Everyone has experienced a “gut feeling” at one time or another, but not everyone voices his or her feelings. Implicit attitudes, or gut feelings, tend to guide our behaviors. However, our explicit attitudes, the way in which we give voice to our emotions, are not always aligned with our implicit attitudes. In fact, research has shown that there is quite a gap between implicit and explicit attitudes. Societal expectations and conformity could have something to do with this, causing people to stifle their true feelings in order to be socially accepted. But so could our moods. Jeffrey R. Huntsinger of the Department of Psychology at Loyala University in Chicago believes our explicit attitudes more closely reflect our implicit attitudes when we experience anger.

In an attempt to determine if anger closes the gap between implicit and explicit attitudes, Huntsinger recently conducted a study involving three separate experiments. Huntsinger assessed the association between implicit and explicit attitudes of participants after they experienced angry, sad, and neutral emotional cues. He found that anger resulted in a more authentic explicit manifestation of implicit attitudes than neutral or sad moods. Huntsinger believes anger is like happiness, which causes a similar effect, in that both happiness and anger increase confidence. People who are sure of their emotional states will be more likely to voice their true opinions, their gut feelings, than those who are less sure of themselves. When they doubt their implicit attitudes and are less confident in themselves, as is the case in moments of sadness, people are less likely to exhibit their authentic attitudes in explicit ways.

“Although this research concerned the influence of anger on agreement between implicit and explicit attitudes, these results have implications beyond this particular domain of inquiry correspondence,” Huntsinger said. In particular, the appraisals associated with anger may be associated with other emotions, such as disgust. Each of these unique emotions also influences approach and avoidance behaviors. All of these factors should be explored in more depth in future research in order to capture a more comprehensive picture of what draws our implicit and explicit attitudes closer together and what drives them apart.

Reference:
Huntsinger, J. R. (2012). Anger enhances correspondence between implicit and explicit attitudes. Emotion. Advance online publication. doi: 10.1037/a0029974

We all know the feeling, but few of us want to talk about it. Shame often runs our lives and undermines our relationships, but we often keep it hidden. We’re ashamed of being ashamed. I felt it today when my wife reminded me of something I had said to her that was unkind. I pride myself on being a sensitive, caring man, and when she pointed out this shortcoming, I could feel the shame rise up in me. I felt myself getting warm. My first thought was, “I didn’t do it.” My first words were, “I never said it.” I felt confused and off balance. I wanted to run away and hide. I wanted to disappear.

I was awash in my shame, but I tried to cover my discomfort. Shame is such a wretched feeling, most of us try and deny we are feeling it, hoping that if we don’t look at it, shame will magically disappear. But shame is stubborn. The more we deny it, the more it sticks to us like glue.

Recent research shows that shame is conceptualized as a multidimensional construct, manifesting in various physical and emotional ways. Shame manifests physically in a wide variety of forms. “The person may hide their eyes; lower their gaze; blush; bite their lips or tongue; present a forced smile; or fidget,” psychotherapist Marc Miller said. Other responses may include irritability, annoyance, defensiveness, exaggeration, or denial. Research indicates that the strongest correlates of shame across studies include individual differences in nonacceptance of negative emotions and expressive suppression. Because the effect of shame often interferes with our ability to think clearly, we may experience confusion, being at a loss for words, or a blank mind.

“Man is the only animal that blushes,” Mark Twain once said. “Or needs to.” He reminds us how central shame is to the human experience.

Find a Therapist

When couples come to me for counseling, they rarely mention shame as a cause for their difficulty. Yet I’ve found that shame is a major factor of relationship problems. Research shows that shame can have a severe negative impact on intimate relationships, leading to negative shame loops between partners. We know that couples often fight about money and sex. He gets angry when she spends money on things he thinks are not important. Underneath his anger we often find feelings of inadequacy. Beneath her spending patterns may be feelings of loneliness and unworthiness.

Key Insight: Nathanael Schlect, Licensed Associate Counselor “Shame often operates alongside other vulnerabilities such as fear, grief, or insecurity rather than existing in isolation.”

One partner wants more sex, and the other feels tired or withdrawn. One gets angry. The other feels hurt. Shame is rarely discussed, but is always present. One may feel like a lousy lover. The other may feel unattractive.

Recent umbrella reviews show that a relative majority of studies conceptualize shame as a multidimensional construct, representing what Helen B. Lewis, a pioneer in recognizing the importance of shame to psychotherapy, argued was an entire family of emotions. This family includes humiliation, embarrassment, feelings of low self-esteem, belittlement, and stigmatization. Shame is often experienced as a critical inner voice that judges us as “damaged goods,” inadequate, inferior, or worthless.

Shame in Men and Women

I’ve found the things that trigger shame differ in men and women. Research confirms that gender stereotypes maintain that women experience more guilt and shame than men, with meta-analyses showing small but significant gender differences (d = -0.29 for shame). Women often feel shame when they are unable to do all the things they think they should do. They must be a good mother, a sexy wife, a successful breadwinner, a caring friend, a good sister, and more. Studies show that women avoid the shame they may have if others observe that they overestimated themselves, while men do not seem to be similarly shame averse, possibly due to different societal expectations where men are expected to be overconfident.

The list is smaller for men. Shame usually manifests when we don’t feel strong. Dr. Brené Brown, an expert on shame, says, “While women are faced with a web of many layered, competing, and conflicting expectations, there seems to be one major expectation for men—do NOT appear weak.”

I’ve also found that men and women often react to shame differently. Research indicates larger gender gaps in shame with trait versus state scales, and gender differences in shame about domains such as the body, sex, and food tend to be larger than other domains. While individual responses to shame vary widely and are not strictly gender-bound, often women often blame themselves when they feel ashamed. They look embarrassed. They turn inward. Men often blame others when they feel ashamed. They often look angry. They may explode outward.

Key Insight: Nathanael Schlect, Licensed Associate Counselor “While patterns can differ across socialization, people of any gender may turn shame inward or outward depending on personality, history, and context.”

In fact, male violence is often an attempt to ward off shame. Recent research shows masculinity threats lead to emotions including shame, guilt, and a reduction in empathy, and these masculinity threats predict harmful behaviors such as men’s aggression, sexual violence, anxiety, shame, self-harm, and homophobic attitudes. Dr. James Gilligan has spent more than 30 years researching anger and violence in men. His research traces the role that shame plays in the etiology of murder and shows how feelings of shame cause violent and vengeful behavior. He says, “I have yet to see a serious act of violence that was not provoked by the experience of feeling shamed and humiliated, disrespected and ridiculed, and that did not represent the attempt to prevent or undo this ‘loss of face.’ ” Respect is important to all of us, but for men it is essential. Recent research on masculinity and violence shows that when men were targets of partner violence, many described feelings of weakness and shame, reflecting assumptions that men should be dominant and not victimized. Feeling disrespected or “dissed” can cause a man to strike out in rage.

