Believe it or not, listening is a skill just like writing or playing football is. That’s good news, because it also means you can learn to listen and be with the person who’s talking to you when they’re talking to you. In the meantime, it helps to understand some of the reasons we don’t listen. By identifying those reasons that ring true, you can then work on improving your listening skills, focusing on being aware of those reasons next time you find yourself not listening.

Awareness itself is not enough, however. You may need to practice “active listening” skills as well, and spend some time and effort in re-learning your normal listening behaviors. Being there when a person is talking to you can be a very rewarding experience, and often can enhance an existing relationship with friends, family, or your significant other.

1. Truth

You take a dualistic position that you are right and the other person is wrong. Dualism supports a preoccupation with proving your point of view. Directly expressing your feelings and thoughts without needing to be “right” allows you to express yourself, and listen to and understand others (without binding your communication to a right/wrong mindset).

2. Blame

You believe that the problem is the other person’s fault. Problem ownership, based on the identification of your needs, is a functional alternative to a “blame-game (i.e., to attribute to others what may not reflect their personal reality).

3. Need to be a Victim

You feel sorry for yourself and think that other people are treating you unfairly because they are insensitive and selfish. Listening minimizes becoming a voluntary victim or martyr — a position commonly observed when an individual performs tasks for others without their explicit request or approval.

4. Self-Deception

An individual’s behavior can contribute to an interpersonal relationship problem although he or she does not “own” the problem. A “blind spot” prevents an individual from being aware of how her or his behavior affects others. An individual may be evaluated as dogmatic or stubborn; however, the evaluator could be unaware of her or his tendency to be oppositional with regard to that person’s thoughts and ideas.

5. Defensiveness

You are so fearful of criticism that you cannot listen when someone shares anything negative or unacceptable. Instead of listening and evaluating the perceptions of an individual, you prefer to defend yourself.

6. Coercion Sensitivity

You are uncomfortable with being supervised or given task-related instructions. Without concrete evidence, a position is taken that specific or general others are controlling and domineering; therefore, you must defend yourself.

7. Being Demanding

You feel entitled to better treatment from others, and you get frustrated when they do not treat you in a manner that is consistent with your entitlement. An insistence that they are unreasonable, and should not behave the way they do, negates your ability to understand the probable needs that are met through the other person’s behavior.

8. Selfishness

You want what you want when you want it, and you become confrontational or defiant when you do not get it. The absence of an interest in what others are probably thinking and feeling is a barrier to listening.

9. Mistrust

The position of mistrust includes a fundamental belief that others will manipulate you if you listen to them. An absence of empathic understanding prevents you from listening to others.

10. Help Addiction

You feel the need to help people when they need someone to listen to and understand them. The tendency to find “solutions” when others are hurt, frustrated, or angry is viewed as “helping” (although the speaker did not explicitly request your recommendations or intervention).

Reference:

Burns, D.D. (1989). The feeling good handbook. New York: William Morrow.

Learning why you have trouble expressing your feelings can go a long way into changing that behavior. Saying how you feel is something you can learn how to do, just as readily as you can learn how to fix a faucet or mend a button on a shirt. Here are ten common reasons why people find it difficult to express their emotions to someone else.

1. Conflict Phobia

You are afraid of angry feelings or conflicts with people. You may believe that people with good relationships should not engage in verbal “fights” or intense arguments. In addition, you may believe that disclosing your thoughts and feelings to those you care about would result in their rejection of you. This is sometimes referred to as the “ostrich phenomenon” — burying your head in the sand instead of addressing relationship problems.

2. Emotional Perfectionism

You believe that you should not have feelings such as anger, jealousy, depression, or anxiety. You think you should always be rational and in control of your emotions. You are afraid of being exposed as weak and vulnerable. You believe that people will belittle or reject you if they know how you really feel.

3. Fear of Disapproval and Rejection

You are so terrified by rejection and ending up alone that you would rather swallow your feelings and put up with some abuse than take the chance of making anyone mad at you. You feel an excessive need to please people and to meet what you perceive to be their expectations. You are afraid that people would not like you if you expressed your thoughts and feelings.

4. Passive-Aggressive Behavior

You pout and hold your hurt or angry feelings inside instead of disclosing what you feel. You give others the silent treatment, which is inappropriate, and a common strategy to elicit feelings of guilt (on their part).

5. Hopelessness

You are convinced that your relationship cannot improve no matter what you do. You may feel that you have already tried everything and nothing works. You may believe that your spouse (or partner) is just too stubborn and insensitive to be able to change. These positions represent a self-fulfilling prophecy–once you give up, an establish position of hopelessness supports your predicted outcome.

6. Low Self-Esteem

You believe that you are not entitled to express your feelings or to ask others for what you want. You think you should always please other people and meet their expectations.

7. Spontaneity

You believe that you have the right to say what you think and feel when you are upset. (Generally, feelings are best express during a calm and structured or semi-structured exchange.) Structuring your communication does not result in a perception that you are “faking” or attempting the inappropriately manipulate others.

8. Mind Reading

You believe that others should know how you feel and what you need (although you have not disclosed what you need). The position that individuals close to you can “divine” what you need provides an excuse to engage in non-disclosure, and thereafter, to feel resentful because people do not appear to care about your needs.

9. Martyrdom

You are afraid to admit that you are angry, hurt, or resentful because you do not want to give anyone the satisfaction of knowing that her or his behavior is unacceptable. Taking pride in controlling your emotions and experiencing hurt or resentment does not support clear and functional communication.

10. Need to Solve Problems

When you have a conflict with an individual (i.e., your needs are not being met), avoiding the associated issues is not a functional solution. Disclosing your feelings and being willing to listen without judgment to the other is constructive.

Reference:

Burns, D.D. (1989). The feeling good handbook. New York: William Morrow.

You can also learn more about these techniques on your own, and through self-help books. Keep in mind that not every technique is appropriate for every kind of concern or every person — some may work better than others for you. If you fail at one, don’t despair; it means you should either try again until you succeed with that technique, or try another one from the list.

1. The Experimental Method

Do an experiment to test your belief that you’re “cracking up,” having a heart attack, or losing control.

2. Paradoxical Techniques

Exaggerate your fears instead of running away from them. If you have the fear of cracking up or having a stroke, you try your hardest to crack up or have a stroke.

3. Shame-Attacking Exercises

Purposely do something silly in public, in order to overcome your fear of appearing foolish.

4. Confront Your Fears

Expose yourself to a frightening or high anxiety situation instead avoiding it and allowing your fear to control you. There are three common methods:

• Sudden Exposure or “Flooding.” You allow yourself to experience all your symptoms, no matter how bad they get. You endure your fears until they run their course and wear out.

• Gradual Exposure. You gradually expose yourself to whatever you’re afraid of (such as being away from home alone, going into grocery stores, or riding a bus or elevator). Thereafter, you withdraw when your anxiety becomes excessive.
• The Partnership Method. If you are afraid of walking alone, you can ask a trusted person to walk a certain distance ahead of you, and wait. After walking to meet her or him at the location, the individual will walk further ahead before you meet her or him again. This gradual method of managing fear-related anxiety will increase the distance to a point that you are able to walk reasonable distance alone.

5. Daily Mood Log

Write down the negative thoughts that make you feel anxious or frightened. Identify the cognitive distortions associated with those thoughts, and replace them with realistic and positive thoughts. Instead of worrying and constantly predicting failure and catastrophes, tell yourself that things will turn out reasonably well.

6. The Cost-Benefit Analysis

Make a list of the advantages and disadvantages of worrying and avoiding whatever you fear. Weigh the advantages against the disadvantages (refer to the Cost-Benefit Analysis worksheet). Make a second list of the advantages and disadvantages of confronting your fears. Contrast the advantages with the disadvantages.

