The Psychology of It All
By Dr. Raymond Zakhari, NP
Dr. Raymond Zakhari is a triple board certified (adult-adolescent, family, psychiatry) nurse practitioner and trained in sex therapy. He is private practice in New York City where he provides primary care and psychiatric house calls to high net-worth individuals and families.
To learn more about his private practice log on to www.MetroMedicalDirect.com
To learn more about his private practice log on to www.MetroMedicalDirect.com
Ejaculation Problems: Too fast and too slow
Premature ejaculation occurs when a man ejaculates (cum) too soon. It can be as early as the thought of sex or if it occurs in less than 2 minutes after your penis enters your partner. Premature ejaculation is a common sexual complaint of both men and women. Up to one-third of men can experience this sexual dysfunction at one time or another for various reasons. As long as it is not the pattern of usual performance it is generally not a cause for concern. The diagnosis of premature ejaculation requires the man to feel distressed and if you can answer yes to the following questions: Do you always or nearly always ejaculate within one minute of penetration/ stimulation? Are unable to delay ejaculation during sexual stimulation or intercourse all or nearly all of the time? Is it different when you are masturbating? Do you tend to avoid sexual intimacy as a result of premature ejaculation? Is premature ejaculation a problem or a feature? That depends on how the condition is affecting you. This is treatable and more common than you think. Delayed Ejaculation Delayed ejaculation — formerly known as retarded ejaculation — is a condition in which it seems like an extended period of sexual stimulation is required orgasm (climax) and ejaculate. Treating delayed ejaculation depends on the underlying cause (chronic health conditions, surgeries and medications). Delayed ejaculation is only a problem if it is distressing to you or your partner. It is most common for delayed ejaculation to be a temporary problem. It is common for men to feel anxious or depressed regarding any sexual dysfunction such as delayed ejaculation. For some men, a minor physical problem that causes a delay in ejaculation might cause anxiety about ejaculating during a sexual encounter. The resulting anxiety might worsen delayed ejaculation.
July 31, 2020
Graduate School: Concepts and Theory
Now that you have identified a question, reviewed and appraised the literature, and leveled the evidence you need to develop a guide to help you design your scholarly project. A concept is a linguistic representation of a framework that will serve this purpose.
December 06, 2019
Graduate School: Leveling the Evidence
There has been push towards providing evidence based care. Unfortunately, not all evidence is created equal. A lot of care is still practiced based on low level evidence (sometimes it is because that is all we have, and other times we need to overcome cultural inertia.). This episode will explain how to determine what level of evidence you have based on one particular classification system (Melnyk). The other systems are fairly similar so this is a good primer on how to level the evidence.
December 06, 2019
Graduate School: Appraising the Literature
When attempting to get buy in from various stake-holders it is important to present them with good evidence to justify the change. As you conduct your literature search it is essential that the evidence you gather is of sufficient quality and well suited to the question. This brief episode will review the process of appraising the literature you have found in your search.
December 06, 2019
Graduate School: Literature Search
Graduate students who have formulated a question have general scanned the literature. However, conducting a literature search to specifically address a question requires a very systematic approach of reputable sources. This episode will explain the literature searching process to give you an overview and to help focus your efforts.
December 06, 2019
Graduate School: Formulating a Research Question
Students often struggle when deciding to apply to graduate school because they are challenged by the daunting task of identifying a question. The purpose of this podcast is to help prospective graduate students formulate a sufficiently narrow question that will guide an evidence based scholarly project in their academic and professional career. Having a clear question with sufficient breadth and depth will help ensure that you will actually finish your course of study and contribute something of value to your field of interest.
December 06, 2019
How is a psychiatric diagnosis made?
Have you ever wondered how a psychiatric diagnosis is made? Unlike other medical specialties there are no blood tests, or brain scans that prove that someone has a mental illness. The steps that the psychiatrist should take in formulating a diagnosis include making sure your behaviors are not due to an underlying medical condition, and that it is not caused by some substance you are taking. For example marijuana can cause people be feel and act paranoid, cocaine can make someone act and feel grandiose, opioids can make some feel and act depressed. Also a good psychiatrist needs to make sure that they are not being played and they have to figure out if your behavior is due to an unconscious process. As for medications, there is no magic pill. To learn more request an appointment at www.MetroMedicalDirect.com
June 28, 2019
Sex Therapy and how it can help
Sex therapy can help couples and individuals understand their core sexual script that plays out in their daily life. It can help address sexual problems related to relational conflicts such as arousal and orgasm difficulties. Sex therapy can help facilitate conversations about needs and desires. You can ask questions on Twitter @MetroMedicalNY or on the Facebook page @DrRaymondZakhariNP
June 08, 2019
What is the difference between therapy and getting advice?
