Psych Central Original articles in mental health, psychology, relationships and more, published weekly. 2016-09-27T17:28:56Z http://psychcentral.com/lib/feed/atom/ Stan Rockwell, PsyD <![CDATA[Book Review: Treatment Plans & Interventions for Obsessive-Compulsive Disorder]]> http://psychcentral.com/lib/?p=46417 2016-09-23T18:01:52Z 2016-09-27T17:28:56Z People sometimes make jokes about being OCD or anal retentive or type A and might even see the terms as interchangeable. You might run across articles in popular magazines like […]]]>

People sometimes make jokes about being OCD or anal retentive or type A and might even see the terms as interchangeable. You might run across articles in popular magazines like Women’s Health that explain the difference between the terms. But despite the term’s popularity as a punch line on sitcoms, it is not a laughing matter.

Simon Rego’s Treatment Plans and Interventions for Obsessive-Compulsive Disorder is part of a series published by Guilford and edited by Robert Leahy that gives therapists guidelines on evidence-based practices for working with clients with specific problems such as OCD,  bulimia, depression and anxiety, and insomnia.

Rego does a nice job of explaining just what obsessive-compulsive disorder is and putting it into the context of everyday thoughts and behaviors. Everyone has thoughts and feelings from time to time that, as Robert Louis Stevenson once said, “would shame hell.” With OCD, the person has trouble differentiating themselves from those thoughts, and the level of insight within the person changes over time. At one point, the person may see that it’s just a thought and an irrational one at that, but at other times he or she might be convinced that the thoughts are accurate and be very distressed. Rego also gives a history of the diagnosis going from the days when the person was thought to be possessed to the current revisions in the DSM 5. He includes theories of the cause or causes of OCD and the rationale for treatments.

While many, if not all of us, have intrusive thoughts from time to time and rituals to get us through the day, they generally do not cause us distress. Rego’s discussion of OCD has gotten me interested in the cultural aspects of behavior. For instance, how does religion factor in? I have worked with individuals who converted to Catholicism because the rituals of the Church brought them comfort and reduced anxiety. Confucianism is based on ritual, and the rituals are there to teach you to be able to react in the way of virtue in any situation by rehearsal of ritual. It is a question of when ritual becomes problematic. Are you late to work because you have to check that you locked the door fifty times before leaving? Are you unable to use a public toilet because of fear of contamination? Rego gives examples of people for whom the fears, obsessions, anxiety, and rituals cause them great pain. He points out that in the United States, the lifetime prevalence of OCD is about 2.3%. It is the fourth most common psychiatric diagnosis in the U.S. Even with that commonality, it takes about fourteen to seventeen years for a person to receive an accurate diagnosis and treatment.

The treatment in this manual is based in exposure and ritual prevention, or Ex/RP, and is similar to exposure therapy in cognitive behavioral therapy that is used for conditions such as phobias and PTSD.  Rego also references adjunct therapies such at metacognitive therapy, acceptance and commitment therapy, and biological treatments for those who do not respond to talk therapy and/or medication. He does give an overview of medications that have proven effective and gives the evidence as to how that may work.

Rego gives a very comprehensive and detailed guide to working with an individual with OCD. He covers the phone interview before the first appointment, what is included in the evaluation, how to form a treatment plan geared to the individual, and a sixteen session treatment regimen. He has educational handouts on CBT, evaluations, and more that are included as handouts that you can copy from the book or download from the Guilford website. Homework is very important for success in this model, and whether the person does the homework may have more of an effect on the outcome than the number of sessions. Throughout, he emphasizes working with the person in front of you and working collaboratively rather than trying to fit the person into the model. He includes how to do the exposure therapy and includes an optional home visit and how to set that up and carry it out. He is very attentive to confidentiality and ethics throughout. He has a wealth of resources at the end of the book — websites, books and more that clinicians can use both for their own learning and for their clients to use. The final session is on relapse prevention.

He ends with a case study that takes the reader through each session and shows how to work with issues that come up. He also shows how measuring desired outcomes consistently is important in working collaboratively with the person. For example, the person may actually feel worse and lose motivation at the beginning. Ex/RP is based on a person giving up the rituals that have brought them anxiety relief, but in doing so reinforced ritual continuation, which increases anxiety. Sometimes working with the person to help them stick with the process can be a challenge, and Rego includes motivational interviewing as part of this method. Each chapter ends with a “take-home message” and each session ends with “based on what we have accomplished today, what have you learned and how will this change how you live your life?” I like that very much and have begun using it myself with clients.

Treatment Plans and Interventions for Obsessive-Compulsive Disorder
The Guilford Press, April 2016
Paperback, 222 pages
$35.00

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Payam Ghassemlou, MFT, Ph.D. http://www.drpayam.com/ <![CDATA[A New Way of Being]]> http://psychcentral.com/lib/?p=46741 2016-09-25T20:39:15Z 2016-09-27T12:35:16Z ]]> a new way of beingThe mind is often busy focusing on one concern or another. Sometimes you might be dealing with remorse about the past, and other times you might be worrying about the future. In addition, you can have thoughts of regret, resentment, and feelings of insecurity which can all be part of your mental activities. Not to mention some of your painful memories from the past or dreams about the future. Sometimes your mind, like a chatter box, can involve critical inner dialogues which can lessen your enjoyment of life. All these are part of your mental process. It makes sense to learn how to stop listening to the chatter box, and grow beyond your ordinary mental activities.

Worrying and ruminating about real or perceived life problems is common because scientific research on the human brain shows that it is constantly scanning the environment for threats to physical and emotional safety. Also, the brain gives shorter notice to positive experiences, usually only two to three seconds before moving on to the next thought. The negativity bias of the brain coupled with rumination about our problems can lead to anxiety, depression, and an overall pessimistic view of life. Fortunately, this is not a hopeless situation because you can learn to grow beyond the activity of the mind. As the Persian poet Rumi stated, “Out beyond ideas of wrongdoing and right doing, there is a field. I will meet you there.”

When you grow beyond identifying with the activities of your mind, you can reach a loving open field. In this free space, you are not your thoughts, your intense emotions, and your memories, and yet you are mindfully aware of them. You can mindfully observe your inner dialogue and issues that go through your mind and yet you are not trapped by them. In such an infinite space, you can experience life from a place of clarity where you don’t let your focus move toward unhealthy habits and behaviors. This loving open field is not just another state of mind to get to. It is a way of being.

How can you reach a state of being that is beyond the activity of your mind? There is no such thing as one size fits all when it comes to personal growth. Everyone is unique. Everyone needs to discover their own path to enlightenment or personal growth. In this brief article, I attempt to offer what I have learned from Sufi poets and teachers, mindfulness practices, and Jungian psychology when it comes to taming the busy mind. The goal is not stop thinking or feeling, but to choose which thoughts and emotions deserve our attention. We can develop a new consciousness of being watchful of our mental activities and decide whether to focus on something or letting it go.

Given we live in a world that focuses heavily on “I think, therefore I am,” as stated by Rene Descartes, it would be difficult to imagine going beyond our thinking and focus on being. It can be done because others have done it.

As a start, imagine you are sitting in your living room and noticing without any judgments all the objects in the room. For example, you notice the couch, TV, coffee table and few other things and at the same time you are aware of your presence in the room. You are aware that you are noticing all the furniture in the room and yet you are separate from them. You do not over identify with any object in your living room. You are not judging them, analyzing them or making story about them. You are completely detached and at the same time present. I like you to use the same concept as you witness your mind activities. You are looking at your thoughts and emotions going through your mind without judging them and over identifying with any of them. You do not define yourself by them. You are the one who is aware of them, and you can use your will power to choose how much attention you like to give anything going through your mind.

You can enrich this practice of witnessing your mind by inviting your heart to participate in the process. Your heart is a place of connection to love, Divine Oneness, Higher Power, God, Universal Compassion or anything comforting that feels true to you. You can activate the feeling of love in your heart by remembering a heartfelt experience and focus on that. The tool that you have in this process is your focus. “Whatever you focus on, it becomes your reality.” In other words, “You energize anything that you give your attention to it.” So why not energize the love in your heart. You might not be able to stop your mind from producing thoughts, but you can fill the spaces between your thoughts with energy of love. The marriage between the heart and the mind can give birth to a new way of being.

To summarize, you notice your mind as if you are standing in a train station and watching each train of thoughts and/or emotions going by without getting on the train. Instead, you can direct your attention to the love in your heart. You can do that one day at the time, and experience having a new consciousness in partnership with your heart. Welcome to a new way of Being.