Self-Disclosure and Empathy

The most difficult thing in the world to do when we are feeling down on ourselves is to admit how we feel. Yet self-disclosure is what we need to do to stop the cycle of shame and blame that so many of us get caught up with. Recent research on intimacy shows that self-disclosure, a fundamental component of intimacy, occurs only when vulnerability is met with acceptance rather than rejection. However, shame disrupts this process by inhibiting vulnerability and promoting defensive strategies. It’s harder than hell to say to my wife, “You’re right, what I said was unkind. I’m sorry.” But that’s the key to washing the shame away.

Attachment research shows that shame loops within couple relationships may not only be triggered by negative cues, such as criticism from a partner, but can also innocently be triggered by a partner seeking connection or even offering comfort. It feels counterintuitive. We’re afraid that if we admit our faults, we’ll feel even more ashamed. But the opposite is true. The more we’re able to say, “Yes, I messed up,” or, “Yes, I made a mistake,” or, “Yes, I’m sorry for what I said,” the better we feel about ourselves.

We all know the good feeling we get when we can own our mistakes and be forgiven. But that takes empathy on the part of our partner. Our partner has to be able to feel with us, not blame us or put us down. Recent clinical trials of Emotionally Focused Couple Therapy show significant improvements in intimacy and reductions in shame when couples learn to address these dynamics. For men, it often means admitting our weakness. And for women, it means accepting that we can still be strong, adequate men, even when we are weak.

Men need also to practice empathy with the women in our lives. We have to understand the things we do that shame them, the subtle ways we may put them down. And we all need to be more empathic with ourselves. We don’t have to be successful at everything, all the time. We don’t have to be strong all the time and hide our weakness. We can learn to love and accept the wonderful, flawed, human beings we all are.

References:

1. Mirzazade, Z., Molazade, J., & Hadianfard, H. (2025). The effect of emotionally focused couple therapy (EFCT) on shame and intimacy in couples: a randomized controlled trial (RCT). BMC Psychology, 13, 1111. https://doi.org/10.1186/s40359-025-03415-3
2. Frediani, M. J., et al. (2024). Seeking connection can trigger shame loops in couples: An attachment-based understanding. Family Process, 63(1), 34-47. https://doi.org/10.1111/famp.12888
3. Vescio, T. K., et al. (2025). Masculinity threats sequentially arouse public discomfort, anger, and positive attitudes toward sexual violence. Personality and Social Psychology Bulletin, 51(1), 3-20. https://doi.org/10.1177/01461672231179431
4. Stanaland, A., Gaither, S., & Gassman-Pines, A. (2023). When is masculinity “fragile”? An expectancy-discrepancy-threat model of masculine identity. Personality and Social Psychology Review, 27(4), 285-315. https://doi.org/10.1177/10888683221141176
5. Swerdlow, B. A., Sandel, D. B., & Johnson, S. L. (2023). Shame on me for needing you. Emotion, 23(3), 737-752. https://doi.org/10.1037/emo0001109
6. O’Donnell, S., et al. (2024). Masculinity and violence interconnectedness: Defining and reconciling the gender paradox among men with cumulative lifetime violence histories. SAGE Open, 14(3), 21582440241266998. https://doi.org/10.1177/21582440241266998
7. Else-Quest, N. M., Higgins, A., Allison, C., & Morton, L. C. (2012). Gender differences in self-conscious emotional experience: A meta-analysis. Psychological Bulletin, 138(5), 947-981. https://doi.org/10.1037/a0027930
8. DeSantis, A. J., Eshelman, L. R., & Messman, T. L. (2025). Emotional dysregulation, anger, and masculinity in men who have experienced lifetime sexual violence. Journal of Interpersonal Violence, 40(21-22), 5199-5222. https://doi.org/10.1177/08862605241301790
9. Deshmukh, A., Mehta, R., & Acar, Z. (2024). Perceived criticism and intimacy avoidance in couples: The mediating role of shame. Research and Practice in Couple Therapy, 2(1), 1-10. https://doi.org/10.61838/rpct.2.1.1
10. Bardi, L., et al. (2024). Conceptualization and assessment of shame experience and regulation: An umbrella review of synthesis studies. Clinical Psychology Review, 113, 102436. https://doi.org/10.1016/j.cpr.2024.102436

When parents view their child’s “problematic” behavior, attitudes, or troubles as a reflection of them, it can be a terrible blow to the ego. For parents with positive self-feelings, anger, hurt, and disappointment can occur when they don’t see themselves reflected in their children. (“My child should be just like me.”) For parents who do not feel very good about themselves, seeing a child as being “just like me” can feel devastating. Parents who lack self-esteem often feel like their child’s problems are their fault. Their inability to differentiate themselves from their children can also result in guilt and painful feelings of responsibility that are often overstated and inaccurate. Many parents who struggle with the idea that their child is a reflection of them (for better and worse) have not separated from their children. These parents tend to feel some responsibility for their child’s situation. Most often they believe that, either in their early behavior with their children or in their biological contribution (or both), they have profoundly affected their child’s life and character.

“Peter” came to his therapy session in a rage about “Adam,” his 25-year-old son. He had just come from his son’s apartment and was disgusted about the dirt and disarray he encountered: “What is the matter with that kid? He’s such a slob. There is stuff everywhere. It feels so chaotic! I have the same feeling when I think about how he gets drunk with his friends on the weekend. He’s a mess!”

When I asked Peter what made him so angry about this, he began to express remorse about being so enraged. Choking up, he said, “I guess I’m really hurt. I feel like Adam is being disrespectful to me. He knows I hate his messes and his drinking behavior. I feel like he’s on a terrible path of disorganization and disaster. I keep asking myself, ‘How did he turn out this way?’ ”

I asked Peter what he thought about why Adam was like this. “I don’t really know,” Peter said. “But I honestly believe it’s my fault. You know I was a terrible workaholic during Adam’s first 10 years. I neglected him when he was growing up. Then I think, if I was a workaholic, will he be an alcoholic? I know I made him this way. I’m a mess of a father.” Peter was tortured by his painful feelings and disappointment that his son hadn’t turned into the ideal adult that Peter wished he could be.

Over time, as we explored Peter’s feelings, it became apparent that he put all the responsibility for the person Adam was at age 25 on himself. He found it very difficult to see Adam as a separate individual with his own reasons for behaving the way he did. Slowly, Peter was able to consider that his influence hadn’t only been negative and that he wasn’t the only influence on Adam’s development. Adam’s mother was nurturing; Adam had many friends growing up. Peter could even recall some teachers who were influential in Adam’s life. He acknowledged, for example, that a high school teacher had encouraged Adam to stay with his music, and Peter admitted that Adam was a successful musician.

