Family burden is a term that encompasses all of the challenges that may exist for an individual who lives with someone who has experienced a significant illness, particularly a long-term illness. Even if the illness does not require that the family member provide care for their loved one, the emotional toll that the illness can have on the family is part of the overall burden. Additionally, any caregiving responsibilities and financial, relational, and personal effects are considered part of family burden. Because family caregiving is becoming increasingly popular and more individuals are living for longer periods with physical and mental illnesses, it is imperative to understand how family burden affects the caregivers and even significant others who do not have to provide care. Therefore, Edel Ennis of the School of Psychology at the University of Ulster in the UK recently conducted a study that explored the relationship between family health, family burden, and participant psychological well-being.

Ennis considered the type of illness, noting that some illnesses such as bipolar, dementia, and Alzheimer’s are particularly emotionally taxing on family members, the relationship between the participant and ill family member, marital status, income, and gender. After examining over 3,000 participants, Ennis found a direct and distinct relationship between family burden and individual mental health. Specifically, the higher the perceived family burden was; the worse the psychological well-being of the participant. For women, high family burden was related to increased risk for depression. For men and women, low income, and singlehood were risk factors for increased stress and poor mood. Ennis believes that limited finances and lack of other people in the home to provide support could explain this finding.

One result that was unexpected was that the participant’s relationship to the ill family member did not affect overall psychological well-being. Previous research has suggested that caring for a spouse is often more emotionally depleting than caring for a parent or child. However, in this study, that was not the case. But, Ennis did find that younger caregivers were more vulnerable to negative psychological outcomes. For all the participants, higher family burden was reported for family member mental health problems versus physical health problems. In conclusion, this study shows that individuals living with an ill family member, even those who do not directly provide care, are at risk for psychological problems and should be targeted for interventions. Ennis added, “This is essential given the increasing numbers of individuals requiring additional support, and the increasing reliance on the family to provide this support.”

Reference:
Ennis E., Bunting, B.P. (2013). Family burden, family health and personal mental health. BMC Public Health 13: 255. Published online 2013 March 21. doi: 10.1186/1471-2458-13-255

Boy, what a stressful situation this must be for everyone. I think your concerns about your children and desires to keep them safe are perfectly normal—and warranted, given the erratic and “disruptive” behavior of your (ex?) husband, which apparently includes visits to jail and mental hospitals. I think the first thing, if you haven’t thought of this already, is to make sure any potential visits (even if Dad is “on his meds” and reportedly doing OK) are strictly supervised. Perhaps the most appropriate thing, if/when he is again permitted to have visits with the children, is to ensure visits are made in very controlled, safe situations. Again, this may have occurred to you already, but there it is.

The main point of your question is how to speak to kids about things that even we adults struggle to comprehend, and that may even frighten us. We Westerners, with our love of hard science, tend to be more at ease with what we can see and touch; mental issues often seem intangible, hard to define and treat with the same precision as physical illnesses. This can create anxiety and frustration, including the question of how to talk to children. Rest assured, there is no “right” way to do this. The only way is trial and error, in the seeking out of that elusive combination of honesty and appropriateness, much of which, of course, depends on your children. Some kids are astonishingly open-minded and earthy about things; others have more anxiety and need to be treated much more delicately. Some 8-year-olds may say matter-of-factly, “So my friends say Dad’s crazy, is that true?” Others may very tentatively say, with much worry, “What’s wrong with Daddy?” The first step is to acknowledge their feelings about what’s happening, validate their experiences (“yes, this stuff is a little scary”), and most importantly to reassure them that his behavior has nothing to do with them. I’m sure their father is a good person in a bad predicament.

Know that it’s OK for you to share some of your own feelings about this, including anxiety, worry, frustration, what have you. It’s likely worth talking about with a friend first, to sort out what you do and don’t want to say to your kids. (For instance, if you’re angry at him, it would be more appropriate to vent to a confidant than the children, though you might say that sometimes you get angry at the behavior, that his illness makes him do things that are hard to understand.) The point is, you are going to be the prime role model in how to handle this. If you are calm and balanced (as best as you can manage), they’ll feel that; if you seem overly anxious, angry, or indifferent, they’ll likely pick up on that, too. I don’t get that impression from your letter, by the way. You seem quite involved and caring.

It’s OK to say “I don’t know” if you don’t know the answer to something. Perhaps you can pursue answers as a family. For instance, there are helpful children’s books on mental issues, available via Google or Amazon. Seeking knowledge and education makes things less scary, and the good news is that, as awful as these issues are, better medications and treatments are coming along, seemingly every other day. (Is it possible, incidentally, that the schizophrenic episodes are connected to the mania? I’m not sure what “bouts of schizophrenia” means, unless you mean bouts of psychosis—visual or aural hallucinations, extreme paranoia, etc.—which can be related to the mania. Fortunately, the medications available are much better than they were, say, even 10 or 20 years ago. Is he regular with his medication? Many with bipolar are not, which only worsens the other symptoms, such as posttraumatic stress, psychosis, etc.)

I also wonder how much of their father’s issues are personality driven. With all due respect, I have worked with people with psychotic and extreme mood issues, and not all of them end up in jail. I don’t want to make any presumptions, but it sounds like he may have some other issues going on that might also explain his illegal and disruptive behaviors. (Does he have a drug problem?)

