Recently, when I put my 6-year-old son to bed, he reminded me of something I can sometimes lose sight of, particularly when I’m anxious or worried. As I kissed him on the forehead, he said, “No fair.”

“What’s no fair?” I asked.

“You kiss me more than I kiss you,” he said.

“Well, and isn’t that good? When I give you a kiss, doesn’t that raise your love meter?”

My son rolled his eyes in the greenish glow of his Teenage Mutant Ninja Turtles night-light.

“Your love meter gets higher from giving love,” he said.

This idea—that love is something we get more of by giving it away—is a radical one, though it’s nothing new. Folks as varied as St. Francis of Assisi, Mahatma Gandhi, and Martin Luther King Jr. have encouraged people to cultivate true wealth and freedom through conscious unconditional loving, for their own and the world’s sake.

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For many of us, though, living from this principle is easier said than done. The experience of feeling vulnerable and threatened triggers our fight-or-flight response, and it becomes hard to remain aware of ourselves and of our options as we relate to others. Usually, we default to our habitual defensive positions—blame, avoidance, projection, rationalization, just to name a few. And yet, being able to tap into our capacity to give love—even when we’re scared—may be an urgent necessity if we want to preserve our sense of agency and balance in the aftermath of one of the most anxiety-provoking transfers of power in American history.

For one thing, our agendas and ulterior motives have a way of creeping into our words and actions, influencing how the love we try to give those around us is experienced. Sometimes, it’s not attuned to what the recipient needs, like the porridge in Goldilocks and the Three Bears. It’s too hot or too cold, too much or too little. Sometimes, the love we offer reaches its recipient contaminated by our concerns and preoccupations, and we feel hurt when it’s shrugged off, minimized, or ignored.

Defenses against receiving love, or giving it, aren’t necessarily good or bad. We learn to defend ourselves against taking in the very things we deeply want for important reasons, including our own psychic survival.

When the tables are turned and we’re on the receiving end, we get to experience firsthand how hard it is to take love in: whether it’s in the form of a goodnight kiss, a hug from our partner, or a stranger’s compliment, opening our hearts requires something from us we’re not always willing to give: trust, surrender, vulnerability, emotional availability, or even self-love. If you feel unworthy of it yourself, how can you accept it from another?

Defenses against receiving love, or giving it, aren’t necessarily good or bad. We learn to defend ourselves against taking in the very things we deeply want for important reasons, including our own psychic survival. Even if we can’t remember having ever truly trusted another human being to love us selflessly, for exactly who we are, we’ve all counted on someone’s appreciation or approval only to experience it withheld or withdrawn. We’ve all opened to another’s concern and felt it suddenly morph into something suspect, a projection or judgment, a form of control. As sensitive beings imprinted with these types of experiences, it’s not unusual to grow up wary about receiving the emotional gifts others offer us, lest they turn out to be Trojan horses or a version of Narcissus using us for a mirror.

As therapists, one of our jobs is helping people understand what gets in the way of taking in the love that’s already in their lives, even when circumstances are difficult. The more people can access and metabolize the love they’ve been disregarding or ignoring, the more it can nourish them and help them love others. In accelerated experiential dynamic psychotherapy (AEDP), the way in which people take in others’ emotional offerings—referred to as our “receptive affective capacity”—becomes rich ground within the therapeutic relationship for exploring, understanding, and expanding this ability well beyond the therapy session.

The relationship between giving and receiving love can seem like a riddle worthy of a sphinx—a human conundrum we begin grappling with early in our lives, as my 6-year-old son reminded me with his take on the true metrics of love. However you frame it, being able to receive love from another seems to be inextricably linked with our own desire and ability to give it. Finding ways to expand our own and others’ capacity to take in and produce love locally, rather than seeking it elsewhere, has the potential to create a more stable and sustainable psychic economy.

Stalking. The word alone inspires fear and anxiety in many people. For those of us who have experienced it, it may conjure painful images we never stop seeing, no matter how hard we try.

Although the term is used far too casually in some parts of our society, stalking, as defined, is serious stuff. A crime in many jurisdictions, it generally involves unwanted or obsessive attention, following, harassing, or monitoring behavior that might cause a reasonable person to experience fear.

One out of every six women is stalked in her lifetime, according to data compiled by the Centers for Disease Control and Prevention. Men are stalked too, of course, but much less frequently (one in 19).

I’ve been stalked three times.

