Types of Boundaries

There are several areas where boundaries apply:

• Material boundaries determine whether you give or lend things, such as your money, car, clothes, books, food, or toothbrush.
• Physical boundaries pertain to your personal space, privacy, and body. Do you give a handshake or a hug – to whom and when? How do you feel about loud music, nudity, and locked doors?
• Mental boundaries apply to your thoughts, values, and opinions. Are you easily suggestible? Do you know what you believe, and can you hold onto your opinions? Can you listen with an open mind to someone else’s opinion without becoming rigid? If you become highly emotional, argumentative, or defensive, you may have weak emotional boundaries.
• Emotional boundaries distinguish separating your emotions and responsibility for them from someone else’s. It’s like an imaginary line or force field that separates you and others. Healthy boundaries prevent you from giving advice, blaming or accepting blame. They protect you from feeling guilty for someone else’s negative feelings or problems and taking others’ comments personally. High reactivity suggests weak emotional boundaries. Healthy emotional boundaries require clear internal boundaries – knowing your feelings and your responsibilities to yourself and others.
• Sexual boundaries protect your comfort level with sexual touch and activity – what, where, when, and with whom.
• Spiritual boundaries relate to your beliefs and experiences in connection with God or a higher power.

Why It’s Hard

It’s hard for codependents to set boundaries because:

1. They put others’ needs and feelings first;
2. They don’t know themselves;
3. They don’t feel they have rights;
4. They believe setting boundaries jeopardizes the relationship; and
5. They never learned to have healthy boundaries.

Boundaries are learned. If yours weren’t valued as a child, you didn’t learn you had them. Any kind of abuse violates personal boundaries, including teasing. For example, my brother ignored my pleas for him to stop tickling me until I could barely breathe. This made me feel powerless and that I didn’t have a right to say “stop” when I was uncomfortable. In recovery, I gained the capacity to tell a masseuse to stop and use less pressure. In some cases, boundary violations affect a child’s ability to mature into an independent, responsible adult.

You Have Rights

You may not believe you have any rights if yours weren’t respected growing up. For example, you have a right to privacy, to say “no,” to be addressed with courtesy and respect, to change your mind or cancel commitments, to ask people you hire to work the way you want, to ask for help, to be left alone, to conserve your energy, and not to answer a question, the phone, or an email.

Think about all the situations where these rights apply. Write how you feel and how you currently handle them. How often do you say “yes” when you’d like to say “no?”

Write want you want to happen. List your personal bill of rights. What prevents you from asserting them? Write statements expressing your bottom line. Be kind. For example, “Please don’t criticize (or call) me (or borrow my . . .),” and “Thank you for thinking of me, but I regret I won’t be joining (or able to help) you . . .”

Internal Boundaries

Internal boundaries involve regulating your relationship with yourself. Think of them as self-discipline and healthy management of time, thoughts, emotions, behavior and impulses. If you’re procrastinating, doing things you neither have to nor want to do, or overdoing and not getting enough rest, recreation, or balanced meals, you may be neglecting internal physical boundaries. Learning to manage negative thoughts and feelings empowers you, as does the ability to follow through on goals and commitments to yourself.

Healthy emotional and mental internal boundaries help you not to assume responsibility for, or obsess about, other people’s feelings and problems – something codependents commonly do. Strong internal boundaries curb suggestibility. You think about yourself, rather than automatically agreeing with others’ criticism or advice. You’re then empowered to set external emotional boundaries if you choose. Similarly, since you’re accountable for your feelings and actions, you don’t blame others. When you’re blamed, if you don’t feel responsible, instead of defending yourself or apologizing, you can say, “I don’t take responsibility for that.”

Guilt and Resentment

Anger often is a signal that action is required. If you feel resentful or victimized and are blaming someone or something, it might mean that you haven’t been setting boundaries. If you feel anxious or guilty about setting boundaries, remember, your relationship suffers when you’re unhappy. Once you get practice setting boundaries, you feel empowered and suffer less anxiety, resentment, and guilt. Generally, you receive more respect from others and your relationships improve.

Setting Effective Boundaries

People often say they set a boundary, but it didn’t help. There’s an art to setting boundaries. If it’s done in anger or by nagging, you won’t be heard. Boundaries are not meant to punish, but are for your well-being and protection. They’re more effective when you’re assertive, calm, firm, and courteous. If that doesn’t work, you may need to communicate consequences to encourage compliance. It’s essential, however, that you never threaten a consequence you’re not fully prepared to carry out.

It takes time, support, and relearning to be able to set effective boundaries. Self-awareness and learning to be assertive are the first steps. Setting boundaries isn’t selfish. It’s self-love – you say “yes” to yourself each time you say “no.” It builds self-esteem. But it usually takes encouragement to make yourself a priority and to persist, especially when you receive pushback. Read more on setting boundaries in Codependency for Dummies and my e-book, How to Speak Your Mind and Set Limits.

While Leathers’s book strives to be a source of inspiration to those who have dealt with abuse in any form—and while it’s intriguing to follow Reb on her journey of self discovery and struggle—the lack of a structured story, lack of character development, and copious grammatical errors make this book a challenge to read.

Reb endures a childhood tainted with abuse from her oldest brother. That trauma haunts her well into her adult life, and she finds herself hard pressed to trust many of the people around her. Physical injuries from her brother cause her life to spiral downwards, and at 55 years old she finds herself begging god for a do-over. Then, the morning after her prayers, she wakes up to find herself in her 4-year-old body with her 55-year-old brain. Through her new life, she makes substantial changes and learns lessons about what is truly important.

It’s clear that Do Over is about the lessons that Leathers learned as she grew up and got past her own trauma. While the character Reb does grow and progress, the book is unfortunately written such that the story and the characters fail to connect emotionally with the reader. It is difficult to be convinced or drawn in simply by a rote description of a character’s personality traits, struggles, or experiences. But Leathers almost mechanically lists off what Reb’s personality is like and how she feels in certain situations. After reading the book the reader knows how Reb sees herself, but isn’t able to get the feeling of what Reb says or how she acts when interacting with others. In other words, Reb remains two-dimensional, despite the author’s attempts to describe her.

Leathers’s writing is also very disjointed and in need of editing. Blatant grammatical errors aside, the lack of structure in Do Over makes it very hard to follow. The first ten pages are spent on what different parts of Maine are like. Certain characters are named and never mentioned again, while Reb’s son, an integral part of the character’s life, isn’t mentioned by name until the story is half over. Some parts of Reb’s tale are repeated, and some situations are not explained in a way that allows the reader to understand Reb’s mindset or motives.

Do Over also focuses heavily on religion and god, illustrating the role that both play in Reb’s recovery. As with the rest of the book, though, there’s a disconnect between what the author tells us and what we, the reader, feel. We’re told that Reb gets a lot of peace from religion, but we don’t get a real sense of how it works for her. The reader knows that Reb likes to sing for her church choir, but there’s no story or experiences that are shared to help us understand Reb’s emotions as she sings her songs of worship or attends church. As a writing instructor would point out, Leathers tells instead of shows.

Still, the author is able to convey some important ideas through Reb. As an advocate for children going through the welfare system, I found that Leathers’s book gave me a glimpse into what these children have to face as they get older. Reb’s character illustrates how small obstacles can be exacerbated by childhood trauma. Her lifelong struggle to get past what happened to her and live a normal life helped me realize the importance of early intervention and how necessary it is to get the kids I work with into stable, loving homes.

Ultimately, though, the lack of structure, character development, and quality editing keep the reader from connecting with the characters and the story in a meaningful way. While I personally applaud Leathers for her struggle to overcome her trauma and her success in moving on to appreciate what matters in life, I cannot recommend Do Over.

Do Over
Xlibris, September, 2012
Paperback, 270 pages
$19.99 

However, after reading Melissa Francis’s memoir, Diary of a Stage Mother’s Daughter, I believe Mommy Dearest may have met her match in Francis’s mother.

Francis’s career as an actress started when she was barely a toddler. From that point forward, she writes, much of her time was spent rushed to auditions, memorizing lines, and shooting commercials and TV shows. Francis made her mark on television when she landed the role as Cassandra on the popular show Little House on the Prairie. In her memoir, she relates stories and memories from her time on sets with great clarity. What is most impressive is her ability to capture the thought processes that she had in various moments, as well as her childhood innocence and naivety.

