Psych Central Original articles in mental health, psychology, relationships and more, published weekly. 2016-12-09T15:33:25Z http://psychcentral.com/lib/feed/atom/ Edie Weinstein, MSW, LSW <![CDATA[What Is the Difference Between Loving and Being in Love?]]> http://psychcentral.com/lib/?p=47695 2016-12-08T18:30:25Z 2016-12-09T15:33:25Z ]]> Tree of love in autumn. Red heart shaped tree at sunset.Autumn sMost of us have grown up on the “once upon a time… and they lived happily ever after” relationship fable. It is written into the script of nearly every Disney film and we have bought it, lock, stock and barrel. We lose ourselves in dreaming of Prince or Princess Charming who will fulfill all our romantic desires, will never disagree with us and will appear eternally youthful and beautiful.

Recovery pioneer John Bradshaw coined the phrase Post Romantic Stress Disorder to describe an all too common dynamic in relationships. You meet the person of your dreams, as your emotions are on overdrive and your heart races. You are enamored of this oh-so-perfect person. You can’t wait to be in his or her presence and you are loath to leave it. His book, which was released not long before he died this past year, is entitled Post-Romantic Stress Disorder: What to Do When the Honeymoon Is Over. It highlights the hormonal high-jacking that takes place and has you pondering your discernment when it comes to attracting a partner.

Bradshaw elaborates that the ‘in love’ experience is “dominated by the physical, when testosterone is off the charts for both people. That’s what happens when you fall in love. The dopamine and norepinephrine kick in and suddenly you’re higher than you’ve ever been. You may think you died and went to heaven — or hell.” Cue the Robert Palmer song, “Addicted to Love

He adds that the duration is fairly fleeting; 18 months or so and then the reality of who each person is, begins to trickle in. It isn’t always pretty. That’s when the mettle of the two gets tested. What initially attracted you to them may begin to drive you bonkers (that description is not found in the DSM-V by the way) and you may wonder what you ever saw in them. Time to determine whether you want this connection to sustain over the years. When a couple face the potential life challenges, such as illness, injury, financial issues, job changes, children being born, children leaving home, their true nature surfaces.

The ability to handle these expected events stems, in part to what was modeled by the adults who raised you. Were your parents loving, demonstrative and supportive of each other as a couple? Did their behaviors feed or starve their relationship? When (metaphorically speaking) ‘push came to shove,’ did they actually verbally or physically push and shove or did they work together in harmony?

For some, the expectations of what love looks like also comes from a desire to feed what might be perceived as gaps in their own lives.  Beloved author Shel Silverstein’s book called The Missing Meets the Big O highlights this idea beautifully. A sense of incompleteness pervades the lives of many and, rather than beginning within to initiate the healing process, they engage in a journey of seeking externally for what they believe is absent within themselves.

Phyllis Klaper, a clinician, whose professional skills have had her working with clients who face relationship and addiction issues, shares her perspective, “I didn’t know. I honestly did not know that being IN LOVE was temporary and that LOVING another person encompassed so much more… than just sex and date night. I mean, I knew it, but I didn’t really “get it.” I carried my idea of what love felt like at 16, into adulthood. I did. So, when the TEMPORARY MADNESS subsided, as it always will, I was left with this emptiness, this “what’s wrong with me?” feeling. I chased that madness like a junkie chasing a fix. I did. I chased it, I was desperate for it, I needed it, and when I couldn’t have it… I was lovesick (dope-sick) If that’s not the description of addiction, I don’t know what is. And when I managed to re-create that in love “feeling,” the sickness went away… temporarily. Always. Every time. It is becoming clearer and clearer that my core addiction is the need to attach myself to another human being so I will not have to face the pain of being dope-sick. Now, after spending 3 years alone, unattached, experiencing the emotional and physical pain of withdrawal, from, dare I say it, another human being… I understand why I needed it, that I don’t need or want that drug, and that authentic grounded love is what I am waiting for. I’ll know when it arrives. There will not be a trace of desperation or fear. That’s how I’ll know… until then, I’m good. Better than good.”

She isn’t alone in her longing for love and lusting after the high that comes with it, while hoping against hope that the inevitable crash doesn’t come.

Co-depen-dance

Relationships often feel like an intricate tango during which we do our level best not to step on each other’s toes while wearing hobnail boots. Sometimes it involves improvising and at other moments, we want the dance to be choreographed, with every step mapped out. In a healthy, well-balanced relationship, the partners take turns leading and following, even if on the literal dance floor, one is more skilled at the twists and turns and more graceful in their execution. When a relationship is co-dependent, one dynamic is not knowing where you begin and someone else ends. Boundaries are either nebulous or rigid, rather than appropriate and in the best interest of the joint entity.

Saying What Isn’t Being Said

How do you have those daunting, but necessary conversations that may help keep your love-ship from running aground while you remain afloat for the long sea cruise? Relationship coach and sex educator, Reid Mihalko, created a Difficult Conversation Formula entitled Say What’s Not Being Said.” In it, he encourages each party to express all of those withholds that we hesitate to share out of fear of being misunderstood or rejected.

A couple who has been married close to 15 years sometimes prefaces communiques’ that may cause distress, with “My ego wants to tell you….” Since they have been using that for so long, it loses its threatening implications and they generally laugh about it.

What are the qualities of a healthy and loving relationship that has sustainability?

  • Trust
  • Accountability/reliability
  • A sense of having each other’s backs
  • Open communication
  • Safety (physically and emotionally and knowing that your partner won’t intentionally harm you)
  • A willingness for each person to do the inner work to help the relationship thrive, rather than expecting the other person to take on the responsibility for you
  • Cleaning up your own messes; or as Reid Mihalko also shares, “Leave the campground better than you found it.”
  • Co-creating the rules for relationship; maintaining them or re-negotiating them
  • Focusing on strengths, as well as awareness of areas that call for improvement
  • Knowing where there is room for adjustment vs. non-negotiables

Compassion vs. Passion:  How Can You Tell the Difference?

Elaine Hatfield, PhD and Richard L. Rapson, PhD  determined that here are two basic types of love:

  1. Compassionate love
  2. Passionate love.

They contend that “Compassionate love is characterized by mutual respect, attachment, affection, and trust. Compassionate love usually develops out of feelings of mutual understanding and shared respect for one another.

Passionate love is characterized by intense emotions, sexual attraction, anxiety, and affection. When these intense emotions are reciprocated, people feel elated and fulfilled. Unreciprocated love leads to feelings of despondency and despair.

In much the same way, Bradshaw viewed the ‘might as well face it, I’m addicted to love,’ brain chemical cocktail reaction, Hatfield viewed passionate love as short-lived, usually lasting between 6 and 30 months.”

Ideal relationships are a fusion of the two.

Rose and Harry had such a relationship. After meeting in their early 30’s, they married, raised two children, had successful careers, volunteered in their community and had an active social life. They faced the early deaths of their fathers prior to their marriage, followed by the deaths of their mothers before their oldest daughter was in her mid-teens. Each endured health problems and there were times when he was laid off from his jobs, so money was limited during those periods. During each of those events, they existed in both of the aforementioned realms. Throughout their nearly 52- year marriage, they saw each other as sweethearts and treated each other as such.  There was indeed sexual attraction, fulfillment, elation and affection; absent the other less savory aspects of passionate partnership. They called each other sweet names, wrote cards and love notes and danced in the kitchen. Despite disparities in upbringing; having grown up on ‘different sides of the track,’ what helped them maintain their marriage was that they were certain that love was louder than any doubt that might have told them otherwise.

They were both head over heels in love and loved each other for who they were, flaws and all.

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Taylor Bourassa https://insidethecollectiveunconscious.wordpress.com/ <![CDATA[Why Art Therapy?]]> http://psychcentral.com/lib/?p=47699 2016-12-07T19:10:54Z 2016-12-08T15:00:30Z ]]> Art therapyThere are a number of different forms of therapy and choosing which one is the best choice may prove to be a daunting task, especially when faced with low motivation and affect as a symptom of your mental illness. Typical therapies* include those where everyday forms of communication are used — that is, a client seeking aid for an issue uses verbal communication to discuss their ills with a trained therapist. However, these therapies involve a certain level of comfort — with your self and your issues. They also require you to be comfortable expressing these issues with others. Art therapy is an excellent alternative starting point.

Art therapy offers the client an emotional outlet through artistic mediums and allows the client to better understand their situation. In this article I will outline what makes art therapy therapeutic, the effects art has on the brain, and in turn on behavior. I will also discuss how art as a form of therapy works to help clients better understand their behavior, and how art therapy can help clients alter their thoughts and behavior through cognitive behavioral therapy (CBT).

What is art therapy?

Randy Vick states that art therapy is a hybrid between art and psychology, (Vick, 2003), combining characteristics from both disciplines. Art acts as an alternative language, and helps people of all ages explore emotions, reduce stress, as well as resolve problems and conflicts, all while enhancing feelings of well-being (Malchiodi, 2003). The Canadian Art Therapy Association explains art therapy as a combination of the creative process and psychotherapy, a way to facilitate self-exploration and understanding. It is a way to express thoughts and feelings that may otherwise be difficult to articulate (CATA, 2016; http://canadianarttherapy.org/).

What are the effects?

The Ontario Art Therapy Association (OATA, 2014; http://www.oata.ca/) states that art therapy can assist in resolving emotional conflict, increasing self-esteem and self-awareness, changing behavior, and developing coping skills and strategies for problem solving. Through his cognitive model Aaron Beck has shown us that emotions, thoughts, and behaviours are interrelated and influence each other (Beck, 1967/1975). When we think a certain way about others, or ourselves this will reflect in our actions towards others and ourselves. This occurs both with positive and negative thoughts and feelings.

Take for example, experiencing thoughts of worthlessness due to an academic failure. When we think we are worthless we also experience the negative feelings that accompany such a thought — feelings of sadness, guilt, fear of judgment, and of future failures. This then affects our behavior, and we begin to behave in such a way that mirrors these thoughts and feelings. This turns into a vicious cycle that can only be stopped by challenging the precipitating thoughts.

