How Women Can Better Self-Nurture, with Alice Domar

Last Editorial Review: 10/23/2003

By Alice Domar
WebMD Live Events Transcript

Dr. Alice Domar will discuss her book 'Self-Nurture: Learning to Care for Yourself as Effectively as You Care for Everyone Else' and focus on how self-nurture can improve a woman's health.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live's Mind and Body Auditorium. Today we are discussing How Women Can Better Self-Nurture, with Alice Domar, Ph.D. 

With her outgoing, down-to-earth personality, Dr. Domar has been featured on national TV shows including The Today Show, Good Morning America, CBS This Morning, Dateline, CBS and NBC Nightly News, and CNN. Dubbed the "fertility goddess" by the media, Domar's research on the effects of stress on female well being shows that the practice of self-nurture can treat a host of women's health problems.

Dr. Domar, welcome back to WebMD Live.

Domar: Thank you.

Moderator: What exactly does self-nurture mean?

Domar: I'd say it means to care for yourself and put yourself amongst your own list of priorities. A lot of people, women, think when I talk about self-nurturing, that I'm talking about being selfish. And there are a lot of books out there on self-care, and they talk about selfish behaviors like 'don't call your friends back' which I don't think makes sense at all. But all the suggestions made throughout my book, half involve self-nurturing with other people. So it doesn't mean a half hour bath or jetting off to Paris for the weekend.

Moderator: Can self-nurture solve or prevent most health problems, in your opinion?

Domar: Absolutely. Stress, right now, is the number one problem cited by American women, mostly because balancing work and family is so hard. And when we juggle them, we leave ourselves last which takes a huge toll on our mental and physical health.

Moderator: In your book you talk about the mother/daughter connection. How does it work?

Domar: A lot of people live in fear that they're going to become their mother. (laughs!) And yet a lot find themselves acting like their mother without even trying. I do a lot of couples therapy, and one of things that's so hard for people to understand is that we tend to learn behaviors after using our parents as role models. So the things that pir mother could do, we also can do, and vice versa. So, there are lots of ways to self-nurture, in terms of your relationship with your mother, ranging from doing something with her to get out of your normal routine, all the way to doing 'cognitive restructuring' to challenge your own negative 'self-talk' when it comes to your mother. I'm 41 years old and my mother is 80 and I still find myself wanting to please her, which I think is a thing so many women find hard to shake.

Moderator: Women are connected to our bodies in a love/hate way. How do we get off this merry-go-round?

Domar: I think it's generous to say 'love/hate'. I can't think of a single woman I know who loves her body. A few years ago, Vogue did a story about me and because of that, celebrities wanted to come and see me. And by everyone's standards, they were gorgeous and physically perfect. Yet they'd sit in my office and list things they hated about themselves. The average woman stands in front of a mirror and points out the things she doesn't like! Men don't do that.

Moderator: Why don't men do that?

Domar: Men are less judged by their appearance, I know that. I read an article a few years ago that asked 'who do you think is more overweight, Roseanne or Jack Nicholson?" Most people said Roseanne, but the fact is that they're equally overweight. Women are definitely judged by their bodies much more so than men are. There are actually many more male actors right now that are overweight than female actors. You get to the point where you don't want to watch these, like Ally McBeal. ALL of them are skinny now! The influence of the media is horrific as far as presenting unrealistic body types to the masses.

Moderator: How important is one's childhood in determining how capable she is of self-nurture?

Domar: I think it's somewhat important. I've certainly seen patients in the last few years who had childhoods which made them feel completely unable to self-nurture, often, the oldest daughter of large families. And everyone can learn. For a lot of people, it's a tremendous relief that goes along races, ages, levels of socioeconomic status. It's a woman thing.

Moderator: How did you start on this self-nurture teachings?

Domar: I've been teaching mind/body for a while. At one of my first groups in 1987, my co-leader was sick and the subject matter we were supposed to cover was too difficult for me to do by myself. And, he said, "teach what you feel comfortable teaching." So, I thought that the one thing missing from our curriculum was teaching women how to be kind to themselves and take care of themselves. But it's no coincidence that I started writing this book when my daughter was 4 months old, because becoming a mother really puts the self-nurturing issue into focus.

