Psych Central Original articles in mental health, psychology, relationships and more, published weekly.2016-02-07T19:23:18Z Bethany Duarte <![CDATA[Book Review: Joy in Every Moment: Mindful Exercises for Waking to the Wonders of Ordinary Life]]> 2016-02-01T14:21:00Z 2016-02-07T19:23:18Z I’ve heard all my life not to judge a book by its cover, but when I picked up Joy in Every Moment: Mindful Exercises for Waking to the Wonders of […]]]>

I’ve heard all my life not to judge a book by its cover, but when I picked up Joy in Every Moment: Mindful Exercises for Waking to the Wonders of Ordinary Life, my judgment was an accurate one. With pink tones highlighting the word “Joy” across the cover, I couldn’t help but smile as I held the book.

Joy in Every Moment, by Tzivia Gover, is packaged as a gifting book, one that you might expect to receive after an accomplishment or graduation. The design, weight, and overall aesthetic immediately appealed to my eye and hands, courtesy of the vibrant illustrations by artist Olaf Hajek and the matte texture of the pages. A quick flip through the pages show that the colors of the cover are interspersed inside as well. Inspirational quotes and full-color pages punctuate the text. While these factors may not sound like an important part of a psychology-related book, they fit the overall theme of joy perfectly and put my mind at ease as I sat down with a cup of tea and began to read.

Gover takes on the often obscure topics of joy and happiness with a light, relatable, and practical touch that’s evident from the opening chapter. Gover, a writer, educator, dream therapist, and Reiki master, walks us through how joy can be found at each stage of the day and of life. While that encapsulates the overall premise of the book in one short sentence, what Gover packs into a delicately designed read far exceeds my brevity. The eight chapters break down the process of embracing joy by defining it and seeing it all day long: at home, at work, on the go, in solitude, with others, and in celebration.

For the purposes of this review, I chose to read the book cover to cover, but for my second read-through, I plan to read a page a day and journal my way through, as Gover suggests.

The core message is just what the title implies: using creative exercises and elements of mindfulness to choose and embrace joy in every moment, regardless of circumstances. From journaling and writing lists of the little moments of joy throughout the day to meditation techniques and self-affirming moments of pause and gratitude, Gover makes the cultivation of joy and happiness a step-by-step, moment-by-moment process. The simple little things she suggests particularly affected me, such as choosing to drive in the right lane to slow down and set a calmer pace for the day, and taking the time to deeply feel the moment before moving on to tackle the next task.

One thing that Gover did incredibly well was leave the existentialism out of the explanation. She strikes a perfect balance between poetic nothings about happiness and the harsh realities of life.

“A phosphorescent green comma of a bird weighing little more than a penny, the hummingbird hovers above the bright flame of a lobelia’s petal while probing its depths,” she writes. But while this “little fleck of winged beauty seems to float effortlessly for the pure pleasure of it,” the creature, Gover writes, “is actually hard at work.”

Indeed, the bird reminds us that “drinking in joy is not a passive pursuit. Hummingbirds us all their physical powers and tricks to achieve their goals. They fly forward and backward, and even upside down, in their quest for the best of what life has to offer.”

As a very busy small-business owner, writer, editor, student, and artist, I seriously struggle with taking the time to “stop and smell the roses,” to pause and see the good in each moment. Idioms about the pursuit of happiness have always nauseated me, since they usually come with no practical action to follow through on. Gover’s book is incredibly helpful in that regard. She addresses the problem with clear, day-by-day, concrete steps to take.

I can see adopting the majority of this book into my daily activities, as Gover makes it relatable to the everyday person with everyday problems. While a section for journaling or an accompanying blank journal would have made the text even more ready-to-use, this is a book that really helps.

Joy in Every Moment: Mindful Exercises for Waking to the Wonders of Ordinary Life
Storey Publishing, November 2015

Paperback, 220 pages

Megan Riddle <![CDATA[Inside the Mind of a Gambler: The Hidden Addiction & How to Stop]]> 2016-02-01T14:21:32Z 2016-02-06T19:37:06Z The whir of the slots, the clatter of dice, the rapid wush-wush of expertly dealt cards: the sights and sounds of the casino are designed to draw our attention and entice us […]]]>

The whir of the slots, the clatter of dice, the rapid wush-wush of expertly dealt cards: the sights and sounds of the casino are designed to draw our attention and entice us to try our luck. We start with the cheap slots, watching the pictures spin by. Three in a row and there is that instant buzz of success as our winnings are displayed and chips tumble out. This is clearly our lucky day.

We gather our chips and move on, taking our chances. We win some, we lose some. The pile of chips grows and we float on a cloud of success. Then it begins to shrink — but just one more game and we can win it all back.

Such is the perpetual hope of the gambler. The next game could be the big winJust one more.

Each year, over 100 million Americans gamble. For many, it is a mere occasional pastime — a trip to Vegas, a few lottery tickets when the numbers are too big to ignore. We recognize it for what it is — expensive entertainment with little chance of coming out ahead. We can walk away after a day at the casino and go back to our regular life. For some, however, gambling takes the driver’s seat. When this happens, it can wreak utter havoc, draining savings accounts, leading to mortgage foreclosures, destroying marriages, and leaving many caught in a web of lies.

In his book, Inside the Mind of a Gambler: The Hidden Addiction and How to Stop, author Stephen Renwick delves into the psychology of gambling by exploring the life of a compulsive gambler called Guy.

Guy’s first memory of gambling was winning £100 on a scratch card in his teens. In Guy’s twenties, Renwick writes, he started to play the slots after work, then moved on to the roulette wheel and larger sums. Soon the amounts he owed ballooned.

After a win, Guy tells Renwick, gamblers “are looking for that same fix again. They’ll spend everything they have and more to get it. This is when you know you’re a compulsive gambler and need help. It’s almost as though winning any amount would not be enough.”

Like many, Guy kept his debt a secret from his girlfriend for eight years, eventually confessing when the strain was too much to bear — and forever altering the course of their relationship. Eventually, Guy finds himself searching for spare change, and finally recognizes how dire things have become. It is at this point that he begins to take steps to regain control of his life.

“One reason I gambled is that it gave me a rush and a huge thrill,” Guy tells Renwick. But it did more than that. “Gambling helped me escape my anxiety and depression. I felt I hadn’t made the most of my life. I dreamt of being married with a happy family, kids and nice home.” Winning money, Guy says, “would have made life easier,” adding, “I could win a lot and then be accepted and liked by others.”

In the end, though, Guy’s hopes cost him over £100,000 in losses. Through Renwick, he shares his advice to others in similar straits on how he overcame his addiction.

Then, in the second half of the book, Renwick goes into some of the research behind our current understanding of gambling. He includes different perspectives on how gambling starts, what leads people to continue, and what may trigger a relapse, exploring genetic, cognitive, and learning theory perspectives. He also describes possible treatment, including cognitive behavioral therapy.

Renwick ends the book with a note on life after gambling from Guy, who offers this: “Be kind to yourself and focus on your qualities rather than on what you’re lacking. … You can break the pattern of your addiction if you are willing to take things day by day and use baby steps.” And, Guy tells readers, it is okay to ask for help.

Renwick’s short text is a primer on gambling addiction. As a basic overview, it will probably not be of interest to the professional who is likely to have already been exposed to this information. However, it may be useful to those curious about this significant problem, particularly those with friends and family affected by it.

Inside the Mind of a Gambler: The Hidden Addiction and How to Stop
Trafford, September 2015
Paperback, 88 pages

Megan Riddle <![CDATA[Paranoid: Exploring Suspicion from the Dubious to the Delusional]]> 2016-02-01T14:21:47Z 2016-02-05T19:27:55Z The man in the bed watches me walk into the room. According to his nurse, that is what he has been doing all day: keeping vigil over the comings and […]]]>

The man in the bed watches me walk into the room. According to his nurse, that is what he has been doing all day: keeping vigil over the comings and goings of the hallway. At the patient’s behest, they have pulled back the curtain that usually surrounds the bed to offer a modicum of privacy, allowing for a full view of the long corridor. But unlike those patients simply curious about the bustle of the hospital or passing time as they recover, this man’s watchfulness has darker origins.

“Are they still out there?” he asks, as I pull up a chair to the end of the bed.

“Hi Mr. Jones, I’m Dr. Riddle. I’ve come by to talk with you about what been going on lately,” I say, as I’ve done hundreds of time by now. “Is who out there?”