However, the real story in this book is the outrageousness of her mother. Unpredictable at best, Francis’s mother was at times sweet and spoiling while at other times downright devious and frightening. It quickly becomes apparent that the sweet and spoiling side of this Mother Dearest came when she needed Melissa to act the part in a commercial or television episode.

When she wanted something from her daughters, she was not afraid to use bribery. But the second someone crossed her, they were punished, and she doled out these punishments in a variety of formats. It could be scathing words, being locked out of the house in only a bra and jeans, being shoved out of the car to walk home—even being pushed down the stairs. The author or her older sister, Tiffany, experienced each at various times.

One of the best examples of how this behavior reached out beyond the family involved another family in the Francis’s neighborhood. The Parkers lived a few doors away, and reported the Francis family to animal control due to feral cats in the area. Animal control picked up the Francis family dog, KC. The author’s mother decided to have revenge. She drove to the Parker household and returned home a while later. When the author confronted her, she saw that her mother had taken the Parker’s dog’s collar. Her mother replied, “It’s Coco’s. The Parkers’ dog. I took her in my car, and drove her out to the pound in Simi Valley. And I turned her in. A lost dog. Like KC.”

The weight of this was not lost on Francis: Since Coco did not have her collar, and the pound that she was dropped off at was far from their home, the Parkers would never find their pet. “Mom had effectively murdered our neighbors’ dog,” she writes.

As the years roll by, the impact of her mother’s behavior becomes more apparent. Tiffany leaves for college and continues a destructive path that started when she was a teenager. She uses alcohol and drugs and, unfortunately, 16-year-old Francis, our memoirist, is a witness to this behavior. Mother Francis continues with her antics after Tiffany leaves the house, but now, rather than sharing that burden with Tiffany, the author is left to fend for herself.

She begins planning her escape from the home, plotting a way to get to Stanford summer school. At this point, you may be wondering where the author’s father is. He was there, but just barely, Francis tells us. Rather than assist in the dramatics and try to curb the chaos, he hid away in his study or at work, avoiding the wrath of his wife and laughing it off as though it were a minor flaw.

The family could not turn a blind eye to Mother Francis’s behavior forever, though. After the author got married, her sister Tiffany’s health took a serious turn. Her pancreas had been destroyed by her drug and alcohol abuse, which was only discovered after a couple rounds of rehab. The problem seemed to awaken Father Francis from his stupor, and he immediately took action to take care of Tiffany. Mother Francis, on the other hand, seemed to find Tiffany’s condition more of an inconvenience than something to be truly worried about. After one of Tiffany’s nights in the hospital, the author recalls, the two sisters were talking in the car. Tiffany wiped tears from her eyes and said,

“You know, I was lying in the hospital last time and in the middle of the night I was just in so much pain. And… so scared. All I could think was, it would be so nice to have a mom.”

This seems to be the final straw for Francis. She confronts her mother and ends the conversation with these words: “All the craziness. It ends with me. I swear it, once and for all. One way or the other. It’s your choice how it ends. But it ends with me.”

Such a powerful moment in the book: I silently cheered and presented Francis with a standing ovation.

And Francis’s book is worth cheering for, too. I absolutely love reading memoirs. When an author writes one with raw honesty, great style, and a narrative that holds you every second, she creates a real treasure. Francis’s is a great example — I could not put it down. At times, I wanted to reach in and comfort young Melissa and Tiffany. Other times, I wanted to reach in and teach Mother Francis a lesson or two. All in all, Diary of a Stage Mother’s Daughter is a solid, gripping read.

Diary of a Stage Mother’s Daughter
Weinstein Books, November, 2012
Hardcover, 304 pages
$26

The statistics regarding obesity in America are alarming. Currently, 35 percent of American adults are obese (CDC, 2012), and that number is projected to rise to over 50 percent in most states by 2030 (Henry, 2011). We’ve been fighting the so-called “war against obesity” since the 1980s, and yet despite all of our efforts, the problem has only gotten worse. Clearly, what we’ve been doing to try to solve this problem isn’t working and is possibly making it even worse. In my opinion, the reason for this is that the psychological piece hasn’t been addressed yet and until it is, we will have an increasing problem on our hands.

Years ago I was seeing a client who we’ll call Sarah. Sarah was very obese and desperate to lose weight. Her doctor had recently told her that if she didn’t lose a significant amount of weight she would lose her mobility as well as have a host of other medical consequences. Sarah tried numerous diets and exercise programs but nothing worked. She even enrolled in a weight loss clinic but had no success. She actually ended up gaining even more weight during this time. Not knowing what else to do, Sarah’s doctor told her that she needed to talk to a therapist.

When I met Sarah she was quite desperate to lose the weight and very depressed. Much to her surprise, I told her that I didn’t want us to work on her losing weight, but rather I wanted to work on her depression and teach her to accept and love herself unconditionally. This seemed the opposite of what she needed in order to lose weight, but Sarah decided to trust me anyway. You see, like a lot of people, Sarah thought that if she could just hate herself enough, that would motivate her to do whatever it took to lose the weight. As a therapist, I know that that is simply not going to work. We therapists follow something called the “Rogerian hypothesis,” which states that people tend to move in a positive direction only when given unconditional love and acceptance. Well, I’m happy to say that after we had alleviated Sarah’s depression and she had learned to love and accept herself, the weight came right off.

The current methods for helping people lose weight seem to be the opposite of love and acceptance. Much of the efforts seem to involve trying to shame and scare people into losing weight. This simply doesn’t work. The worst thing you can do is give someone more anxiety and depression regarding their weight, and I’m going to explain why that is later on. Also, the ways we go about teaching people to lose weight are much more complicated than they need to be. One should not have to read a book, go to a clinic, or take a class to learn how to lose weight. There is a very successful diet that has been around for thousands of years and all of the big celebrities do it. Can you guess what it is? It’s called “Moving more and eating less.” How you go about accomplishing this is up to you. I believe that losing weight is not complicated and that people intuitively know how best to do it when it comes to themselves. They simply need to stop feeling so anxious and depressed about it.

Obesity and Genetics

Before I talk more about how obesity is linked to depression and anxiety, I first want to briefly address the popular belief that obesity is purely a problem of bad genes. This is the popular belief and I can see why it is so popular. In a society where people are constantly trying to shame you about your weight, it can feel good to be able to say “Hey, you have no right to shame me about my weight! It’s not something I can control! It’s because of these bad genes I have!” But in order for this to be true, it means that our genes would have had to somehow change since the 1960s. Scientists agree that genetics is not responsible for the obesity epidemic, although they do agree it is a factor. Depending on which study you look at, genes only account for between 1 percent and 5 percent of a person’s body mass index (Li et al., 2010). I think that most people would agree that 5 percent of bad genes doesn’t excuse the 95 percent of it that scientists claim is due to bad habits.

When confronted with these facts, people often cite that most of the people in their family are also obese, so it must be genetics. However, the more likely possibility is that families tend to eat the same foods and have similar habits. Genetics also doesn’t explain why obese people also tend to have obese pets (Bounds, 2011). Obviously the dog doesn’t share the same genes as the owner, but they do share the same environment. Of course, we can’t mention genetics without looking at twin studies. Since identical twins have identical genes, researchers often compare twins to examine the effects of genetics and the environment on a person.

Obesity and Depression

Researchers aren’t quite sure if obesity causes depression or if depression causes obesity, but the two are definitely linked. In fact, the two conditions are so intertwined that some are calling obesity and depression a double epidemic. Studies have found that 66 percent of those seeking bariatric, (weight loss) surgery have had a history of at least one mental health disorder. And of course, it doesn’t help that the medications people take for depression and other mental health issues can cause dramatic weight gain.

Consider this: According to the CDC, half of Americans will suffer from some sort of mental illness, and most of them will not receive any treatment for it. 63 percent of Americans are also overweight or obese. There are almost as many Americans taking diet pills as there are taking antidepressants (8 percent and 10 percent). People with mental health issues are twice as likely as those without them to be obese, and that’s even before they start taking psychiatric medication (McElroy, 2009).

