying in the mornings. What’s going through your mind?”

“You seem a little quieter when we talk about school. Is something on your mind?”

“I’ve noticed your stomach has been hurting in the mornings. Sometimes our bodies let us know when we’re worried about something. I wonder if there’s anything about school that’s been on your mind?”

Sometimes, less pressure = more communication. Your child may need a little time before they can identify or explain what they’re feeling.

3. Validate Before You Reassure

When children tell us they’re scared, our instinct is often to make the fear go away.

“You’ll be fine!”

“There’s nothing to worry about!”

“You’re going to love your new teacher!”

Those responses come from a loving place, but sometimes children need something else first: to know that we understand.

Try:

“It makes sense that you’re nervous. There are a lot of new things happening.”

Or:

“I can understand why not knowing anyone in your class feels scary.”

Validation doesn’t mean agreeing that something terrible will happen. It means communicating: “Your feelings make sense to me, and you don’t have to handle them alone.”

4. Practice What You Can

Anxiety often grows when children don’t know what to expect. When possible, turn some of those unknowns into experiences your child can practice.

Depending on your child’s age and situation, you might:

• Visit the school or playground beforehand
• Walk or drive the route to school
• Look at pictures of the teacher or classroom
• Practice packing the backpack
• Role-play saying goodbye in the morning
• Talk through what lunchtime or dismissal might look like
• Practice what your child can say if they need help

You can’t prepare for everything—and you don’t need to. The goal is simply to make some of the unfamiliar feel a little more familiar.

5. Communicate Confidence

Children often look to the adults they trust for clues about whether a situation is safe and manageable.

That doesn’t mean you have to hide your own feelings or pretend everything will be perfect. Instead, try to communicate both empathy and confidence:

“I know this feels hard, and I believe you can do hard things. We’ll figure it out together.”

It’s possible to take your child’s anxiety seriously without letting anxiety make every decision.

Avoiding something scary can bring immediate relief, but sometimes that relief makes the fear even stronger the next time. When appropriate, gently help children keep moving toward school and other important activities so they can discover, “I was scared—and I was able to do it.”

And Remember…

Your child’s anxiety doesn’t mean you’re doing something wrong—and it doesn’t mean they’re not ready for school.

Transitions are hard!

Your job isn’t to make every uncomfortable feeling disappear. It’s to help your child know:

“I see you. I hear you. We’re going to figure this out together.”

If anxiety is interfering with your child’s ability to attend school, sleep, eat, participate in activities, or enjoy their day-to-day life, consider reaching out for additional support. Your child’s teacher, school counselor, pediatrician, or a mental health professional can help you better understand what’s happening and think together about ways to support your child.

You know your child best. Trust your instincts, stay curious, and remember that behavior is communication.

-Posted by Marci Hameroff

Marci Hameroff, a therapist at Jonah Green and Associates, LLC, offers therapy for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas. 

The post Back-to-School Anxiety 🎒✨ Helping Your Child Feel Ready and Supported appeared first on Jonah Green and Associates.

Couples often come to therapy wanting to feel close again, but they are not always sure where to begin. They may imagine reconnecting will require a week away, a perfectly planned date, or long conversations in which they finally say everything exactly right.

One of the most useful ideas in the work of John and Julie Gottman, who have spent decades studying relationships, is that connection grows through the accumulation of ordinary, repeated interactions such as warm greetings, brief, gentle touches, or words of appreciation. 

One kind of healing interaction involves responding to “bids for connection.” A bid is an invitation to share attention or affection. It might be a sigh, a joke, a question, or a comment about one’s day. Noticing and answering more of them can gradually strengthen a relationship. Other ways to nurture connection include affection, appreciation, curiosity, rituals, and repair, which offer other small opportunities.

Here are several practices couples can try. I recommend starting with one or two.

The six-second kiss

The Gottmans recommend regular kisses lasting about six seconds to create moments of warmth. Some couples prefer hugs, holding hands, or other gestures. The aim is moments of affection that feel good to both partners.

The stress-reducing conversation

At the end of a demanding day, partners often want different things. One person may want to talk, while the other wants to “decom. Or one partner begins describing a problem and the other immediately offers a solution, only to discover that advice was not what was needed. These different needs can create feelings of disconnection and frustration.

As an antidote, the Gottmans suggest setting aside about 20 minutes for a “stress-reducing conversation.” The conversation focuses on pressures outside the relationship: work, family, traffic, health, or the difficult email that arrived that afternoon. Each partner gets a chance to speak and listen.

The listener might communicate understanding with phrases such as:

“That sounds exhausting.”

“I can understand why you felt dismissed.”

“What was the hardest part?”

The listener does not offer advice unless asked. The purpose is to come alongside your partner and help them feel heard.

Specific Appreciation

Specific appreciation stimulates warm feelings and encourages more positive behavior. “I appreciated that you called my mother yesterday” tells a partner exactly what you noticed.

More examples:

“I appreciated that you washed the dishes without my asking.”

