Family Conflict

Nick:
Welcome to the Ascend Health Show. I’m your host, Nick Angelis. I’m a nurse anesthetist and one of the owners of Ascend Health Center. And I’m here with Amanda Kotsura, a psychotherapist and a friend of mine. How are you doing today? I’m doing.
Amanda:
Good. Thanks for having me, Nick.
Nick:
You’re welcome. So we had this great idea that we’re going to talk about ways during the holidays you can solve family conflicts or at least stay out of them. But then I just realized right before we started taping that the people who have made it, I don’t know, 15 seconds into the show already, are probably the ones that are already solving the conflicts. They’re not the ones causing them. Maybe a good way to explain it to you all is so right now the fun thing to watch on the Internet is fights at Waffle House. But when Amanda and I were younger, the thing was Jerry Springer where you would just see people throwing chairs at each other and people would shout Jerry, Jerry and that sort of because of the quality of people that are either in Waffle House sometimes at 3 a.m. or on the Jerry Springer Show. So some of this is very dependent on what your family’s like. If they’re the Jerry Springer Waffle House combo, you have to realize that. And maybe some of these therapeutic interventions that will mention just it’s not going to be enough. So I thought I’d start with that. And also because I want to talk about the Waffle House really quick.
Amanda:
I don’t know about the Waffle House plates, but as you talked, I was thinking also not only Jerry Springer, but also just throughout the years of holiday shopping and the chaos that happens, people fighting and like trampling over people to get that toy right.
Nick:
Like, you know, Samsung makes more than one TV. Like if you don’t get this one, there will be another one manufactured at some point. Yeah.
Amanda:
And all of those situations, what I see is what I preach regularly is a lack of emotional regulation skills and a lack of coping skills. Right. A lack of boundaries. The things that you’re not taught in school or in society.
Nick:
Right. And so that’s the main first point is that I realize that this is challenging because again, people watching or listening are those who often have the boundaries and the skills. Because I mentioned we tried to do this show before around Christmas time and you were a little under the weather because we did your podcast right before and I was thinking, I don’t need to ask a man if she’s fine. She’s a therapist, she’s got great boundaries. She’ll let me know if she’s sick. Otherwise we’re just doing this show. And then I realized, well, that’s kind of mean because even as a therapist, she clocks us, you know, she’s off the clock or has her. So I actually emailed you like, Hey, do you want to reschedule? How are you feeling? And then I realized, oh, that was like a really nice thing to do to actually ask you if you want to do this, especially since we know each other. But you could have been like, Oh, maybe he’s really dedicated and he’ll be really disappointed if I can’t do this TV show instead of what happened, which is I think I convinced somebody to do two shows and it was perfectly fine.
Amanda:
Yeah, I was actually glad that you asked because as a therapist it is challenging sometimes, honestly. And so to have you ask was an opportunity for me to practice the boundary, right? And and also I was very foggy and wasn’t really looking ahead at the next day. So it was like, oh yeah, that’s probably a good idea to reschedule.
Nick:
So I think that’s a good point that like again, sometimes we have to ask people like one method is if someone says something awkward at a family gathering, just ask them to repeat themselves and then they’ll either realize what they’re saying like, Oh, that’s not appropriate or they’ll charge on ahead. But at least, you know, at least they have that chance to back off.
Amanda:
I’ve started to develop some really unique responses, not only for myself but for clients. And a lot of them come from TikTok, but like, oh, that’s a really strange thing to say out loud. Or when you said that it sounds like you were meaning this and kind of laying that out there for them. Is that what you meant and clarifying? And then if it makes them look or feel bad, they’re like, oh, no, no, that wasn’t what it was. So really just kind of re putting it back on them to clarify. And then they have to kind of say it again consciously and mindfully. And then they’re like, Oh, I don’t want to look like that. So know what I meant Is this okay?
Nick:
And it’s it’s not really slick either because it is a genuine like. Well, that was a really strange thing to say. So let’s make sure we’re all and that way too. Like, if they want to be offensive, they get their chance to be offensive That way there’s no like, do they really mean it that way? Or.