So why are people with mental health issues so much more likely than those without them to be obese? We know that depression and bipolar depression slows down your metabolism (Lutter & Elmquist, 2009). Depression also depletes our willpower, making us less likely to avoid eating unhealthy foods. Depression also causes us to crave high-fat foods and sugar. This is where emotional eating comes in. When we’re feeling down, fatty and sugary foods make us feel better, at least temporarily. Of course, you don’t need to have depression or a mental illness in order to engage in emotional eating. It’s something we learn at a very young age. Eating something unhealthy is much easier than fixing the problem or dealing with what’s causing us to feel unhappy. Teaching people how to deal with unpleasant moods other than by eating would certainly cut down on emotional eating and would certainly lead to significant weight loss.

So if depression causes weight gain and antidepressants cause weight gain, then what is the solution? Well, research has shown that talk therapy is just as effective at relieving depression as antidepressant medication (Doheny, 2010), and talk therapy doesn’t have the negative side effects that medication does. Another option is exercise. In a 2005 study on the effects of exercise vs. Zoloft (anti-depressant medication) on the treatment of depression, participants were randomly placed into two groups. On group received 150 mg of Zoloft while the other group engaged in 20 minutes of cardiovascular exercise three to four times a week. After eight weeks, they found that the exercise was just as effective at reducing depression as the Zoloft! Another thing to consider is that Zoloft has negative side effects such as weight gain, sleep problems, and sexual dysfunction. As you can imagine, the side effects of exercising are the opposite of that.

Shame involves an internalized feeling of being exposed and humiliated. Shame is different from guilt. Shame is a feeling of badness about the self. Guilt is about behavior — a feeling of “conscience” from having done something wrong or against one’s values.

Shame underlies self-destructive behaviors:

• Hidden shame often drives self-destructive behaviors and other psychological symptoms such as rage, avoidance, or addictions.
• Self-destructive behaviors often are an attempt to regulate overpowering, painful feelings but lead to more shame, propelling the self-destructive cycle.
• Secrecy, silence, and out-of-control behaviors fuel shame.
• Shame makes people want to hide and disappear, reinforcing shame.
• Shame is created in children through scolding, judging, criticizing, abandonment, sexual and physical abuse.

Breaking the Cycle of Shame

Breaking self-destructive habits requires action, not just willpower:

• Changing destructive behaviors requires trying out new, affirming behaviors to replace them.
• New behaviors that generate positive feedback and reward create new connections in the brain, creating the momentum for ongoing growth and change. (Learning on a neurobehavioral level)

Shame can be relieved and healed by:

• taking healthy risks to be seen and known authentically, acting from a positive motive and trying out new behaviors in a safe (nonjudgmental) setting.
• taking actions that generate pride — the antidote to shame.
• breaking secrecy with people who understand.

You think you are being verbally abused by your partner. In fact, you suspect that you are in an impossible situation, living with a partner who doesn’t honor you, wants to change you, or at least wants always to be in charge at your expense.

It’s hard to admit it. It’s terrible to give up the image you once had of your guy as a loving, strong, smart and caring mate. But it’s been a long time since you saw him that way. Instead, you find yourself always braced for the next verbal assault; the next incident where you are found lacking in some way or to blame for things being the way they are. You feel ashamed and sad and angry but stuck. It’s hard to believe it. You don’t understand what happened. You even sometimes think it is all your fault.

Why do women stay with men who put them down? The reasons are varied and complicated.

It’s not uncommon for partners to be completely taken by surprise. Often, people who abuse do nothing of the sort while dating. If the person in pursuit makes any negative comment, it is quickly explained away. There are apologies and promises. He may even cry. Once married, the situation turns. Now that he has her, he doesn’t feel the need to keep himself in check. Afraid that she will in any way have the upper hand in any discussion, he begins a campaign to keep her off balance. The wife is mystified. She wonders what she did wrong. Where did the fun guy she married go? He tells her it’s all her fault. If he is artful about it, she wonders if he is right and works overtime to fix it – not understanding that he doesn’t have any intention of fixing it.

Other women think they can see the insecurity inside the person who is always asserting control. She tries to help him. She agrees with him that life has been unfair to him. She sides with him against the world, not understanding that in his eyes the world includes her. When he turns on her, she tries to be understanding and to explain the situation to him. Once in a while, he even accepts her help, which gives her the false impression that things are changing. What she doesn’t understand is that his insecurity is bigger than his love for her. It is bigger than rational thought. It is bigger than his desire to have a mutual, equal partnership.

Still other partners think the problem is one of communication. Couples therapists and counselors will tell you that the most frequent presenting problem is “we can’t communicate.” Often enough, what that means is that one of the partners doesn’t really want to communicate if communication means sharing decision-making and power. From his point of view, she stubbornly won’t understand when he is being perfectly clear that he’s the one in charge. She is sure that the therapist will help him recognize that he needs to hear another point of view. After all, he is a rational person, right? She thinks he wants the relationship to succeed as much as she does. She doesn’t get it that a need for control isn’t rational and, yes, he wants the relationship to succeed, but only on his terms.

Other women are too scared, insecure, embarrassed, or dependent to leave. Her confidence is shot. Over time, she’s been worn down and worn out. She may have given up trying to have friends since he always objects to her spending any time with them. She may have lost any say about the finances, even if she is making the bulk of the money. She is so convinced of her own powerlessness, she doesn’t think she can make it on her own or that she can find a better match. Feeling unlovable, worthless and helpless, she sinks into a low-grade, or not so low-grade, depression that keeps her stuck.

What to Do if You Are Being Verbally Abused

After soul-searching, you admit it. You are in a relationship that is making you feel bad about yourself. You don’t want to give up on it but you also can’t stand the idea of spending the rest of your life fearing that you’ll be torn down whenever you begin to feel good about yourself or whenever your opinion differs from that of your spouse. You know it isn’t good for you. Just as important, you know that it isn’t good for your kids to grow up believing this is the way people who love each other treat each other.

7 Reasonable Responses to Unreasonable Verbal Abuse

1. Give up on the idea of trying to change him. You can’t. There are important but mistaken reasons why he is the way he is. It may be grounded in his own upbringing, his insecurities or in a narcissistic personality disorder. You can’t do his therapeutic work for him. But – if he wants to change himself, there’s hope. Unless he has a history of being violent, you could ask him to get into some therapy before your relationship is beyond retrieval.
2. Never match his verbal abuse with that of your own. It won’t teach him a thing. It will only confirm in his mind that you are the irrational one. Instead, take the high road. Calmly tell him that you are sorry he feels that way about you but that you don’t share his opinion. Tell him that you love him too much to put him down.
3. Set limits. If your partner calls you names, treats you with disrespect and sarcasm, or loses it when you act only like the equal person you are, calmly tell him you expect to be treated the way he would treat someone he values, admires and respects. If he keeps it up, tell him that you will leave the conversation if he doesn’t stop. If he doesn’t stop, calmly leave the room, telling him you are giving him space to think about his behavior; you’ll be back in an hour or so. (Caution: Don’t do this if he is likely to escalate. See No. 7.)
4. People who need to control their partners often try to prevent them from having a life separate from the couple. You can’t leave if you have nowhere to go. Maintain your own support system. Make sure you spend time with your friends and stay in touch with family members you love. Friends can remind you that you are a valuable person when you start to feel like your partner is right that you aren’t.
5. If you think things won’t improve or will only get worse, start a savings account for yourself. Put enough money away that you always feel it is a choice whether or not you stay. Have at least enough for a bus ticket to your family or a friend’s. Better yet, save enough to pay rent for a few months so you never have to feel trapped.
6. Get counseling if you think your relationship is salvageable. If you’ve tried your best but you and your partner haven’t been able to forge a loving, mutually supportive relationship, find a couples therapist to help you. If your partner won’t go because of his pride, stubbornness, or his conviction that you are the only one who needs “fixing,” go yourself. You need the support. Your counselor may be able to help you identify ways to make counseling a little less threatening to your partner so he might join you.
7. If your partner has escalated from verbal to physical violence – leave. There are domestic abuse programs in almost every city in the U.S. Counselors there can help you figure out where to go and what to do. If you are in a rural area of the U.S. or in a country without such help, go online. Make sure you use a computer your partner can’t use. Some people become violent when they see that their partners have tried to reach out for some help. In the U.S., you can call the National Domestic Violence Hotline at 1-800-799-7233. For more information about their services, click on thehotline.org

Verbal abuse takes many forms: from loud rants to quiet comments; from obvious put-downs to not-so-obvious remarks that undermine the partner. What all the methods have in common is the need to control, to be superior, to avoid taking personal responsibility, and to mask or deny failures.