Markin/Bigstock

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Megan Riddle <![CDATA[Book Review: How Does That Make You Feel?]]> http://psychcentral.com/lib/?p=45822 2016-09-23T18:02:03Z 2016-09-26T17:28:53Z “We’re all crazy and the only difference between patients and their therapists is the therapists haven’t been caught yet.” – Max Walker The therapeutic relationship is an unusual one. You […]]]>

“We’re all crazy and the only difference between patients and their therapists is the therapists haven’t been caught yet.” – Max Walker

The therapeutic relationship is an unusual one. You go once a week and spend fifty minutes pouring out many of the most intimate details of your life — tragedies, triumphs, infinitesimal slights that are still eating away at you for reasons you cannot understand. Then you pay and leave. You think about the session afterwards, anxiously anticipate the next meeting. But who is this person, really, with whom you share all your heartfelt thoughts and emotions? While they may offer tidbits of their own lives, the skilled therapists keep the sessions focused on their clients and remain, by and large, a mystery. Yet, as patients, we often perseverate over even these kernels of information about their lives. I had one therapist who liked chickens, another with two children, a third who enjoyed traveling abroad (much to my chagrin — how dare you leave me to go to some far flung, potentially dangerous part of the globe?). In her new book, How Does That Make You Feel? True Confessions from Both Sides of the Therapy Couch, Sherry Amatenstein brings together essays from both therapists and clients as each shares their experiences in therapy and in life.

Amanstein, a Licensed Clinical Social Worker and therapist based in NYC, has written a number of other books, including The Q&A Dating Book, Love Lessons from Bad Breakups, and The Complete Marriage Counselor: Relationship-saving Advice from America’s Top 50+ Couples Therapists. Now, rather than offer advice, she provides a look inside the relationship between client and therapist with a collection of revealing essays.

In “Shrinking Around,” Susan Shapiro tells us about trying to move on from her long-term therapist, Dr. Winters, when he relocates. Anyone who has felt abandoned by their therapist on some level (even when you are the one who moves — what do you mean you can’t come to New York with me?!?!) will relate to her mixed emotions. “I’d realized,” Shapiro writes, “he charged me $200 a session while possible replacements on my medical network cost only $25 co-pay. Screw him for deserting, I thought. For one overpriced Winters tete-a-tete, I saw eight shrinks in eight days, looking for his clone.” But she takes it a step further than most of us ever have, writing a graphic novel based on the experience and then setting up “speed shrinking” sessions at book signings, all the while on some level still searching for Dr. Winters. The ending has a slight twist as the two reconnect, this time on a literary level.

Some of the essays share harsh truth from the vantage of the therapist. In her essay, “I Really, Really Hate You,” Beth Sloan reveals that those of us who offer therapy do not always have the unconditional positive regard for our clients that Carl Rogers intended. Sometimes, we must work with really, really difficult people, like Sloan’s client, Marcelle, who complains about her $2,500 weekly allowance from her husband and does an amazing job of pushing all her therapist’s buttons. What Sloan shares with us, though, is not simply that this patient is difficult, but why. Because the truth is, we all have difficult clients, but only a select few truly get under our skin (otherwise we couldn’t do this job), often those who most remind us of other people in our lives. In this case, Marcelle reminds Sloan of her own mother, another demanding narcissist. When Marcelle leaves therapy, feeling as though she has been cured, Sloan reflects on her own needs, recognizing that “the best thing I can do for myself is avoid narcissists and bullies.” She offers, “…one of my brilliant therapists told me many years ago, ‘Sometimes understanding is the Booby prize!’….My journey continues.”

There are also stories that make me cringe. Laura Bogart writes with brave honesty in “My Shrink’s Ultimatum” about her experience when she is referred for therapy as a college student for PTSD and generalized anxiety. While initially therapy focuses on love and acceptance, the therapist develops her own agenda — to get Laura to lose weight. Attention suddenly shifts to calorie logs and time on the treadmill. “She explained that only fetishists (i.e. creeps) were into ‘obese women.’” I seethed reading that essay. How dare she?!?! But, in a true show of her own resilience, Bogart is able to leave her therapist and notes, “These days, I joke that despite her best intentions, Roberta [the therapist] has turned me into a self-actualized fat woman.” You go, girl.

How Does That Make You Feel? is an engaging, moving book that will be enjoyed by many, regardless of what side of the couch you happen to be sitting on.

How Does That Make You Feel?: True Confessions from Both Sides of the Therapy Couch
Seal Press, September 2016
Paperback, 320 pages
$17.00

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Edie Weinstein, MSW, LSW <![CDATA[How Loss and Challenge Make Us Stronger and More Resilient]]> http://psychcentral.com/lib/?p=46726 2016-09-25T20:37:36Z 2016-09-26T12:30:52Z ]]> how loss and challenge make us stronger and more resilient“The bamboo that bends is stronger than the oak that resists.” -Japanese Proverb

When we incarnate into this human form, wouldn’t it be so much more convenient if we were provided with a guide book to help us navigate the choppy waters of life, love and loss? We would know what to expect and how to respond to any eventuality. It would tell us in an easy to understand 1-2-3 fashion the way to pick ourselves up when knocked to the ground as relationships end either by choice or chance, as illness ravages us or loved ones, as natural or human made disasters wash away our foundations. At 57, I have looked for such a tome and have yet to find it in any library or book store. As a therapist, it would indeed be a handy tool to have at my disposal as I would be able to turn to page 255 when a client has lost a child to a drunk driver and to page 145 if a fire has rampaged through a home and page 222 when a needle in a vein has taken the life of a spouse.

When such life events occur, we are called on to rise to the occasion without this primer. It takes fortitude, ingenuity, support, courage and for some, hope, faith and a belief in something beyond the boundaries of their own skin to emerge from the abyss.

The definition of loss according to the Merriam Webster Dictionary includes: “failure to keep or continue to have something and the experience of having something taken from your or destroyed.”

Resilience is described as: “the ability to become strong, healthy, or successful again after something bad happens, as well as the ability of something to return to its original shape after it has been pulled, stretched, pressed or bent.”

Robert Brooks, PhD, is the co-author (along with Sam Goldstein, PhD) of The Power of Resilience: Achieving Balance, Confidence, and Personal Strength in Your Life. He observed, “The more we can develop a ‘resilient mindset,’ the more equipped we will be to cope effectively with the joys and setbacks that are a part of all of our lives.”

Measuring Loss

The Holmes-Rahe Stress Inventory highlights major life challenges and changes.

It incorporates 43 life events and the numerical value for each one. Some relating to loss include:

Death of a spouse: 100 points
Divorce: 73 points
Marital separation: 65 points
Detention in jail: 63 points
Death of a close family member: 63 points
Major personal injury or illness: 53 points
Being fired at work: 47 points
Death of a close friend: 37 points

When compiled, these figures indicate the risk of major health crises, ranging from 150 points or less, foretelling relatively low risk, up to 300 points or more, increasing the odds by 80 percent.

Consider the possible challenges in your own life:

  • Disillusionment when a cherished dream doesn’t come true
  • Declaring bankruptcy
  • Becoming an empty nester
  • Changing jobs after a lay off
  • Injury or chronic illness that is incapacitating
  • Loss of driver’s license following a DUI
  • Incarceration due to legal issues
  • Hospitalization or rehab to treat mental health diagnoses or addiction
  • A motor vehicle accident
  • Feeling betrayed when a relationship partner is unfaithful
  • Watching a loved one destroy himself or herself with an addiction
  • Secrecy in relationship that causes financial disaster

I have been in the bereavement field for many years, following the first-hand experience of widowhood in 1998. As a result of my own journey as caregiver for my husband for six years prior to his death from Hepatitis C, I have been able to distill hard earned lessons into a tonic of treatment for those who are walking that path. Back then, I relied on others who had traversed the treacherous territory with my ‘widow to widow’ questions.

Since that time, I was introduced to the term ‘loss layers’ when reading a book entitled Glad No Matter What: Transforming Loss and Change into Gift and Opportunity. Author and artist SARK (Susan Ariel Rainbow Kennedy) penned what for me, has become a grief guide. She wrote it in the midst of the death of her mother, followed by the passing of her 17-year-old cat and the ending of a romantic relationship.

She explains that “loss happens in spirals and layers and not in steps like a ladder.” The image that comes to mind is that of the child’s game of putting one hand on top of the other and then moving the bottom had on top of the person’s above it until a tower of hands is built. We can only reach so high before stretching too far and need to step back.

On March 5, 2016, Kennedy experienced yet another devastating loss; that of her beloved partner John Waddell, PhD, with whom she had co-authored a book entitled Succulent Wild Love: Six Powerful Habits for Feeling More Love More Often. The two had met a few years earlier when embarking on a literal and figurative oceanic voyage in search of devoted partnership. He himself had been widowed after a 10 -year marriage when his wife died of cancer; the disease that ultimately claimed his life.

Kennedy has grieved in the public eye and in her characteristic style, has used her experiences to help others heal. That is a powerful description of one who is a resilient thriver.

