Play therapy is widely recognized as an effective therapeutic approach for children who are unable or unwilling to communicate their psychological distress. Elementary-aged children represent an especially vulnerable segment of the population when it comes to mental health barriers. First, it is during these formative years that behavior patterns are set. Children who have psychological problems early on tend to have higher rates of substance misuse, aggression, risk-taking behavior, and academic challenges than their peers. Additionally, many young children who have attention-deficit hyperactivity disorder, obsessive compulsive disorder, posttraumatic stress, autism, or other difficulties may have significant academic challenges and can benefit greatly from effective and meaningful in-school therapy.

But believing in the viability of play therapy and delivering it are two different things. Many school counselors report significant barriers to play therapy. Christine Ebrahim of the Department of Counseling at Loyola University in New York wanted to take a closer look at the barriers that counselors faced and how they overcame them. Ebrahim enlisted 359 elementary school counselors from the American School Counselor Association and had them complete online surveys regarding barriers to play therapy. The participants reported barriers such as time, space allocation, financial resources, and administrative and parental support. However, nearly all the counselors who cited these obstacles also described how they overcame them. For instance, they used their own money for supplies when they could not get funding, moved sessions to alternative locations when space was limited, and provided education about the benefits of play therapy when administrative and parental support was lacking.

One barrier was more difficult to surmount: the limited availability of play therapy training. “In looking at the data, most counselors identified specifically a lack of training as their primary problem,” Ebrahim said. Play therapy courses are not part of the curriculum at all colleges. Therefore, counselors are forced to learn through textbooks or online, or they must pay for training out of their own pockets. These results are promising in that they suggest that counselors are willing to do whatever it takes to offer play therapy to students in need. However, Ebrahim believes the findings clearly demonstrate that elementary school counselors are in desperate need of more professional play therapy training.

Reference:
Ebrahim, C., Steen, R. L., Paradise, L. (2012). Overcoming school counselors’ barriers to play therapy. International Journal of Play Therapy. Advance online publication. doi: 10.1037/a0029791

This is the second in a series of articles designed to explore some of the issues and concerns that arise around what is currently called Asperger’s syndrome, which will soon be incorporated into the broader spectrum of autism disorder when the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in 2013.

Emotional intelligence (EI) is generally understood to be a person’s ability to identify and assess his or her emotional state, as well as the emotional state of others. It is not related to the kind of intellectual capability or intelligence typically assessed by IQ tests. Rather, it corresponds to a person’s ability to relate to others, work in groups, read between the lines in conversation, and interpret behaviors and moods displayed by others. It also relates to an individual’s understanding and regulation of those qualities within. High emotional intelligence provides a sort of shorthand for smooth interpersonal relations and communication.

Emotional intelligence is related to theory of mind. (See my previous blog, titled Asperger’s Syndrome: Theory of Mind.) The better able you are to imagine the world from another person’s point of view, the more likely you are to score high on a measurement of emotional intelligence. Persons with high EI are able to anticipate what someone might do in reaction to certain circumstances or statements. They are able to empathize with unspoken sadness because they are able to interpret an event in ways another person is likely to interpret it, given what they know about that person. They are able to avoid certain topics of conversation because they can predict which subjects might be problematic for another person. They understand the concept of conversational finesse. High EI is at the very heart of diplomacy.

A person with Asperger’s syndrome experiences the world in a very different way. With a tendency to take conversations and events literally, the emotional subtext often is unseen. This can lead to behavior that appears inappropriate at best, heartless or cruel at worst.

Imagine, for example, not being able to understand why the death of a beloved pet is still a sensitive issue for your friend even several years after the pet has passed away. Imagine saying something such as, “But that cat has been dead for two years!” And then imagine the reaction of your friend, who in that moment is feeling sad about the loss, feeling it as strongly as if he or she had lost the pet yesterday. Your friend is not likely to react well. Your words might sound intentionally cold, uncaring, and thoughtless. But when your friend does not respond favorably, you are confused. What do you do now? You made a simple statement of fact, and now your friend is upset with you.

This is the experience of challenged emotional intelligence. This is commonly the experience of a person with Asperger’s. Anxiety soars as the person wonders what he or she did wrong, what he or she failed to understand, or what was missed.

