The Two Profession Family (Or: Where to find the time?)

Over the past few generations we have moved from a ‘breadwinner – homemaker’ family system to one where both adults and parents assume full time vocations. So, instead of two jobs in a family, we now have three. If we add children to the mix, there is a fourth job – child rearing. Precious time and energy is divided between child care, housekeeping, jobs, social events, family activities, adult time with a spouse, friendships, and personal self-care time. Sounds like a lot? It is, and something has to give.

Often we sacrifice time with our spouse and self-care time, thinking that we can make up for this later. The result can be emotionally disastrous. When we hollow out the marital bond and neglect to take good care of our physical and emotional needs, we set up a parallel marital system and lose the very things that enhanced our marriage to begin with. We used to talk, now we cope. We used to feel tender toward our precious mate, now we expect him or her to fend to him/her self. We used to touch each other, now we touch in passing rather than in passion. When was the last time we hugged until we felt totally relaxed?

So, what shall we do? Maybe it is time to sit down with our mate and make sacrifices that will lead to increased intimacy and care for each other and ourselves. If funds are available (after all, we are both bringing income into our system), consider hiring someone to carry out some of the housekeeping and child care. Nannies have become a growing business, and sharing a nanny with family friends can provide valuable time for adult intimacy. Is every outing with other friends or with the children? If so plan and keep a date night at least once each week where we can talk about our feelings for each other, our hopes and dreams, and how important we are for each other. No business talk, only focus on the precious things we talked about before we married. Perhaps we need to reduce the friendship and activities time to make quality time for each other.

A patient of mine was working 70 hour weeks and her husband was working over 60 hours, planning to have time for each other some day. Now each of them is experiencing health problems and ‘some day’ may never come. As doctors tell us, no one confesses on their death bed that they wish they had worked harder. Now is the time for quality in life, including an open and intimate relationship with our partner.

The Most Common Problem: Low Self Esteem

  • You don’t speak up when you know you should.
  • You often feel guilty about disappointing someone else.
  • You aren’t sure you can do something new, so you decide not to try it.
  • You let others take advantage of you.
  • You are sometimes shy about letting people get to know you.
  • You often don’t let others know what you want or how you feel.


  • You have a deep feeling that you might be superior to other people.
  • You pride yourself on doing everything just right.
  • You are ashamed when you make a mistake or don’t succeed.
  • You are good at what you do but you sometimes feel like a fraud.
  • You are quite impatient when you have to wait your turn.
  • You are careful not to reveal too much about yourself.

Do any of the above statements describe what you feel and do? While everyone may feel some of those feelings now and then, all together the statements are representative of two distinct patterns of low self esteem. In simple low self esteem, the person feels inferior to others. The second group describes the pattern called narcissism. In narcissism, the person feels superior to others, but this is a coverup for insecurity about his or her own self-worth. Not feeling valuable, precious, and lovable is probably the most common problem which therapists eventually encounter after they ask a new patient, “What brings you in?”

People may say, “I’ve been feeling stressed out lately,” or “I think I might be depressed,” or even “My wife is leaving me,” or many other initial complaints, but often the root issue is the person’s innermost feeling about himself. It is also frequently a profound cause of relationship difficulties. Fixing self esteem problems does not happen overnight, but collaborating with a skilled therapist individually or in a group can work wonders and make a tremendous improvement in a person’s overall happiness and quality of life.

Am I Hooked on the Web?

As the TV ad says, “You are all surfing, googling, tweeting, and gaming,” but this can cross the line and become an Internet “addiction” or compulsion.

Here are some signs of web addiction/compulsion:

  1. Am I spending more time online than with friends and family?
  2. Do I feel depressed when not net connected?
  3. Is my avatar more important to me than my own self identity?
  4. Do I feel anxious if I haven’t checked my e-mail recently?
  5. Do I put off doing school work or other regular tasks to surf the web?
  6. Do I try to hide how much time I spend on-line or lie about it?
  7. Is talking to on-line “friends” more important than talking with my family or real friends?
  8. Do I stay up late, getting less than 7 hours of sleep in order to surf?
  9. Does my being on-line make me late to scheduled events?
  10. Do I prefer on-line-sex to dating or going out with friends?
  11. Do I drive while ‘intexicated’? Funny, but serious.
  12. Is my romantic partner only on-line and never in person?
  13. Do I feel the best when I’m surfing the net?
  14. Do I feel anxious until I read a text?

If you have answered yes to four or more of these questions you may be developing an unhealthy behavior pattern and can use some professional help. To schedule an initial appointment with one of our doctors please call Cathy at 512-346-2332.

Psychologist Kimberly Young’s book The Eighth Wonder is a good resource to better understand how this growing behavior is effecting many people, from adolescents to older adults. Local Psychologists who work with obsessive and compulsive behavior can help too. If this is a challenge for you, help is available. For a thorough discussion of different points of view about this behavior check out the following article on Issues for DSM-V: Internet Addiction.