In therapy the use of silence is very helpful in allowing the client to speak freely. The therapist is listening for more than the content of you speech. I am listening for how you say it, when you say it, the order in which you say it, the number of times you repeat yourself, while looking at your reaction to the words coming out of your mouth. I am also listening for your fantasies about the situation and how that relates to your life. The work of therapy begins with Change Talk which makes itself known when you express Desires, Abilities, Reasons, and Needs for making a particular change as well as your level of commitment to following through. In therapy the aim is to help you face your fears of success, failure, being alone, realizing abilities or inabilities, and character flaws that may be affecting your well-being. Sometimes if you are not expressing change talk it is a sign that you are not ready for change or you may be wanting me to think something that is not true because you may fear my reaction to the truth. Are you happy and content with your current situation? Do you want to be in the same place mentally a year from now? What are you willing to do about your situation? How are you going to do it? How will this time be different? Request an appointment at www.MetroMedicalDirect.com
April 23, 2019
Abuse in Teen Dating
Abuse in teen dating relationships can and does occur, but because it is so unexpected it often goes missed by parents. There 5 common types of abuse that can occur. They are physical, sexual, emotional, psychological (mental), and financial. Abusers can be either male or female as can their victims. Parents should remain vigilant in the dating lives of their children, and pay special attention to isolating behaviors. Parents should be especially attuned to changes in personality with the onset of a new boyfriend. They can even empower their children to independence by prohibiting the relationship which can give their child the necessary resolve to leave the abuser. Extreme caution should be used when insisting an abused person leave their abuser as that is the most dangerous time for the abuser to escalate their abuse, violence and the abused may have genuine fear for their well-being or the well-being of her family or even the family pet. Letting your child know you are dependable and building a social network of support of people with like minded values is always a good idea. In any abuse situation isolating the victim and grooming the support network is a key feature.
March 15, 2019
Disqualifying the Positive and Jumping to Conclusions
Cognitive distortions are the biased perspectives we take on ourselves and the world around us. They are irrational thoughts and beliefs that we have unknowingly reinforced over time. The first step to behaving rationally is to be aware of our biases and work to achieve a balanced perspective. I am going to talk about 2 cognitive distortions one of which has 2 parts. The first is Disqualifying the positive: Disqualifying the Positive can be difficult to identify sometimes, because you have the pretense of weighing both sides, and then making what seems to be a rationale decision before settling on your pre analysis conclusion. The “Disqualifying the Positive” cognitive distortion acknowledges positive experiences but rejects them. For example, a person who receives a positive review at work may reject the idea that he is a competent employee and attribute the positive review to political correctness or to his boss simply not wanting to talk to you about what you have already deemed to be subpar performance. This is an especially malignant distortion since it can facilitate the continuance of negative thought patterns even in the face of a lot of evidence to the contrary. In the area of dating and relationships It is important that we do our own work as individuals and ensure we are showing up in a relationship with an understanding of how we make decisions, our biases, and our habits. If we rely only on relationships, intimate partners, or sexual experiences to enhance our positive self-image, we may be more susceptible to this thought distortion and attracting the wrong person Jumping to Conclusions – Mind Reading The “Jumping to Conclusions” cognitive distortion is revealed as the inaccurate belief that we know what another person is thinking. While it is possible to have an idea of what other people are thinking. This Mind Reading Jumping to Conclusions distortion is when we close off any possibility that the other person maybe thinking something completely different than what it is we are convinced. Usually, we take a negative interpretation and assume it to be true. For example, you may seeing someone with a scowl on their face and we jump to the conclusion that surely she is thinking something negative about me. Her scowl may have nothing to do with you. Jumping to Conclusions – Fortune Telling Fortune telling refers to our tendency to make conclusions and predictions based on little to no evidence and believing it as gospel truth. One example of fortune-telling is predicting that we will never find love or have a committed and happy relationship. And we base this on the fact that it has not yet happened. There is simply no way for you to know what the future holds but we become biased in predicting the parade of horribles as the only possible outcome. A guy may jumps to a conclusion about his partner’s thoughts regarding love: he may assuredly say to himself “I know I’m not as exciting in bed as I used to be therefore she is no longer in love with me and is only having sex with me out of obligation.” What of this delusional thinking, convinces you, that this is a good mindset for enhanced intimacy and great sex? So how do you overcome this irrational behavior so that you can reboot your love life? Step 1 Recognize your thought pattern? Write down the belief that this driving your behavior. Step 2 Challenge your belief. What evidence do you have to support your conviction? What would a good friend say about your interpretation? Is it possible your interpretation is wrong? What evidence do you have that shows you are wrong in your conclusion? You have to give each side a fair hearing of the facts. Remember thoughts feelings are not facts they are merely data in need of analysis. A fact must