With therapy, a person with Asperger’s can learn to decode some of what seems mysterious in the realm of emotional intelligence. It is possible to discern intellectually what may not come naturally emotionally. For example, to use the above scenario as a basis of conversation in a therapy session might help a person with Asperger’s see that there are different ways of responding to the death of a pet, and that the person’s own, seemingly logical way may not be the way others respond to something as essentially emotional as the loss of a pet.

Learning that there is such variability helps a person with Asperger’s navigate the complex emotional undertones of daily life. It also helps relieve the free-floating anxiety that can accompany conversations and events, both familiar and unfamiliar, because it broadens the range of expectations and softens the likelihood of inadvertent blunders.

Emotional intelligence is a challenge for individuals with Asperger’s, but it is also a fruitful topic for exploration in therapy because it is so central to most interactions with others, both in social and in intimate contexts.

Some of the symptoms of schizophrenia include delusions, mood fluctuations, and impaired social functioning. One of the reasons social interactions are challenging for people with schizophrenia is the way in which facial expressions are processed. Specifically, it is theorized that schizophrenia deteriorates the recognition processes of individuals and makes it more difficult for them to distinguish between familiar and unfamiliar faces. This can cause significant social struggles because accurately perceiving the facial expressions of others is how people determine their reactions to them. It is also how people decide which faces are threatening and which are safe.

Fabrice Guillaume of the Laboratory of Cognitive Psychology at Aix-Marseille University in France recently led a study that explored facial recognition in individuals with schizophrenia in order to get a better idea of impairments that occurred and why. Guillaume assessed 20 individuals with schizophrenia and 20 without as they evaluated the familiarity of facial expressions. The electrophysiological (ERP) responses of the participants were monitored as a set of faces was presented with expression changes, without expression changes, and then, finally, new faces were presented. Guillaume discovered that when the expressions changed, the participants with schizophrenia did not recognize them as familiar, even though they had seen the faces before.

The participants with schizophrenia also had a hard time distinguishing between familiar faces with new expressions and unfamiliar faces. “This result suggests that patients with schizophrenia are more sensitive to the expression change and appears to be inconsistent with studies showing spared familiarity in schizophrenia,” Guillaume said. The findings could be interpreted to indicate a broader, more global perception of faces occurs in schizophrenia, and that individuals with schizophrenia have an impaired ability to retrieve the global perception when perceptual nuances, such as expressions, occur. In sum, the results of this study reveal that people with schizophrenia can experience facial recognition deficits, which can have a dramatic impact on social interactions, even when they try to identify faces familiar to them.

Reference:
Guillaume, Fabrice, Francois Guillem, Guy Tiberghien, and Emmanuel Stip. Mismatched expressions decrease face recognition and corresponding ERP old/new effects in schizophrenia. Neuropsychology 26.5 (2012): 568-77. 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.

This is the first in a series of articles designed to explore some of the issues and concerns that arise around what is currently called Asperger’s syndrome, which will soon be incorporated into the broader spectrum of autism disorder when the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in 2013.

As a therapist, I see clients with a variety of traits clustered at the high-functioning end of autism, now commonly referred to as Asperger’s syndrome, a term I will use until the DSM-5 makes it no longer accurate.

No two clients with Asperger’s syndrome exhibit the same cluster of traits, nor does any one client exhibit them all. However, there is one element that I recognize as pervasively diminished in all Asperger’s clients. This element is called “theory of mind.”

What is theory of mind? It is a person’s ability to imagine the interior life of another person. This includes understanding why someone else does something, how someone might feel in a certain circumstance, what might be important to that person: in short, it is the ability to put oneself in the mind of another person and see the world from that person’s point of view. Theory of mind means being able to create a theory about the way another person’s mind works.

Theory of mind provides the basis for empathy because if you can walk in someone else’s shoes, you also become capable, by extension, of feeling any pain or delight that person experiences. You understand motivation. You catch a glimpse of fears and dislikes. You get to know the other person from the inside out.