The Losses We Deny

What happens when we bury our losses in the service of ‘keeping on keeping on’?  Jamie is an example of that dynamic. She too has experienced those loss layers which Kennedy eloquently expressed in her book. Her grandmother died when she four years old, she had a series of physical challenges in a childhood, she lost her partner when in her 40’s, her home in a natural disaster, her parents in a 2 ½ year period, followed closely by several severe health crises and then a job layoff. She has said that she rebounded from each of them and describes herself as one who has the strength and resilience to find her way through even the toughest challenges. People in her life marvel that she has done so.  In spite of maintaining a pro-active and positive attitude, she notices that she experiences fatigue and what she doesn’t acknowledge consciously, she manifests in physical form. An example came to the surface recently when a dear friend was in a hospital ICU for open heart surgery. He was intubated, hooked up to beeping, whirring and swishing machinery as had her husband been nearly 19 years earlier. She had herself convinced that she had gotten past the trauma of the original experience and was fully able to be handle the hours spent in her friend’s room and the waiting room with their family and friends, as well as those family members of others whose bodies lay in their own respective beds.

Happy tears were shed when he emerged successfully from the surgery. Jamie went home that night, exhausted and with respiratory difficulties and a sore throat. Uncharacteristically, she slept for 12 hours. In retrospect, she wonders how much of that came from denying the triggering of painful memories and re-traumatization. She questioned whether as someone who is admittedly an empath who sometimes ‘takes on’ the pain and symptoms of others, she was feeling what her intubated friend might be experiencing. Following that aha moment, she noted that the distressing symptoms abated.

Getting Over Losses or Getting On with Life?

While well- meaning family and friends may tell those who have experienced loss that they need to ‘get over it,’ it is one of the most dismissive statements than one who is grieving can hear. More effective and compassionate is acknowledging the depth of the loss that might be unimaginable. Even if you yourself have been there, each person’s experience is unique to them. “I know how you feel,” is another lovingly intended statement, by equally untrue. Asking, “How can I support you and help you get through this, especially when you might be feeling it is impossible?” Even if the answer is, “I don’t know,” sometimes just a silent and compassionate presence will serve for the time being.

Three of the most powerful pieces of guidance I have heard, “You don’t get over it. You just get on with it.” “There is no statute of limitations on grief.” “Once you have experienced loss, there is no going back to normal. You have changed and have to create a new sense of normal.”

Following a heart attack in 2014, I knew I couldn’t return to normal, since my habitual choices and behaviors almost killed me.

Resilience Resources

The American Psychological Association (A.P.A) offers a series of articles and guides about bouncing back from loss.

Measure your own resilience with three scales.

Compile a resilience tool kit that includes:

  • A list of people who are your go-to folks and can be called on 24/7 for support.
  • A journal into which you can pour your feelings at a moment’s notice.
  • Time in nature which can be restorative.
  • A willingness to express emotions in healthy ways (meaning that you will refrain from harming yourself or anyone else in the process).
  • Focus on gratitude for what remains and not just the loss.
  • Read books that inspire you to take the next steps in your life.
  • Seek therapy if needed.
  • Take time to sleep and recharge yourself.
  • Eat healthfully and not excessively.
  • Avoid self -medicating with substances.
  • If you are a 12 step program, stay in touch with your sponsor.
  • If you have a mentor, speak with him or her.
  • Move your body, whether in the gym or dance floor, on the street or the yoga mat.
  • Meditate
  • Pray (whatever that means to you)
  • Sing
  • Dance
  • Drum
  • Create art
  • Cry
  • Give yourself time and permission to heal at your own pace.
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Sophia Dembling <![CDATA[Book Review: Frientimacy]]> http://psychcentral.com/lib/?p=46420 2016-09-23T18:02:09Z 2016-09-25T17:24:20Z Shasta Nelson has made a career out of understanding, encouraging, and helping women make and maintain healthy friendships. In Frientimacy: How to Deepen Friendships for Lifelong Health and Happiness, she […]]]>

Shasta Nelson has made a career out of understanding, encouraging, and helping women make and maintain healthy friendships. In Frientimacy: How to Deepen Friendships for Lifelong Health and Happiness, she breaks down what we seek in intimate friendships and how we can do our part to attain them.

While bookstore shelves bend under the weight of books about romantic relationships, the literature on friendship is surprisingly sparse. But when push comes to shove, as life often does, friends are our buffers, sounding boards, cheerleaders, and straight talkers. If we’re lucky, we have friends who have known us throughout our lifetime. Many friendships just pass through our lives. But friendships of all kinds are as much a backbone of life as family. Sometimes they are our family.

Friends are important, and developing fulfilling friendships is important. Frientimacy is a “relationship where two people feel really seen in a way that feels satisfying and safe for both of them,” Nelson writes. It is the Platonic ideal of friendship that we carry in our hearts: the friend who is always glad to hear from us, always game for an outing, always listens with love and wisdom. We seek those friends with the wistful longing of preadolescent love, waiting for our own (Carrie Bradshaw? Insert your favorite girlfriend archetype here) to stumble into our lives and sprinkle the fairy dust of frientimacy on us.

When no perfect friend appears, we find ourselves stuck with the imperfect cast of characters already in our lives, our disappointing gaggle of friends. The ones who don’t invite us out enough, who talk about themselves too much, who forget to ask about important events, with whom we struggle to develop anything more than friendly acquaintanceship.

But these are the people, Nelson writes, we should look to for frientimacy. She says, “Many women remain lonely because they think having close friends is a product of discovering the right people. But the truth is that meaning friendship is actually the product of developing the right friendships.” And Nelson goes on to say, “We don’t need better friends, we need better friendships.”

Part One of Frientimacy focuses on the problem — the nagging feeling many women have that their friendships lack true intimacy. In Part Two, Nelson builds her advice for better friendships around a “Frientimacy Triangle,” with positivity as the base of the triangle; consistency as one leg; and vulnerability as the other.

Low positivity is just a bummer — the friendship that leaves us drained, angry, or unhappy in some way. Low consistency — not investing time in the friendship — leaves us with lives that are “just a collection of conversations and dinner parties,” Nelson writes. Consistency is the way to build trust into a friendship, and that basically means showing up, again and again. Nelson points out, “There is no way to develop friendships without time.” Vulnerability requires both admitting vulnerability to your friends, and allowing them, even inviting them into, a safe space to express their own vulnerability.

Drawing from her own life, interviews with other women, and research, Nelson explains and provides strategies for developing each side of the triangle, while providing a wake-up call to the ways we ourselves might be contributing to our own dissatisfaction with our friendships. For example, in the chapter on positivity, Nelson examines perceived imbalances of giving and receiving and finds there’s a good chance that if you consider yourself the giver in relationships, other people are thinking the same thing about themselves. You just both might see giving differently.

Part Three examines “Obstacles to Intimacy” — what blocks and errors we might make or encounter that negatively affect our friendships, such as fearing rejection, jealousy, walking away from friendships too soon, or holding ourselves back. Though she writes with compassion, Nelson pulls no punches, urging us to consider whether we are defensive, demanding, or ungenerous towards our friends’ humanity, labeling people “toxic” and walking away too easily.

Nelson admonishes, “Let’s freely acknowledge that we don’t always present to our friends the most enlightened, healthy, and happy versions of ourselves — nor do they. The trick is to judge less, observe more, and continue working on ourselves.”

In Frientimacy, Nelson provides not only a new prism through which to view our friendships and our place in them, but also exercises, concrete ideas, and “Friendspiration” for transforming unsatisfying friendships into something more fulfilling.

Frientimacy: How to Deepen Friendships for Lifelong Health and Happiness
Seal Press, March 2016
Paperback, 256 pages
$16

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Suzanne Kane <![CDATA[How Much of the Truth Should You Tell Your Kids?]]> http://psychcentral.com/lib/?p=46530 2016-09-20T22:18:34Z 2016-09-25T14:40:11Z ]]> how much of the truth should you tell your kids?Parents have a big responsibility raising children, but they often find themselves in a quandary over how much of the truth to tell their kids.

Dr. Anita Gadhia-Smith, a Washington, D.C. psychiatrist who counsels individuals, couples and families, offers her thoughts on the topic.

No one-size-fits all.

The issue is complex. As Dr. Gadhia-Smith sees it, there is no one-size-fits-all manual for raising kids. “First-time parents will go through a trial an error process, and each child within a family may be very different,” she says. “In general, children do have very different levels of comprehension, depending on individual personality development and age.”

As for whether there’s an age-appropriate version of the truth, Dr. Gadhia-Smith says that children under five cannot comprehend the complexity of life and relational issues that an older child can. “The older the child, the greater the need for fully honest disclosure and guidance that will help the child integrate and set their own value system.”

Don’t lie but don’t tell all either.