7. Positive Imaging

Substitute reassuring and peaceful images for the frightening daydreams and fantasies that make you feel excessively anxious.

8. Distraction

Distract yourself with intense mental activity (e.g., crossword puzzle), strenuous exercise, or by getting involved with your work or a hobby.

9. The Acceptance Paradox

When you feel anxious or panicky, you may make matters worse by insisting that you should not feel that way. This type of verbal or sub-verbal negativity only increases your anxiety. One way to develop greater self-acceptance is to write out a dialogue with an imaginary hostile stranger who puts you down for feeling excessively anxious. The hostile stranger is simply a projection of your own self-criticism. When you talk back to that symbolic person, you will develop greater self-acceptance, and you are better able to manage your anxiety or fear.

10. Getting in Touch

When you feel anxious or panicky, you could be ignoring a problem that is best addressed instead of being ignored. Review your life, and identify situations that are making you feel uncertain and fearful. When you find the courage to address a problem such as the fear of rejection in a direct and open manner, a sense of calm will replace uncertainty or fear.

Reference:

Burns, D.D. (1989). The feeling good handbook. New York: William Morrow.

How Does This Work?

Life confronts us with unexpected challenges, like a global recession that drives good companies out of business. This becomes your problem when you discover that your employer of 20 years is shutting down next week. Your world has just turned upside down. You don’t know what to do. You catch your breath and find yourself with scary choices. Do you abandon your career? Take any job you can find? Go back to school for more training? Move to a smaller home?

You (and many others) might find it difficult to pick up the phone to get things going and put yourself down for being “weak” or “lazy.” You can’t muster the “get up and go” to get it done. Maybe you force yourself to act. Even then, why was it so hard? Are you really lazy? And how do you overcome that?

When The Going Gets Tough, The Tough Get Going

Our cultural ideal is to be strong in adversity. It’s an ideal because it’s not something everyone can do. It’s also far too easy to see toughness under pressure as an ability you either have or not. But our living world has few absolutes. Most handle some situations well and get overwhelmed by others. Can you strengthen your ability to keep your wits under pressure? Absolutely! Let’s see how you can build mental muscle to be tough in adversity.

Think of a decathlete in the Olympic Games who competes in 10 events that test strength, skill and endurance over a grueling two days. A decathlete’s training cannot neglect any of these attributes and needs time to succeed. Otherwise, they’ll excel at the shot put but fail at the javelin throw or 1500 meter run. Likewise, if you’re going to build mental muscle, you’ll build on your strengths and shore up weaknesses.

A person with mental toughness faces challenges directly and is effective in solving them. I believe that someone who’s mentally tough has a combination of willpower, skill and resilience. How does therapy help you develop these attributes? Let’s look at the elements of mental toughness, and how these are addressed in psychotherapy.

An experienced therapist will consider your specific needs and apply proven approaches to help you. Growth usually doesn’t occur in a simple, straight path but unfolds through a process of trial and error over time. Therapy can help you pace and track this process.
It’s the therapist’s job to explain a treatment plan that specifies goals, methods, time and costs.

Building Mental Toughness with a Therapist’s Guidance

Willpower can be thought of as a combination of intention, effort and courage.

• Intention is the “will” in willpower. It’s the tenacity to stay on task or return to it until the work is done. To build awareness of what may need to happen, your therapist may help you clarify your values to make choices consistent with them. You may also explore the consequences of changing a behavior – what you may fear losing as well as what you may gain, so when you’re ready, you’ll choose to change on your own terms.

• Effort is power and is enhanced by helping you accurately gauge the amount that’s needed. If you’re facing a big challenge, you may be scared or feel helpless or hopeless about taking it on. If this is the case, your therapist will address your vulnerability to anxiety or depression, so you don’t stall out. If you give up easily, you may surface the thoughts or past experiences that leave you feeling scared, helpless and hopeless and then explore alternative ways to view the situation. All along, you’ll be buoyed by the therapist’s encouragement and support.
• Courage is the willingness to bear the intensity of fear and other emotions and do what you need to anyway. An essential element of courage is awareness. Newer cognitive behavior therapies train people in mindfulness to build their capacity to witness their experience and act in their best interest despite discomforts and distractions.

1. Identify Our Cognitive Distortion.

We need to create a list of our troublesome thoughts and examine them later for matches with a list of cognitive distortions. An examination of our cognitive distortions allows us to see which distortions we prefer. Additionally, this process will allow us to think about our problem or predicament in more natural and realistic ways.

2. Examine the Evidence.

A thorough examination of an experience allows us identify the basis for our distorted thoughts. If we are quite self-critical, then, we should identify a number of experiences and situations where we had success.

3. Double Standard Method.

An alternative to “self-talk” that is harsh and demeaning is to talk to ourselves in the same compassionate and caring way that we would talk with a friend in a similar situation.

4. Thinking in Shades of Gray.

Instead of thinking about our problem or predicament in an either-or polarity, evaluate things on a scale of 0-100. When a plan or goal is not fully realized, think about and evaluate the experience as a partial success, again, on a scale of 0-100.

5. Survey Method.

We need to seek the opinions of others regarding whether our thoughts and attitudes are realistic. If we believe that our anxiety about an upcoming event is unwarranted, check with a few trusted friends or relatives.

6. Definitions.

What does it mean to define ourselves as “inferior,” “a loser,” “a fool,” or “abnormal.” An examination of these and other global labels likely will reveal that they more closely represent specific behaviors, or an identifiable behavior pattern instead of the total person.

7. Re-attribution.

Often, we automatically blame ourselves for the problems and predicaments we experiences. Identify external factors and other individuals that contributed to the problem. Regardless of the degree of responsibility we assume, our energy is best utilized in the pursuit of resolutions to problems or identifying ways to cope with predicaments.

8. Cost-Benefit Analysis.

It is helpful to list the advantages and disadvantages of feelings, thoughts, or behaviors. A cost-benefit analysis will help us to ascertain what we are gaining from feeling bad, distorted thinking, and inappropriate behavior. Note: 1) clinical concept of secondary gain; and 2) refer to cost-benefit analysis.

Reference:

Burns, D.D. (1989). The feeling good handbook: Using the new mood therapy in everyday life. New York: William Morrow.

For instance, a person might tell themselves, “I always fail when I try to do something new; I therefore fail at everything I try.” This is an example of “black or white” (or polarized) thinking. The person is only seeing things in absolutes — that if they fail at one thing, they must fail at all things. If they added, “I must be a complete loser and failure” to their thinking, that would also be an example of overgeneralization — taking a failure at one specific task and generalizing it their very self and identity.

Cognitive distortions are at the core of what many cognitive-behavioral and other kinds of therapists try and help a person learn to change in psychotherapy. By learning to correctly identify this kind of “stinkin’ thinkin’,” a person can then answer the negative thinking back, and refute it. By refuting the negative thinking over and over again, it will slowly diminish overtime and be automatically replaced by more rational, balanced thinking.

Cognitive Distortions

Aaron Beck first proposed the theory behind cognitive distortions and David Burns was responsible for popularizing it with common names and examples for the distortions.

1. Filtering.

We take the negative details and magnify them while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted.

2. Polarized Thinking.

Things are either “black-or-white.” We have to be perfect or we’re a failure–there is no middle ground. You place people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and situations. If your performance falls short of perfect, you see yourself as a total failure.

3. Overgeneralization.

We come to a general conclusion based on a single incident or piece of evidence. If something bad happens once, we expect it to happen over and over again. A person may see a single, unpleasant event as a never-ending pattern of defeat.