“I guess I haven’t focused enough on Adam’s successes, just on the ways I see him as a failure and blame myself,” Peter said. “Sometimes I still think that maybe Adam is punishing me when he messes up in ways he knows I hate. I guess I really have to admit that it isn’t all about me. Adam is a different person from me. It’s just hard to be OK with that. But I do want to get there. I know that would be best for our relationship.”

Peter is slowly beginning to separate from Adam and experience Adam’s successes and failures as more about Adam than him. He is also beginning to take Adam’s character and behavior less personally. Giving up the idea that “it was all my fault” makes space for Peter to see Adam as a separate individual.

“Rose,” another client, began to talk about her 10-year-old daughter, “Jessica,” in our therapy sessions.  Rose was obsessed with worry that Jessica, who had learning disabilities, would never have a successful life. She said with some sadness: “Her brain is damaged. How will she ever be OK?”

“What do you mean, ‘Her brain is damaged’?” I asked.

“You know that we had her tested and she has so much trouble focusing and organizing her thoughts,” she responded.

“Yes, I know she has some learning disabilities, but seeing her as ‘a person with a damaged brain’ seems a rather extreme way of defining your daughter,” I said.

“I sort of know what you’re saying is true,” she said. “But you know I had learning disabilities as a kid. No one identified them; no one did anything about it. I still struggle at work and in my life in general with being focused and organized. I get so depressed and anxious when I forget things or don’t get stuff done like I promise my husband or my boss. I know my brain is messed up, and Jessica is just like me. Why would I think her fate is going to be any different?”

Rose had a very strong belief that biology was determining her future as well as her daughter’s. She was reluctant to consider that her daughter’s life could take a different path from hers. She had a difficult time thinking about Jessica as a separate person with her own unique characteristics. I reminded her that she and her husband had been addressing Jessica’s learning problems and getting help for her. I also pointed out that this was very different from her own experience growing up. I emphasized that there are many influences other than biology that influence a person’s development. I also asked Rose to tell me anything she could think of about Jessica’s accomplishments. We both listened to the list Rose came up with: “Great piano player, really good artist, hula-hoop champion, kind person, good swimmer, and I guess other stuff, too.” Rose reluctantly acknowledged, “Yes, I suppose her brain works OK in some ways.”

Rose and I spent a lot of time talking not only about Jessica, but also about Rose’s negative sense of self. It was harder for her to take seriously that she has her own accomplishments. It was even more difficult to consider that Jessica was like her in some ways and not others. (Rose is a terrible artist and swimmer!) Our work has centered on Rose’s struggle to experience herself in positive ways and on seeing Jessica as a separate, differentiated individual. We have also been talking about how painful it is to see your child have areas of deficit, and even worse when you feel you are the cause. Helping Rose to talk about her impaired sense of self and its development has allowed her to make distinctions between her own experience and Jessica’s. I have tried to help Rose consider that while there could be some biology at work in regard to Jessica’s learning disabilities, so much more than being “just like me” is involved in what makes Jessica who she is.

We are familiar with parents feeling great pride in how they played a role in their children’s successes. But when parents boast incessantly about their children’s accomplishments to the extent it doesn’t feel like typical parental pleasure, we typically consider them to be narcissistic. For Peter and Rose, their great dismay in what they perceived as their children’s deficits, problems, and failures was also narcissistic.

The term narcissism comes from the Greek myth of Narcissus, in which Narcissus falls in love with his own reflection in a pool. The notion of reflection is pertinent to the experiences of Peter and Rose. Rather than experiencing narcissistic pleasure, these distraught parents experienced a narcissistic wound. They couldn’t tolerate the pain of looking into the pool (i.e., at their child who also represents the parent) and seeing something that is not “beautiful” reflected back. When they looked at their children, they saw a reflection of themselves. It was intolerable that the reflection they saw was “a mess” or had a “damaged brain.” It was not “beautiful.”

These parents are responding narcissistically, and they have not differentiated themselves from their children. One has to wonder how parents, who view their children as reflections of themselves, may have influenced their child’s separation/individuation process. As parents become more aware that their beliefs that their children are or are supposed to be “just like them” are assumptions, they will be in a better position to examine those beliefs. As a result, parents will experience less pain, and their children will be helped to develop into separate, unique individuals.

One of the reasons many children do not tell anyone about being sexually abused is because they fear that their loved ones will not believe them. Often, their abuser is a friend or family member, and although children may know that what occurred is wrong, they may be confused and worried that their caregivers will think they have misconstrued the behavior. Children who feel neglected or maltreated by caregivers may feel reluctant to disclose abuse, and many abusers threaten children, creating more reasons for nondisclosure. However, when children do reveal abuse, getting them to explain the abuse in a way sufficient to lead to prosecution can be challenging.

Various methods of interrogation are used on child-abuse victims, including open-ended questions, yes/no questions, “What happened?” questions, and “How did that make you feel?” questions. For the most part, open-ended questions and “what” questions tend to provide the least amount of detail. Children often are unable to articulate the details of their abuse. And while “how” questions that prompt children to reveal their physical reactions and feelings allow them to detail their personal experience in great detail, this is the most rarely used form of interrogation. To explore which method would provide the most accurate recollection of abuse and elicit emotional responses that could demonstrate credibility to jurors, judges, and therapists, Thomas D. Lyon of the Department of Psychology at the University of Southern California recently examined transcripts from more than 100 child-abuse cases.

Lyon discovered that when children were asked closed-ended questions such as yes/no, their responses were narrow and they exhibited little emotion. Similarly, when they were asked “What happened?” they were hesitant to reveal details and appeared emotionally undisturbed. But when children were asked how the abuse made them feel and what their physical reactions were, the responses were extremely vivid and consistent. They demonstrated emotional responses and used words such as angry, sad, afraid, confused, “sick to my stomach,” and dirty. They manifested facial and physical reactions that allowed those interviewing them to see the damage of the abuse in ways that the children could not articulate when prompted with direct questioning. “Children can be surprisingly articulate about their reactions to sexual abuse, despite their apparent lack of affect in describing the abuse itself,” Lyon said. He hopes that these findings will motivate interviewers, prosecutors, and mental health professionals to evaluate physical and emotional reactions of abuse as a means to gather details from child sexual abuse victims.

Reference:
Lyon, Thomas D., Nicholas Scurich, Karen Choi, Sally Handmaker, and Rebecca Blank. ‘How did you feel?’: Increasing child sexual abuse witnesses’ production of evaluative information. Law and Human Behavior 36.5 (2012): 448-57. Print.