A big question is whether it’s ever OK for parents to lie to their kids. Here’s where it comes down to using good judgment.

“In general, it is not advisable to lie,” Dr. Gadhia-Smith says. “However, it is not always advisable to tell all either. Parents need to use their own inner guidance about what feels right to them. Some children are more mature than others, but you also don’t want to parentify a child and use them as your support system.”

When outside support systems may be best

What about one parent unloading all his or her emotional anguish on the kids, perhaps over a divorce, separation or break-up? This could very well be too much of an emotional burden for the children. Dr. Gadhia-Smith has some clear advice for parents to avoid such an inappropriate emotional dump on their kids.

Indeed, if a parent is going through a separation or divorce, Dr. Gadhia-Smith says it is best for everyone involved if each person has their own support system outside of the family.
“Psychotherapy can be very helpful for children who are struggling with divided loyalties and feeling caught in the middle between divorcing parents,” she says. “Parents need to be mindful not to use their children as their best friend or therapist. It may be tempting, as they are readily available, but the impact on the child could be detrimental.”

Telling the truth about divorce.

Speaking of divorce, what truth should parents tell their kids about the decision to do that? Is saying, “Daddy is going to be traveling for a while” not a good approach? What is better? Again, does it depend on the age of the child how much of the truth the parent(s) tell?

Here Dr. Gadhia-Smith recommends the direct approach. “It is best to be honest and straightforward about it. As difficult as this may be, the sooner the child learns of reality, the better.”

But that doesn’t mean blurting out the facts just to get it over with. A little finesse is required to do this right. “It is important to take the time necessary to help the child understand what divorce means, and that there will still be a family (if at all possible),” she says. “The child needs to understand that he or she is not being divorced; it is the parents who have made this decision in the best interest of everyone.

“It is also important to speak in a positive manner about the person you are divorcing. Remember at the child is half of each of you, and needs to love you both. Modeling compassion, empathy, courtesy, generosity, and decency during the process of divorce is invaluable to children’s’ development.”

The importance of modeling truth-telling

Parents also play a vital role in showing their children what telling the truth looks like. This another area parents struggle with and one where Dr. Gadhia-Smith offers some practical advice.

“Modeling truth-telling is critical, because children learn from what they see you do more than from what you tell them to do. Children need to develop skills in honest communication, confronting difficult life situations, and setting appropriate values.”

Confront the truth with love

Suppose a child repeatedly tells lies and the parents want to help the child change his or her behavior. This might be especially difficult if the parent(s) have been caught in lies and the kids know it.

“If a child repeatedly lies, and parents want to change their behavior, a good approach is to confront the truth with love, and then model truth-telling and talking about reality,” Dr. Gadhia-Smith says. “If a child is lying, they may be uncomfortable about some aspect of their reality, and it can be very helpful to look underneath the behavior and examine what is driving it.”

Dealing with truth in the news

The news is often brutal, graphic and distorted. This is another area where parents often need help about what they should say to their children about they see and hear in the media.
In general, parents shouldn’t shield their kids from the news, but they shouldn’t go too far in the other direction either, according to Dr. Gadhia-Smith, who says that overprotecting children is usually not in the best interest of the child.

“Life is difficult, confusing, and contains many contradictions,” she says. “And life is not always fair. The news should not be over idealized or demonized. It is helpful for children to understand the way the world is. To create a fantasy about the world is not helpful, but at the same, overexposure to anything is not balanced.”

yongtick/Bigstock

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Stan Rockwell, PsyD <![CDATA[Book Review: Listening, Learning, Caring & Counselling]]> http://psychcentral.com/lib/?p=45832 2016-09-23T18:02:16Z 2016-09-24T17:32:29Z Australian mental-health expert Dr. Cate Howell, the author of Listening, Learning, Caring & Counselling: The Essential Manual for Psychologists, Psychiatrists, Counsellors and Other Healthcare Professionals on Caring for Their Clients, […]]]>

Australian mental-health expert Dr. Cate Howell, the author of Listening, Learning, Caring & Counselling: The Essential Manual for Psychologists, Psychiatrists, Counsellors and Other Healthcare Professionals on Caring for Their Clients, has over thirty years’ experience in the healthcare field and began in occupational therapy. Her specialty is mental health and she is trained in clinical hypnosis, couple therapy, cognitive therapy, acceptance and commitment therapy, and interpersonal therapy. She wrote this book not as a skills training resource, but as a guide to her way of counseling which she calls, “listening, learning, caring and counseling.” She explains that the “heart of LLCC is caring or kindness,” and this work is designed “to be a guide, full of ideas, and to become an essential and faithful companion” to therapists. She accomplishes her goal in a straight forward, easy-to-follow, thoughtful, and well-researched way. I wish I had had a book like this when I first started, and it will be a book I can use not just as a therapist, but also with those to whom I provide clinical supervision.

I think the breadth of her experience helped immensely with devising the LLCC method. Not only has she worked in occupational therapy and counseling, but also in oncology and cardiac units. She has numerous degrees and has won many awards for her work. She is what I think of as a good example of a person with a well rounded liberal arts education that includes formal learning as well as life learning. Howell has a nice way of sharing that learning and while she says this is not a book about fundamental counseling skills, your skills can improve with taking the LLCC approach in your practice. Her focus is on working with adults and on using evidence-based practices.

The book is in three parts, with the first being the foundations of LLCC. This is especially beneficial for someone just starting a counseling career, but it is also helpful for established counselors looking to grow and improve. She covers the fundamentals of counseling, as well as what to include in a comprehensive intake evaluation. The intake is extensive and includes history (including a genogram), mental status, goals, management planning, crisis planning, relapse prevention, and more. The evaluation can take more than one session. As I read, I thought of how insurance companies are tracking not just length of stay or number of sessions these days, but how long each session is for a person and strongly suggesting how long sessions should be. Howell instead emphasizes the therapeutic relationship, the part of the practice that can have the greatest impact on outcome. The relationship is more important than the techniques. As tracking becomes more intense from third-party payers who want to manage costs, however, I wonder what the impact will be on the therapeutic relationship. I think perhaps insurers could benefit from knowing about the LLCC method. Howell also outlines the integrative approach of LLCC, which she draws from her training using many types of therapies, including solution-focused therapy, mindfulness-based therapy, acceptance and commitment, hypnosis, cognitive-behavioral, and more.

Part two is how to use the LLCC integrative method in a variety of problem areas , such as sleep issues, stress and anxiety, depression, anger, guilt and shame, and more. A chapter is devoted to each area and includes at least one case study, ways of using the various therapies, books and websites to recommend to clients on the problem area, as well as phone apps. Many of the sites are based in Australia, so when you check them out, you do need to be sure to type the “.au” at the end of the URL.

The third part is about crisis intervention and self care. There is information on suicide and assessing for suicidal risk. The last chapter is all about taking care of yourself by treating yourself with compassion, and she ends the work with a Buddhist loving-kindness poem.

For areas outside Australia, you will need to supplement parts of the confidentiality components of the intake with whatever the mandated duties to warn and report are in your area. You may come across some differences in language, like SAD standing for social anxiety disorder rather than seasonal affective disorder.

Howell includes an appendix with many tools for assessment, management, and for clients to track moods and more in their work to change. There are “LLCC Tips” throughout the book to give you specific ways to focus on the topic, for example, tips on perfectionism.

This book feels like knowledgeable, caring, wise guidance from a teacher and mentor. I hope Dr. Howell’s work gets widespread exposure outside Australia. What she has to say is important for all of us in the healthcare professions.

Listening, Learning, Caring, & Counselling: The Essential Manual for Psychologists, Psychiatrists, Counsellors & Other Healthcare Professionals on Caring for Their Clients
Exisle Publishing, July 2016
Hardcover, 336 pages
$24.99

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Payam Ghassemlou, MFT, Ph.D. http://www.drpayam.com/ <![CDATA[LGBT Suicide and the Trauma of Growing Up Gay]]> http://psychcentral.com/lib/?p=46739 2016-09-20T22:19:58Z 2016-09-24T14:15:00Z ]]> LGBT suicide and the trauma of growing up gay As a mental health counselor for the past twenty years, I have listened to many painful stories from some of my lesbian and gay patients regarding their upbringing in a homophobic and heterosexist world. Many of my gay and lesbian patients, including a number of bisexual and transgender individuals, have shared with me that as young as age five, they felt different. They were unable to articulate why they felt different, and, at the same time, they were too afraid to talk about it.

Many reported that they knew this feeling of being different was related to something forbidden. “It felt like keeping a tormenting secret that I could not even understand,” described one of my gay patients. Others shared with me that this feeling of difference revealed itself in the form of gender nonconformity, which could not be kept secret. Therefore, it made them more vulnerable to homophobic and transphobic mistreatment at school and often at home. They had to cope with a daily assault of shame and humiliation without any support.