According to autism specialist Simon Baron-Cohen, individuals with Asperger’s syndrome typically have delayed access or no access to this phenomenon of human communication and share a problem that is called mind-blindness. Since interpersonal communication is approximately 65% nonverbal, you can quickly see that not being able to formulate a theory of mind leaves these individuals at a distinct disadvantage in relationship with others because the behavior of other people does not make sense to them.

For parents, this gap can create difficulties when they treat their son or daughter with Asperger’s with the same set of interpersonal expectations with which they treat their other children and assume intact theory of mind capabilities. This can lead to incorrect understanding of the child’s behavior as being intentionally hurtful, for example, when in fact it was based in lack of awareness.

A common test used with children suspected of being autistic is called the Sally and Anne Test:

Sally has a basket. Anne has a box. Sally has a marble. She puts the marble into her basket. Sally goes out for a walk. Anne takes the marble out of the basket and puts it into the box. Now Sally comes back. She wants to play with her marble. Where will Sally look for the marble?

Most children will answer that Sally will look in her basket, because that’s where she put it and that’s where she expects it to be when she returns from her walk. Baron-Cohen discovered that only 20% of children with autism were able to answer correctly. A full 80% answered that Sally would look in the box, because that is where the marble is.

This test is often used to demonstrate the theory of mind deficits in children with Asperger’s syndrome. They believe Sally will look in the box for her marble because they know that’s where it is. They are unable to put themselves into Sally’s mind in order to understand that from her perspective the marble should be right where she left it: in her basket. Can you imagine how unpredictable and irrational the world must appear to a child whose logic is denied in such a manner? This is the world of a child with Asperger’s syndrome.

I work with children to help them build bridges toward understanding the behavior of others, so that they can come to anticipate that their own logical view of the world may not apply in all circumstances. This is one of the primary goals of therapy with these children. It is an attempt to help them experience the world as a safer place than it appears when their logical perspective is consistently shattered by experiences that do not align with it.

How many relationships do you see around you that you would actually want to be in? For most of us, we can count the number on one hand. An even better question might be, “Am I in the kind of relationship I would want my own child to be in someday?” If you want to top that and move into the area of upping your chances to have an exceptional relationship, you will ask yourself, “Am I being the kind of partner I would want my child to have someday?”

As a therapist who has worked with couples for more than a decade now, I see a disturbing trend on the rise. We are settling for mediocrity in ourselves as partners while expecting our partners to be exceptional, asking more of them than we do from ourselves. If you are thinking to yourself, “Could this be me? Am I being an exceptional or mediocre partner?,” please keep reading. because there are three simple traits that genuinely happy and fulfilled couples seem to have in common. If you are looking to take your relationship to the next level, consider raising your personal standards in any of the following ways, remembering that if you want a better relationship, it begins with looking at one’s own self first and foremost.

1. Exceptional partners have a good idea about what makes it difficult to have themselves for a partner, and they feel a sense of appreciation and respect for the challenges their own personality presents for their partner. They work hard to keep these attributes in check and not let them get out of control. Mediocre partners are rather hazy about their own shortcomings as a partner but can easily enough rattle off a long list of their partner’s flaws.

It is easy enough for most people to list off a handful of traits that make it difficult to have their significant other for a partner, but when the question is turned back on oneself—”What makes it difficult to have MYSELF for a partner?”—the exceptional partner demonstrates a rare willingness to identify his or her own shortcomings and backs this up with a steady commitment to managing and keeping his or her own difficult traits and imperfections in check so that they don’t impact the partner in unfair ways.

Whenever I work with a new couple, I always eventually get to that question because it helps me understand how to best help them. The old saying, “We can see everyone but ourselves when we enter a room,” applies to relationships, too. It’s normal to not know the answer to this question, but the willingness to be open and want to know the answer is everything. As the research from the world-renowned Gottman Institute has found in Seattle, Washington, female partners in particular need to know that their opinions and feedback truly matter to their partners. This is actively demonstrated by listening with the sincere intent to understand the other’s feelings and positions and find common ground and areas for compromise and by validating your partner’s stance without necessarily agreeing with it.

2. Exceptional partners understand that while they are not responsible for their partner’s happiness, contributing to their partner’s happiness is nonetheless a top priority. Mediocre partners, in contrast, are primarily focused on their own gratification first, and while they too can be thoughtful, thoughtfulness is not a daily habit.