The first time it happened, I was around 21 years old. It was 11 at night, I was walking home from a friend’s house, and I noticed someone was following me in a car. This was in the suburbs, and there was no one else out on the street. At first I thought maybe it was my imagination, so I turned up a one-way street going the wrong direction for the driver, expecting him to continue on his way and not follow me. He followed me anyway, and that’s when I knew I was in trouble. Then he got out of his car and exposed himself.

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I ran to the nearest house with lights on and began ringing the doorbell and knocking. The man drove away. Then I realized no one was home in the house I had chosen as my refuge—or maybe they just didn’t want to answer. I hid, cowering on the stoop, and looked around carefully. Finally, when I thought it was safe, I fled.

When I was in my early 30s I was stalked again. Although I wasn’t threatened physically, I was tormented for several months and was left terrified for a long time.

I lived in an apartment house. My apartment was opposite the service stairs, and sometimes I thought I saw someone hiding in the stairwell near the door to my apartment, watching. This happened repeatedly, but I never actually saw anyone’s face—just a disappearing shadow. I almost didn’t believe there was anyone there; the first time, I wondered if it was my imagination. I told my husband, but he never saw anybody and thought it was nothing to worry about.

Then a man got hold of my phone number somehow and called me repeatedly for months. This was the same guy who hung out in the stairwell, I figured. For me, this was confirmation he was real; this was not my imagination. I almost wasn’t sure if that made things better or worse. The only thing I was sure about was I was petrified.

I was often home alone with my new baby at that time. The man phoned repeatedly and seemed to know my every move. I was afraid to leave the house and afraid to stay home, too. I was scared to answer the phone. I told my husband again, but nothing ever happened when he was home. I felt like he didn’t take my fears seriously, and I was so scared. He suggested maybe it was just a lot of wrong numbers. Was I exaggerating?

I wasn’t sleeping much because I had a new baby, and on top of that, now I was too scared to sleep. Every time I sat down to relax, the phone rang, and there was nothing I could do but endure—I could never let my guard down. I started having nightmares.

Sometimes a man with a disguised voice phoned to say nasty things. Other times, I just heard someone breathing. It went on and on, and finally my husband started to worry, too. Once, he intercepted one of the nasty calls and told the guy off, but the calls went on anyway. This was in the time before phone numbers came up when you were called, before you could block specific numbers. I was being tortured, and it felt like it would last forever with no way out. I began feeling helpless and weak. I got very depressed. How could I protect my baby if I couldn’t defend myself?

I contacted the police. The phone company put a tap on my phone, but the person never stayed on long enough to make an ID. A police officer advised me to buy a whistle, and when the person phoned the officer told me to answer the call with a piercing blast of the whistle. That was okay with me. I wanted to blow this guy’s eardrums out! I wanted to cause him as much pain as he was causing me. I wanted revenge. But most of all, I just wanted him to leave me and my baby alone.

Even if you’ve never been physically hurt, the emotional disturbance of knowing someone is out there watching, listening to, or otherwise intending to scare or intimidate you is dreadful, especially if you think you’re trapped and can’t do anything.

The whistle worked. He stopped calling. I wondered who he was, of course, and eventually I found out the person stalking me was my neighbor, somebody I used to smile at and say, “Have a nice day!” to when we bumped into each other in the elevator. He lived two doors away from me.

That all ended a long time ago, but I still always check to make sure that the door to the service stairwell in front of my apartment is securely closed.

Just recently, someone stalked me on the message app on my phone. I’ve blocked that person—one benefit of technology, though there are downsides, too, that allow for cyberstalking.

Some of the people I see in therapy have also been stalked and badly frightened, like I was. One young woman got extra locks put on her door after she broke up with her boyfriend. He called her repeatedly, as often as 20 times a day, and lurked on the street near where she lived. She gave his contact information to her sister and to a friend and instructed them to go to the police if something happened to her—and made sure her ex knew it.

Even if you’ve never been physically hurt, the emotional disturbance of knowing someone is out there watching, listening to, or otherwise intending to scare or intimidate you is dreadful, especially if you think you’re trapped and can’t do anything. Except for a situation like the first one, where I believed I was in immediate physical danger, authorities advise people not to try stopping stalking behavior by themselves, as that could provoke the person to get more aggressive and violent.

They have a point. I’m scared just thinking about the idea. But while I hope this article doesn’t provoke anybody, I won’t be scared into silence. People who stalk tend to try to bully their targets into silence so they can continue their harmful and potentially criminal actions.