The myth in Hank’s and Mary’s relationship is that he is much, much smarter than she is. She does admire him, but not as much as he admires himself. He trumps anything she says with a stronger, maybe louder opinion. He calls her ideas naïve or ill-informed or even idiotic. Mary thinks he may be right. Since marrying Hank 3 years ago, her self-confidence has plummeted.

Jake, on the other hand, hides his need for control in his relationship with Marilyn under sarcasm, jokes and puns. “Why,” he says, “doesn’t Marilyn understand I’m just joking?” Why? Because she is the object of those sarcastic remarks, “jokes” and puns. He both publicly and privately keeps her off-balance by joking about her insights, her goals, and the things she cares most about. She has come to question her judgment about her ideas and about him. Lots of people think he’s funny. Maybe, she thinks, he doesn’t mean it. Maybe, she tells herself, she needs to have a better sense of humor.

Frank can’t stand to be seen as responsible for any failure. When he makes a mistake, his mantra is “I may be wrong but you are wrong-er.” If his wife says he has hurt her feelings, he claims not to remember having said what he said or having done what he did. He tells her she is “too sensitive.” He whines about being a scapegoat for other people’s problems. He doesn’t seem to get that he is the perpetrator, not the victim.

Al isn’t subtle. His wife and kids never know what to expect when he comes home. Will loving, caring Al be at the door with treats for the kids and something nice for his wife? Or will the Al who flies into rages, who threatens them with physical abuse and swears and calls them names show up? The whole household walks on eggshells. Even when loving-Al is around, things can change in an instant if he is the least bit frustrated. Last week when his 5-year-old spilled milk at the dinner table, he yelled at her for an hour. When his wife tried to intervene, he backhanded her. Everyone got real quiet. Then – the storm blew over and Al left for the rest of the evening.

If you recognize yourself in any of the above scenarios, you are being verbally abused. Make no mistake: Although verbal abuse doesn’t leave visible scars, it does do damage. The victims’ self-esteem is eroded. Children who watch one parent being put down and diminished by the other develop a skewed and sad view of how relationships are supposed to be.

6 Signs You Are Being Verbally Abused

1. Like Mary, you feel you just can’t win. No matter how carefully or kindly you try to work out a problem, your partner says things that make you feel like you’re in the wrong.
2. Your self-esteem and self-confidence are shot. Your partner isn’t your greatest fan but your greatest critic. He often tells you that his comments are “for your own good.”
3. When you say he has hurt your feelings your partner, like Frank in the scene above, tells you that you are too sensitive. When you point out that he has said something inappropriate or hurtful, he accuses you of trying to make him look bad. You notice that he rarely takes responsibility for his part of a problem. Somehow he manages to convince himself and even you that anything that goes wrong is your fault.
4. You often are the brunt of jokes that make you feel bad. The guy who is fun and fun-loving outside the family unleashes a more vicious or undermining humor inside. Other people don’t believe you that the guy they know is so different from what you experience. Like Marilyn, you find yourself constantly questioning yourself.
5. You have to walk on eggshells at home. Your home isn’t a sanctuary for you and your kids. It is the place where you are most afraid and embarrassed. You and the kids stay away as much as you can. When you are there with your partner, you all do everything you can to make sure nothing happens that could set him off.
6. If you’re not very careful, the verbal abuse escalates to physical altercations. Even if you are very careful, what starts with words can end up with physical aggression toward you or destroying things, especially things you value.

Whoever made up that rhyme about “sticks and stones will break my bones but names will never hurt me” was just plain wrong! Words do hurt. They can break a person on the inside just as surely as a whack with a stick bruises the outside. People who are subjected to verbal abuse suffer. People who are subjected to it over time can get so used to it that they lose their sense of themselves as people worth loving. If you see yourself in any of these stories, know you are not alone. There are things you can do. Part II of this article will discuss them.

Codependency underlies all addictions. The core symptom of “dependency” manifests as reliance on a person, substance, or process (i.e, activity, such as gambling or sex addiction). Instead of having a healthy relationship with yourself, you make something or someone else more important. Over time, your thoughts, feelings, and actions revolve around that other person, activity, or substance, and you increasingly abandon your relationship with yourself.

Recovery entails a 180-degree reversal of this pattern in order to reconnect with, honor, and act from your core self. Healing develops the following characteristics:

• Authenticity
• Autonomy
• Capability of being intimate
• Integrated and congruent values, thoughts, feelings, and actions

Change is not easy. It takes time and involves the following four steps:

1. Abstinence. Abstinence or sobriety is necessary to recover from codependency. The goal is to bring your attention back to yourself, to have an internal, rather than external, “locus of control.” This means that your actions are primarily motivated by yourvalues, needs, and feelings, not someone else’s. You learn to meet those needs in healthy ways.Perfect abstinence or sobriety isn’t necessary for progress, and it’s impossible with respect to codependency with people. You need and depend upon others and therefore give and compromise in relationships. Instead of abstinence, you learn to detach and not control, people-please, or obsess about others. You become more self-directed and autonomous.

   If you’re involved with an abuser or addict or grew up as the child of one, you may be afraid to displease your partner, and it can require great courage to break that pattern of conceding our power to someone else.

2. Awareness.It’s said that denial is the hallmark of addiction. This is true whether you’re an alcoholic or in love with one. Not only do codependents deny their own addiction – whether to a drug, activity, or person – they deny their feelings, and especially their needs, particularly emotional needs for nurturing and real intimacy.You may have grown up in a family where you weren’t nurtured, your opinions and feelings weren’t respected, and your emotional needs weren’t adequately met. Over time, rather than risk rejection or criticism, you learned to ignore your needs and feelings and believed that you were wrong. Some decided to become self-sufficient or find comfort in sex, food, drugs, or work.

   All this leads to low self-esteem. To reverse these destructive habits, you first must become aware of them. The most damaging obstacle to self-esteem is negative self-talk. Most people aren’t aware of their internal voices that push and criticize them — their “Pusher,” “Perfectionist,” and “Critic.”¹

3. Acceptance.Healing essentially involves self-acceptance. This is not only a step, but a life-long journey. People come to therapy to change themselves, not realizing that the work is about accepting themselves. Ironically, before you can change, you have to accept the situation. As they say, “What you resist, persists.”In recovery, more about yourself is revealed that requires acceptance, and life itself presents limitations and losses to accept. This is maturity. Accepting reality opens the doors of possibility. Change then happens. New ideas and energy emerge that previously stagnated from self-blame and fighting reality. For example, when you feel sad, lonely, or guilty, instead of making yourself feel worse, you have self-compassion, soothe yourself, and take steps to feel better.

   Self-acceptance means that you don’t have to please everyone for fear that they won’t like you. You honor your needs and unpleasant feelings and are forgiving of yourself and others. This goodwill toward yourself allows you to be self-reflective without being self-critical. Your self-esteem and confidence grow, and consequently, you don’t allow others to abuse you or tell you what to do. Instead of manipulating, you become more authentic and assertive, and are capable of greater intimacy.

4. Action.Insight without action only gets you so far. In order to grow, self-awareness and self-acceptance must be accompanied by new behavior. This involves taking risks and venturing outside your comfort one. It may involve speaking up, trying something new, going somewhere alone, or setting a boundary. It also means setting internal boundaries by keeping commitments to yourself, or saying “no” to your Critic or other old habits you want to change. Instead of expecting others to meet all your needs and make you happy, you learn to take actions to meet them, and do things that give you fulfillment and satisfaction in your life.Each time you try out new behavior or take a risk, you learn something new about yourself and your feelings and needs. You’re creating a stronger sense of yourself, as well as self-confidence and self-esteem. This builds upon itself in a positive feedback loop vs. the downward spiral of codependency, which creates more fear, depression, and low self-esteem.