Amanda:
My husband actually surprised me. We were in a family setting and one of my family members said something that was definitely racist. And my husband said, Hey, if you have to whisper those kind of things, you probably shouldn’t be saying them at all. Right? So just to give people like some skills because a lot of people people are just caught off guard or shocked or hurt or whatever the thing is and they don’t know what to say, so they don’t say anything. Right. And I think especially in those situations, it’s definitely our job to disrupt that. And so giving people the tools to say that.
Nick:
And that’s a good question too, because and again, this is more of the disclaimer part, but Amanda is the expert in this. I’ve got plenty of opinions and I think they’re amazing. But if you hear something that I say and then she disagrees with me, she’s. Probably right. I’m probably wrong because a lot of a lot of the shows here, it is almost like an infomercial like where we both know all about the mango squeezer. But in this particular case, it is like, well, I’ve got really great opinions about how to solve family conflict. But what’s more of like the research based psychotherapist version of it and that’s regardless of people’s beliefs. And that’s for me, that’s the most fascinating part of all this because a lot of these are religious holidays or you’re with people that you don’t always spend a lot of time with. And it’s not your job to be a crusader for your personal beliefs or against their personal beliefs. So what you said about racism, that’s a really interesting portion. Like so there’s this try not to be offensive, but I can’t help it. So it’s almost like a like a white person trying to save everyone sort of thing sometimes like the movies Dances with Wolves or Avatar, there’s this theme of like, okay, the natives can’t help themselves until someone takes their sides and champions for their justice. But a lot of times when you talk to either indigenous groups or minorities or any marginalized community, it’s like, well, thank you for your help. But that’s not really the issue here. Here’s what’s really going on. So how can you keep your family from being racist or xenophobic or a bigot but at the same time not necessarily championing people who aren’t there at the gathering? Sorry, That was a really long, convoluted explanation.
Amanda:
Yeah, no, it’s okay. And yeah, and I as a cis white woman am not. I know you said you’re the expert. I won’t claim to be the expert because I don’t live those experiences. I am an anti-oppression informed practitioner with the National Association of Social Workers and I do a lot of justice work, anti-oppression work. However, I won’t say that I’m an expert and now I already forgot the question.
Nick:
No, that’s because I talked for like three minutes about it. I’m saying where is that line between when we want to advocate for those who aren’t there to advocate for themselves and when you want to just be like, You know what, today I’m your cousin. I’m not the psychotherapist who stands up for truth and justice. Like how do you And there’s no perfect answer.
Amanda:
I just it’s definitely a situation by situation type thing. We have that discussion a lot in those sort of platforms where I’m doing that work and it’s really save yourself first. Like if you’re exhausted, you’re depleted and you know that having that discussion, having that engagement is going to exhaust you more. And tomorrow you’re not going to be able to fight because of that, then maybe you kind of let it go. You walk away, You you get a safe space for yourself. It really just depends on the situation. If you know that no matter what you say, that person is going to be toxic or abusive or not, you’re not going to be able to change their opinion. Right. It just depends on the setting and the person.
Nick:
That makes sense. So it’s really more of like, do I have a chance to change this conversation and some good sort of like we all know if we write a Facebook comment about something we disagree with, no one’s going to be like, You know what? That was really insightful. I was wrong. You’re right. But with families, especially if there’s already a relationship there, which might be sort of the basis of this whole show, like if you can form warm, healthy relationships with your family members, then you can have these discussions and even disagree but still see different points of views. And it’s not the thing where like, well, Amanda started the yearly fight because we’re all going back to our homes now. Yeah, so that makes sense. So for a little bit of a roleplay, let’s say I’m like covid’s a conspiracy, I shouldn’t get my shot and all You guys are fools for getting jabbed. Like that’s the one for me. Like, how would you respond to something like that? Again, you’re not like the CDC. There’s you know, Dr. Fauci would not cry if you just said, well, can you pass the potatoes? So what would be like more of a better response than getting into it?