4. Jumping to Conclusions.

Without individuals saying so, we know what they are feeling and why they act the way they do. In particular, we are able to determine how people are feeling toward us. For example, a person may conclude that someone is reacting negatively toward them and don’t actually bother to find out if they are correct. Another example is a person may anticipate that things will turn out badly, and will feel convinced that their prediction is already an established fact.

5. Catastrophizing.

We expect disaster to strike, no matter what. This is also referred to as “magnifying or minimizing.” We hear about a problem and use what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”).

For example, a person might exaggerate the importance of insignificant events (such as their mistake, or someone else’s achievement). Or they may inappropriately shrink the magnitude of significant events until they appear tiny (for example, a person’s own desirable qualities or someone else’s imperfections).

6. Personalization.

Thinking that everything people do or say is some kind of reaction to us. We also compare ourselves to others trying to determine who is smarter, better looking, etc. A person sees themselves as the cause of some unhealthy external event that the were not responsible for. For example, “We were late to the dinner party and caused the hostess to overcook the meal. If I had only pushed my husband to leave on time, this wouldn’t have happened.”

7. Control Fallacies.

If we feel externally controlled, we see ourselves as helpless a victim of fate. For example, “I can’t help it if the quality of the work is poor, my boss demanded I work overtime on it.” The fallacy of internal control has us assuming responsibility for the pain and happiness of everyone around us. For example, “Why aren’t you happy? Is it because of something I did?”

8. Fallacy of Fairness.

We feel resentful because we think we know what is fair, but other people won’t agree with us. As our parents tell us, “Life is always fair,” and people who go through life applying a measuring ruler against every situation judging its “fairness” will often feel badly and negative because of it.

9. Blaming.

We hold other people responsible for our pain, or take the other track and blame ourselves for every problem. For example, “Stop making me feel bad about myself!” Nobody can “make” us feel any particular way — only we have control over our own emotions and emotional reactions.

10. Shoulds.

We have a list of ironclad rules about how others and we should behave. People who break the rules make us angry, and we feel guilty when we violate these rules. A person may often believe they are trying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before they can do anything.

For example, “I really should exercise. I shouldn’t be so lazy.” Musts and oughts are also offenders. The emotional consequence is guilt. When a person directs should statements toward others, they often feel anger, frustration and resentment.

11. Emotional Reasoning.

We believe that what we feel must be true automatically. If we feel stupid and boring, then we must be stupid and boring. You assume that your unhealthy emotions reflect he way things really are — “I feel it, therefore it must be true.”

12. Fallacy of Change.

We expect that other people will change to suit us if we just pressure or cajole them enough. We need to change people because our hopes for happiness seem to depend entirely on them.

13. Global Labeling.

We generalize one or two qualities into a negative global judgment. These are extreme forms of generalizing, and are also referred to as “labeling” and “mislabeling.” Instead of describing an error in context of a specific situation, a person will attach an unhealthy label to themselves.

For example, they may say, “I’m a loser” in a situation where they failed at a specific task. When someone else’s behavior rubs a person the wrong way, they may attach an unhealthy label to him, such as “He’s a real jerk.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded. For example, instead of saying someone drops her children off at daycare every day, a person who is mislabeling might say that “she abandons her children to strangers.”

14. Always Being Right.

We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.

15. Heaven’s Reward Fallacy.

We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn’t come.

So now that you know what cognitive distortions are, how do you go about undoing them? Read how in Fixing Cognitive Distortions.

References:

Beck, A. T. (1976). Cognitive therapies and emotional disorders. New York: New American Library.

Burns, D. D. (1980). Feeling good: The new mood therapy. New York: New American Library.

Aging brings a certain amount of natural deterioration in cognitive performance, which can interfere with normal activities. However, in previous studies, a more powerful indicator of poor medical outcomes is “functional decline.”

Functional decline has been defined as “a reduced ability to perform tasks of everyday living, for example, walking or dressing, due to a decrement in physical or cognitive functioning.” Up to half of geriatric patients have either loss of or reduced ability in at least one activity of daily living. The decline can begin as early as the second day in hospital.

Dr. Leocadio Rodriguez-Manas and colleagues from Getafe Universitary Hospital in Madrid say that hospital care for people over 65 years old requires “a thorough assessment to assess the risk of functional decline,” which they state is the main determinant of quality of life, cost of care, and prognosis.

Delaying such decline and helping patients return home are at least as important as reducing mortality, the researchers believe. They analyzed 11 studies on the outcomes of specialized acute geriatric units compared with conventional hospital care. Patients were at least 65 years of age and had medical problems which did not necessitate treatment in other specialized units.

There was an 18 percent lower risk of functional decline at discharge, and in the next three months, following care in a specialized unit. The patients were more likely to remain mobile and be able to carry out usual daily activities. They also had a 30 percent higher chance of returning home after leaving the hospital. There was no difference in mortality rates or cost of care between the two groups.

Each of the individual studies showed similar results, the team reports on the website of the British Medical Journal: “Since admission to hospital is a risk factor for case fatality, functional decline, and admission to a nursing home, any intervention that helps reduce this risk is potentially important.”

They add that the 18 percent reduction in functional decline associated with specialized geriatric units is similar to that found in an earlier study of similar patients who received multidisciplinary care. Future studies should examine whether the reduction in functional decline persists in the medium-term after discharge, they write. Ideally, more patients would be involved, and they would be randomly allocated to standard or specialist care.

However, commenting on the study, Dr. Graham Ellis of Monklands Hospital in Lanarkshire, Scotland points out that specialized units may not be necessary for all patients over 65. Those without evidence of frailty, disability or multiple problems may not benefit, he writes. “Future research should focus on whether or not it is possible to accurately identify frail and at-risk groups,” he states.

The original researchers responded by saying that their study did not aim to identify the characteristics of patients who get more benefit from specialized units. They agreed that trials are needed to examine whether the effectiveness of these units varies with frailty, disability or co-morbidity.

Previous studies on geriatric units have shown benefits lasting up to a year after discharge, compared with usual hospital care. These units either improve functional status or reduce the rate of decline, and cut the likelihood of admission to a nursing home. The new research adds to the evidence that specialized geriatric units can improve outcomes without an increase in mortality, repeat hospital admissions, or costs.

This opinion is shared by nurse researcher Erin Sarsfield of Penn State College of Medicine. She writes: “The demographics of our country are changing. With increased life expectancy comes more elderly critical care patients whom may have never sought medical care until a critical event has occurred.

“We must pay close attention to this group of patients and continually strive to give them the best care possible. By utilizing continuous process improvement strategies, which are similar in many ways to the nursing process, we can best meet their needs.”

Sarsfield believes that a complete functional and clinical evaluation on admission to hospital is crucial for uncovering medical and socioeconomic problems, like social isolation, that can cause disability and interfere with quality of life and survival.

References

Bazta, J. J. et al. Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: Meta-analysis. The British Medical Journal, 2009;338:b50.
www.bmj.com/cgi/doi/10.1136/bmj.b50

Sarsfield, E. Continuous process improvement and the elderly critical care patient. Critical Care Nursing Quarterly, Vol. 31, January-March 2008, pp.79-82.

Inouye, S. K. et al. Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. Journal of the American Geriatrics Society, Vol. 48, December 2000, pp. 1697-1706.

Often enough, they make themselves more anxious than they need to be. It’s an anxiety born of love and hope. They want to be the very best parents they can be for this child who is, of course, the very best child in the world. If they had good parents, they hope and pray they will do the job as well. If their parents’ parenting fell short, they vow that they will do it better - while at the same time worrying that they won’t know how. Common myths about what it takes to be good parents both inspire and overwhelm them. Whether as a professional counselor or a family friend, I usually find myself talking to them about some or all of these myths:

1. “I have to be a great parent to be good enough.” No, you don’t. For one thing, it’s impossible. No one is a perfect parent. Anyone who says he or she is a perfect parent is delusional or lying. It’s enough to set your standards at a reasonably high level and then to do your best to meet them. By the way, since you are human, you will fail - probably many times. It’s enough to be “good enough” most of the time and to keep making the effort.