   Words are actions. They have power and reflect your self-esteem. Becoming assertive is a learning process and is perhaps the most powerful tool in recovery. Assertiveness requires that you know yourself and risk making that public. It entails setting limits. This is respecting and honoring yourself. You get to be the author of your life – what you’ll do and not do and how people will treat you.²

The four A’s are a roadmap. Learn all you can about recovery. Join a 12-step program and begin keeping a journal to know yourself better. Codependency for Dummies lays out a detailed recovery plan with self-discovery exercises, tips, and daily reminders. Your recovery must be your priority. Most important, be gentle with yourself on your journey.

1. To help you, I wrote a handy ebook, 10 Steps to Self-Esteem — The Ultimate Guide to Stop Self-Criticism.
2. Because being assertive is so fundamental to recovery, I wrote How to Speak Your Mind — Become Assertive and Set Limits.

Child sexual abuse is any sexual behavior directed toward a child by a person who has power over that child. Such behavior always involves a betrayal of the child’s trust.

Some forms of sexual abuse involve physical contact. These include masturbation, intercourse, fondling, oral sex, and anal or vaginal penetration with objects. Other types of sexual abuse, such as exhibitionism, leering, and sexual suggestiveness, do not involve physical contact.

People who sexually abuse children do so in order to meet their own needs. Abusers do not have the child’s best interest in mind. Abusers need not be strangers. They can be anyone in a position of power or trust: fathers, uncles, cousins, stepfathers, siblings, mothers, teachers, babysitters, neighbors, grandparents, peers, clergy, or doctors.

How prevalent is child sexual abuse?

It has been estimated that 20-40 percent of girls and 2-9 percent of boys are sexually abused by the time they reach eighteen. These are probably conservative estimates since many incidents of sexual abuse are never reported.

Child Sexual Abuse in Asian American Communities

Little is known about the prevalence of child sexual abuse in Asian American communities. Existing research overwhelming suggests that the reporting of sexual abuse of Asian American children is proportionately lower than those for other ethnic groups. This could mean that the prevalence of child sexual abuse is lower in Asian Americans and/or that Asian Americans are not as likely to report when child sexual abuse does happen.

Surprisingly, lack of self-confidence is not necessarily related to lack of ability. Instead it is often the result of focusing too much on the unrealistic expectations or standards of others, especially parents and society. Friends’ influences can be as powerful or more powerful than those of parents and society in shaping feelings about one’s self. Students in their college years re-examine values and develop their own identities and thus are particularly vulnerable to the influence of friends.

A 1992 research report by Rao and colleagues suggest that Asian American children may respond differently than other ethnic groups. Unlike children from other groups, Asian Americans are more likely to express thoughts of suicide or attempt suicide and less likely to respond with anger or inappropriate sexual behaviors.

Asian Americans also differ from other ethnic groups with respect to the response of the primary caretaker (usually the parent). Rao et al. (1992) found that compared to caretakers from other ethnic groups, Asian American caretakers were least likely to report abuse to authorities, more likely to disbelieve the abuse, and least likely to complete evaluation and treatment of the abuse victim.

Asian American cultural values have been implicated to explain the low prevalence rates for reported child sexual abuse and the response patterns in Asian American families. Specifically, researchers have suggested that many Asian Americans fear a loss of face from others and tend to keep problems within the family. In addition, because Asian American families tend to be patriarchic, reporting child sexual abuse when the perpetrator is the father can lead to significant disruptions in the family structure.

How can I know if I was sexually abused?

If you remember being sexually violated as a child, trust your memories, even if what you’re remembering seems too awful to be true. Children simply do not make things up. It is common, however, for individuals who have been abused not to have clear memories. One way of coping with sexual abuse is to repress or forget that it ever happened. Even in the absence of conscious memories, certain experiences can trigger intense feelings of fear, nausea, and despair. Some of these “triggers” include specific sounds, smells, tastes, words, and facial expressions.

Whether or not you have specific memories, if you suspect that you were sexually abused, then you probably were. Often the first step in remembering involves having a hunch or a suspicion that some type of violation occured. Pay attention to these feelings, for people who suspect that they were sexually abused generally discover that this has been the case.

If it happened back then, why do I have to deal with it now?

There are many factors that make it impossible for children to receive the help that they need at the time of the abuse.

Unfortunately, many children who do seek support are met with reactions such as disbelief, lack of concern, and even blame. Despite efforts to seek help, the abuse may continue or even get worse.

There are many understandable reasons why children do not seek help at the time of the abuse. Abusers often scare children by threatening to retaliate or by insinuating that the child will not be believed. The abuser may also confuse the child by implying that the abuse is the child’s fault. Comments such as “You asked for it,” “You were all over me,” and “I know you enjoyed it” are often used to blame and to silence the child. Sexual abuse of a child can never be the child’s fault.

For whatever reason, if the abuse is not dealt with at the time, its damaging effects will still be present years later.

What are the effects of child sexual abuse?

There are many ways that people experience the harm that results from having been sexually abused. Consider the following questions (Bass and Davis, 1988):
Self-Esteem

• Do you often feel that you are not a worthwhile person?
• Do you feel bad, dirty, or ashamed of yourself?
• Do you have a hard time nurturing yourself?
• Do you feel that you have to be perfect?

Feelings

• Do you have trouble knowing how you feel?
• Have you ever worried about going crazy?
• Is it hard for you to differentiate between various feelings?
• Do you experience a very narrow range of feelings?
• Are you afraid of your feelings? Do they seem out of control?

Your Body

• Do you feel present in your body most of the time? Are there times when you feel as if you’ve left your body?
• Do you have a restricted range of feelings in your body? Do you find it difficult to be aware of what your body is telling you?
• Do you have a hard time loving and accepting your body?
• Do you have any physical illnesses that you think might be related to past sexual abuse?
• Have you ever intentionally hurt yourself or abused your body?

Intimacy

• Do you find it difficult to trust others?
• Are you afraid of people? Do you feel alienated or lonely?
• Do you have trouble making a commitment? Do you panic when people get too close?
• Do you expect people to leave you?
• Have you ever been involved with someone who reminds you of your abuser or someone you know is not good for you?

Sexuality

• Do you try to use sex to meet needs that aren’t sexual?
• Do you ever feel exploited sexually or use your sexuality in a way that exploits others?
• Are you able to “stay present” when making love? Do you go through sex feeling numb or in a panic?
• Do you find yourself avoiding sex or pursuing sex you really don’t want?
• Do you experience flashbacks during sex?

Will I Ever Feel Better?

The devastating effects of sexual abuse do not need to be permanent. You can heal! You have already survived the worst part, the abuse itself. You have choices now that you didn’t have then. If you choose to commit to your own healing process, have patience with yourself, and let others support you along the way, you can learn that it is possible not only to “survive,” but to experience what it means to be truly alive.

Where Do I Begin?

If you think that you may have been sexually abused, speaking with a trained professional can be extremely helpful. You don’t need to be alone in your pain. In fact, “breaking the silence” is one of the most important components of the healing process. Make an appointment with a professional who will understand what you have been through.

Need Additional Help?

The following are excellent sources of information on child sexual abuse:

1. The Courage to Heal. Ellen Bass and Laura Davis. New York: Harper and Row, 1988.
2. The Courage to Heal Workbook. Laura Davis. New York: Harper and Row, 1990.
3. Victims No Longer. Mike Lew. New York: Harper and Row, 1990.
4. Outgrowing the Pain: A Book for and about Adults Abused as Children. Eliana Gil. San Francisco: Launch, 1983.
5. Incest and Sexuality: A Guide to Understanding and Healing. Wendy Maltz and Beverly Holman. Lexigton, MA: Lexington Books, 1987.

Courtesy of the Counseling Center at University of Illinois Urbana-Champaign.

Drew, 19, and Steve, 20, were close brothers raised in a volatile family. When Drew started getting into trouble in college, their mom arranged for the brothers to live together in an apartment, hoping that Steve could watch out for Drew. This solution backfired; the boys acted out family-related power plays. Physical confrontation escalated along with family-related conflict and hostility. At this point, the mom sought help.

Mom and Dad’s Perspective

Kate was an immigrant from Italy who, more than anything, wanted a better life for her children. She worked tirelessly to earn money for their education.

Consistent with the old-school style of authoritarian parenting with which she was raised, Kate demanded devotion and obedience. She was very involved with her sons and, though caring, she was also high-strung, anxious and unrelenting when they didn’t perform – yelling, threatening and lecturing – reminding them of her very real sacrifice and suffering on their behalf.