There are many parallels between living with a disability and dealing with an uninvited house guest. If you have ever had an uninvited house guest, I am sure you remember moments when things may have been uncertain and, at times, tense or uncomfortable. At the very least, having an uninvited guest requires some adjustments, much like living with a disability.

An uninvited guest may arrive unannounced, leaving no time to plan or prepare. Likewise, in many cases people living with disability have little or no time to plan for the many changes to come. While there may have been no way to prevent the disability and requisite life changes, having time to prepare—psychologically and literally—can make a huge difference in a person’s ability to adapt and cope.

A period of psychological adjustment is required for a person who has a disability, his or her spouse/partner, parents, and other family members. The adjustment process people frequently talk about resembles the grief process in many ways. Like the grief process, people often experience feelings in what seem to be stages. Similar to the grief process, this adaptation process usually begins with a period of denial.

Denial
In my work with couples and families living with multiple sclerosis, I often hear concerns that one person seems to be “stuck in denial.” To people who have moved through the initial denial stage, it may seem as if their loved one is not progressing as quickly as others. The truth is, different people work through this period of adjustment differently, and it takes as long as it takes. The denial stage usually happens at the time of diagnosis or disability, and may come up again at other times. For example, in a progressive illness, if one begins to lose mobility or other limitations arise, the initial stage of the adjustment process may be triggered again.

It may seem clear to a caregiver/partner or family member who has been helping someone walk even short distances that a mobility device is needed (cane, walker, scooter). For the person who is having mobility difficulty, admitting that it is time to talk to a doctor about a mobility device may affect his or her identity, hope for recovery, or future progress. If so, working through the denial and bargaining, and then later stages of adaptation, may be necessary. It is not unusual to see all members of the family triggered by new developments that start the process over.

Denial is believed to be a protective measure that prevents us from becoming emotionally overwhelmed. Denial slows down the process of coping with traumatic events, giving us more time to psychologically prepare ourselves for the onslaught of feelings. The process of denial, known as a defense mechanism, should not be rushed or sabotaged by well-meaning loved ones who are at a different place in the adaptation process. Doing so can cause the person who needs more time to become emotionally overwhelmed without the necessary skills to cope effectively.

Coping skills: A person with disability and his or her family members should try to be empathetic and understand things from the perspective of others. Be honest, but gentle, about your perceptions. Choose the time to discuss these issues carefully—not when either of you are tired, frustrated, or angry. Always talk to your loved one(s) before bringing up concerns with doctors or other professionals.  Caregivers and family members should keep in mind that their needs are important, too. Take care of yourself and make sure you have plenty of support. When children are involved, be very careful what and how you share information with them. Children need to hear things based on what is appropriate for their age and stage of development. Ask for guidance from a professional if you are unsure how much to tell children or how to talk to them about disability.

Bargaining
The stage that usually follows denial is bargaining. During this time, people often are looking for second opinions, alternative therapies, and other remedies. It can also be a time when we promise the gods that we will turn our lives around if given a second chance without the disability or diagnosis.

It is true that finding the best medical providers, keeping a positive outlook, and staying informed of new research and possibilities is important. However, this can also be a time when people are vulnerable to scams and false promises. Unfortunately, there are a lot of companies and people who offer products and services that guarantee outcomes without doing the necessary research required to back up those assurances.

It is a good idea to check out any new or experimental treatments carefully before trying them—particularly if there is a large commitment of money, resources, or time involved. Check with local and national nonprofit organizations that provide services to people with your specific issue or health challenge. Agencies such as the National MS Society, American Cancer Society, and others often have information about ancillary and alternative therapies. They may be able to send you information or answer your questions.

Coping skills: Make decisions together based on facts. Find local and national organizations that you trust to support you and provide well-researched information. Be sure that any second opinions or ancillary providers have access to all the information you have from other providers. In some cases, taking medications or treatment without being fully aware of how they interact with your other treatment can be life-threatening. Make a commitment to fully investigate any new or experimental treatments before deciding to try it. Ask for and check references when appropriate. Verify the credentials of all providers before visiting them. At some point, you may have to accept a new reality that you had not planned for and do not welcome. If you have prolonged difficulty coping with the diagnosis or prognosis, find support from a professional or support group to help you with the transition.

Over the next few months, I will explore additional aspects of disability, how it affects the lives and relationships of the people involved, and ways of coping with these situations. If you have ideas to share about how you have effectively coped with any of the situations presented, please join the discussion by leaving comments below. Likewise, if you have questions, feel free to ask for input from others who read the blog.

Sports generally are viewed as harmless pursuits, a source of social interaction and bonding, exercise, and stress relief. But in recent years, highly publicized incidents of fan violence have raised concerns about the culture surrounding sports. The vicious 2011 beating attack on Bryan Stow at Dodger Stadium in Los Angeles is just one such example. Alcohol-fueled fights and skirmishes are increasingly common at all levels of competition, from playgrounds to professional leagues. Most people who have attended a sporting event have witnessed at least one example of an out-of-control fan.

What’s behind this surge in violence? The problem may not be the nature of sports themselves, but rather the way society treats sports in conjunction with personal factors. A closer look at some factors that may contribute to fan violence:

Overidentification

For many sports fans, their teams of choice become a proxy for their own identities. Overidentifying personally with a favorite team may be a contributing factor to sports violence. A person who watches a favorite team lose, or witnesses an unfavorable referee call, may behave as if he or she has personally suffered. The advent of Facebook and other social media, as well as message boards and other gathering places for fans, may make it difficult to disengage from favorite teams or let go of bad memories. These platforms also provide more access to inflammatory views from rival teams’ fans, fueling deep feelings of loyalty, protectiveness, and anger that boil to the surface amid the emotional current of a live game.

Alcohol

Alcohol plays a significant role in many fan altercations. At National Football League games in 2011, more than 7,000 fans were ejected for inappropriate or violent behavior. Some fans spend all morning and afternoon tailgating and drinking with friends before watching the event and then celebrating—or grieving—afterward. People often are intoxicated before even entering a venue. The feelings of deep loyalty and anger that many fans feel can be exacerbated by alcohol consumption.

Hypermasculine Culture

Despite years of progress toward gender equality, many men feel pressured to meet expectations of traditionally masculine behavior. Sports can be a significant platform for masculine identity, and people who identify with hypermasculine culture may be more likely to attend sports events. Combined with adrenaline, overidentification, and ready access to fans with opposing allegiances, some men may be inclined to be violent when exposed to triggers. Likewise, women in hypermasculine environments that promote disrespectful or violent behavior may also be more inclined to engage in it.