It’s scary to consider this, and not easy to say, but as parents (and I am one) we want to keep our kids safe, protected, and healthy, but there are limitations to those protections, since we are all too human. One of the very positive things my parents did for me was to take the stigma and fear out of seeking out counseling or therapy. I can’t help thinking that a family therapy session or two might help you—not only to destigmatize the mental health profession (which their dad so obviously needs), but also to allow your children to talk to a professional about their father’s issues. Education and de-escalating fears, again, creates greater emotional safety. These issues are difficult, but they need not be terrifying. Having a professional involved, even briefly, takes some pressure off of you, while it allows you to role-model for them an example of seeking help rather than the pressure of having to know all the answers (who does?).

A long, drawn-out course of therapy may not be needed; however, these kids have been exposed to some pretty disorienting fatherly behavior, and it might be a relief to them to talk freely to someone about their feelings, questions, and perceptions, someone not directly involved. Very often kids are protective of their parents’ feelings, or wary to contradict what they sense one parent is feeling about the other. Speaking openly and freely about their emotional experience could help reduce any potential anxiety.

I hope this is helpful. Your children are lucky to have such a caring, protective mom. Thanks for writing.

Respectfully,
Darren

Children are a product of their environments. Just as children who are brought up in loving, supportive, and caring environments are more likely to behavior that way as adults, children who are brought up in fear, anger, and hostility have a higher chance of experiencing similar environments in adulthood. But does this same theory apply to acoustic and physical chaos? Syeda Shamama-tus-Sabah of the National Institute of Psychology at Quaid-i-Aaam University in Pakistan wanted to explore this question. In a recent study, Shamama-tus-Sabah reviewed parent and teacher reports on 150 elementary school children. The children ranged in age from 8 to 11 years old and were all living with educated mothers. The children were assessed for depression and aggression to measure adjustment.

Shamama-tus-Sabah found a direct link between chaos and adjustment. “The results indicate that children from high chaotic families exhibit more aggression and depressive symptoms as compared to children from low chaotic families as reported by their parents and teachers,” said Shamama-tus-Sabah. This finding suggests that children who are not living in structure and routine may be more likely to struggle with behavior problems. This can lead to risk taking, including alcohol and drug use, tobacco initiation, and even sexually risky behavior. When Shamama-tus-Sabah looked at gender as a contributing factor, she found no difference in the chaos-adjustment relationship for girls and boys.

Some research has suggested that boys are more sensitive to chaotic environments, and therefore have higher levels of maladjustment than girls from similar environments. This research provided no support for that theory, but future research might explore that more in order to see if other types of maladjustment, aside from depression and aggression, manifest in boys more than girls. In western cultures, chaotic homes are not uncommon. However, in Pakistan, the increase in chaotic home lives, with more parents working and cities becoming overcrowded, could increase the risk for maladjustment in the youth population. In order to get a broader picture of the effects of chaos, future work should examine the gender aspect more thoroughly and should include parents of varying degrees of education and socioeconomic status.

Reference:
Shamama-tus-Sabah, Syeda, et al. (2013). Chaotic home conditions and children’s adjustment: Study of gender differences. Pakistan Journal of Psychological Research 27.2 (2012): 297-313. ProQuest. Web.

According to sociobiology, genetic preservation is at the core of human behavior. Because it is inherent in our genetic structure to ensure survival, individuals are predisposed to take measures to guarantee their genetic survival. In other words, they favor strategies and methods that will increase the likelihood of their family lineage being carried on. This is done through positive and negative methods. Positively, people have children so that their genetic tree can be extended to further generations. Negative methods of preserving genetic lineage also exist and include violence and aggression toward people who are not blood relatives. Based on these theories, it could be assumed that stepchildren are more likely to be abused by parents than biological children. In fact, some research has provided evidence of a 5-fold increase in risk of child abuse for step-children compared to biological children.

There is abundant evidence that children living in stepfamilies are more likely to experience sexual abuse. And children living with unmarried parents are also at risk for abuses including physical, sexual and emotional abuse. However, it has not been clearly established if stepchildren are injured as a result of their abuse more often than biological children. To get a better look at abuse rates among biological and stepchildren, Stewart J. D’Alessio of the Deaprtment of Criminal Justice at Florida International University recently examined data from more than 130 cities that was used as part of a larger study on abuse incident reporting. He looked at the biological status of the children, as well as the socioeconomic condition of their environment, as it has been suggested that disadvantaged communities have higher levels of stepchildren abuse.

D’Alessio found that children living in disadvantaged communities were more likely to experience abuse than those in socioeconomically advanced environments. He also found that the age of the perpetrator was influential of abuse. Younger parents were more likely to abuse children than older parents. However, there was no evidence suggesting that stepchildren were at increased risk for injury. “Contrary to expectations,” said D’Alessio, “Our results showed that the effect of a child’s genetic status on the likelihood of physical injury was in the opposite direction as predicted by sociobiology.” In fact, the stepchildren were less likely to be physically injured than the biological children. D’Alessio notes that these findings raise more questions for future research, and that that exploration should consider that many incidents of abuse are never reported. Methods to ascertain more reliable and valid abuse rates should be investigated in future work in this area.

Reference:
D’Alessio, Stewart J., PhD, and Lisa Stolzenberg. (2012). Stepchildren, community disadvantage, and physical injury in a child abuse incident: A preliminary investigation. Violence and Victims 27.6 (2012): 860-70. ProQuest. Web.