Drew perpetually disappointed and upset Kate. He failed to live up to her expectations and often lied to appease her. She worried about his ability to be independent, responsible, and protect himself. Steve, on the other hand, was seen as the ideal son: high-achieving, responsible, and aggressive. She constantly compared the two of them.

Both Kate and Don, the boys’ father, had frequent, explosive outbursts and acknowledged that, at times, they were physically abusive to their boys. Don had a short temper and unpleasant disposition, often angry, entitled and humiliating toward Kate and Drew. He was only minimally involved with the boys and didn’t attend therapy.

Brothers: Steve and Drew

With family, Drew typically was argumentative and defiant, defensively reacting to criticism and attacks for failing to measure up. Otherwise, Drew was friendly, good-natured and sensitive. He had a palpable longing to be loved, and a chameleon quality designed to get it. Drew’s sense of worth was tied up in how he appeared, always needing others’ approval, and often feeling insecure, anxious and bad about himself.

Drew had come out as gay in high school. In college, he tried to emotionally break away from his mom and flaunt his separate identity. Seeking admiration and celebrity, he began to dress in a flamboyant and revealing style, posing online in sexually provocative photos, and behaving in ways that put him at risk to be victimized, which he was.

In college, Drew became involved in mutually obsessive relationships in which he was dominated and controlled. In these relationships, he was unable to hold his own or break away, leading to the downward spiraling of his grades, family relationships, and friends.

Growing up, Steve acted as man of the house, protecting Drew and their mom from their dad, who picked on Drew. Steve also actively defended his brother from bullies at school.

Steve proudly considered himself “the alpha male,” coming across as loud, aggressive, and stilted as if lecturing. He had an intensity, dominance and perseverance reminiscent of his mom.

Steve behaved in a paternalistic and arrogant way toward his brother, acting as co-parent and agent of their mom. As they got older, this dominance and loyalty to their mom led to increasing fights between the two willful brothers.

Power Plays between Brothers

This cycle intensified after they moved in together, escalating into physical brawls, as Drew felt ganged up on and put down. Seeing himself as in charge, Steve used his authority and physical strength to try to force Drew to behave as he deemed appropriate, including around the house. Drew rebelled and fought back. Though weaker and less physically powerful than his brother, Drew wouldn’t back down, but inwardly became increasingly panicked.

Therapy initially involved Drew and his mom, but evolved into sessions with the brothers alone.

Psychologically Speaking

Children internalize blueprints from the family. Experiences in the family become imprinted in the brain, serving as templates for future relationships. In this family, aggression and threats were used to force obedience. The mom also used emotional force in the form of guilt and shaming.

Drew and Steve learned that the only roles available in relationships were perpetrator and victim, dominance and submission. In this dynamic, power is abused, and force is used to control other people in order to manage one’s own anxiety and helplessness.

Both boys internalized this blueprint. They submitted and accommodated to what was expected in an instinctive effort to keep their mom from getting upset. Doing so also protected themselves from physical and psychological threat.

This has spawned a number of self-help books intended to serve up the latest brain research for the benefit of mental health practitioners and patients alike. Oddly enough, especially considering the mounting literature addressing developmental trauma and abuse, John J. Lemoncelli’s  2012 offering, Healing from Childhood Abuse: Understanding the Effects, Taking Control to Recover, is not such a book.

As surprising as it may seem, not one neuroscience study is listed in the book’s bibliography. Indeed, out of 43 entries, only four are research papers published since 1990 — the year that opened the “decade of brain.” None are post-2000, when brain research took yet another leap forward; an oversight which seems akin to willful neglect for a book published in 2012. Still, for those who are looking for an eclectic psychospiritual approach to therapy, Lemoncelli offers some useful metaphors, ecumenical spiritual imagery, and case histories that will support certain patients who are struggling to cope with the effects of childhood abuse — particularly those whose abuse occurred against a backdrop of religious or spiritual belief.

Lemoncelli’s primary focus is the sense of being damaged or “bad” that many survivors of childhood abuse experience. Like other practitioners who work with traumatized patients, he began to notice that his patients tended to assume personal responsibility for the abuse. In describing their feelings of worthlessness and shame, they used similar terminology. “Many of these patients expressed a sense of a thing inside of them that caused them to feel sick inside all the time,” writes Lemoncelli. “Was there a thing inside of them that created these feelings? If there was a thing inside of them, what was this thing?”

Quite reasonably, Lemoncelli recognized that a better understanding of the results of abuse and trauma should lead to better approaches in therapy. However, instead of looking to recent trauma research — which has a great deal to contribute to this understanding — he chose to look to biology for imagery that might answer these questions sufficiently for his patients.

Rejecting viruses and bacteria as useful comparisons, Lemoncelli homed in on the idea of a parasite. “Parasites exist for two reasons,” he points out, “(1) to consume the host and (2) to replicate themselves.” As a tool for imagining how the effects of abuse can be passed from perpetrator to victim, the idea of a parasite does offer some support. In this analogy the abuser, who is first affected by a parasite, contaminates the victim through abusive behavior and communication. The parasite then replicates itself inside the victim, perpetuating the abuse by regurgitating its poisonous thoughts and schemas in a self-fulfilling cycle. The goal from Lemoncelli’s perspective is to help his patients realize that they aren’t the damaged souls they imagine, but that their self-blame is driven by a parasite within them that needs to be “excreted.”

The case histories that are dispersed throughout the text are perhaps the strongest support for his goal: Here, readers can more easily acknowledge how misplaced self-blame can be as they observe it in someone else, and Lemoncelli’s natural compassion and empathy pave the way toward this understanding. In fact, it is impossible to find fault with Lemoncelli’s determination to connect with his readers, which speaks to his effectiveness as a therapist. After all, research does back up the fact that a resonant and supportive therapeutic relationship is one of the most important factors in the success of psychotherapy, whatever approach is used.

Lemoncelli also demonstrates an admirable willingness to learn from his patients. Inexplicably, however, he seems to miss an important pearl of wisdom from his patient Alisha. The parasite analogy, she says, has helped her and she is learning a new, coach-like way of talking to herself rather than succumbing to parasitic thoughts. “I know I can continue to replace my parasite with my coach,” she says. Although Lemoncelli takes two helpful lessons away from this thought — one about forgiveness and one about inner wisdom — he overlooks what could be an important refinement to his analogy. Rather than focusing on “excreting” the parasite as Lemoncelli suggests earlier in the text, perhaps Alisha has the right idea: that of turning a parasitic relationship into a symbiotic one. This strategy is not unknown in human biology. And from a research perspective, healing from trauma requires integrating our life story: We don’t heal by expelling the difficult memories, we heal by incorporating them into a meaningful thread in which we see the trauma as having increased our resilience rather than sapped it. An awareness of the last two decades of trauma research would certainly reinforce this connection.

It’s impossible in a brief review to cover all of the metaphors and psychological approaches Lemoncelli draws into this relatively short book as he works toward bringing understanding to his patients. His examples are not ineffective — in fact, some are brilliantly illustrative. But they lack a strong, unifying foundation: a need that would have been well supplied by even a brief sketch of the relevant trauma research.

Such a foundation would have strengthened the book considerably and worked to prevent its dismissal by a segment of readers that could potentially benefit from it, including those practitioners who hope to bridge the wide gap that yawns between research and practice. Without this foundation the book suffers some of the same symptoms of developmental abuse that Lemoncelli accurately observes in his patients. “For the longest time,” he writes, “the parasite has had you literally running around in circles with no sense of direction,” which “maintains your sense of hopelessness and helplessness.”

Despite this challenge, Lemoncelli’s book is sure to appeal to those who gravitate toward a psychospiritual approach, many of whom may believe that science and spirituality cannot be reconciled. But the author’s ignoring of potentially very helpful research on that basis is counterproductive. A more constructive approach would be to demonstrate, by including the research, that the two approaches can be reconciled. Nevertheless, it is that reader who holds a mistrust of science together with an eclectic spiritual bent who will be most comfortable with this book.