2. “I have to parent perfectly so my kids will turn out okay.” No, you don’t. Chances are your parents bungled quite a few things and you turned out okay. More important than perfection is the willingness to admit mistakes and to talk with the kids about what to do differently the next time. This models for kids that mistakes are how we learn.
3. “Kids are scarred for life by the mistakes of their parents.” No, they’re not. Abuse and neglect can and do cause long-term harm. But within the realm of the ordinary mistakes made by ordinary people, children survive and thrive. Being imperfect and making mistakes shows them we’re human.
4. “Someone out there knows exactly how to do parenting the right way.” No, they don’t. There are hundreds of parenting books on library and bookstore shelves. Each one has a different take on parenting. Each will work for some parents at least some of the time. For parents who really haven’t had any positive role models, the books can provide some guidance for consistent parenting. But ultimately it comes down to this: Love your kids. Provide them with some clear limits for responsible behavior. Behave responsibly and lovingly yourself. Be consistent but flexible. Love them lots. After that, it’s details.
5. “If I don’t teach them everything they need to know, I’m a failure as a parent.” No, you’re not. There is no way that you can know everything about everything. Whatever you can’t teach them, someone else can and will. Chances are you have had many teachers in your life. Some of them were older adults. Some were peers. Some were the mistakes you made and learned from. Your children will have many teachers too. You will help them find various mentors (coaches, youth leaders, relatives, etc.). It’s also important that you support them when they find some of their own.
6. “If I don’t provide them with everything they want, I’m failing as a provider.” No, you’re not. It’s important to do the very best of your ability to provide them with shelter, food, clothing, and health care. Everything else is an extra. It’s great to be able to provide a trendy wardrobe, ballet lessons, and tennis camp but it isn’t necessary. Not everyone has the good fortune to be able to live the middle- and upper-middle-class lifestyle. What kids need more than $150 sneakers or a big-screen TV are parents who love them, who help them solve life’s problems, and who find time to play with them.
7. “It’s important that I be my kids’ friend.” No, it’s not. Children need you to be a parent. Your child is not your peer. He is not your partner. She is not your confidant. Kids need room to be kids. They need to feel that you are in charge well into their teens. As they grow, they will push for more independence and you will require more responsible behavior. They will push some more. You will gradually let go. This is the rhythm of growing up. Treating kids as equals too soon or too fast disrupts their natural development into mature, healthy adults.

Close Enough to Perfect

My young friend and her husband have a lot going for them even though they are just starting out. They’re smart, sensitive people who love each other very much. Their apartment is small, their car is old, and they pay out a staggering amount each month to school loans but they do have jobs and they have figured out how to get by. Friends and family are as excited as they are about their pregnancy. Like all first-time parents everywhere, they won’t be perfect parents—but they will be perfect enough.

My college yoga classes took place in a dance studio at my university. It was my first experience with entering a room and immediately removing my shoes. I recall finding it to be a little strange. The room was long, skinny, and brightly lit. Cushioned gym mats lined the floor from wall to wall. We practiced our yoga on these gym mats; I did not know what a yoga mat was until years later.

My first yoga classes were a semester-long journey at the beginner level. I enjoyed the classes so much that I signed up for the intermediate class the next semester. After that, I began advanced classes. In my college mind, that was the proper progression. It was like taking Yoga 101, followed by Yoga 201, followed by Yoga 301. It did not occur to me that I needed to master one level before moving on to the next. Apparently, it also did not occur to my yoga teacher that she should mention this.

One day after my advanced yoga class, I decided to speak with the teacher about a study abroad program I was hoping to do. To get into the program, we needed a university faculty or staff member to write us a letter of reference. As my yoga teacher was the staff member I had spent the most time with, I decided to ask her.

This decision went all wrong. My yoga teacher began to tell me how terrible I was at yoga. How she had not noticed until that day how bad my technique was and how overall, I was horrible at yoga. I held it together until I was out of the dance studio, then burst into tears. It did not occur to me that it was really the fault of the teacher for not properly guiding me. All I knew was that I had been told I sucked at something I liked and had been working hard at. For my 19-year-old self, this was heartbreaking.

I stopped going to yoga after that. Instead of proving my teacher wrong and working harder, I gave up. My teacher noticed my absence in class. She called me and apologized about how she had mishandled that situation. The phone call did not help. I did not go back to yoga for years.

It was three years before I decided to try yoga again. I was living in a new city and looking for things to do. I saw a flyer for an introduction to yoga seminar. The seminar was taking place near my house, so I decided to check it out. I remember enjoying the experience (and meeting a yoga mat for the first time), but did not pursue classes. I’m not sure why I did not decide to start practicing again. I just didn’t.

It was another couple years until I decided to try yoga again. A co-worker and I decided to try out a local yoga studio. I really enjoyed my experience at the studio and began going to classes sporadically. It wasn’t until my workplace began offering yoga classes after work that I began to take yoga seriously.

Only a few of my co-workers were interested in the yoga classes. Once a week after work, a handful of us would gather in one of the conference rooms. A private yoga instructor would come in and take us through basic poses. Because there were not many people, I was able to get a lot of individual attention from the instructor. It was during this time that I began to love yoga and improve my skills.

When I left that workplace, I began to attend yoga classes at a couple different studios. I tried to get to at least one a week. Two classes if my schedule would allow it. I was able to keep this up for a few years. My yoga began to improve dramatically.

When I got laid off from my position as a marketing manager, I decided to pursue a career in fitness. I hadn’t liked marketing and fitness was something I was passionate about. I got a job at a local gym and began studying for my certification exams. I quickly passed the exams and began building my personal training business.

At the gym where I work, all the personal trainers must declare a specialty. It’s kind of like choosing your major in college. The obvious choice for me was yoga. I began to look into certification programs. It seemed that in yoga teacher training, you can do your certification fast or you can do it right. To get myself started, I decided to do it fast.

I enrolled in a weekend-long, yoga teacher training course. The course was produced by a company specializing in teaching yoga in gyms. It was supposed to give you the foundation to teach in an environment where you can’t control things the same way you can in a yoga studio. In a gym, you generally have no control over temperature, no yoga props, and it is often noisy. This course was meant to get your around those obstacles and make yoga more “friendly” to gym-goers. While I initially thought that was a great approach to yoga, I definitely saw that this was a valid issue to address.

I arrived at my weekend training with an open mind. The course began with everyone explaining why they had decided to take the course. Many people had emotional reasons for being there. One woman even cried. I was there because I enjoyed the physical process of yoga and I needed to fulfill the “specialty” requirements of my job. This immediately made me feel out of place.

The weekend continued with an emotional slant. Twice a day, we had “sharing circles.” This was where we sat knee-to-knee in a circle and talked about our feelings. In some of them, we were even asked to hold hands. I’m not one to openly share my innermost thoughts with strangers, so I did not like those sharing circles. I failed to see what the sharing had to do with yoga.

Overall, the weekend of teacher training was not great. I learned a little about the sequence of postures and common mistakes, but did not come away feeling like a confident yoga teacher. I’m now going to go back and do my teacher training the right way, in a 300 hour registered yoga teacher training. This scares me a little bit, as it is a huge commitment of time and money, but I want to be the best yoga teacher I can. I don’t want anyone to have the experience I did in college, where I was made to feel inept and turn away from yoga.

After 14 years of going to yoga on and off, I’m now in it for the long haul. The experience is what you make of it, not what one teacher or school of thought tells you.