Art therapy is not merely expressing your emotions and leaving the session feeling better — it also involves challenging the negative emotions and thoughts that we have. Art therapy can very easily be combined with cognitive behavioral therapy methods, to make for the best results.

Similarly, by expressing our emotions in atypical ways (through the creative process) instead of through verbal communication, we may actually come to understand them more completely. It can be challenging for some people to communicate their feelings, particularly when it comes to conflicts with other parties — we tend to resort to negative behaviours such as yelling, name calling, or finger pointing. A way to avoid this is by first dealing with the emotions in a constructive way before addressing them with the other party.

I have commented before on how art can help in documenting our feelings and emotions by acting as a sort of creative-expressive journal. This means that we have a cathartic experience through our artistic expression, and with the guidance of an art therapist, are able to uncover latent meaning, thereby discovering our underlying emotions and thoughts. With this sort of assistance, we can be shown how to alter our ways of thinking.

In art therapy we do not just draw, or paint, rather we delve deeper and see inside ourselves — just as we would in psychotherapy. The most positive aspect of art therapy is that it is a non-verbal approach to understanding the self, and our latent thoughts and feelings that may be affecting our behaviors. Art therapy acts as a way to pry into the content and begin to understand more than meets the eye. Our creative-expressive journal helps act as a coping strategy — it reads as a narrative. We are able to refer to such a journal and understand what we were feeling at the time, and how we coped with it – whether it is positive or negative. By referring to this we may be able to monitor feelings and behaviours, and employ positive coping strategies. Clients may even be able to paint or draw outside of therapy sessions when they feel as though they are reaching a state of negative emotionality. This helps clients cope independently from therapy sessions, which helps the client develop increased self-esteem and self-efficacy. Their ability to cope on their own demonstrates to the client that they are capable, and when they find they are able to deal effectively with a negative mood, or thought, they end up feeling positively about themselves.

The effects art has on the brain.

There are a number of brain areas that are activated during artistic expression, and Lusebrink divided these into three levels: kinesthetic/sensory, perceptual/affective and cognitive/symbolic (Lusebrink, 2004). The Kinesthetic/sensory level refers to kinesthetic/motor and sensory/tactile interaction with the art media. The sensory stimulation facilitates imagery formation, and is likely to stimulate emotional responses. The perceptual/affective level is concerned with formal elements in visual expression, and focuses predominantly on the visual association cortex. The ventral stream of the visual association cortex determines what an object is, while the dorsal stream determines where the object is. Visual expression helps facilitate the construction of good gestalts through visual feedback; in art therapy, exploring external objects through touch or vision helps define and elaborate these forms (Lusebrink, 2004).

The affective aspect relates to the expression and channeling of emotions through artistic expression, and the effect emotions have on information processing (Lusebrink, 1990). Emotion influences the artistic expression – different mood states display differences in type and placement of lines, colors, and forms (Lusebrink, 2004).

The cognitive/symbolic level refers to logical thought, abstraction and analytical and sequential operations (Lusebrink, 2004). The brain area most involved with this level is the frontal cortex, and the parietal cortex (Fuster, 2003). In art therapy the interaction with the art medias and the actual expressive experience facilitates problem solving, and conceptual and abstract thought (Lusebrink, 2004). Another important aspect of the cognitive level is the ability to name and identify the images that are created – placing value and emotion on them. The symbolic aspect of this level refers to the understanding and integrating of certain symbols within the artistic experience. Lusebrink indicates that this exploration helps a client grow, and further develop their understanding of their self and others, (Lusebrink, 2004). The brain areas most activated in the symbolic level are the primary sensory cortices, as well as the uni-modal primary sensory cortices, which are especially important in exploring symbolic aspects of repressed or dissociated emotions and memories (Lusebrink, 2004).

As we can see, artistic expression has a significant effect on the brain – through activation and processing. Art acts as a way to activate emotions, memories, and gestalts or symbols – it acts as a catharsis for the client, and assists them in understanding their emotions, memories and current situation. Especially important is the bringing to light of repressed memories, which once addressed, can be integrated healthily into the clients’ personality, and can be treated effectively. As we know, repression causes somatic symptoms as well as mental symptoms, which contribute to the clients’ mental health issues.

Art Therapy as a Cognitive Behavioral Therapy

As we have seen art expression helps clients express and understand their emotions and understand their memories and aspects of their psyche that lay just below the unconscious. By bringing these aspects of the self (whether repressed, dissociated, or displaced) into consciousness the client is able to integrate them positively, and effectively, into their self. This proper integration leads the client to what Rogers called their “ideal self,” which means the client is closer to a fully integrated self, and self-actualization. A client who is self-actualizing is more well-rounded, has more positive coping strategies, is more resilient to external negative situations (which makes them less likely to internalize the negativity), and is more content.

How then does art relate to CBT? Cognitive behavioural therapies are focused on altering negative thought patterns and behaviours into more positive and adaptive ones. Artistic expression puts a client in the proper headspace for this sort of change to occur. Art as a cathartic experience allows the client to alleviate the stressors impacting their mental state, and allows the client to see their negative thought and behaviour patterns. It also helps the client to see the interaction between their thoughts and behaviours. By understanding the underlying issues influencing a mental state, we can deal with the issue and work towards effectively changing negative thought patterns.

Conclusion

Art therapy is much more than a source of entertainment. It is rooted in the intersection between psychotherapeutic interventions and art as expression. Art has long since been regarded as a healing process – Plato saw music as having a calming effect on the soul (Petrillo &Winner, 2005) and Freud believed art allowed both the creator and viewer to discharge unconscious wishes, which resulted in relief from tension (Freud, 1928/1961). Slayton, D’Archer and Kaplan performed a review of academic journals in the field of art therapy in 2010, publishing the results in the journal Art Therapy. This systematic review demonstrates how far the field has come, as well as supporting evidence for the efficacy of art therapy as a therapeutic intervention. They showed that art therapy was effective with multiple and different populations, ranging from emotionally disturbed children to adults with personality disorders to those with depression, developmental disorders and chronic diseases (Slayton, D’Archer & Kaplan, 2010).

Art therapy is an intervention meant to assist clients express themselves when they otherwise are unable to do so, and it can significantly improve a clients mood, decrease their levels of stress and anxiety, and assist in better understanding the self, and their individual situation. With a plethora of activities and art mediums at their disposal, those who partake in art therapy will experience a positive change through catharsis, and will be able to apply what they learn in therapy to their everyday lives while dealing with feelings of stress, depression and anxiety.

* When I say “typical therapies” I am not solely referring to psychoanalytic psychotherapy.

References:

Beck, A.T. (1967). The diagnosis and management of depression. Philadelphia, PA: University of Pennsylvania Press. 

Beck, A.T. (1975). Cognitive therapy and the emotional disorders. Madison, CT: International Universities Press, Inc. 

Freud, S. (1961). Dostoyevsky and parricide. In J. Strachey (Ed.),

The standard edition of the complete psychological works of Sigmund Freud (Vol. 21). London: Hogarth Press. (Original work published 1928.)

Fuster, J. M. (2003). Cortex and mind: Unifying cognition. New York: Oxford University Press.

Lusebrink, V. B. (1990) Imagery and visual expression in therapy. New York: Plenum Press.

Lusebrink, VB. (2004). Art Therapy and the Brain: An Attempt to Understand the Underlying Processes of Art Expression in Therapy. Art Therapy: Journal of the American Art Therapy Association, 21(3) pp. 125-135.

Malchiodi, C. (2003). Handbook of Art Therapy. New York: Guilford Press.

Petrillo, L, D., & Winner, E. (2005). Does Art Improve Mood? A test of a Key Assumption Underlying Art Therapy. Art Therapy: Journal of the American Art Therapy Association, 22(4) pp. 205-212.

Rogers, Carl. (1951). Client-Centered Therapy: Its Current Practice, Implications and Theory. London: Constable.

Rogers, Carl. (1961). On Becoming a Person: A Therapist’s View of Psychotherapy. London: Constable.

Slayton, S.C., D’Archer, J., & Kaplan, F. (2010). Outcome Studies on the Efficacy of Art Therapy: A Review of Findings. Art Therapy: Journal of the American Art Therapy Association, 27(3) pp. 108-118.

Vick, R. (2003). A brief history of art therapy In: Handbook of Art Therapy. New York: Guilford Press.

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Rachel Wagner <![CDATA[Identifying and Reducing Burnout among Healthcare Professionals]]> http://psychcentral.com/lib/?p=47686 2016-12-06T20:20:32Z 2016-12-07T18:15:06Z ]]> Stress Bomb Represents Exploding Explode And TensionIn a field where caring for others is a priority, sometimes personal health can be side-lined for healthcare professionals. Feelings of fatigue, isolation, loss of motivation, and sense of failure could mean much more than a bad day — you could be experiencing burnout. Burnout, defined as a state of mental and physical exhaustion caused by stress, is rampant in the healthcare field, and is recognized as one of the leading causes for nursing shortages in America.1

What causes burnout?
A variety of factors play into burnout among healthcare professionals, many of which are non-modifiable such as gender, socio-demographic variables, personality, and age2; however, the top cited reason for burnout is work overload.3 When a person works in a high stress field such as healthcare they are exposed to emotionally draining experiences all the time so the added pressure of working while the hospital is understaffed only piles on to that stress. Many studies within hospitals have found a direct link between reducing workload and reduced burnout among healthcare professionalswhich led to a significant drop in patient deaths.5

It is impossible to expect for us as healthcare professionals to do the work of two or three people and still give the same quality care to a patient as usual. Burnout only leads to mediocre patient care and a poor work environment, which continue the vicious circle to only cause more burnout. and Medical institutions across the world have attempted to provide both preventive and curative care for healthcare workers who are at risk for experiencing burnout; however, many of these attempts were unsuccessful and do not address the underlying problem: overworked staff.

