Somebody, somewhere, declared April to be Autism Awareness Month. I’m all for it. We need to be more aware of it so that children are diagnosed early and accurately to make sure that they get the treatment they need.

What is Autism?

Autism is a neurological disorder that usually becomes apparent by the age of 3 if people know what to look for. Part of the problem in diagnosing autism is the wide range of possible behaviors and abilities. However, there is usually a distinct pattern of significant impairment in three major areas:

• Impairment in reciprocal social interaction. Children who are on the autism spectrum don’t get the give and take of conversation and sharing of experience. Even when very little, neurotypical kids will point to things that interest them so that others will see it too. They will babble back and forth, imitating conversation. Autistic kids seem to be in their own world, uninterested in sharing it with others or unable to understand that other people aren’t as interested as they are in their obsession of the moment. Higher-functioning kids with autism may come off as rude, clueless, or self-centered because of their apparent inability to read what is socially appropriate at any given time.
• Impairment in communication skills. Their language may be unusual, stilted, or limited. High-functioning kids on the spectrum may have large vocabularies but may use words incorrectly or idiosyncratically. Lower-functioning kids may not speak at all.
• Presence of stereotyped behaviors, interests, and activities.Spinning, flapping, and finger-flicking are common in young kids and even in some autistic adults. Many rock to comfort themselves. Children may develop an intense obsessive interest in just about anything. I’ve known kids who are walking encyclopedias about pirates or fishing or who know every detail of every one of the Star Wars movies. They can talk for hours about their “thing” but are unable to have even a brief conversation about almost anything else.Some of the more disabled kids with autism I’ve known have been obsessed with things such as different kinds of tires, ceiling fans or string. They are happiest when they can watch or play with their particular interest. High-functioning autistic adults may become experts in arcane academic or technical areas, again to the exclusion of almost everything else.

  In addition, many of these children show sensory processing disorders. They can be intensely over- or under-sensitive to sensory stimulation (lights, sounds, smells, or touch). Some are unable to stand the buzz of fluorescent lights or the smell of certain foods, the sensation of certain fabrics or changes in temperature, to name only a few examples. Some have a very high tolerance for pain. (A school program called me recently because a teenaged girl seemed to feel no pain when she pulled off fingernails.) Some can’t manage any discomfort at all. I know one preschooler who walks on tip-toe whenever he is barefoot because he can’t tolerate how grit feels on his feet.

Autism is associated with a known medical condition in only 10 to 20 percent of cases. It is thought to be genetic since 60 to 90 percent of identical twins both have it while in fraternal twins it is less than 5 percent. As yet, there is no genetic test or brain scan or medical test to use for diagnosis. We rely on observation and the experience of professionals.

Why Does the Prevalence Rate Keep Growing?

In my professional lifetime, the odds of a child having autism have kept growing. In the 1970s, the statistic worldwide was 4 in 10,000. Between 1985-1995, the number tripled to 12 in 10,000. The rate was estimated to be 1 in 155 by 2002; 1 in 110 in 2006 and 1 in 88 in 2008. Some studies are now suggesting that it afflicts 1 in 50 kids in the U.S.

What happened? Partly it’s about a change in the acceptance of autism as a genuine, distinct disorder. Partly it’s due to a change over time in the description of criteria and the number of criteria that need to be met to make a diagnosis.

When I was in graduate school in the early 1970s, we were using the DSM-II. Autism isn’t mentioned except as a subset of childhood schizophrenia. Frankly, back then, I’d never heard of it. When DSM-III came along in 1980, a section on infantile autism was added and the first effort was made to delineate criteria. It took until the DSM-IIIR in 1987 for autism disorder to appear with a well-articulated set of 16 criteria, 8 of which had to be present to warrant a diagnosis. By the time the DSM-IV (1994) and DSM-IVR (2000) came out, the number of criteria had been reduced to 12, with 6 being needed for a diagnosis. With each succeeding edition, mental health professionals became more aware of autism as a possible diagnosis.

At least some of the increase in prevalence is due to that awareness on the part of professionals. Some of it is probably because kids who at one time might have been diagnosed with psychosis or retardation or hyperactivity are now being assigned the diagnosis of autism. And some of it is due to the fact that parents and teachers have become much more attuned to the possibility that a child is on the autism spectrum, so evaluations are occurring at a much earlier age. Finally, it’s possible that there is something going on in our environment or in genetics that is causing an increase in the disorder. That last one remains a mystery.

What if You Suspect Your Child Has Autism?

With the increase in autism prevalence and awareness has come an increased sophistication in screening. A diagnosis of autism is rarely assigned before 15 to 18 months of age. If by then you suspect that your child isn’t developing as he or she should, you can first go to one of the many websites that have quizzes and checklists for the symptoms of autism for the age of your child. But please don’t go on the results of those websites alone. There are many reasons why a child may not be keeping up with peers. It’s just a good, if crude, first effort.

The next step is to ask your pediatrician to take a look at your web-based checklists and to decide if a referral to an autism screening team is advisable. There are early childhood interventions (EI) teams all over the U.S. who can make a more refined diagnosis and who can offer treatment if it is needed. If there is no EI team nearby, there is probably a diagnostic team in a mental health clinic or children’s hospital near you. An accurate diagnosis is essential. Diagnosis is what determines what types of treat may be the most helpful for your child.

Early Intervention Matters

There is no cure for autism but when children get intense and appropriate treatment early on, preferably before age 3, many can and do learn compensatory skills. Excellent programs provide physical, occupational and speech therapy as well as coaching in social and language skills for the child. They also provide coaching and support for parents so they can reinforce and continue the treatment at home. If there is no comprehensive program nearby, there is often a resource center connected with a school or with a medical center that can help families get the services the child needs.

Other factors, including cultural context and faith, play an enormous role in implementing crisis interventions. This paper will compare and contrast some of these elements and models to examine how crisis interventions can be best handled now and in the future.

Crisis Intervention

Crisis management after a natural disaster is critical. Going about it properly is key to the success of crisis aversion.

There are many elements to examine when looking at a natural disaster. These include: disaster type; disaster zone environment; available resources; and delivery of resources to the area in which the disaster occurred.

Psychological First Aid

It is important to consider psychological first aid when talking about crisis management for natural disasters. This model examines the needs of the first responders and those involved with crisis recovery and management. Such people can include rescue workers, police officers, firefighters, humanitarian relief workers and any others who are in a position to help out during a natural disaster. This model includes key aspects such as education, providing support of peers, speedy recovery, mental health accessibility and a continuum of care (Castellano & Plionis, 2006).

As Castellano and Plionis (2006) discuss, first responders view themselves as having to be strong for others. Showing emotion is considered a type of weakness. This often develops into a hesitancy to seek help, which ican lead to worsening mental health. This creates a domino effect. The first responder needs to be psychologically and physically healthy enough to assist others. However, if their own physical and psychological health is ignored, the person in need may not be taken care of either (Kronenberg, Osofsky, Osofsky, Many, Hardy, & Arey, 2008).

However, psychological first aid is not applicable only to the first responder. It also is a model of how the first responder is able to help those in need. Providing compassionate engagement is key to helping those who are faced with a natural disaster, as well as allowing those in need to know that the first responder’s purpose is to provide safety and emotional comfort (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

The first responder also must be able to collect information pertinent to disaster victims’ immediate needs. The first responder must be clear-headed enough to recognize the population’s needs and resources available to meet those needs. This requires the first responder to maintain psychological steadiness (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

Stabilization is another key to psychological first aid. A first responder must be able to calm those who are in crisis due to a recently experienced trauma. This is applicable to those who are helping the first responders as well. However, the level and immediacy of stabilization may be different according to the different scenarios and to the needs of a crisis victim vs. those of a first responder. (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

Cultural Considerations

As with most other topics, cultural considerations come into play when looking at crisis management for natural disasters. For instance, within an Asian setting, emphasis may be placed in different areas of a crisis intervention model than it would in a Western one (Udomratn, 2008).