Amanda:
That was a challenge for me, I might say. You know, I’m not in like, you know, I’m in the medical field, not in the medical field. So I might say something like, Oh, well, I hope that you’re finding other ways to stay safe or, you know, protect yourself from spreading it to other people or hey, how did you know? Again, it depends on the person. Like if someone’s really that gung ho about that perspective, I don’t know if I want to engage because it might just go down a rabbit hole.
Nick:
So it is a little bit of almost like staying in our lanes. For example, for me as a nurse anesthetist, I want to own that COVID lane. I talk all about it. I’m really passionate about it and at least I have some sort of background in it. So it’s more of like, okay, fine, you can talk about it. You’re a nurse and a nurse anesthetist, but then if someone asks me about something that I really have opinions about but no expertise, it’s the same thing of, All right, let’s pass the mashed potatoes because I think for that one too, because I dealt with those, I was really passionate about people getting their first immunization. Like at least have one COVID shot, see what it does to you. And then after that, no dog in the fight where I was like, Oh, you don’t want a booster, you don’t want to do this or that. Well, that’s fine. That’s controversial. So it would be nice if I guess you wouldn’t need the show if everything was so cut and dry. Like you’re wrong. And here’s why.
Amanda:
Yeah, I think. Curiosity kind of comes to mind, right? Like instead of judgment, it’s like, Oh, how did you come to that conclusion or what made you decide that or, you know, things like that. Like how are you staying safe or how are you preventing the spread or.
Nick:
So it’s almost like instead of, okay, here’s my agenda for Thanksgiving. It’s more like, well, I want to be curious to see how my relatives feel about things. I think that can go a long way, actually. Just the this is a chance to because it used to be, you know, family members believe mostly the same things as community. But now the way the Internet works, we’re all fractured into these little tribes. So it’s almost the opposite. All of a sudden you’re forced to be with people who the algorithms never put you next to. So it’s almost jarring to hear other people’s truths, so to speak.
Amanda:
That’s such a I was just thinking that, right? It’s like when people say these things, it can become such a visceral reaction and our survival response. Right. That it’s fear. Right? But we don’t recognize that and we don’t recognize that it’s so primal. Nor do most of us have the coping skills or emotional regulation to handle that. And it can get really messy really fast, right? That’s where the fights can happen. The police can get called. You know, people are getting kicked out type of thing. So yeah, I think if you come from a place of curiosity rather than judgment, it really can help kind of defuze that.
Nick:
Okay, that makes sense. So instead of something that’s written forever on a Facebook wall, it’s like this is a conversation we won’t even remember it 100% accurate. So I need to be clear and you know, how do you find I’ve got so many questions today. How do you find that way of like not being triggered where, you know, you don’t want to also just have this weird, cold, dismissive relationship with your parents and your cousins where it’s like, Oh, okay, Interesting that you think that and you never get deep because that’s like it keeps you safe and keeps you from being triggered. But it’s also makes for really lame Thanksgiving or Christmas, which by the way, we’re going to trot this video out every single Thanksgiving from now until like 2033.
Amanda:
Yes. Have all the tips for all the holidays because then they’ll suspect like, well, Amanda looks the same. But is it Nick’s hair a little grayer than than he seems so, yeah. 2033 is a cut off.
Nick:
Okay. Got it. We can’t do it past that. But how do you just make sure you still have a warm, actual relationship instead of like. “Well, let’s not talk about that”?
Amanda:
I think the thing here is something I often I have a very small caseload. I don’t take a lot of clients, but something regularly that we teach clients is you’re never going to I don’t want to say never because that’s an absolute but rarely are you going to be able to fully control your environment to where you’re not going to be triggered, right? Again, that survival response is very visceral and depending on what your past life experiences are and what your current stressors are, it could be easily activated. So my thing is when I’m activated for whatever reason, it’s. Breath may be walking away now that it’s cold outside. Get outside and activate your vagus nerve and that cold air and get some calm and clarity before you just readily and actively respond. Right.
Nick:
That makes sense.
Amanda:
Or react versus being able to respond.
Nick:
Right. So they might be asking me like, Nick, why are you massaging your carotid artery to stimulate your vagus nerve? Like nothing. It’s fine.