His brows furrow; I seem to have dropped down a notch in his eyes by not already knowing the answer. “They know I’m here. I saw the way that guy looked at me when the ambulance brought me here. That’s why I have to leave. I can’t stay.” He drops his tone. “It’s the FBI.”

“I can tell you’re worried —”

“Wouldn’t you be? You try being followed every day, never knowing where. Never knowing when.”

I glance down at his ankle, pins projecting from the broken bones. “What happened to your leg?” I ask, attempting to veer toward a different subject, though I am doubtful we will get far.

“They were in the house. Had to go out the window.” He shrugs, matter of fact, and continues watching down the hallway.

Paranoia. It is the stuff of nightmares and horror films, but for all too many it is a very real part of their lives.

We have all experienced brief brushes with paranoia. We may worry that others are talking behind our back at work without any objective evidence. We might misplace something, but jump to the conclusion that it was stolen. In these cases, though, we are usually able to reality check, to recognize that the water-cooler chatter is just about the weekend’s sport victories and that the lost object can be found wherever we left it.

But when paranoia continues to grow, unchecked by reality, true tragedy can result. Sometimes that tragedy is personal: the paranoid person living out a solitary life, or, in the case of Mr. Jones, fracturing their ankles after leaping out a second-floor window. And sometimes, that tragedy can grow to massive proportions that end up splashed across headlines. We have seen this repeatedly. Consider the Virginia Tech massacre, the Oklahoma City bombing, or recent events like the San Bernardino shooting. This is paranoia turned deadly.

In his book, Paranoid: Exploring Suspicion from the Dubious to the Delusional, psychologist David J. LaPorte delves into this world.

The book combines research and case studies with personal observation to help us better understand the paranoid individual. Having spent a fair amount of time with individuals like this, I found LaPorte’s descriptions accurate and illuminating, though his solutions a bit lacking.

To someone with paranoia, LaPorte writes, “nothing is ‘innocent,’ happens by chance, or appears as it seems. A shrug, a wave of the hand, or a cough can all have meaning. … Minor events of innocuous things in the environment can be twisted to fit the paranoid individual’s belief system.” He illustrates the illogical with cases — such as the man who, fearing he is being poisoned through the heating system of his house, turns it off and wraps himself in bubble wrap and duct tape.

LaPorte also delves into the origins of paranoia, arguing that it offered some degree of evolutionary advantage. Those “who developed more refined aspects of trust/suspiciousness,” he writes, “had an adaptive advantage as they more readily were able to identify friends.” He describes the common causes of paranoia, including drugs and dementia. And he goes into detail regarding the violence that can emerge from paranoia, offering an entire chapter of often grisly stories.

While LaPorte does offers an overview of potential treatments, including medications, psychotherapy, electroconvulsive therapy, and even “psychosurgery,” the book is somewhat lacking in what to do about paranoia. I wanted more on where the research stands regarding what we should be doing for these individuals. LaPorte has made a convincing argument that paranoia is a real problem — highlighted with recent mass shootings — but fails to fully explore the next steps.

So where do we go from here? The last chapter does touch on this to some degree, focusing on the need for a better understanding in order to better care for and deal with these individuals. However, it leaves one with more questions (and fears) than answers.

Paranoid: Exploring Suspicion from the Dubious to the Delusional
Prometheus Books, September 2015
Paperback, 300 pages

Tamara Hill, MS <![CDATA[Killing Mr. Hyde: Allowing God to Destroy What’s Destroying You]]> 2016-02-01T14:22:06Z 2016-02-04T19:46:13Z According to the National Institute on Alcohol Abuse and Alcoholism, about 16.6 million adults had an alcohol use disorder in 2013. To make matters worse, more than ten percent of children […]]]>

According to the National Institute on Alcohol Abuse and Alcoholism, about 16.6 million adults had an alcohol use disorder in 2013. To make matters worse, more than ten percent of children live in a household with at least one parent who struggles with alcoholism. And yet, for many people with this type of addiction, it is difficult for them or those around them to identify the problem.

Alcohol consumption is typically social. We tend to drink at birthdays, holidays, weddings, and other special events. We drink with coworkers at happy hour. Everywhere we turn, there are drinks. And because alcohol has been normalized, someone who is abusing it or has become dependent may slip through the cracks.

In Killing Mr. Hyde: Allowing God to Destroy What’s Destroying You, Michael Lassman shares his own story of alcohol use disorder through a Christian lens — including how easy it was for him to drink at social gatherings and how hard it was for him to overcome.

Lassman looks back to parts of his childhood that may help explain some of his adult behavior and alcoholism. He dissects his social relationships growing up and how those relationships may have contributed to his need for adoration, inclusion, and success. His parents, Lassman writes, both held somewhat high expectations for him — expectations he believes were responsible for his deep-seated need to fit in and be successful. This need drove Lassman to take on multiple business projects, he writes, and to pursue various business-related ideas at the expense of others.

And as he was pursuing those business ideas or traveling the country for work, he was desperately searching for the next drink.

The drink could be in a bar, in a liquor store, or during a business gathering or dinner. Many business trips and corporate parties, Lassman writes, offered some form of alcohol to celebrate. Even during a golfing event: alcohol. Not only did Lassman struggle to make a decent living and impress his family, but he also struggled with an addiction hidden behind a veneer of social drinking.

Lassman holds the reader’s interest as he explores multiple challenges throughout his adolescence, young adulthood, marriage, and social relationships. His book reads much like a timeline, with vivid examples of his emotional and psychological struggles. He recounts how difficult it was to live up to the expectations of his family, his wife, his business partners, and himself.

Alcohol addiction, Lassman writes, is very hard to overcome without the appropriate treatment tools. Eventually, he realized that the “appropriate treatment tools” for him were not a several-month-long rehabilitation program, a thirty-day detox center, or a spiritual resort for alcoholics, but a developing understanding of and relationship with God.

Lassman describes in great detail the scars he inflicted on those who loved him, those who trusted him, and those who needed him. He explains the depths of hell that he often visited when he was desperately in search of the next alcoholic beverage. He writes that his journey back to sobriety was often met with his own resistance, denial, hopelessness, depression, anxiety, and lack of commitment to change.

About the various programs he tried, Lassman writes, “the one thing I didn’t learn was that Narconon, AA, any 12-step-program, another person, or even I could relieve me of my alcoholism. Only God could and would if I were willing to seek Him. I wasn’t.”

He humbly admits throughout the book that he was stubborn, unbelieving, stuck, depressed, arrogant, and confused. He had never been the type of person to rely on religion during difficult times, he writes. He frequently found himself in a place of desperation to change, but could not set himself free, no matter what. The love and support of his wife, children, friends, and even business associates could not change him. He hit rock-bottom and nothing and no one could rescue him, until, eventually, his faith in God did.

Indeed, Lassman writes that he became so tired of relapsing, he decided to reach out to God for help: “Spirit, let me wake up and be different. I don’t want to be that person from the past. I want to be who God says I am and the person He designed me to be. I want to be the opposite of who I’ve been!”

As a therapist who subscribes to a Christian and faith-based approach to life, I enjoyed Lassman’s candid overview of his attempt to find stability in the midst of emotional and psychological chaos.

Unfortunately, some Christian readers might struggle with some of the profanity found in the book. Even more, some readers might also question the legitimacy or accuracy of the book due to a note at the beginning, which reads:

“Time, long periods of incoherency, and despondency have blurred some of my memories and I also realize that perceptions of history are sometimes recollected based on how we subconsciously need to piece together the past. The stories in this book are to the best of my knowledge true, but I stand to be corrected.”

That said, memoirs often contain similar notes, acknowledging that no one’s memory is completely accurate. And, perhaps a writer’s memory is even less accurate when he is recalling intoxicated moments.

Overall, however, Lassman has written an interesting book that can open the eyes of family members, friends, or even co-workers to someone who may be struggling with alcohol addiction. It is a book that therapists can recommend to their clients or their clients’ families if a Christian lens is appropriate. Fortunately, because it can be very difficult to identify when someone is becoming an alcoholic, we have authors like Lassman who can provide insight into the thought processes, emotional voids, challenges, heartbreaks, confusion, and resentment that the person and those around them experience.