The experience of carrying a sense of differentness, because it related to some of the most taboo and despised images in our culture, can leave traumatic scars on one’s psyche. Most school-age children organize their school experience around the notion of not coming across as queer. Any school-age child’s worst nightmare is being called “faggot” or “dyke,” which is commonly experienced by many children who do not flow with the mainstream.

One gay high school student disclosed to me that, on average, he hears more than twenty homophobic remarks a day. Schools can feel like a scary place for LGBT children, or any child who gets scapegoated as queer. For the most part, LGBT kids do not get any protection from school officials. This is a form of child abuse on a collective level. Mistreatment of LGBT youth and a lack of protection are contributing factors to the issue of LGBT teen suicide.

The feeling of differentness as it relates to being gay or lesbian is too complex for any child to process and make sense of, especially when coupled with external attacks in the form of homophobic, derogatory name calling. Unlike a black child whose parents are typically also black, or a Jewish child with Jewish parents and relatives, the LGBT youth typically does not have gay or lesbian parents or anyone who could mirror his or her experience. In fact, many families tend to blame the mistreated LGBT youngster for not being like everyone else, making the child feel like he or she deserves this mistreatment.

When parents are either unable or unwilling to “feel and see” the world through the eyes of their child and do not provide a reflection that makes the child feel valued, that child cannot develop a strong sense of self. They’re faced with isolation, confusion, humiliation, physical violence, not being valued in the eyes of their parents, and carrying a secret that the youngster connects with something terrible and unthinkable is too stressful for any child to endure — especially when there is no empathic other to help him or her to sort it out. The youngster suffers in silence and might use dissociation to cope. In a worst-case scenario, he or she could commit suicide.

Many LGBT youth who found the courage to open up about their identity issues have experienced rejection from their families and peers. Some families treat such disclosures as bringing shame on the family. They may throw their kid out of the house, which forces the youngster to join the growing population of homeless kids on the street.

The stress of trying to come to terms with a complex matter such as same sex attraction, one’s family’s rejection as a result of finding out about same sex attraction, and becoming victimized through verbal and physical abuse by peers due to being different are contributing factors to the trauma of growing up gay or lesbian. Such traumatic experiences can explain why lesbian, gay, bisexual, transgender, and questioning youth are up to four times more likely to attempt suicide than their heterosexual peers. Suicide attempts by LGBT youth are their desperate attempts to escape the traumatic process of growing up queer.

Those of us who survived the trauma of growing up queer without adequate support and managed to reach adulthood can benefit by becoming conscious of our internalized homophobia. When a gay or lesbian youngster experiences humiliation every school day for being different and has no one to protect them, that child can develop internalized homophobia. Internalized homophobia is internalization of shame and hatred that gay and lesbian people were forced to experience. The seed of internalized homophobia is planted at an early age. Having one’s psyche contaminated by the shadow of internalized homophobia can result in low self-esteem and other problems later in life. Bisexual and transgender youngsters can also internalize the hatred they had to endure growing up, and may develop self-hatred.

To not deal with internalized homophobia is to ignore the wreckage of the past. Psychological injuries that were inflicted on LGBT people as result of growing up in a homophobic and heterosexist world need to be addressed. Each time a LGBT youngster was insulted or attacked for being different, such attacks left scars on his or her soul. Such violent mistreatment caused many to develop feelings of inferiority.

Life after the closet needs to include coming out of toxic shame, which means becoming aware of repressed or disassociated memories and feelings around homophobic mistreatment that was experienced growing up. All the rejection and derogatory name-calling one suffered growing up queer can be stored in the psyche in the form of implicit memory: a type of memory that impacts one’s life without one noticing it or consciously knowing its origin.

Coming out of toxic shame involves recalling and sharing what it felt like growing up in a world that did not respect one’s identity, fully feeling the injustice of it. Providing empathy and unconditional positive regard for the fact that one has endured many years of confusion, shame, fear, and homophobic mistreatment can give birth to new feelings of pride and honor about one’s LGBT identity. This is an alchemical process that involves transforming painful emotions through love and empathy.

As a community, learning to know ourselves can add vitality to our struggle for freedom. The LGBT liberation movement should not only include fighting for equal rights, but also working through the injuries that were inflicted on us while growing up queer in a heterosexist world. External changes such as marriage equality or the repeal of the “Don’t Ask Don’t Tel”l policy alone cannot heal us from homophobic mistreatment and rejection we received growing up gay or lesbian. We need to open a new psychological frontier and take our struggle for freedom to a new level.

The gay civil rights movement is like a bird that needs two wings to fly, not just one. So far, the political wing has been the main carrier of this movement. By adding psychological healing work as the other wing, the bird of gay liberty can reach even greater heights.

AnnaV/Bigstock

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K.M. McCann, PhD <![CDATA[Book Review: Present Over Perfect]]> http://psychcentral.com/lib/?p=45828 2016-09-23T18:02:29Z 2016-09-24T03:48:02Z You do not have to quit your job and move to a cabin in the mountains in order to live a simpler, happier life. All you need to do is […]]]>

You do not have to quit your job and move to a cabin in the mountains in order to live a simpler, happier life. All you need to do is train yourself to find the beauty in the ordinary, present moment. Sounds easy, doesn’t it? Well, yes and no. In Shauna Niequist’s new book, Present Over Perfect: Leaving Behind Frantic for a Simpler, More Soulful Way of Living, she reflects on her rude awakening from the mythical American dream. Where was the happily ever after that so many children’s books had promised? Why can’t a job, a family, and a house be enough to equal complete and utter bliss? Perhaps most upsetting is the often unanswered question, “Why, despite what we are conditioned to believe, can’t we truly have it all?”

First, says Niequist, we need to come to terms with the fact that saying ‘No’ is okay. We must set realistic expectations for ourselves, and for those around us. Having ‘Yes’ as a default setting leaves everyone exhausted, both physically and emotionally.

“We disappoint people because we’re limited. We have to accept the idea of our own limitations in order to accept the idea that we’ll disappoint people. I have this much time. I have this much energy. I have this much emotional capacity,” writes Niequist. (Italics Niequist’s.)

Furthermore, take vacations, advises Niequist. This does not mean a month-long jaunt to do a Grand Tour of Europe; instead, it means short weekend trips, or even weeklong getaways that put you close to nature. There is a unique magic in being elsewhere; “it’s away, and away allows us to see the rhythms and dimensions of our lives more clearly.” Whatever you decide, research shows that spending money on experiences, not stuff, increases happiness.

Throughout the book, Niequist charts her journey of rebuilding a more realistic, more manageable version of contentedness, customized to fit her own life. As the title implies, no one is perfect; instead, we are all perfectly imperfect. “Perfect calls to mind stiffness, silicone, an aggressive and unimaginative relentlessness. Perfect and the hunt for it will ruin our lives—that’s for certain.”

Niequist shares moving and deeply personal reflections on motherhood, marriage, and her faith, all of which offer support, purpose, and, sometimes, anxiety and stress. And that’s okay, she says, because balance is beautiful and without the downs it would be difficult for us to truly appreciate the ups in life.

Perhaps one of the most important themes in Niequist’s book is to simply Let Go. Let go of the need to control every detail, let go of the illusory ideal of the American Dream, let go of the need to please everyone else, and, of course, let go of rumination, pain, and anger. Ruminating on past failures, near misses, and regrets adds fuel to the fires of depression. In order to more fully appreciate the present, we need to clear away the past. “Of all the things I’m learning to leave behind,” says Niequist, “one of the heaviest is the opinion of others…it devolved into care-taking and people-pleasing at the expense of my own self.”

There is a theme of silence throughout Present Over Perfect, but in this context silence does not mean failure to speak. Silence is something that is carried within; a state of living in the world that contemplative therapists might call mindful awareness or direct perception. In other words, this is a way of seeing the beauty in each moment, no matter how mundane, and accepting that those small, ordinary moments are the ones that compose the bulk of our lives. Although Niequist approaches the topic of being present from a Christian worldview, her message spans spiritual and religious boundaries and speaks to something uniquely human in all of us — the desire to feel at peace in our lives.

At the moment, there is no shortage of books on mindfulness, being present, and simple living. Niequist offers readers a beautifully written, near confessional look at one woman’s journey from noise to silence. Her personal experiences as an affluent mother and wife may not appeal to everyone, but there are certain messages about contentedness and the need to speak our truth in her book that will resonate with any audience.