Moderator: Explain the relationship quadrant for us.

Domar: Basically, if you are in a relationship with somebody, and let's say it's a relationship between a woman and a man, both of you have two states of being, either okay or not okay, Which means there are four possible options, you're okay, he's okay, which is great. You're okay, he's not okay, which means you're still fine. You're not okay, he's okay, which means you're still fine. Or, the dangerous quadrant, you're not okay, he's not okay! And, this is the one you want to identify and work on preventing. And the example I gave in the book, or one of several, was of a couple that I had been seeing who were separated and they identified their quadrant, her two states were either scattered or together. And he was either a nice guy or a jerk. What they found was that three quarters of the time, they were fine. But when she was in a scattered phase and he was being a jerk, they got into trouble. So they worked on identifying and preventing that dangerous quadrant. So, he became a jerk (he was a lawyer in a trial) and she became scattered when she said yes to too many people. So they realized that if he had a trial coming up, she needed to say 'no' more often, or if she was in a scattered phase, he had to work really hard not to be a jerk when he got home. And it worked, identifying that quadrant. I've used it with numerous couples.

Moderator: This must mean that these couples are great communicators. Most couples aren't. How does this work?

Domar: You don't actually need both of them to do this. Most people in a relationship know the two states and you can figure out your own. The key is to figure out that danger quadrant and try to avoid it. It also works with kids and parents. I've found out the hard way that she's (my daughter) is obnoxious or cooperative and I'm impatient or patient. So, if she's in an obnoxious mood, I need to work hard to stay patient and if I'm in an impatient mood, I need to work hard with activities to keep her from getting into an obnoxious mood.

Moderator: How does self-nurturing work for single women, especially women who want to be in relationships?

Domar: Because it's so hard to be single -- I was single for a long time and hated it -- I encourage single women to write down their thoughts and feelings. A lot of them time we project our pathologies into new relationships and that doesn't help. So if you can get some of your craziness out on paper, you won't need to subject a new man to it. I fact, the very first time I tried this with a single woman, she found it such a relief to write about her insecurities and hopes and dreams and all the things she didn't want to talk about with a man on the first few dates. And she found very quickly she could enter into a healthy relationship and got married rather quickly.

Moderator: What would you say to someone who thinks the connection between mind and body to be overstated, and not important enough to solve major health problems (i.e., infertility)?

Domar: I think there is a reality in terms of there is SOME mind/body connection. Anybody who's ever watched a scary movie and noticed their heart speed up has to acknowledge that's a mind/body connection. Your brain is watching the movie, but your body is responding. I think there's a huge danger in overestimating the impact the mind can have on the body. I think that this came up in the 70's when cancer patients were taught imagery techniques and encouraged to imagine that their white blood cells were like Pac Men and could "eat up" the cancer cells. The danger of such an approach is that your average cancer patient can do imagery perfectly and yet not be able to heal themselves. And, then will feel guilty that they clearly didn't do the imagery right. I strongly believe that most disease has an organic basis. I also believe that stress can make many diseases worse. And so why not learn mind/body techniques to improve your sense of comfort? If it happens to reduce your physical symptoms, so much the better! I would never allow a patient of mine to pursue mind/body techniques rather than traditional modern medicine. It's always in conjunction. I think the best medicine is a combination of the two approaches.

Moderator: Are physical, emotional, and spiritual fatigue entirely different, separate things?

Domar: I think they're tied in. It's hard to tease them out. Physical fatigue is if you don't get enough sleep or if you've been running around. But emotional/spiritual fatigue often feels the same.

Moderator: What are some every day things a person can do to nurture herself?

Domar: I have two easy things to do. Every day, at least once a day, when you start feeling stressed out, stop yourself and say, "What do I need right now?" I do that. It may be something simple as to take a two minute relaxation break, or look up a joke on email, or call a friend, or go for a walk, or decide to order a pizza for dinner! But you need to check in with yourself on a daily basis to find out what you need. And every morning, when your alarm goes off, spend 30 seconds to think about what you can do that's nice for yourself that day. Whether it's buying yourself a fabulous piece of fruit, or calling a great friend, or buying yourself flowers, anything!