Amanda:
That’s me over here tapping.
Nick:
But actually, that might also be another technique. So emotional release work and tapping. Or one reason I really even started talking about this with you was I had a lot of my patients over Thanksgiving say that went really well. Like that was the first time that me and my family got together and they were doing Ketamine infusions. So I realized, oh, some of these techniques and I’m not saying that everyone in the audience needs a Ketamine infusion before Christmas, but it may help if you start some technique to give yourself some space. The way we describe it at the clinic is okay. So depression and anxiety, it’s sort of like a bear is chasing and you’re trying to do calculus. If we can at least get the bear out of the picture. Like life still might be hard. You might still have this disease or this problem, but you’re doing calculus at your own pace instead of also being triggered. So whether it’s talking to a therapist like you, of course, or doing some sort of intervention that will just give you some space between you and your feelings and what you said, like your body thinking, Oh, this is a threat. I must respond.
Amanda:
I think yeah, I think modern or not modern, but like the general public doesn’t necessarily understand how often that there’s a tiger standing in front of us. That feeling is and it’s so primal and it was needed back then, right? But in modern society, it’s activated every single day, multiple times a day. Right. I’m pulling in. I know, Nick. Like I know you. I’ve talked to you. I’ve done shows with you like on our podcast. And still there’s this, right? Like as if there’s a tiger standing in front of me. Right? And we’re not taught how to manage that. And I think if we can kind of get that information out there and teach people, hey, it’s okay, we can we can regulate that and get on a more stable ground to be able to move forward. That’s that’s natural.
Nick:
So is there almost like a good kind of anxiety? Like for me, I like to play sports. Some of the treatments we do at Ascend Health Center, that’s how they kind of work. Like it seems like it’s going to provoke more anxiety if you’re doing something like Ketamine, which really is difficult on the brain, but the end result is less anxiety. It’s almost like you have to prepare your brain for that for it to recognize like this is I run away from the tiger or this is a complex family situation that, you know, getting my adrenaline pumping isn’t going to do anything for me.
Amanda:
Yeah, I mean, stress in general isn’t all bad, right? There’s good stress. So I think the little bit of stress I was feeling today was excitement, right? Or if you’re going to see family and you enjoy most of them, you might get a little bit of excitedness right? And so or you’re doing a big presentation for work, right? Some of that can be good stress. It’s just when it starts to become physical, it’s kind of where I like to intervene. Are you starting to have chest pain or are you getting clenching your jaw? Are you getting warm where it’s really escalating to the point of your body thinking that you’re in a fight flight freeze situation.
Nick:
So knowing your body is like really helpful for these family situations, that makes sense because like I’ve always whenever I took a big test, I’d try to think of it as an adventure or a way to prove that my brain works well. Like instead of like the negative side of it. So it can be like, Oh, I might learn some new things about my family or this might not be a great idea. But you know, even if there is some sort of argument or some altercation, it might be really interesting for me to watch. So is that one inappropriate? Because it’s kind of funny, But.
Amanda:
I mean, entertainment is great, especially if it makes you laugh, right? So.
Nick:
Well, it’s still the right approach. Like you’re distancing yourself from the triggering aspect, the fear that’s happening.
Amanda:
My my thing to look forward to at family gatherings is the food. Yes. So if anything’s going chaotic, at least I can enjoy the good food.
Nick:
So so in that case, it’s almost like a delayed reward kind of mindset. Like, yes, I do have to listen to Uncle Bill talk about how the birds are robots and what the five G is doing, but I also get Fran’s dessert, so it’s just part of the equation of what I have to do today.
Amanda:
Yeah. And I think knowing your body, like you said, is I mean, we talk about that all the time, the mind body connection. So knowing your body truly is it So how much can I tolerate this? I’m sitting there, I’m eating my lasagna. We’re Italian, I’m sitting there, I’m eating my lasagna and so-and-so is talking about this stuff and I’m noticing that I’m starting to clench my toes and I’m starting to get real tense and I’m getting irritable. I’m taking my breaths. I’m. I’m tapping publicly, like under the table where people don’t know I’m doing all the things that I’m still just not able to regulate. That’s where I need to get up and excuse myself and go the. Bathroom, maybe splashed cold water on my face or just distanced myself because no situation in my opinion is worth getting that dysregulated over, right, Unless you’re in a pure survival situation.