Visions of winning the lottery are enough to turn just about anyone into a dreamer who fantasizes about helping family members, starting charities, and—of course—buying a few nice cars and homes. But a 2006 study published in the Journal of Health Economics found that while lottery winners experience extreme happiness after winning, their happiness levels return to pre-lottery levels not long after.

For some lottery winners, winning the jackpot leads to utter misery. Bankruptcies, divorce, family troubles, and mental health issues including suicidal ideation sometimes come along with winning the lottery; many winners have met disastrous or tragic ends. How can a dream come true turn so rapidly into a nightmare?

Massive Change
Statistically speaking, happy life events such as the birth of a baby, a new marriage, or buying a house are among the most stressful experiences a person can have. Lifestyle changes require rapid adjustments, personality alterations, and negotiation of new boundaries and relationships with loved ones.

The lottery is no different. Going from rags to riches overnight can be overwhelming. Not only must a lottery winner plan for what to do with the money, he or she must negotiate changed relationships with friends and family, the challenges of a new lifestyle, and the potential boredom that comes with no longer working. People are vulnerable to depression and anxiety during major life changes, and the lottery may ignite a cascade of negative psychological and interpersonal events.

Poor Preparation
Low-income people are more likely to play the lottery than other groups; some analysts have even argued that the lottery functions as a “tax on the poor.” People who are unaccustomed to balancing complex budgets may be ill-prepared for the financial demands that come with winning the lottery. A $100 million jackpot might sound like a lot, but when it’s split between 20 relatives, a dozen charities, 10 new cars, and five houses, it’s not what it’s cracked up to be. Predatory financial planners may also prey on lottery winners, taking large commissions in exchange for poor or nonexistent advice.

Unceasing Demands
The moment a lottery winner wins, the phone starts ringing. Charities, friends, family members, and political causes all want a piece of the action. The price of saying no can be costly, particularly among family members who don’t understand why deep-pocketed lottery winners can’t finance their dreams—or at least their basics. Relationships may be left permanently broken, and the constant demands from strangers and loved ones can be crushing.

Little Credibility
Unlike people who build businesses or even inherit their money from successful parents, lottery winners might not be readily welcomed into the club of the super rich, and they may be derided as simply lucky. A lottery winner who dreams of building a charity or a new business might be questioned about his or her competence. Jealousy over winnings can cause people to say hurtful, mean-spirited things, and a lottery winner might spend the rest of his or her life hearing that the good fortune is not deserved. Pressure in the form of stress, anxiety, guilt, and self-image issues can add up.

References:

1. Adams, S. (2012, November 28). Why winning Powerball won’t make you happy. Forbes. Retrieved from http://www.forbes.com/sites/susanadams/2012/11/28/why-winning-powerball-wont-make-you-happy/
2. Doll, J. (2012, March 30). A treasury of terribly sad stories of lottery winners. The Atlantic Wire. Retrieved from http://www.theatlanticwire.com/national/2012/03/terribly-sad-true-stories-lotto-winners/50555/
3. Spector, D., Lubin, G., & Kelley, M. (n.d.). 18 signs that the lottery is preying on America’s poor. Business Insider. Retrieved from http://www.businessinsider.com/lottery-is-a-tax-on-the-poor-2012-4?op=1

Some people come to therapy full of negativity and anger toward parents whom they hold responsible for the way they feel and the lives they live. For example, they might explain their difficulties in relationships by referring to a parent’s emotional coldness, criticalness, or divorce. Or they will fault a parent’s lack of encouragement and involvement when they were growing up for their failure to do well academically or professionally. Blaming parents for their struggles keeps these people stuck in angry, anxious, and depressed feelings, and interferes with their ability to think about what they could do to make their lives different.

“Gloria” came to her first therapy session with me and immediately began to talk. Sounding irritated, she explained, “I’m here because I can’t take it anymore. I hate my life. I’m either angry or depressed. I’m 29 years old and I haven’t been in a relationship for more than three months. I can’t seem to keep my jobs for much more than a year. For nine months, I’ve been working as an assistant in a recruiting firm where I answer phones and type résumés. I know I’m smarter than that, but I don’t know what else I want to do. I seem to go from one dead-end job to another. I’m such a loser.” Then Gloria sobbed, “I am just so stuck.”

Gloria began therapy. She typically entered my office with heaviness and depression, and talked about how miserable her life was and how hopeless she felt. She believed that nothing could change. When I asked her why, she thought she was stuck in this awful place, her lethargic demeanor changed to anger, and her voice turned strong.

“How could I change?” she said. “It’s all about my childhood. My parents separated when I was 5. My father left the house and I rarely saw him. Sometimes he would take me for a weekend, but I never believed he really wanted to. He met this woman, Fran, and all he ever talked about was her. They got married when I was 7, and then he moved to another state. I would visit them three or four times a year. She had two daughters. I could see how much he loved Fran. He never looked at me like that. He would criticize how I dressed and compare me to my stepsisters. I hated them. I could never get anything right, and they were so pretty and perfect, and I could see they were the children he wanted. When I would go home to my mother and complain, she would hardly listen. She never seemed very interested in me, either. She had a big, important job, and as I grew up, I didn’t see so much of her. She never got very involved in anything I did. She would even get nasty and critical if I told her about something good that happened. I remember when I told her that I had been asked to run for class secretary in middle school. She laughed at me and said, ‘You’ll never get elected, so you shouldn’t run. You’re just not popular enough.’ I believed everything she said about me, so I didn’t run. By middle school she had a serious boyfriend and she was always with him and never had time for me. I never thought I was good enough for much. When I think about it now, I can see my mother was really into herself and I think she was competitive with me. I don’t think she wanted me to succeed or dress well or have boyfriends. I guess she is still getting her way.”