Sociological Factors

Certain people are at a greater risk of engaging in violent behavior. People who have experienced a recent stress such as job loss, the death of a loved one, or a perceived humiliation are already on edge and more likely to react emotionally. Many people attend sporting events to alleviate stress. However, when a favored team loses, a person is heckled, or a person loses a significant bet associated with a game’s outcome, stress may explode into rage.

Group Dynamics

Millions of people attend sporting events every year, and the vast majority never commit a violent act. When 100,000 people pack a stadium, though, the odds are high that a number of them are under the influence of alcohol. Combine this with an emotional, hypermasculine environment and exposure to opposing sentiment, and you’ve created a recipe for fan violence. Proactive measures such as reporting inappropriate behavior immediately, limiting alcohol intake, and actively encouraging sportsmanship among peer groups, can help address an increasingly challenging threat to our enjoyment of sporting events.

References:

1. Aguirre, B. E. (2008). Sports fan violence in North America. Contemporary Sociology: A Journal of Reviews, 37(2), 157-158. doi: 10.1177/009430610803700235
2. Associated Press. (2012, May 31). Witnesses describe violent scene. ESPN. Retrieved from http://espn.go.com/los-angeles/mlb/story/_/id/7991565/witnesses-depict-violent-scene-bryan-stow-beating
3. Handwerk, B. (n.d.). Sports riots: The psychology of fan mayhem. National Geographic. Retrieved from http://news.nationalgeographic.com/news/2005/06/0620_050620_sportsriots.html

A client recently described how thrilling it was to take her daughter to see the Broadway musical Annie.  She recalled that her mother took her to see it when she was a child, and it had been an indelibly wonderful experience. Now she had the pleasure of providing the same thrill for her daughter. I thought how special it was for my client to share this with her daughter and how lucky my client was that her daughter had the same feelings about the experience. It also reminded me that so many parents who want to provide what they believe to be all the right things for their children are not always met with such good feelings.

I recalled another client whose desire to recreate his delight for his son was dashed when he took him to the rodeo and was met with the response, “This is stupid.” In spite of their most nurturing and positive intentions, parents may find that their wishes and rules for their children are met with rejection. This can create painful feelings, including insult, hurt, anger, and disappointment. “Drew,” a 42-year-old client, was in a prolonged struggle with his 8-year-old daughter about piano lessons she adamantly refused to take. He told me, “When I was a kid, I refused to continue piano lessons after a few months. My parents never insisted I continue. I’m not going to let that happen to my daughter. She isn’t old enough to know what she wants or what the consequences of her actions will be.”

As Drew and I explored his feelings, it became clear that he not only felt disappointed, he felt rejected by his daughter. “It feels like she is telling me, ‘Get out of here, you don’t know what’s good for me,’ ” he said. I responded: “I can see how upset you are about this, but I wonder what it is that makes you feel so personally rejected. Is it possible that your daughter is different from you?” Drew’s first response was, “She’s my daughter and she is like me. I just know this is very important for her to do. When I was a child, I didn’t know I was making a terrible mistake. My parents should have known and pushed me to continue.”

It took a lot of talking for Drew to become aware of his many disappointments about the ways his parents had been involved in his life when he was a child. He began to consider that he might not need to protect his daughter from this disappointment. He recognized that his daughter might, like him, regret not learning the piano, but forcing her to take lessons could easily turn her away from the piano. He realized that her experience and development was and will be different from his and she is a different person with her own thoughts and feelings. After all, she has different parents than he did. The more Drew could understand his daughter’s need to differentiate from him, the easier it was not to feel so rejected and hurt.

When parents assert their desires for their children, it is not unusual for them to be met with expressions of different or opposing wants and needs. Pushing back against what parents want is a necessary part of a child’s development. For a healthy sense of self to grow, children need to differentiate from their parents and become unique, separate, individual selves. This doesn’t mean children are totally different from or always in opposition to their parents. It does mean children need to develop minds of their own. Having one’s own mind is about being able to think about your needs and wants without being overly influenced by others. Ideally, the wishes of others are considered, but ultimately one makes his or her own life choices. Obviously, the degree of autonomy for a 4-year-old differs from that of a 13-year-old and again for a 20-year-old. When children are not given the space to differentiate from their parents and don’t develop a self that is confident and strong, they will not have developed the autonomy to make life choices and get what they want as they enter full adulthood.

At age 53, “Anne” was struggling with her teenage son, “Noah.” She came to therapy expressing feelings of anger and insult from their encounters. She explained that he fought her at every turn about anything she asked of him: cleaning his room, doing household chores, getting his college applications completed.  “I don’t believe how he treats me,” she said. “He says things like, ‘Leave me alone and mind your own business.’ Is that any way to speak to your mother? I feel so hurt and insulted. Doesn’t he know I only want what’s best for him?” In great distress, Anne added, “He has become a terrible person. He is so mean and inconsiderate. He seems like a completely different person than the son I felt loved me a year ago.”

As we talked, Anne described how when she was growing up she never went against her parents. When we explored her past and present relationships, Anne began to wonder if her early experiences being compliant are related to her difficulty asserting herself as an adult. She described how difficult it is for her to disagree with her husband and how she doesn’t always feel so good about herself. She realized that it wasn’t just with her son that she felt so badly treated. “I guess I don’t feel very powerful,” she said. “I have a lot of trouble believing that what I think and feel is OK. I always followed the rules with my parents. Maybe I didn’t develop what Noah needs to do—be someone who feels OK asserting himself when there is opposition.” Many parents with teenagers experience difficult feelings in their parent-teenager relationships. For Anne, the feelings of insult and rejection were intolerable. Even worse for her was the terrible shame she felt about her negative feelings toward her son: “I’m the terrible person. Mothers shouldn’t feel this way.”

How to handle this kind of situation with teenagers is controversial. Furthermore, how any parent hears what a child says is open to interpretation and may be related to how the parent differentiated from his or her own parents. While Anne felt insulted and hurt, another parent in these circumstances might shrug and think, “When will these awful teenage years pass?” On one end of the continuum of parental response, parents might believe that a child of any age should never be permitted to say anything that is hurtful, disrespectful, or angry to a parent. At the other end of the response continuum, parents might accept any expression their child makes without intervening. An extreme example might be if a teenager said, “You’re an awful parent, you have no business having children,” and a parent made no protest about being treated that way. On this far end of the continuum, the lack of a parental response to push against doesn’t provide the child with the feeling that there is a strong parental self to separate from. If there is no other out there to individuate from, it becomes difficult for a child to develop a sense of who he or she is and the ability to be autonomous. The child is left wondering, “Who am I?” Potentially more problematic, the child may be left with a feeling of powerlessness. He or she has not been given the experience of successfully asserting his or her developing self in the world.