What to Do If You Are Stalked

If you believe you are being stalked, the U.S. Department of Justice advises you to trust your instincts and take the behavior seriously.

• Your first duty is to protect yourself. If you’re in immediate danger, call the police. Do what you need to do to find safety while you await help: run away, make a lot of noise, or otherwise try to let others know what is going on.
• Keep a record of what is happening and when, especially if the situation is ongoing. Save any evidence you have—emails, messages, physical items.
• If you feel comfortable doing so, connect with an advocacy organization that can support you and walk you through your options. One such outlet is the National Domestic Violence Hotline: 1-800-799-SAFE.
• Experiencing stalking can be quite traumatic, and it can be particularly helpful to seek the support of a mental health professional who works with trauma and domestic violence cases. Some of us know what you’re going through, at least to some extent. Regardless, expect us to do everything we can to help you get what you need so you can feel safe again and heal.

References:

1. National intimate partner and sexual violence survey: 2010 summary report. (2010). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/pdf/nisvs_executive_summary-a.pdf
2. Stalking. (2016, January 6). The United States Department of Justice. Retrieved from https://www.justice.gov/ovw/stalking

Narcissism is difficult to diagnose and treat. As with all personality issues, the narcissistic traits a person possesses exist on a continuum. Not all people with narcissism are the same, and treatment approaches vary from individual to individual. This article is written as a basic guide for treating a person who either self-identifies as narcissistic, or one you identify as having narcissism.

Please note the steps below may need to be repeated over and over again, and not necessarily in order.

Step 1: Understand Narcissism

The therapist must be well versed on what it means to be in a narcissistic relationship. It is one thing to read about narcissism, another altogether to be in a close relationship with someone with narcissistic qualities. Many therapists have no idea how intoxicating, exciting, and heart-wrenching life with a narcissistic person can be.

Understand that the three main traits of narcissism are sense of entitlement, lack of insight, and lack of empathy.

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Step 2: Build the Therapeutic Alliance

The therapist must require two things from the therapeutic relationship with a person who has narcissistic tendencies: respect and collaboration. Respect for and collaboration with others is challenging—some might say impossible—for people with narcissism. They will be learning how to practice these interpersonal skills in real time, in vivo, in their relationship with the therapist.

Step 3: Identify the Defenses

The narcissistic person’s defenses come in the form of personality modes or personas (think multiple personalities, but different). The therapist must endeavor to help the person identify some of the protective personality modes they use throughout life. Here are some common examples:

• The critic
• The judge
• The detached persona
• The addict
• The womanizer
• The entitled one
• The victim
• The abuser
• The manipulator
• The rage-aholic
• The superior one
• The bored one

Note: This list is not exhaustive. Therapists should work collaboratively with each person to identify their unique defenses.

All of the above-listed personas are protective personalities that people with narcissism use for emotional protection. The two feelings people with narcissism tend to avoid at all costs are neediness and vulnerability.

Step 4: Identify the Underlying Triggers

The underlying schemas are what cause the need for the protective personas. Think of schemas as triggers or buttons that are pushed when someone causes what is known as a “narcissistic wound.” Here are some common triggers experienced by people identified with narcissism:

• Feelings of emotional abandonment
• Feelings of inner defectiveness
• Feelings of lack of control or security
• Sense of emotional deprivation
• Fear of ridicule or shame

Through both role modeling and psychoeducation, you can teach a person with narcissism about the need for re-parenting the early attachment wounds they have experienced.

It is difficult to identify these underlying triggers because you are working with someone who may have low insight and who may be emotionally “split off” or “blocked” from feeling these vulnerable and devastating emotions. You will likely encounter a protective mode before you will identify the underlying “root” of the problem. Understand that the primary emotional experience the person with narcissism is avoiding is a sense of shame. Rather than experience this sense of shame, the person “flips” into a protective mode.

It is important to help the person with narcissism to manage these underlying feelings of shame by teaching self-compassion and offering healthy self-soothing strategies. Also, as you remain in the relationship with the person, being present with them as they dare to “go there,” they will hopefully learn how to experience and process through relational “demons.”

Step 5: Develop an Inner Healthy Adult/Parent

The job of therapy is to help the person with narcissism learn to re-parent their inner hurt child. The inner child is responding to early attachment trauma or some other type of lack of emotional attunement as a child. Without going into a complete analysis of the causes of narcissism, suffice it to say a developmental component exists.

Developmentally, as a child, the person with narcissism was not properly emotionally regulated in the inter-relationship with the parent(s). This may have caused the child to develop “split off” protective personas as defenses to protect their inner sense of shame.