“That was thoughtful when you asked how my pain felt.”

“You were so patient with our son today.”

Ask a question you do not already know the answer to

We may know our partner’s history, routines, preferences, and familiar complaints, but we do not always know how their experience is changing from day to day.

Open-ended questions help people feel important, especially when they show an awareness of the other person’s life. Instead of “Did you have a good day?”—which can be answered with a single word—try:

“How did the presentation go today?”

“What do you think of the novel you’re reading?”

“You seem especially busy. What do you wish you had more time for?”

“What feels important to you about that?”

The Gottmans use the term “Love Maps” for our knowledge of a partner’s inner world: stresses, hopes, relationships, pleasures, worries, and dreams. A Love Map is never finished. Curiosity allows us to keep meeting the person our partner is becoming.

Couples looking for more prompts can explore the free Gottman Card Decks app. The book Eight Dates: Essential Conversations for a Lifetime of Love also offers a structure for conversations about trust, conflict, money, intimacy, family, dreams, and shared meaning.

Respond to small bids

Imagine that your partner says, “Look at that cardinal,” while you are reading something on your phone. Underneath the comment may be an invitation: Share this moment with me.

Turning toward might mean looking up, following your partner’s gaze, and saying, “Beautiful!” It might also mean laughing at a joke, asking a follow-up question, or placing a hand on a shoulder when you hear a sigh.

We all miss bids. We may impatiently realize too late that our partner was trying to reach us. Connection does not require perfect attentiveness. It does benefit from recognizing that many exchanges carry a relational question: Are you there? Does my experience matter to you?

Create small rituals of connection

Another strategy the Gottmans suggest is the development of rituals. Rituals are helpful because they do not depend entirely on spontaneity. In busy lives, waiting until both people happen to feel relaxed, affectionate, and available may mean waiting a long time.

Rituals need not be elaborate. A couple might drink coffee together for ten minutes, take a short walk after dinner, text at lunchtime, or say goodnight with a hug.

Offer a small repair

All couples misread each other, become defensive, speak sharply, or lose the thread of a conversation. A repair is any attempt to interrupt the slide and find one another again.

Examples of reparative statements:

“That came out more harshly than I meant.”

“You have a point.”

“I’m getting overwhelmed, and I’m not hearing you like I want to. Can we slow this down?”

A repair does not resolve the whole disagreement. It helps protect the relationship while the disagreement continues.

Let the practice be small

Small experiments often work best, rather than ambitious plans that may fall short and lead to discouragement. Try one or two practices and notice what happens—not just whether your partner changes, but what happens inside you. Do you feel warmer, more awkward, more hopeful, or more resistant? Even awkwardness can be useful information. Uncomfortable feelings can be a sign that you are opening up and taking risks to strengthen your relationship.

Small practices cannot fully repair betrayal, coercion, addiction, or long-standing hurt. But repeated moments of affection, interest, appreciation, and repair can provide essential “glue’ for a relationship. In couples therapy, these practices can also help new ways of relating take root between sessions.

Readers who want to explore more Gottman-informed practices for closeness may appreciate John Gottman and Nan Silver’s The Seven Principles for Making Marriage Work, the Gottmans’ overview of the Sound Relationship House, and the Gottman Institute’s video channel.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

Another blog post that addresses Gottman-informed practices for closeness:

Look at That Bird: Turning Towards Bids for Connection to Improve Your Relationship 

The post Nurturing Your Connection as a Couple Through Small Moments appeared first on Jonah Green and Associates.

One of the most influential books in this movement is Bessel van der Kolk’s The Body Keeps the Score. Van der Kolk shows how overwhelming experiences—whether a catastrophic event or chronic emotional neglect, abuse, or instability—can become encoded in our nervous systems. Even after danger has passed, our bodies may respond as though it is still present.

Therapists often see this. Clients tell us, “I know I’m safe, but I don’t feel safe.” Their shoulders remain tense, their breathing shallow, their sleep disrupted, and their nervous systems on alert.

Not All Trauma Looks the Same

Many people think of trauma as experiences of combat, assault, or serious accidents. But trauma can also arise from growing up with unpredictable caregivers, living with criticism or emotional volatility, bullying, physical injuries, loss, or experiences of shame. Even the absence of consistent emotional attunement can leave imprints on the nervous system.

These experiences may lead to hypervigilance, anxiety, emotional numbing, intrusive thoughts, chronic muscular tension, or a persistent feeling that something is wrong—even when life is objectively going well.

The Rise of Somatic Therapies

This growing understanding has contributed to the development of somatic therapies such as Somatic Experiencing or Sensorimotor Psychotherapy. These approaches, which have growing evidence for their effectiveness, help the nervous system rediscover safety, flexibility, and regulation. 

This development is deeply compatible with what Carl Rogers, the founder of person-centered therapy, taught decades ago. Emotional healing can begin when individuals experience safety, acceptance, emotional attunement, and authentic relationships. Somatic approaches extend these principles to bodily experience.