Killing Mr. Hyde: Allowing God to Destroy What’s Destroying You
Yorkshire Publishing, June 2015
Paperback, 394 pages

Stan Rockwell, PsyD <![CDATA[The i’Mpossible Project: Reengaging With Life, Creating a New You]]> 2016-02-01T14:22:29Z 2016-02-03T19:39:04Z We live our lives in stories. And so we make changes in our lives by changing our story’s characters, plot lines, themes, and protagonists — a.k.a., ourselves. Hearing others’ stories […]]]>

We live our lives in stories. And so we make changes in our lives by changing our story’s characters, plot lines, themes, and protagonists — a.k.a., ourselves. Hearing others’ stories can inspire hope and strength to carry on and to get better. The i’Mpossible Project is a collection of just such stories, brought together and minimally edited by Josh Rivedal.

I say minimally edited because Rivedal points out that he keeps the integrity of the voice of each storyteller intact. I appreciated this light touch, as it lets each personality come through. The contributing writers — fifty in all — give us straight-up prose, some poetry, and one mini-book.

Rivedal’s own tale is powerful. After his father killed himself when Rivedal was in his early twenties, after a lawsuit from his mother over his father’s estate, and after a break-up with his longterm girlfriend, Rivedal himself began to contemplate suicide. His recovery has included touring as a one-man show called Kicking My Blue Genes in the Butt.

As the name of his play reveals, Rivedal likes to play with words. The book’s title has two meanings: facing impossible situations, and realizing that “I am possible.” The stories Rivedal curates are drawn from people he has met over the years who have faced what felt like impossible situations and were able to come through them.
I liked the structure of the book. There are sections dealing with specific situations — family troubles, physical health issues, trauma, mental health, suicide, LGBT issues, and second chances. Rivedal also includes information on groups and organizations that help with some of the problems the writers touch upon. I found myself listing these as I read so that I can share them with my clients.

The stories are each about three to four pages each. One that touched me the deepest was written by a teacher about a student of his. Called “Jason’s Story,” by Carl Ballenas, it made me think of how often teachers make profound and lasting differences in our lives. Sometimes those differences are positive, sometimes negative. Those powerful figures can boost our self-efficacy and confidence, but they can also damage it deeply. And often, a student can touch a teacher in a deep and lasting way, too.

As Ballenas writes, Jason was a student who was disengaged from school. The story involves frustration balanced with patience and compassion. But I don’t want to give away what happens, because I hope you will read it and feel the impact yourself.

As I read through the collection, I flipped to the back to read each writer’s bio and learn more about them. Overall, I admired and appreciated their courage in telling these very personal and painful stories and in sharing how they have coped and thrived despite quite difficult circumstances.

This is Rivedal’s second book. His The Gospel According to Josh: A 28-Year Gentile Bar Mitzvah is on the American Foundation for Suicide Prevention’s list for recommended reading. And his i’Mpossible Project is a nonprofit media organization doing work to “entertain, educate, and engage on suicide prevention, mental health, diversity, and social change.” I look forward to his upcoming work.

The i’Mpossible Project: Reengaging With Life, Creating a New You
Skookum Hill Publishing, January 2016
Paperback, 258 pages

John M. Grohol, Psy.D. <![CDATA[Questions to Ask Your Doctor About Schizophrenia]]> 2016-02-04T12:48:16Z 2016-02-03T17:38:48Z ]]> Questions to Ask Your Doctor About SchizophreniaGetting a new diagnosis is rarely good news — most people have a fair amount of anxiety and trepidation in learning they’ve got some sort of condition. Nowhere is this more true than with the diagnosis of schizophrenia. A schizophrenia diagnosis can be particularly scary because it is so misunderstood by so many people. It’s also one of the more rare but severe forms of mental illness. However, given that about 1 out of 100 people will be diagnosed with schizophrenia, it’s likely you’ve met or know someone with it.

But fear can be put to rest by asking questions and getting the facts you need to know in order to move forward with your life. Many times a newly-diagnosed person with schizophrenia may be in crisis, so these questions can also be asked by a family member or caregiver.

If your schizophrenia diagnosis did not come from a mental health professional — such as a psychologist or psychiatrist — your first order of business should be to see such a professional. While any medical professional can technically make a schizophrenia diagnosis, only a mental health professional is sufficiently trained in the complex science of diagnosis and treatment of this disorder.

Have you ruled out other conditions as the cause of these symptoms?

Just like many medical conditions, there’s no definitive set of tests that can be conducted to ensure a schizophrenia diagnosis is 100 percent accurate. Ensuring your doctor has ruled-out other possible conditions — or even an undiagnosed medical problem — helps to ensure the diagnosis has been carefully considered.

Is schizophrenia one of the disorders you regularly treat?

While it may seem disrespectful to ask a doctor this question, it’s important you’re seen by a professional who has deep experience in treating schizophrenia. While a specialist is ideal, a professional or doctor who’s regularly treated people with schizophrenia will also work just as well.

What kind of treatments are available for schizophrenia?

While traditionally doctors have focused on medications to treat this condition, a study published in 2015 demonstrates the importance of a holistic approach to the treatment of schizophrenia. A first-time psychotic episode is best managed by a team-based approach to treatment. This includes “recovery-oriented psychotherapy, low doses of antipsychotic medications, family education and support, case management, and work or education support, depending on the individual’s needs and preferences.”

Make sure that if your doctor doesn’t offer psychotherapy, you walk out of the office with a referral to a therapist who has seen patients with schizophrenia or specializes in the disorder.

How soon after I begin treatment should I start noticing a change in my symptoms?

Most modern schizophrenia treatment will work on combating and reducing the most serious symptoms of the disorder — the hallucinations and delusions. With a combined, holistic treatment approach that includes both medications and psychotherapy, people will generally start to feel some improvement in their symptoms in the first few days or weeks. If you don’t feel an improvement after the first few weeks, you should talk to your doctor about the lack of progress.

What are the most common side effects of the medications I’ve been prescribed?

It’s always a good idea to ask your doctor about the most significant side effects you’re likely to experience on the prescribed treatment. Also ask about ways you can help minimize such side effects. If side effects are too significant, talk to your doctor about changing your medication or dosing levels.

I take XYZ medication. Can I take it with the new medication prescribed?

Always tell your doctor all of the medications and supplements you’re currently taking before they prescribe you something new. Some medications do not interact well together, but your doctor won’t necessarily know about your other medications unless you specifically mention them.

What happens if initial treatment fails or doesn’t seem to be working very well?

Your doctor should be aware of and up-to-date on the latest drug treatment guidelines for treatment-resistant schizophrenia.

Is there any hope for someone with schizophrenia?

So many negative things have been written about people who have schizophrenia. But today, due to advances in the treatment and understanding of the disorder, a person with schizophrenia is no longer relegated to the fringes of society. Contrary to society’s perceptions, most people with schizophrenia who also get and maintain treatment lead pretty ordinary lives. You can have a job, live on your own, and even be in a relationship — there are no limits on what a person with schizophrenia can do.

Can I drink alcohol while on medication? Smoke pot? Do some other drug?

Many people with schizophrenia initially approach alcohol or drugs to try and self-medicate against the hallucinations or delusions they’re experiencing as a part of the disorder. It usually only works for a short period of time, and is often self-defeating in the long run. Most medications prescribed to treat schizophrenia don’t mix well with alcohol or drugs. Talk to your doctor about what kind of limits your specific medications might put on your drinking behavior or drug use.

How can I reach you in case of emergency?

Most doctors will readily provide emergency contact information in case of a crisis or other situation that needs immediate attention. Keep this information in a safe and readily-accessible location, and make your family members or caregiver aware of it in case you are somehow incapacitated.

Is schizophrenia ever cured? Or will I be on treatment for the rest of my life?

In most cases, most doctors treat schizophrenia similar to the way they would treat Type 2 diabetes — as a life-long condition needing constant care and treatment. While some people do indeed recover from schizophrenia without needing future treatment, the vast majority of people will benefit from long-lasting treatment throughout much of their life.

What should I tell my friends and family about my condition?

There is no single, right answer to this question, but it generally boils down to this: tell them whatever you’re comfortable sharing with them. Due to the nature of schizophrenia symptoms, it is often a good idea to identify at least one ally among your family or friends whom you feel comfortable in confiding the details of your condition. That way, there’s at least one person who knows what to do if suddenly decompensate or find yourself in a crisis situation.

What other kinds of help can I get within my local community?

Many local communities have specific programs setup to help people with schizophrenia or other types of serious mental illness. You or your caregiver can contact your local chapter of NAMI to find out what’s available in your community.