February 04, 2019
Cognitive Distortions: Overgeneralization and Mental Filter
Today I am going to continue going through cognitive distortions. Like defense mechanisms, a cognitive distortion is a habit of mind that we rapidly deploy to convince ourselves how right we are in our understanding of the circumstances around us, for the purpose of reducing our perception of distress. For more on defense mechanisms download and listen to the previous episodes. Short of a life-threatening situation it is wise to second guess what your brain is telling you. Our minds have developed a habit of making connections between thoughts, ideas, actions, and consequences to help us draw conclusions and make assumptions. However, sometimes these connections are made with incomplete information, and therein lies the problem. Cognitive distortions are the biased perspectives we take on ourselves and the world around us. They are irrational thoughts and beliefs that we have unknowingly reinforced over time. The first step to behaving rationally is to be aware of our biases and work to achieve a balanced perspective. Over generalization is when we assume one instance is representative of all similar situations. This can become especially pronounced in instances of anxiety and depression. Over generalization and mental filtering are among the most difficult depressive symptoms to treat, and they can lead to an entrenched negative thought pattern. For example: Perhaps you gave a poor performance once, then you assume and believe that all subsequent performances will be equally bad. Over generalization can cut both ways for example: In the area of sex, you may have an instance in which you fail to rise to the occasion and then you perpetuate this anxiety and create a self-fulfilling prophecy: you fool yourself into a confirmatory bias. You try again but you are so anxious that you do not become aroused and you reinforce your cognitive distortion that you are impotent. Or perhaps you made an investment against all odds that happens to pan out, and now you are convinced that you are the new oracle and Buffett better look out. When the investment does not pan out again you use all sorts of mental gymnastics (like defense mechanisms and other cognitive distortions) to convince yourself the loss was abnormal, and you try to repeat the irrational behavior again. Depending on your mental rigidity you may become stuck in this self-sabotaging pattern. So how do you overcome this irrational behavior so that you can be the stud you really are, so you can cut your losses, sell your losers, and regain your mojo? Step 1 Recognize your thought pattern? Write down the belief that this driving your behavior. Step 2 Challenge your belief. Ask yourself if what you are convinced of is actually true? What evidence do you have to support your conviction? What would someone else say about your conviction? Have you had an alternative experience? Could you possibly envision an alternative scenario? Step 3: Replace your thought pattern be it overly negative or excessively rosy. Rather than thinking you are terrible lover who will never get it up again, consider the possibility that perhaps you ate too much or drank too much? There is nothing like a big meal and alcohol to divert the blood flow from your penis to your stomach and liver. Similarly, rather than think you are the new oracle, recognize that perhaps there was an unusual occurrence in the market that led to your isolated return on investment, and the market really does prefer predictability. As they say of investing advice past performance is not indicative of future results. Your past falter is not a guarantee of future falter. Over generalizing can cause you to adopt some views that are incongruent with your moral compass for example a person of a particular race, faith, ideology, treated you in a certain way and then you forever more assume that a
January 25, 2019
All or nothing thinking: Cognitive Distortions
For the next few weeks, I am going to be explaining Cognitive Distortions and the role they play in self-sabotage. So let me begin by first defining what I mean by a Cognitive Distortion. Cognitive distortions are the biased perspectives we take on ourselves and the world around us. They are irrational thoughts and beliefs that we unwittingly reinforce over time, to the point where they become automatic and almost reaction like. If you recall from the previous series on Defense Mechanisms, reactions can be trained. The goal is to train our thinking to reduce bias and contend with reality. The first step in preparing the brain how to think clearly is to recognize the need to change. The difficulty in realizing the necessity lies in our tendency to strongly believe in our objectivity. Actually, we think there is no possible way we are holding on to any blatantly false beliefs. I hate to break it to you, but you are a mere mortal. The difference between occasionally believing your own nonsense, and those who are perpetually and consistently convinced of it, rests in the ability and willingness to confront our patterns of thinking. Cognitive distortions are automatic thought processes that interfere with our ability to consider other ways of thinking about a situation. When we become overly reliant on thesse thought errors, we tend to interpret our world in ways that fuel mental distress and emotions such as depression, anxiety, and anger. All-or-Nothing Thinking / Polarized Thinking Also known as “Black-and-White Thinking,” this distortion manifests as an inability or unwillingness to see shades of gray. In other words, you see things in extremes – something is either fabulous or foul, you are either great success or a total failure. It is not difficult to see how this type of thinking can cause you to self sabotage. For example, imagine you are on a job interview and you get asked a question you deem out of left