Am I at a higher risk for burnout? If you are…

  • A male.
    You are at a higher risk for developing depersonalization, which is a direct indicator for burnout.6,7
  • Under the age of 30.
    Younger healthcare professionals with less experience usually handle stress worse compared to older, more experienced peers.
  • A “Type-D” personality.
    People with Type-D personalities are those who experience a wide arrange of negative emotions but suppress said emotions in social situations to avoid judgment. They are 5 times more likely to develop burnout.8
  • Living in a rural area.
    Those living in more isolated areas experience a higher rate of burnout in the healthcare field compared to those living in highly populated areas.9

What you can do:
While you can’t change the amount of work you need to complete today, you can follow some of the following tips to help reduce your chance of developing burnout or combat burnout you already experience.

  • Be aware of how you are feeling each day.
    While everyone has bad days, if you have been having a bad day for the last two weeks something is wrong. Go talk to a trusted friend or see a therapist to try to sort through some of the feelings you have been having so you can get back to being the best you possible.
  • Talk it out with a co-worker if you feel overwhelmed.
    Interacting with another person who can identify with what you are going through can be very beneficial. Emotional support from peers at work is essential to combat burnout.
  • Take time to care for yourself. 
    Whether it’s during a 15-minute break or an hour before bed, do something that you find enjoyable and relaxing. Taking a little time out of each day for “me-time” may seem difficult to do but the benefits are definitely worth it.
  • Join a support group.
    Various methods such as mindfulness-based stress reduction (MBSR) combined with other types of therapy such as group therapy can reduce burnout significantly.

Taking the time to care for your needs will only help you in the long run, both for yourself and for those you care for at work.

References:

  1. Toh, S. G., Ang, E., & Devi, M. K. (2012). Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/hematology settings. International Journal of Evidence-Based Healthcare, 10(2), 126-141. doi:10.1111/j.1744-1609.2012.00271.x
  2. Garrosa, E., Moreno-Jiménez, B., Liang, Y., & González, J. (2008). The relationship between socio-demographic variables, job stressors, burnout, and hardy personality in nurses: An exploratory study. International Journal of Nursing Studies, 45(3), 418-427. doi:10.1016/j.ijnurstu.2006.09.003
  3. Toh, S. G., Ang, E., & Devi, M. K. (2012). Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/hematology settings. International Journal of Evidence-Based Healthcare, 10(2), 126-141. doi:10.1111/j.1744-1609.2012.00271.x
  4. Weigl, M., Stab, N., Herms, I., Angerer, P., Hacker, W., & Glaser, J. (2016). The associations of supervisor support and work overload with burnout and depression: a cross-sectional study in two nursing settings. Journal of Advanced Nursing, 72(8), 1774-1788. doi:10.1111/jan.12948
  5. Aiken, L. H., Sloane, D., Cimiotti, J., Clarke, S., Flynn, L., Seago, J., . . . Smith, H. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904-921. doi:10.1111/j.1475-6773.2010.01114.x
  6. Singh, C., Cross, W., & Jackson, D. (2015). Staff burnout –a comparative study of metropolitan and rural mental health nurses within Australia. Issues in Mental Health Nursing, 36(7), 528-537. doi:10.3109/01612840.2014.996838
  7. Fuente, G., Vargas, C., Luis, C., García, I., Cañadas, G., & Fuente, E. (2015). Risk factors and prevalence of burnout syndrome in the nursing profession. International Journal of Nursing Studies, 52(1), 240-249. doi:10.1016/j.ijnurstu.2014.07.001
  8. Geuens, N., Braspenning, M., Bogaert, P., & Franck, E. (2015). Individual vulnerability to burnout in nurses: The role of Type D personality within different nursing specialty areas. Burnout Research, 2(2-3), 80-86. doi:10.1016/j.burn.2015.05.003
  9. Breen, M., & Sweeney, J. (2013). Burnout: the experiences of nurses who work in inner city areas. Mental Health Practice, 17(2), 12-20.
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Darlene Lancer, JD, MFT <![CDATA[Codependency Addiction: Stages of Disease and Recovery]]> http://psychcentral.com/lib/?p=47676 2016-12-05T18:00:25Z 2016-12-05T18:00:25Z ]]> bigstock-122754980Codependency has been referred to as “relationship addiction” or “love addiction.” The focus on others helps to alleviate our pain and inner emptiness, but in ignoring ourselves, it only grows. This habit becomes a circular, self-perpetuating system that takes on a life of its own. Our thinking becomes obsessive, and our behavior can be compulsive, despite adverse consequences. Examples might be calling a partner or ex we know we shouldn’t, putting ourselves or values at risk to accommodate someone, or snooping out of jealousy or fear. This is why codependency has been referred to as an addiction. In 1956, it decided that addiction was a disease, and in 2013 also named obesity a disease. A prime motivation in both cases was to de-stigmatize these conditions and encourage treatment.

Is Codependency a Disease?

In 1988, psychiatrist Timmen Cermak suggested that codependency is a disease noting the addictive process. Psychiatrist and doctor of internal medicine, Charles Whitfield , described codependence as a chronic and progressive disease of “lost-selfhood” with recognizable, treatable symptoms — just like chemical dependence. I agree with Dr. Whitfield, and in Codependency for Dummies refer to codependency as a disease of a lost self. In recovery, we recover our selves.

Codependency is also characterized by symptoms that vary on a continuum similar to those associated with drug addiction. They range from mild to severe and include dependency, denial, dysfunctional emotional responses, craving and reward (through interaction with another person), and inability to control or abstain from compulsive behavior without treatment. You increasingly spend time thinking about, being with, and/or trying to control another person, just as a drug addict with a drug. Other social, recreational, or work activities suffer as a result. Finally, you might continue your behavior and/or the relationship, despite persistent or recurring social or interpersonal problems it creates.

Stages of Codependency

Codependency is chronic with enduring symptoms that are also progressive, meaning that they worsen over time without intervention and treatment. In my opinion codependency begins in childhood due to a dysfunctional family environment. But children are naturally dependent, it cannot be diagnosed until adulthood, and generally begins to manifest in close relationships. There are three identifiable stages leading to increasing dependence on the person or relationship and corresponding loss of self-focus and self-care.

Early Stage

The early stage might look like any romantic relationship with increased attention and dependency on your partner and desire to please him or her. However, with codependency, we can become obsessed with the person, deny or rationalize problematic behavior, doubt our perceptions, fail to maintain healthy boundaries, and give up our own friends and activities.

Middle Stage

Gradually, there’s increased effort required to minimize painful aspects of the relationship, and anxiety, guilt, and self-blame set in. Over time, our self-esteem lessens as we compromise more of ourselves to maintain the relationship. Anger, disappointment, and resentment grow. Meanwhile we enable or try to change our partner through compliance, manipulation, nagging, or blaming. We might hide problems and withdraw from family and friends. There may or may not be abuse or violence, but our mood worsens, and obsession, dependence, and conflict, withdrawal, or compliance increase. We might use other addictive behaviors to cope, such as eating, dieting, shopping, working, or abusing substances.

Late Stage

Now the emotional and behavioral symptoms begin to affect our health. We may experience stress-related disorders, such as digestive and sleep problems, headaches, muscle tension or pain, eating disorders, TMJ, allergies, sciatica, and heart disease.  Obsessive-compulsive behavior or other addictions increase, as well as lack of self-esteem and self-care. Feelings of hopelessness, anger, depression, and despair grow.

Recovery

The good news is that the symptoms are reversible when a codependent enters treatment. People don’t generally seek help until there’s a crisis or they’re in enough pain to motivate them. Usually, they aren’t aware of their codependency and may also be in denial about someone else’s abuse and/or addiction Recovery begins with education and coming out of denial. Reading about codependency is a good beginning, but greater change occurs through therapy and attending a Twelve-Step program, such as Al-Anon, CoDA, Nar-Anon, Gam-Anon, or Sex and Love Addicts Anonymous.

In recovery, you gain hope and the focus shifts from the other person to yourself. There are early, middle, and late stages of recovery that parallel recovery from other addictions. In the middle stage, you begin to build your own identity, self-esteem, and the ability to assertively express feelings, wants, and needs. You learn self-responsibility, boundaries, and self-care. Psychotherapy often includes healing PTSD and childhood trauma.

In the late stage, happiness and self-esteem doesn’t depend on others. You gain the capacity for both autonomy and intimacy. You experience your own power and self-love. You feel expansive and creative, with the ability to generate and pursue your own goals.

Codependency doesn’t automatically disappear when a person leaves a codependent relationship. Recovery requires ongoing maintenance, and there is no perfect abstinence. After a number of years in treatment, the changes in thinking and behavior become increasingly internalized, and the tools and skills learned become new healthy habits. Still, codependent behavior can easily return under increased stress or if you enter into a dysfunctional relationship. Perfectionism is a symptom of codependency. There is no such thing as perfect recovery. Recurring symptoms merely present ongoing learning opportunities!

©Darlene Lancer 2016

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Tina Arnoldi <![CDATA[Suicide Is Our Modern Day Leprosy]]> http://psychcentral.com/lib/?p=47652 2016-11-29T22:25:22Z 2016-11-30T18:10:34Z ]]> Leper Rubber StampWhen I was preparing a talk about suicide prevention for a local church, there were moments when I become emotional just thinking about the subject matter. I felt confident when I started the presentation for a fantastic group of lay counselors, but did not plan for the water works to begin five minutes into the talk.  

It wasn’t just the heavy topic matter, it was looking at a room of people and realizing they took time from their busy schedules to learn more about what they can do to prevent suicide. I was overwhelmed by their compassion. Suicide prevention needs to be discussed everywhere and it’s a must-have discussion for our churches.