There is a lot of room along this continuum for parents to develop responses that feel comfortable to them while allowing some room for their children to develop their unique selves. It helps if parents let their children know what behaviors are acceptable. For instance, telling a child, “You can’t talk to me that way” is not the same as saying, “You can’t be angry at me,” or “You are hurting my feelings.”

When children respond to parents in disappointing or unacceptable ways, it is important that parents stop and consider how they will meet that response. Each situation requires thought. Sometimes, interfering with the child’s wishes or experiences provides an opportunity for the child to push back against the parent and feel a sense of his or her developing self. At other times, supporting the child’s differentiation provides the child with a sense of confidence and recognition of his or her developing self. No matter the age of the child, parents who are curious and interested in why there is disparity or opposition are communicating their openness to more than one way of behaving and/or feeling. This openness to difference helps children develop into self-confident, autonomous adults. Moreover, parents are less likely to repeat the dynamics of their own childhoods if they consider their children’s behavior from a developmental perspective. They will be in a better position to not take things so personally and will feel less hurt, insulted, or disrespected by their children.

Many mental health professionals consider the three “A’s”—addiction, affairs, and abuse—sufficient reason to leave a partner. This blog addresses lower-level offenses related to the first two. While most couples can overcome low-level indiscretions in any area of the three “A’s,” when multiple indiscretions occur or the degree of severity is greater, it may be time to throw in the proverbial towel. As couples grapple with why one partner cheated or entered the depths of alcoholism or drug addiction, they need to evaluate the patterns of relating they have become used to, the interpersonal dynamics they engage in, the dances they dance, and the issues they may have brought into the relationship. One theme that consistently emerges is the degree to which couples are honest with each other. How much do they divulge? How important is it to tell the truth? Do you really need to tell your partner everything?

In Alcoholics Anonymous, we hear people say, “We are as sick as our secrets.” Family addiction therapists are fond of saying that there are no family secrets. By this, they mean that even when we believe that other family members don’t know a certain secret, that secret still has an impact on everyone in the family. If individual members don’t know the specifics of the secret, they are still impacted by it and sense or experience it unconsciously—and that can affect the whole family. I work with patients who learned in their twenties or later in life that they were adopted, that their parents were once married to an abusive spouse, or that they have a sibling they never knew, among other revelations.

I’ve also become aware of the extent to which sober and recovering clients keep things from their partners. Even in relatively healthy relationships, there appears to be a fair amount of small-scale concealment and deception, though the extent of the infractions often is debatable. Several clients I see—coincidentally or not, all men—have reported engaging in exercise cheating. What’s that, you ask? Exercise cheating, essentially, is exercising and not telling your partner, or not revealing how much or what type of exercise one engages in.

Even I have been guilty of cheating on my wife. A few years back, as I was setting up my new Philadelphia office, I decided to buy a painting by an artist that my wife and I liked. My wife studies art history, and I thought she would appreciate that I was acquiring a painting by a Temple University master’s graduate. And while $650 is no small chunk of change for this sort of thing, I thought it was a great investment for my new office. I thought I would surprise her with the purchase. Instead, she was angry. “You art cheated!” she cried as soon as she saw it. She was genuinely annoyed that I had not consulted with her on a purchase of this magnitude. Whether I was right or wrong in purchasing something of that cost for my office was not the issue. What is important is my partner’s perceived betrayal and need for dialogue, negotiation, and consultation.

Many hypothesize that cheating behavior is related to vestiges of evolutionary differences among men and women. While this theory would be a gross generalization in today’s society, it suggests that it was more adaptive in an evolutionary way for men to cheat than for women to cheat. Assuming evolution prioritizes any behavior designed to propagate one’s genes, men may benefit from spreading their genes in a quantity-focused way. Women, meanwhile, have long gestation and nursing periods which may temporarily move them to be more devoted and committed to their offspring. Thus, they benefit from finding a better quality mate. In other words, women are biologically, or at least evolutionarily, better at taking care of their young, especially in early developmental stages. Most people agree, and research appears to back this up, that most men think about sex more frequently than women do. While both men and women want to find a quality mate, men may be more inclined to seek quantity than women are.

According to this evolutionary perspective, neither men nor women want their mates to cheat because a mate who cheats may have more offspring, which in turn means that mate is less likely to care for the original partner’s offspring and more likely to leave and care for his or her new offspring. It is in a man’s evolutionarily best interest not to alert his partner to the fact he is cheating. Any behavior—sexual or not—that results in producing healthy offspring is powerfully reinforced to the extent that it aids in propagating an individual’s genes. So, infidelity and hiding that infidelity through the processes of natural selection and evolution can become more prevalent over time.

A fair question would be whether cheating sexually is related at all to other types of cheating. Just because a partner doesn’t tell a mate where he or she is going and what he or she is doing doesn’t mean that an affair is happening, and it doesn’t mean that a tendency toward nonmonogamous behavior is the cause of disingenuous behavior in the context of the couple. In fact, the point of this article is to lessen the impact of minor violations of the honesty contract. Putting small indiscretions of dishonesty in an evolutionary context may allow couples to see this behavior as resulting from the natural instincts of the animals we are. What is important, though, is that as humans we have the capacity to dialogue. This is precisely what can keep our natural tendencies in check. Speaking honestly to our partners about our needs and wants, while often challenging, is the hallmark of a healthy relationship.

Smoking gun example: A client once described an interaction he had with his wife after she busted him for smoking pot in the garage. She smelled the smoke even as he vehemently denied he had been smoking marijuana. When she found his metal pipe, still warm, he stuck to his story. “The lie just came out,” he explained later. “I was so used to it.” He eventually was able to talk about why he lied and why he has often felt the need to cover things up. It had nothing to do with infidelity, but was instead linked to his history of struggling to feel good about himself, to be able to ask for help with his emotions feelings and thoughts and to find purpose and meaning in his life. Beginning to discuss these issues with his wife and therapist helped him think more carefully about his tendency to lie and cover his tracks. He became better at advocating for himself and negotiating with his partner in a more healthy way.

Honesty is important in recovery from any mental health issue, whether it be depression, anxiety, or stress, but it is especially important in recovery from addiction and substance use because of the strong tendencies to hide, deny, and minimize one’s behaviors. Seeing an addiction psychologist or other specialist is an important first step in understanding one’s self. It is in this therapeutic relationship that a quick foundation can be set for the basis of an honest dialogue with one’s partner, friends, and family. Rebuilding relationships with those we love and who love us is essential to recovery from addiction. Understanding ourselves and the reasons we might cheat and lie can enable us to pause just long enough to ask ourselves whether we really want to go ahead with the behavior or if we might be able to rely on those close to us to help us through the difficult times. Honest communication with the people in our lives is the only way we can become and stay sober or make meaningful and lasting changes in our lives.