Healing from Childhood Abuse: Understanding the Effects, Taking Control to Recover
Praeger, April, 2012
Hardcover, 171 pages
$37

In The Attachment Therapy Companion: Key Practices for Treating Children & Families, attachment experts Arthur Becker-Weidman, Lois Ehrmann, and Denise H. LeBow seek to create a foundational text. Though they suggest that the book might be useful for caregivers as well, it is designed as a manual for clinicians, outlining the existing best practices in attachment therapy and organizing the field for the way forward. The text has an unfortunate tendency to repeat itself and some of the later chapters feel insubstantial; still, the authors have crafted a strong case for attachment therapy as an exciting theory deserving of further research.

Attachment therapy is new enough that it does not yet have a fixed terminology, so the authors wisely begin with a discussion of key definitions and concepts. The book is careful to distinguish what it terms “attachment-focused therapy” from more heavily “touch-reliant” techniques, explaining that, though touch may be involved in some successful attachment-focused strategies, the focus of the therapy is building an emotional understanding and trust between the child and caregiver. There is also an emphasis on the importance of reciprocity: The child must not only feel the effects of the caregiver’s love and support but also feel that the caregiver is affected by the child in turn. A major theme is that the caregiver’s place in the therapeutic process is equally significant to the child’s, whereas the clinician “takes more of a coaching or consultant role.”

The book argues that attachment is already the basis for many trauma-focused therapies, though it may not always be explicitly labeled. By making attachment the specific target of therapy for children who have experienced lasting trauma, the authors believe that clinicians will be able to avoid frequently used but insufficient diagnoses such as PTSD or bipolar disorder. The authors devote significant time to discussing the particular difficulties of diagnosing and treating children, and claim that attachment-focused therapy is especially suited to the developing minds of the young. They emphasize the necessity of a flexible, individualized treatment plan and rely more on case studies and examples to guide readers in working with their own clients than on step-by-step methodologies.

The Attachment Therapy Companion seems to do a fine job of consolidating current knowledge in the field and paving the way for future developments. The chosen examples are presented in a dialogue format that effectively demonstrates ways in which the clinician can strengthen the child-caregiver relationship. The emphasis on careful listening and avoiding blame for disruptive behavior, with the clinician playing the role of facilitator, provides a convincing image; it is easy to picture the children in the chosen examples making significant progress.

However, it is a bit difficult to imagine a clinician reading this book and successfully implementing its ideas without significant further research, as the text tends to be vague on the beginning stages of the therapy. The book states that a prerequisite for these techniques is a comprehensive assessment of the suitability of both child and caregiver, including “an assessment of the child and the caregiver’s capacity to be insightful, responsive, sensitive, reflective, and committed, and their state of mind with respect to attachment.” Yet it does not offer advice on how to locate and enlist such a qualified caregiver. The book addresses the fact that many traumatized children have difficult family situations when discussing behavior management and treatment logistics but does not address the seemingly larger question of how an attachment therapist would find a suitable caregiver in the lives of these children. As the book argues that attachment-focused therapy is the best way to treat these children and that the role of the caregiver is essential, the lack of strategies offered to find such a caregiver is glaring.

Ultimately, the book seems a useful resource for clinicians interested in working with child victims of lasting trauma—but it is not quite the foundational text it seeks to be. It is by no means comprehensive, and its weaknesses call out for further research and further writings. Considering the integral role of the caregiver and the significant emotional qualifications required of him or her, it seems like the logical next book would be a primer for the caregivers themselves. (Attachment-focused therapy puts an uncommon amount of responsibility on the parent figure, so he or she deserves to be provided with an uncommon amount of clinical information.) What The Attachment Therapy Companion does, however, is outline a new therapeutic model that requires more psychological knowledge from the client. Though it does not solve all of the problems of such a model, it proves the worth of its field.

The Attachment Therapy Companion: Key Practices for Treating Children & Families
W. W. Norton & Company, September, 2012
Paperback: 240 pages
$27.95

Whoever made up that rhyme is just plain wrong. Consider these comments from letters to Psych Central’s “Ask the Therapist” column:

• “My folks just tell me that I’m fat and stupid. They’re always telling me I’m no good.” –14-year-old girl
• “No matter what I do, my parents criticize me. I get good grades. I help out at home. My girlfriend is polite to them. But I can never do things enough right for them.” –17-year-old boy
• “Both my parents yell at me all the time. I try to stand up for myself but it only makes it worse. They say they wish I’d never been born.” – 11-year-old girl
• “I think my mom is depressed. She stays in bed all the time. She expects me to clean house, cook dinner every night, take care of my little sister, and bring her whatever she wants. She’s not a bit grateful. Actually, she complains about me to my grandmother and to my dad. Then they yell at me too. I don’t think I can take it much longer.” – 16-year-old boy

The anguish and bewilderment in these kids’ voices is heartbreaking. Some of the letters are laced with anger. Most are testaments to the pain of feeling unloved by the very people who the whole world tells you should love you — your parents and extended family.

The teens who write are essentially good kids who are doing all they can to do okay in school and contribute at home. They try to please their folks. They often do far more in the way of housework and child care than is reasonable to expect. All they want is for their folks to love them but all indications are they don’t. These kids want an explanation. They want to make it right. They wish and hope and dream that there is something they can do to make it different.

Sadly, there’s probably not a thing they can do to make loving parents out of angry and inadequate adults. Their parents are too caught up in their personal pain or too unloved themselves to comfort and nurture their kids.

If you relate to the kids in the beginning of this article, know that you are not alone. It’s not fair that you need to take charge of your own life so young. But constantly thinking about the unfairness will only keep you stuck and hurting. A better use of the energy that is born of anger and disappointment is to use it to fuel efforts to move on. The teen years do not last forever and there is much you can do to set yourself up for a happier present and more promising future.

Don’t add self-abuse to your parents’ abuse.

Cutting, isolating, failing in everything you do, abusing drugs and alcohol and attempting suicide may seem like reasonable responses to pain. But none of these tactics are likely to make you feel better or impress unloving parents. Although hurting yourself may provide a temporary distraction or relief, it won’t make your life better. Not loving yourself won’t help you find love.

Take it seriously but not personally.

It’s really hard not to take things personally when you’re the person being attacked. But when parents don’t love their kids, it’s usually not about the kids. Usually the parents have mental health issues of their own. Sometimes there is a family secret around the child’s birth (like a rape or grandparents’ disapproval) and the child gets scapegoated. Sometimes parents got so little nurturing themselves as children they haven’t a clue how to be good parents.

Whatever the case, it’s important that you refuse to accept your parents’ opinions. They are not an accurate assessment of your worth, lovability, intelligence, appearance, or potential. They are a reflection of your parents’ inadequacy.

Drop your end of the tug of war.

When parents are inadequate, yelling, arguing, debating, and defending yourself go nowhere. It only frustrates you and makes your parents more angry. In some cases, it fans the flames to the point where the parent gets violent. Give it up. You’re not going to change who they are or how they treat you. You don’t need to hear whatever they say when you get into a fight with them.

Develop a life outside of your home.

When home isn’t a place you want to go home to, it’s essential to find other places where you feel safe, supported, and seen for who you are. Join up with an organization, team or cause or get an evening and weekend job where you can hang out, where you can make a contribution, and where you can find friends and adult mentors who appreciate you. The best antidote for feeling bad about yourself at home is to feel very good about yourself in the larger world.

Be open to other older people who are ready to love you.

Some people aren’t born to the right family. They have to make one. When an older relative, a teacher, a friend’s parents, or a coach offer to mentor you, follow up. Invest some time in getting to know them. These people can give you some of the wisdom and support your own parents can’t give you. Some of these relationships can evolve into lifelong friendships.

Prepare for independence.

It may not be fair, but it’s important to be real. Unloving parents aren’t going to prepare you for independence. They’re just going to be glad when you move out. It falls on you to learn the skills you need to know to survive out there on your own. Make a list of what you need to know how to do, from doing your own laundry to managing money, and set out to learn how to do it. Get a job and start putting money away so you can rent a place of your own the day you graduate from high school. Get good grades and ask your school counselor to help you identify scholarships so you can go away to college.

Report.

If your parents move beyond criticism and belittling words to physical or sexual abuse, report to the local authorities and get yourself out of there. Talk to your school counselor or your doctor or the local children’s services department. Yes, it’s hard to give up on your family. But it can take years to recover from chronic abuse. You deserve better — even if your parents don’t think you do.

Anyway. I am writing to share some things I have learned in the last 10 years of therapy. I can only hope it may help one person. If it shortens his or her journey by even one long, painful, depressingly suicidal day it would be well worth it.