In India, the Nitte Rural Psychiatric Project was adapted for those with limited access to resources. This project offers free care. Its goal is to overcome the stigma of mental health care by utilizing respected community members of, such as religious leaders and local doctors. Education, lectures and awareness are components to mental health care and crisis management. (Akiyama, Chandra, Chen, Ganesan, Koyama, Kua et al., 2008).

However, in another part of Asia, Senior Peer Counseling may be viewed as important in crisis intervention. In Singapore, the respect given to elders may play a valuable role in developing models of overcoming crises after a natural disaster (Akiyama, Chandra, Chen, Ganesan, Koyam, Ku., et al., 2008). In Korea, the Seoul Mental Health 2020 project offers a review of key components of the community mental health resources available to those in the area. This includes looking at adequate coverage, diversifying services in particular areas and also an integration of services. This model is looks at the overall structure of mental health and crisis intervention and aims to improve it (Akiyama, Chandra, Chen, Ganesan, Koyam, Ku., et al., 2008).

Holistic support also may be an important consideration in crisis intervention needs within an Asian population, as discussed in the Yuli psychiatric rehabilitation model for Taiwan.

Faith-based Interventions

Faith-based models also may be considered when dealing with crisis intervention following natural disasters. One model in particular, called the Camp Noah model, focuses mainly on children who have been affected by natural disasters. It is a week-long camp that allows children to express their trauma and be in an environment that supports their faith. It also relies on fun activities to provide therapeutic relief of trauma for these children (Zotti, Graham, Whitt, Anand, & Replogle, 2006).

The Camp Noah model is similar to some of the culturally-based Asian models in that it takes the context of the individual and community to heart. However, its format differs. It does not take on the viewpoint of therapy, but of a therapeutic means of expression. The Camp Noah model is more of a strategy, whereas the Asian-based models are more of an implementation. The Camp Noah model utilizes Bible study, therapist consultation, music, games and crafts. It also has the elements of low participant ratios for quality care and highly trained staff to provide adequate care for children (Zotti, Graham, Whitt, Anand, & Replogle, 2006).

Camp Noah seeks to improve disaster trauma processing and coping skills related to natural disasters. Most of the Asian-based models focus on reducing the stigma of seeking mental health care when a natural disaster does occur. There also are similarities between these models: the community setting is taken into account, and the community and its available resources are included.

Integrative Reviews

An examination of the purpose, sample, method, procedure and results of differing models is a good means of conducting an integrative review for crisis intervention models. Walsh (2009) examined different means of cultural crisis interventions for relief workers after natural disasters had occurred. A cross-cultural sample was examined in-depth to see what governmental and non-governmental agencies could do to intervene.

Walsh (2009) focused primarily on the incidence of reducing post-traumatic stress disorder and how each model worked within the context of cultures such as New Zealand, Germany, the United States, Australia, Turkey, Taiwan, Israel and Iran. Walsh found that three key elements in the data reduction model were relevant to each culture. These three elements included: debriefing, team building and preparation. These elements were different according to the cultural context; however, each proved effective in each of the cultures (Walsh, 2009). Walsh notes that long-term effects on relief workers should be further researched for future crisis intervention models (Walsh, 2009).

Conclusion

Crisis intervention has many elements in the context of a natural disaster. There are the considerations toward the population involved in the natural disaster and the aftercare of not only this population, but the relief workers as well. Models based on cultural contexts are necessary to provide effective intervention and treatment to particular populations. There is also the element of faith when developing crisis intervention models, so as to look at ways of coping with and overcoming trauma. And finally, there is the relevance of examining a model within the cross-cultural context that integrates key elements so as to be globally applicable and efficient in reducing such traumas as post-traumatic stress disorder and other mental health concerns.

References

Akiyama, T., Chandra, N., Chen, C., Ganesan, M., Koyama, A., Kua, E., et al. (2008). Asian models of excellence in psychiatric care and rehabilitation. International Review of Psychiatry, 20(5), 445-451. doi:10.1080/09540260802397537.

Castellano, Cherie, and Elizabeth Plionis. 2006. “Comparative analysis of three crisis intervention models applied to law enforcement first responders during 9/11 and Hurricane Katrina.” Brief Treatment and Crisis Intervention 6, no. 4: 326-336. PsycINFO, EBSCOhost.

Kronenberg, M., Osofsky, H., Osofsky, J., Many, M., Hardy, M., & Arey, J. (2008). First responder culture: Implications for mental health professionals providing services following a natural disaster. Psychiatric Annals, 38(2), 114-118. doi:10.3928/00485713-20080201-05.

Udomratn, P. (2008). Mental health and the psychosocial consequences of natural disasters in Asia. International Review of Psychiatry, 20(5), 441-444. doi:10.1080/09540260802397487.

Vernberg, E., Steinberg, A., Jacobs, A., Brymer, M., Watson, P., Osofsky, J., et al. (2008). Innovations in disaster mental health: Psychological first aid. Professional Psychology: Research and Practice, 39(4), 381-388. doi:10.1037/a0012663.

Walsh, D. (2009). Interventions to reduce psychosocial disturbance following humanitarian relief efforts involving natural disasters: An integrative review. International Journal of Nursing Practice, 15(4), 231-240. doi:10.1111/j.1440-172X.2009.01766.x.

Zotti, M., Graham, J., Whitt, A., Anand, S., & Replogle, W. (2006). Evaluation of a Multistate Faith-based Program for Children Affected by Natural Disaster. Public Health Nursing, 23(5), 400-409. doi:10.1111/j.1525-1446.2006.00579.x.

Though the author died in 2008, her publisher, W. W. Norton & Company, has released a new edition this year, this time with a companion CD. The book is written mostly for those practitioners either in training or early in practice, and it remains quite relevant.

Lukas writes clearly and concisely, offering quick yet interesting insights. She helps readers understand why assessment is important, then provides skills to improve one’s interviewing skills. There are two goals for the first interview with adult self-referred clients, Lukas writes: allowing the client to tell their story in their own words, and letting the client know that you understand their point of view. She reminds clinicians to meet the client where they are instead of going by their own pre-set agenda for the session.

In assessing a new client’s mental state, Lukas writes, one should observe appearance, speech, emotions, thought processes, perceptions, capacities, and attitudes. However, observing mental state is not enough: One must also assess a client’s medical history — something Lukas says clinicians tend to overlook. The book provides templates for write-ups of both the mental state and medical history aspects of the assessment.

Lukas also provides guidance on assessments in situations beyond that of the adult self-referred client. She discusses the distinction between systemic family therapy and simply seeing families, as well as special considerations for interviewing children.

In a separate chapter, she helps therapists navigate clinical interviewing with couples, reminding us to never assume that a couple wants to stay together just because they are seeking therapy. A significant portion of the book is also dedicated to the assessment of safety issues such as self-harm, substance abuse, and child neglect.

Perhaps one of the most useful aspects of Lukas’s work is that she makes it a point to address the ways assessments must differ depending on the client. This, paired with her templates and tips for write-ups, makes her book a useful reference for any mental health practitioner.

Where to Start and What to Ask: An Assessment Handbook
W. W. Norton & Company, May, 2012
Paperback, 208 pages
$29.95

People may be afraid that they are “crazy” or that others will look down on them for it. They may have an irrational fear that they will be locked up. The truth of the matter is that seeking professional help is a suitable course of action in many situations.

If you are resisting seeking mental health help, there are a few things that can help you move forward.

Figure Out Why You Are Reluctant

Some people can point to very specific things that teach them that they should not engage in seeking mental health help, but other people have only a strong and unconsidered resistance to the idea. If your mind automatically shies away from thinking about the possibility, ask yourself why. Are you afraid of how you will be seen? Are you concerned about the idea of being put on drugs that will affect you adversely? Once you figure out why you are averse to the idea, you can move forward.