Megan Riddle <![CDATA[101 Solution-Focused Questions Series Set]]> 2016-02-02T22:01:08Z 2016-02-03T15:59:44Z The buzz of the emergency department whirls around us as I pull my chair closer to the middle-aged woman sitting on the gurney. I know she was brought here by […]]]>

The buzz of the emergency department whirls around us as I pull my chair closer to the middle-aged woman sitting on the gurney. I know she was brought here by her concerned husband, who told the triage nurse she just has not been herself. Her husband is concerned about what she might do to herself, as she has struggled with depression for years.

I introduce myself, and offer, “It sounds like things have been rough lately.”

“I just can’t do it anymore,” the woman says. Tears spring to her eyes, and she reaches quickly for a tissue. “I tried to go to work, but I can’t focus. I’m making mistakes and people are starting to notice. I can barely manage to get dressed in the morning to take the kids to school — sometimes I don’t. And then my husband has to pick up the slack. I feel so guilty.”

Her voice fades, as though the simple act of speaking has drained her. We talk through what has been going on lately — her mother was just diagnosed with cancer, her father is drinking too much, her boss wants her to take on more responsibilities. Over and over she reiterates, “I just can’t do it anymore. I can’t do it.” Even in the busy emergency department, her hopelessness is palpable.

When treating someone with depression, it can become easy to focus on the negative, emphasizing how the disorder has removed their vitality and zest for life. The low mood, the trouble with sleep, the lack of appetite. But it extends beyond the mere diagnostic symptoms. Depression is the calls not returned, the invitations deferred, the friends rebuffed. Whereas in the initial interview it is important to understand the breadth and depth of the person’s mood, in therapy, it is critical to shift the focus away from the struggles of the past and toward the promise of the future.

Yet this is easier said than done. In 101 Solution-focused Questions for Help with Depression, clinical psychologist Fredrike Bannink offers insight into an approach that works to move clients forward. The book is part of a three-book set in which Bannink also offers guidance in treating individuals with trauma and anxiety.

Solution-focused brief therapy emphasizes outcomes rather than symptoms. It takes a goal-oriented approach that looks to help the client reach specific goals. The belief is that clients already possess many of the life skills they need to create change in their lives, but that they may need help identifying and implementing these skills. That is where the therapist comes in.

Bannink has more than thirty years of experience in psychotherapy and has published multiple articles and books. Her prior work in this series includes 1001 Solution-Focused Questions, a well-received book that offers an overview of the solution-focused method. Her new books offer the same readable style and can serve as companion texts or stand on their own.

While each book does offer the 101 questions advertised in the title, each goes far beyond a simple list of questions. Instead, Bannink opens by laying the foundation for the solution-focused approach. This includes the research-based evidence behind the principles, which she manages to include without compromising the readability of the text.

In one section of the book on depression, Bannink helps the therapist focus on his or her client’s strengths. “Shining the spotlight on change illuminates clients’ existing strengths and resources,” Bannink writes. “Despite life’s struggles, all clients possess strengths and competencies that can help to improve the quality of their lives and their well-being.” The questions in this particular chapter encourage the client to talk about their abilities. Bannink provides questions such as “What strengths do I have to stand up to this depression?”, “What have I done to stop things from getting worse?”, and “What are some of the things that I have thought, said or done that have helped me move from where I started to where I am now?”

She also offers case studies, sharing examples of how clients may respond to this approach. In addition, she includes a variety of exercises in each chapter that help clients explore and build upon their skills. One exercise entails coming up with three things that worked before in difficult situations; another helps the client brainstorm fifty ways of coping.

Overall, these books offer a concise, solution-focused approach to addressing difficult, all-too-common issues. Bannink provides a treasure trove of ideas for working with clients. I’ll be referring to these texts in the future.

101 Solution-Focused Questions Series Set
W. W. Norton & Company, October 2015
Paperback, 624 pages

Rebecca Chamaa <![CDATA[Managing Schizophrenia: 9 Things Every Caregiver Should Know]]> 2016-02-02T22:01:19Z 2016-02-03T14:36:07Z ]]> Managing Schizophrenia: 9 Things Every Caregiver Should KnowThe symptoms of schizophrenia manifest in each person differently. Some people with schizophrenia are capable of managing their symptoms and care while others may require the help of family members or a caregiver. Here is a list to guide those people who find themselves in a position to assist or care for someone diagnosed with schizophrenia. It is important to note that everyone with a mental illness can benefit from support even if they manage their own care.

  1. Educate yourself on the symptoms of schizophrenia.

    Knowing what is and what isn’t a symptom of schizophrenia will help you to determine if the person you care for is struggling with their illness. A simple search on Google can provide you with many articles about the difference between the negative and positive symptoms of schizophrenia. You can also ask your doctor for available resources and information. Educating yourself is the first step in understanding what the person you care for is experiencing.

  2. Know the side effects of all medications the person you care for is taking.

    Knowing the side effects can alert you to a potentially serious problem before it becomes critical. Many medications require regular blood work to check cholesterol and sugar levels. Check with a doctor for other tests that may be necessary for a specific medication. Make sure to check with a doctor or pharmacist before taking any over-the-counter medications. Some over-the-counter medications can cause negative drug interactions.

  3. Know the rights and laws regarding the mentally ill in the state in which you reside.

    No one wants to think of the worst case scenario, but planning for a crisis or emergency is necessary. If the person you care for needs hospitalization, know the laws regarding involuntary and voluntary commitment in your area. Know the location of the nearest hospital with a floor for patients having a psychiatric crisis.

  4. Make an emergency plan.

    Talk to the person you care for while they are stable and ask them what they would like to do in case of an emergency. Do they want you to contact their psychiatrist immediately? If they do want you to contact their psychiatrist, make sure a “release of information” is in place, so their doctor is legally allowed to share information with you.

  5. Keep all treatment-related telephone numbers in an easily accessible place.

    Some important phone numbers might include pharmacies, therapists, doctors, family members, etc. If there is an emergency, you don’t want to have to search for telephone numbers.

  6. Research all available services in your area.

    The person you care for may be eligible for services of which you are unaware. There also may be groups or research studies that would be beneficial.

  7. Encourage self-care and independence.

    For some people suffering from the symptoms of schizophrenia, things such as personal hygiene can become difficult to maintain. Teaching or encouraging participation in basic skills such as laundry, cooking, and other ways to care for a home and oneself, can help build self-esteem and motivation.

  8. Encourage social interactions.

    Many people with schizophrenia can lack motivation, especially when it comes to social engagement. Some cities and towns have clubhouses for people in recovery from psychiatric crises. Clubhouses can help the person you care for to build relationships, engage in activities, and possibly get job training. If your area doesn’t have a clubhouse or meeting place for people with a mental illness, you can check with your local chapter of NAMI (National Alliance on Mental Illness) for possible opportunities for social involvement.

  9. Take care of yourself.

    Having a family member with a mental illness can be stressful for everyone involved. Make sure you have a support network for yourself and take the steps necessary to make sure to meet your needs. Coffee with a friend, a night out, a trip to the gym, or any activity that makes you feel good can help give you a renewed sense of energy to meet daily challenges.

With treatment and early intervention, it is possible for people with a schizophrenia diagnosis to recover and return to their former lives. Seeking out examples of people who are living successfully with the same diagnosis can bring hope, and hope can help you make it through some of the most difficult days.


Man helping woman available from Shutterstock

Megan Riddle <![CDATA[Tales from the Couch: A Clinical Psychologist’s True Stories of Psychotherapy]]> 2016-02-01T14:23:15Z 2016-02-02T19:37:02Z Sitting across from someone in a therapy session is simultaneously intimate and clinical. As the therapist, you must balance a few things at once: develop a diagnostic understanding of the client […]]]>

Sitting across from someone in a therapy session is simultaneously intimate and clinical. As the therapist, you must balance a few things at once: develop a diagnostic understanding of the client while also integrating the individual experiences that make each person’s story unique.

Having sat on both sides of the therapeutic couch, so to speak, I always look forward to reading about other therapists’ experiences. In his latest book, Tales from the Couch: A Clinical Psychologist’s True Stories of Psychotherapy, clinical psychologist Bob Wendorf lets us inside his office, showing us glimpses of rich clinical relationships.

Wendorf draws from his more than thirty-six years as a psychotherapist and marriage and family therapist. He has experience in a variety of settings, including residential treatment centers, psychiatric hospitals, community mental health centers, and private practice. In the book, Wendorf focuses on a different psychological issue or diagnosis in each chapter, then illustrates it with portraits of individuals he has seen over the course of his career. While he offers stories about well-known issues like depression and anxiety, he also jumps into topics slightly off the beaten path, including enmeshment and multiple personalities.