Teaching the person with narcissism to re-parent their inner hurt child, through the process of imagery, is effective and powerful for initiating healthy change in the person’s inner world.

Step 6: Heal the Inner Child

Even before a person with narcissism learns to re-parent themselves, you, as the therapist, can begin the process by trying to meet their inner hurt child and begin bonding with them. You can be a healthy role model, offering a “corrective emotional experience” for the person. Perhaps you are the only person who has ever been able to reach their inner child in a way that represents safety.

Through both role modeling and psychoeducation, you can teach a person with narcissism about the need for re-parenting the early attachment wounds they have experienced. They may deny they have any such hurts, but explain to them that their behavior “tells on them.” Do not argue with the person; rather, simply state and instruct what is happening.

Step 7: Develop a Recovery Plan

Not only is it essential to heal the inner world of the person with narcissism, it is also important to identify all of the person’s “bottom-line behaviors” and begin a “program of recovery.” In essence, treat the narcissistic symptoms as part of an addiction of sorts that needs to be put in remission.

Here is a list of some possible items to go on the abstinent (“no-fly zone”) list of the person with narcissism:

• Entitlement
• Blame
• Womanizing
• Substance abuse
• Yelling
• Silent treatments
• Dramatic exits
• Passive-aggressive behaviors
• Manipulation
• Defensiveness

Help the person identify their own “go-to” strategies for self-protection.

Conclusion

As you can see, helping a person with narcissism to heal is a challenging endeavor. While you are working within this relationship, make sure you take care of yourself. I will end by offering these final words of advice for self-care:

• Require and model respect.
• Consult often; debrief after each session.
• Exercise and take care of your physical health.
• Do not personalize the behaviors of people with narcissism.
• If you feel defensive, back off, take a deep breath, change something.
• Do not have a power struggle with the person you’re trying to help.

Remember: While it takes hard work to help a person with narcissistic qualities, there is little to be gained from working harder than they do.

People who are unhappy in their marriages may turn to mental health professionals for help, unaware therapy could in fact make things worse. I’m not talking about bad couples therapy, although therapists who lack training in effective couples therapy certainly can do more harm than good. What I’m referring to is bad individual therapy when the focus of treatment is an unhappy relationship.

There are some good reasons people in an unhappy relationship might seek individual therapy. Sometimes a partner may be unwilling to come to couples therapy, leaving individual therapy as the best available option. Some people may feel too frightened or unsafe to speak openly in front of a partner. By beginning with individual therapy, they may develop more self-confidence and feel better prepared for couples therapy. And for some people who are uncertain about whether to continue working on their relationship, individual therapy can provide a safe, private place to talk through their feelings and concerns.

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However, while some therapists help unhappy partners gain a new perspective that can help both themselves and their relationship, others—especially therapists with no training in couples or family therapy—may further undermine shaky marriages. Many unhappy partners are influenced, either inadvertently or purposely, toward ending a marriage that could be improved with effective couples therapy.

How do you know if your therapist may be harming your marriage? Here are five warning signs:

1. Your therapist allows you to focus almost exclusively on your partner’s flaws, with little attempt to help you understand your role in your unhappy relationship. Regardless of your partner’s shortcomings, every relationship is the result of a pattern created by two people reacting to one another. When the focus of therapy is only on what your partner does, you may feel increasingly hopeless about the relationship and powerless to change it. If you do decide to end your marriage, you will also have lost an important opportunity to learn from this experience and avoid repeating ineffective patterns in the future.
2. Your therapist labels, diagnoses, or criticizes your partner without ever meeting them. Any well-trained couples therapist knows each partner has a unique perspective, and a full understanding of a relationship requires knowledge of both partners’ experiences and perspectives. Even objectively indefensible behavior such as name-calling, shaming, and threatening can usually be addressed much more effectively by understanding and addressing the underlying feelings and dynamics than by labeling the person who has behaved this way.
3. Your therapist does not help you understand your partner’s “bad” behavior in context. There is a world of difference between a partner who purposely uses name-calling, shaming, and threatening to manipulate or control, and a partner who erupts in anger and then feels ashamed or remorseful for losing control. Sometimes the partner on the receiving end may have a difficult time distinguishing between these two very different patterns—another reason therapists should avoid judging or labeling people, especially those they haven’t met.
4. Your therapist clearly prioritizes your individual needs over the marriage and family. While no one should tolerate a relationship in which their own needs are ignored or dismissed, neither should they expect to have a healthy marriage and family if they don’t also attend to the needs of others. An individual therapist who focuses only on the feelings and needs of the person in the room may implicitly discourage the kind of compromise and interdependence that characterize healthy families.
5. Your therapist encourages you to end your relationship for any reason, other than to protect your physical safety, without an adequate trial of couples therapy. Many serious relationship problems can be addressed with the help of a well-trained couples therapist. Therapists who do not recognize this possibility do a disservice to couples and families who may never get the help available to them. It can even be helpful for you and your partner to discuss such “deal-breakers” as a serious, active addiction or an ongoing affair with the help of a skilled therapist before making a final decision to end a relationship.