The more I learned about Gloria’s childhood, the more I could understand why it was so difficult for her to have positive feelings about herself and to believe that if she worked at something, she could succeed. She consistently assumed people’s responses toward her would be negative personally and professionally. While her expectations were understandable in light of her childhood experiences, she was able, when pushed, to come up with memories of positive relationships, work experiences, and even good feelings about herself. Nevertheless, these exceptions to what she anticipated did not go very far in allowing her to step back and consider that she was not (in her words) “doomed to fail.”

It became clear to me that Gloria was stuck in blaming her parents for how she saw herself and how her life turned out. What made it so hard for her to move on? Was there some risk in letting go of her anger? Was there a downside to not living up to what she saw as her parents’ view of her? Was there something positive in it for her to blame her parents? These were the questions that occurred to me as I listened to Gloria, who presented herself repeatedly as a victim who would always be at the mercy of the impact of her past treatment by her parents.

I began to raise these questions to Gloria, who became curious about them. She began to consider the risks of letting go of her anger and blame. She talked about worrying that she would be letting her parents “off the hook” if she stopped blaming them or being angry. “They know how I feel and I like to think I make them feel guilty,” she said. “When I was a kid, they never seemed to expect me to amount to much. They’ve gotten what they wanted, but I do think I’ve managed to finally make an impact. I think I’ve succeeded in making them feel guilty. If my life got better, maybe they wouldn’t feel so bad or guilty. I feel bad and I want them to feel bad.”

At first, when Gloria continued to talk about her desire to hurt her parents, she smiled and said, “Now that I understand that this is what I’m doing, I have to say that revenge is sweet.” She would also get angry in our sessions and acknowledge that this new awareness created a real conflict for her. “Rationally, I get that it’s me,” she said. “I can see that I think my parents are responsible for my being a failure. They made me this way, so I’ll be the loser they created. I want to hurt them. I guess I could work on getting the life I’m always moaning that I’ve never had, and I know that would be the best thing for me. But I just don’t want to give them any good stuff.”

As we continue to talk about this conflict, which creates great anguish for Gloria, she has not been able to choose to work on giving up her anger and blame. However, she is considerably less attached to viewing her life through the lens of doom and failure caused by her parents. She has begun to take some steps to get more for herself. She has gotten a promotion to recruiter, and has made a placement that will double her income this year. She has also enrolled in a management class at a local college. We’ve even begun to talk about online dating. As Gloria continues to work in therapy, I believe she will achieve more for herself and gradually be able to see her identity in a new way and identify less and less as a victim. As she allows herself to experience the satisfactions of success, I am hopeful that the pleasure of revenge will be less gratifying.

My work with Gloria is just one illustration of the ways in which blaming your parents can keep you stuck. There is a terrible paradox in these situations: You are angry and blame your parents’ treatment of you growing up for your unhappiness and failures in your adult life. But the wish for revenge and these angry, blaming feelings keep the connection and repeat the relationship between your “bad parents” and you, the unsuccessful, unhappy child. As a result, you are stuck in the position where you cannot become the person you say you wish to be or create the life you say you desire.

“I hate you!”

“You’re the worst parent who ever existed!”

“I can’t wait to move out!”

If you have recently heard these words (usually screamed at full volume, followed by the loud slamming of a bedroom door), you may be the parent of a teenager.

Only those of us with halos and wings are consistently able to respond to such statements with perfect compassion and sweetness: “I love you, honey, and I’ll be right here for you whenever you need me!” Parents are human beings, and as such we have a limited set of emotional reserves and resources, which can quickly become taxed by a raging or withdrawn teen.

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In fact, although you love your child as much as ever, you may be struggling with feelings of intense hurt, anger, dislike, distrust, grief, anxiety, and loneliness. You may feel that although you love your teenager, you just don’t like him or her very much right now. It may feel at times that your teenager has his or her finger on every one of your buttons, and is pushing them … all at once!

What can you do when the very child you love and worry over appears to hate and reject you as a parent?

Teens are known for their emotional volatility. Unfortunately, when parents become as overwhelmed by negative emotions as their teens are, they are no longer in a strong position to be stable, loving, or helpful to the teen. In fact, the parents’ hurt and anger can easily add fuel to the fire and bring about a downward spiral that both parents and teens feel helpless to stop.

To say teenagers value their friends and social life is an obvious understatement.  However, to family members around that teenager, it can seem as if by “choosing” to value their friends, the teen is showing the family that they no longer matter. Indeed, as illustrated by the quotes above, the average teenager may even say as much in the midst of an angry, hormone-fueled argument.

The traditional task of adolescence is to move away from exclusive identification with family and to explore the greater world outside of the home. Separation of the child from the parents is absolutely necessary and healthy at this stage. However, that separation must be counterbalanced by the availability of the parent to continue to meet the adolescent’s needs. Therefore, this is an extremely frustrating time for many parents.  They feel as if the teen is pushing the parent away, only to pull the parent back whenever he or she “wants something from me.”

In order for the adolescent to explore the larger world in a healthy way, the home and family must be a sort of “home base.” This means the teenager needs to experience his or her family as stable, its identity as stable, its love and acceptance as unconditional, and its boundaries as safe and secure.