field. Things were going very well up until that point. You realize that you did not answer the question exactly how you would have liked, but instead, you immediately disparage yourself as utterly unqualified and assume the entire interview was a horrible waste of time. This is the same type of cognitive distortion that sabotages most New Year’s resolutions. It reinforces the fallacy that one indiscretion has ruined everything done thus far. How many of you have decided to go on a diet? And you are doing well on day 1, and day 2, and then day 3 you ate a cookie. You deem your efforts a failure and therefore you eat the rest of the cookies, and you deploy defense mechanisms to reinforce your biased thinking ( I really like how my fat pushes out my wrinkles making me appear younger, who needs to lose weight anyway). The fact remains you may indeed need to lose the extra pounds for your physical health and well-being and your cognitive distortion is sabotaging your efforts. So how do you fix this faulty thought process? The answer is to recognize shades of grey. Just because you have a thought or a feeling it does not make it a fact. Facts require evidence to support them. Ask yourself, What evidence do you have for your thoughts? What evidence is there against your automatic thought? Are you thinking rationally or are you having an irrational emotional reaction? Force yourself to come up with other plausible explanations for alternatives. Just practicing this will allow you to slow down enough to process and truly confront reality. Did you really gain back all the weight you lost by eating 1 cookie? Did you really blow the interview because the one question caught you off guard? Are your self-sabotaging thoughts helping you achieve your goals? Is it possible that you are interpreting the situation all wrong?
January 08, 2019
Humor, Humility, Altruism & How to screen for Mr or Miss Right in 2019
Today I am going to talk about 3 mature defense mechanisms, and I will conclude with a list of 10 behaviors to help you Screen Mr. or Miss right in 2019: Humor is an adaptive technique to help us to cope with tense or stressful situations. Requires a bit of humility (our 2nd defense mechanism today) to use this tactfully. It requires us to lower our expectations, sacrifice our pride and focus on the well-being of others which will be our third mature defense mechanism, altruism. The use of humor can enable you to pacify those around in tense conflicts and encourage cooperation. Looking for a funny aspect in an environment in which we lack control can help us to endure it. The use of humor can even be an act of altruism. Learning to spin a traumatic experience in a way that provides some comedic relief can alleviate much suffering for all parties involved. Self-deprecating humor is often most helpful if it is not coming from a place of pity in which you are seeking compliments. Using humor is often away to joke about your own insecurities before someone else pokes fun at them. It also puts your humanity at the forefront and can make your more relatable. The ability to use humor requires a person to have good resilience. If this is not something, you have there will be a subsequent podcast talking about cognitive behavioral therapy techniques to enhance your resilience. So what would be an example of using humor: A person gets a diagnosis of cancer and must undergo chemo therapy which results in hair loss? The person reframes this by indicating that the bald head will take the attention off his massive growth, or that he will be saving a ton of money on shampoo, or comment on his lifelong desire to look like daddy Warbucks. Another means of using humor is when a man is concerned about his\/ Modest endowment, and he refers to his member as the Fun Sized, Just-in Slugger measuring thousands of microns designed for maximum comfort. The idea is to laugh at yourself and allow others to laugh along with you. Laughter enhances oxygenation, cardiovascular efficiency, surges endorphins and relaxes your muscles. A well placed chuckle can defuse much stress. Humility is not thinking less of yourself, but rather thinking of yourself less. Humility is intelligent self-respect which keeps you from thinking too highly or too unkindly of yourself. Humility requires a state of being in which you realize you are likely far worse than accusers claim if they only knew how base your thoughts and motives are or have been. A humble mindset reminds you that you are not above succumbing to a similar circumstance or worldly trapping, it takes you out of the position of the judge so that you do not stand in moral judgement over someone who maybe engaging in a vice that you do not happen to struggle. The scriptural references often quoted implores you to remove the plank from your own eye, before you attempt to remove the spec from your brothers eye, or in the words of Christ, let he who is without sin cast the first stone. Altruism: simply defined as a constructive service to others for their own well-being. The sustainability of this defense mechanism usually requires the individual derive some personal satisfaction out of performing the service. If you have had struggles in your life often you are well poised to help someone else who has had a similar struggle. Many recovery programs build on this through various sponsorship and mentoring arrangements. So what should you be on the lookout for when considering romantic love and possibly marriage 2019? I am going to list 10 behaviors to be on the lookout for in a potential love interest or quality friendship. If they are demonstrating these behaviors they are lik
December 31, 2018
The Psychology of It All: Displacement, sublimation, identification and reaction formation
Continuing with explaining how some defense mechanisms help us self-sabotage and limit our success. This episode will cover displacement (socially unacceptable) and sublimation (socially acceptable). Also, identification with the aggressor (sometimes called Stockholm Syndrome), and reaction formation (acting in the exact opposite manner than what you really feel).