Use Anonymous Help Lines

There are a number of anonymous help lines where trained counselors can help distressed people or suggest ways to handle mental health concerns. Though suicide hotlines are the best known, there are others which will help you understand mental health services and put you in touch with the organizations that you need. There is no pressure in calling an anonymous hotline, and you’ll find that it can make you much more inclined to talk about getting the help that you need.

Stop Using Pejorative Language

Many people afraid of seeking help for mental illness speak derogatorily about those who do. They use words such as “crazy,” “psycho,” or “loony bin.” Not only does this shame people who might be listening, it also creates a distance between themselves and something that could potentially help them. When you catch yourself calling yourself or someone else crazy, stop yourself. At the very least, it might clue you in to how you are behaving.

Ask Around

It can be hard to find a mental health professional who is suited to you. For example, if you are dealing with issues related to alternative lifestyles, sexuality or abuse, you want to make sure that you are dealing with a professional who is skilled in these matters. If your friends or family members regularly see a therapist, ask them for advice. If you feel as though you cannot talk to anyone who knows you, go online. Many people review their counselors on the Internet, and it can help you find someone who can help you.

Talk it out

Talk out your fears with a sympathetic friend. Find someone you know who is aware of issues like this, or at least someone you know will be understanding. Sometimes, it can be a good way for you to overcome your fears; others may be able to point out things that you miss. It also can be very freeing to talk to someone about something you may perceive as shameful or problematic. This is something that can give you the courage you need to move forward.

Ask for Company

If you are making your first steps toward seeking professional psychological help, you’ll find that it can be tough to even make it out the door. You might find yourself delaying the trip or repeatedly putting it off. Making that first step is hard, and sometimes, it is a good idea to make sure that you have a friend who can help you with it. Ask a friend to go with you on your first trip to a mental health center. They may simply drive you there, or they may wait there with you. This can be quite comforting if you are worried or if you have anxiety problems. Your friends want to be there for you, so remember to let them.

Keep a Journal

Sometimes, people have very short memories when it comes to their mental health. They may have a good idea, and in some ways, they simply forget that they ever have bad ones. It is a perilous see-saw. They do not get help when they are upset because they lack the willpower or motivation, but when they are feeling happy, they don’t get help because they’re convinced that they will always be happy. Keeping a journal that tracks your moods can help you establish patterns that will help you understand what is going on. Also, a journal is a great thing to give to a mental health professional, as it shows where you have been and what you have been going through.

Consider Support Groups

If you know the area with which you are struggling, it can benefit you to go to a support group. Support groups often are mediated by people with some kind of mental health training. In some cases, a support group is less intimidating because you can hang back before you participate, and the focus is not necessarily on you. If you live in a major city, support groups often are quite numerous, but if you live in a smaller city or a rural area, they may take some effort to attend. Remember that participation in a support group is purely voluntary, and that you can leave at any point during the meeting that you want to.

Consider What to Expect

People often are nervous about seeking psychological help because they are afraid of the unknown. They may think that someone will make a snap judgment about their case, and they may be afraid that they will not be able to negotiate their needs. When you go in for a mental health appointment, you will be asked to fill out a questionnaire about yourself and your reasons for seeking treatment. Then a therapist will talk to you, and if it is appropriate, outline their ideas for treatment. None of this is binding, and you are allowed to state your preferences.

Set Limits

Some people feel that they will be completely helpless when they are dealing with a counselor. The truth of the matter is that unless you are speaking of doing something illegal or you are going to harm yourself, a mental health professional cannot detain you in any way, nor can they force treatment on you. If you do not want to be on medication, you can set that as a limit, and if there are some things which disturb you or upset you, you can set limits there too. Mental health professionals should always encourage good boundaries.

Mental health can be a frightening issue to deal with, but learning more about it can make you much healthier and happier.

As humans, when we are stressed, we find a way to cope. This helps survive. Identifying how people do something that is such second nature can be challenging. In his new book, Psychological Adaptive Mechanisms: Ego Defense Recognition in Practice and Research, Beresford’s stated goal is “to present a simple, consistent, usable model and method [for] recognizing human psychological adaptive mechanisms.”

As an apologetically  academic work, Psychological Adaptive Mechanisms may not be the best book for someone looking to casually learn a little bit more about this subject. Psychological Adaptive Mechanisms is written for academics and psychology students, not for people with a general interest looking to bone up on this topic.

That said, for those in academia, as well as those with a serious interest in psychology, Psychological Adaptive Mechanisms presents a compelling argument that is well-written, well-outlined and well-supported.

The basis of psychological adaptive mechanisms is worth devoting a few lines. Beresford writes:

“As an act of life, [humans] engage in a ritual that draws them close together and itself allows for a greater range of freedom in living their own lives. In this sense, although not negating the inevitability of demise, they come to terms with it in a way that allows them to function… the ultimate goal of successful psychological adaptation is to increase adaptive options to include the most flexible, creative, and therefore most effective actions available to any single person at any given point in time.”

The endgame of psychological adaptation, like physical adaptation, is survival, or, as Beresford puts it, “effective human functioning.”

Early on, Beresford outlines human adaptation and explains the need for it. In the second chapter, “The Clinical Model,” he describes his unique model for recognizing psychological adaptations. Admittedly an elementary representation, Beresford presents two drawn figures: the first is a large circle, which represents “the experience of the Self.” Within the circle is a smaller circle, labeled “ego.” External to the larger circle (the Self), is “Stress,” as perceived by the ego.

The second figure appears identical yet it depicts the smaller circle becoming increasingly larger as well as elongated: “As stress perturbs the ego, it generates anxiety, defined as a sense of either impending disaster or doom.” This feeling is uncomfortable. It will not necessarily cause disaster or doom, but it can make us believe it will. In order to maintain “effective human functioning,” we must adapt. We must find a way to relieve the stress.

Occurring on an unconscious level, this is not something which most of us control. Meditation and stress-relief exercises are of use. As conscious choices, they play little or no role in this scenario.

Tracing stress back to its most primitive of uses, Beresford writes: “For humans, anxiety — that subjective sense of either doom or disaster — can be considered the subjective human equivalent of the fight-or-flight discomfort that occurs in less neurally complex organisms.”

In this sense, stress is of obvious benefit, for “were anxiety not at all present in the human…as part of his or her biological and psychological makeup, no physiological reaction or fear would attach itself to the presence” of impending disaster. Humans would be unable to survive.

The understanding the basis of psychological adaptation is vital to understand Beresford’s model as well as why and how it differs from other approaches.

As a lay person, I cannot judge Beresford’s conclusions. What I can say, however, is that Beresford’s writing is clear and understandable. Psychological Adaptive Mechanisms is an admirable book and I believe it’s safe to say its worth will not be downplayed.

Psychological Adaptive Mechanisms: Ego Defense Recognition in Practice and Research
Thomas P. Beresford
Oxford University Press, USA, June 8, 2012
Hardcover, 338 pages
$59.99

This is not just the subhead of the book “Almost a Psychopath,” but the underlying question that authors Ronald Schouten and James Silver help readers understand as they delve into the complex and often contradictory behaviors of psychopathy and its cousin, near psychopathy.

Readers learn about real people who show characteristics of actual psychopathy: manipulation, exploitation, deceitfulness, and lack of remorse. The authors compare these traits to people who have what they classify as “almost” psychopathy, as well as medical conditions with similar traits: borderline and narcissistic personality disorder, bipolar disorder, brain injury, Asperger’s syndrome, and even toxin poisoning.

By book’s end, readers should have a basic understanding of psychopathy—enough to do a lay assessment and map out a strategy for seeking help.

Silver and Schouten approach this topic and explain it with a breadth of experience and knowledge. Both are attorneys who’ve represented criminals in the courts. In addition, Schouten is a Harvard professor of psychiatry and director of the Law & Psychiatry Service at Massachusetts General Hospital. They combine their first-hand experiences with current scientific research to examine this topic in both abstract and concrete terms.

