Blog Posts

March 2020 Posts

How to Talk to Your Children About COVID-19

by Dr. Robin Norris

My ride with three kids in the car after school helped prompt this blog. They were full of questions, comments, correct facts and other wildly incorrect ideas.

The best movie overall to help explain this, for those that enjoy media, is the Frozen Fever short animated movie. In it, the sneezes produce lots and lots of little snow men called Snowgies and they just keep multiplying and taking over a bunch of places. This show helps kids to get the idea of germs spreading even when we try not to have this happen.

Since thankfully most of the kids are not sick, you can use the following analogy of invisible glitter. Kids know and love glitter. They understand how it sticks to places you didn’t mean for it to stick for a very long time and sometimes you don’t even know how you got it because it wasn’t yours to begin with. A shut down allows for everyone to stop spreading the invisible glitter and for it to be vacuumed up or give it time to blow away.

Ultimately reassuring the child that they are doing their part to keep their bodies as safe as possible by handing washing is important. Talking to the kids about the real facts can be helpful depending their age. Never tell a child something can’t ever happen unless for sure you are sure. So, when one of my kids asked, “Have any kids died?” My answer was, “Not to my knowledge.” When they told me that some old people have died. I told them, “Yes this is true and for many this is sad.” When they asked if they or anyone we know can get it, I told them, “We will try our best not to," but at no point did I tell them no. You want to reassure your children as much as you can and to have them know that many adults are working on tons of ideas about how to keep them safe. Take this time to challenge them to learn new things about their immediate world around them and enjoy the little things each day.


Understanding Brain Injuries: What You Need to Know

by Dr. Alison Krawiecki

March has been designated “Brain Injury Awareness Month,” which provides a good opportunity to discuss a widespread personal and public health issue that touches most of us, in some way, over the course of our lives. There are many types of brain injury, many levels of severity, and significant variability in outcomes for people who have sustained brain injuries.

The Centers for Disease Control and Prevention (CDC) defines a Traumatic Brain Injury (TBI) as “a disruption in the normal function of the brain that can be caused by a bump, blow or jolt to the head, or penetrating head injury.” TBI is a major cause of death and disability in the United States. In 2014 there were approximately 2.87 million TBI-related emergency department visits, hospitalizations and deaths in the US, according to the CDC.

TBIs range in severity from “mild” (which include an alteration mental status or brief loss of consciousness) to severe (which can include extended periods of unconsciousness, amnesia for the event and time before and/or after the event, and ongoing cognitive and physical problems). TBIs of various levels of severity can be associated with short or long-term impairments in thinking and memory, personality and behavior change, and significant psychosocial and occupational disability.

There are millions of people each year who sustain concussion (a mild TBI), the vast majority of whom recover to their pre-concussion baseline within weeks or a few months post-event. People of all ages sustained concussions in various ways, including athletics (e.g., football, lacrosse, soccer, equestrian sports).

When I clarify to patients in my practice that a “concussion” diagnosis is given any time an accident or other event has caused an alteration in consciousness (e.g., “getting one’s bell rung,” or “seeing stars”) and/or associated symptoms including nausea and dizziness, people often go from telling me they have had one concussion to telling me, “well, if you define it that way I have had several.”

We know that the effects of concussion are cumulative, meaning that each one a person sustains seems to negatively affect them more than the last. The brain’s threshold for what it can tolerate is lowered each time there is an additional concussion. If a person sustains a second concussion before they have recovered from the first (i.e., “second-impact syndrome”) they are much more likely to experience a complicated and/or incomplete recovery. Unfortunately, the people that are at high risk for concussion are often the people who have already sustained one or more. This may be related to their risk-taking behavior (e.g., an “adrenaline junkie” who has not stopped or changed high-risk sports), the context in which they live (e.g., domestic violence is a common cause of concussion) or because symptoms of the initial concussion make them more susceptible to another (e.g. dizziness making them more likely to trip and fall). There is a very high percentage of individuals involved in the legal system who have sustained one or more concussions.

Regardless of the age of the person or the way in which they have sustained a concussion or other brain injury, it is imperative that they receive medical attention as soon as possible after the event. They should also be sure to report their concussion history to their medical and mental healthcare providers from that point forward, as part of their medical history.

In terms of mental healthcare, providers need to take into account a person’s brain injury history when assessing their presenting problems and when treating them over time. Referring the patient for a neuropsychological evaluation can be an extremely helpful way to better understand the presence, nature, severity and implications of cognitive and psychological symptoms of brain injury and how those are all brought to bear on the patient’s presenting problems and treatment needs.


Brain Injury Association of America

Centers for Disease Control and Prevention

February 2020 Posts

Love and Relationships: Managing Conflicts with Emotional Intimacy

by Jacque Bitanga, LPC

As Valentine’s Day approaches, we can’t help but think about love and intimacy in our own lives. We thrive on closeness. We long for loving relationships. We strive to foster meaningful relationships with friends, family, and significant others. However, we are scared of conflict in those relationships and shield ourselves from developing stronger bonds when conflict is present.

Conflict is a natural and normal part of any relationship. If managed poorly, it can damage the best of relationships. But, when managed with kindness, respect, openness and trust it can foster deeper connections and strengthen bonds.

While there are various types of intimacy - including physical touch (i.e. - hugging, kissing), emotional connections (i.e -the intellectual sharing of ideas, goals and values), and shared experiences (i.e- creating memories together), not all of these are valued the same. What is often overlooked and underestimated is the importance of emotional intimacy.