How to Avoid These Pitfalls in Individual Therapy

If you are unhappy in your relationship and are seeking individual therapy, either because your partner is unwilling to come with you or you are not ready to talk with your partner, there are several steps you can take to minimize the chances of further damage to your relationship:

Many unhappy partners are influenced, either inadvertently or purposely, toward ending a marriage that could be improved with effective couples therapy.

1. Choose an individual therapist who is also trained in an effective model of couples therapy, such as emotionally focused therapy. Most trained couples therapists also practice individual therapy, and they can use their understanding of couples dynamics to help you gain a clearer perspective on your marriage. If you have been unable to get your partner to come with you to therapy, a therapist who understands couples dynamics may also have suggestions for new ways to approach your partner without putting them on the defensive.
2. Ask your therapist directly for help in understanding your partner’s perspective. Your therapist may feel a primary responsibility to be supportive of your feelings and needs, and thus may be reluctant to bring up your partner’s experience. By directly asking for this input, you give your therapist permission to help you understand your relationship from a broader perspective, including how you may unknowingly trigger unwanted reactions in your partner.
3. Focus your individual therapy on your personal growth rather than on your partner’s shortcomings. Focusing on changes you want to make for yourself is the most constructive way to use your time in individual therapy. As it turns out, it is also often the most helpful thing one partner can do to improve a relationship. And if the relationship ends, your increased self-knowledge will help you move forward in healthier ways.

There are, of course, many other signs of questionable therapy, as well as indicators you’ve found a good therapist. If you decide to reach out to a therapist, be sure to ask plenty of questions based on what you’ve read to help you determine which side of the spectrum they fall on.

Two new studies suggest video games could aid the treatment of depression. One study, published in the journal Depression and Anxiety, found a video game could address cognitive issues associated with depression in older adults. A second study, published in the Journal of Medical Internet Research, found video games can improve symptoms of depression, particularly among people whose depression symptoms are more serious.

Improving Cognition in Older Adults with Depression

Researchers in the first study used an app called Project: EVO with 10 adults age 60 and older who experienced depression. The app is meant to improve attention and focus. Though not specifically designed to treat depression, the researchers say improvements in attention might reduce symptoms of depression.

Even though most participants had never used an app on a tablet or played a video game before, all were compliant with the recommendation that they play the game for at least 20 minutes five times per week. Participants also had weekly meetings with a clinician.

A second group of 12 adults with depression attended weekly problem-solving therapy sessions. Compared to the control participants who attended weekly therapy, the participants who played video games experienced similar improvements in depression symptoms.[fat_widget_depression_right]

An App, a Video Game, and a Placebo for Depression

A larger trial involving more than 600 participants with mild or moderate depression assessed the value of video games in the treatment of depression. One group played Project: EVO. A second group used an app called iPST, which uses problem-solving therapy to reduce depression symptoms. A placebo control group used an app called Health Tips, which offered users healthy suggestions.

All three groups experienced similar improvements in mild depression symptoms, suggesting any purported treatment might help reduce mild depression symptoms. However, participants who were more than mildly depressed saw greater improvements with iPST and Project: EVO than with the placebo app.

The results are preliminary, and researchers do not yet know if the improvements will persist over time. They suggest the potential for an app or video game to treat depression could reduce the cost and time commitment associated with traditional depression treatment options.

References:

1. Anguera, J. A., Gunning, F. M., & Arean, P. A. (2016). Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial. Depression and Anxiety. doi:10.1002/da.22588
2. Nodell, B. (2017, January 3). Game your brain to treat depression, studies suggest. Retrieved from http://hsnewsbeat.uw.edu/story/studies-suggest-gaming-your-brain-treat-depression

Trauma bonds occur in very toxic relationships, and tend to be strengthened by inconsistent positive reinforcement—or at least the hope of something better to come. Trauma bonds occur in extreme situations such as abusive relationships, hostage situations, and incestuous relationships, but also in any ongoing attached relationship in which there is a great deal of pain interspersed with times of calm (or maybe just less pain). I liken it to a heroin addiction—the trauma bond relationship promises much, gives fleeting feelings of utopia, and then it sucks away your very soul.