December 24, 2018
The Psychology of it All: Avoidance and Repression
The psychology of it all helps people become aware of the self-sabotaging behaviors we all do from time to time. This episode explains the defense mechanisms of avoidance and repression. There is a psychotherapy DIY 5 step process to help you avoid the couch and stop avoidance coping. Step 1 Recognize it does not work Step 2 Answer the question: What have you been trying to avoid? What is making you feel awkward? What is making you anxious? What thought is convincing you that you are not good enough? Step 3 Recognize the cost of avoidance coping. How much has this self-sabotaging behavior cost you in time, money, and relationships? Step 4 Increase your distress tolerance, and "embrace the suck". Step 5 Anticipate potential anxiety-provoking behaviors so that you are not caught off guard when they occur. Pay attention to your physical signs and symptoms that alert you of anxiety, and then psychologically soothe yourself by slowing your breathing, and heart rate and then your thoughts. Learn to act deliberately so that you are not a perpetual victim of your negative thoughts and feelings.
December 11, 2018
Denial, Rationalization, and Projection
This is episode 5 in the series The Psychology of It All. A defense mechanism is an unconscious psychological reaction to reduce mental anguish arising from an unacceptable stressor. Denial is characterized by unconsciously blocking out events or stressors from conscious awareness in order to reduce mental stress and anguish. Rationalization is a person’s self-justifying explanation of an alternate and more tolerable reality that will often downplay the severity of objectively verifiable reality. Projection is when a person attributes their own unacceptable thoughts, behaviors, feelings, or motives to another person.
November 30, 2018
The Psychology of it All: Dissociation, Acting out, Blocking
Defense mechanisms are unconscious psychological reactions to reduce mental stress. Becoming self-aware of personal maladaptive coping strategies can increase the chance of learning new ones that are not sabotaging in nature. This episode covers dissociation, acting out and blocking.
November 23, 2018
The Psychology of It All: Somatization
Somatization is a physical symptom caused by a psychological problem. A defense mechanism is a reaction of the mind designed to protect the person for mental distress. Defense mechanisms are not volitional, and everyone uses them.
November 16, 2018
The Psychology of It All: Regression
Defense mechanisms are an automatic response that helps us deal with stress. Regression is an immature defense mechanism that can manifest in both adults and children during stressful times. Dr. Raymond Zakhari is triple board certified nurse practitioner in private practice in New York City. He provides medical and psychiatric house calls. www.MetroMedicalDirect.com
November 09, 2018
The Psychology of It All
A review of defense mechanisms and common cognitive distortions that lead to our detriment. Being aware of these mind games can help train our reaction so that we are well-adjusted members of society.
November 02, 2018
Male Insecurities: What is your hangup?
Apparently the modern millennial man wants the ability to shower and change in the locker room without ever being publicly nude. I have had many men tell me that they have been seeing their doctor for years and he has never seen them naked. If you are an adult man you probably look generally the same as every other adult man.
October 09, 2018
Men's mental health is often neglected for various reasons. A confidential psychiatric house call is an ideal way to get the help you need without the hassle of going to a psychiatric mental health clinic. Therapy on your own couch.
October 02, 2018
Medical Detox alternatives
An alternative to inpatient rehab/ detox and traditional outpatient rehab and detox services. Now confidential care can be delivered as a medical and psychiatric house call.
September 25, 2018
Medical and psychiatric house calls in Manhattan. The way care ought to be!
September 15, 2018