Nick:
So when is it that we have to decide like, okay, my family’s too toxic for me. So like with my Greek background, it’s sort of like, well, they did try to murder me, but they are family, so it is what it is. I’m not saying that’s a healthy cultural phenomenon. When can you decide that, you know what, Christmas just isn’t worth it?
Amanda:
This is a challenging one, especially when you take into perspective different cultural backgrounds and approaches. There’s a common intervention in a lot of like white therapist’s modes, especially CBT and things like that where it’s like, Oh, just set a boundary and cut them off and they’re toxic and don’t, you know, blah blah blah. Whereas other perspectives, other cultures might say, Hey, we’re more collective and so we want to heal collectively. How can we bring them in? How can we heal that type of situation? So again, it’s something that’s very individualized depending on the person. I would offer that though, like if I’m talking to a client, I say what feels right for you, What feels right for your family. Do you feel like this is anywhere that you could collectively kind of come together as a family and heal and work on the situation? Or is it is it just not going to go anywhere? And you really need to separate yourself and it might not be a full cutting off. It might just be a full like a distance where you rarely see them or communicate.
Nick:
Right. Because I’m because of my background. I’m biased on that. Like, yes, sometimes life is hard and relationships are hard. Big deal. Just deal with it. I realize it’s not always therapeutic, but what you’re saying is that it still is a very individual decision. Yes. So basically you shouldn’t decide it based on watching the show. Yes. Yes.
Amanda:
And it’s definitely something like if I mean, when people are having these issues and they come to therapy, it’s not like a one and done session and then they’re like, oh, I know what to do now. It’s something that we talk about and people there’s grief with that. Whether you decide to cut the relationship off or not, because especially if it’s like a parent, right? That’s our core attachment. Those are people that we really want to stay connected to. So even if you don’t decide to cut them off, just the grief of not having the relationship you thought that you would have or that you’ve maybe seen friends or other family have with their parents that can be really grief stricken. Right. Striking.
Nick:
So you’re also saying that we’re to look at it objectively because you’re right, there is that approach of like, well, if this doesn’t serve me, but life isn’t all about being served like none of us are this the galaxy isn’t meant to be this smorgasbord of a buffet for us where okay, like this, I don’t want this in my life. And I think we’ve both seen that in our clinics where like there’s people who try so hard to curate everything so that no negativity is in their lives. And often those are, you know, the most miserable patients that we come across.
Amanda:
And that makes sense when you think about a survival approach, right? If you feel like you’re always in fight flight freeze and everything is out of control, many people then overcorrect right and have severe anxiety or maybe full blown OCD because they’ve tried to control these situations that are so out of control. Right. But there really is you know, the universe doesn’t allow us that level of control.
Nick:
Right. And that kind of circles back to our first point. Like if you can picture your family members gathered around on Thanksgiving and that they fit really well on a Jerry Springer show or in a Waffle House throwing waffles at each other, then maybe this isn’t something that you with your powers of being the one that tries to keep things together can actually fix. If, on the other hand, they’re like, Nope, we’re just people. And the way the world works right now, we’ve, you know, had different influences over the last year and now we’re all coming together. And you know, Uncle Jim has been listening to Tucker Carlson and I’ve been watching MSNBC and this person, you know, and I don’t want to say it’s again one of those things where you just have to avoid all these topics where you’re like those couples that are been married for 50 years and all they can talk about now is the weather. But I guess, again, that’s an individual decision.
Amanda:
Yeah. And I think it is okay to say, hey, these are safe topics that we can talk about or hey, I’d prefer if we didn’t bring this up when we’re around each other type thing. Like that’s an okay boundary to set. Hey, I’d prefer you know, we never we can never agree and we typically get in an argument when we bring this up. So maybe we just don’t talk about this when we meet. It doesn’t mean that you only talk about the weather, but hey, maybe covid’s off the table when we’re at family gatherings or maybe politics. You know, like political party type things are off the table or and then kind of back to your point like, hey, if your whole family is a little toxic and doesn’t have the best coping skills and you’re the one constantly taking care of them, just maybe reflecting and thinking, how is that impacting my physical, mental, emotional, spiritual, social, all the areas of health.