Church is a place for broken people, not perfect people, and should be the safest place for people struggling with thoughts of suicide. Unfortunately, some of the messages that have come from churches make the assumption that mental illness — depression especially — can be fixed if people would “pray more,” or “have more faith.” When this is the message congregants hear, of course they’re not going to seek mental health treatment. And they are certainly not going to consider medication regardless of how depressed they may feel.

During my talk, I referenced scriptures these lay counselors may want to use when they encourage people since this was a Christian ministry. However, I said that offering comfort to the hurting person needs to come first from the helper before the hurting person hears scripture. Although this may rub some people the wrong way, we can easily hide behind scripture. Now, I’m a big believer in the Bible and what it teaches us about life. But assurance needs to come first from the person sitting across the table.  

Before prayer or scriptures of comfort are offered, the hurting person needs to hear, “I’m with you”, “I’m sorry you feel so bad that suicide seems like the answer”, “I want you to live — let’s work through this together.” To hear these words from a fellow church member that their thoughts of suicide feelings won’t push people away — that their suicidal ideations do not make them a leper — is an incredible first step. Someone recognized their suicidal feelings are as big and real as cancer. Luke 10:33-34 says “But a Samaritan, as he traveled, came where the man was; and when he saw him, he took pity on him. He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, brought him to an inn and took care of him.” Our wounds are not only physical. They are also emotional and need equal care.

What I would love is to hear is that other churches in our communities want to learn how they can help in this fight for prevention. Their church members may have suicidal thoughts too, even the person who is there every Sunday, or who serves in children’s ministry, or who passes the offering plate. They’re human and not exempt from the chemical imbalances that happen in the brain.  

There’s a burden on my heart to reach more churches about this topic. I’m not going to beat anyone over the head with a Bible, but I will use scripture as a reason for those in ministry to get trained on this issue. Carry each other’s burdens, and in this way you will fulfill the law of Christ.” (Galatians 6:2) As a Christian, I absolutely believe there is a place for the Bible in helping other people.  Unfortunately too many people end up in my office when they reach out about their mental health issues — or suicidal thoughts in their church homes – and they’ve been made to feel they are struggling because they are not living the Christian life. And in some cases, that’s true. If we continually get fired from jobs because we have a habit of stealing from our employers, we may feel depressed because it brings financial problem, but clearly we brought that on ourselves! Most of the time, the cause is not that clear.

I believe that healing is possible and that suicide is preventable. But we can’t prevent what we don’t talk about. I also believe in the power of prayer — and medicine — to get people through these challenges. They are not mutually exclusive. There is a place for both of them. Suicide prevention is a big deal but unfortunately not enough people are discussing it. What if you knew you could save just one life? Would that be enough to address suicide prevention in your church? I believe we can reach the point where suicide is not our modern day leprosy.

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Edie Weinstein, MSW, LSW <![CDATA[Reason, Season, Lifetime: Accepting Impermanence in Relationships]]> http://psychcentral.com/lib/?p=47639 2016-11-28T21:13:20Z 2016-11-29T18:15:31Z ]]> Couple Standing Back To BackIt has been said that people enter our lives for a reason, a season or a lifetime.  

  • Reason (a project or one time activity, a “guardian angel” encounter when someone steps in and moves you out of a dangerous situation, a fleeting/swoop by lesson)
  • Season (a short term; perhaps a few months or years, interaction that teaches you lessons that you may not have learned otherwise.)
  • Lifetime (long term connections that may begin at birth or anywhere along the timeline, that endures, perhaps despite challenges, or may even strengthen thus)

The reality is that one day someone will die or leave you, or you will die or leave them. Sound morbid or maudlin? It need not. Instead, it calls for an awareness of the precious and often-times fleeting nature of relationship.

It begins with a desire for connection. According to scientist, Matthew Lieberman, the author of Social: Why Our Brains Are Wired to Connect, we are social creatures with an inherent need to engage with others.

Everyone you now know and love was once a stranger. When you gaze back over your timeline, can you recall a time when many of these people were not in your life? Some have been with you for so long, that it might be unimaginable.

Sara shares her experience, “Throughout his life my son would look at me puzzled when he would see me smile or greet ‘strangers.'” He would ask, “Do you know that person?” When I would respond, “Not yet,” he would continue, “Then why are you saying hi to them?” My answer was always, “Because they are in my world.”

Continuing, “How sad it would be to have missed the opportunity to connect with certain people who grace my life and how rich I am to now know and love them. It is hard to imagine what it was like before they stepped on stage. I have had fleeting encounters with folks whose smile or comment have made my day. I have lifelong relationships that I treasure. I anticipate connecting with anam cara (Gaelic for soul friend) as each day I set an intention for having extraordinary experiences and meeting amazing people.  And each day I do.”

“Walking through my door will be people I will love for decades and look forward to embracing as new links in those overlapping soul circles that so delight me,” she adds poetically. “I am grateful for my far-flung tribe, wherever it is that they are living and breathing now.”

Many of our interactions seem “meant to be,” or in Yiddish, “beshert.” Consider people who show up in unexpected ways as if scripted. You may have thought how wonderful it would be to have someone help you with a task and within short order, a person crosses your path who is ready, willing and able to be of assistance. A desire arises for a new friend who will engage in fun activities with you and later that day you hear about a meetup in your area that focuses on the very thing that peaks your interest.

Once a relationship is established, you may find yourself taking the person for granted; assuming they will fit into the “lifetime” category. Relationships need to be cultivated and tended to like a blossoming garden. With neglect, they will wither and with loving attention, they will flourish. This is so, whether we are speaking of platonic friendships, family relationships or romantic partnerships.

How to maintain the garden:

  • Keep the lines of communication open. People are not always mind-readers and can only respond to what they imagine you are thinking or feeling.
  • The same behaviors that drew you to each other can be maintained. Keep courting each other with kind and loving words and gestures.
  • Don’t let the fire get doused. Feed it with fun, attention and the fuel that lit it initially.
  • Speak to this person as if they are someone you love and would like them to remain in your life.
  • Start with the ending and imagine that the relationship is over, so that the pressure is off and you can speak the truth about who you are, rather than hiding your shortcomings to make a good impression.  
  • We can think about the concept of, “If I had a year to live, what would I do in that period?” An even more revealing question might be, “What if I knew my parent/child/partner/friend had a year to live, how would I treat them?” Would you be more patient and understanding? Would you spend more time together creating memories that will carry you through the loss?
  • Don’t sweat the small stuff and it is mostly all small stuff. Richard Carlson, the author of the beloved series by that name, had it all going for him. A wonderful marriage to Kristine, two thriving daughters, a solid career as a writer and speaker. On board a plane, headed to New York from California, he had a pulmonary embolism and died on December 13, 2006 at the age of 45. Would you be better able to accept what comes your way if you knew that each breath could be your last?

What happens when the show is over and the curtain comes down on the relationship?

Sometimes, despite your best efforts and that of the other person, the relationship dynamics shift and the person leaves your life either by your choice, theirs, or by agreement. Conscious uncoupling has become a more commonly spoken about concept, with the split between actress Gwyneth Paltrow and Chris Martin; lead singer of Coldplay. How do you maneuver those sometimes-treacherous waters?

It would be understandable to harbor emotions of sadness, anger and resentment in the wake of the loss. Allow yourself to feel it all, but be aware that permitting them to take up residence in your mind, might keep you trapped in a downward spiral. Find supportive people to be on your recovery team as you heal your heart.

Some relationships have toxic qualities (such as abuse, untreated addiction, lying, infidelity, criminal activity) that are better left, lest they pull you down into the abyss. Even if love remains between the two of you, there are times when it is safer to love from a distance.

Remind yourself that you had a life prior to meeting this person and will have one following the changing of the relationship dynamics. Once the relationship completes (as much as any relationship can be fully over), take a pro-active and self-loving stance as you decide who you truly are, outside its structure. Even as it can be a painful process, shedding the layers of who you were with this person, ask yourself who you are without them.

Thank the person, either aloud or in your mind, for the lessons that came as part and parcel of the relationship. There is always a gift in every interaction, even if it might not seem so at the time. Gratitude has a way of easing the pain and smoothing away the rough edges.

Regardless of the ways in which relationships change, be compassionate with yourself and the others involved, to help heal any residual wounds. Honor and appreciate it for what it was as you open the door for even more to enter and enrich your life.

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Irving Schattner, LCSW http://www.mytherapistdelraybeach.com/ <![CDATA[Living with Panic and Anxiety]]> http://psychcentral.com/lib/?p=47628 2016-11-26T19:49:27Z 2016-11-28T18:10:02Z ]]> bigstock-150021326Intense fear, terror, panic or dread my leave you feeling physically and emotionally drained to the point where even normal activities may be avoided or curtailed. You may experience a number of distressing or debilitating symptoms including, but not limited to, tightness in the chest, racing heart, difficulty breathing, trembling hands or limbs, racing thoughts or being in a mental fog, or feeling detached from your body. You may have obsessive thoughts and excessive worry, and self-medicate or engage in other behaviors to calm your nerves. These are all classic symptoms of Anxiety.

Generalized Anxiety Disorder (GAD) involves excessive anxiety, worry, fear, or unease about events or activities. Its duration, intensity, or frequency is disproportionate to the actual likelihood or impact of the anticipated event.  People suffering with generalized anxiety disorder experience difficulty controlling worrisome thoughts which interfere with managing tasks at hand. It is common for persons with this disorder to worry about daily, routine tasks and circumstances such as school, job or career responsibilities, health, finances, household chores, being late for appointments, or question or evaluate the competence of their performance in given situations. The focus of their worries or anxiety may shift from one concern to another, as it is common for such persons to complain about persistent thoughts of worry, anxiety, fear, distress or dread which they feel incapable of shutting off.

Unlike normal worry, persons with generalized anxiety disorder find the excessive nature of their worries of everyday life significantly interfering with healthy, adaptive psychological, emotional and social functioning. Second, worries are more distressing and longer lasting.