Present Over Perfect: Leaving Behind Frantic for a Simpler, More Soulful Way of Living
Zondervan, August 2016
Hardcover, 240 pages
$22.99

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Megan Riddle <![CDATA[Book Review: You Only Live Once]]> http://psychcentral.com/lib/?p=45818 2016-09-23T17:47:07Z 2016-09-23T17:47:07Z “Too many people spend money they earned… to buy things they don’t want… to impress people that they don’t like.” –Will Rogers “Money often costs too much.” –Ralph Waldo Emerson […]]]>

“Too many people spend money they earned… to buy things they don’t want… to impress people that they don’t like.” –Will Rogers

“Money often costs too much.” –Ralph Waldo Emerson

I want to talk about money. Wait! Don’t go away. I know, you’re thinking, this is Psych Central, not WSJ, and I agree with you. But money is so intimately tied in with so much of our lives; our goals, dreams, aspirations and self-worth can be all tied up in the value of a dollar. And yet it often remains a taboo topic of sorts. Our money, what we make and how we spend it, is no one’s business but our own, and yet sometimes we don’t even make it our own business. We make an income, spend it on things we want at the time, but don’t have any bigger picture in mind. If we make ends meet, that’s counted as a success and we don’t put much more thought into it. Or we know we should think about it more, and we worry about that, but we leave the whole thing at the worry stage, hoping that it will just “work out” and our retirement will be there when we need it. In his new book You Only Live Once: The Roadmap to Financial Wellness and a Purposeful Life, Jason Vitug offers a guide to understanding your own personal money mindset and helps you take action towards an improved financial future.

Jason Vitug is a millennial who has dealt with his own complex relationship with money, one to which many can relate. In college, he got his first credit card and was soon mired in debt. After college he scrambles to dig out of the debt, becoming “professionally successful but personally unsatisfied.” He notes, “Money was the obstacle to my dreams. I came from a place of fear and scarcity. I chased money as the solution to my problems and believed my ability to spend corresponded with control.” Focused on his finances, he says, “I had achieved financial success and set financial goals, but without a sense of purpose…” Realizing his life was not headed where he wanted, he resigned from his stable executive job to backpack around the world. On returning, he founded his own personal financial website Phroogal, and created a grassroots campaign to break the social taboo about money that involved a road-trip around the country to speak with people in campuses and communities about their relationship with money. He distills the knowledge gained from that journey into his book.

You Only Live Once (OK, you knew someone would use that as a title eventually), is focused on his self-defined ACT process, which stands for Awareness, Creating a plan, and Taking control. The section on Awareness works on making you more cognizant of your relationship with money. Many of us simply earn money and then spend it, with little real thought to the overarching process. “Everyone has a money mindset,” Vitug writes. “You may not be aware that your current financial situation is a result of this mindset. A money mindset — how you think and feel about money — creates a set of beliefs that determines your behaviors, attitude, and outlook with respect to life and money.” Throughout this section he asks a series of questions to try to get you to explore your own money mindset, including why you spend what you do. “What emotional need are you looking to fill?” he asks. He points out that “[n]o amount of spending and borrowing or saving and investing will get you what you want if you’re not clear about what you really value and what you’re working toward.”

In the section on creating a plan, Vitug helps you create a budget “that aligns with your values and priorities the goals that support the vision for your life” (sounds kind of like CBT principles lurking in there). He examines what gets in the way of people creating — and then following — budgets. He focuses on “purposeful” spending rather than simply looking for good deals or making sure your income is greater than your expenses. In the final portion of the book, Taking Control, Vitug focuses on turning these plans into action and moving towards financial goals, as well as ensuring all of this moves you closer to larger life goals.

Overall, this is an easy read, particularly for a book about finances. Some of the ideas and concepts do seem a bit simplistic and idealistic, but there is plenty of straightforward, reasonable advice to make it a worthwhile book.

You Only Live Once: The Roadmap to Financial Wellness and a Purposeful Life
John Wiley & Sons, Inc, June 2016
Hardcover, 169 pages
$27.95

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Edie Weinstein, MSW, LSW <![CDATA[Is Anger an Addiction?]]> http://psychcentral.com/lib/?p=46359 2016-09-17T19:05:21Z 2016-09-23T14:45:40Z ]]> is anger an addiction? The American Society of Addiction Medicine, defines an addiction as, “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

“Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”

Addictions fall into two categories: substance and process; the former through the abuse of alcohol and drugs, the latter, behaviors such as gambling, hoarding, spending, eating disorders, workaholism, co-dependence and surprisingly, inappropriate use of the normal human emotion of anger.

When used constructively, anger can fuel positive and pro-social action, such as women securing the right to vote. “Imagine what the women’s suffrage movement would have been like if women had said, ‘Guys, it’s really so unfair, we’re nice people and we’re human beings too. Won’t you listen to us and give us the vote?” says social psychologist Carol Tavris, PhD, author of Anger: The Misunderstood Emotion

The organization, known as MADD (Mothers Against Drunk Driving) was born out of anger and grief over the needless death of 13-year-old Carli Lightner in 1980. It was founded by her mother, Candy Lightner, who discovered that the man who killed her daughter got behind the wheel while intoxicated had a previous arrest record for driving under the influence.

Most people experience anger when they feel that circumstances are beyond their control or they believe they have been wronged in some way. When considering the positive uses for anger, call to mind Mahatma Gandhi, Martin Luther King, Jr. and Jesus of Nazareth who were able to channel their anger toward injustice.

When Anger Becomes (D)angerous

My experience with anger in childhood was minimal. Rare were voices raised in ire. My parents generally resolved conflict quietly. My sister and I would be verbal combatants at most and when my father felt we needed some physical release, he — having been a Golden Gloves boxer in the Navy and taught boys in our community to engage in the pugilistic art — would lace up gloves that dwarfed our hands and provide us with mouth guards and head gear and have us go at it. We took playful swings at each other and ended up laughing, which was his intention as a way of defusing our anger. Not sure either of us ever landed a punch or experienced a sisterly TKO.

Later in my life, I avoided conflict nearly at all costs. I had the “don’t rock the boat” and “if it ain’t broke, don’t fix it” mentality. Often I would allow comments to slide off as if on the no-stick surface of a Teflon pan. I somehow internalized the belief that anger was hazardous, so I didn’t want to invoke it in anyone.

In my early years as a budding therapist, I sometimes found myself intimidated by angry clients. I knew I was in no physical danger, simply unprepared to ride the waves with them.

It was when I was employed as a social worker on an inpatient psychiatric unit that I witnessed first-hand, anger run amok. Fighting between themselves, sometimes assaultive behavior with staff. Blessedly, the closest I came to that state was when an angry patient threw an orange at my door that I was able to close in time before it splattered on me. Before another patient took a swing at me, I was able to close my hand around her fist and stop it, telling her, “You really don’t want to hurt me.”

Violent words were cast at me when in my office, an irate client was cursing a blue streak. In frustration myself, since at that point, I was only willing to maintain a professional veneer while setting firm boundaries, I replied, “I don’t get paid well enough to get cursed out by you. Knock it off.”

His return volley? “Well, then get a different job.”

I took a deep breath and answered, “I’m the one who helps you get discharged from the hospital. Be nice to me. I’ve been speaking to you respectfully and expect the same from you.”

He grumbled a bit and then left my office. He returned the next day and apologized for his outburst. From then on, there was mutually respectful dialogue between us.

A Place That Anger Called Home

My marital home was a place where anger dwelled as well; an unwelcome presence not easily evicted. My husband was raised by a father who was an alcoholic/rageaholic and a mother who tolerated it and as is often the case, it becomes a multi-generational disease.

This co-dependent erroneously believed she could quell the “anger dragon” that lurked beneath the surface of an otherwise loving, affectionate, intelligent and charismatic man. Not always able to do so and not accepting that it was never my role in the first place, I permitted behaviors that I would never have allowed for had I been the boundary setting, assertive woman that I am now.

In retrospect; 18 years after my husband’s death from Hepatitis C, I recognize that some of the roots grew in a soil that was fertilized with frustration that he had no skills to tend. Even as a therapist, I remained helpless, since I was not able to disentangle my two roles; devoted wife and outspoken advocate for others facing abuse. Had I been able to view his dysfunctional expression of anger as an addiction, I would have addressed it differently.

How Does Anger Become Addictive?

  • In the same way that substances trigger brain chemical rushes, so too does the expression and expulsion of anger. The amygdala is a structure in the brain with the important task of noticing the presence of a physical or emotional threat and then sounding the alarm. The brain is then hijacked, with the possibility of crashing into a mountainside. Emotional air traffic control is needed to land the plane safely.  
  • The neurotransmitter chemicals known as catecholamines are released causing a blast of kinetic energy that can last a few minutes. In a counterintuitive way, feeling bad sometimes feels good. Like any addiction, anger can induce discharge of dopamine epinephrine and norepinephrine — also referred to as adrenaline and noradrenaline.
  • The adrenalin rush contributes to a sense of strength and invulnerability.
  • Our brains register pleasure when these chemicals are doing what comes naturally to them, and then get reinforced each time we engage in similar behaviors.
  • For some, feeling anger creates a sense of aliveness that may enhance an otherwise constricted or neutral emotional state.
  • As is so in any addictive condition, there are consequences such as loss of job, family, friends, health and money.  
  • Anger addiction carries with it the same guilt and shame game that is present in substance or other process addictions.
  • People with PTSD are prone to addictive anger, since often they are not aware of the degree and depth of reaction until they are totally in it. Triggers such as family events at which there is sincere drama can occur.