Where Qigong Fits In

Qigong (pronounced chee-gong) is an ancient Chinese healing practice that combines gentle movement, relaxed, rhythmic breathing, focused awareness, meditation, and imagination. It is used alongside Traditional Chinese Medicine (TCM) to heal emotional and physical injuries and prevent disease. Growing bodies of research support the benefits of mindful movement practices like qigong for healing from trauma, as well as for stress reduction, improved focus, pain management, emotional well-being, and overall physical health. Its simplicity and approachability make it an excellent form of somatic healing. 

Qigong is a form of exercise, but it is not only about burning calories; it helps you gently and mindfully inhabit your body. It encourages practitioners to notice sensations with curiosity as they engage in relaxed, flowing motion. These qualities can help individuals regulate their nervous systems, be more connected to their bodies, and feel safe within themselves. 

What I personally appreciate about qigong is its extraordinary gentleness.

Movements can be practiced standing, seated, or even lying down. The emphasis is usually less on stretching or holding postures and more on fluid and mindful movement.

There is also a distinctive emphasis on “felt imagery.” You might imagine gathering energy (“qi”) from the earth, expanding through the heart, floating through clouds, or feeling tension drain downward. Whether one understands these images literally or metaphorically, they can help people shift into a calmer, more integrated state.

How Is Qigong Different from Tai Chi?

Qigong and Tai Chi are closely related. In fact, Tai Chi can be understood as a form of qigong because it cultivates many of the same qualities: mindful awareness, coordinated breathing, relaxed movement, balance, and whole-body integration.

Tai Chi’s graceful forms have been refined over centuries and offer tremendous physical, emotional, and meditative benefits, as well as martial applications. Many practitioners find it to be a deeply rewarding lifelong discipline.

For beginners, qigong may be a gentle, approachable entry point. Most exercises can be learned in just a few minutes and offer calming and grounding benefits from the very first session.

A Few Movements 

Different teachers use different names for each of these, but there are several movements you might find especially helpful:

Shaking the Tree uses gentle rhythmic shaking to release unnecessary muscular tension. Many people are surprised by how naturally their breathing changes after only a minute or two.

Parting the Clouds encourages expansive movements that open the chest while coordinating breath and attention. People often describe feeling more “spacious” inside.

Pushing the Waves uses smooth forward and backward movements that naturally synchronize with breathing. There is something deeply settling about its rhythm. Rather than fighting the current, the movement suggests working with it.

Qigong Can Also Be Relational

Although qigong is often practiced individually, it can also become surprisingly relational.

Partners can practice together, moving and breathing in synchrony. Families can learn simple movements as part of a daily routine. Parents and children may enjoy playful forms involving animals or flowing movements.

From a family therapy perspective, this is especially intriguing.

We often think of regulation as an individual skill. Yet decades of attachment research remind us that human beings regulate one another through co-regulation. 

Shared movement can become another way to foster emotional safety—not as a replacement for conversation, but as a pathway toward connection, belonging, and trust.

Sometimes talking becomes easier after bodies have first learned to settle.

A Few Places to Begin

If you’re curious about exploring qigong, here are several resources I have found helpful.

For readers, I highly recommend Ken Cohen’s The Way of Qigong, perhaps the most comprehensive introduction available. The Healing Promise of Qi by Roger Jahnke clearly explains qigong concepts and offers a range of tools, practices, and techniques.

There are also many excellent online teachers. Marisa Cranfill’s YOQI program offers a thoughtful progression from basic awareness to increasingly sophisticated practice. Anthony Korahais of Flowing Zen presents qigong in a clear, welcoming style. Ken Cohen offers numerous online lectures and demonstrations that beautifully combine scholarship with decades of practical experience.

A Final Reflection

Sometimes our culture encourages us to approach healing the way we approach everything else: work harder, think harder, solve the problem.

Healing from trauma asks something different of us: to slow down, to notice, to breathe, to experience our surroundings, and to find safety within our minds and bodies. Sometimes it begins with a slow breath or a gentle movement. For people whose bodies have learned to anticipate danger, this can be profoundly restorative.

Recovery rarely comes from a single technique. It grows through safe relationships, compassionate curiosity, and practices that help both mind and body remember that danger has passed. For many people, qigong offers one gentle path towards healing.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy services for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

The post Trauma, the Body, and the Gentle Wisdom of Qigong appeared first on Jonah Green and Associates.

When people seek therapy during times like these, they often assume they are “not handling it well.” They wonder why they feel anxious, sad, angry, or uncertain—even when the change is something they wanted. Recognizing these reactions as normal can help reduce self-judgment and foster self-compassion.

In reality, these reactions are often exactly what we would expect.

There Is No “Right” Way to Feel.

Most transitions bring mixed emotions. Relief may exist alongside grief. Excitement may coexist with fear. Even positive changes involve letting go of the familiar.