Understand that by focusing on his or her peers, your teenager is not rejecting you. Instead, the teenager is simply transitioning through an intense period of changes. The teen needs the family life to remain solid and secure, so that he or she can return to it for comfort and healing when the peer world becomes too intense or overwhelming.

Teenagers may often resemble adults physically, but socially as well as cognitively, they still resemble children much more than adults. We now know that the human brain does not fully mature until the mid- to late twenties. Executive functions such as prioritizing, consequential thinking, and evaluating options are still coming online. Furthermore, teenagers do not have the life experience, confidence, or savvy to navigate the complicated demands of life as adults do.

Because of these factors, it can be useful for parents to see past the bravado and the occasional glimpses of maturity that their adolescent displays; to understand that, inside, there still exists the child who has needs he or she does not have words to express, who cannot meet those needs independently of the parent.

The family itself is also moving through a transition period. They must move into a new life stage, with new roles for each family member. It can be difficult to feel entirely ready for these changes. Many parents of teenagers experience this time as a loss: the loss of the innocent and impressionable child they once knew and enjoyed; the loss of the role of all-knowing nurturer and protector.

Parents often report that they feel that “time is running out.” When your 5-year-old threw a temper tantrum, you knew as a parent that you still had “endless” years in which to heal relationships and correct behavior. When your child is 15, you understand that the years are not endless and that damage done to the relationship now may persist into your child’s adulthood.

Because the family is a “safe launching pad” for their forays into the larger world, teenagers move into and out of their family, and not always on the parents’ timeline. Your teen may refuse to join you for dinner, hiding out in his or her room; he or she may seem to eat, sleep, and shower with iPod headphones on. He or she may argue endlessly over attending important family functions such as weddings or funerals. And, just when you think the teen has disowned the family forever, there he or she is, curling up next to you to watch a movie or opening up from the passenger seat on a long drive.

Recognize your teenager’s attempts to reach out to you for what they are: The teen is looking for reassurance from you that he or she is still a part of the family; he or she wants to know that no matter what he or she screamed at you last week, you still love him or her. The teen needs to feel certain that if the “real world” becomes too scary, he or she still has a safe place to return. In order to practice being an adult, your teen needs to periodically return to being a child—and this will happen when you least expect.

Nobody said being the parent of a teenager is always easy, fun, or fair. As the adult in the relationship, it is you who holds the responsibility. It is you whose role, although different, is still most important in these last years of your child’s development. It is you who must keep the gates of the family open for your teen when he or she needs to reenter them.

Once you can view your teen’s behavior from this developmental context, you can depersonalize it. It is no longer about your teen’s rejection or manipulation; it’s an understandable and necessary stage in his or her journey to reaching his or her own, full potential as a young adult. It becomes easier and more natural to meet the ebbs and flows of your teen’s changing needs. Even when, sometimes, the need is for separation from the parent.

Marriage counseling can save your marriage, prepare you for the stress of a baby, help you communicate more effectively, and get you on track for a lifetime of love. But when marriage counseling doesn’t work, it’s like throwing away money. This can make marriage problems even worse; studies show that many couples tend to fight often about money, and the false hope given by bad marital therapy can lead to despair and increased conflict.

If you need help in your relationship, it’s usually not enough to pick the first therapist you find online or on your insurance plan. Not every marriage counselor works well for every couple, and couples seeking help need to find someone who works for their specific situation.

Reputation and Recommendations
Recommendations from friends and other people you trust can be a great starting point for finding a therapist. If you’ve noticed meaningful change in someone else’s relationship, the odds are good that his or her therapist is doing something right.

If you can’t rely on recommendations from friends, read online reviews and check out discipline records with licensing boards. A therapist with a stellar reputation—particularly one who has been in practice for several years—is likely one who has a long history of helping couples wade through difficulties.

Shared Values
Marriage counselors each have their own approach to marriage. Some draw on biblical principles, while others are influenced by feminism and humanism. You don’t need to agree with your therapist about everything, but you do need a therapist who shares your core values.

If you and your spouse are struggling to build an egalitarian relationship in which you share chores, you need a therapist who recognizes this goal as important and who has helped similar couples. If you’re deeply religious, you need someone who understands the important role faith plays in your marriage. If you start therapy and your counselor makes a recommendation that runs counter to your core values, find someone else.

Strategy
A therapist isn’t a paid friend. And while marriage counselors can serve as referees and mediators, this should not be their only role. Your therapist should have a specific strategy for helping you move past marital issues.

Ask your therapist how he or she wants to proceed with treatment, and if there’s a specific therapeutic modality he or she uses. After you’re in therapy, if you don’t feel like the therapist takes control and directs the session, it may not be a good fit.

In therapy, many people want results without having to make lifestyle changes. If your therapist doesn’t call you on problematic behaviors or make suggestions about what you can do at home in between therapy sessions, he or she might not be proactive enough to help you navigate the storms of marriage.

Results
After you’re in counseling, the key measure of success is results. Your marriage won’t be changed after one session or even five, but if you’re slogging out your differences in therapy week after week with no change, it’s time to move on.

Some people get stuck with an ineffective therapist because they like the therapist or because they’re not carefully monitoring results. But good counseling works, and if you don’t notice changes within a few months, find someone else.