One of the most common methods for assessing the behavioral and emotional state of a child is a parental report. This type of evaluation usually comprises a parent’s observation and evaluation of the child’s feelings, mood states, and behaviors over a period of time. But just how accurately do parents gauge the emotional temperature of their children? That was the question at the center of a recent study conducted by C. Emily Durbin of the Department of Psychology at Michigan State University. Because parental reports can vary quite dramatically from reports obtained by other observers, such as teachers, counselors, and classmates, Durbin wanted to determine what factors, if any, skewed parents’ perceptions.

Durbin chose to focus on the effects of maternal depression on parental reports. She based her decision on the fact that other conditions, such as alcoholism, parental anxiety, and family distress, have been shown to influence maternal reports. Durbin extended the existing research and compared mothers’ reports with those of unbiased observers on a sample of 190 children ranging from 3 to 6 years old. Participants were instructed to rate levels of sadness, fear, happiness, surprise, and anger in the children after they completed 10 emotion-inducing tasks. Durbin found that the mothers with a history of depression or anxiety tended to rate their children as less happy than mothers with no such history. Additionally, these same mothers viewed their children as overly fearful, and rated girls as sadder than boys. This could be a result of maternal sensitivity to emotions such as fear and sadness. However, the outcome showed a significant disparity between observers’ ratings and those of the mothers with a psychological history. “These mothers may have greater difficulty setting aside their perceptions of the child’s typical emotional adjustment to focus solely on rating the behavior the child is currently exhibiting,” Durbin said. Although the sample size was limited to young children and did not contain a large number of mothers currently exhibiting depressive symptoms, the results warrant further investigation. Durbin believes it is essential to expand this research to include older children, comparison to other assessment tools, and evaluation of other aspects of childhood development.

Reference:
Durbin, C. Emily, and Sylvia Wilson. Convergent validity of and bias in maternal reports of child emotion. Psychological Assessment 24.3 (2012): 647-60. Print.

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

• Core mindfulness: The first of the four primary modules of DBT, this concept involves learning to observe one’s emotions, describe those emotions, and fully participate in present experiences. This skill forms the foundation for the other three modules, and is derived largely from eastern practices of living in the moment.
• Interpersonal effectiveness: The second core component of DBT teaches clients assertiveness skills and strategies to ask for what they need, set boundaries and say no when appropriate, and deal more effectively with interpersonal conflict.
• Distress tolerance: The third module entails clients developing nonjudgmental acceptance of themselves as well as their current situation. The focus is on learning to accept the present reality and to tolerate crises, and making use of strategies such as distraction, self-soothing, and improving the moment. Practicing these skills will increase the client’s ability to tolerate challenging events and environments.
• Emotion regulation: The final module of DBT consists of three main goals: to understand one’s emotions, reduce emotional vulnerability, and decrease emotional suffering. With this in mind, some of the specific skills taught in DBT include identifying and labeling emotions as well as evaluating: events that prompt the emotion, interpretations that trigger the emotion, how the emotion is experienced, how the emotion is expressed behaviorally, and the aftereffects of the emotion.

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

• Enhance behavioral capabilities: DBT helps clients develop important life skills that help them regulate emotions, experience the present moment, improve interpersonal interactions, and better tolerate distressing situations.
• Improve motivation to changes: DBT supports clients’ motivation to change by tracking and reducing detrimental behaviors, thereby increasing quality of life.
• Generalize capabilities to other environments: In order for the client to make progress, the skills learned in therapy must transfer to a wide variety of situations. This is accomplished through homework assignments and practicing skills. Telephone consultations also can be valuable in helping clients utilize these skills in their daily lives.
• Support client and therapist capabilities: DBT aims to maintain and build the capabilities of therapists through continued training and consultation-team meetings.
• Enhance therapist motivation: The DBT model encourages the use of support, validation, feedback, and encouragement between therapists to avoid burnout and improve their effectiveness.

Stages of treatment:

The course of DBT generally flows through three stages:

• Stage 1: This stage is primarily focused on eliminating or reducing serious behaviors, including self-injury, suicidal thinking, and aggression. Behaviors that interfere with therapy also are addressed, such as missing appointments and not returning phone calls.
• Stage 2: The client strives to increase quality of life and experience emotions in a less intense manner. The client continues to eliminate or decrease destructive behaviors, and address other issues or situations that are interfering with daily life, such as past trauma.
• Stage 3: The client is experiencing increased feelings of completeness, self-respect, and love.

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

• Difficulty with emotional regulation
• A high level of reactivity, with a slow return to baseline
• Impulsiveness with a tendency toward self-destructive behaviors
• An inclination toward extreme thinking, unable to perceive a middle ground
• A lack of sense of self, tending to feel incomplete or empty
• A history of instability in relationships, and difficulty with interpersonal interactions
• Extreme sensitivity, accompanied by rapid mood swings, anxiety, and depression
• Fears of abandonment and trouble with intimate relationships

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

I was talking with a new client and he was telling me about his temper when he gets mad and what consequences he receives. As he was talking, he stated, “when I’m bad…” and continued the conversation about his consequences. When he was done, I asked if he thought he was a “bad” kid. He said no. I was glad to hear that because I think overall, we are inherently good. Yes, there are people out there who would fit more in the “bad” category, but that is not what is being addressed.

As parents and disciplinarians, we try to shape our kids to make wise decisions so the negative consequences can be few or needed when necessary. When a kid gets angry and has tantrums and it happens over and over, it can be very frustrating to deal with. When the kid understands the consequence of his behavior but continues to still get angry and throw tantrums, parents may not be sure of what else to do. Parents slip. Teachers slip. The slip is telling the child that he is “bad” even though the behavior that he is doing may be more the focus of “bad.” I do not think that parents or even teachers slip on purpose and telling the kid that he is “bad,” but we are human and make mistakes, and it happens. Repeating this slip impacts the child’s self esteem. Over time, these children may see themselves as “bad” because they keep repeating the “bad” behavior, receiving the consequence, and having parents become frustrated, and a negative self-image begins to form. I know that is not what we as parents want for our kids. We want them to have a good sense of self and know what is “bad” behavior. So, how can this happen?

Here’s an idea: How about getting away from “bad” and “good” behavior. I know it’s hard to do because “good” and “bad” has been around for a very long time; it’s habitual and creating a newer way can be difficult.

What I am suggesting is to name what is “bad.” For example, your child is hitting a younger sibling because the sibling did not want to share a toy with the child. Instead of saying, “that’s bad,” point out that “hitting is bad.” Tell the child, “It’s not okay to hit when you are angry.” When we point out the behavior that is not okay, it helps us to not get into the “good” versus “bad” cycle. Another example: When your child is sitting on the floor and waiting patiently and you tell him “good boy.” Point out the WHAT that he is doing: sitting and waiting patiently. When he knows what he is doing that makes him a “good” boy, he will be able to associate that behavior in other areas and he will know he is doing well.