Third, this excessive worry may appear to be without cause. Fourth, excessive worry may be accompanied by physical symptoms such as feeling on edge, being easily fatigued, muscle tension, sleep disturbance, concentration difficulties or having one’s mind seemingly go blank, trembling, shakiness, sweating, nausea, diarrhea, increased heart rate, shortness of breath and dizziness, irritable bowel syndrome, headaches, and other debilitating symptoms.

Overcoming Generalized Anxiety Disorder

The good news is that Generalized Anxiety and Panic are highly treatable!!!  With the expertise of a mental health professional who specializes in treating anxiety disorders, and utilizing an approach that’s based on proven interventions individually tailored to meet the needs of each client, you will be well on the path to Recovery.

Cognitive Behavioral (CBT) is one of the most effective treatments for Generalized Anxiety Disorder.  Studies have shown that the benefits of CBT may last longer than those of medication, but no single treatment is best for everyone. CBT examines the interconnection between one’s negative thought patterns, feelings and behaviors, and how they maintain, reinforce, and even intensify anxious thoughts and worry associated with generalized anxiety. Learning to replace negative thoughts and beliefs with more realistic, supportive, adaptive thoughts and feelings leads to less generalized worry and anxiety, which translate into increased behavioral mastery and competence in those same or similar situations.

Mindfulness and applied relaxation are other effective treatments which work by focusing one’s awareness of the present moment (vs. future events) by acknowledging and accepting feelings (whether positive or negatively charged) and deactivating bodily sensations. Being mindful makes one aware of what one is feeling and experiencing in the moment while remaining in a calm, accepting state. Applied relaxation focuses on muscle relaxation and visual cues to maintain that state of calm and acceptance. Yoga and other meditative techniques have proven highly effective in reducing or deactivating the “anticipatory anxiety” normally associated with generalized anxiety disorder.

Treatment for Panic and Anxiety Disorders

Panic disorder and other anxiety disorders require specific targeted interventions that are individually tailored to the needs of the client (as no two clients are alike). It is crucial that you receive the guidance, coaching, and expertise of a mental health professional who “specializes” in treating Panic (and other anxiety disorders), as traditional “talk therapy” is ineffective.

Anxiety and panic disorders, if left untreated, not only reinforce continued avoidance of feared situations (for example, in the case where an attack occurred while driving, you may seek alternative routes or stop driving completely).. The anticipation of having another attack may generalize into situations previously not associated with the original fear or panic. These disorders may also lead to Agoraphobia, which is characterized by severe anxiety in situations where an individual feels trapped by their surroundings. Panic sufferers may also experience anticipatory anxiety and generalized anxiety. This disorder can create significant psychological, emotional, and physical distress, as well as avoidance of opportunities personal and professional growth, relationships, and happiness.

The following approaches are evidence-based and proven as most effective for the relief of Panic and Anxiety. They include:

  1. Psychoeducational into the nature, cause, and biological basis of Panic on Anxiety.
  2. Exposure and Response Prevention (ERP) Therapy which is based on the principle that the only way to overcome Panic is by guided, gradual exposure to the feared event or trigger. While avoidance maintains and increases Panic and often generalizes to new situations, facing your fear eventually desensitizes you to the feared event by reducing the intensity of symptoms and with continued practice can extinguish them all together.
  3. Cognitive Behavioral Therapy focuses on challenging (or disputing) negative thoughts and core beliefs that fuel panic and anxieties. Breaking the vicious cycle between maladaptive thoughts and beliefs leads to increased mastery over adaptive behaviors which support healthy functioning.
  4. Psychodynamic Therapy examines Panic in the context of historical events and relationships that may have played a direct or indirect role in the development of the disorder.
  5. Self-regulation addresses emotional and behavioral activation which sustains and reinforces anxiety, fear, and Panic. Strategies include, but are not limited to, mindfulness techniques, meditation and visual imagery, corrective breathing, and progressive muscle relaxation.
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Tamara Hill, MS, LPC <![CDATA[Book Review: Ending the Parent-Teen Control Battle]]> http://psychcentral.com/lib/?p=47381 2016-11-21T18:03:44Z 2016-11-27T15:45:11Z My mother, a loving mother dedicated to her children, used to say, “raising children is hard.” As I grew older and began working with children and adolescents, I recognized her […]]]>

My mother, a loving mother dedicated to her children, used to say, “raising children is hard.” As I grew older and began working with children and adolescents, I recognized her saying was more than just a saying. It was in fact truth. I receive multiple questions from tired and overwhelmed parents all over the world asking me for tips and advice on how to deal and cope with their irritable, outspoken, and difficult child. A difficult child seems to be the norm today.

Our kids are growing at such a fast rate and most parents are rather overwhelmed by the pseudo-mature attitude of most teens and the series of advances in social media and technology. To put it bluntly, parents are feeling left behind and out of touch.

For the desperate parent, Neil D. Brown’s new book, Ending the Parent-Teen Control Battle: Resolve the Power Struggle and Build Trust, Responsibility, & Respect, might be a light at the end of the tunnel. Brown begins his book by explaining why he became interested in parent-child conflict, which is steeped in a type of family therapy known as Structural Family Therapy (SFT).

SFT, created by Salvador Minuchin, describes repeated patterns of behaviors that negatively interfere with appropriate and healthy interactions within families. Family therapists who follow SFT teach families how they relate and how to create healthier patterns. Brown’s book is very similar to this approach and focuses on empowering the parent(s) to maintain the appropriate temperament when relating to the child and how to hold the child accountable.

His approach is somewhat different from what other parenting experts have suggested. For example, Brown makes it clear that teens should learn that they can live without privileges and that their parents will take away privileges (i.e., cell phones, time with friends, games, social media, sporting events, etc.) if necessary. Brown encourages parents to make their teens’ privileges dependent upon their behaviors and attitudes and not on a set time frame.

As a child, adolescent, and family therapist I can confidently say that this approach does work and I have used it with most of my families. These families have reported success in getting their teen to comply and truly strive to change negative patterns of behavior. Why? Because the loss of privileges highlights the fact that the teen is lucky to have a privilege. It also highlights that changes in behavior need to be long-lasting, not for a few hours, a week, or a month, in order to earn something back.

In addition, Brown discusses important variables that influence negative family patterns, such as temperament, reactive personalities, parenting style, personalization, emotional tone, stages of adolescence, puberty and physiological changes, ADHD and learning disorders, and mental health challenges like depression. It is important that parents understand these variables so they know how to approach their child and disengage from the Control Battle. Brown has chapters focused on shifting behaviors, changing the vision of the parent and teen, building self-esteem, and exploring other treatment options for teens who are struggling to remain safely in the home and community environments. Each chapter offers insightful information to desperate, tired, and discouraged parents.

It is important for me , as a therapist, to mention that not all of Brown’s techniques or suggestions may fit every family or specific situation. Every teen is different. And while Brown discusses concepts that are practical and easy to understand, there aren’t concrete details or empirical research mentioned in the book to help convince families that the approaches mentioned will be effective. It is also important that parents be patient with the techniques discussed in this book. Techniques can only work when parents are patient, truly digest the theory behind the techniques, and do their best to stick to the original plan. Any deviation or “giving in” can undermine not only the effectiveness of the technique(s), but the power of the parental role.

In addition, there are some parts of the book that readers may question, such as the fact that Brown uses a “one size fits all” approach to setting standards or expectations and rules. Some teens, primarily those with difficult temperaments, may respond to the techniques initially but later stop responding. Or the teen may struggle with special needs or severe mental illness and not be affected by the suggested approaches offered in Brown’s book. Children with special needs or severe mental health challenges may benefit from another approach.

While I completely support the fact that this book presents practical and interesting tools for parenting a difficult teen, it is not necessarily a book with new ideas. Many parenting books focus on privileges, setting expectations, maintaining family discussions on family standards, and putting the burden of earning back privileges on the teen. Many books focus on changing the attitude and perceptions of the teen and family. Brown’s books is not the first. However, this book pares down the topic of parenting to a practical and easy-to-follow format. It takes “old information” and repurposes it for today’s readers.

Ending the Parent-Teen Control Battle: Resolve the Power Struggle and Build Trust, Responsibility, & Respect
New Harbinger Publications, October 2016
Paperback, 200 pages
$16.95

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Tamara Hill, MS, LPC <![CDATA[Book Review: Behavioral Challenges in Children]]> http://psychcentral.com/lib/?p=47191 2016-11-21T17:58:12Z 2016-11-26T15:57:50Z Raising a child with special needs is a difficult thing. Not only does a parent or guardian need a high tolerance level, but also knowledge on how to cope with, […]]]>

Raising a child with special needs is a difficult thing. Not only does a parent or guardian need a high tolerance level, but also knowledge on how to cope with, comfort, and teach their child. Understanding that each child is different and that their experience of the world around them is different will help parents and providers approach the child in a way that can improve deficits and lead to growth and change.

In her new book, Behavioral Challenges in Children with Autism and Other Special Needs, Diane Cullinane addresses these differences by discussing the developmental model, advances in special education and treatment modalities, and how the DIR (Developmental, Individual Differences, Relationship) Model can facilitate a greater understanding of children with special needs and the strengths they need to work on developing.

One of the most common emotions of parents of children with special or developmental needs is frustration. Why? Because parents of children with special or developmental needs are not skilled at working with a child who may develop at a slower pace than other kids. Another reason is that many parents struggle to identify any kind of progress because weaknesses are so prevalent and so very clear to parents. Having the ability to understand developmental milestones beyond the typical motor development (i.e., walking, talking, playing, etc) can lend some hope to burdened parents. Cullinane’s book clearly explains normal developmental stages so parents and caregivers can identify, rather quickly, if the child is developing appropriately or where the child is in need of more skills.

Part I of the book focuses on helping the reader understand why the developmental model can help families, and even professionals, better understand a child who is struggling with developmental deficits. The reader will learn a lot about the DIR Model and how to implement its teachings in working with or raising a child with developmental challenges. Part II of the book focuses on implementing appropriate techniques in the moment.