Rather than asking yourself whether your feelings are reasonable, it can be more helpful to become curious about them. What are they telling you? What are you afraid of losing? What matters so much that this transition has touched it?

Our emotions often point toward the people, roles, relationships, and values that have been important to us.

We Naturally Hold On to What Feels Safe

When life changes, most of us try to regain our footing as quickly as possible. We search for certainty, replay decisions, imagine worst-case scenarios, or wish things could simply go back to the way they were.

These responses are understandable. They are usually attempts to protect ourselves.

The challenge is that no amount of worrying can eliminate uncertainty. Sometimes the most healing step is not finding immediate answers, but gradually becoming more able to live with questions that have not yet been resolved. Techniques like mindfulness, journaling, or seeking support can help build this resilience.

Small Steps Matter

Major transitions can feel overwhelming. Looking too far ahead often increases anxiety.

Instead, it can help to ask a simpler question:

What is one step I can take today?

That step may be making a phone call, updating a résumé, reaching out to a friend, returning to a familiar routine, or simply getting outside for a walk.

Small actions rarely solve everything, but they remind us that we are not powerless.

Relationships Help Us Find Our Way

Periods of change are easier to navigate when we do not face them alone.

Being with someone who listens without rushing to solve the problem can help us organize our own thoughts and emotions. Often, we become clearer simply because someone has taken the time to understand our experience.

Whether that support comes from family, friends, a faith community, or a therapist, feeling understood can make uncertainty much easier to bear and help you feel less alone.

Transitions Invite Reflection

Although transitions are disruptive, they also invite us to pause.

What matters most?

What kind of relationships do I want to cultivate?

What do I hope my life reflects going forward?

These questions rarely have immediate answers, and that’s okay. They are less about making dramatic changes than about becoming more intentional as life unfolds.

Moving Forward

Most transitions do not resolve quickly. There are often periods when little seems to be happening, even though important emotional work is taking place beneath the surface.

Looking back, many people discover that they became more compassionate, more grounded, or more connected to what truly matters—not because the transition was easy, but because they allowed themselves to move through it rather than around it. Reflecting on these insights can foster a sense of personal growth and resilience.

While we cannot prevent change, approaching it with patience rather than urgency can help you feel more reassured and confident in your ability to navigate uncertainty.

-Posted by Lori Rothfeld, JD, LMSW

Lori is a therapist at Jonah Green and Associates, LLC, a practice that provides therapy for children, teens, families, and adults in North Bethesda, Maryland, for clients in Chevy Chase, Montgomery County, Washington, DC, and the surrounding areas.

The post Navigating Transitions: Making Sense of Change appeared first on Jonah Green and Associates.

Most caregivers do not enter their roles reluctantly. They care deeply. They show up day after day because someone they love needs them. Whether you are caring for a child with special needs, an ill spouse, an aging parent, or another family member, your caregiving likely stems from love, loyalty, and commitment.

Yet even the most devoted caregivers can reach a point where caring begins to feel different.

You may notice that you are more irritable than usual. Small frustrations feel bigger. Your patience is shorter. You find yourself withdrawing from people or feeling emotionally numb. Sometimes caregivers become troubled by a thought they never expected to have:

“I just want a break.”

Or even:

“I don’t know how much more of this I can do.”

When this happens, it does not mean you are a bad caregiver. It may be a sign of compassion fatigue.

More Than Burnout

Compassion fatigue is often confused with burnout, but the two experiences are not quite the same.

Burnout usually develops from chronic stress, excessive demands, lack of resources, or feeling overwhelmed by responsibilities. A burned-out person may feel exhausted, frustrated, or ineffective.

Compassion fatigue is more personal. It develops through prolonged exposure to another person’s suffering. It is rooted in the emotional connection between caregiver and care recipient.

People experiencing burnout often think, “I can’t keep up with all of this.”

People experiencing compassion fatigue often think, “I have nothing left to give.”

The difference matters because compassion fatigue strikes at a person’s sense of empathy and connection. It can leave caregivers feeling guilty, confused, and ashamed precisely because they care so much.

A Common Scenario

A mother has been caring for her adult son with developmental disabilities for years. She has coordinated appointments, managed paperwork, supervised daily activities, and encouraged him to develop independent living skills. She loves him deeply.

Yet lately, she finds herself snapping at him over small things. She feels emotionally drained. She feels guilty whenever she takes time for herself. At night, she lies awake worrying about what will happen when she is no longer able to care for him.

What she is experiencing is not a lack of love.

In many cases, it is the accumulation of years of caring without enough opportunity to rest, grieve, process, or replenish herself.

Signs of Compassion Fatigue

Compassion fatigue can show up as:

• Physical and emotional exhaustion
• Sleep disturbance
• Headaches or digestive problems
• Irritability and impatience
• Numbness or detachment
• Anxiety or sadness
• Intrusive thoughts and excessive worry
• Feeling trapped, hopeless, or resentful
• Withdrawing from friends, family, or enjoyable activities

Many caregivers are surprised by these reactions. They may judge themselves harshly or wonder why they no longer feel like themselves.