Years ago, I placed a beautiful canopy bed up for sale. A couple arrived to purchase it. As they dismantled the bed piece by piece, there was an attitude of playfulness and a sense of mutual joy they took in one another that was striking in its rarity. “What’s your secret?” I asked them. They shared that the secret of their successful marriage was that every morning they ask themselves, “What might I do today to let my partner feel loved?” Exceptional partners make it a habit to be exceptionally thoughtful. They seem to recognize that life is short and seek out ways on a regular basis to express their love. For these couples, love is indeed not just a feeling but an active verb.

3. Exceptional partners ask a lot of themselves and not more nor less of their partners. Mediocre partners, on the other hand, have the balance tipped in the opposite direction. They either are asking more of their partner than they are of themselves or sacrificing their needs regularly in order to serve everyone else, leading to chronic feelings of depletion and often bitterness and not feeling appreciated.

It is often said that we should ask more from ourselves than others because this is the one thing that is in our control. However, this advice has its limits when it comes to the person we spend our lifetime beside day in and day out. Exceptional partners consider themselves a work in progress and make a habit of expressing their needs and desires in a direct yet respectful way. They insist on both treating their partner well while also being treated well in return. In other words, they invest heavily in the success of the relationship and expect their partner to bring this same level of consideration and commitment.

Mediocrity in our relationships may be our conditioned norm, but we can move into the exceptional this very moment by expanding our commitment to ask more of ourselves, appreciating our partner in ever deepening ways, and becoming voluntary stewards of one another’s joy.

Related articles:
Creating the Foundation for a Healthy Relationship
9 Secrets for a Lifetime of Like, Love, and Lust
If Only My Partner Would Change, Then Everything Would Be OK

Texting has, in many ways, made communication easier by helping people avoid long, unpleasant phone conversations and making a quick “Hello” much easier. According to the Pew Research Center, 72% of teenagers text regularly, and one in three sends more than 100 texts per day. Clearly, texting is the preferred method of communication among young people, and that trend is moving upward toward adults, who are also texting much more frequently. While texting hasn’t been around long enough for researchers to study its long-term effects on communication, there is circumstantial evidence that it is rapidly altering the ways people communicate with one another both via text and in person.

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Face-to-Face Communication

Texting encourages rapid-fire, single-sentence thoughts, but this style of communication isn’t conducive to face-to-face communication. Consequently, people who text a lot may be more uncomfortable with in-person communication and may even use their cell phones to communicate with people who are in their presence. Parents often report that their teens text during dinner, and the friend who texts during a group night out is a common phenomenon. The reality may be not that these people are being rude but that they are uncomfortable with slow-paced, in-person communication.

Surface-Level Communication

Texting increases the frequency of small talk and can be a great asset to people beginning to form a friendship; they may be much more comfortable texting each other witty one-liners than they are picking up the phone and calling. But texting is, almost by definition, surface-level communication. When people communicate primarily via text, they’re much less likely to have meaningful conversations.

Written Communication

People know they’re using improper grammar when they text; it’s merely a shortcut that enables them to relay a message quickly and effectively. But over time, the way we communicate—even if we know the way we communicate is “technically” wrong—affects the way we think. The result is that people who have grown up texting may have much poorer writing skills than people who regularly communicate using grammatically correct sentences either in person, over the phone, or via email. Even worse, they may lose their ability to modify their tone and style depending upon who they talk to. Many employers complain that entry-level hires have no idea how to send a business email or communicate appropriately to superiors.

Impatience and Instant Gratification

Texting is real-time communication but is not in person. This creates an odd situation in which people feel compelled to respond immediately via text, but they aren’t really participating in an ongoing, progressively deepening conversation. The instant gratification of texting can lead to incredible impatience, even aggression. But when people are in person, the requirement of communicating immediately can be daunting for people communicating primarily via text. Thus texting can inhibit both in-person communication and texting itself.