In one section, he relays the story of Kami Sue and her daughter Kami Two, who came dressed in matching outfits and completed each other’s sentences. “The reason for this craziness, and Kami Two’s distress,” Wendorf writes, “soon became clear. She and Kami Sue shared everything. There were no secrets, no boundaries, no generation gaps. Their individual personalities blended and merged into one amorphous super-amoebic blob.” Through therapy, Kami Two begins to recognize this, saying, “I have no life, no self of my own.”

While organizing chapters around psychiatric diagnoses may sound detached and clinical, the stories are often personal and touching. A chapter called “Elvis and Asperger’s” opens with a longterm patient singing to Wendorf. The patient, Donald, was dressed in a full rhinestone-studded jumpsuit, Wendorf writes, and “was more remarkable than the real owner of Graceland.”

Living in a time before autism was a well-known diagnosis, Donald “had been diagnosed with major depression, obsessive-compulsive disorder, bipolar disorder, paranoid schizophrenia, attention deficit hyperactivity disorder, social phobia, panic disorder, and a raft of other illnesses, but really didn’t fit the classical picture for any of them.” As a result, he had been on a cocktail of different medications, with limited benefit. However, psychotherapy seemed to help — and Donald was not the only one affected by it.

“Psychotherapy is intended to be a time-limited process, which ends when problems are resolved,” Wendorf writes. “But what of a patient, like Donald, whose problems (if such they be) will never be fully resolved? Therapists are taught not to take their patients home with them (either literally or figuratively), but sometimes you can’t really help it. I’ve been seeing Donald every couple of months for years,” Wendorf writes. “… He was part of our office family, and I’m part of his, and I continue to be long even after my retirement from active practice. I’m okay with that. Besides, he and his family have been wonderfully supportive of me through some family medical crises.”

Indeed, Donald’s father made Wendorf’s son a cane to help him walk, and Wendorf and Donald occasionally meet for lunch. “As Elvis would say,” Wendorf writes, “we’re taking care of business.’”

Here is a reminder that for all the learned clinical detachment, it is ultimately the human touch that makes psychotherapy so rewarding for both people.

Still, this book left me wanting more. Wendorf gives us a glimpse inside the therapist’s office as he shares with us pieces of his clients’ lives, but I felt somewhat unsatisfied with such a brief peek. I wanted to come in and sit a while.

Each chapter is full of anecdotes from different patients, but I wish Wendorf had spent more time going in depth with a few of these clients, to flesh out their problems, their tragedies, and their triumphs and to show how his therapeutic relationship with them evolved over time. While we get some of this throughout the book, I would have like to see it more developed. Many of the stories are just a brief few paragraphs in length.

Also, Wendorf’s tendency to at times refer to people by their illness, calling them “paranoids” and “autistics,” for example, feels like it is from another decade. These days, we try not to superimpose the illness onto the identity of the individual. And so, given our current emphasis on the recovery model of illness, Wendorf’s language seemed out of sync, and also at odds with the typically empathic stories that are the hallmark of his book.

On a whole, however, the book is an engaging work of storytelling, interweaving the personal and the clinical to create a highly readable text.

Tales from the Couch: A Clinical Psychologist’s True Stories of Psychotherapy
Carrel Books, November 2015
Hardcover, 224 pages

Rebecca Chamaa <![CDATA[7 Things that Help in Managing Schizophrenia]]> 2016-02-01T14:35:39Z 2016-02-02T14:45:23Z ]]> 7 Things that Help in Managing SchizophreniaPeople living with schizophrenia often go from periods of psychosis to periods of relative stability. There are many tricks and tools that long-term suffers have learned in order to have the best chance for increasing stability and for avoiding a psychiatric crisis. Avoiding a crisis is a high priority, because it is so disruptive to life and can cause job loss, loss of self-esteem, the loss of a home, and many other negative consequences. Here is a list of seven things that can assist in increasing stability on a daily basis. Of course, these are not meant to replace the recommendations of your doctor or treatment professional.

  1. Work with a doctor to find a medication (or combination of medications) that works for you.

    When someone has a new diagnosis, it can take many trials on different medications to find the right doses and type of medication. Changing medications is a difficult process to go through because of side effects, but it is a process that can be critical to overall health. For many people, medication is the foundation of treatment.

  2. Put together a treatment team.

    Find a primary care doctor, psychiatrist, and therapist whom you trust. If you feel comfortable, bring a family member to your appointments so that someone who sees you on a regular basis can help identify problems if they come up. If you are married, you may consider bringing your spouse to appointments because she or he sees you more than anyone else and can easily identify a change in behavior or an issue of concern if one arises.

  3. Prepare for a possible crisis.

    No one wants to have an episode of psychosis that requires intervention, but preparation is important if hospitalization or intervention is necessary. For preparation, make sure that all professionals on your treatment team have each other’s business cards and contact information in your files. Also, if you have a family member that you feel comfortable including in your treatment team, make sure that you have signed a release of information so that your doctors or therapists are allowed to share information with your family member in an emergency. It is illegal for a professional to share information with a third party without this document. If you wait until you are in crisis, you may be unwilling or unable to sign the necessary paperwork for your family member to stay informed.

  4. Develop a routine.

    Routines can be comforting, and structure can be a guide or framework for mental health. If you follow a routine and that routine breaks down, it can be obvious to someone that you may need to see a doctor, change your medication or some other form of intervention. An inability to follow your normal routine can serve as a warning signal that you are in need of help or assistance.

  5. Get enough sleep.

    For many people with schizophrenia, the loss of or reduced need for sleep is an indicator that an episode of psychosis is developing. Try to go to bed at the same time most nights and wake up at the same time each morning. Sleep, like having a routine, can be an early warning sign that trouble is brewing. Monitoring sleep is one of the easiest things that you can do to make sure your medications are working and that your symptoms are not getting increasingly worse.

  6. Eat well and exercise.

    Eating a balanced diet and getting some exercise most days of the week can help boost your mood. Diet and exercise are particularly important for people on many antipsychotic medications because of the possible side effects of weight gain, fatigue, high cholesterol, and high blood sugar. Make sure to check with your primary care physician before beginning to exercise to make sure you are in good enough health to incorporate an exercise routine into your day.

  7. Learn your triggers.

    For people with schizophrenia, it is common for busy social situations to be a trigger for anxiety. It is also common to have feelings of paranoia around certain people or things. If you can discover what things cause you to develop symptoms, you can either prepare yourself by having an exit plan or avoiding those situations and things completely.

Managing schizophrenia, and making sure you can live the best life possible has much in common with managing a chronic illness of any kind. There are regular doctor appointments, treatment options, diet and exercise, the avoidance of stress (triggers) and making sure you are taking the best care possible to give yourself the best chance at fewer symptoms and possible recovery. It takes effort initially to incorporate these suggestions into your daily routine, but once they become habits, the less you will have to focus on them and the more you can get out and enjoy life.

Doctor and patient photo available from Shutterstock

Bella DePaulo <![CDATA[Introverts in Love: The Quiet Way to Happily Ever After]]> 2016-02-01T14:48:33Z 2016-02-01T21:45:11Z If you are an introvert, that characteristic is just one part of who you are. Yet it can be a mightily important one. In Introverts in Love: The Quiet Way […]]]>

If you are an introvert, that characteristic is just one part of who you are. Yet it can be a mightily important one. In Introverts in Love: The Quiet Way to Happily Ever After, Psych Central blogger Sophia Dembling explains the special role of introversion in romantic relationships. The book is a quick, illuminating read, with brief, engaging chapters in which Dembling shares insights from psychological research and interviews with introverts and experts, and tells us about her own experiences, too.

Dembling breaks the book down into three parts. First, she asks readers to consider what they want from a relationship. She offers a balanced perspective on what introverts can find in other introverts as compared to what they can get from extroverts. Risks as well as rewards come with each type of partner, Dembling writes, and she spells those out clearly and compassionately.

The first section ends with my favorite chapter, one that is missing from many other relationship self-help books, yet one that should be mandatory. Titled “One Isn’t Necessarily the Loneliest Number: Some People Are Meant to Be Single,” the chapter ends with a paragraph that includes this: “Are you, deep down, looking for permission to stay single? Well, then, permission granted.” (Full disclosure: I’ve been single all my life, I’ve been studying single people and single life for nearly two decades, and I was quoted in that chapter.)