According to Peter J. Norton, Ph.D, Director of the Anxiety Disorder Clinic at the University of Houston and co-author of The Anti-Anxiety Workbook, anxiety disorders have success rates that make other researchers jealous. The key is to get the right treatment and stick with it.

Here’s a look at what effective treatment entails, including the ins and outs of psychotherapy and medication, plus tips for finding a qualified therapist, managing panic attacks and more.

Common Misconceptions

1. Anxiety disorders aren’t that serious. This myth persists because “anxiety is a universal and normative emotion,” said Risa Weisberg, Ph.D, Assistant Professor (research) and Co-Director of the Brown University Program for Anxiety Research at Alpert Medical School. However, anxiety “can be a hugely distressing and impairing symptom.”

2. “I can overcome this on my own.” In her research on anxiety disorders in primary care, Weisberg found that nearly half of primary care patients with anxiety disorders weren’t taking medication or attending therapy. When asked about their reasons for not engaging in treatment, one of the most common answers was that they didn’t believe in receiving these treatments for emotional problems. Anxiety disorders have a chronic course and “the bottom line is that good treatments exist, so there is no reason to suffer on your own,” Weisberg said.
3. Anxiety disorders are a character defect. “Anxiety has a genetic and neurological basis,” said Tom Corboy, MFT, Director of the OCD Center of Los Angeles.
4. “I need medication in order to improve.” Though medication can be effective in treating anxiety disorders, “research suggests that in many cases, cognitive-behavioral therapy (CBT) is better or just as good as CBT plus medication,” said Jon Abramowitz, Ph.D, Associate Professor at the University of North Carolina at Chapel Hill and Director of the UNC Anxiety and Stress Disorders Clinic. CBT teaches patients the skills for lasting benefits.

Disclosing Your Diagnosis

You may be unsure about sharing your diagnosis with others. Corboy suggested discussing your anxiety with individuals you trust, who have your best interests in mind. If you’re considering telling a significant other, wait “until that person has earned your trust,” he said.

Treatment

A great deal of research over the past 10 to 15 years has shown that CBT is the most effective treatment for most anxiety disorders, Corboy said, making it the first line of treatment. Research also has shown that selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants and benzodiazepines are effective in treating anxiety.

Doctors usually prescribe SSRIs and SNRIs first because they’re effective, can treat depression — which often co-occurs — and tend to be better tolerated. According to the scientific literature, there’s a higher rate of relapse with medication, Norton said. The key is to supplement medication with CBT, said Peter Roy-Byrne, M.D., Professor and Chief of Psychiatry at the University of Washington at Harborview Medical Center. In fact, medication is sometimes used to facilitate psychotherapy.

Psychotherapy

The first step in CBT is to understand your anxiety, Abramowitz said. You and the therapist will work together to gain insight into how your thoughts and behaviors fuel your anxiety. “People with anxiety tend to jump to conclusions and overestimate,” he said. Behavior such as regularly rehearsing what you’re about to say actually feeds your anxiety, nourishing the belief that you can’t think on your feet and you’re a poor public speaker.

Cognitive restructuring helps patients identify their thoughts and expectations and modify problematic patterns, Abramowitz said. He pointed out that cognitive restructuring “is not the power of positive thinking; it’s the power of logical thinking.”

In exposure therapy, another CBT technique, therapists help patients face their fears in various contexts in a systematic and safe way. Together, you and your therapist create a hierarchy, listing the least anxiety-provoking situation to the greatest, and work your way up, confronting each situation.

Most CBT programs consist of 8 to 15 weekly sessions, Norton said. When individuals start to experience gains varies. At his clinic, Norton typically sees patients improve the most from the 5th to 7th session of their 12-week program. However, there’s no universal standard for staying in therapy. Weisberg recommended that patients continue with CBT until they fully understand and have mastered the above skills to manage their anxiety.

Weather didn’t matter. Short of a hurricane or a nor’easter, it was “Out you go!” from the adults. No matter the season, we roamed the neighborhood and the adjoining woods with the other kids. In the winter, we made snow forts and snow angels. In the warm months, we made stick forts, played with a hose, and climbed trees. On rainy days, we splashed in puddles and made mud creations.

After school and summers, we hopped at least 6 variations of hopscotch, jumped rope and played tag and hide and seek. We rode our bikes and roller-skated. We pretended we were pioneers, astronauts, and princesses. We caught tadpoles and turtles and watched them for hours. We traded baseball cards, popbeads (does anyone else remember them?) and marbles. All this occurred without adult suggestion, guidance, or supervision.

What did we learn? We learned that if you want to have enough people for two teams, you don’t leave anyone out. We learned how to negotiate conflicts so we could keep everyone in the game. We learned how to create our own fun and to listen to the ideas of others. Sometimes we learned how to follow. Sometimes we learned how to lead. We learned how to turn what could have been an endless afternoon of boredom into active adventure or quiet imagining.

So much for nostalgia. Did my own kids raised in the 1980s and ’90s have the same run of the neighborhood? No. Do my neighbors with young families send their kids out into the world on their own now? Also no. The reasons are multiple and not without merit. Over the last 30 years the world has changed and parenting has changed with it. In times of Amber Alerts and the increase in single-parent and two -earner families, we find ourselves both more fearful and less available.

When the adults of the household are all working, no one is home to be backup if a kid gets sick or injured. Programs with structured activities and adult supervision have therefore taken the place of neighborhood free play in that time between the school dismissal bell and dinner. In a world that feels less safe, most of us are uncomfortable with the idea of kids being out of sight and out of touch for hours at a time. Those who can afford it enroll the kids in programs. Those who can’t sternly instruct kids to stay home with the doors locked.

Further, when our kids are home, chances are the neighbors’ kids aren’t. When we are home, many of us want to spend time with our children so we’re often involved in their play, whether at the playground, in the yard, or on a vacation. When we’re exhausted, we, and the kids, go to the TV, the video game, or online to relax or just to zone out for awhile.

An unintended result of the changes in family life and parenting style is kid dependence on adult involvement and outside structure and stimulation. No one intended to raise kids who can’t figure out what to do with a summer day. None of us meant to create a world where kids need to be supervised or isolated and kept busy to be kept safe. Few parents you ask will say (at least out loud), “I’m glad my kids are happy in front of a TV or computer when I’m too tired, too busy, or too stressed out to deal with them.”

Nonetheless, the unintended but very real consequence of so much parental involvement is a big part of a generation of kids who can’t function for very long without being told what to do, how to do it, and how to get along with the kids they have to do it with. When these kids have unscheduled and unstructured time, they quickly run out of ideas. “I’m bored” is a code phrase for “Tell me what to do.” And we adults oblige. Search “boredom and kids” on the Internet and you’ll come up with dozens of sites like these: “Boredom Busters for Kids.” 100 Craft Ideas for Bored Kids.” “Travel Games to Relieve Kid Boredom.” “Summer Boredom Relievers.” The message is clear: If the kids are bored, it’s our job as parents to fix it.

Bored Kids Are Creative Kids

Fortunately, researchers are taking a new look. It turns out that boredom is good for kids. When kids are allowed to have nothing to do—including being cut off from the ubiquitous screens—they start to feel restless. When adults kindly refuse to fill the gap in the action, they get frustrated. When they can’t turn to the external world, they start to turn to the internal one. Restlessness + Frustration + Inner reflections are the ingredients of Creativity. The kids start to look around on their own for something to occupy their minds and their bodies. Since most kids are good kids, they usually don’t resort to mischief. Instead, they invent, they make art, they explore, they read, and they look for other kids to interact with in person instead of on a screen. This creative play is the much-needed rehearsal for kids to become innovative, creative, socially adept adults.

Waite does not condone McKinnon’s illegal Internet activity. However, he does believe that McKinnon should not be held to the same standards as other international criminals because he suffers from the developmental disorder Asperger Syndrome. Other celebrities and legal experts also have announced their backing of McKinnon, but Waite’s statements have more emotional appeal, considering the personal trauma he endured as a hostage.