One of the most important chapters is the chapter on relationships, which focuses on how the parent-child interaction may be affecting the child’s overall development. For example, a parent who is emotionally distant and confused by their child’s behavior may not understand how their emotional distance is contributing to the child’s inability to regulate his or her own emotions. This chapter highlights emotional interconnectedness as an important component of relationships with children with special and developmental needs. The following chapters focus on implementation of techniques and developing a long-term, future-oriented plan.

Overall, this book is a useful tool for parents, families, students, and professionals working with children who have special and developmental needs. However, there are some limitations to this book, including technical language that may be intimidating to parents and families unfamiliar with the “developmental approach” or the DIR Model. The DIR model can also be particularly intimidating as the language is not only technical but at times convoluted. Parents and families may give up on a book that seems to use terminology and concepts that require some prior knowledge of developmental psychology or behavioral health rehabilitation. Even more, some parents and families, perhaps even students and providers, may find the book dry and slightly disengaging, particularly the beginning of the book, which focuses on introducing the developmental model and the challenge of children with special and developmental needs.

In spite of a few limitations, Cullinane does a good job of providing a comprehensive review of developmental psychology, the DIR Model, and its usefulness in treating children with developmental challenges. Cullinane provides a structured and comprehensive foundation for those seeking greater knowledge of how to treat children with special needs.

Behavioral Challenges in Children with Autism and Other Special Needs: The Developmental Approach
W.W. Norton & Company, August 2016
Hardcover, 368 pages
$37.95

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Janet Singer <![CDATA[The Rhyme and Reason of Rituals]]> http://psychcentral.com/lib/?p=47594 2016-11-21T22:04:36Z 2016-11-26T15:04:49Z ]]> Christmas candles burning at night. Abstract candles background.Whenever my children travel, I always make sure to tell them to “have a safe trip.”  Before my husband goes to sleep at night, he makes it a point to be sure all of our doors are locked. A basketball player insists on reciting a specific prayer before each game, and a runner wears her lucky running shoes every time she competes. Do any of these behaviors seem abnormal to you? Probably not.

In this study on ritualistic behavior, researchers concluded that repetitive behavior, especially ritualistic-like behavior, is a common human (and animal) occurrence. This behavior is thought to have evolved as a means to induce calm and alleviate stress. Rituals provide us with the illusion that we are in control of a situation that is really out of our control.

Hmm, sounds a lot like obsessive-compulsive disorder, doesn’t it? While the researchers acknowledge a behavioral link between “normal” human rituals and OCD, they bring up a very important difference: Those with OCD continually wrestle with the feeling of incompleteness, never truly convinced that their task has been completed. Doubt always manifests itself and fuels the fire of OCD.

In general, people with OCD are also more rigid in their adherence to rituals than those without the disorder. As Dr. Jonathan Grayson tells us, “Consistency is the measure of severity, the more consistent you are, the worse your OCD is.” In other words, the more tied you are to your rituals, the more your OCD is controlling you. For example, if for whatever reason I’m not able to tell my children to “have a safe trip,” I might feel a bit uneasy for a minute or two, but I won’t dwell on it and I will still be able to move on with my day. However, someone with OCD with this same ritual might become distraught if not able to perform it and might possibly develop other rituals to “make sure” everything will be okay. For example, he or she might feel compelled to repeat “Everything will be fine” a certain number of times to quell the anxiety felt until the children in question return home safely. These are two very different reactions and it’s not difficult to see how the second scenario could snowball out of control and lead to hours and hours of compulsions.

I believe it is important to remember that the thoughts and rituals of those with OCD are often no different from those who do not have the disorder. Many people don’t realize this. What is different is the severity of these obsessions and compulsions, as well as the importance placed on them by the person with obsessive-compulsive disorder. Back to our example above. If I’m not able to say “have a safe trip” to my children for whatever reason, I might be annoyed or upset over the situation but my feelings would pass quickly. Someone with OCD, however, might think, “What’s wrong with me? What kind of mother forgets or doesn’t make it a priority to tell her children to have a safe trip? Now they might get hurt and it will be all my fault. What a horrible person I am.” It’s easy to see how these thoughts can become obsessions with lives of their own and rituals become compulsions that overtake the OCD sufferer’s life.

Why does this happen? While researchers continue to try to unlock the mysteries of OCD, the good news is we don’t have to understand where OCD comes from to treat it properly. Exposure and response prevention (ERP) therapy teaches those with obsessive-compulsive disorder how to best deal with their intense thoughts and rituals, so they can regain control of their lives.

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Julia Patt <![CDATA[Book Review: Stuck in a Rut]]> http://psychcentral.com/lib/?p=47387 2016-11-17T22:11:21Z 2016-11-26T03:09:18Z However perfectly we plan, very few of our lives will turn out exactly as we expected. Most of us well know the feeling that we’re spinning our wheels, not living […]]]>

However perfectly we plan, very few of our lives will turn out exactly as we expected. Most of us well know the feeling that we’re spinning our wheels, not living the way we wanted or intended. We aren’t pursuing our dreams, caring for ourselves the way we should, or making time for what we value most. It isn’t unusual to feel trapped by our circumstances and unable to change our lives in a meaningful way.

Many people turn to life coaches for this very reason — like Stuck in a Rut: How to Rescue Yourself and Live Your Truth author Fiona Craig, who has put many of her practices and recommendations into her book. Like many self-help authors, Craig seeks to enable her readers to live more authentically, make healthier choices, and strive for attainable goals.

In many regards, Stuck in a Rut is a typical self-help book. Craig encourages readers to reflect on their childhood experiences and the values they received from their parents. She uses case studies and quotes from previous clients. She offers exercises for dealing with your inner critic, becoming more creative and playful, and defining your life goals. Readers will also find the ubiquitous “power of positive thinking” arguments and rampant individualism that persist in the genre. And as in similar texts, despite her universal approach, it will become obvious that Craig’s audience is much narrower and consists mainly of middle class mothers and white-collar professionals. However, that does not mean that Stuck in a Rut is without merit. It’s an accessibly written book with some worthwhile recommendations amid the self-help standards.

After introducing herself and telling her own story of getting stuck and then unstuck, Craig lays out a sensibly ordered discussion divided into three parts: “Breaking Limitations,” “Inner Balance” and “Finding Joy.” She recommends that readers engage with her methods gradually, saying, “it’s not a novel,” and the book’s structure certainly lends itself to a slower engagement with its ideas and exercises. Within the different sections, you’ll find offerings like “Bad Habits,” “Fearing Failure,” “Creative Spirit,” “Bully-Busting,” “Self-Care,” and “Celebrating No.” Craig concludes each chapter with a variation on the same exercise: listing three action steps to getting unstuck as it relates to the chapter. As has become popular, there are more exercises and worksheets available online, which can be accessed by entering the url in your browser (more convenient for e-readers) or by scanning a barcode in the book with your smartphone.

Given the ordering of the sections, Stuck in a Rut is clearly meant to have a cumulative effect — Craig is a self-admitted holistic or Gestalt psychotherapist, so her remedies are not at all piecemeal. First, we discard the negatives in our lives like our feelings of guilt and attachment to values other than our own. Next, we develop strategies to cultivate creativity and emotional balance, followed by exercises to attend to our needs, get organized, and maintain boundaries. Then, we’re ready to embark on the lives we always wanted to live.

If it sounds a little overly simplistic, it often is, although Craig is open about the fact that getting unstuck takes a tremendous amount of work, self-reflection, and perseverance. Indeed, there is much more to do than can be reflected in two hundred or so pages. (This is perhaps, the true failing of much of the self-help genre and certainly not limited to Stuck in a Rut.)

Ultimately, whether all of the methods will work for everyone is highly debatable, but there are some key lessons in Stuck in a Rut that seem widely applicable, particularly those chapters related to self-care and undermining our inner critics, which Craig calls our “inner bullies.” While some might feel selfish putting aside time for themselves or feel silly holding court with imaginary adversaries, these exercises are practical methods available to any reader, even those who don’t have access to life coaches or the means to completely re-imagine their careers. Moreover, the simple reminder to look after our own needs and reflect on our own desires can be a beneficial one, however we proceed from there.

Stuck in the Rut, then, is ultimately a mixed bag. Some might find the techniques here enlightening and beneficial, which is certainly positive. Others, however, will recognize the all too common tropes of self-help, from the uncomplicated success stories to the overuse of “mindfulness” to the testimonials and life coaching package deals in the back of the book. Discerning readers will be able to pick out what’s helpful, but whether they wants to make the effort is ultimately up to them.

Stuck in a Rut: How to Rescue Yourself and Live Your Truth
True Balance Coaching, October 2015
Paperback, 244 pages
$12.00

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Marie Hartwell-Walker, Ed.D. <![CDATA[Buying Toys for Kids? Get Beyond the Gender Stereotypes]]> http://psychcentral.com/lib/?p=47601 2016-11-21T22:03:31Z 2016-11-25T15:02:37Z ]]> bigstock-153962540It’s so discouraging. While out shopping for a  gift for a three year old, I was confronted by how little has changed over the last 50 years. Women’s roles may have broadened considerably in the workplace and men may be doing more childcare but you’d never know it if you make a trip down the toy aisle. I found that toys for tots are more gender-categorized than ever. In the 50’s, I remember getting colorful tinker toys and a toy doctor kit as well as a doll for Christmas. Now it seems that choices for girls are bathed in pink and most construction toys are in the aisle of gifts “for boys.”

According to whoever arranges toys in the local big box stores, boys stuff is about sports, action and aggression (think footballs, action figures and light sabers) and girls stuff is about appearances, nurturing and quieter play (think Barbies, baby dolls, dress up/make up kits and crafts kits). Yes, to give the Mattel Company credit, Barbie sets do show her in various careers but the emphasis is still on looking glamorous while she does them. Not so incidentally, Ken doesn’t come with a baby and a diaper bag.