Questions to Ask
A good therapist will happily answer your questions, so if you struggle to get information, this is a glaring red flag. Some questions to consider asking in your first few sessions include:

• How long have you been in practice?
• How do you define success? How will we know we’re making progress?
• How long can we expect to be in therapy?
• How much of your practice is devoted to marriage counseling?
• What is your background and training?
• Do you think divorce is ever an option? Would you ever recommend divorce?

References:

1. Harley, W. F., Jr. (n.d.). How to find a good marriage counselor. Marriage Builders. Retrieved from http://www.marriagebuilders.com/graphic/mbi7100_counselor.html
2. Meineke, S. A. (n.d.). How to choose a marriage counselor. Center for Marriage. Retrieved from http://www.centerformarriage.com/how_to_choose_marriage_counselor.html
3. Questions to ask a marriage therapist. (n.d.). The National Registry of Marriage Friendly Therapists. Retrieved from http://www.marriagefriendlytherapists.com/questionstoaskatherapist.php

It is not unusual for people to come to therapy with feelings of confusion about what they want, think, and/or feel. I find that many grew up in families in which one or both parents involved themselves in their children’s lives in ways that interfered with the development of separate, individual thoughts and feelings. Most of these parents were well-intentioned. Their intrusion into their child’s life typically came from a need to protect the child from painful feelings or to assure that the child’s behavior and choices were the “right” ones. As a consequence, these children grew up relying on their parents to define not only what they should feel or how they should behave, but ultimately their identity: who they are as individuals. As adults, these children spend a lot of time in their heads worrying about the choices they make, how they are seen in the world, if they upset their parents by having separate ideas, if they did the right thing, etc. They become confused when the thoughts they have about themselves are different from what they know their parents believe. “What is true and real about me?” becomes the question that these patients bring to therapy.

“Sam” came to see me filled with anxiety. He didn’t know if he should continue in a relationship that was becoming serious. “I think I’m in love with Kara,” he said. “We have a really good time together, and she is very good to me. But then I get confused: Do I really want to spend my life with her? My father thinks she isn’t a good match for me. She’s Italian, and I’m German. I never really thought about things like that, but my father thinks that the cultural differences are too much. He also thinks that Kara’s family is very different than ours and that will be a problem when we have a family.” Sam continued to describe his uncertainty about how he felt and what he should do. I asked him if he thought he would be less unclear about Kara if his father approved. It was striking to me that this question seemed to startle Sam. It hadn’t occurred to him that his father’s opinion about what was good for him had such a profound influence.

Sam agreed to begin therapy, and we began to explore how he thought about himself and how he determined what he wanted and needed. It soon became apparent to both of us that Sam’s father had always played a big role in characterizing who Sam was. Sam recalled that he wanted to take guitar lessons when he was about 10. His parents bought him a guitar, and he liked strumming it and learning to play, but he had trouble with dexterity and was not developing into a very good player. After about six months, his father told him, “You’re not very musical. You should find a different hobby. You should try chess; you would be good at that.” Sam recalled: “Even though I enjoyed playing and fooling around on the guitar, I stopped the lessons. My father started to teach me chess. I did get pretty good at it and joined a chess club in middle school. My father always says with great pride how he knew I would love it because I’m such a rational and logical person, that chess is perfect for me.” Sam paused and thought a minute and said, “It’s funny, I never thought about this before. I think of myself as a logical guy, but then I never know what to make of all the feelings that seem to boil up in me. My parents don’t see me as emotional.” Sam paused again, seemed deep in thought, and then sadly said, “Wow, I guess I hide that part of myself from them. They don’t really like emotions.”

As Sam and I continued to talk, he became increasingly upset as he began to discover that much of what he thought about the kind of person he was mirrored his father’s view of him. He also began to realize that there was a judgmental attitude when his father told him what he thought. For example, his father still believed that Kara was not for him. His father had explained, “You’re not someone who can deal with opinionated people. She is too aggressive for you.” Instead of becoming confused and wondering if his father’s idea was true, Sam began to consider his own experience. He was learning to ask himself what was happening in his internal life and to study what went on externally. He thought about Kara and her opinions and realized that many of her ideas were different from those of his parents. But he also saw that she was flexible and, in fact, he often agreed with her. As he was more able to focus on himself and create some space apart from his father’s influence, he could consider how he felt. He didn’t feel conflict with an opinionated Kara. Rather, he was becoming aware that he disagreed with his father. This was not an awareness that he allowed himself to experience very often. It made him anxious, but now he second-guessed his experience less, and he was beginning to make space for his separate feelings and ideas to emerge.

Sam and I still have work to do. He is working on his relationship with Kara. As he develops the ability to know what he wants and feels, he is more able to express himself to Kara and that relationship is getting stronger. Sam continues to work on individuating from his father. After 30 years of relying on him to define and characterize who Sam is, it takes time to develop confidence in his own thoughts and feelings. There is still anxiety for Sam when he asserts his newly found voice with his father. Sam has recognized that his father’s judgmental tone has made it difficult for him to feel that his own perspectives are valid. His memory of his father telling him, “I’m your father and I know what you like and what is best for you” no longer feels just about his father’s love and concern. Sam is beginning to understand that his father is anxious, too, and that it is his anxiety that drives him to try to control Sam and to believe that he knows what’s right. Hopefully, as Sam’s sense of identity becomes more solid, he will be able to negotiate the relationship with his father so there will be room for multiple thoughts, feelings, and perspectives.