The book opens with a story about a true psychopath, Bill, who works in his company’s shipping and receiving department. He is known to have an explosive temper and brags about keeping a loaded shotgun in the trunk of his car.

When he asks a co-worker, Amy, on a date, she declines. Seeking revenge, Bill asks Amy’s best friend on a date. When they go out, Bill takes some suggestive photos of Amy’s friend. He then posts them on Facebook and sends the link to Amy, who is disturbed. A few weeks later, Bill calls Amy to the mailroom, claiming she has received a package. Though suspicious, Amy goes to the mailroom, where she finds Bill in a rage. He has learned that Amy went out with a co-worker, after turning him down. He screams at her, slams the door, and punches his fist through the wall. Amy escapes and Bill is promptly suspended.

What makes him a psychopath and not a near psychopath? The authors spend an entire chapter exploring this question. Readers learn the most prominent, consistent characteristics of actual psychopaths are narcissism, deceitfulness, and a lack of empathy. They may or may not have a criminal history. The majority do, because they have trouble abiding by the normal rules and laws of society.

This understanding of psychopathy serves as the foundation for all further explorations and comparisons. What separates this book from others on this topic is the authors’ “Almost Effect” theory. As they see it, behavioral and emotional aberrations fall onto a continuum, running from socially acceptable behaviors to full-blown psychopathy—a type of spectrum that we think of when talking about autism. As for the “Almost Psychopath,” the authors write, “Whether because of the nature of their behavior—simply beyond what most of us can comfortably ignore—or because they violate social or legal norms so frequently, these people live their lives somewhere between the boundaries of commonplace ‘not-so-bad’ behavior and psychopathy. In that balancing of influences, their calculations more commonly lead them toward behaviors that most of us would find offensive and contrary to social norms.”

In medicine, this “almost effect” is referred to as a sub-clinical disorder. In fact, this book is part of the “Almost Effect” series, which, so far, includes this book and “Almost an Alcoholic.”

Their theory not only makes sense, but is slightly comforting. Anyone who has spent time in the mental health system knows that there are more shades in of gray in psychological labeling than black and white definiteness. A sliding scale seems more realistic (unless, of course, you’re dealing with Charles Manson or Ted Bundy). The authors take a conversational and practical approach, though the text is in no way dumbed down.

There’s not much to criticize about this book. However, despite of the authors’ strident efforts to distinguish between the different mental conditions, the sheer difficulty in pinpointing an exact psychiatric illness remains tough. Readers may come to the confusing and frustrating conclusion that the person they’re trying to understand is part narcissistic, part bipolar, and maybe even part psychopath.

At that point, they may conclude it’s time to meet with a professional. For that, the authors provide help too. Like the rest of the book, their advice comes across as experienced, honest, and very practical.

Almost A Psychopath: Do I (Or Does Someone I Know) Have a Problem with Manipulation and a Lack of Empathy

Ronald Schouten, M.D., J.D., and James Silver, J.D.

Hazelden Publishing, June, 2012

Paperback, 280 pages

$10.17

We asked several clinicians to describe their mottos. Perhaps their tenets will stir you to take the time to think about the words you’d like to live by.

Joyce Marter, LCPC, psychotherapist and owner of Urban Balance, LLC:

In life, we are all dealt a different hand of hardships and blessings. We each have a unique life experience that will help us learn, grow and develop emotionally, relationally and spiritually. We must each honor our personal life history to gain awareness of how our earlier experiences have shaped and molded us into who we are today.

We have the choice to let go of old belief systems and negative thinking patterns that constrain us and create our own ceilings. We have the power to attract positivity in our lives by silencing our inner critic and practicing gratitude.

In my practice and in my own life experiences, I have come to believe that some of the greatest life challenges bring about gifts such as increased consciousness, awareness, depth, perspective, empathy, compassion, resiliency, wisdom, strength, capability, tolerance, and serenity.

Our life outcome all depends on how we view the hand we are dealt. If we focus on the negative, on our egos, or on the hardships of the past we will not thrive and prosper. If we view our hardships as opportunities for growth and learning and empower ourselves to move forward in life in a way that is compassionate and loving to ourselves and others, we will succeed personally and professionally.

John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens:

For myself, I try to follow a couple of guides. First, I try to follow “The Four Agreements” as delineated by Don Miguel Ruiz in his book of the same name. The very basic agreements read:

• Be impeccable with your word.
• Don’t make assumptions.
• Don’t take anything personally.
• Always do your best.

I’ve distilled these down to two: Be impeccable with your word, and always do your best. If I achieve these every day, I believe I’ve led a good life.

I also try to keep the Serenity Prayer in mind every day: Grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference. I calm myself with these thoughts whenever I get anxious.

Deborah Serani, Psy.D, a clinical psychologist and author of Living with Depression:

I love using proverbs and quotes to help guide me in life. I weave them into my clinical practice with people I work with too. One of my favorites for when life seems tough is the Japanese proverb: “Fall down seven times, get up eight.”

It helps me realize that no matter how many times I fall, I have the power to rise again. So this wonderful, wise proverb helps me summon resilience.

Ari Tuckman, PsyD, a clinical psychologist and author of Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook:

[My motto is] Good deeds tend to be rewarded. I don’t believe in karma, but I do believe in playing the odds. Good deeds build good will, so the more people who have positive thoughts about you, the more likely it is that good opportunities will come your way. Being diligent about handling your responsibilities and being generous about helping others out builds fans who are happy to reward good performance and return the favor.

I’ve found that some “sure bet” opportunities didn’t work out as expected but also that interesting opportunities came out of the blue, so you can’t be too mercenary about it or expect a direct reward for every good deed. Rather, it’s a general mindset that doing enough of the right things will bring enough of what you want.

Beyond the obvious aspects of you scratch my back, I’ll scratch yours, there is also the more subtle aspect that people like to associate with others who they see as capable, generous, and positive.

Emily Campbell, LCPC, CEAP, a psychotherapist at Urban Balance, LLC:

[My motto is] Love God, love people. It comes from Jesus’ words that the greatest commandments are to “love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength, and to love your neighbor as yourself.”

It means focusing first on loving God, and allowing His love to flow through us to others, treating them as we would wish to be treated. Our relationships with God and other people comprise our life; everything else is just the extras.

Alison Thayer, LCPC, CEAP, a psychotherapist at Urban Balance, LLC:

[My motto is] Everything will be OK in the end. If it’s not OK, it’s not the end. (I believe the author is considered unknown.)

I use this motto to highlight the significance of the journey and the lessons we experience in life. So often, we get caught up in not having what we want when we want it. This is particularly valuable to perfectionists, or “Type A” personalities who are driven and expect to get immediate results. These individuals can really struggle when the results are not exactly as they anticipated, and they may view the alternative result as a failure (also known as all-or-none thinking).

Instead, that alternative result may generate personal growth, goal clarification, or lead one to realize what they wanted isn’t what they want anymore. Or, they may get what they want, but at a later time, and they may value it more than ever.

Richardson highlights the significant role Knox played in devising methods of screening immigrants for mental deficiencies during Knox’s brief four years as an inspecting physician at Ellis Island, from 1912 to 1916. Knox and his colleagues were charged with assessing immigrants’ mental capacities, because federal law then mandated that anyone deemed to be an “idiot,” an “imbecile” or “feeble-minded” be denied admittance to the country on the grounds that they would pose a burden to the state.

Under significant public pressure to carefully cull the arriving groups for those deemed mentally deficient, Knox, with help from colleagues, devised a battery of pioneering “performance tests.” They were the first to attempt to measure intelligence in a “culture-free” way — one that would not penalize test-takers whose first language wasn’t English or who had grown up with skills and cultural knowledge very different from those one would acquire living in the United States.