Science projects and construction toys are more likely to feature pictures of boys on the boxes while kitchen sets picture girls. Doctor kits are still marketed for boys and nursing kits for girls despite the fact that more women than men are graduating from medical schools and nursing has long embraced men into its ranks.

What we choose for our children is something to consider. If we want to let our girls know it’s okay to be strong and even tough and our boys know that it’s all right to be sensitive and to care for babies; if we want to encourage scientific curiosity in our girls and appreciation for the arts in our boys, how do we expose them to all that is possible when toys are packaged and marketed in such gender-specific ways? If we want to give our kids every chance to discover who they are rather than what the marketing departments of manufacturers think they ought to be, how do we offer more choices?

Good questions.  I can only offer a few suggestions to consider:

  1. Stock the kids’ toy box with a variety of toys. By all means, give your girl a doll she craves or your boy a football but consider doing the reverse as well. All of my kids got toy tool kits so they could pretend to fix things – and take in the idea that both moms and dads know how to wield a hammer. Each of my young kids, male and female, got a new doll whenever a new baby entered the family. They rocked their babies while I rocked mine. Note: If you’d like to hear a wonderful song about boys and dolls, click on this Youtube recording of William Wants a Doll by Alan Alda and Marlo Thomas: https://www.youtube.com/watch?v=Lshobg1Wt2M.  (I wish there was a parallel song for girls who want trucks but maybe you can make one up.)
  2. Provide opportunities for role playing that don’t emphasize gender stereotypes. Any day care or preschool teacher will tell you that the boys as well as the girls like to play in a pretend kitchen. Girls as well as the boys are interested in digging in the sandbox and playing with balls. All kids like to vroom-vroom toy cars and make up stories with animal figures.
  3. Add music to your lives. Although I wasn’t thrilled when my sister gave my kids some drums, the fact is that they loved them. With a little coaching from me, they learned to do more than just bang on them. Kazoos and toy instruments are a great way to introduce kids to music before committing to lessons.
  4. Provide quiet time activities that emphasize creativity.  Give kids a box of age appropriate art supplies and let them go to it. Once they are 4 or 5, take them on short trips to local museums to see that everyone makes art.
  5. Don’t forget science kits. I challenge you to find me a kid who isn’t fascinated by bugs. What kid doesn’t love to see a miniature volcano erupt or a rocket take off?
  6. Books. Books. Books. I know it may seem retrograde but kids do still like books. Take them to the library. Explore all topics. Resist the notion that there are boys’ stories and girls’ stories. A good story is a good story. Ditto for age appropriate video and computer games, music and movies. Don’t be fooled by animal animations. Watch for stereotyping there too.
  7. Running, jumping and generally moving around is a natural part of childhood. Girls and boys all enjoy having a catch, tossing a football, trying out a martial art and running for the sheer joy of it.  Encourage your kids to try lots of things and they will soon find where they have talent and interest.

Why is it important to get beyond the idea that certain toys are girly or boyish? Because play matters. Play is the “work” of childhood. The kids are having a good time but they are also rehearsing the roles they will play as adults and integrating the not so subtle messages of the marketing people into their identity. Research shows that kids who are encouraged to play with gender neutral toys do better academically, socially, artistically and physically. When toys are limited by gender, it limits a kid’s imagination and goals.

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Bella DePaulo <![CDATA[Book Review: The New Better Off: Reinventing the American Dream]]> http://psychcentral.com/lib/?p=47390 2016-11-17T22:08:38Z 2016-11-25T00:06:40Z Courtney E. Martin opens The New Better Off: Reinventing the American Dream with the fact that “For the first time in history, nearly two-thirds of Americans do not believe that […]]]>

Courtney E. Martin opens The New Better Off: Reinventing the American Dream with the fact that “For the first time in history, nearly two-thirds of Americans do not believe that the next generation will be ‘better off’ than their parents are — an opinion shared by men and women, rich and poor alike.” Martin is not bemoaning that new reality, though; she is redefining the meaning of “better off” and embracing the opportunities the new version offers.

The next generation is failing to be “better off” than their parents only if we accept rigid and outdated measures of success. The prevailing notions of “making it” are familiar ones: the winners have stable, high-paying jobs that reward them with the opportunity to make even more money and buy more and more stuff; they live with a spouse and kids in the suburbs in detached single-family homes that they own; their schedules are crammed with obligations; and their hands are holding the latest devices.

The conditions of contemporary life, including a challenging job market and housing market, can make such purported accomplishments seem elusive. But when the standard varieties of success are not readily attainable, something magical can happen: People can lead thoughtful, intentional, authentic lives. They can make life choices that enable them to live meaningfully and in accord with their deepest values.

The New Better Off is a book of profound questions. Although it is a serious book, the author does not take herself too seriously. She writes engagingly and with great wit. She shares stories from her own life as well as relevant social science research as she takes readers along on a moving exploration of how we can all create our own version of the good life.

Each of the chapters in The New Better Off creatively examines an essential element of contemporary life. The topics include job choices; forging friendships when so many people are freelancing and have no office water cooler to gather around; finding ways to create a social safety net when so many are freelancers with no retirement benefits or health insurance; honoring values and goals that are not just monetary; falling in love with fatherhood; going all-in on an economy based on sharing rather than ownership; creating community; investing in local communities; and inventing rituals that mark meaningful moments. The final chapter (other than the conclusion) opens with the question, “How do you know if you are a good person?”

Central to The New Better Off is the significance of community. Martin loves her ties with other people. Creating community is one of her many talents. But the matter is not just personal. Among the research she mentions are studies showing that one of the best predictors of whether a neighborhood will be violent is not the level of poverty or its racial composition, but whether there is trust and reciprocity among the people who live there. Similarly, the communities most likely to weather actual storms such as hurricanes and heat waves are the ones in which neighbors know and care about one another.

In the pages of The New Better Off, we meet people who illustrate the many innovative ways of creating community in twenty-first century America. For example, there are people trying to put together a portfolio of gigs who have no workplace, so they create coworking spaces to share with others in similar situations. There are groups of men who get together regularly to reflect on important life questions. There are cohousing communities, such as the one where the author lives in Oakland, California (also described in my own book, How We Live Now: Redefining Home and Family in the 21st Century). There are groups who gather around a table to break bread and share their stories of loss and grief.

Martin is married and has a young daughter but she is not selling the standard ideology of marriage and family. “I think that depending on your nuclear family to meet all of your needs is unhealthy,” she tells us. Her chapter on reimagining rituals poses this question: “So many of our modern rituals are tied to marriage and children — but what becomes of someone who doesn’t want either?” What follows is a touching and validating story of a non-wedding event created by a single woman in which she celebrated the community she had nurtured throughout her life (her “tribe”) and asked them for their ongoing love and support.

To people who can barely earn enough to avoid poverty and live with a modicum of dignity, the questions posed by The New Better Off would probably seem fanciful. It takes some level of privilege to be able to line up different versions of the good life and choose the most fulfilling one. Martin does not believe we should have an impoverished class. She argues forcefully for a universal basic income.

If Courtney Martin’s vision of the new better off took hold, more and more people would be “turning away from job opportunities that are prestigious but not courageous, making families out of friends and neighbors, buying less, giving away more, sharing and renting rather than owning, reinventing rituals and ritualizing reinvention.” Her version of the good life is not for everyone. For many, though, it has the potential to be inspiring and life-changing.

The New Better Off: Reinventing the American Dream
Seal Press, September 2016
Hardcover, 304 pages
$24.00

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Ben Taylor <![CDATA[Machiavellianism, Cognition, and Emotion: Understanding how the Machiavellian Thinks, Feels, and Thrives]]> http://psychcentral.com/lib/?p=47562 2016-11-21T22:01:19Z 2016-11-24T15:03:39Z ]]> Close up Blue PSYCHOLOGICAL MANIPULATION Text at the Center of WMachiavellianism is a personality trait involving manipulativeness and deceit, cynical views toward human nature, and a cold, calculating attitude towards others. The trait was conceptualized in 1970 by Christie and Geiss, and describes the extent to which individuals adhere to the political philosophy of Italian writer Niccolò Machiavelli, who advocated views involving cunning, deceit, and the notion that “means justify the ends.”

Machiavellianism is one of three interpersonally aversive personality traits that collectively constitute what is known as the “Dark Triad”; the other two traits being narcissism and psychopathy. Relative to Machiavellianism, narcissism involves a grandiose, inflated view of oneself, superficial charm, and deficits in the consideration of others. Comparatively, psychopathy is a personality trait involving reckless, antisocial behavior, lying, cheating, and a callous disregard of others that may border on aggression and violence. Machiavellianism, along with narcissism and psychopathy, share a constellation of features which have been referred to as the “core of the Dark Triad.” These features include shallow affect and a poor emotional attachment to others, an agentic self-focused approach to life, deficits in empathy, and low levels of honesty and humility. Machiavellianism is a distinct trait on its own however, and the distinctiveness of this trait will be discussed below. The trait of Machiavellianism is normally measured with the MACH-IV questionnaire, and for the purposes of this article, individuals who would score highly on this questionnaire are referred to as “Machiavellians.”

A cold, calculating view of others

Machiavellians are strategic individuals who are willing to lie, cheat, and deceive others in order to achieve their goals. Due to the Machiavellian’s lack of emotional attachment, and shallow experience of emotions, there may be little that holds these individuals back from harming others in order to achieve their goals. This in fact is one of the reasons why Machiavellian views and attitudes are so aversive and problematic. Indeed, similar to psychopaths who may harm others for enjoyment, or narcissists who may harm others due to their lack of empathy, Machiavellians may manipulate or deceive others in order to advance themselves, with little consideration of the emotional collateral.