Moderator: I love the time pie. Explain how I can reorganize my life to have more time.

Domar: The idea is that most of us waste a fair amount of time ... so we recommend that you take a piece of paper and draw a circle and visualize this as a pie. It's a time pie of your average weekday. So, if you cut it into 24 slices, that represents the 24 hours of your average weekday. So, if you sleep eight hours at night, that's a third of your pie. If you work eight hours a day, that's another third, 12 hours a day is half your pie. And then figure out what are all the other slices of your pie, which would include commuting, child care, exercise, phone calls, TV, errands, meals, cooking, eating, cleaning up, etc. See, after you've done the time pie, if there's any way you can rearrange your day to give YOU more time.

Moderator: What the did the women in your workshops discover?

Domar: What I uniformly hear is that they can't account for all 24 hours and they realize they spend a lot of time doing things (like watching TV or long phone conversations) that aren't as nurturing as other things they could be doing.

Moderator: Doesn't it shake up the people in your life when you start to make these changes?

Domar: Well, we suggest that you tackle one area of your life every six weeks so it doesn't shake anybody up. The book is divided into the different areas of your life. You should start with the area you want most to change, whether it's your job, your body, your spirituality, your relationship with friends/siblings, creativity or leisure time, etc. Start nurturing one area of your life every six weeks or so, it won't feel shocking to you or anyone else.

Moderator: I feel so guilty when I say no to my kids. I feel that's the one area where I should never say no.

Domar: First of all, no mother should say 'yes' to her kids all the time. It's not good for the kids. And keep in mind that you can self-nurture with your kids! I dance with my daughter, bake cookies with her, go for walks with her ... these things nurture us both. But, you will be a better mother and a MUCH better role model if you take care of yourself, too.

Moderator: But it seems as if there's nothing in society that supports that.

Domar: Well, I think we have to look at men as role models. Men are much better able than we are to care for themselves. They're much better able to sit down in front of the TV and watch football for three hours and not feel guilty about it! And instead of resenting them for it, we need to model ourselves after them! If he watches sports every Sunday for three hours, then you get to do what you want to do every Saturday for three hours.

Moderator: Why do you concentrate on women when it seems obvious that life is overwhelming for everyone in our society?

Domar: I'm not focusing on women to be sexist. I happen to be married to a man, so I see that men, indeed, have stress in their lives. But, I focus on women for two reasons. One, because several research studies have shown that women report more day-to-day stress than men do. And because I think that women have such a struggle caring for themselves that they need more attention right now.

Moderator: In your book you talk about couples who were able to conceive after trying some of these techniques. Is the data supported or do people feel it's just a coincidence?

Domar: No, I actually published a study this month in 'Fertility and Sterility' that showed that women who went through a Mind/Body group or a Support Group drastically increased their pregnancy rates versus women who just received medical care. I believe that women who are infertile should be in a support group. At the very least, they'll feel better.

Moderator: Why doesn't everyone do this who's going through this problem?

Moderator: Have you been criticized for giving false hope?

Domar: Thousands of times. I'm always criticized for perpetuating a myth, "just relax and you'll get pregnant." And the fact is is that there's increasing evidence that depression may hamper fertility. And the patients who go through my program work their butts off. It's not just relaxation. They incorporate a lot of mind/body skills into their lives. They change their eating habits and what they're doing is decreasing their depression levels. If depression decreases fertility, then when the depression lifts, you'd expect to see more fertility, and that's indeed what happens.

Moderator: So this involves a real commitment on their parts?

Domar: Absolutely. It's a 10-session program.

Moderator: How do friends play into this?

Domar: You know, it's a lot of fun to self-nurture with your friends. Women are more socially isolated now than at any other time in human history. Think about it ... until 20 years ago, for all of man's history, women lived amongst other women, with mothers, grandmothers, aunts, cousins and sisters. And women cared for each other. They didn't need to self-nurture because they cared for each other. But in the last 20 years, not only do we have nuclear families, but women work outside the home, so they're very socially isolated. Women need to be around other women. They have a unique gift in terms of compassion, empathy and sharing. And social support is crucial for our mental and physical health.