Well-intentioned parents who are critical and controlling may promote their child’s reliance on them to determine and define what is good and acceptable about the child. When a loving parent is so certain that he or she knows what is right for the child and does not consider that the child may have valid, different ideas about what he or she wants, needs, and feels, there is no space and no invitation for the child to develop the ability to express his or her own self with separate ideas, feelings, and needs. Over time, as the child grows to adulthood and is exposed to more ways of thinking about things, there is typically a good deal of confusion about identity, thoughts, and feelings. Unless there is an opportunity to develop a separate sense of self, there will likely be a lot of anxious thinking about what is real but little ability to think for oneself in a self-reflective way.

Editor’s note: Melissa Orlov, LLC, is a marriage consultant who specializes in working with couples impacted by ADHD. She is the author of the award-winning book, The ADHD Effect on Marriage: Understand and Rebuild Your Marriage in Six Steps, and provides seminars for couples and therapists. Her continuing education presentation for GoodTherapy.org, The ADHD Effect on Couples, is scheduled for 9 a.m. PST on January 25. This event is available free with 1.5 CE credits for all GoodTherapy.org members. For details, please click here.

In your couples practice, you may well encounter couples in which one partner is chronically angry while the other keeps making mistakes that are hard to understand, such as regularly forgetting to do something they’ve committed to, constantly irritating their partner by being late, or never cleaning up after themselves. The angry partner tries many things to motivate his or her partner—nagging, scolding, pleading, crying—but nothing seems to work. The forgetful partner is genuinely contrite, yet continues doing the same “stupid” things.

It is possible that this couple’s relationship is being impacted by undiagnosed attention-deficit hyperactivity (ADHD).

Learning how to work with couples affected by ADHD is a relatively new and very much needed skill in couples therapy. It is only recently that we have been thinking much about ADHD in adults, and according to expert ADHD researcher Dr. Russell Barkley, as many as 90% of adults with ADHD remain undiagnosed (1). Clients often don’t know they have ADHD or that it contributes to their marital issues. Many times, neither do their therapists. Unfortunately, unrecognized ADHD can wreak havoc in a relationship—in some research studies, almost doubling rates of marital dysfunction and divorce (2).

One of the side effects of the repetitive missteps of an ADHD partner is that anger builds in the relationship. Chronic distractibility, disorganization, and difficulty remembering things are hallmark traits of adult ADHD that can severely impact one’s life. They also don’t play particularly well in a relationship or at home. A chronically distracted partner is often not particularly good at attending to his or her partner in a way that communicates love. The feelings of love are there, but the partner is simply off doing other things. It is no surprise that non-ADHD partners often report that they feel intensely lonely in their relationship (3).

As distraction, disorganization, and other ADHD symptoms continue unabated, partners of those with ADHD can lose patience and become so angry that it colors every aspect of the relationship. Minor gaffes become major blow-ups because they are symbolic of bigger issues in the relationship. For example, an ADHD partner who leaves the milk out on the counter may be reprimanded by his or her partner for “never paying attention” or being “lazy,” even though in other situations leaving milk out might be considered a “nonevent.”

With enough rebukes, an ADHD partner (who often suffers from self-esteem issues in any event) begins to avoid engaging with the non-ADHD partner. Anger that he or she is being constantly criticized builds, too. Arguments escalate more and more quickly, and the couple find themselves in a strong, negative behavioral spiral. They don’t understand their partner’s seemingly arbitrary behavior, but do understand they don’t like it.

My observation is that by the time ADHD-impacted couples make it to counseling, they are often in very significant trouble. They’ve tried everything they can think of to “fix” things, but because they don’t know about the ADHD, have not found a workable solution to their conflicts. They are suffering from great emotional pain, and are often feeling hopeless about the relationship. Many are trying to decide whether to get divorced, but are confused. They feel they ought to be able to do better and don’t understand why they can’t.

The good news for therapists is that working with these couples can literally turn their lives around. First, couples are typically greatly relieved to realize that there is a reason for their problems. Also, identifying ADHD provides a significant chance for behavioral improvement in the ADHD partner. With effort, about 70% of those with ADHD can find treatment that provides almost complete, or at least very significant, improvement in their symptoms (1).

Naming the problem not only provides renewed hope, it creates an opening for redirecting interactions between partners. Certain types of communication tactics, organizing habits, and ways to “attend” to each other simply work better than others for couples impacted by ADHD. These are often not the same tactics that couples not impacted by ADHD use (3), so therapists need new training to optimize their effectiveness.

Sometimes that training includes learning a new style of interacting with clients. I find that these couples respond well to an “activist” approach to counseling that puts the therapist in multiple roles at different points in the therapy—that of expert educator, listener, ADHD coach, sex advisor, and investigator, to name some of the most common. These couples tend not to learn through self-reflection. Rather, they need active guidance to learn a new skill set that will enable them to live together successfully and bridge their often very considerable differences.

Yes, these couples often have really significant problems. Not all of them stay together. But with the right assistance, many of them are able to turn their relationships back into something they treasure. For therapists, it can be incredibly fulfilling work.

References:

1. Barkley, R.A. (2010). Taking charge of adult ADHD. New York, NY: The Guilford Press.
2. Barkley, R. A., Murphy, K. R., Fischer, M. (2008). ADHD in adults: What the science says.New York, NY: The Guilford Press.
3. Orlov, M.C. (2010). The ADHD effect on marriage: Understand and rebuild your relationship in six steps. Plantation, FL: Specialty Press.