The first step for me was realizing everything is not as it could or should be upstairs! This may be glaring and painfully obvious to you all day every day. Take pride in that because you are actually ahead. I was practicing a lot of really reckless behaviors and endangering my life and health almost daily, but thinking that I was “fine.” Realizing this sort of behavior was probably not coming off a basis of any sort of concern or care for my welfare was the start of identifying my poor self-esteem (understatement).

It took some time and therapy but this realization grew and grew until my therapist and I started to see the depths of my problems. It wasn’t just poor self-esteem, it was utter self-hate and loathing. It was cruel and critical, cold and unrelenting, vicious and violent and nothing could halt its path. This voice operated twenty-four hours a day on full acceleration. It was a raging beast and interfered with every second of my days and nights.

At this stage some work was done to intellectually provide me with an infrastructure for another way of thinking. The theory that all of these beliefs about myself were incorrect was introduced to the raging beast. The beast thrashed through this new talk and reduced it to splinters every time it was raised. The only way I could even intellectually entertain the idea that I was not innately bad, evil, filthy, genetically wrong and hideous beyond comprehension literally was to talk about another person. I would never ever treat another person this cruelly. No matter what one of my friends had done in the past, I would never think they were remotely bad. I would want them to love themselves as I loved them. That was a starting point for me.

If you also have this raging beast in your head, you are probably one of those people feels mildly irritated when complimented or does not give it a millisecond to sink in because it’s just plain ridiculous, nearly irrelevant. You can have glaringly obvious talents, but you either have absolutely no awareness or belief in them or think that that one positive is outweighed by 600,000 negative and evil horrible parts.

The next significant step was adding some other types of therapy to open up and expose this secret, dark, raging beast. I had to feel it and express it. I used primal therapy, inner child work and art therapy both to expose the beast and to start to allow my more vulnerable and kinder parts a voice. This was a fairly lengthy process, but I believe it was probably a lot quicker than talking about it because the beast listens to no one. It wasn’t until I felt the feelings that I “got it.”

For example, someone told me that because I was only a child, being sexually abused wasn’t my fault and I wasn’t dirty or bad because of it. Using the process so far as an example I went from denial (“yeah whatever, of course it’s not the child’s fault, I don’t think I’m dirty and I don’t care so shut up”) to “If I thought of my friend/sister/a child on the street it would absolutely never ever be their fault that they were abused and it should never ever happen to anyone and they should never ever have to carry that burden” to feeling the humiliation, powerlessness, degradation, shame, and physical pain of that sexual abuse. This step allowed the beast to start letting in the tiniest momentary, usually temporary rays of compassion.

The other important aspect of this was just exposing the beast, lying on the floor and telling a benevolent witness (therapist) everything this voice was saying. After 10 minutes of emptying the latest derogatory diatribe that was on repeat in my mind, it seemed to have lost so much of its power. It did seem almost childish whereas 10 minutes previously I was a slave to its mastery and perceived wisdom.

Among and throughout these varying stages were periods of crisis, either deadly depression (in bed, staring comatose at the wall, with no will to do anything) or suicidal fantasies and active self-harm. Crisis management became really important. There was no management initially as the beast ruled. There was no sharing of decisions with anyone more mature, compassionate, caring or even sensible. It was what the beast — all the negative thought processes and critical cruel voices — says goes. There can be no other way.

So the first step was becoming aware that there was always something else to do, that these were just feelings and that I was not only made of my negative feelings. At first it was a lot about just stalling action. If I felt tempted to cut or burn myself, instead I would draw the cutting and burning, or I would call a friend, or book a session with my therapist, or get a drink or have a shower. Often in the heat of the moment you think the feeling is forever and so painful and horrible that it could never be stalled. Often, though, it can reduce in a short period of time with a distraction or by expressing those feelings through art or a feeling session or even just moving your body and energy to somewhere or someone else.

Now I have the crises more under control and don’t feel like a danger to myself so much anymore. I am building on this self-love thing. If you search for love with the Google search engine, you’ll find numerous definitions. I particularly like the Wikipedia one: “Love is an emotion of a strong affection and personal attachment. Love is also a virtue representing all of human kindness, compassion, and affection —”the unselfish loyal and benevolent concern for the good of another. Love may describe actions towards others or oneself based on compassion or affection.”

Now that’s a definition I can start to relate to.

Feeling my suffering as a child when I was intellectually and physically unable to defend myself has led to a compassion for myself and an affection of sorts for the wild ways I tried to deal with that pain and the courage I have shown to move through the impasse that seemed so impossible. I’m no Martha Stewart bumblebee now but the beast is more balanced and I think probably relieved that its job is over.

To everyone out there drowning in suffering, depression, suicidal despair and fear and loathing in Las Vegas, hang in there. Try some feeling and expressive therapies, use any tricks you can to ease the self-hate. I know you won’t believe me but you deserve to get better and it really is possible! Hang in there comrades!

The basis of Red Flags is that some people—more than we typically assume—are sociopaths, and if we are not careful to educate ourselves about their potential dangers, we are all capable of being victims of, as Andersen calls it, love fraud.

Andersen is quick to caution that the word “sociopath” is not meant in a formal sense, as a medical professional might use it. It is instead used “as a generic description for a social predator, someone who lives his or her life by exploiting others.” Although Andersen does provide a solid amount of psychological background on sociopaths, the fact that she uses the word in a way in which it is not supposed to be used is rather curious. By painting overly broad strokes, Andersen runs the risk of oversimplifying and writing in absolute terms when doing so is inappropriate.

As Andersen writes: “Sociopaths are male, female, old, young, well-groomed, disheveled. They come in all shapes and sizes.” In this way, it is frustrating that Andersen chose to cast the term that is the basis of her thesis as something of a catchall.

This is not to devalue the merits of Andersen’s book. While her subject is not widely known, it is indeed interesting and worthy of analysis. That said, when dealing with a subject that is so psychologically complex, it is counterintuitive to make the foundation so simplistic.

There are a lot of good things in Red Flags. Often, though, general themes and ideas are restated in different ways, and the same advice and wisdom is recycled. Again, what is said is certainly interesting and noteworthy, but the constant restating diminishes the impact of the ideas and negates some of their legitimacy. It’s not so much what is said that falters, but how it is said.

Along these lines, another criticism of Red Flags is its implicitly anti-male tone. Admittedly, Andersen does cite a statistic that men are three times more likely to be sociopaths than are women, and, as evidenced by the quotation above, she does concede that women, too, can be sociopaths. But of the numerous examples Andersen includes throughout the book, only a handful portrays a woman as the sociopath instead of a man.

Moreover, of the almost 250 pages, Andersen spends only two discussing female sociopaths. Despite the fact that men are statistically more likely to be sociopaths than are women, it would have been prudent to dedicate more text and examples to women being the predator. To not do so comes off as a something of a covert attack on men.

Despite these criticisms, it must be noted that Red Flags does provide some useful information. Through her website, Andersen has heard from and communicated with thousands of people who were, like she, victims of love fraud. And in the modern age in which we live, many of these relationships were started through online dating websites. Andersen writes:

Because of its global outreach and anonymity, the Internet is custom-tailored for social predators. It offers an endless supply of potential victims, so the hunt is simply a numbers game. Sociopaths register on multiple dating sites simultaneously. They randomly friend people on Facebook. They just keep baiting their hooks until someone bites.

Anonymity is a core characteristic of the Internet. When communicating via the web, you never really know with whom you are talking, and sociopaths use this to their advantage, pretending to be anybody they want.

Approximately one in five relationships is started through online dating. With the medium continuously gaining popularity and appeal, Andersen is right to caution against blind faith in it. While online dating is without question a useful—and for some, necessary—tool, it should be approached with a certain level of caution, especially when someone whom one is talking to fits Andersen’s bill of a sociopath.

Although Red Flags of Love Fraud is perhaps not as academic as it should be, it is nonetheless informative. It is certainly flawed, but it is also prescient: Considering how many people are victims of love fraud, not nearly enough are aware of its realities. Andersen’s book is a good first step.

Red Flags of Love Fraud — 10 Signs You’re Dating a Sociopath
By Donna Andersen
Anderly: June 11, 2012
Paperback, 246 pages
$19.95