Getting the most from therapy

We often think of our success or failure in reaching our therapeutic goals as dependent on the therapist’s work, or our own ability to use the counseling effectively. While these situations can occur, most of the time our lack of progress is related to communication. Here are some ways to increase the effectiveness of your therapy.

Choosing a therapist who is skillful in listening, understanding and helpful in communicating is essential to making progress on personal challenges and relational issues. Also, ‘chemistry’ is important in establishing a secure and safe feeling when dealing with sensitive and vulnerable topics. I encourage new clients to tune in to their feelings about my style, the office personnel and surroundings, and whether they feel OK here or might feel more at ease with a different professional or setting. Some folk like my big ‘tree house’ room and some prefer a more cosy and intimate setting. Some feel supported by my active feedback style, and some prefer a quieter and more passive approach. In many cases talking about the ‘chemistry’ between us can actually make the therapy more effective.

I often ask my clients if their therapy is working for them, and if not, why not. Have they reached a growth plateau and need time to integrate their new insights? Do they need a change of direction in our work together?

Be honest with your therapist about your thoughts and feelings. While we psychologists are usually perceptive, we are not mind readers. The more open you are with your thoughts the better the therapist can understand you and respond to who you really are. This is usually a challenge as you are getting to know someone.

In addition to honestly expressing your thoughts, it is important to be open in the therapy session with what and how you are feeling, both at the moment and in your daily life. Even if you are unclear about just what you are feeling, sharing physical symptoms can help the therapist understand what you are experiencing and can help you identify and clarify your emotions. Ask yourself, “Do I tighten up when talking about certain things? Are certain areas hard for me to put into words? Do I feel anger when the psychologist says some things or acts in certain ways? Does she or he remind me of an emotional figure from my past?”

Be clear when you disagree with your therapist. This will become easier over time as you build a trusting and comfortable relationship. Asserting your opinion is a sign of self confidence and strength. As I jokingly say, “Therapists are mostly human.” – and do make mistakes. Of course, if you find you always disagree with the therapist, you probably are working with the wrong professional or you may just enjoy being oppositional – a good issue to work on.

Finally, be clear that you are here for your growth and life satisfaction, not to please the therapist. If you need to do your work with someone else, or if you have achieved your personal goals, it is time to leave. A healthy and open farewell can start you on your using life as your best therapy. You can come back later for a ‘retread’ when the time is right.

Want to marry? We need to talk.

Hidden in the romance and feelings leading a couple to marry there are important issues that can determine the success or failure of the relationship. We may want to believe that “love conquers all,” and certainly love is an important ingredient in a happy marriage. However, several other less romantic factors will affect the durability and success of the relationship. So “You need to talk” and answer eight critical questions before deciding to tie the knot.

Communication: Am I willing to be open with my spouse? Are there secrets and promises I have not shared with her/him? Do they know my family history? What models for verbal behavior do I follow? How will we deal with conflicts? What topics are hard for me? Is language or culture an issue in understanding my partner? What is my style of non-verbal communication? Are there heritable health issues? Can we agree to disagree? How do I give and receive love?

Finances: What does my partner bring to our relationship in assets and debts? Many a new marriage has been tarnished by surprises over money. Am I taking on my partner’s past living on credit? Can I support unexpected debt? Do I want to feel beholden to him or her about finances? Do I wonder if he or she likes me for my money? Do I want to control all the finances? Who will balance the books, review the credit card receipts and write the checks?

Lifestyle: Are we well matched in our buying and saving preferences? Is one satisfied with the essentials and the other wanting ‘the finer things of life’? Do I want to ignore the price and he or she wants to stay within a budget? Does one want to save for the future and the other spend what they have? Do I want to eat out evenings and my partner likes home cooking? Do I need a new car or computer every two years?

In-laws: When and how we interact with the other’s family can present some difficult situations. Do we want them to come over whenever they want? Will one of us spend hours talking with a parent or sibling while the other feels neglected? Can we maintain the primacy of the marriage and establish clear boundaries with family members? Do I get along with my spouse’s family? Do they like me more than they like my partner?

Religion: As has been said, “Many a marriage has died on the cross of religion.” Differences in church background may seem trivial when choosing a mate, but can lead to irreconcilable conflicts, especially when rearing children. Even subtle contrasts between ‘flavors’ of the same religious group can lead to serious conflicts. Have we agreed which faith system, or none, we will teach our children? Do we understand and respect the other’s beliefs?

Children: Do we agree on the number and spacing of children, if any? Will our parenting styles mesh? Will there be a stay-at-home parent? Am I emotionally ready to take on any stepchildren? Is it realistic for me to become a parent and continue my profession? How will we decide on division of labor as parents? Is having a child more important than being married?