Often, the problem is not a lack of commitment. It is a lack of replenishment.

Caring for the Caregiver

One of the greatest challenges for caregivers is recognizing that their own well-being matters.

Many people believe they must put themselves last. Over time, however, chronic self-neglect can undermine the very compassion they are trying to provide.

Protective factors can include:

• Maintaining supportive friendships and social connections
• Establishing realistic boundaries
• Taking regular breaks when possible
• Prioritizing sleep, nutrition, and exercise
• Engaging in spiritual or mindfulness practices
• Participating in caregiver support groups
• Seeking therapy or counseling

Just as importantly, caregivers benefit from having places where they can speak honestly about their frustrations, fears, grief, and exhaustion without being judged.

Extending Compassion to Yourself

Compassion fatigue is not a character flaw. It is a human response to prolonged exposure to another person’s suffering.

If you recognize yourself in these descriptions, consider offering yourself the same understanding you would offer a loved one. Caring for others requires energy, patience, and emotional presence. You need the same.

Seeking support is not a sign of weakness. It is often one of the most caring things you can do—for yourself and for the people who depend on you.

As the physician and author Dr. Naomi Rachel Remen observed:

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.”

Posted by Heidi Cohen LCSW-C 

Heidi is a therapist at Jonah Green and Associates, LLC, which provides therapy for children, teens, families, and adults in North Bethesda, Maryland, for clients in Chevy Chase, Montgomery County, Washington, DC, and the surrounding areas.

The post Tending to Compassion Fatigue: Caring for the Caregiver appeared first on Jonah Green and Associates.

While financial questions are essential, the emotional side of retirement is just as important.

Retirement is a major life transition that can affect identity, marriage, family relationships, health, purpose, and daily structure. Even when the transition is largely positive, it can bring stress, vulnerability, and unexpected feelings.

People entering retirement may feel relieved, energized, restless, lonely, or uncertain. Most experience a mixture of feelings that shift over time.

The Losses People Don’t Always Expect

One challenge for individuals and families is that retirement often involves ambiguous loss. Nothing catastrophic has happened, yet something important has changed.

As work fades, routines shift, and relationships with coworkers fade. Even when people feel relief about leaving work, they may still miss feeling needed, productive, connected, or recognized.

For many people, work quietly provided:

• structure
• identity
• social contact
• stimulation
• a sense of competence
• predictability

Without realizing it, people may find themselves grieving aspects of life they assumed they would gladly leave behind.

Retirement for Couples and Families

Retirement can bring renewed romance and joy for many couples, as they gain the freedom to travel, enjoy their grandchildren, or pursue interests. The transition can also bring challenges. One partner may hope for closeness or structure while another craves freedom or spontaneity. When one partner continues working, differences in lifestyles and outlooks may widen. 

Adult children may also begin relying more heavily on retired parents for childcare, transportation, emotional support, or help caring for grandchildren or aging relatives. While grandchildren can bring great joy, retirees may have conflicted feelings about these new demands.

These conversations can touch deep concerns about fairness, aging, usefulness, dependence, and changing family roles.

Health, Aging, and Vulnerability

Retirement can make health and aging feel more salient as physical limitations, chronic illness, or cognitive changes create feelings of vulnerability. 

People may find themselves grappling with:

• mortality
• dependency
• loss of identity
• fears about cognitive decline
• fears about isolation

A Brief Vignette

A couple in their late sixties came to therapy several months after the husband retired from a long professional career. Financially, they were stable, and both had looked forward to retirement. From the outside, things seemed to be going well.

But gradually, the husband became more irritable and withdrawn. He found himself reacting sharply to small frustrations at home and quietly wondering, “I don’t really know what I’m for anymore.”

His wife had imagined retirement bringing greater closeness and ease, but instead felt increasingly tense in his presence and emotionally distant. At the same time, their adult children had begun to rely on them more heavily for help with their grandchildren, emotional support, and practical needs.

As therapy continued, the couple began recognizing that retirement had stirred up losses for both of them. The husband was grieving not only the loss of a career but also the loss of structure, identity, and daily connection with colleagues. He also found himself reflecting more deeply on his changing role as a husband, father, and grandfather.

The couple had open conversations about the transition and grew closer. The husband pursued part-time volunteering, reconnected with friends and family, and developed a renewed sense of purpose. The couple set healthier boundaries with their children.

New Possibilities

Retirement entails loss, but it can allow people to develop:

• friendships
• spirituality
• volunteering
• creativity
• exercise
• travel
• family relationships
• neglected interests

Some people may be able to “semi-retire,” making space for new activities and maintaining the positive experiences that work brought them.

Therapy, Meaning, and the Next Chapter

In therapy, retirement conversations often involve grieving losses while also making room for new forms of meaning, connection, and identity.

While retirement can bring contraction and fear, it can also be a period of deepening—more time with family, renewed friendships, spiritual exploration, mentoring, creativity, community involvement, or simply a slower, more intentional way of living.