Anger Management Rules

Ways of addressing anger include:

  • Take a cleansing few breaths. When we become excessively angry, the tendency is to hold our breath which makes it more challenging to think clearly.
  • Take a time out. Much like a petulant two year requires some down time to decompress, so too does an angry adult. Returning after pushing the reset button, can provide a fresh perspective.
  • Write down items and issues that trigger an angry reaction. Generally, the reasons are surface level and are not always directly correlated to the stimulus.
  • Have a conversation with a symbolic representation of your anger. It could be an animal, like a lion, tiger or bear (oh my) and ask what it wants you to know, so it doesn’t attack.
  • Attend Rageaholics Anonymous meetings with others who are also feeling like they are at the mercy of their addiction.

Dean Drobot/Bigstock

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Claire Nana <![CDATA[Book Review: The ABCs of How We Learn]]> http://psychcentral.com/lib/?p=45815 2016-09-15T19:14:07Z 2016-09-22T14:28:51Z Humans have a basic need to learn. From navigating a busy freeway, to watching an exceptional tennis match, learning is happening all around us. And yet, the questions of just […]]]>

Humans have a basic need to learn. From navigating a busy freeway, to watching an exceptional tennis match, learning is happening all around us. And yet, the questions of just how we learn, which types of learning are best for each person, and how each specific type can be used to solve everyday problems, such as disengaged learners, is seldom addressed. With this in mind, Daniel L. Schwartz, Jessica M. Tsang, & Kristen P. Blair pen their new book, The ABC’s of Learning: 26 Scientifically Proven Approaches, How They Work, and When to Use Them.

Schwartz, Tsang, and Blair, all Stanford faculty and learning experts, combine their vast knowledge to offer a novel approach to understanding the science behind how we learn. Separated into 26 chapters, with each dedicated to a unique type of learning, the authors present what each type is, the research behind it, why it works, and then give specific examples of how and when it may be used.

Learning occurs in multifaceted ways through various perceptual faculties, and achieving learning outcomes often depends on finding the right learning strategy. Creating an analogy is one example, where a novel idea is explained by drawing on a familiar one. And when we use analogies — especially ones that help transfer information accurately — we are as much as 46% more likely to learn.

Another interesting, and frequently overlooked, type of learning is social learning. Particularly when people feel as if they belong, or are taught by someone who is part of their social group, not only are they able to reframe their attributions more positively, but they also see setbacks as part of the learning process and not signs of social exclusion. The authors cite one study where African Americans who were given a “belonging booster” cut the achievement gap between themselves and their European American counterparts by 79%. The authors eplain, “People try harder when they belong, and they are not distracted by a sense of alienation.”

Learning also occurs through deliberate practice. But here the authors make the point that deliberate practice is not appropriate for all learning settings. Because it demands a narrow focus to automate skills and concepts, making them faster, more efficient, and less effortful, it is best used in environments where distractions can be controlled. For example, instead of trying to shoot 300 free throws and simply sink the ball, we should be focusing on knee bend, balance, and perfect form.

Not all learning is physical, either. Often, learning depends on memorizing and retrieving large amounts of information. For this, elaboration is a helpful strategy that improves the way in which we memorize declarative information — that is, things we can talk about. If we want to remember our Bank of America password, for example, we might use the keyword America to trigger our memory of things which we associate with America, one of which might be the Bald Eagle. In thinking of the Bald Eagle, we will remember our password, which is Bald&Bold.

Similar to elaboration is imaginative play, which can be used to improve executive function and cognitive control, especially in children. The authors write, “Imaginative play involves two key moves. The first is that it requires preventing the stimulus from driving one’s responses to the environment (a fork is not a fork). The second move is to construct an alternative, cognitively controlled interpretation (a fork is a mother). Exercising these core human abilities should spur [childrens’] maturation.”

Because learning is also an active process, strategies such as making something, participating in an activity, teaching another person, and self-explanation can also help drive feelings of productive agency, ownership, and self-efficacy. In the case of teaching, the authors note the protégé effect, where students make greater efforts to learn on behalf of others than they do for themselves.

Learning strategies can also be used to improve student engagement. Through positively arousing emotions, the brain’s reward system and the amygdala become activated, which improves the process of forming new memory traces. This is also why babies learn language better from a real person than from a video of a person.

Arousal, the authors tell us, is also highly linked to the same reward processes that are active when we enter a state of optimal performance (or flow). And because optimal performance is such a powerful intrinsic motivator, it often leads us to seek out and engage in increasingly difficult tasks, which further stimulates learning. Indeed, the more we overcome challenges, the more we develop a sense of mastery, improve our feelings of self-efficacy, and create a growth mindset that enables us to take on the very struggles and challenges that facilitate learning.

Packed with tips, tools, and exercises for every type of learner and learning situation, The ABC’s of Learning is a book whose utility goes far beyond the classroom, but into every area of life — from remembering your password to learning to play golf — and it should be required reading for us all.

The ABCs of How We Learn: 26 Scientifically Proven Approaches, How They Work, and When to Use Them
W.W. Norton & Company, August 2016
Paperback, 341 pages
$24.95

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Tamara Hill, MS, LPC <![CDATA[Book Review: Done With the Crying]]> http://psychcentral.com/lib/?p=45801 2016-09-15T19:11:23Z 2016-09-21T14:34:48Z What do you do when your child suddenly disappears from your life? How do you explain it? Who do you blame? For many mothers of adult children who no longer […]]]>

What do you do when your child suddenly disappears from your life? How do you explain it? Who do you blame? For many mothers of adult children who no longer contact them or involve them in their worlds, self-blame, doubt, fear, and uncertainty reign supreme. That’s why Sheri McGregor, a certified life coach, wrote the book Done With the Crying: Help and Healing for Mothers of Estranged Adult Children, which highlights the emotional, psychological, and even physiological turmoil that results from a broken relationship with one’s adult child.

An adult child walking away from his or her parent(s) is not a topic we hear of everyday. Sadly, it isn’t even a topic that mental health professionals or relationship experts discuss at great length. You can Google the term “estranged adult child” and find just a few articles and blogs on this topic. There are very few contemporary research studies or stories to explain adult child estrangement. As a result, parents and families must find solace through blogs or through support groups.

McGregor begins her book by discussing the topic of estrangement from adult children in a general fashion prior to sharing her own experience as a mother of an estranged adult child. She shares many of her own thoughts, emotions, and struggles as she highlights the experience of other mothers like her. She does a great job highlighting the challenge of moving forward and embracing other family members who may also be feeling captive by guilt, self-blame, shame, anxiety, depression, and uncertainty. She normalizes the experience of these emotions for mothers who may be too hard on themselves or eager to find a reason for the estrangement.

Chapter 2 focuses on the questions disowned parents have about their estranged children. The following chapters focus on obtaining support, adjusting to the change/shock, and moving forward. One thing McGregor makes very clear in her book is the need for a hurt and abandoned parent to move forward in life despite the emotional pain that comes with the realization of loss. She attempts to normalize the occurrence of depression, anxiety, and suicidal thoughts while encouraging the reader to reach out for support. She concludes her book by discussing reconciliation (if that were to occur) and finding the motivation to go on.

As a mental health professional and writer, I had many questions while reading this book, including:

  1. Did the “estranged adult child(ren)” have mental health, substance abuse, or behavioral problems that contributed to the estrangement?
  2. Did the “estranged adult child(ren)” have unresolved grief, trauma, or anger/resentment that led to their estrangement from their parents?
  3. Did the “estranged adult child(ren)” feel misunderstood by their families and saw estrangement as a remedy?
  4. Did the “estranged adult child(ren)” have a personality disorder that prevents them from being able to empathize or understand the totality of their actions on their families?

These questions, and perhaps many more the reader may have, are unanswered in this book. The reader will need to be willing to accept what the writer has produced. There may also be questions around how the estranged child(ren) views the entirety of the situation. In this book we only have access to the parent’s perspective and not the child(ren). As a result, it is possible that there is more to the story than what we are given access to. Even more, during the introduction McGregor highlights changes she has made to preserve the confidentiality and rights of those spoken about in the book. She writes:

“To protect others’ privacy, I have used a pseudonym for my son, and I have changed or omitted all other identifying details such as appearance, background, profession, and place of residence. I have done the same for the parents and adult children who agreed to share their stories in this book. To further protect identities, many additional details have been changed, the stories have been altered, and some of the people described in this book are composites based on several different families.”