Sex and affection: Are we matched in our needs for physical expression? Can we let our future spouse know what we like and need? Can I regard my partner’s needs as important as my own? Are we willing to compromise when we have differences? Are we physically at ease with each other? Is my main attraction to him or her sexual?

Friendship: Are we best friends? Do I treat my partner as well as I treat anyone? Do we tell others about our relationship in ‘we’ language rather than ‘I’ terms? Am I more critical or rude to my future spouse than I am to my close friends? Do I want to spend more time with my buddies than with my partner? Do we like each other in addition to loving each other?

The way we deal with these difficult questions can determine ones chances for a compatible and lasting marriage.

Relationship Repair: Calming Down

As John Gottman says in his book, The Science of Trust, “Every couple, in their daily life together, messes up communication, and every relationship has a potential ‘dark side.’ ”

It’s too much to expect that we can always have good communication with our partner. There are always misunderstandings, stress, distractions, hurt or angry feelings, and sometimes even just not hearing what was said. Even in stable, happy relationships, bad things sometimes happen, such as coldness, criticism, stonewalling, etc. Fights are inevitable.

But what Gottman found out in his research is that the thing that matters most for couples is their ability to repair things when they go wrong.

This involves your ability to remain physiologically calm during conflict, that is, your heart doesn’t race, you don’t start yelling, your palms don’t sweat, your eyes don’t dilate. In order to listen well and be understanding with your partner, as well as express your own thoughts and feelings in a way that they can be heard, you need to remain calm.

Can you take a deep breath or two and exhale slowly to calm yourself down? Can you soothe yourself by thinking positive thoughts, like “We will get through this,” or “I know he loves me,” or “I may have hurt her, but I am a good person and I mean well,” and, maybe, above all, “It is OK to make mistakes”? Can you quietly say to your partner, “Please don’t come at me like that,” or “I’m not trying to blame you”? As Gottman says, “The ability to create peace and the ability to self-soothe and soothe one’s partner are central to relationship happiness.

Can you do this? If not, what seems to get in the way? What are you feeling and thinking when you want to calm down but can’t?

How could group therapy help me?

Most people have heard of some type of group: a grief group, AA, divorce group, prayer group, feminist group, support group, maleness group (with drums!), looking-for-work group, singles group, a yoga group and so on. Each of these groups has merit and can be helpful to some folk.

A psychotherapy group is different from these others, and can provide particular benefits for many people. For one, a therapy group is led by a professional therapist, usually a PhD psychologist or masters level counselor, who has extensive training in group therapy. He or she understands the complex dynamics present in a group and can maintain the boundaries necessary to ensure each member receives maximum help with his or her issues.

In the protected and confidential situation of the therapy group (only first names are used and the relationship between members is kept within the group) the person can present their relevant history, old sacred oaths, repressed fears, and family secrets without fear of reprisal or condemnation. In addition, each member can relate to the others in an authentic and open way not possible in most social settings.

A therapy group has unique power to help people give and receive feedback on how each person relates to others. Is he afraid to be open with women? Does she see other females as a threat? Is his view of another man based on his father’s stern behavior? Does she need to use sex to feel valued? Is his drive for money to compensate for his feeling inferior? These and many other dynamics become clear in the process of group therapy, allowing each person to make changes and ensure healthier relationships. In addition, each member can learn how important she or he is to other group members and appreciate how valuable she or he can be in relationships.

Finally, group therapy can be an economical way to make the changes you desire, especially in important relationships in you life. Fees typically run from one-third to one-half those for individual sessions. If you currently have a therapist, ask him or her if a group is right for you.

If you are interested in exploring how a therapy group might help, give me a call at 512-346-2332. Or our office manager Cathy can schedule a time for us to meet.

Dr. Tom (to many of my clients)

4 Signs of a Troubled Marriage

The country’s foremost relationship expert, John Gottman, PhD, has discovered through years of research four things that some couples do which reliably predict divorce ahead for them unless they recognize and change these things.

  1. Harsh Startup
  2. The “Four Horsemen of the Apocalyse”
  3. Flooding
  4. The Body Language of Emotional Distress

Let’s look at each one.

Harsh Startup

In a discussion or disagreement, someone gets negative, sarcastic, condescending or accusatory in words or tone in the first three minutes.  “I don’t know why I bother talking to you about this, but would you please pick up your damn socks!”

“The Four Horsemen of the Apocalypse”

These are four negative behaviors that are lethal to a relationship.

  1. Criticism – “What is wrong with you?  I’ve told you not to do it that way.”
  2. Contempt – name-calling, sneering, eye-rolling, mockery, laughing at in a hostile way.
  3. Defensiveness – “Me?  I haven’t’ done anything wrong!  You’re the problem!”
  4. Stonewalling – one partner simply tunes out,  walks away, refuses to answer or acknowledge and disengages emotionally and physically from the other.