Cold empathy vs. hot empathy

A distinction has been made between empathy that is cognitive and ‘cold’, and empathy that is emotional and ‘hot’. Specifically, cold empathy refers to our understanding of how others may be thinking, how others may act in particular situations, and how events may unfold involving certain individuals. For example, a manager may rely on cold empathy to understand the sequence of actions that may occur when they provide negative feedback to their employee: which could involve defensiveness, disagreement, and eventual acceptance of the feedback. The very same manager may also recruit hot empathy to resonate on an emotional level with their employee; e.g, “Sarah will feel frustrated and embarrassed as I tell her this feedback, so I want to be as friendly and constructive as possible.” In the latter case, the manager’s emotional resonance enables her to shape the way she talks in order to avoid emotionally harming her employee. Comparatively, a Machiavellian manager may have a good understanding of the manner in which her employee will react, yet fail to resonate with her employee on an emotional level. The result of this might be that the manager comes across as harsh and unfriendly, and may fail to realize or care about any emotional harm she might have caused.

An evolutionary advantage?

Research has shown that while some Machiavellians display deficits in hot empathy, others have a good ability to understand the emotions and feelings of others, yet simply do not care. Specifically, a subgroup of Machiavellians have been found to ‘bypass empathy’; that is, they have a good understanding of the thoughts and feelings that may arise in others as a result of deceit, manipulation or other ill treatment, yet fail to curtail their actions in response. This lack of a moral conscience in Machiavellians has been seen by evolutionary psychologists as “evolutionarily advantageous,” in the sense that these individuals may not held back by a consideration of others, in the pursuit of their goals. The question arises however, regarding how Machiavellians are able to develop and maintain long-lasting, emotionally satisfying relationships with others if they lack the ability to emotionally resonate, or simply have little concern for the thoughts and feelings of others.

Theory of mind

Theory of mind refers to the ability to understand and appreciate why people think in the unique ways that they do. Theory of mind differs from empathy, in that it more broadly refers to the goals, aspirations, desires, and contents within an individual’s mind, rather than their moment-to-moment changes in thinking and feeling. In theory, Machiavellians must have a reasonably good theory of mind in order to be able to understand what drives the behaviors of others, so that they can manipulate these others. Research has shown however that Machiavellianism is negatively associated with social cooperative skills and theory of mind; which suggests that these individuals may not be as successful in understanding and manipulating others as they purport to be. Thus while the trait of Machiavellianism may comprise a set of beliefs and attitudes about manipulating others, there is no guarantee that this manipulation will be successful.

Behavioral inhibition

According to Grey’s reinforcement-sensitivity theory, behavior is driven by two separate neurological systems: the behavioral activation system, and the behavioral inhibition system. The behavioral activation system is associated with ‘approach’ tendencies including extraversion, social behavior, and taking action. Comparatively, the behavioral inhibition system is associated with ‘avoidance’ tendencies such as introversion, withdrawn behavior, and ‘thinking rather than doing’. Recent evidence suggests that psychopathy and narcissism are associated with higher levels of activity within the behavioral activation system, while Machiavellianism is associated with greater activity within the behavioral inhibition system. Thus narcissists and psychopaths are more likely to engage in approach behaviors involving action and socializing, while Machiavellians are more likely to engage in withdrawn behavior and rely on their thinking and intuition. This is consistent with the profile of Machiavellians as cunning, calculating manipulators who plot against others, rather than actively violating their rights, such as a psychopath would.

Alexithymia

Machiavellianism is associated with alexithymia, which describes a deficit in naming and understanding one’s emotions. Individuals who are alexithymic have been described as cold and aloof, and out of touch with their emotional experiences. Alexithymia in Machiavellians may be a product of a reduced understanding of emotions, that arises from a shallow experience of these emotions, or deficits in empathy and theory of mind. Regardless of the cause, evidence suggests that Machiavellians are individuals who are overly cognitive in their approach toward others and themselves, and who are out of touch with emotions generally.

Conclusion

Machiavellianism is a personality trait involving a cold, calculating view toward others, and the use of manipulativeness and deceit to achieve one’s goals. Machiavellians have limited empathy for others, both on a cognitive and emotional level, and appear to have a reduced theory of mind. Machiavellians are more inhibited and withdrawn than psychopaths and narcissists, which fits with their profile as being cunning individuals who strategically plot against others in order to get ahead in life and achieve their goals. Due to the limited emotional resonance and emotional experience displayed by Machiavellians, these individuals may possess an evolutionary advantage, in the sense that they will not consider the harm they may cause to others in the pursuit of their goals. This lack of moral conscience may be dangerous, and is part of the reason why Machiavellianism is so interpersonally aversive, and considered one of the three ‘Dark Triad’ personality traits. Although a Machiavellian worldview may be associated with numerous perceived advantages, one must question the extent to which Machiavellians can live happy, emotionally fulfilling lives. The question also arises as to how Machiavellians are able to develop and sustain lasting and fulfilling relationships, in the event that they continue with their cold, manipulative ways. Thus in bypassing empathy, the Machiavellian also bypasses human nature.

References

McIlwain, D. (2008). Cascading constraints: The role of early developmental deficits in the formation of personality styles. Personality down under: Perspectives from Australia, 61-80.

Neria, A. L., Vizcaino, M., & Jones, D. N. (2016). Approach/avoidance tendencies in dark personalities. Personality and Individual Differences, 101, 264-269.

Paal, T., & Bereczkei, T. (2007). Adult theory of mind, cooperation, Machiavellianism: The effect of mindreading on social relations. Personality and individual differences, 43(3), 541-551.

Wastell, C., & Booth, A. (2003). Machiavellianism: An alexithymic perspective. Journal of social and clinical psychology, 22(6), 730-744.

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Tina Arnoldi <![CDATA[Book Review: All or Nothing]]> http://psychcentral.com/lib/?p=47194 2016-11-17T22:04:29Z 2016-11-24T00:02:19Z Type-A personality: The person who is always driven to achieve, even at the expense of everything else. If you are not that person, you probably know someone who operates that […]]]>

Type-A personality: The person who is always driven to achieve, even at the expense of everything else. If you are not that person, you probably know someone who operates that way. In All or Nothing: Bringing Balance to the Achievement-Oriented Personality, Mike McKinney addresses the type of person whose drive for success often results in burnout and fatigue. His goal is to help people understand the consequences of their behavior and feel empowered to change it.

When asked how you are doing, is your standard answer “busy”? If so, you may be an A/N (all-or-nothing) person. A/N people are always on the go and particularly sensitive to criticism of their actions, allowing others’ opinions of their performance to determine their self-worth. These factors work together to increase the likelihood of anxiety and depression, as well as physical health problems.

When an A/N person is praised for achievement, he or she may feel even more pressure to continue doing well. A fear of failure then becomes the driving factor for all actions. Either they succeed or fail. There is no in-between. As a result, every activity, role, and task of the A/N person is done with a single-minded focus of how likely it is to bring success. It is a very limiting view of the world because A/N people are unlikely to try things that are not guaranteed to bring success. They stay boxed in to only the area where they already know they perform well, and miss out on new experiences. Even in the areas where they do perform well, there is the danger of “analysis paralysis” when they overthink every single detail of an action.

McKinney’s comparison to a dimmer switch is right on. At times, people may need to push themselves a bit harder to achieve a specific goal, but can learn to increase their efforts for a short period of time and “dial out” once the goal is reach. Success does not have to be an “all-or-nothing” pursuit where people consistently put all their effort into only one part of life. A dichotomous view of the world is what can get people into trouble.

A/N personalities often find themselves with incomplete projects. Although they may operating at 100% when they start a venture, as the conclusion to a project approaches, they become subject to judgment, and out of fear, they regularly do not finish what they start. They fear failing so they stop before failure is possible. Since identity is built around goal achievement, the sense of self is threatened at the possibility of failure because who they are is tied directly to what they do.

However, by learning to tolerate uncertainty and be present in the here and now, A/N personalities can learn to appreciate life and view uncertainty as an opportunity to learn. To get there, they need to first willingly step into situations that have a risk of uncertainty. Taking small risks and feeling a little uncomfortable is the first step towards overcoming these feelings.

These A/N tendencies are further complicated since many A/N people are their own worst critics. When people believe negative things about themselves, these thoughts impact actions in a negative way, especially for A/N people, who lose objectivity when their harsh inner critics are shouting at them. Since this feedback comes from themselves, they are more inclined to believe it, no matter how off base it may be. Since worth is based on achievement, A/N personalities are overly focused on the outcome rather than the process. The inner critic does not give any credit for efforts — the end goal is all that matters. McKinney encourages people to stop accepting feedback from their harsh inner critic and instead view it as a “quality control advisor,” thus lessening the negative impact. A/N people also need to stop and ask if there is any real evidence for the statements running through their minds. Simply questioning messages from the brain can help stop this influx of negativity into the mind.

Perfectionism is another obvious trait of the A/N person. In this chapter, I disagree with his assumption that there can be a “healthy perfection driver.” Although I understand the positive parts of challenging oneself, the word “perfection” has so many negative connotations, I’m more comfortable just throwing it away.

Throughout the book, McKinney offers practical exercises to help readers identify their A/N traits. One of the first exercises asks the reader to complete sentences: “If I finished work earlier each night I would be able to…” and “Not expecting myself to be perfect will allow me to…” Readers can examine their own personality traits without judgment to see if they tend to think in all-or-nothing terms. Another exercise encourages the reader to think about what they are motivated to achieve and driven to avoid, which helps identify dichotomous thinking patterns.

McKinney’s overall tone is encouraging and empowering. Many people can relate to at least some of the traits of this personality style and have the opportunity to use practical skills to overcome those tendencies. His underlying message is a reminder that “you are you and not just what you have previously done.” Both clinicians, lay people, and business executives will discover nuggets of wisdom to help them make changes in their behavior where needed.

All or Nothing: Bringing Balance to the Achievement-Oriented Personality
Exisle Publishing, September 2016
Paperback, 215 pages
$24.99

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