Should McKinnon, a UK citizen, be extradited to the U.S. to stand trial for his crimes against the American government? If so, should the U.S. government consider his diagnosis of Asperger Syndrome a mitigating factor? I am not a legal expert and certainly not a celebrity. I am an American psychologist who treats individuals and families with Asperger Syndrome. The fate of Gary McKinnon could change the way Asperger Syndrome is treated all over the world. I for one am not sure anyone fully grasps the depth of the problems when a mental disorder becomes a political issue. Gary McKinnon is just one man fighting for his freedom, but in the process thousands of people with Asperger Syndrome and their families will be judged.

Eminent Psychologist Says Hacker Has a Disability

Asperger Syndrome is not a mental illness per se, but a developmental disorder on the Autism Spectrum. In fact McKinnon was diagnosed by Cambridge Professor Simon Baron-Cohen, a well-known expert on adult Asperger Syndrome. Along with Terry Waite, Baron-Cohen believes that McKinnon should not be treated as an ordinary criminal but as someone with a disability.

According to Professor Baron-Cohen, McKinnon is obsessed with finding the truth, which is why he penetrated the NASA and U.S. military computer systems in search of information on extraterrestrials. McKinnon believed that information on UFO technology was being suppressed by the U.S. government. Furthermore, he claims to have found proof.

This obsession with the truth is taken to an extreme by those with Asperger Syndrome because they have a characteristic called “mind blindness,” according to Baron-Cohen. “Mind blindness” is a complex theory, but in a nutshell McKinnon’s “mind blindness” prevented him from fully understanding the social consequences of his actions, in spite of his obvious intellectual giftedness.

Is McKinnon a cyber-terrorist?

So who did Gary McKinnon hurt by his actions? There are some estimates that it cost the U.S. government $700,000 to track him down, not to mention the hundreds of thousands being spent to litigate the case. Certainly he embarrassed NASA and the Pentagon by using simple hacker tools, including a dial-up modem and software that generates passwords. But are there other injuries? I can only imagine that others followed Mr. McKinnon through the portals he created. In fact, he openly admits to watching other hackers at work during his “research.” Were these others just as obsessed with the truth as McKinnon, or did they have other motives? Not everyone hacking into the Pentagon computers is interested in extraterrestrials. There are undoubtedly many innocent lives at stake as a result of this type of cyber-crime.

Cyber-crime is a new frontier that is baffling local policing authorities, not just the CIA and FBI. I have had a personal experience with this phenomenon that is more than unnerving. I received a string of anonymous and threatening emails over a two-year span from a stalker who claimed he wanted to expose the truth too (just like Gary McKinnon). He said he was watching me, had been to my house, determined that my daughter was a “retard,” and that we both deserved to be driven from the community . . . because he considered me a “liar” and a “roach.” Needless to say I was frightened and sought protection from the local police for myself and my family.

I don’t know if my personal stalker has Asperger Syndrome. When he was finally tracked down and identified he admitted that he was angry with me for prevailing in a lawsuit his grandmother had filed against me. He told the police that his actions were perfectly justified, which sounds pretty obsessed to me. The city prosecutor was not impressed by the stalker’s logic and determined that he was guilty of cyber-stalking and sentenced him to a year of diversion, fines and anger management therapy.

Is Gary McKinnon’s hacking somehow less dangerous than my private stalker? My stalker was certainly obsessed with me (and is still on a mission to prove the “truth”), so does that mean if a person is obsessed they are disabled and shouldn’t be tried for the crime? Dr. Baron-Cohen suggests leniency since McKinnon is “disabled.” Terry Waite suggests that the end justifies the means since McKinnon’s hacking exposed the frailty of U.S. security. With this logic I suppose this means that some stalking is OK and other stalking is not, but who decides — the stalker?

Stages of Sleep

Wakefulness includes Gamma, High Beta, Mid Beta, Beta Sensory Motor Rhythm, Alpha, and Theta brain waves. Our composite brain wave, that is, what you would see if you had an EEG (electro-encephalo-graph, or picture of the electrical activity in your brain), would be made up of many of the brain waves named above, all at the same time.

Stage One

When we are preparing to drift off, we go though Alpha and Theta, and have periods of dreaminess, almost like daydreaming, except we are beginning to fall asleep. These are interesting states, in that we experience them throughout the day and some people may have more of these waves than others.

Those who practice meditation, or deep prayerfulness, often kinda “hang out” in Alpha. It’s a restful place. During this stage, it’s not unusual to experience strange and extremely vivid sensations or a feeling of falling followed by sudden muscle contractions. These are known as hypnogogic hallucinations. You may even feel like you are hearing someone call your name, or the phone ringing. Recently, I thought I heard the doorbell, but realized that it was a hypnogogic hallucination and went back to sleep.

We then begin to enter Theta, which is still a relatively light period between being awake and asleep. This usually lasts for 5-10 minutes. Research has shown that the average sleeper takes about 7 minutes to fall asleep. You may fall asleep sooner, or take longer.

Stage Two

The second stage of sleep lasts about 20 minutes. Our brain begins to produce very short periods of rapid, rhythmic brain wave activity known as Sleep Spindles. Body temperature begins dropping and heart rate starts slowing down.

Stage Three

Deep, slow brain waves known as Delta Waves begin to emerge during this stage. It is a transitional period between light sleep and a very deep sleep.

Stage Four

This is sometimes referred to as Delta Sleep because of the delta waves that occur during this time. Stage Four is a deep sleep that lasts for about 30 minutes. Sleepwalking and bed-wetting typically happen at the end of Stage Four sleep. (This does not include the problems that can happen with sleep medications like Ambien and Lunesta).

Stage Five: REM

Most dreaming occurs during Stage Five, known as REM. REM sleep is characterized by eye movement, increased respiration rate and increased brain activity. REM sleep is also referred to as paradoxical sleep because, while the brain and other body systems become more active, your muscles become more relaxed, or paralyzed. Dreaming occurs because of increased brain activity, but voluntary muscles become paralyzed. Voluntary muscles are those that you need to move by choice, for example, your arms and legs. Involuntary muscles are those that include your heart and gut. They move on their own.

Rapid eye movement, or REM sleep, is when you typically dream. You may have images float by in earlier stages, particularly when you are going through Alpha or Theta, but the actual dream state occurs in REM.

This period of paralyzation is a built-in protective measure to keep you from harming yourself. When you are paralyzed, you can’t leap out of bed and run. Do you ever feel like you can’t escape during a dream? Well, the truth is, you can’t. You can breathe, and your heart is working, but you really can’t move.

Cycles

Sleep does not progress through all of these stages in sequence, however. Sleep begins in Stage One and progresses into stages 2, 3, and 4. Then, after Stage Four sleep, Stages Three, then Two are repeated before going into REM sleep. Once REM is over, we usually return to Stage Two sleep. Sleep cycles through these stages approximately 4 or 5 times throughout the night.

We typically enter REM approximately 90 minutes after falling asleep. The first cycle of REM often lasts only a short amount of time, but each cycle becomes longer. This is why we need long periods of sleep each night. If we get short periods of sleep, we can’t really get through the stages we need to heal and stay healthy. REM can last up to an hour as our sleep progresses. In case you are wondering, if you feel like a dream is taking a long period of time, it really is. Contrary to what was once believed, dreams take as long as they actually seem.

Getting sleepy? OK, sleep well, perchance to dream….

