Month: February 2026

February 2026

Coping with Uncertainty…

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The Empty Vessel…

Narcissists struggle to keep their vessel full. Why? Fill it up and move on. It is not that easy because the vessel empties as soon as it is filled.

People with strong narcissistic tendencies often feel empty and carry a long-standing sense of inadequacy. They doubt their ability to be loved, and many develop a sense of grandiosity, which masks their underlying self-contempt. Power, control, and dominance become ways to prove to themselves and others that they are strong, worthy, and valuable. 

The problem is that their strategies don’t work. There is never enough. As the vessel empties, they must fill it with new feel-good supplies. Like Sisyphus, they must keep pushing the rock uphill, only to see it roll back. They are doomed to live with an empty self, no matter how much they accumulate.

Narcissists have trouble taking responsibility. They want to avoid blame and criticism because they are vulnerable and fragile. Criticism typically provokes a strong defensive response. They are not strangers to rage.

Narcissistic seniors often struggle with aging. As their abilities and powers begin to fade, they sometimes panic. Think of the Hollywood mogul who had to surround himself with beautiful young women, fancy cars, and a showcase home. It is harder to fill a vessel in old age, and aging for the self-centered set can lead to depression and despair … and, sadly, to the destruction of a 250-year-old nation.

On Time

We mark our moments with clocks, dates, and calendars. We try to fix our experiences in time and memory. But time has a way of eroding, distorting, and transforming experience, especially its memory. Some people jokingly call the recollection of the past revisionist history. Memoirists will tell you about the moment when their lives seemed to become fictional. Memories fade, blur, refocus suddenly, even reappear in dreams. We think about our memories because, in a deep sense, they are us.

We take a history from our patients—timelines from the past. Many of us working in hospitals and clinics, as well as when completing insurance forms, are asked whether the patient is oriented to time, place, and person (oriented x 3). It’s important that we prioritize orientation in time. Perhaps this temporal orientation is the anchor in a sea of time, and we hold on to it above all else. Some of us rely solely on observable behavior or reported feelings rather than a detailed history. 

Some of us take a family history and create a genogram. We all observe and listen. Some of us hear a story, a narrative, a collection of themes we connect to other pieces of knowledge. All of us struggle to understand each other. Regardless of our theoretical approach, most of us gather some form of history. It guides and shapes us. Even psychologists mainly focused on a person’s current behavioral problems need to take at least a brief history to place the behavior within a time context. Every individual we meet tries to revisit past times through storytelling. Our work also takes place over time, and our own memories echo (counter transference) as we follow the narrative. Years ago, at a V.A. Clinic, I asked veterans to recall their parents’ disciplinary styles. “Well, how do we know if it’s true?” someone asked. “It’s all that’s left,” I answered. I then asked the veterans to describe how they disciplined their own children, and indeed, there was a similarity between their memories of their parents and their own reported behaviors. It was all that was left, literally.

Continue reading “On Time”

Third-Wave Cognitive Behavior Therapies and Older Adults


The global average lifespan was 73.3 years in 2024, and the older adult population is estimated to rise to 1.4 billion in 2030 (World Health Organization [WHO], 2025). While the population is aging, mental illness remains highly prevalent. In the United States, in 2021, 57.8 million adults reported having a mental illness, 14.1 million adults reported having a serious mental illness, and 19.4 million adults reported having a co-morbid substance use disorder and mental illness (National Alliance on Mental Illness [NAMI], 2023). There is a paucity of research on the intersection of older adulthood and mental health. 

Older adults face unique mental health challenges due to aging, chronic health conditions, cognitive decline, identity disturbance, and changes in interpersonal functioning. Ageism, internalized stigma, and generational perceptions of psychological treatment are additional factors that likely contribute to the ambivalence older adults may feel about seeking help for mental health issues (Elshaikh et al., 2023). This situation poses risks: Elevated levels of anxiety in older adults, for instance, heighten the risk of coronary heart disease (Kubzansky et al., 1998) and suicide (Pearson & Brown, 2000). Despite the risks associated with medications for older adults and the proven effectiveness of behavioral treatments (Thorp et al., 2009), psychopharmacological treatment has been prioritized over behavioral interventions in this population despite the risks of medications in older adults and the strong efficacy of behavioral treatments for older adults (Thorp et al., 2009). 

Cognitive-behavioral therapy (CBT) is the most widely accepted, evidence-based treatment for some psychiatric disorders (American Psychological Association [APA], 2017b). CBT focuses on how thoughts, feelings, and behaviors are connected and how they can influence each other (Beck et al., 1979). CBT works by increasing adaptive behaviors (as through behavioral activation and exposure therapy), challenging distorted thought patterns, and encouraging adaptive coping mechanisms (Beck & Fleming, 2021; Beck, 1963). Psychosocial therapies have shown reduced levels of attrition, greater reduction in symptom severity, and lower risk of recurrence compared to pharmacotherapy (Van Etten & Taylor, 1998; Thorp et al., 2011). 