As Richardson shows, Knox’s contributions to intelligence testing ultimately reached far beyond the immigration center in New York Harbor to influence towering figures in the field. Richardson discusses the eugenics movement that flourished during this period and, most significantly, provides a comprehensive history of intelligence testing in the first half of the 20th century.

The result is an exhaustively researched book that will surely appeal to historians of intelligence testing and historians of science, as well as professionals with a particular interest in the developmentally or mentally disabled. However, it is likely to prove too detailed and scholarly to sustain the attention of most general readers.

Knox is a fascinating figure, a young general physician who seems to have fallen into this area of research almost by accident. He was posted to Ellis Island during a time when screening immigrants for mental deficiencies was both a legal mandate and a topic of broad public concern. As Richardson writes:

For just four years, between 1912 and 1916, Knox was not just a conscientious physician and government employee; he was also a highly prolific scientist at the forefront of developments in the construction of intelligence tests.

Richardson argues that even though Knox’s contributions to intelligence testing were largely overlooked and forgotten, especially in the decades after the Second World War, he should be looked at as “a major figure” in the field. His work provided a key link between earlier pioneers, such as those whose work formed the basis of the famous Stanford-Binet IQ tests, and later, even present-day, researchers.

In particular, Richardson convincingly argues that Knox’s approach was groundbreaking because he set out to create tests that, at least in theory, would not rely on immigrants’ verbal knowledge or familiarity with norms of American or Western European culture. These “performance tests” were adapted and incorporated into intelligence testing and cross-cultural research around the globe in ways, Richardson says, that Knox himself “could scarcely have imagined.” 

Knox’s ideas about the importance of nonverbal testing were an inspiration for the developers of many later tests, including large-scale mental testing carried out on Army recruits during the First World War; cross-cultural research on ethnic minority populations around the globe; and the Wechsler Intelligence Scale, which are still among the most commonly used assessment methods. One included a version of one of Knox’s tests until its 2008 revision.

Despite his obvious respect for Knox’s achievements, Richardson is ultimately critical of Knox-style performance tests’ ability to be truly “culture-free” and to rely on completely nonverbal means of administration and execution. Richardson cites research, for example, showing that ethnic minorities’ scores on performance tests in many different areas of the world have been higher depending on the extent to which they were exposed to Western culture by being educated in Western-style schools. In the end, Richardson writes:

The tests are artifacts constructed within a specific culture, and they cannot be expected to transfer to different cultures from the one in which they were constructed.

Unfortunately, most of Richardson’s apt analysis doesn’t come until the end of the book. He spends most of Howard Andrew Knox presenting a straightforward and detail-laden history that relies heavily on archival research but tends to bury the readers in facts, with little guidance as to how to interpret their significance.

Richardson seems to have combed the historical record thoroughly, so the lack of analysis may be due in part to gaps in the available source material. For example, although he provides a thorough examination of Knox’s academic and popular writings describing and publicizing the tests, Knox doesn’t seem to have kept personal journals or to have carried out extensive personal correspondence that would allow more in-depth insight into the rationale and motivation behind his work.

As a result, we get a detailed picture of the tests he developed – or helped develop, since evidence is lacking about exactly what role his colleagues at Ellis Island played in devising the tests. But the picture of Howard Andrew Knox the man is more thinly fleshed out, including the intriguing question of why his involvement in the field of intelligence testing was so brief. After just four years, he left Ellis Island to become a “country doctor” with no involvement in the field of research or even in administering the tests he created.

Still, the book provides an important account of the role that one man played during a fertile and important period in the history of American immigration and intelligence testing.

Howard Andrew Knox: Pioneer of Intelligence Testing at Ellis Island
By John T.E. Richardson
Columbia University Press: November 22, 2011
Hardcover, 352 pages
$55

Shapiro explains that Eye Movement Desensitization and Reprocessing (EMDR) therapy has been practiced by 70,000 clinicians worldwide. According to the book, over 20 million people have had a positive response to the treatment.

Shapiro goes on to discuss post-traumatic stress disorder (PSTD). PTSD involves extreme emotional distress from significant trauma such as major accidents, physical or sexual abuse, combat or natural disasters. Her research has shown that many people have the same symptoms of PSTD, including feeling anxious, fearful, jumpy or shut off from others, intrusive thoughts, guilt or disturbing dreams.

The book examines topics such as finding out who we really are, how the mind, brain and body are interlinked, finding a safe or calm place, blame, and searching for the source, among many other interesting insights. There are also many techniques included to help get hold of some those negative thoughts so that they can be reprogrammed into more positive thinking and actions.

The first chapter addresses the automatic response, as illustrated by asking you to say what pops into your mind when you hear “Roses are red…” Nearly everyone will say “Violets are blue,” even though violets aren’t actually blue.

Each subsequent chapter takes a different theme, such as “What’s running your show?,” and then looks at how EMDR addresses that. Sprinkled throughout the text are examples for using certain self-help techniques, such as the butterfly hug. One technique Dr. Shapiro seems to find especially useful is a breathing technique martial artists use to remain calm and in control.

Appendix A is an excellent resource for someone who wants to get on an easy-to-maintain program of well-being.

Appendix B, “Choosing a Clinician,” provides information for the reader who wants to begin EMDR therapy but doesn’t know how to do that. It also provides information on EMDR humanitarian assistance programs.

Appendix C, “EMDR: Trauma Research Findings and Further Reading” is probably meant for the medical practitioner. Many of the listed sources are professional journals.

While the author does build a case for EMDR’s success, she recommends practicing it only with trained professionals. There are a few clinical terms that really enhance the book instead of burden the reader. All in all, the book is a good read and I’d recommend it to those who are on a self-exploration mission. The book does provide many stop-and-think moments that the reader may or may not enjoy, depending on the memories that may be released.

Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy
By Francine Shapiro, PhD
Rodale: February 28, 2012
Hardcover, 352 pages
$26.99

Dr. Baumgartner is not a stylist, but a psychoanalyst of closets: She runs InsideOut, her own wardrobe consulting business.  She is also a practicing clinical psychologist and a former math teacher, lending credibility to her analytical and psyche-focused approach.  You Are What You Wear centers on how we can learn to see our clothes as a link between our internal and external selves. Only by fully understanding this connection can we begin to improve our whole person.

Dr. Baumgartner begins with an initial questionnaire about the past, present, and future of your clothing choices.  Following the results, the reader is directed to the applicable chapter(s), all of which follow the same outline: a checklist for self-assessment, a case study as illustration, and a step-by-step action plan, ending with “Your Turn,” a section of specific techniques for implementation.

The first few chapters cover familiar territory, at least to those who watch reality television: shopping addiction, hoarding, and being stuck in a rut.  Or, as they are known to Dr. Baumgartner: using shopping as therapy, having your clothes stand in for goals and dreams, and general apathy toward life.  She stresses that we all have these problems at some point, specifically emphasizing the roles of dopamine and social learning.

The middle section more directly concerns body image issues, such as dressing too young or too old for your age and too small or too big for your size.  Everything from the media’s sexualization of women to vanity sizing to fear of mortality is examined in context of the reasoning behind wardrobe choices.

The final portion of You Are What You Wear deals with the more complex situations of work/life balance, designer obsession, and of course, the dreaded ‘mom jeans.’  The through-lines of having pride in your appearance, not fusing your identity with your clothing, and being true to yourself continue, connecting anecdotal case studies with broader lessons.

The book concludes with an epilogue, appropriately titled, “Now What?”  It leads directly into a Do-It-Yourself Analysis, using the information in the preceding chapters to guide the reader through a complete wardrobe overhaul, step by step.

Dr. Baumgartner’s emphasis on the commonality of the wardrobe problems addressed here, and the reasons behind them, allow the reader to feel understood and that she is not alone.  The reasons and motivation behind these behaviors are explained using an application of hard science and psychological theory to clothes, including social learning theory, transtheoretical theory of change, and exposure therapy.  It may seem odd to some to combine such a ‘frivolous’ subject with academic research, but whatever the entry point is to greater self-awareness, the goal remains the same.