Objectifying the behavior takes away the “good” or “bad” titles, which decreases the opportunities for us parents to accidentally say that the child is “bad.”

Remember when your child was a baby and you were telling him what type of person he was going to grow up to be? If not, it’s okay. What I am getting at is when a kid is younger, parents may encourage the child a little more than at an older age. We encourage young children to try new foods, feed themselves, and use utensils, and we teach/show them how to do it then praise them for what they learned, even if it may not turn out well. Somehow as the child ages, the cycle of “good” or “bad” begins or replaces the encouraging aspect of parenting. Yes, kids do need to know right from wrong AND they still need to know that they are capable of doing great things.

Objectifying the behavior can help start a different way of helping your child to know how to make healthy choices. Continuing to encourage your child to try new things or to keep trying something can also help. Asking children what they think about their behavior and maybe what they could have done instead to not receive a consequence can also help. The asking can help your child learn how to see the cause and effect of a particular behavior. This can be a great learning and shaping tool for preparing the child to see more cause and effect as he or she ages and matures. Reminding the child that he or she is a wonderful child, has great possibilities, and is loved unconditionally can also reinforce a positive sense of self, regardless of whether the child has made a mistake or chooses wisely.

The goal of parenting is to help shape a child to have a good sense of self, to know how to behave appropriately, and to be able to self correct or recognize when he or she does not make a good choice. When the “bad” behavior is directly addressed, it takes away from parents accidentally slipping and saying that the child is “bad” when the focus needs to be more on the actual behavior.

It takes awareness and practice to create a new way of responding. Hopefully, this article will enlighten and small steps can be made to get out of the good/bad cycle and help the child to still have a good sense of self, even when he or she makes a poor choice.

Related articles:
Temper Tantrum Behaviors
Building Self-Confidence From the Ground Up
Adolescent Consequences, 100% Natural and Organic!

I am frequently asked what the best complementary or alternative therapies for kids are. This is a broad and potentially complex question, with appropriate courses of treatment depending on both on the child’s struggles and the balance of safety and efficacy of the therapy being considered. Eventually, many parents eventually find a complementary or alternative medicine (CAM) therapy that feels right for their child.

The most recent data from the National Center for Complementary and Alternative Medicine (NCCAM) found that 12% of the 9,000 children surveyed in 2007 had used some form of CAM during the previous year. CAM use typically ranges from providing remedies in lieu of medical treatments—such as using a homeopathic flu remedy instead of a prescription—to using CAM in conjunction with conventional remedies. The latter can be as simple as giving a child a zinc lozenge or tea with honey in addition to the antibiotics a doctor prescribes when a child has a sore throat or throat infection. Another example is when a child has been diagnosed with attention deficit hyperactivity disorder (ADHD), and his or her parents employ dietary changes even if the child is also receiving medication or psychotherapy. CAM therapies are often used to help children manage symptoms of chronic pain conditions or notable anxiety, ideally in combination with psychotherapy (and appropriate medical care, if this is indicated).

Remembering Developmental Differences

A point NCCAM emphasizes is that children are not merely smaller versions of adults. Similarly, more studies have been conducted regarding the effects of many CAM therapies on adults, although there is a growing body of research on CAM with children. Thus, what may be considered an appropriate CAM therapy or dose of therapy for an adult is not necessarily what we can recommend for a child.

That being said, there are a number of treatments that are considered generally safe for children, particularly when provided or informed by appropriately trained professionals. My favorites are listed here. I chose to emphasize non-oral intake therapies, although at times these may also be appropriate.

1. Guided imagery or self-hypnosis can be helpful for managing mood symptoms, pain and itching, sleep difficulties, and nausea.
2. Mindfulness or other types of meditation can aid in improving mood, pain, itching, sleep, nausea, and concentration.
3. Aromatherapy can help reduce anxiety and enhance feelings of calm, especially when paired with other therapies, including cognitive behavioral therapy, meditation, imagery/hypnosis, or massage.
4. Movement therapies, such as yoga, dance therapy, or tai chi can increase a child’s feelings of mastery, discharge excess physical tension, provide focus, and improve mood.
5. Massage  decreases muscle tension or soreness and increases relaxation.
6. Energy therapies, such as Reiki or therapeutic touch, may help increase calmness and decrease stress. These may also help with some physical discomforts.
7. Art therapy can help children cope with change, shed light on emotions and concerns that they may have trouble verbalizing, and reinforce healing images created during guided imagery and hypnosis.
8. Homeopathy is gently calming and is reported to help with fears, anxiety, and tantrums. There is less data on this therapy, but it is generally considered to be safe.
9. Diluted ginger tea can help with upset stomach/nausea.
10. Dietary changes, which may include eliminating processed foods, caffeine, or sugar and emphasizing whole grains, fruits, vegetables, legumes, and healthy sources of protein, are health-supportive overall, and some parents report improved mood, sleep, and concentration when processed foods are limited or eliminated.

One common theme that runs through most of the therapies listed above is that they help children to feel calmer. Some of the approaches provide children with tools to help them directly impact how they feel via what they do (movement therapies, imagery/hypnosis, meditation, art), which enhances children’s feelings of mastery and control. All of these approaches require at least initial participation and monitoring from parents—a key ingredient in helping children to feel safe, loved, and supported.

As always, it is essential to keep healthcare providers in the loop when using CAM therapies with children, particularly with those who have a medical or psychological illness.

Modeling Emotional Intelligence

Finally, if I were to add a number 11 to the list, it would be to emphasize that children pick up on and are undoubtedly affected by their parents’ moods. It is essential for parents dealing with anxiety, depression, or other psychological challenges to obtain appropriate treatment. Doing so helps parents feel better, enhances their ability to cope with the many demands of parenting, and teaches children about the value of self-care. Furthermore, emotionally healthy parents tend to parent more effectively, which also reduces children’s feelings of anxiety and depression.

Resources:

• National Center for Complementary and Alternative Medicine: CAM Use and Children
• Columbia University’s Integrative Therapies Program for Children with Cancer: A leading program that emphasizes both research and clinical practice. Their website contains a wealth of information about a variety of therapies, as well as helpful links.
• This article details an integrative (CAM) treatment of pediatric pain and itch (pruritus) with a seven year-old girl:
  • Stein, T. R., Sonty, N., and Saroyan, J. M. (2012). “Scratching” beneath the surface: An integrative psychosocial approach to pediatric pruritus and pain. Child Clinical Psychology and Psychiatry, 17(1), 33-47.