This was a big decision; one I thought long and hard about. Psychotherapy has always been helpful, but I simply didn’t want to go anymore. My sessions had ceased covering tragic life events, occupational crises, my childhood, and my parents. Therapy had become a place where I discussed everyday trivialities. These trivialities were still important topics in my life – how to make more money, where to take my career, and how to best deal with relationships – but they did not seem worthy of going to a therapist to discuss. In my session yesterday, I talked about how glad I was that I had mopped my kitchen floor. Seriously? I had so little to talk about in therapy that I was starting to discuss household chores? It was time to move on.

I had been seeing my therapist for a little more than a year. When I started going, my life was filled with uncertainty. I had been laid off for six months and was starting a job I was not sure I wanted. I also was going through a difficult breakup. In the beginning, my sessions were extremely hard. I felt like I had to make the best of my new job. My therapist thought I was in the wrong career. We would argue endlessly about it. I would vehemently exclaim that work didn’t matter, I just needed money. He would retort that if I had work that I enjoyed, the other pieces of my life would come together more easily and that I would place less importance on my continually failing romances. This argument continued until I got laid off from my new job as well and I was relieved of the effort of making my “new” job work.

At that point, our discussions shifted slightly. I was stuck to the idea of finding a job that was similar to my old ones. I was in a field that I did not particularly like, but the money was pretty good and I was used to the environment. I knew what to expect from my old line of work and I found that comforting. Even though I had been laid off twice in less than a year, the types of jobs I had previously held represented security for me. In my mind there were two types of jobs. Jobs where I would have financial security and jobs that I would enjoy. I wanted the financial security. This opinion fueled disagreement after disagreement with my therapist. He believed that if I kept working at the same types of jobs I had held before, I would continually be dissatisfied and get laid off again and again. He thought that the cycle I was in would endlessly continue until I found work I was passionate about.

As I searched for jobs, our disagreements continued. My therapist kept encouraging me to try a different career path. To think about graduate school. To consider working at non-profits. He guided me to think about the things that I enjoyed doing outside of work and how to make a career out of them. I did not listen to him and kept looking for the same kinds of jobs. My therapist often spoke of short-term financial sacrifice for long-term gain. I was not into this idea. Searching for meaningful work while living with 12 roommates and eating ramen noodles was not at all appealing to me.

If I had found a job easily, things may have turned out differently. As it was, there were very few jobs available in my field. Even if I wanted those types of jobs, I could not seem to get one. I was forced to think about other options. Although I was starting to agree with my therapist’s opinion about my work, I was still argumentative about it. During those days, I was difficult to deal with. I doubt that my therapist looked forward to our confrontational sessions.

All these arguments with my therapist eventually took their toll. I was forced to switch directions in my career because my old one did not seem to exist anymore. I had to start fresh on a new path. It was intimidating, but turned out to be for the best. When I tell the story of leaving one career behind and starting a new one, most people perceive it as a story of bravery. Really, I had no choice. And a good therapist.

Once my career issues were on a positive track, I found I had less to talk about than I did before. I still wanted to discuss financial issues with my therapist, but found that we would end up having the same conversation over and over again. He had good ideas, but my continued stubbornness got in the way of some of his suggestions. We sometimes spoke about my dating life, but I had also gotten that area of my life vaguely under control. I rarely had anything hugely dramatic to speak about.

As this shift continued, I began to dread going to therapy. I started to view it as just another task I had to do. I did not feel like I was getting a lot out of my sessions anymore. As my life is full of tasks that I have to do, I decided to cut back my sessions to every other week.

At this point, I also ran into a problem with my health insurance. I had a new insurance plan and provider that considered my therapist to be ‘out of network.’ The insurance provider granted me a couple extra months of sessions, but requested that I use that time to look for a new therapist. I had no interest in looking for a new therapist and my current one was nice enough to work out a deal for me so I could keep seeing him. As much as I appreciated this, I still did not look forward to our sessions. I weighed the pros and cons of the situation and decided to stop going.

It was one thing to decide I was not going to therapy anymore. It was another to actually do it. I went to a handful of sessions fully intending to quit, but I kept chickening out. Yesterday was the day I finally psyched myself up to tell my therapist I was not coming anymore. At the end of our session, he got out his appointment book and asked me when I wanted to come again. I asked if I could call him if I wanted to come. He said yes, but told me he wished I had brought this up earlier. I’m guessing that he knew I had not brought it up earlier because I did not want to be talked out of my decision.

It feels a little strange knowing that I will no longer see my therapist. Therapy was an extraordinary experience that brought me to a more peaceful existence, but I am ready to move on.

In the second half of our interview, Sari Fine Shepphird, Ph.D, clinical psychologist and author of 100 Questions & Answers about Anorexia Nervosa, offers important information about eating disorders and their treatment. For more information about Shepphird and her book, please visit her website.

Q: Can you talk about the warning signs for eating disorders?

A: Some of the more obvious signs include: the person avoids eating with others; starts to restrict the types of foods they eat (not just the quantity); becomes secretive (e.g., is evasive when asked what they had for lunch); skips meals; makes frequent trips to the bathroom after meals; starts to exercise excessively; begins to weigh themselves frequently; makes negative comments about their own bodies or other people’s bodies; seems to idealize thin celebs or thin friends; compares themselves to others (which actually isn’t a normal thing to do, even though we’re conditioned to do this by our society); starts to count calories frequently; comments about certain foods being “bad” foods and feels like a “bad person” for eating these foods.

The more subtle signs include: the person starts to dress in very baggy clothes to hide their frame; develops strange behaviors around food (e.g., only eats at a certain time of day, or in a certain order); shows great concern about weight gain and makes a lot of weight-related comments; loses or gains a significant amount of weight; begins to make general self-critical comments; develops perfectionistic tendencies; shows signs of low self-esteem; is embarrassed or ashamed after eating; puts pressure on themselves to exercise, even when they’re tired or injured.

Q: Recently, the news has reported that kids as young as five are being diagnosed with eating disorders. Why do you think patients are getting younger? Aside from general warning signs, are there specific things to watch out for with kids?

A: It is disconcerting indeed that patients with eating disorders are seemingly getting younger. Interestingly, older patients are being diagnosed with greater frequency as well. The emphasis on thinness in our culture has only gotten stronger in the past decade. Children are exposed to greater amounts of media and role models, including children’s role models, are themselves feeling a greater pressure toward thinness. Parents also feel that pressure to a greater degree and perhaps unwittingly convey their own body image concerns to their kids through their actions and words.

Parents may want to let their child’s pediatrician know if they notice any unusual behaviors around food. Picky eating is normal for children, but any behaviors that persist or seem odd or extreme should be brought to their doctor’s attention. Feeding disorders of childhood can be ruled out by their doctors, and treatment is important. Such disorders can also be precursors to later eating disorders.

Parents should be sure to start their kids off early with a healthy approach to eating, rather than a restrictive one. Children naturally have hunger and fullness cues that help to regulate their eating. These cues can become skewed if children are made to feel guilty for eating a healthy diet, or if unhealthy behaviors around food are modeled in the home.

Q: What are some ways family and friends can approach their loved one if they notice warning signs?

A: It’s difficult to approach someone who has an eating disorder. Most people are afraid that they’ll lose the friend or the loved one will be angry with them or defensive. But it’s worth the risk to express your love and concern. One thing I recommend is that people use “I” statements, so it doesn’t seem like you’re somehow attacking their behavior. This way, you come across like you’re expressing your concern. I suggest this formula, “I feel ___ when ______ because ____.” For instance, “I feel frightened when I see you skip meals, because I’m concerned that you’re losing too much weight.” Start by talking about how you feel rather than accusing the person, which is more likely to make them defensive.