Dr. Baumgartner also makes sure not to neglect her responsibilities as a therapist, raising notes of caution for when symptoms progress to clinical disorder:

Ricki struggled with poor body image, but fortunately her negative feelings did not reach levels that would have warranted clinical diagnosis and intervention.  Body dysmorphic disorder […] is a psychological disorder characterized by excessive concern about and preoccupation with perceived defects or minor deficits in one’s physical features…Treatment is essential owing to the disorder’s distressing symptoms as well as its high risk of suicidality. (p. 113)

For more externally-oriented readers, You Are What You Wear includes pure style advice such as balance between accessories and clothes, the importance of a good fit, the formality of different occasions, etc.   This advice does tend to get oversimplified, though (most likely because of space restrictions).  For example, if “…you [are] a younger woman with items from your grandmother’s closet…it may be time to rework your favorites (p.165)”—this comment implies that you can only be fashionable if you dress exactly in the current styles for your age and your era, but vintage style (sometimes directly from a mother or grandmother’s collection) is frequently seen today on some of the world’s most admired fashionistas.

While You Are What You Wear is overall an extremely readable, enlightening look at how our clothing choices reflect our internal states, there is some room for improvement.  As mentioned in the introduction, if the book’s cover image and title don’t make it clear, let me reemphasize that this book is definitely for women.  There is one short anecdote of a male subject in the entire work.  Acquiescing to the general gender stereotypes, however, it seems that the appropriate audience is being targeted.

Dr. Baumgartner seems to have a personal anecdote for every chapter concerning every situation. At first this is a nice tool to increase relatability, but after a while it becomes hard to believe that she personally has experienced all the issues. She mentions Internet resources in a few chapters, but suggesting specific sites would be much more useful.  Finally, there is a great section of “The Dos and Don’ts of Office Wear” in Chapter 7; it would have been even better to see similar lists in many of the other chapters.

The book’s well-explained and well-justified lesson remains, however, and that is that we live our lives now, not in the past or future, and our clothes need to fit us, not vice versa.  You Are What You Wear even inspired me to clean out my closet, armed with new knowledge and an entirely different perspective (and the abovementioned appendix analysis, which is surprisingly helpful and easy to use).  Dr. Baumgartner has found a unique niche in psychoanalytical wardrobe consulting, and her book makes it very clear it’s much more interesting and even perhaps more respectable than it first appears.

You Are What You Wear: What Your Clothes Reveal about You
By Dr. Jennifer Baumgartner
Da Capo Lifelong Books: March 27, 2012
Paperback, 272 pages
$16

One of our main frustrations with the program stemmed from the way my husband and I were regarded by the staff. For reasons that are still not completely clear to me, they saw us as overbearing, controlling parents, and instead of encouraging Dan to include us in the major decisions regarding how he should proceed with his life, they discouraged him from consulting with us at all.

Though this part of Dan’s journey occurred almost four years ago, I think about it often. Was it us? Did we really come across as overpowering and manipulative with our son? I honestly don’t think so and am still baffled by this scenario. I don’t have an explanation, but I have some thoughts which may be helpful to those considering a residential program for their child.

For one thing, the staff at this program not only saw Dan in the worst condition of his life, they saw his parents in pretty bad shape as well. By the time our son entered this program, he had been dealing with severe OCD for several months; OCD so bad that he would often spend entire days just lying on the floor, doing absolutely nothing. Not surprisingly, our whole family was affected by this situation, and my husband’s and my nerves were frayed. We were exhausted, stressed, confused, and most of all, terrified. While family and friends who knew us well saw us as caring parents who weren’t quite “ourselves,” the staff at the program didn’t really know us at all. I’m sure they saw us as a dysfunctional family, and, to tell you the truth, by the time Dan arrived at the program, we were. Still, while we may not have been in great condition, we weren’t raving maniacs either.

Another issue was Dan’s age. He had turned 19 the week before starting the program, and was considered an adult. The staff felt he should make his own decisions regarding how long he should stay and whether he should go back to school.

This still floors me. Of course Dan’s opinion mattered, but we absolutely should have been included in these discussions. What amazes me most is that the staff knew how bad Dan’s OCD was. How could they expect a 19-year-old who was barely functioning to make these major life decisions without his family’s input? Why should he have to? Ultimately, we did have control over Dan’s length of stay, as we were paying for it.

Perhaps what the staff at this program disliked about us the most was the fact that we openly disagreed with them over how Dan’s treatment should progress. After spending nine weeks there, we knew it was time for Dan to leave the program and go back to college. It was obvious to us he was becoming institutionalized, and the bottom line was that Dan had chosen this summer program because he was so intent on going back to the college he loved.

We knew that leaving was the right thing for him to do, and our decision was supported by two psychologists outside of the residential program. But his treatment providers wanted him to stay. This is when it really became “Us vs. Them,” and though we tried to work together, they kept insisting that they knew best and we were making a big mistake.

The main problem, as I see it, is that the psychologist, psychiatrist, and social worker at this residential treatment program didn’t know the real Dan. They knew the Dan who entered their program in the worst shape of his life, battling severe obsessive-compulsive disorder. But he was our son, and we knew him better than anyone, even better than he knew himself at the time. Rather than viewing us suspiciously, as if we had some type of ulterior motive, it would have been so beneficial to Dan if we could have all worked together.

Instead it became adversarial, and this made an already difficult situation worse. Dan had enough to deal with without the added stress that arose from feeling torn between his parents and the staff with whom he had grown so close. While I know his treatment providers may very well have had his best interests at heart, he was still just one of their many clients. But he’s our son. And nobody cares about him, loves him, and is as totally vested in his well-being as we are. We had to remind Dan’s social worker and therapists of this more than once; we shouldn’t have had to tell them at all.

If you are considering a residential treatment program for your teenager or young adult with obsessive-compulsive disorder, I would suggest having some conversations before they even enter the program. How is it determined how long they will stay? Who decides? How is ongoing communication maintained with parents? And if you have any issues, questions, or concerns while your loved one is there, address them immediately with your liaison. Most important, remember that you care about your son or daughter more than anyone, and your feelings and opinions should be respected.

Why is it that we don’t act to change patterns, even when we promise to do so and it is obviously in our best interest? A good example of this seemingly illogical phenomenon comes from therapy. We invest time and money in counseling but then, even when we agree with the given recommendations or homework assignments, neglect to follow through.

Often it takes repeated failures for us to figure out that something is awry and more is needed than willpower or good intentions. In many situations, we never even question whether the person we are trying to help is actually on board as a true ally in the work, though this is often the key issue.

Michael’s therapist had been seeing him and his wife in marital therapy. When they met privately, it became clear that he had again failed to follow through on homework that he had agreed would help improve his marriage. This was curious, given his motivation and genuine desire to be closer with his wife. His progress had not been a problem before, particularly because his wife had been very rejecting and critical of him for years. She was the one who needed to change first in order for the marriage to go forward. She had since worked hard to make those changes and was, in fact, sustaining the relationship. But now Michael was causing a stalemate.

Michael explained that he was “forgetting” to do the assignments. Though at first this sounded like an excuse, it actually was not implausible — Michael was somewhat forgetful in general. Further, given his limited experience and lack of comfort with emotional expression and connection, the changes he needed to make were not natural to him and required conscious thought and effort. However, this is true with most change.

In this case, Michael was asked to state aloud to his wife positive feelings about what she was saying, doing, or how she looked. This assignment required him to notice and make explicit his own feelings and feelings about her. Though he could retrospectively report having positive feelings toward her at various times throughout the week, these internal experiences were often not “on his radar screen” or easy to make explicit.

Making a Commitment to Change

Michael was a highly successful entrepreneur and a man of integrity. To have reached such a prominent position in his career, he must have figured out how to remember and follow through on difficult matters. But why couldn’t he do the same in his private life?