Social Boundaries

Unlike phone calls, there are no clear rules about when it’s acceptable to text. And because texting doesn’t result in an angry person answering on the other end, many people feel more comfortable texting at any time and in any circumstance. The result is a decrease in privacy and social boundaries. People may text in the middle of the night or while someone is on vacation and expect an immediate response, because of the impatience texting encourages. The result is a blurring of the lines between public and private. While a couple might previously expect no interruptions on a vacation or honeymoon, they can now anticipate receiving and responding to texts. Because texting is not old enough for psychologists to know how this affects intimacy, we can only guess at its long-term effects on relationships.

References:

1. Alison Bryant, J., Sanders-Jackson, A., Smallwood, A. K. (2006). IMing, Text messaging, and adolescent social networks. Journal of Computer-Mediated Communication,11(2), 577-592. doi: 10.1111/j.1083-6101.2006.00028.x
2. Hanna, J. (n.d.). W&L Psychology Project examines cell-phone usage and adolescent health. Washington and Lee University. Retrieved from http://news.blogs.wlu.edu/2012/07/24/wl-psychology-project-examines-cell-phone-usage-and-adolescent-health/
3. Influence of Texting on Communication Skills. (n.d.). Influence of texting on communication skills. Retrieved from http://artofeloquence.com/texting/

According to a recent article, being completely honest with your mate about infidelity might not always be the best strategy. Clinical Psychologist Bruce Stevens explained that understanding the need to be honest about the affair can help guide the decision whether to do so or not. Stevens has worked with couples for more than two decades and said that his experience has shown him that only about half of marriages survive after an affair has been revealed. He says, “After an affair is found out, it’s like a bomb has been dropped on the relationship and you cannot predict how it will go.”

When someone confesses to having an affair, it can create a sense of chaos unlike any other the relationship has ever experienced. Stevens knows that couples who put in the effort to work through the many issues that arise after the affair have a good chance of salvaging their relationship and usually have a stronger, better, healthier relationship because of it. Stevens says that many people admit to their affair in order to assuage their own guilt. He believes that this reason should not be the motivating factor for full disclosure. Stevens says there is no guarantee that both partners will be able to overcome the damage caused by the truth and thinks it’s almost like playing Russian roulette.

The good news is that Stevens also thinks that there is significant hope for couples who can be realistic after they go through the pain of discovering an affair. If both partners are willing to accept responsibility and recognize that they are both human beings, flawed and imperfect, they have a very good chance of moving forward in their life together. Regardless of whether partners choose to come clean about their infidelity or not, Stevens reminds us that affairs are like fairytales. They are illusions that allow us to temporarily escape reality. The difference is, affairs rarely end “happily ever after.”

Related articles:
Reasons for the Affair
When Is the Marriage Really Over?
The 5 Truths Every Married Person Needs to Know About Affairs

One of the primary goals of successful therapy is the formation of a meaningful and strong therapeutic alliance. This bond between the therapist and client is essential for creating an environment of openness, acceptance, and trust. Therapists are largely responsible for developing this foundation, but clients contribute significantly to the bond as well, even if they are unaware they are doing so. Many clients bring past experiences into therapy. Negative and judgmental encounters with previous therapists can cause clients to be distrusting and fearful in treatment, creating barriers to constructive working alliances. Understanding how clients’ past experiences influence the therapeutic bond, and how therapists can overcome these challenges, was the focus of a recent study conducted by Christian Moltu of the Division of Psychiatry at the District General Hospital of Forde in Norway.

Moltu interviewed a dozen therapists and asked them to describe how they overcame hurdles they experienced with hesitant and resistant clients. The therapists were trained in a range of approaches and yet each described similar methods for interacting with difficult clients. Each therapist stated that he or she achieved a productive working alliance, despite their clients’ reservations, by doing one of three things. The therapists said that successful alliances occurred when clients asked the therapists to help them with the relational challenges they faced. Additionally, therapists noted that bonds were built when they acknowledged the clients’ willingness and courage to overcome existing challenges. Lastly, when clients were unable to move past victimization and suffering, therapists found a way to build a bond with them by recognizing this deficit in their clients and explaining that the goal of therapy was to move from challenging situations to positive outcomes. Moltu added, “We found that participants experienced the client as contributing relationally and that this influences how the therapists respond and are present in the interaction.” By being attentive to the past experiences a client brings to therapy, a therapist can work with the client to overcome these limitations and ultimately develop a strong and cooperative therapeutic relationship.