I also recommend this often: You may wish to avoid addressing the eating disorder directly if you feel they may become defensive, but instead talk about something related, such as “I’ve been noticing you’re under a lot of stress lately. I can see it in your behavior. Can I help?” This approach becomes sort of a dance, take a step forward, and take a step back and perhaps even let it be for awhile. Give your loved one time to absorb what has been said, time to react and think about it. Be caring and very gentle, without feeling like you need to hammer in the point. Instead of saying, “You have a problem. You have to get help or I can’t be your friend anymore,” you can say, “If you’d like to talk more, I’m here for you.”

Q: What can you do if a loved one refuses treatment?

A: A child can be brought by their parents for involuntary treatment. However, it is difficult with an adult, because you cannot force someone into treatment unless perhaps they are gravely disabled. People with an eating disorder often feel that their eating disorder has benefits, or fear the thought of recovery. This fear of not wanting to recover is actually a symptom of the illness. The person isn’t necessarily going to consider change when they might not see the need for it.

One thing that a person can do is to point out how their (loved one’s) life would improve if they were to get treatment. Perhaps they’d have more energy to meet their goals, feel a greater sense of calm or improve their sense of self-esteem and self-worth. People with eating disorders are under a great deal of stress. Getting help will allow them to develop other kinds of coping skills to reduce stress and improve their lives. I have many patients who start going to therapy for depression, anxiety or stressful life circumstances. They don’t tell me about their eating disorder at first, or don’t want to talk about it. At a later point in treatment, they’re ready to address it. So, a great way to get someone to seek help is to offer help for or suggest discussing a different issue. Once they’re in treatment, they might be more open.

Q: Finding out your child has an eating disorder can be incredibly overwhelming and parents might not know where to start. Can you take us through the steps in finding a treatment team and helping your child through recovery?

A: It can be hard to know where to find a good professional. Oftentimes the best thing to do is to ask your primary care doctor if they know someone who specializes in eating disorders. Or, ask another trusted source, such as a religious leader or a close friend, for a recommendation. There are also specialized treatment Web sites that list people who are specifically trained in eating disorders, including: ED Referral, the Gurze Website, National Eating Disorder Association, and the National Association of Anorexia Nervosa and Associated Eating Disorders.

Even when you find a recommendation for a professional, it’s best to ask a series of questions to make sure they’re a good fit for you. Just because they’re trained in eating disorders doesn’t mean they’re automatically a good fit. Have an initial phone call to get a sense of the practitioner’s personality; ask about training and level of experience; and practical things like whether they accept your insurance, how long they’ve been treating eating disorders and if they treat your child’s specific type of eating disorder. (For questions to ask your therapist, download Shepphird’s form here.)

The best way to approach treatment is through a team approach, so make sure that person usually works with a multidisciplinary team of professionals.

If you need to find a treatment center, the same suggestions apply. You may even want to visit the treatment center and ask questions about their approach to treatment. If a treatment center has a policy that doesn’t allow parents to visit, then I would generally not recommend that center.

Once a child starts treatment, then the parents can choose various forms of support. For an adolescent or child with an eating disorder, one of the best ways we know through research for parents to be involved is a very hands-on approach. For instance, in the Maudsley approach, parents take an active approach in helping to re-feed their child and teach them about being healthy. Before, parents used to be on the sidelines, but now for younger patients, parents are encouraged to be part of the recovery.

For an older patient, Maudsley doesn’t necessarily apply. However, loved ones are still encouraged to be supportive and compassionate. It means a great deal to patients to know that people love and support them, even though they may seem uninterested or unfazed by the offer of support.

Further along the process, once a loved one is in recovery, there are some things to keep in mind. Unless it’s Maudsley therapy, where parents encourage weight gain directly, refrain from making comments about a person’s weight, such as “You’re losing weight. Are you sure you’re eating enough?” or “You look like you’ve gained some weight.” Instead, comment on other changes: “You seem happier, more energized.” “I’m so proud of you for all your hard work.”

One thing you want to avoid with adult friends and loved ones is a power struggle about recovery. While you can encourage your loved one, criticizing, blaming or berating them for not taking recommendations is probably doing them a disservice. Patients are likely already doubting themselves and feeling like a failure. Criticism can serve to set them back rather than help them along.

Also, loved ones should avoid commenting about their own weight. I’ve seen kids who’ve made progress in recovery go home to see their parent is on a diet or is being picky with food. This reinforces what the patient has worked so hard to unlearn. Having your own healthy body image can be a means for supporting a loved one who is in recovery.

Another important thing is for loved ones to find support for themselves. Studies show that having a loved one with an eating disorder can be just as difficult if they had cancer or some other serious, chronic illness. This can cause personal and marital stress, financial difficulties and jealousy among siblings. There is no shame for parents to be in therapy themselves. Therapy is a supportive place where you can gain strength and tools for managing your life.

Q: You mention in your book that anorexia isn’t all about food and weight; that these are symptoms of underlying issues. What are some of these underlying issues?

A: Although the symptoms of anorexia largely surround food and eating, the truth is that at its core, anorexia and other eating disorders do not solely have to do with food. Often we find that people with eating disorders are experiencing underlying emotional distress, relationship or psychological conflicts, difficult life transitions or past trauma. Eating disorders can be part of an overall picture of struggle in a person’s life. When combined with genetic and biological factors, these struggles can sometimes be a precursor to eating disorder symptoms. For some people, anorexia serves as a complex distraction from other painful, seemingly unmanageable feelings or life events. Part of the recovery process from anorexia is learning other, more healthy ways of coping with life’s challenges.

Q: We’re only recently discovering that anorexia occurs in men and older women. What are some key points about anorexia in these populations?

A: Anorexia does occur in males! There is a common stereotype that anorexia is a female illness; however, that is not the case. We know that 10% to 15% of anorexia cases are diagnosed in males, and those are just the cases that go reported. Experts feel the rate may be significantly higher; however, many men feel a greater stigma about eating disorders, so they may not seek treatment. When they do, they will unfortunately find that there are far fewer treatment programs available to men than to women. Some co-ed programs do offer specially designed treatment “tracks” that address uniquely male concerns, but there is a need for many more such programs.

Male athletes have a higher reported rate of eating disorders than the general population, due in part to the belief that weight loss is a necessary requirement for peak athletic performance in their sports, and a higher rate of anorexia has also been reported in homosexual and bisexual males.

We know from recent research that eating disorders occur across the lifespan, not just among young women, as many may presume. Body image dissatisfaction is fairly stable across the age span, and many of the same risks for eating disorders in younger women can be precursors for older women as well.

While health care professionals may be less likely to suspect an eating disorder in an older woman, the risks are real nonetheless. Factors such as growing public awareness, social pressure to be thin and an aging population of “image conscious” baby boomers may be some of the contributing factors for more cases of eating disorders among older women. And challenges such as divorce, childbirth, widowhood, menopause, chronic dieting and other age-related changes are examples of later-life events that may represent an increased vulnerability for the onset of anorexia at a later age. Complications of eating disorders can be greater for an older person, so it is important for older men and women to see a doctor soon after symptoms appear.

Q: Anything else you’d like readers to know about anorexia or eating disorders in general?

A: One of the main things that more people need to realize is that eating disorders are serious, often debilitating medical and psychiatric illnesses. Many times we do not realize how serious these illnesses are. I don’t think it’s been said enough how high the death rate is from eating disorders or how debilitating the complications can be.

Also, sometimes people think that anorexia and bulimia are the only forms of eating disorders. However, there are also non-classified eating disorders, which are just as serious. In fact, someone can die from a short-term eating disorder. One of my colleagues lost her daughter to bulimia after just one year of symptoms. You don’t have to have an eating disorder for five to seven years in order for it to be serious.

Unfortunately, because of the media, eating disorders sometimes seem as though they are almost encouraged and admired. Yet this is unfortunate as they’re serious, devastating illnesses that need to be treated. A person can lose their health, their family, their motivation for living and ultimately their life.