There is so much criticism, yelling, name-calling, contempt, blaming or general hostility from one spouse that the other feels overwhelmed, hurt, angry, helpless, often to the point where he or she just shuts down.

Body Language of Severe Emotional Distress

  • Heart rate elevate to >100 beats per minute
  • Adrenaline kicks in, ready for fight or flight
  • Blood pressure rises
  • Sweating
  • Higher thought processes (necessary for creative  problem solving) shut down

These behaviors tend to build upon each other, says Dr. Gottman, such that one leads to another in a mounting storm.  The good news is that you can learn to recognize and stop this pattern.  A good first step is to admit to yourself (and your partner) what role you might play in this kind of interaction.  Are you the one who starts it, so fed up that you can’t help taking a jab? Are you the one who gets outraged and defensive because the accusation seems so unfair?

Deep-seated emotional reactions like these usually take professional help to alter.  However, in my next article we’ll look at some of the important changes that make a big difference.  And, you can always look for one of Dr. Gottman’s excellent books for a complete explanation.

Why Should I See a Psychologist?

There are undoubtedly fine practitioners among each different category of licensed mental health professional. How can you make the best choice for what you need? Here are some reasons to choose a psychologist:

  1. Psychologists study the entirety of human development and behavior. To be a “Psychologist” in Texas means that you have a doctorate and have studied not only case histories and clinical observations, but also scientific research.
  2. Licensed psychologists have all conducted their own research into some aspect of human behavior. They are “scientist/practitioners,” and thus are always seeking what works best to help people grow and change.
  3. Licensed psychologists have the most stringent ethical standards of all mental health practitioners.
  4. Psychology doctoral programs last from four to seven years, all of it devoted to human behavior and the diagnosis and treatment of behavioral disorders.
  5. Psychotherapy is a major part of training for licensed psychologists; and psychotherapy is much more effective than medication for treating most psychological problems.
  6. If you do need medication, your psychologist will refer you to a medical doctor.
  7. Psychologists begin their clinical practica (actually working with patients or clients) during graduate school. At the end of their studies, they do a clinical internship, followed by a year of professionally supervised practice AFTER receiving the doctoral degree.
  8. To obtain licensure, a psychologist must pass written and oral examinations in clinical issues and ethical practice. Psychologists are the most highly vetted mental health practitioners. (It is so tough that there is even a funny You Tube video about it.)

Feeling comfortable with your psychologist or other mental health professional is even more important than choosing your medical doctor. If it doesn’t feel right, ask questions or try someone else.

You are looking for someone who really listens carefully to you, understands what you are trying to communicate, respects what is important to you and feels like someone you can trust.

Licensed Mental Health Providers in Texas

The many different types of mental health professionals can present a confusing dilemma for most people. The fact is, there are seven different types of licensed mental health professionals, in Texas, and there are many other unlicensed folks who hang out a shingle and offer help without having had to meet any state requirements for training, experience and ethical practice. I recommend that you look for one of these professionals, who have had to prove their expertise before a regulatory body whose job is to protect the public:

Licensed Professional Counselor (LPC) or Licensed Mental Health Counselor (LMHC) – has a master’s degree in counseling, including principles of human development, and has completed 3000 hours of supervised experience.

Licensed Marriage and Family Therapist (LMFT) – usually has a master’s degree, including the study of family systems theories and techniques. The degree requirements include 3000 hours of supervised experience.

Licensed Clinical Social Worker (LCSW) – has completed a master’s degree in Social Work, including the enhancement of social and psychosocial functioning of individuals and groups, and has completed two years of supervised clinical experience.

Licensed Chemical Dependency Counselor (LCDC) – assists individuals or groups in treating chemical dependency problems. The LCDC has a two-year associate’s degree and is not authorized to treat mental health disorders or problems which do not include chemical dependency.

Licensed Sex Offender Treatment Providers (LSOTP)– must hold another mental health license and treats those who have been convicted or adjudicated of a sex crime or a sexually motivated offense.

Psychiatrist (MD) – is a medical doctor. This person has a four-year degree from an accredited medical school and the successful completion of a psychiatric residency program. This doctor will typically focus on medication in treating psychiatric problems. Some receive training in talk therapy as well.

Psychologist (PhD, PsyD, or EdD) – holds a doctoral degree from an accredited university graduate program in either clinical practice or research. All psychologists have been trained in psychological assessment, diagnosis and in different types of psychotherapeutic treatment (talking therapies) for various disorders. In Texas, a psychologist who engages in clinical practice must also be licensed, which involves a supervised internship, post-doctoral clinical supervision and written and oral examinations in practice and ethics.