The Family Man, starring Nicholas Cage, is a great Christmas movie, and I watched it last night. Nick’s character makes a choice at the beginning of the movie and, more than a decade later, is a very wealthy man. There’s a message from his old girlfriend, Kate, but he does not call her at that point. After a brush with fate, the next morning there’s a change in his life: He’s with Kate, two kids, little money, and he’s got to figure out what is important to him.

When he finally realizes what is important, he wakes up having never been married, and meets up with Kate—who is going to be flying to Paris and wants to give him back his old stuff. Back in his penthouse, he sifts through a box of memories. He goes to the airport to try to stop her and convince her about the life they would have had if only he’d made a different choice. If you have not seen the movie, I do not believe I totally spoiled it for you, but if I did, I am sorry. I wanted to capture the basics of the movie, but you will have to watch it to get the essence of the movie.

It’s Christmas time, and every year at this time, we are scrounging around to get the best gifts for our families or friends. The stores are packed, the after-Christmas sales will be going on very soon, people will be returning gifts to get what they really want, and the attitudes of people are not always joyous. If you do not need to be out shopping, then don’t. Each year, the shopping comes earlier and earlier, more sales, etc. I also think that each year, the meaning of Christmas—the birth of Jesus, being around family, friends, sharing love, kindness, helping others, and spreading cheer—diminishes. This is my opinion.

We each have a choice to make. Yes, I have fallen into making sure that my family and friends get the “best gift,” and feel so ragged that it can be hard to be joyous. Having a kid changes your perceptions on what is important and what is not.

With my almost 2-year-old son, I am reminded that it is not about the quantity of gifts that I give or receive but rather the quality of the time I spend with my family and friends. Whether it’s baking homemade peppermint patties (York need not worry about going out of business), decorating cookies, reading about the birth of Jesus, or watching holiday movies, it’s what I am doing with family and friends that counts. It’s watching my son’s face light up when we play with Legos together, or crash his trains and get the toy ambulance to come and help the trains get all bandaged up. The quality time I have with my husband is very important as well—how I do my part to strengthen the relationship (not talking about sex), the unity that we have, and help each other stay focused and not get lost in the emptiness that can come with giving a gift because it’s on sale.

Almost all Christmas movies are about being with the ones you love, spreading joy and cheer, laughing, playing, creating memories, etc. Many are also about people who are trying to get ahead and how empty they may feel because they are not connected to their friends or family. It’s like a wake-up call, and it happened to Nick in The Family Man.

This is your wake-up call. Remember: Each day, not just at Christmas time, tell your friends and family how much you love them, and play with your children and friends’ kids when you visit them. Allow the children to help you relive your childhood memories, and after Christmas, keep spreading that joy all year long.

Watch The Family Man. It might remind you of what is really important and help you find balance in your life.

Nicole is 16, and Ethan is 14. Their father, Jack, has battled brain cancer for the past two years. Jack was told recently that further treatment had a less than 10% chance of being successful. Jack wants to enjoy whatever time he has left feeling good and not being wiped out by chemotherapy. While no one wants to say it out loud, it’s clear that this will be Jack’s last Christmas (please substitute Hanukkah, Kwanzaa, etc., as appropriate).

How is Jack’s family supposed to come to terms with this? It can’t possibly be true. After the shock and complete denial subside, the painful reality begins to sink in. A flood of emotions comes with this realization, with profound sadness and anger often topping the list. It’s harder to face if your loved one is young and he or she has young children. The holidays speak of possibilities and are supposed to be a magical time for children; belief is suspended, and all holiday stories have happy endings.

The first step in dealing with this situation is to acknowledge that this will be someone’s last Christmas. Just saying that out loud will address the elephant in the room and help to decrease the stress that family members have been carrying internally. There will be tears, to be sure, but then the family can begin the process of grieving this sad reality together, rather than each member trying to deal with it alone. It is often the case that people don’t share their feelings with each other because they don’t want to be a burden, or want to protect the other person. In reality, family members are usually feeling at least some of the same things: fear, sadness, anger, and disbelief, to name a few.

After getting the topic out in the open, it’s time to think about how you want to celebrate this year. Don’t hold on to traditions if they don’t feel right. If you usually decorate your house to the rafters and host a cocktail party and an open house, it’s perfectly fine to do only some, or none, of those things this year. Every year, we all search for ways to make the holidays less commercialized and more significant. This year, it is especially important to ask yourself what makes the holidays meaningful for your family and your loved one. It may be as simple as sitting on the couch with a cup of eggnog and looking at the lights on the tree. Watching Christmas movies.  Listening to Christmas music. Going to a lights display. If your loved one is too ill to go out, he or she may still enjoy the experience by seeing photos of what others have done.

The person who is ill can give the gift of memories to those he or she will be leaving behind by writing letters or creating videos. If you are a parent, your children will one day be interested in what your life was like when you were young/their age. What words of wisdom do you have for them when they get their first boyfriend/girlfriend? Graduate from high school? Get their first job? Get married? Have a child? For some people, it is too daunting to consider making videos/writing letters; it puts them face to face with their own mortality too directly. In that situation, I suggest trying to think about it from your child’s point of view, not your own. The reality is that all of us will die, but not all of us will have the opportunity to choose how we spend the time we have left.

“It is not the magnitude of our actions but the amount of love that is put into them that matters.” —Mother Teresa