Reference:
Moltu, C., Binder, P.-E., Stige, B. (2012). Collaborating with the client: Skilled psychotherapists’ experiences of the client’s agency as a premise for their own contribution in difficult therapies ending well. Journal of Psychotherapy Integration. Advance online publication. doi: 10.1037/a0028010

Children with social, emotional, and behavioral difficulties (SEBD) often exhibit speech, language, and communication needs (SLCN) as well. Clinicians and educators who work with these children have the challenge of identifying which type of treatments will best serve the needs of these special children. SEBD has been shown to be linked to communication deficits, but this relationship has not been fully explored. Gender, social conditions, intelligence, and relationship styles are factors that contribute to both SLCN and SEBD. Most children with these problems are not identified until they enter school, making the correlation between them more convoluted. For instance, executive function deficits may not be discovered until children enter school and exhibit symptoms of attention deficit hyperactivity disorder (ADHD). Other children may live with negative psychological and physical conditions such as abuse or neglect that can cause the children to stifle their communication, resulting in communication problems later on.

The most common type of treatment for SEBD is cognitive behavioral therapy (CBT). In a recent analysis of existing research, James Law of the Institute of Health and Society at Newcastle University in the UK looked to see whether CBT was ever combined with communication therapy for children. He also studied the research on CBT outcomes in children with Asperger’s, autism, and anxiety to determine whether the therapy had any positive impact on communication skills. For his research, Law examined 19 separate studies that included data from 148 children with SEBD and SLCN.

Although Law did not isolate one particular CBT approach that would be most beneficial for these children, he did discover that variation in communication enhancement techniques had a positive impact. Specifically, more formal techniques appeared to help the children with autism spectrum issues the most, and naturalistic and educational approaches were identified as effective methods for children with mild communication and behavior problems. In conclusion, Law added, “The potential overlap between SLCN and SEBD needs to be widely recognized by practitioners, and the implications for practice of this overlap explored more fully.”

Reference:
Law, J., Plunkett, C. C., Stringer, H. (2012). Communication interventions and their impact on behaviour in the young child: A systematic review. Child Language Teaching and Therapy, 28.1, 7-23.

Whether or not we believe we should talk about sex with our therapist in treatment may have something to do with what we believe therapy is for or what the expected outcome is.

Are you going to therapy for a relationship issue? For a mental disorder such as depression or anxiety? To overcome trauma? Or because you are having a difficult time adjusting to a new situation? Therapy is useful for a multitude of issues, and no, sex may not be the most significant thing affected by a particular issue, but it definitely doesn’t hurt for the therapist to ask about it, to allow for the conversation to include some open, honest discussion not just about sex but also about sexuality, to at least let the client know it is okay to bring up the topic of sex in the therapist’s office.

Pervasive in our society is the inability to talk about sex, awkwardness, and embarrassment, which in turn leave us often bereft of the coping skills required to handle sexual issues in our relationship as they come up. When we avoid talking about sex with our partners, it can lead us down the path of avoiding talking about lots of other things as well. We all know that open, honest communication is key in successful relationships, so the absence of conversation and inability to talk about sex with our partners can be like a ripple effect in the breakdown of communication in a relationship.  And when we go to therapy and our therapist also doesn’t feel comfortable talking about sex, the therapist in turn perpetuates what society has taught us—that sex is too taboo to talk about. This may be okay for some, but not for all. Some people want a more comprehensive experience.  Some people want more than just a quick fix for their problems. Some people want to address the problems at their root. Some people want real change and real growth.

In treating relationships, sex must be addressed. Sex is not always everything, but in relationships it is definitely something. Most therapists treat some aspect of relationships. Even when an individual comes in for treatment for depression, anxiety, trauma, a new life situation, etc., if the person in therapy is involved in a relationship, or is dating, or even if they are single and celibate, a few questions encouraging open, honest communication about any concerns he/she has about sex can make all the difference in the world. Therapy should be a nonjudgmental safe haven where an individual can work stuff out, ask questions, and find answers. An avoidant therapist who is uncomfortable talking about sex sends a subtle message that can perpetuate feelings of shame, guilt, or embarrassment about sex, which in the end thwarts growth. Therapy should promote growth, not thwart it.  In couples therapy, it is absolutely pertinent to ask about sex.