Family therapy can help families talk about essential concerns such as caregiving, finances, health, changing roles, and hopes for the future. It can help individuals process grief, uncertainty, and identity shifts while strengthening relationships and helping people find new meaning and purpose.

Later life inevitably involves some forms of decline, but it can also be a period of resilience, reflection, repair, and growth.

As people retire, they often begin asking deeper questions about what gives life structure, connection, and meaning. Therapy can be a valuable part of that process.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy services for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

Families looking for practical support and aging-related resources can also explore the Eldercare Locator. This public service connects older adults and caregivers with local programs, transportation services, caregiving supports, and other resources.

Additional resources:

• National Institute on Aging
• Family Caregiver Alliance
• AARP Caregiving Resources
• Therapy Services at Jonah Green and Associates
• The Jonah Green and Associates Blog

The post The Emotional Side of Retirement appeared first on Jonah Green and Associates.

Families naturally come to therapy focusing on problems. Eager to address grief, trauma, or conflict in a safe environment, conversations circle what isn’t working—how people hurt others from what they say or don’t say, who is at fault, and what feels broken. Therapists must make space for people to express and hear each other’s pain.

At the same time, there is almost always another story in the room, quieter and easier to miss. Moments of care, stories of resilience, or small gestures that didn’t turn into conflict. Ways people have already tried—sometimes successfully—to reach each other.

Appreciative Inquiry, a flexible approach that focuses on strengths and successes, is one way therapists help families find that other story.

A Different Kind of Question

The questions therapists ask families help shape how they feel about each other and how easily they can connect.

When a therapist asks, “Why does this keep happening?”, the conversation often tightens.

If, instead, they ask, ‘Can you tell me about a time when this went a little better?’ it can feel unfamiliar or challenging, but the family story can shift from one of problems to one of hope, success, and connection, even during times of challenge.

Words Create the World We Live In

One guiding idea behind Appreciative Inquiry, which shares commonalities with solution-focused and narrative approaches, is that the way we talk about events shapes our experience of them.

If the story becomes, “We’re always fighting,” then interactions fit that frame.

When families ask:

• “When do we not fight?”
• “What helps us get through hard moments?”
• “What do we appreciate about each other?”

A different and fuller picture emerges.

What Therapists Listen For—and Invite

In appreciative work, the pain of loss, trauma, disability, and difficult transitions—like divorce or illness—is taken seriously and held with care. At the same time, the therapist listens for:

• Where are there threads of connection?
• When have family members shown up for each other?
• What values does this family live by, even under strain?

And then the therapist helps bring those moments into the conversation, you might hear questions like:

• “When you think about your family at its best, what stands out?”
• “Can you remember a time—even a brief one—when you felt understood?”
• “What helped you get through that period together?”
• “What does that say about who you are as a family?”

These questions highlight strengths, helping families recognize what’s already working and feel more capable and hopeful.

From Remembering to Reimagining

As families notice what has worked—even in small ways—they can start to reimagine what they want more of, inspiring hope and motivation for positive change.

A couple going through a painful separation might realize:

“Even now, we can talk calmly about the kids when we slow things down.”

A parent and teenager in conflict might notice:

“We do better when we talk in the car—side by side, not face to face.”

A family coping with illness might say:

“We still laugh together, even on hard days.”

In the Midst of Loss and Transition

Appreciative questions can sit alongside and help validate grief, trauma, and loss through questions such as:

• “What has helped your family get through other hard times?”
• “What do you want to hold onto about your relationship, even as things change?”
• “What would honoring your connection look like in the wake of this tragedy?”

A Way of Being, Not Just a Technique

Through Appreciative Inquiry, families begin to take on that same stance:

• noticing effort
• naming appreciation
• remembering successes 
• speaking to each other in ways that make connection possible

Bringing It Into Everyday Life

You don’t have to be in therapy to bring such questions into everyday life.

You might try asking:

• “What was one good moment for you today?”
• “When did we feel most like ourselves this week?”
• “What’s something we can appreciate that someone did, even if it was small?”
• “What do you want more of in our family right now?”

A Gentle Reframe

Families transform not just from solving problems, but from seeing themselves differently—and treating each other in ways that reflect that new understanding.

Appreciative inquiry helps families remember:

We are more than our hardest moments.

Over time, families can begin to see themselves differently. And from there, something new can begin.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy services for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

The post Appreciative Inquiry and Family Therapy: Building Hope and Connection appeared first on Jonah Green and Associates.

A Complex Stage for Aging Families

As parents age, families-regardless of structure or cultural background-navigate a range of decisions and emotions, often all at once, and therapy can provide support and guidance.

The practical questions:

• How do we think about safety and independence?
• Who will help with what?
• What needs to be put in place legally—wills, power of attorney, medical directives?

And emotional undercurrents:

• Worry about parental decline
• Discomfort talking about illness or mortality
• Old family roles reappearing

Even in families that generally function well, this stage can feel challenging.