Michael had a ready answer to this question, and knowingly described how he did it. The most important part was that he would make a firm commitment, and then later remind himself explicitly by thinking about it and planning the details. Once he did that, success in following through was guaranteed.

Michael’s resistance to change — which took the form of a lack of commitment to his therapy assignments — was surprising, and had been well hidden. He did not seem to be struggling with anger or resentment, the most common reasons for couples’ underlying resistance. Anger and resentment often express themselves as resistance to moving forward through passive-aggressive acting out. Then, disowned anger or resentment spills out unconsciously and symptoms such as “forgetting” occur. However, Michael did not seem to be harboring resentment or acting out. He also seemed fully engaged and motivated in the treatment.

As sessions probed Michael’s failure to commit to therapy and the work required to improve his marriage, he talked about feeling hopeless that his marriage would work out in the end. He feared that it would not and seemed to be preparing himself for the inevitable. Believing that his actions would not have an effect on the marriage was a familiar feeling for Michael. A central dynamic in his relationship with his wife was that he felt invisible, dismissed, and devalued. This dynamic accumulated, leading him to feel defeated and give up (though this was unconscious), despite his wife having made changes.

Those suffering from major traumas such as sexual or physical assault, combat experiences, accidents or the sudden death of a loved one can be diagnosed with post-traumatic stress disorder (PTSD) if certain symptoms exist. These include intrusive thoughts of the event; nightmares or flashbacks; avoidance of reminders of the incident and increased arousal, which can include problems such as sleep difficulties; angry outbursts; being easily startled or having difficulty concentrating.

Research has also indicated that medically unexplained physical symptoms, including fatigue, gastrointestinal problems and pain can also go along with this disorder. Anyone suffering from PTSD can benefit from EMDR therapy.

In order to be officially diagnosed with PTSD it is necessary to have experienced a major trauma. However, recent research has also revealed that other, less dramatic life experiences can cause even more symptoms of PTSD than major traumas. Many of these disturbing life experiences take place throughout childhood and can include hurtful experiences with parents or peers. The negative impact on the person’s sense of self takes place since, just as with diagnosed PTSD, “unprocessed memories” are running the show.

This happens because the experience was so disturbing that it disrupted the information processing system of the brain. One of the functions of this system is to take disturbing experiences to mental adaptation. So if something happens to us that is disturbing, the processing system “digests” the experience and the appropriate connections are made, while the reactions that are no longer useful — such as the negative self-talk, emotions and physical sensations — are let go.

However, if an experience is too disturbing, it disrupts the system, causing the memory to be stored with the negative emotions, physical sensations and beliefs. Current experiences must link with the memory networks in our brain to be interpreted. If there is an unprocessed memory, the negative emotions and sensations can emerge and color our perception of this current situation. In short, the past is present.

That’s where EMDR therapy can help. While EMDR cannot remove a problem caused by genetics or organic injury, the research indicates that even in these cases negative life experiences can exacerbate problems. When a person is held back from doing things he or she would like to do by feelings of insecurity, anxiety, fear, or unremitting sadness, or is pushed into doing things that are not useful — such as overreacting to people or situations — the reason can generally be found in the memory networks. Many times the problems are unprocessed memories from the past that are poisoning the present.

In my new book, Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy, I provide numerous procedures that will allow the reader to identify the earlier memories that are at the root of their problems, and ways to change their emotions, physical sensations and negative thoughts. There are also techniques to help achieve desired goals in work and social relationships. These self-control techniques can make life more manageable, and understanding why we are doing things that don’t serve us can often help to bring things into perspective.

But if the techniques aren’t sufficient to give you a good feeling about your life, or you feel better for awhile but the old feelings continue to come back, then it would be useful to read the stories in the book that illustrate why different kinds of problems emerge, and decide if EMDR therapy would be a good choice for you.

Part of that evaluation involves taking stock of both your personal and professional relationships. Do you feel happy and fulfilled? Do you have a good support system? Or do you feel frustrated and troubled by disturbing thoughts and emotions?

Generally, there are three categories of negative feelings and beliefs that can emerge. These are the feelings of not being good enough, not being safe, or not being in control. If we often feel insecure, fearful or anxious — or notice that these feelings arise intensely in certain situations — we have the tendency to blame ourselves. Friends aren’t able to reassure us no matter how hard they try, because the problem is generally caused by the unprocessed memories associated with the negative emotions, physical sensations and beliefs.

When certain things happen in the present — even minor ones, like the expression on someone’s face — the memories can get triggered and the emotions, beliefs and accompanying sensations (like a tightness in stomach or chest) surface. We don’t get an image that goes along with it, so we don’t realize it’s really the “old stuff.” Then, since our distress can debilitate us, we may have problems interacting with people in the present, causing new memories of “failures” to be stored and thus increase the problem. That’s how depressions can also increase: our new negative experiences just dig the hole more deeply.

So, the bottom line is that we deserve to have happiness and fulfilling relationships. Problems involving negative thoughts and emotions are generally the result of negative past experiences that are improperly stored in our brains. The negative feelings may appear to be true to us, but they are actually the result of physiologically stored memories. This makes it not a “mental problem,” but rather a physical problem that can be remedied. If you break your leg, you would not just hobble along. You’d have no question about going to a doctor to align your bones properly so that healing can take place.

Likewise, if you go to an EMDR therapist for assistance, a good history will be taken and you will be prepared for memory processing. Then the memory will be accessed and aligned in a certain way, while the information processing system of the brain is stimulated so the memory can be transformed into an adaptive learning experience. The negative emotions, physical sensations and beliefs can be discarded and a positive sense of self can emerge.

EMDR therapy is not limited to simply taking symptoms away. It addresses the past, present and future. The goal is to allow the person to achieve a complete state of emotional health. It has also been used to help athletes, performers and executives to achieve a state of “peak performance.”

If you feel stuck personally, or in your relationships, and the self-help techniques provided in Getting Past Your Past are not sufficient, then consider fully addressing the problem with EMDR therapy. Ultimately, the goal is to liberate you from the confines of the past into a happy and productive present and a fulfilling future.

I use that quote as a reminder of just how extraordinary Barack Obama’s 2008 election really was. It wasn’t just a change in leadership, but a fundamental shift in the way we all saw our world, and the possibilities within it. Overnight, science fiction became reality.  And, just as quickly, expectations started to build. This man had already changed the world before even becoming President. What would he go on to achieve once he was in office?

In 2009, less than two weeks into office, Obama was nominated for the Nobel Peace Prize. He won - the first U.S. president to receive the award during his first year in office — but it was never clear what he had actually done to earn this recognition. On accepting the award, the bemused president himself said that he was “surprised” by the award, and did not feel he deserved it. It seemed that simply being Barack Obama was enough. Before he had even set foot in the White House, the world had decided that this man was a hero, and that he would change everything.

It’s perhaps unsurprising, then, that Obama hasn’t been able to meet all of these impossible expectations during his first term in office. As someone who was presumably expected to have some kind of magical power and fix all of the world’s problems with a click of his fingers, simply doing the job of being a competent, pragmatic president has attracted a wave of criticism. Cynics have been disappointed by his failure to come through on some of the promises made during his campaign, and feel that the Obama that exists in the White House isn’t the same as pre-election Obama, who promised so much to so many. As the 2012 presidential campaign shifts into high gear those doubters are asking “What – if anything – has changed?” And it is that conundrum which lies at the heart of this book by Justin A. Frank:

My decision to analyze our presidents has its roots in wondering about the ways their psyches and the external and internal pressures they feel influence the difficult job they are trying to do. But what really propelled me in the case of our current president was being struck by what seemed like a disconnect between Candidate Obama and President Obama. I wanted to understand that better, since in this case I don’t think it’s simply a matter of a politician promising one thing and doing something else. And I was interested in how and why we, by an overwhelming majority, chose Obama to be our leader.