While this is certainly an important step to take to ensure privacy, some readers may question the legitimacy of the book as a whole since events discussed in the book might not have actually happened.

Sadly, chapter 7, which focuses on reconciliation, may also give some parents false hope of reconciliation. As a therapist who has worked with multiple broken and dysfunctional families, a full reconciliation is unlikely to occur. As McGregor expresses after speaking with her son after 1 year of no contact, “…part of me doubted the connection was even real…I was scared to trust him.” Many parents (and even the estranged child) struggle with re-building trust, establishing appropriate boundaries, and getting to know each other again. For some families, the journey to reconcile is so difficult that separation feels more plausible for everyone involved. Essentially, the hope of reconciliation is often destroyed by the reality of an unstable parent-child relationship.

The final chapter, Life Goes On, is helpful for parents and families who are concerned about supportive resources within the community around end-of-life decisions.

McGregor does a nice job in summarizing the emotional and psychological challenges mothers go through when they become a victim of estrangement. For parents suffering at the hands of an adult child who no longer wants to include them in their lives, Done With the Crying may be the only resource they can find that will tell them what to do next.

Done With the Crying: Help and Healing for Mothers of Estranged Adult Children
Sowing Creek Press, May 2016
Paperback, 352 pages
$21.95

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Dave Schultz <![CDATA[Book Review: A Spectrum Approach to Mood Disorders]]> http://psychcentral.com/lib/?p=45812 2016-09-15T19:05:27Z 2016-09-20T14:37:11Z James Phelps’ new book, A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar—Practical Management, is written for professionals, not laymen. I have some familiarity with bipolar disorder […]]]>

James Phelps’ new book, A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar—Practical Management, is written for professionals, not laymen. I have some familiarity with bipolar disorder and its causes, symptoms, and treatments. However, I am not a professional and this book often goes beyond my ability to comprehend. Dr. Phelps has been treating patients and studying and writing about mood disorders for over 25 years, but he makes assumptions that the reader has a higher level of experience or training, and it makes this book difficult for amateurs to fully appreciate.

The basic premise of Dr. Phelps’ book is that there is a broad spectrum of mood disorders, not a simple black and white diagnosis. A black and white diagnosis asks the question, “Is s/he bipolar?” and labels the patient accordingly. By contrast, evaluating a patient along a spectrum of severity acknowledges that there are several inbetween conclusions that can be made. The author suggests that 40% of disorders could be considered mid-spectrum. But even three categories is not enough. Picture instead the color spectrum to get an idea of how patients can be evaluated, with very slight differentiation between levels of diagnosis. The importance of this distinction is that treatment approaches can be more precisely applied by professionals who understand and value these distinctions.

The author addresses many topics using the spectrum approach. He describes the distinctions a patient experiences when diagnosed with depression, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), bipolar disorder, or something else. As you would expect, there are situations when it may not be clear where to place a patient on the spectrum. In fact, patients can also move along the spectrum as their symptoms change.

Phelps also presents a wide range of treatment options, including light therapy, dawn simulators, psychotherapy, amber lenses, sleep, exercise, and social rhythms, and provides suggestions for achieving greater effectiveness. As expected, several of these might be used at once.

There is extensive discussion of prescription medicines. An entire chapter is devoted to lithium and its use for various patients. For mid-spectrum patients, low-dose lithium may have a positive effect, although he cautions against administering higher levels of lithium. He almost suggests that there should be different names for full- and low-dose lithium.

Phelps discusses anti-psychotics, differentiating between their best uses depending on the disorder. Mid-spectrum patients do not need anti-psychotics because they are not manic. He also describes anti-depressant use with different types of patients.

There are three helpful appendices discussing moral reasoning and bipolar disorder, and how different values may affect diagnoses; over diagnosis of bipolar disorder; and bipolar treatments that avoid medication. This is followed by a lengthy citation of references.

In reading A Spectrum Approach to Mood Disorders, I realized how unprepared I was to fully understand the information that Phelps presented. However, there are many in the field of psychotherapy and psychiatry, or other health fields, who might find his book a tremendous resource to help differentiate between cases of mood disorder or bipolar disorder. Dr. Phelps is a respected and highly-experienced physician. He presents a thorough and convincing explanation of the nuances of accepting that a broad spectrum of mood disorders does exist. Professionals who acknowledge this will be able to use Dr. Phelps’ book to provide patients with the focused, in-depth treatment they require.

A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar—Practical Management
W.W. Norton & Company, June 2016
Hardcover, 272 pages
$32.00

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Claire Nana <![CDATA[Book Review: Raising Human Beings]]> http://psychcentral.com/lib/?p=45809 2016-09-15T19:02:59Z 2016-09-19T14:34:57Z Are we raising our kids in the ways that foster the better side of human nature? While this is a question that many parents have probably asked themselves, it is […]]]>

Are we raising our kids in the ways that foster the better side of human nature? While this is a question that many parents have probably asked themselves, it is also the very question that inspired Ross W. Greene’s new book, Raising Human Beings: Creating a Collaborative Partnership With Your Child. Not only does Greene ask us to think more deeply about how we are raising our children, but in many ways, he tells us that we need to reevaluate how we are living our own lives. More than once, I found myself wondering if I was cultivating the values I wish to live up to.

Greene, the bestselling author of Lost At School, draws on his clinical knowledge and timeless wisdom to show that when parents move past tired power struggles, authoritarian approaches, and unrealistic expectations, they actually have more influence with their child, and they also realize the most crucial task of parenting: to help their child figure out who he is, become comfortable with it, and then pursue a life that is congruent with it.

Children, Greene tells us, have always been a “historically subjugated group” which, for many parents, leads to role confusion. Where most parents find themselves is vacillating between overly permissive and overly authoritarian. Where they belong — and where they will have the most influence — Greene asserts, is in a collaborative partnership with their child. Greene writes, “It turns out that what you’re mostly looking for, as a parent, is influence. Not control. And there is more than one way to get that influence. One path involves power and control, but there’s another path, one that enhances communication, improves relationships, and better prepares kids for a lot of what actually lies ahead in The Real World.”

Part of the process of raising children involves the expectations that parents and the world place upon them, and quite often, there is z discrepancy between these expectations and the child’s actual capability. This incompatibility often leads to behaviors that are reflective of larger problems. The role of the parent then becomes that of a helper who sees past surface behaviors to the deeper underlying causes. “Behavior is what is going on downstream,” Greene writes. “You want to focus upstream, on resolving the incompatibilities that are causing the behavior.”

And yet, although struggle is what precedes growth, when parents engage in power struggles with their children, essentially trying to force their expectations upon them, the whole scenario, Greene tells us, becomes “rather pointless.” A better way is through overcoming automatic assumptions about children and embracing the idea that kids will do well if they can, and often prefer to.

How parents arrive at collaborative partnerships with their children involves three critical steps: expressing empathy, defining their adult concerns, and inviting children to engage in finding solutions. Some strategies Greene offers are using reflective listening, asking who, when, and where questions, asking about the situational nature of the unsolved problem, asking a child what he is thinking in the midst of the unsolved problem, breaking the unsolved problem down into smaller parts, making a discrepant observation, asking for more concerns, and summarizing.

Along with this, Greene offers numerous narratives that help parents understand just what to say for each of their child’s responses, such as, saying nothing, “I don’t know,” “I don’t have a problem with that,” or “I don’t want to talk about it right now.” Through first listening and allowing their children to feel heard, expressing investment in their child’s concerns, and laying the groundwork for future discussions, parents can begin the process of working with their children toward mutually beneficial outcomes.

What often inhibits collaboration between parents and children is what Greene calls “parental angst.” When parents don’t address their own anxiety, they often revert to familiar — and ineffective — patterns, such as preempting empathy with assumptions about their children, reacting instead of responding, and using too much control. Greene writes, “In the same way that your child’s behavior communicates that there is a problem that needs to be solved, your anxiety and frustration signal the exact same thing.”

Yet through learning to see their children differently — as human beings who want to do well — parents can embrace the skills of detachment and perspective, and also avoid counterproductive communication patterns. More importantly, when parents aren’t preoccupied with daily struggles over laundry, chores, homework, and rules, they can begin to see the bigger picture — asking themselves just which are the most important positive human qualities they want to model and inspire their children to acquire.

The point Greene makes is that raising human beings depends on asking ourselves, are the ways are we disciplining, teaching, and interacting with our kids fostering desirable human qualities? If we truly want to raise children who have the estimable characteristics of empathy, perspective taking, compassion, honesty, and conflict resolution skills, then we must start with a different model — one that hinges upon collaboration.

Raising Human Beings: Creating a Collaborative Partnership With Your Child
Scribner, August 2016
Hardcover, 304 Pages
$26.00

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