Common Challenges for Adult Siblings and Aging Parents

While every family is different, some patterns tend to emerge.

Different views of responsibility
One person may step in quickly and take on a lot. Another may hold back, either out of disagreement, distance, or uncertainty. Over time, this can lead to frustration on both sides.

Old roles re-emerging
Families often fall into familiar positions. One sibling might fall into their role of organizer; another might question decisions. “Outsiders” might feel left out again. 

Different ways of facing aging
Some parents prioritize maintaining independence, while others are more open to help. Adult children also vary—some want to discuss issues, and others find it hard to have these conversations.

Practical decisions with emotional weight
Legal and medical decisions, such as wills, powers of attorney, and medical or placement decisions, are often pressing. Therapy can help families navigate decisions and address underlying concerns and feelings such as fear, anger, or a sense of unfairness in the process.

Indirect communication and family tension
It’s common for people to talk about each other rather than with each other, creating misunderstandings that build over time.

How Family Therapy Supports Aging Families

Later-life family therapy can ease fear and tension, making family members feel more supported during this demanding stage of life.

A therapist can help by:

• Making space for each person’s perspective
  Families often feel relief when everyone has a chance to express themselves.
• Slowing down difficult conversations
  When things feel urgent, conversations can become reactive. Therapy helps families move more thoughtfully.
• Clarifying roles and expectations
  Clarifying tasks and what each can expect from the other makes responsibilities clearer, helping families feel relieved and reducing feelings of overwhelm.
• “Translating” accusations into underlying concerns
  Therapists can help families understand comments like “You’re not doing enough” to reflect the worry, fear, or sense of aloneness they reveal.
• Supporting shared decision-making
  Therapy supports shared decision-making, helping families feel more empowered and confident in making collaborative choices.

The Opportunities in This Stage of Family Life

This stage can be stressful, but it also offers opportunities for meaningful shifts that can inspire hope and motivate families toward growth.

Siblings may come to appreciate each other’s efforts in new ways.
Parents and adult children can begin relating more as adults, rather than through older roles.
Conversations families may have avoided may become more possible.

Even modest changes—clearer communication, more balanced responsibility, a moment of recognition—can ease the strain and create a greater sense of connection.

A Place to Come Together

Many families try to manage challenges on their own, often during moments of urgency. Therapy offers a place to step out of that pressure and think more clearly together.

It doesn’t remove the realities of aging or caregiving. But it can help families face those realities with more coordination, less tension, and a stronger sense that they are working together.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy services for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

The post Later-Life Family Therapy: Helping Aging Families Navigate Change Together appeared first on Jonah Green and Associates.

They were thoughtful, committed, and trying.

“We love each other,” one partner said. “But it just feels… tense.”

“I feel like I’m always getting it wrong,” the other partner added. “With the kids, with you—everything.”

These are familiar moments in stepfamily therapy. There is love, effort, and goodwill, mixed with confusion and hurt. Therapy can offer a way forward that can clarify the steps people can take towards creating a family that feels more secure.

A Different Kind of Family

Stepfamilies can bring love, support, and meaning into people’s lives—often after periods of loss or transition.

They also come with built-in complexity.

They are not simply first families with new members added in. There are often strong preexisting bonds, and losses from divorce or bereavement. Children may move between homes. Nearly always, there are questions about roles and belonging.

When tension arises, many families ask, “What are we doing wrong?” or begin to focus on one person as the source of the problem.

More often, people are encountering the natural complexity of stepfamily life.

Widening the Lens

In many stepfamilies, strain shows up in one place at first:

A child may grow distant.
A stepparent might feel shut out or undermined.
A parent feels caught in the middle.
A couple begins arguing about parenting or finances.

People naturally locate the problem in one person or the relationship experiencing trouble.

Stepfamily therapy helps shift that perspective. The therapist helps the family ask:

“What is happening here that is making things hard for everyone?”

This shift creates room for a different kind of understanding.

The child is not simply “difficult.”
The stepparent is not simply “too much.”
The parent is not “failing” at effective discipline.

Rather, each person is responding to the arrival of new relationships and a changing family structure.

How Therapy Can Help

Insider–Outsider Experiences

Stepfamily members often experience the pain of feeling on the “outside.” A parent and child may share years of history, rhythms, and familiarity. As a stepparent enters the family, they may feel peripheral. At other times, a child may feel outside as the couple’s bond strengthens.

Feeling a lack of belonging can show up in small, everyday moments—hesitating before speaking, not knowing where to sit, or being unsure whether it is your place to step in.

Therapy helps name these experiences and understand them as part of the structure rather than a personal failing. That shift often makes it easier for people to be more patient and more understanding with one another.

Clarifying Roles

Questions about roles are common in stepfamilies.

How should a stepparent interact with their stepchildren?
How much should the child be expected to follow the stepparent’s instructions?
How close should stepsiblings be?