Frank has carved out a nice niche for himself in the psychology book market by psychoanalyzing people he openly admits he’s never actually met. Not just any people, mind you, but American presidents.  Frank is also the author of the New York Times bestseller “Bush on the Couch,” about George W. Bush, and the premise for his books is simple:

Frank draws upon the time-tested techniques of applied psychoanalysis to undertake a rigorous examination of our current president, providing fresh and valuable insights that will help readers in their frustrating pursuit of the president’s character.

As a reader, I have to admit that this initially caused me to feel skeptical.  I wondered how Frank could profess to offer any kind of genuine insight into people of whom his knowledge has come through secondary sources alone. It sounded like a gimmick to me.

And, to some extent, that’s exactly what it is. Rather than a serious psychoanalysis of the president, what we get here is a dense examination of the president’s life, through painstaking review of a huge number of sources, including his speeches, interviews, and of course Obama’s own books. Step by step, Frank takes us from Obama’s infancy, through his childhood and adolescence to look at the events which shaped the president, and how these might continue to affect his personal and professional decisions to this day. Frank does touch upon a number of compelling issues drawn from his studies, and it is clear from the depth of the material that Frank’s research is thorough and robust, and that his knowledge of the subject is second to none.

An example of this is Frank’s explication of Obama’s “emotional tone deafness;” the apparent lack of empathy or connection he is able to maintain with his supporters, and his failure to truly become the ‘people’s president.’ Frank connects this with abandonment issues, resulting from the lack of a father figure in the president’s childhood:

Though he can recognize the positive effect of his speeches, he misses the sense of abandonment that his supporters have increasingly developed since he assumed office.  Unbeknown to him, his followers often feel as though they are orphaned – that the man upon whom they counted, who unconsciously represented a combined parent to so many, isn’t there when he is most needed… When he rejects his followers in this way, Obama is evading what psychoanalysts call the positive father transference, the attraction patients develop towards a therapist into whom they project the attributes they wanted in their biological father. Obama is afraid to fully feel the father transference yearnings he excited in hurt and betrayed Americans who were looking for change.

As interesting and convincing as this doubtless is, many of Frank’s conclusions still amount to what are ultimately educated guesses, or rhetoric. We could never truly claim to psychoanalyze someone through secondary sources alone, particularly someone in the public eye who has no doubt already gone to great lengths to paint their public image in a very specific way. Furthermore, Frank clearly has his own political opinions and agenda, and these could not help but color the way in which he presents the subjects of his books.

Nevertheless, the level of detail ensures that this is still a fascinating and worthwhile read. It certainly seems to offer more of a complete and measured portrait of the president than any of the other biographies currently on offer. Importantly, Frank also does more than just analyze Obama here – he takes a systemic approach in the later chapters of the book, looking at how the past four years have affected both the president’s supporters and his naysayers, and how this in turn has had a broader impact on politics and society in general. It is this systemic analysis which forms many of the book’s most interesting chapters, including a study of the rise of small-mindedness in certain parts of America, and particularly the Tea Party:

Racism, envy, the demonization of the Other, and other dynamics we’ve been discussing all come together in the Tea Party, a group of people who feel the government, personified by the president, has robbed them of what they once had: a lost, white America where they had the freedom to do what they wanted, even if they accepted that they couldn’t own slaves anymore. The fantasy of being robbed of the freedom we once had and think we still deserve is familiar to all of us because we once were children and felt and lost such freedom… Members of the Tea Party are stuck at this level of emotional development, obsessed with the unchallenged fantasy of frustrated, stolen freedom… To a Kleinian psychoanalyst, the Tea Party is allied with destructiveness out of hatred toward the reality of modern life and resentment that they feel like strangers in their own land and can’t see themselves in their president.

Overall, this is a rewarding and enlightening book, once you get past the initial gimmick. By the time you’ve finished reading it, you’ll be convinced that Dr. Frank knows more about Obama than he even knows about himself, even though they never met. And anyone with a desire to know about the president would be hard-pressed to find a more detailed analysis than this one. It’s certainly being published at the right time, too, just before the 2012 campaign and elections. This would certainly make for excellent campaign reading, and may even persuade a few voters to give Obama that second term he so deserves.

Obama On The Couch: Inside the Mind of the President
By Justin A. Frank, M.D.
Free Press:  October 18, 2011
Hardback, 288 pages
$26

The book is targeted toward mental health professionals but has information that parents or caregivers of child trauma survivors could benefit from as well. Steel and Malchiodi fill the book with illustrations and case studies, giving the book a more powerful and effective edge.

Trauma-informed practice is a term readily defined and supported in the first chapter as well as throughout the book. The authors state that “it [trauma informed practice] means that trauma is predominately a sensory process for many children and adolescents.” The authors go on to say that trauma is an experience that cannot be changed by cognitive therapy alone. They suggest that instead, clinicians must reorganize our current understanding of trauma therapy. Therapists should begin to incorporate different therapeutic techniques that address the sensory process of traumatic stress, not just the cognitive process.

In Chapter One, the authors discuss children’s and adolescents’ unique response to trauma and uses current neuroscience research to back up their explanations. This chapter also solidifies the difference between trauma and grief reactions and helps clinicians understand the different ways to identify and treat them.

Chapter Two discusses assessment, stressing that trauma-informed assessment must “address the importance and validity of evaluating children’s reactions, behaviors and thought patterns that preceded the traumatic events.” The authors also suggest a multidisciplinary approach to assessment; clinicians should strive to find positive characteristics within the child that helped them survive and overcome the trauma. This chapter provides several models of assessment with thorough explanations, helping the clinician find what would work best for each individual client they might work with.

Chapter Three talks more about assessment, but instead of highlighting standardized methods, it discusses sensory-based assessment practices. Many survivors may hesitate to verbalize their experiences, making standardized assessment difficult. Although less well-established, sensory-based assessment uses play and art techniques to “help better understand a child’s preferences for self-expression and disclosure.” The chapter goes on to discuss many specific art- and play-related assessment techniques for a clinician to add their assessment arsenal.

Chapter Four seems to me to be the most important. It focuses on establishing safety through self-regulation, something survivors of trauma, especially children, struggle greatly with. This chapter is based on the idea that our physical bodies remember trauma and ingrain those memories in a sensory-oriented way, inaccessible through word-based therapy. The authors even go so far as to suggest that focusing solely on word-based accounts of the trauma can keep therapy at a surface level, never allowing full integration of the trauma experience.

This chapter also identifies techniques such as mindfulness and self-expression interventions as tools in helping children and adolescents regain their sense of personal safety. Another powerful part of this chapter is the chart provided on key elements of a safe intervention. This clearly defines, for a clinician, what is considered a safe and unsafe intervention.

Chapters Five and Six focus on relationships. The authors explain how to design and implement a trauma-informed environment, one that helps establish feelings of safety and fosters resilience and independence.

Chapter Seven focuses on building resilience in child survivors. By first discussing resilience characteristics, readers get an extensive understanding of what it means and what it looks like to see resilience in a child. Then the authors give age-specific guidelines for promoting those same resilience characteristics in therapists’ clients. There is a final section on post-traumatic growth and what the transition from victim to survivor to thriver looks like.

Finally, Chapter Eight closes with a small section on trauma integration. This section helps the reader understand when therapy has been successful and when it is advisable to end therapy due to full and proper integration of the traumatic experiences.

Overall, Trauma-Informed Practices with Children and Adolescents is a book that I would highly recommend to all mental health professionals. This book is thorough in its explanations and reasoning and makes excellent support for the newer and perhaps, less conventional ideas that it presents. Child and adolescent trauma survivors need special intervention due to the unique ways young people process and integrate traumatic stress. This book helps open the lines of conversation for clinicians to explore different and new ways of treating trauma.

Trauma-Informed Practices with Children and Adolescents
By William Steel and Cathy A. Malchiodi
Routledge: October 27, 2011
Paperback, 279 pages
$39.95