Nick:
So I mean, I can see myself actually saying like, Hey, this time I’m not going to salvage this. I’m actually going to get some more potatoes. You all figure this out just meaning like the responsibility of the peacemaker, which I don’t I don’t have that responsibility to my family. I mean, I’m kind of diplomatic, but I also enjoy seeing things happen. So seeing it play out.
Amanda:
Right, Right. I was the social worker from like five on. So it’s a constant battle to not fall into that role.
Nick:
But that is something that even birth order and some of those family dynamics is something to think of like being a middle child. I’m more naturally going to be the diplomat. So it’s like, okay, am I okay with this role? Am I getting some satisfaction or some purpose out of this role that’s unhealthy where I’m enabling others to take their role of the one who doesn’t have it together.
Amanda:
And what needs of mine aren’t getting met in the process? You know, people can feel kind of I don’t know if disgruntled is the best word, it’s the best thing I can come up with, Right? But like oftentimes when people are mad at other people or frustrated with other people or irritable with other people, it’s because we’re not getting our own needs met. So really taking a moment to say like, is this worth my energy and what needs do I need to get met first? Right.
Nick:
And I think I mean, we could talk about this all day, but I do want to give you a chance to talk a little bit about Carve Your Own Path and what you guys do there because at Ascend Health Center we have Ketamine and TMS and psychiatry, but we don’t want the message here to be like, Are you sad with your family? Come get Zoloft at Ascend Health Center. A much more therapeutic and a much more gentler step is just talk to a therapist, see if this is something that that would benefit you benefit from. So what do you all do there Because it’s a lot.
Amanda:
We do do a lot. So Carve Your Own Path is a nonprofit organization. We focus on preventative, holistic mental health and wellness. We offer traditional mental health counseling. So talk therapy, you just want to come talk out some situations and get perspective and see is this appropriate? How can I cope with this? But then we also offer art therapy, yoga, Reiki and then some wellness workshops for the community to really get engaged. If you’re not ready to dive full into therapy yet.
Nick:
And you have the podcast, too.
Amanda:
We do have our podcast. It’s called Grow Your Path to Wellness and you can find it on YouTube and then all the podcast streaming platforms.
Nick:
And the two of us have done a few episodes together. One was on psychedelics because that might come up at Thanksgiving too. What do you think about psilocybin? I mean, that could be a very interesting conversation with your family and also the one about self care and self pay versus insurance based because that’s the challenge is there’s sometimes so many insurmountable barriers to getting health that it’s a lot of patients that I come across, they’re like, Well, I really have to have this diagnosis and then I’m into the system forever because it’s not like Here’s a pill and you’re done. It’s more like, Oops, I just signed up for a lifestyle of every few months I have to talk about my deepest problems to somebody. So yeah, I mean I often do tell patients like, how about during the holidays you come here more often and then when it’s warm here in Ohio, you probably don’t need us as much.
Amanda:
Yeah. And I just try to normalize for people like we don’t require a diagnosis for you to be seen. That’s one of the benefits of being self-pay. But a lot of the things that people come to therapy for are just the stuff that you don’t learn to cope with in life and you just need some support with. Yeah.
Nick:
Absolutely. Well, that’s great. Well, I think that’s all the time we have for today. Again, if they want to reach out. You’re in Copley. I’m in Fairlawn And you guys do some telehealth too, I believe.
Amanda:
Yeah, telehealth for the whole state of Ohio.
Nick:
Absolutely. So thanks for watching this end health show. Remember to always pass the potatoes to your left in the next family gathering leave room for dessert. And I think that’s all the wisdom I have for now. But thanks for joining me on the show.
Amanda:
Thank you for having me. Take care, everyone.
Voiceover:
You are watching WCTV. Wadsworth Community Television.