Next, Dembling addresses the tasks that can be challenging to many people, but are likely to be particularly daunting to introverts: meeting, dating, and connecting with others. A note on parties aptly captures Dembling’s sensibility. Rather than feeling like a failure because you can’t “work a party like an extrovert,” she writes, “try approaching parties feeling comfortable with your introversion and your introverted ways. That way, you won’t feel like a poor excuse for an extrovert; you’ll feel like a fabulous example of an introvert.”

I also enjoyed Dembling’s knowing quips, such as this one offered in a discussion of that annoying thing some people do: urging you to attend some event because you don’t have anything better to do. “But sometimes you do have something better to do,” Dembling writes, “which just happens to be nothing.”

The second part of the book also includes one of my favorite chapter titles: “Do You Hide Here Often?” That chapter opens with a great set of #introvertpickuplines from Twitter, such as “Hey, I noticed you noticing me, so I pretended to look at something on my phone,” and “You look as uncomfortable as I feel, and I mean that in a good way.”

By the third part of the book, the dating is done and Dembling is offering wisdom and advice for introverts on succeeding in a relationship. One of the most important tasks, she notes, is finding just the right combination of time alone and time together. When I was researching my latest book, How We Live Now: Redefining Home and Family in the 21st Century, I found that we are all looking for that balance in our lives, regardless of whether we live alone or with others, or whether we are single or partnered. Just about everyone wants some time to themselves and some time with other people. What varies greatly is the optimal proportions — with introverts, of course, preferring relatively more time alone.

I’m what I call “single at heart.” For me, living single is how I live my best, most authentic, most meaningful life. So when I read a book about coupling, such as Introverts in Love, I expect an anthropological experience: Oh, so that’s what it’s like in Couple Land.

Much to my surprise, that was not how I felt about Introverts in Love. First, much of what Dembling has to say about the role of introversion and extroversion in romantic relationships also applies to friendships. Most of her advice about finding romantic partners, for instance, applies equally well to finding friends. Second, although I didn’t identify with the coupling parts, I did identify deeply with the introversion parts. I’ve been reading about introversion and extroversion for a long time. I’ve even published some research on characteristics related to introversion. But it took reading this book for me to learn that I’m even more of an introvert than I ever realized.

So I think Introverts in Love is potentially of interest to even more readers than those looking for (as the subtitle says) “the quiet way to happily ever after.” The book is part of the broader cultural project of creating greater recognition for introverts — appreciation of their strengths and talents and understanding of their needs. On page after page, I experienced that sweet sense of identification — Yes, that’s me! — followed by the welcome reassurance from Dembling: Yes, that’s you, and it’s good that that’s you, and you can own it and be proud of it.

If you’re an introvert, you might savor these same offerings from Introverts in Love. And if you’re not, you’ll probably learn quite a lot about the introverts in your life, regardless of whether you have any interest in them as romantic partners.

Introverts in Love: The Quiet Way to Happily Ever After
Perigee, January 2015
Paperback, 208 pages

Jane Framingham, Ph.D. http:// <![CDATA[When Someone Has Schizophrenia]]> 2016-02-01T17:39:29Z 2016-02-01T17:45:40Z Schizophrenia is a serious mental disorder — one the most chronic and disabling types of mental illness. The first signs of schizophrenia, which typically emerge in young people in their […]]]>

Schizophrenia is a serious mental disorder — one the most chronic and disabling types of mental illness. The first signs of schizophrenia, which typically emerge in young people in their teens or twenties, can be confusing and even shocking to families and friends. Hallucinations, delusions, disordered thinking, unusual speech or behavior, and social withdrawal impair the ability to interact with others. Most people with schizophrenia suffer chronically or episodically throughout their lives, losing opportunities for careers and relationships. 1 They often are stigmatized by lack of public understanding about the disease. However, several new antipsychotic medications developed within the last decade, which have fewer side effects than the older medications, in combination with psychosocial interventions have improved the outlook for many people with schizophrenia. 2

Basic Facts About Schizophrenia

  • In the U.S., over 2 million adults 3 , or about 0.7 to 1.1 percent of the population age 18 and older in a given year 4, have schizophrenia.
  • Rates of schizophrenia are very similar from country to country — about 1 percent of the population.5
  • Schizophrenia ranks among the top 10 causes of disability in developed countries worldwide.6
  • Psychotic features of schizophrenia typically start between a person’s late teens and mid-30s. For men, peak emergence of psychotic symptoms is in their early to mid-20s. For women, the peak time is in their late 20s.
  • The risk of suicide is serious in people with schizophrenia.7

News and entertainment media tend to link mental illnesses including schizophrenia to criminal violence. Most people with schizophrenia, however, are not violent toward others but are withdrawn and prefer to be left alone. Drug or alcohol abuse raises the risk of violence in people with schizophrenia, particularly if the illness is untreated, but also in people who have no mental illness.8,9

Research Into Schizophrenia

  • Family studies indicate that genetic vulnerability may be a risk factor for schizophrenia.10 A person with a parent or sibling with schizophrenia has approximately a 10 percent risk of developing the disorder compared to a 1 percent risk for a person with no family history of schizophrenia. At the same time, among individuals with schizophrenia who have an identical twin, and thus share the exact genetic makeup, there is only a 50 percent chance that both twins will be affected with the disease. Scientists conclude that nongenetic factors, such as environmental stress perhaps occurring during fetal development or at birth, also may contribute to the risk of schizophrenia.11, 12
  • Research suggests that schizophrenia may be a developmental disorder resulting from impaired migration of neurons in the brain during fetal development.13
  • Advances in neuroimaging have shown that some people with schizophrenia have abnormalities in brain structure consisting of enlarged ventricles, the fluid-filled cavities deep within the brain.14
  • Schizophrenia can appear in children, though it is very rare. Neuroimaging research of childhood-onset schizophrenia has shown evidence of progressive abnormal brain development.15

While providing clues about the brain regions involved in schizophrenia, these findings are not yet sufficiently specific to schizophrenia to be useful as a diagnostic test.

Treatments for Schizophrenia

The newer medications for schizophrenia — the atypical antipsychotics — are very effective in the treatment of psychosis, including hallucinations and delusions, and may also help treat the symptoms of reduced motivation or blunted emotional expression.16 Intensive case management, cognitive-behavioral approaches that teach coping and problem-solving skills, family educational interventions, and vocational rehabilitation can provide additional benefit.2 Evidence suggests that early and sustained treatment involving antipsychotic medication improves the long-term course of schizophrenia.17 Over time, many people with schizophrenia learn successful ways of managing even severe symptoms.

Because schizophrenia sometimes impairs thinking and problem solving, some people may not recognize they are ill and may refuse treatment. Others may stop treatment because of medication side effects, because they feel their medication is no longer working, or because of forgetfulness or disorganized thinking. People with schizophrenia who stop taking prescribed medication are at high risk for a relapse of illness.18 A good doctor-patient relationship may help people with schizophrenia continue to take medications as prescribed.19

Present and Future Research Directions

In addition to the development of new treatments, schizophrenia research is focusing on the relationships among genetic, behavioral, developmental, social and other factors to identify the cause or causes of schizophrenia. Utilizing increasingly precise imaging techniques, scientists are studying the structure and function of the living brain. New molecular tools and modern statistical analyses are enabling researchers to close in on the particular genes that affect brain development or brain circuitry involved in schizophrenia. Scientists are continuing to investigate possible prenatal factors, including infections, which may affect brain development and contribute to the development of schizophrenia.



1 Harrow M, Sands JR, Silverstein ML, et al. Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study. Schizophrenia Bulletin, 1997; 23(2): 287-303.

2 Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin, 1998; 24(1): 1-10.

3 Narrow WE. One-year prevalence of mental disorders, excluding substance use disorders, in the U.S.: NIMH ECA prospective data. Population estimates based on U.S. Census estimated residential population age 18 and over on July 1, 1998. Unpublished.

4 Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 1993; 50(2): 85-94.

5 Report of the international pilot study of schizophrenia.Volume 1. Geneva, Switzerland: World Health Organization, 1973.

6 Murray CJL, Lopez A.D, eds. Summary: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Published by the Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Harvard University Press, 1996.

7 Fenton WS, McGlashan TH, Victor BJ, et al. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. American Journal of Psychiatry, 1997; 154(2): 199-204.

8 Swartz MS, Swanson JW, Hiday VA, et al. Taking the wrong drugs: the role of substance abuse and medication noncompliance in violence among severely mentally ill individuals. Social Psychiatry and Psychiatric Epidemiology, 1998; 33(Suppl 1): S75-S80.