When these questions remain unspoken, people tend to fill in the gaps on their own—sometimes stepping back too far, and sometimes stepping in too quickly.

Through conversation and reflection, families begin to define roles in ways that fit their particular situation, helping individuals feel more confident and less uncertain. They can also focus on slowly developing bonds, and as they do so, the possibilities for roles expand.

Loyalty Binds 

Many of the most powerful dynamics in stepfamilies happen under the surface.

Children may feel caught between parents and stepparents.
Parents may feel pulled between their child and their partner.
Other households—ex-partners or extended family—may continue to influence the emotional climate. Therapy helps bring these loyalty triangles into the open, making them easier to work with and reducing hidden tensions.

These dynamics shape what people say, what they avoid, and where tension shows up.

Therapy helps bring these patterns into the open and makes them easier to work with.

How Therapy Proceeds

Effective stepfamily therapy usually moves deliberately. The pacing might include:

• starting with the couple to clarify their understanding and goals
• meeting with a parent and child to better understand their experience
• strengthening key relationships before bringing everyone together

This kind of progression helps create a sense of safety.

From there, families can begin to build a more respectful and workable way of being together. Warmth and closeness often develop gradually, rather than all at once.

At the same time, therapy helps families avoid some common pitfalls, such as:

• expecting immediate bonding
• pushing stepparents into discipline too early
• minimizing children’s mixed feelings
• overcorrecting out of guilt
• losing focus on the couple relationship
• forcing closeness that has not yet developed

Instead, the focus shifts to what fits this particular family.

Building Belonging

Belonging in a stepfamily usually develops over time.

It grows through small, repeated experiences—feeling taken seriously, feeling respected, and sensing that there is room for you in the family, which can inspire hope that belonging is achievable over time.

Children often need reassurance of their parents’ continued commitment, along with the freedom to develop a relationship with a stepparent at their own pace.

Stepparents need space to connect without feeling pressure to prove themselves too quickly.

Parents need support in holding both their child and their partner in mind at the same time.

As these pieces begin to fall into place, families often notice subtle shifts. Conversations feel a little easier. Roles feel clearer. People feel less on the outside.

A Different Kind of Hope

Stepfamily therapy is not about making a family look like a first family.

It’s about helping people understand the family they are actually in—and finding a way to live in it together more comfortably.

Over time,  meaningful change can occur: conversations become easier, expectations become clearer, and relationships feel a little steadier. A sense of belonging begins to take hold—not all at once, and not perfectly, but in a way that feels more settled and more real.

-Posted by Jonah Green

Jonah Green, a therapist at Jonah Green and Associates, LLC, offers therapy services for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

Related posts:

Freely Chosen Love: The Unique Potential of Stepparent–Stepchild Relationships

Step-by-Step for Stepfamily Success

Keys to Stepfamily Success

The post Building Belonging: What Stepfamilies Can Gain from Therapy appeared first on Jonah Green and Associates.

Our minds tend to operate in different modes depending on the situation. Dialectical Behavior Therapy describes these modes as “rational mind,” “emotional mind,” and “wise mind.” When we lead from the rational mind, we focus on facts and logic. Asked to solve a math problem, for example, and we rely on rational thinking to arrive at an answer. The emotional mind, on the other hand, is ruled by feelings and urges. When we are emotional, it can become harder to access the facts of a situation. For some of us, our “emotional mind” takes over when we catastrophize and declare that things will never get better or the worst possible outcome will definitely happen. At other times, we may rely only on logic and facts, detaching from our emotions in ways that make it harder to understand and communicate what we are truly feeling or needing. Therapy helps us understand that we can use these modes and balance them through specific techniques, which increases our ability to respond adaptively in various situations.

The Wise Mind

In between these two polarities is the “wise mind,” the balance between the rational mind and the emotional mind. It allows us to draw on both facts and feelings while honoring our emotional experiences. When we listen to both logic and emotion, we create space to relate to our thoughts, feelings, and experiences with compassion and curiosity rather than judgment and avoidance. This balance can empower us to approach challenges with greater confidence and understanding.

Therapy and the Wise Mind

Dialectical behavior therapy can encourage us to connect with the wise mind. By slowing down and examining our automatic reactions, giving voice to feelings that may have been beneath the surface or thoughts that may have gone unspoken, we can begin to observe our internal system with more distance and clarity. From this place of greater awareness, we can start to recognize the wisdom within our emotions and understand what they may be trying to communicate or protect. While this process can sometimes be challenging or uncomfortable, persistence and patience help us develop the skills needed to listen more effectively to both our emotional and rational minds, ultimately fostering greater confidence, clarity, and compassion in handling life’s challenges. 

-Posted by Lydia Sander 

Lydia Sander is an MSW Intern with Jonah Green and Associates, LLC, which offers therapy services for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

Related Posts:

Taking a Break for Self-Care

Walking The Middle Path: Striving For Balance in Parenting

The post Dialectical Behavior Therapy and the “Wise Mind” appeared first on Jonah Green and Associates.