Moderator: You mentioned that as a result of this, we now seek everything from a relationship with a man.

Domar: That's right. Because we don't have the women amongst us and I think that's one of the reasons why divorce rates have gotten so high. No matter how great a guy is, he cannot meet ALL of your needs. When women had each other to talk to, the faults of the men would be kept in perspective instead of becoming all encompassing.

Moderator: How can teenage girls reduce the stress in their lives?

Domar: Mm hmm (agrees). They have a lot of stress. I was at a private school last week and had a meeting with faculty staff and students talking about the self-nurturing process and we talked about how important it is both in terms of body image and relationships, for example, what a teenage girl will put up with in order to stay in a relationship.

Moderator: What do you find out about the state of teenage girls today?

Domar: It's scary. The prevalence of eating disorders, the obsession with being thin, the lack of self-esteem, the obedience to the media. You know, that's not okay! So, we're hoping to have a self-nurture day to teach the students how to better care for themselves and think more highly of themselves.

Moderator: Why is there so much pressure put on children these days? What can parents do to relieve it?

Domar: That's an issue of the parents. My daughter is in pre-school and I hear other parents frequently complain that the day is not structured enough. One parent actually took her kid out because every time she went to the school, the kids were "just playing" and she wanted her kid to be "learning." My response is "four-year-olds SHOULD just be playing!" That's what's so great about being four! That's their job! They'll have plenty of time in their lives to work.

Moderator: Why are girls becoming sexually active so early nowadays?

Domar: I think there's a lot of peer pressure, to be "cool,' and because they can. When you watch TV, every TV show they turn on, their role models are having sex, so why shouldn't they?

Moderator: How can you nurture your relationships with your adult siblings?

Domar: I think one of the best ways is to recapture the things you enjoyed doing when you were kids. One of the beautiful things about siblings is you have so much in common in terms of your childhood experiences. So, go back and play Monopoly or Life. Have a snowball fight, or rent a movie that you watched together as a kid. It'll make you feel good.

Moderator: Let's talk about the workplace where it's difficult to nurture.

Domar: It can be very difficult to nurture yourself in the workplace, especially with so much pressure to work the long hours. And yet the expectation of working the long hours, ironically,  decreases performance. So I tell my patients or people that come to my workshops, to look at their jobs and see how they can nurture themselves at work, which means that they might, every Monday morning, buy themselves one Freesia so that their desk will smell nice all week. Or arranging a lunch with female co-workers once a week just to gossip and have fun. Or take a brisk walk every day at lunch time -- that's a really great thing to do. You need to look at what you NEED at work. You spend a lot of your life there.

Moderator: My husband gives me absolutely no support when I try to do anything for myself and I'm at the end of my rope. How can I make him see what I need?

Domar: I think you can set up an equal system. Say that the two of you arrange a system that he gets to do what he wants every Tuesday evening, and you get to do what you want to do every Thursday evening. Men are always suspicious that women are goofing off. Leaving a man home all day with the kids is great for letting them realize how hard it is. They think being home with kids is really easy, yet those that try it realize it's hard work. If any wife can explain to her spouse that she needs some down time in order to BE a better wife and better mother, hopefully, she'll get cooperation. Women who are well-rested and self-nurturing are better companions. They're more fun, interesting to be around, they may be more interested in sex, these are all things that men appreciate!

Moderator: I always have this voice in my head that I "should" be doing something constructive in my down time. How can I get this voice out of my head?

Domar: First of all "should" in my book is a four letter word. Our humorist said, "Do not should upon yourself." It's a guilt-inducing word. If one of your friends said she was going to goof off for two hours, would you think she was a bad person? No. We need to be just as compassionate to ourselves as we are to our friends. Make a to-do list with things to be done and the other half is self-nurturing activities. And the best part of any list is the crossing things off.