9 Steadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 1998; 55(5): 393-401.

10 NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998.

11 Geddes JR, Lawrie SM. Obstetric complications and schizophrenia. British Journal of Psychiatry, 1995; 167(6): 786-93.

12 Olin SS, Mednick SA. Risk factors of psychosis: identifying vulnerable populations premorbidly. Schizophrenia Bulletin, 1996; 22(2): 223-40.

13 Murray RM, O’Callaghan E, Castle DJ, et al. A neurodevelopmental approach to the classification of schizophrenia. Schizophrenia Bulletin, 1992; 18(2): 319-32.

14 Suddath RL, Christison GW, Torrey EF, et al. Anatomical abnormalities in the brains of monozygotic twins discordant for schizophrenia. New England Journal of Medicine, 1990; 322(12): 789-94.

15 Rapoport JL, Giedd J, Kumra S, et al. Childhood-onset schizophrenia. Progressive ventricular change during adolescence. Archives of General Psychiatry, 1997; 54(10): 897-903.

16 Dawkins K, Lieberman JA, Lebowitz BD, et al. Antipsychotics: past and future. National Institute of Mental Health Division of Services and Intervention Research Workshop, July 14, 1998. Schizophrenia Bulletin, 1999; 25(2): 395-405.

17 Wyatt RJ, Henter ID. The effects of early and sustained intervention on the long-term morbidity of schizophrenia. Journal of Psychiatric Research, 1998; 32(3-4): 169-77.

18 Owens RR, Fischer EP, Booth BM, et al. Medication non-compliance and substance abuse among patients with schizophrenia. Psychiatric Services, 1996; 47(8): 853-8.

19 Fenton WS, Blyler CB, Heinssen RK. Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophrenia Bulletin, 1997; 23(4): 637-51.

Marie Hartwell-Walker, Ed.D. <![CDATA[February School Vacation Planning]]> 2016-02-01T14:48:17Z 2016-02-01T17:28:30Z ]]> Here it comes: Another week-long vacation for the kids; another week of stress for working parents. Yes, I know. There are good reasons for school vacations. Those weeks off tend to break the cycle of contagion of colds and flu in the classrooms. Teachers get a week to regroup from one of the world’s most stressful jobs. Some kids really do need a break from academics. There’s a vacation industry that counts on family dollars to maintain historic and entertainment sites and the jobs that go with them. All true.

But for many working parents, any day or week off from school for their kids, whether a snow day, a teacher conference day, a Monday holiday or those periodic week-long vacations is something to dread. With no parallel adult vacation from work, there is nothing at all vacation-y about it. The planning involved for keeping kids safe and occupied is yet another task and another stress.

The only bright side is that most of the days off (minus those that are weather or illness-related) are scheduled way in advance. We know they are coming. It’s up to us to plan ahead so we’re not crunched or in a panic when we know that the next school vacation is a week away.

When can kids be left alone?

To be safely left alone, kids need to be older than you might think. The part of kids’ brains that governs making good decisions doesn’t mature until well into the teens. The same kid whose judgment, planning and decision-making may seem fine, even advanced, on a day-to-day basis may not respond well in an emergency, no matter how well you think you’ve prepared him.

A friend of mine shared this story as an example of too much responsibility too soon:

“As the oldest,” said Sherry, “I was my mother’s right-hand helper from the time my youngest sister was born. She relied on me to watch the baby while she did other chores or to entertain the younger kids when she was sewing. By the age of 8, she would leave me in charge if she had to run out for a few minutes to do some short errand. By 10, I was babysitting for real; especially if my folks wanted to go out after the younger kids were already asleep.

“I’m told I was responsible, capable and smart. But I was still only 10. One Saturday night when my folks were playing cards at a neighbor’s house, I noticed smoke coming from under the door that led to our basement. I panicked. I called my mom instead of just getting everyone out of the house. She snapped me into action by yelling instructions and then called the fire department. When my folks got home, fire trucks were in the driveway and we kids were all huddled together in tears in the front yard.”

Fortunately, there was smoke, not fire, coming from the furnace. Fortunately, Sherry was able to reach her mother and get direction. But to this day she thinks with horror about the “what-ifs.” What if it had been a fast-moving fire? What if she hadn’t been able to reach her mother? What if she hadn’t been able to get the younger kids to wake up and go with her? What if, what if, what if.

The story is not intended to frighten parents but to remind us that even very mature children are still children. Most psychologists advise that children not be left home alone until they are at least 12 and not be left entirely in charge of other children until they reach high school age. Parents can provide good training for babysitting prior to then by enlisting kids as parent-helpers; entrusting them to watch younger children while the adult is busy but still within yelling distance if there is a problem.

Options for kid coverage during vacation week

The secret to peace of mind is to plan ahead. Here are some of the options available to you if you are a working parent of kids who need supervision when school is not in session:

  • Be aware that in some states, leaving young children alone is grounds for protective services to get involved.

    Make sure you understand your state’s laws regarding how old a child needs to be to be legally left alone.

    If your children (even teens) are old enough to be alone but are not really mature enough to handle extended time without guidance, provide structure and indirect supervision. Hold a meeting with the kids each evening and set up expectations for the next day. Create a schedule together that includes chores, activities and down time. Check in on them hourly (by phone or Skype) to see that they are following the schedule. If they finish their list, there will be time to do something fun when you get home. If they don’t, then everyone will have to do the chores before dinner.

  • Share supervision responsibilities with family members.

    In families with two adults, arrange for one adult to go to work late and the other to come home early. Most or all of the day is then covered. In some families, the adults each take two-and-a-half days vacation or personal time off. Others swap off vacation weeks; one taking responsibility for February, the other taking off the spring vacation. Sometimes relatives who live nearby and who are close to the children are willing to provide supervision for a day or two as well.

  • If you’re a single parent, remember there are other single parents in the same boat.

    Arrange to swap supervision time with one or more other parents you know. If you can get four or five parents to commit to it, each of you only needs to take a day or two off work. This does mean being willing to entertain and manage four or five kids on your day.

  • In recognition of the dilemma for working parents, many schools, youth organizations and local recreation departments offer vacation “camps.”

    Your child may not want to go. But if the choice is being at an organized program or being alone, it is only good parenting to make it a non-choice. Often reluctant kids find they like it once they are there. Even if they don’t, you know your kids are safe.

  • High school kids are on vacation too.

    Many would like to pick up a little cash. Call the guidance office to ask if there are kids they’d recommend for a child care job. Be sure you do your own interview and check references. If you do hire a sitter, be clear about your expectations. Taking care of children for a week is very different from watching them for a few hours.

Maybe future parents will live in more enlightened times. Our school schedule needs to undergo major adjustment to match the reality that more parents than not work outside the home. In the meantime, anxious parents are left to do their best to keep kids safe and happy when school is in recess. These days, school vacation is no vacation for most working parents. We get to relax when school vacation is over.

Calendar image available from Shutterstock

Edie Weinstein, MSW, LSW <![CDATA[Understanding & Giving Support to Someone with Schizophrenia]]> 2016-02-01T14:50:09Z 2016-02-01T14:55:07Z ]]> Understanding & Giving Support to Someone with SchizophreniaWhat comes to mind when the word schizophrenia is spoken? Likely images of a bedraggled man or woman, with wild hair and tattered clothing, chatting away with someone that you can’t see, as they amble down a city street. You might actually cross the street to avoid him or her, so as not to get caught up in their delusion.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) describes the condition as “characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction. For a diagnosis, symptoms must have been present for six months and include at least one month of active symptoms.” These are merely words on a page that allow treating professionals to determine clinical interventions such as psychotherapy, inpatient hospitalization if symptoms warrant, and medication.

Although there is no clear-cut answer, it is known that schizophrenia is considered a brain disease that has genetic components. A cautionary note to consider is that DNA is not a defining factor, since in identical twins, one may present with the symptoms, while the other may not. According to ongoing scientific research, brain development in utero may offer a key to unlock the mystery. Another theory relates to a viral component, which may exacerbate developmental conditions. In short, schizophrenia appears to be a complex condition caused by no single factor by itself.

In men, schizophrenia symptoms generally are noted in the early to mid-20s. In women, symptoms typically begin in the late 20s. It’s uncommon for children to be diagnosed with schizophrenia and rare for those older than 45.