Emotional intimacy occurs when both people feel safe and valued. When they feel comfortable expressing vulnerable emotions. When they feel empowered to validate the expressed emotions of their partner. When they have the emotional intellect and maturity to listen, accept, and appropriately respond to their partners.

When conflict presents itself in a loving relationship, emotional intimacy plays a critical role in the way in which the partners respond to one another and whether the relationship gets stronger through the conflict or breaks down. For a relationship to get stronger, both partners must have the emotional maturity to handle the conflict while protecting the emotional vulnerability of their partners. Partners must share their true feelings, believe their partner hears them, understands their perspective, values their point of view, and validates the feelings even when the partners disagree. Disagreeing can be healthy. It's okay to disagree. The ability to respect the point of view and emotions of your partner, even in conflict, is the critical piece for a continued strong emotional bond.

Although the ability to listen and be receptive to the information given doesn’t guarantee resolution to the conflict itself, it certainly creates an environment where both parties can appreciate the other person’s perspective and work towards a compromise that gives both people the opportunity to thrive as individuals as well as together in the relationship moving forward.

Here are a few tips to help manage conflict and step back from the issue to allow partners to feel valued, understood, loved and cherished during times of conflict and disagreement:

  • Be kind: Before getting defensive try to soften your starting point and understand where the other person is coming from and how they may be feeling. Use statements like "I think" and "I feel" and avoid words like "always" and "never."
  • Be respectful when listening. Be respectful when talking. Show respect when communicating your thoughts and/or feelings to your partner. Make sure that your own communications are made without judgment, blame, criticism or contempt.
  • Continue to strive to create a space for both you and your partner to feel as though you can openly communicate and share your thoughts and feelings with one another without fear of judgment, repercussion, or emotional abandonment.
  • Trust in your love for one another. Trust the other person's willingness, capacity, and desire to resolve the conflict in the best way possible for you both. Trust that all relationships experience some level of conflict and difficulty and one of the biggest predictors of success in a relationship is how we manage those conflicts.

January 2020 Posts

Self-Care: More Than Just a New Years' Resolution

by Alexandre Fleche, LCSW

There is no better time than January for setting intentions for the year. This is the month you'll likely be confronted with societal messages about getting in shape, eliminating bad habits, or doing things that you've been putting off. From water cooler talk about New Year's resolutions, to solicitations from the local gym, to dinner table conversations about finally cleaning out the kitchen cupboards, there is likely no escaping the push to examine your behavior and make a change. But while all this focus on making changes can at times be overwhelming and unwanted pressure, it is a perfect opportunity to set healthy, positive intentions for yourself.

So, in order to dial back the anxieties around making a new start, and to make positive changes for yourself, set a positive intention to nurture yourself this year with healthy self-care practices. More than just a new-years resolution, healthy self-care practices can be essential to emotional and psychological wellness. Here are some self-care ideas to get you started.

Find something that you know has made you feel great in the past, and schedule it into your weekly calendar. One of the best ways to take care of yourself is to do the things you know make you feel well. This may sound simple, but we often either forget or neglect the things that bring us positive feelings. These can be anything from being around friends, to reading, to learning something new. Have you stopped going for bike rides that used to be a regular part of your routine? Going for a hike? Browsing antiques? If you’re having trouble coming up with something, ask someone who knows you well. And don’t forget to put it into your calendar on a weekly basis, or you may risk not following through.

Get to bed just a little bit earlier than you think you need to, and stick with it. Sleep is one of the fundamental things we need biologically in order to function our best in a number of ways. According to the CDC, 35-38% of adults in the state of Virginia average fewer than 7 hours of sleep per night (considered a short sleep duration). Sticking to a consistent sleep and wake time can help stabilize your circadian rhythm which helps with overall biological functioning. This may help reduce stress and improve mood.

Ditch the glass of wine for a cup of tea. According to the National Sleep Foundation, alcohol consumption may contribute to disrupted circadian rhythm, block restorative REM sleep, and contribute to some health problems. Alcohol consumption may also be a complicating factor for depression and anxiety, possibly contributing to these issues even at moderate levels of use. Eliminating or limiting alcohol use may help reduce or manage mood problems and lead to benefits in energy and mental sharpness.

Practice gratitude consistently and regularly. Research has shown gratitude to positively affect mood and even increase healthy behaviors. This relatively simple practice may translate to some of the improvements that can seem so difficult to accomplish on their own, like exercising more. To practice gratitude, simply identify three things each day for which you are grateful, and identify what caused those things. Try this practice each night before bed.

Start a meditation practice. When I mention meditation to people, they often respond that they cannot do it or it does not work for them. The truth is, there are many forms of meditation, and it may be easier and more straightforward than it seems. One simple way of practicing meditation is to listen along to a guided meditation. There are many apps out there that offer guided meditation audio, like Headspace or Calm. Another great resource is Tara Brach who provides recordings of her guided meditations on her website for free, and hosts a free meditation Wednesday evenings in Bethesda, MD. Meditation can help calm the mind and decrease negative rumination.

Although making behavioral changes can be difficult, try framing it as making an investment in your wellbeing and setting yourself up for future success. Investments in self-care result in a reduction of stress, and therefore free you up to do more of the things that truly matter to you. Think of what you might be able to do with your renewed energy, like spending time with people you love, doing creative projects, investing in your finances, traveling, or participating in your community.

Journal prompt: For extra motivation to start the year off with good intentions, consider dusting off your journal (or starting one) and make a new entry. Reflect on the previous year and identify three things for which you are grateful and what caused them. In addition, consider one thing (or more) you will do this coming year to practice self-care, and make a plan for how you will do it.