Moderator: Sometimes when you sit down and examine your life, you see that you really need more help than you can give yourself. Where do you go?

Domar: There are lots of ways to get help, whether it's from friends, family members, church or spiritual organizations, support groups, or seeing a mental health professional (which I highly recommend, of course, being one myself).

Moderator: I'm a single mom with absolutely no time. How can I make this concept work in my own life?

Domar: Nobody has no time. I understand that being a single mom is extremely challenging. No question. Single mothers have the highest level of stress. There are a couple things you can do. If you know another single mom, take turns taking all the kids, so that each one of you has some down time, every other time. And look at how you can be more self-nurturing WITH your kid or kids. It's not going to hurt any of you to have ice cream for dinner once in a while! That's a lot of fun! It's not going to hurt any of you, when you come home from work exhausted, to put on some crazy music and all of you just dance! It's not going to hurt anyone to wear really funky nail polish! There are a lot of creative ways you can better care for yourself which don't involve a lot of time or money. It's just a matter of sitting down, thinking about what you NEED, and putting the thoughts into action.

Moderator: You talked about some spiritual paths to take, but these require that I really break out of the mold. How do I start this?

Domar: You don't have to break out of a mold. A lot of people were brought up in one religion or spiritual orientation and may or may not feel comfortable in that as an adult. It may be that you don't happen to like the local minister and you can go to a different town to see if you like that one better. A lot of people I know go to the Unitarian Church even though they were brought up as Catholics or Jews! Being spiritual doesn't necessarily mean being religious. It means being connected, finding that your life has meaning, etc.

Moderator: Do you think that some of your techniques will be put to use in fertility clinics around the country to help infertile couples?

Domar: That's one of my goals. You know, we are trying to train mental health professionals around the world so that more infertile people can have a chance to learn these skills. Hopefully, I just submitted a book proposal to write, hopefully, the standard mind/body guide to infertility. We'll see if the publisher buys it or not! (laughs)

Moderator: You have a heading called catharsis, insight, action. What does that mean?

Domar: I think that in any situation, you need to tune in to what you're saying to yourself. If you think of your brain as being like a tape recorder, all of us have tapes that play over and over and over in our heads. Ninety percent of these tapes are negative, and almost all of them are false. The first step is to figure out where these thoughts come from. They only come from two sources. They either stem from something someone said to you a long time ago, or it's your fear speaking. Figuring out where the thoughts come from is halfway towards resolution.

Moderator: I love the aspect of "bitch and moan" friendships. How do you change then?

Domar: (laughs!) Well, this is a problem with a lot of female relationships that women feel so free to complain and are so loathe to talk about good things because that will be perceived as bragging. Try doing 'news and goods' with your friends. The next time you talk to a friend, the first thing you say to her is, "what new and good thing happened to you today?" You can do that with your husband, kids, friends, cousins, parents, etc. And it forces you to see the glass is half full. It's not bragging, we get enough bad stuff on the news.

Moderator: How important is girls' night out?

Domar: It's very important. You can get so much from your girlfriends. A number of studies have shown that social support is crucial to our physical health. Women with lots of close friends tend to live longer and are less likely to die from breast cancer. So, go out and hang out with your friends!

Moderator: What if you're single and every night is girls' night out?

Domar: Great! But don't do it to the exclusion of meeting guys if that's one of your goals. We're having a Self-Nurture Symposium in Boston on Saturday called Self-Nurture: Mind, Body, and Spirit at the World Trade Center in Boston on April 29th (that's Saturday). There will be keynote talks by myself, Miriam Nelson and Loretta LaRoche as well as numerous workshops on everything from fitness to mid-life health to an experiential self-nurture workshop. There's a website, it's at  or you can call 617-632-9563 for more information. I have a book I co-wrote with two physicians, entitled 'Enhanced Fertility' and that will be coming out in October. It's published by Simon & Schuster. That's a real medical book.

Moderator: Dr. Domar, thank you for joining us today. WebMD members, please join us every Wednesday at 9 pm EDT here in the Mind and Body Auditorium for our live weekly event. 

Domar: Thanks a lot!

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