The American Psychiatric Association‘s “Guideline for The Treatment of Patients with Schizophrenia” states that “Antipsychotic medications are indicated for nearly all acute psychotic episodes in patients with schizophrenia.” These include antipsychotic medications such as Haldol, Clozapine, Geodon, Seroquel, Risperdal, Zyprexa and Abilify. They are meant to treat the symptoms, but are not considered curative.

Schizophrenic Symptoms

The term ‘positive symptoms’ is used to describe what will follow. It does not indicate that these are desirable, but rather in excess of what people without the disease experience:

  • Delusions: Beliefs not based in commonly held collective reality. Examples include false perception that one is being talked about or harassed when another is merely having a private conversation or physical limitations that are not actually occurring.

  • Hallucinations: Visual, auditory, tactile, gustatory (taste) and olfactory (smell) are the most common. The term ‘responding to internal stimuli’ is often used in psychiatric settings to describe this component of the condition. A 20/20 episode several years ago highlighted technology that allows people to experience in virtual reality what those with schizophrenia live with. Overlapping sounds, voices and imagery that are all temporary distractions to a person who doesn’t have them in his or her daily life can be terrifying to another who does.
  • Disorganized thinking- It leads to speech that makes no sense to the typical listener. Referred to as ‘word salad,’ it may sound like this: “I went to the store because the trash can is on top of the refrigerator, leering at me. It said I had two purple teeth and no belly button.” To the person uttering these sentences, it is in synchrony with their current mindset.
  • Abnormal motor behavior: This may appear as twitching, spontaneous posturing, agitation, frozen, statue-like positions or excessive movement.

The term ‘negative symptoms’ relates to the inability to function in ways that would be considered the societal norm:

  • Limited or lacking eye contact.
  • Frozen facial expression.
  • Monotone speech, without inflection or animation.
  • No emotional component of speech, so that the listener may not grasp what the speaker is attempting to communicate.
  • Poor personal hygiene.
  • Depressive symptoms, such as lack of interest or enthusiasm about life.
  • Social isolation.
  • Limited ability to feel pleasure.

From the Therapist’s Office

  • A client seen in a therapist’s office presented with the erroneous belief that he was nearly bald when he had a full head of hair. It took a great deal of repetition and affirming his concerns, as well as discovering that a family history of hair loss and the ways in which his father and grandfather viewed themselves that may have been at the root of his delusion.

  • A young woman admitted to an inpatient unit in an acute care psychiatric hospital expressed her belief that she was an angel whose deceased father told her to come there so that she could assist the other patients. She was in extreme distress upon admission as she cried and said she wanted to harm herself. After the therapist confirmed with her that being an angel didn’t mean she was invincible, she questioned whether her father’s message was meant to get her the help she needed and perhaps he knew that she wouldn’t admit herself otherwise.
  • A man whose mother was diagnosed with schizophrenia shared his story of riding as a passenger in a car with her and needing to take the wheel when she saw what she thought were demons around them and began screaming. She had stopped taking her medications a few weeks earlier.
  • Another patient on the unit said that he could hear his father’s voice in his head instructing him to “Get off cocaine and be nice to your brother.” He decided to do both.

Stigma attached to the disease

As is the case in most mental health diagnoses, schizophrenia carries with it the burden of stigma, by which the person is viewed as dangerous and a poor fit into society. What treating clinicians and those themselves with the condition have determined is that with proper and consistent intervention, the symptoms can be managed and the individual can be productive and high-functioning. National Alliance on Mental Illness (NAMI) is an educational and advocacy organization that provides support those living with mental illness, as well as for their families and friends. This is an important resource.

How can family and friends be of support?

  • Take care of your own needs, since you can’t fill another’s cup if yours is empty.
  • Seek support from extended circles, such as therapists, self-help groups and clergy.
  • Assist with teaching and reinforcing ADLs (Activities of Daily Living) such as bathing, dressing and grooming.
  • Encourage consistent sleep. It is not uncommon for symptoms to become more severe when someone is sleep-deprived.
    Have them avoid mood-altering substances such as drugs and alcohol.
  • Socialization rather than isolation at their comfort level will enhance stability.
  • Know that the presentation will fluctuate throughout a lifetime and that riding the waves will be necessary, so self-care is essential (see No. 1).
  • Take note of potential triggers. Does your loved one exhibit symptoms at certain times of the year or when particular people are around?
  • Consistent med management is essential. See that they keep appointments with therapist and psychiatrist.
  • There are times when you will need to validate their experience, rather than offer reality orientation, unless you or that person is in immediate danger. It may encourage a sense of trust.
  • There are books available to assist in understanding the disease and act as ongoing support for someone you love, so that neither of you face it alone.


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Stan Rockwell, PsyD <![CDATA[Hakomi Mindfulness-Centered Somatic Psychotherapy]]> 2016-01-26T19:45:57Z 2016-01-31T19:42:58Z Despite my decades of training and practice in psychotherapy, I had not heard of Hakomi therapy until a couple of years ago, when a client asked me about it. The […]]]>

Despite my decades of training and practice in psychotherapy, I had not heard of Hakomi therapy until a couple of years ago, when a client asked me about it. The client studied Taoist philosophy and mindfulness and was wondering if anyone in the area practiced Hakomi. I was intrigued and began to search for information, and was delighted when this book became available.

While the main authors are  Halko Weiss, Greg Johanson, and Lorena Monda, twenty-three writers contributed to this work, including the founder of Hakomi, the late Ron Kurtz. They come from all over the world.

I am drawn to Hakomi because of its use of the body in therapy. What neuroscience, my clients, and self examination teach me more and more is that the mind-body dichotomy is a false one. I have seen people who had epiphanies about their behavior and decision making — but who were then unable to move the insight from their heads to their hearts. Ron Kurtz recognized that long ago. He took therapy beyond just talk and involved the whole person.

Hakomi takes into account that we carry our memories and traumas and feelings in our physical bodies. The system that we live in is nonlinear and our experiences are processed “from within and without.”

As the book puts it, “We do not merely live in the world, we live in the world as we view it, construct it, or interpret it.” We construct our reality based on our core beliefs. Our experiences along the way affect that construct, but that construct and those core beliefs begin forming before we have conscious memory and the ability of language. Among the principles emphasized over and over again in the book is that insight is not enough. It takes experience to modify experience.

I love the respect that Hakomi has for clients. Defensiveness is not seen as denial or rationalization or some mechanism. Defensiveness is met with compassion and curiosity, and the therapist helps the client explore where the defense is coming from, and realizes that the defense is there for a reason.

One thing I noticed while working in a traditional denial busting substance-abuse model many years ago is that the harder therapists pushed against defenses, the better those defenses could become. After all, the defense was there to protect the person. Hakomi places a great emphasis on the state of mind of the therapist and the relationship with the client.

Hakomi also looks at actions as skillful or not skillful and realizes that the flow of the process is not the same for every client — and that it even changes over the course of a single session. What is important is trust, nonviolence, mindfulness of both the therapist and client, and staying with the nonlinear and organic process. One of the principles is that a system cannot change within itself, and one of the processes is called JOOTS, or jumping out of the system.” This can help us to break the pattern of repeating the same thing over and over again.

Therapists who use Hakomi conduct experiments with clients to help them find patterns and systems on a deep level and to begin to change. How many times has someone tried a “geographic cure” only to wind up in the same situation with the same types of people in the new place? Hakomi helps a person where she or he is.

The book contains extensive information on how Hakomi came to be, as well as its theoretical underpinnings, methods and therapeutic strategies, and techniques and interventions. Hakomi draws from many, many theories and philosophies both eastern and western. It was one of the first, if not the first, to specifically emphasize mindfulness.

The book also includes many stories and examples of the therapy itself.  It sounds like it takes very disciplined and skillful therapists to practice Hakomi. This extensive book can teach you much about it, but to practice Hakomi, you need to study with a Hakomi teacher.

The final chapter is on research and historical context. Weiss and Johanson state that despite over 2,500 studies on the efficacy of mindfulness in therapy, there needs to be more studies specifically on Hakomi. The authors do point out that outcome measures can and are used in Hakomi. Perhaps the accumulation of positive outcomes will put Hakomi into the category of, as Scott Miller calls it, practice-based evidence. Whether you intend to learn Hakomi or not, this book is a worthwhile read to expand your knowledge of how we change.

Hakomi Mindfulness-Centered Somatic Psychotherapy: A Comprehensive Guide to Theory and Practice
W. W. Norton & Company, May 2015
Paperback, 432 pages