Continue reading “Third-Wave Cognitive Behavior Therapies and Older Adults”

Mango Kulfi


Kulfi is a traditional Indian dessert that originated in the 16th century. It is dense, creamy, and intensely flavorful. The recipe below is a simple quick version of kulfi and is really a treat, particularly if you enjoy the taste of Indian spices!

1 pint heavy cream
1 30-ounce can of Rani Alfonso Sweetened Mango Pulp (Amazon)
1 14-ounce can sweetened condensed milk
Zest of two large limes
1/2 tsp ground cardamom
Pinch of salt

In a large bowl, use a spatula to slowly mix all of the ingredients until there are no streaks of color. Pour the mixture into an 8-inch glass baking dish and freeze until it becomes hard but still soft enough to scoop or cut into squares. You can also pour the mixture into popsicle forms to freeze as in the picture above.

Legacies: Tom McGee

As people age, they start to worry about their legacy. How will they be remembered? Will they be seen as having lived a meaningful and impactful life? Will they be appreciated for leading a purposeful and accomplished life? Were they a good worker? A good spouse? A creative individual?

Of course, their curiosity is doomed to fail since they won’t be around to see how their legacy unfolds. Additionally, each of us experiences our legacies differently. Here is an example.

Thomas F. McGee, Ph.D. died on October 5, 2021 as the age of 91. Dr. McGee was a respected psychologist with a long record of notable contributions in Chicago, where he served as the State Director of Mental Health. There he was instrumental in the development of several community mental health centers in underserved neighborhoods. Moving to San Diego in 1972, Dr. McGee took the position of Director of Outpatient Psychological Services at Mercy Hospital. Later he joined the faculty at California School of Professional Psychology at Alliant University San Diego. He was known as a creative administrator, talented clinician, and wise supervisor.

I didn’t know Tom very well, but I reached out to him for advice several times over the years when I faced complicated situations. Of course, I was fully aware of his accomplishments, and I held a great deal of respect for him. He was very helpful to me.

Years before he died, Tom was invited to take part in the Odyssey Series program organized by the San Diego Psychological Association. The Association asked distinguished psychologists to share their life stories with members who gathered for an evening of dining and fellowship.

Tom’s presentation focused on his lifelong struggle with self-esteem. He spoke humbly, factually, and without fanfare, without inappropriately revealing personal information. 

So, what impressed me? It wasn’t the content of his talk, although his struggle did surprise me; it was the courage he showed in being transparent in front of more than a hundred people. He was honest and authentic. He was sharing his story as he had lived it.

This was his legacy for me.

P.F. Chang’s


Finding great Chinese restaurants in San Diego can be challenging. One standout option is P.F. Chang’s (since 1993) that has locations in La Jolla (UTC), Mission Valley, Chula Vista and Carlsbad. So, what are the highlights of this restaurant?  The steamed dumplings are excellent and a must-try. They have a wide assortment of egg rolls and the kung pao chicken is fantastic, as are the lo mein dishes. The service is efficient, the quantity of food served generous and the prices are reasonable. At the UTC location, there is an adjacent parking garage. Reservations are recommended as the restaurant tends to get busy.

Netflix: Rita


After a road trip, people often like to pull out a map and see where they have been. Such viewing brings a sense of completeness to the journey in addition to reviving memories, both good and bad.

The same can be said of one’s life journey. Years ago, the artist turned psychoanalyst Erik Erikson wrote of the need for people to integrate their life journeys. It makes sense that we should all create a narrative that helps us understand where we started, where we went, and where we arrived. 

Retrospective analysis can be painful and misguided. Though the task may sound simple at first glance, it is not. If everyone traveled in a straight line, there would be no problem. However, many people took a turn here or there, which complicated their journey. They took the wrong job, failed out of school, ended up with the wrong mate, or drank too much alcohol. Bad choices can create later regret with accompanying sadness and guilt.

Why do I say that? Think about it. The analysis is being made with senior eyes, not those of a twenty-year-old. Older eyes can be critical and judgmental while lacking context and understanding. When evaluating our past, we must step into the shoes of our younger selves. In that way, empathy can lead us to understand better the decisions we make as young people.

The excellent Danish comedy-drama series Rita (2012-2020) on Netflix demonstrates this point well. The series shows Rita, played by Mille Dinesen, as a young girl and later as an adult. She is an independent, headstrong unconventional teacher who went into her profession, she says, in order “to protect students from their parents”. She is nevertheless very flawed and is struggling in her personal life as the mother of three. In watching the series, the viewer sees Rita’s dysfunctional upbringing and how it led to many poor choices. It is easy to step into Rita’s shoes and understand her.

By empathizing with our younger selves, we can accept our past. We may not like it and feel pain around it, but through empathy, we can let go of guilt and regret. We can accept, not condemn, and find peace.