Feelings about our sexuality and our bodies are core in our lives. Many people walk around feeling bad about their desires or fantasies. Shame and guilt about sex are extremely common, and people have very little awareness of this. If a self-loathing, self-hating, guilt-ridden client comes to therapy, is it not best to address where the feelings come from? A client may not be that aware of the root of the problems. It is important for the therapist to open the door for exploration and discussion.

Therapists do not even have to be especially knowledgeable about sex. In fact, therapists rarely know anything about what the client has experienced, in terms of sex or any other aspects of the person’s life. Therapists are trained to ask questions in order to understand the client’s experience. The client is the expert on his or her experience. A therapist’s job is to ask questions and provide a nonjudgmental environment to foster the client’s growth.  In looking at it from this model, therapists do not need to be well-versed in something to be open about it.

Therapy is a holistic health treatment that is helpful in guiding people to lead happier, healthier, genuine, and more honest lives all the way around. In therapy we attempt to break down the road blocks that prevent us from moving forward on our life journey, whether it be in our relationships at work or with our friends, family, or partner. Many psychological issues have a physical manifestation. It is important to remember that a sexual issue may be a representation of something bigger, stemming from depression, anxiety, or a relationship problem. We cannot treat problems in a vacuum. Mind and body are connected. When you leave sex out of treatment, the client’s journey remains incomplete.

Related articles:
Sex Talk
The Importance of Addressing Sexual Issues in General Therapy
The Elephant in the Room: Why We Need Full Disclosure in Sex Therapy

Healthy conflict resolution is essential to maintaining positive and constructive adult relationships. Individuals usually learn how to handle conflict in childhood. Children watch the way adults work through disagreements and model those patterns of behavior as they develop into adults and begin to form relationships with others. The bonds that children have with their caregivers also influence the way in which they address conflicts. People who have secure attachments with their parents and caregivers are often able to work through challenges with other people in respectful, affectionate, and loving ways. They are capable of recognizing when they need to ask for forgiveness and are willing to compromise to achieve a resolution that is mutually satisfying to all involved. Individuals who have insecure attachments, however, are often unable to handle situations as amicably. Insecure attachment can be expressed through avoidant or anxious behaviors. People who are avoidant in nature tend to withdraw and shut down when faced with conflict. Anxious individuals may demand attention, even negative attention, and use aggressive and hostile tactics to engage someone in a conflict dispute.

For children who have grown up witnessing dysfunctional conflict resolution strategies, having a secure attachment with others could help them avoid making the same mistakes of their parents. Rather than continuing the negative behaviors they have seen displayed by their own parents, these secure, self-reliant, and confident people may choose to use healthier mechanisms to maintain harmony in their adult relationships. Joyce A. Baptist of the School of Family Studies and Human Services at Kansas State University wanted to better understand how attachment style affected emotional processing learned in families of origin. She enlisted 203 young adults who had been raised in families with various emotional functioning styles for a study that evaluated how the adult children managed conflict.

Baptist found that the participants who had witnessed extreme disengagement in childhood were more likely to use aggressive and antagonistic disagreement strategies in adulthood. The most anxiously attached individuals in this group were the most apt to engage in hostile behaviors as their anxiety escalated. Those with minimally avoidant styles worked through disagreements in a more civil way. Baptist believes these results suggest that secure attachments can help protect individuals from dysfunctional and destructive conflict resolution patterns. These findings could impact how professionals assist people who have communication and compromise problems in their adult relationships. She added, “Considering the interrelations between emotional processing in families of origin and insecurities in attachment will allow therapists to better identify and treat the root of the destructive conflict behavior.”

Reference:
Baptist, J. A., Thompson, D. E., Norton, A. M., Hardy, N. R., Link, C. D. (2012). The effects of the intergenerational transmission of family emotional processes on conflict styles: The moderating role of attachment. American Journal of Family Therapy 40.1, 56-73.