If you or someone you know has been in an abusive relationship, you have witnessed the strength of this type of relationship. Maybe you or someone you know is trying to get out, but seems incapable of leaving.

Well, there is hope. Here is some advice on how to break a trauma bond:

1. Make a commitment to live in reality

If you find yourself wanting to fantasize about what could be or what you hope will be, stop. Remind yourself that you have made a commitment to live in truth. Even if you don’t choose to leave the relationship immediately, in the meantime you can at least remind yourself that you will stop fantasizing about what is not happening.

Reach out to one of our therapists in Houston, TX, or find a city closer to you.

2. Live in real time.

That means stop holding on to what “could” or “will” happen tomorrow. Notice what is happening in the moment. Notice how trapped you feel. Notice how unloved you feel and how you have compromised your self-respect. self-worth and self-esteem for this relationship. Pay attention to your emotions. Stop hoping and waiting, and start noticing in real time what is happening and how it is affecting you and your well-being.

3. Live one decision at a time and one day at a time.

Sometimes people scare themselves with all-or-nothing thinking. Don’t tell yourself things like, “I have to never talk to the toxic person again or else”; this is akin to trying to lose weight by telling yourself you can never eat chocolate again. While it is true that your relationship is an unhealthy one, you don’t need to make every encounter a do-or-die situation. Don’t scare yourself.

4. Make decisions that only support your self-care and sense of self.

That is, do not make any decision that hurts you. This goes for emotional “relapses” as well. If you find yourself feeling weak, don’t mentally berate yourself, but rather talk to yourself in compassionate, understanding, and reflective ways. Rather talk to yourself in compassionate, understanding, and reflective ways. Remind yourself that you are a work in process and it is a part of the healing process. You will have highs and lows and that is okay. Do not make the uncaring decision to mentally beat yourself up. In every encounter you have with the object of your obsession, stop and think about each choice you make. Make choices that are only in your best interest.

5. Start feeling your emotions.

Whenever you are away from the abusive person in your life and feel tempted to reach out to them for reassurance, stop. Consider writing your feelings down instead. Write whatever comes to you. For example, “I feel ____. I miss ____. I wish I could be with ____ right now, but I am going to sit and write my feelings down instead. I am going to teach myself how to feel my way through the obsession, rather than turning to ____.” This may help you to build inner strength. Learn to simply be with your emotions. You don’t need to run from them, hide from them, avoid them, or make them go away. Once you fully feel them, they may begin to subside. Remember: the only way out is through.

6. Learn to grieve.

Letting go of a toxic and unhealthy relationship and breaking a traumatic bond may be one of the hardest things you ever have to do. You cannot do it without honoring the reality you are losing something very valuable to you.

7. Understand the “hook.” Identify what, exactly, you are losing.

It may be a fantasy, a dream, an illusion. Perhaps your partner had convinced you into believing they were going to fulfill some deep, unmet need. Once you can identify what this need (or hook) is, you can get down to the business of grieving. Grieving means (figuratively) holding your hands open and letting it go. You say goodbye to the notion the need you have may never be met. At minimum, it will not be met by this relationship.

8. Write a list of bottom-line behaviors for yourself.

Possible examples: “(1) I will not sleep with someone who calls me names. (2) I will not argue with someone who has been drinking. (3) I will take care of my own finances. (4) I will not have conversations with anyone when I feel desperate (or defensive, or obsessive, etc.).” Whatever your areas of concern, determine what you need to do to change and make those your bottom-line behaviors.

9. Build your life.

Little by little, start dreaming about your future for yourself (and your children, if you have them); in other words, make dreams that don’t involve your traumatic partner. Maybe you want to go to school, start a hobby, go to church, or join a club. Start making life-affirming choices for yourself that take you away from the toxic interactions that have been destroying your peace of mind.

10. Build healthy connections.

The only way to really free yourself from unhealthy connections is to start investing in healthy ones. Develop other close, connected, and bonded relationships that are not centered on drama. Make these your “go-to” people. It is extremely difficult to heal without a support system. Notice the people in your life who show you loving concern, and care and hang around with them as often as you can. Reach out for professional help as needed.

Mental health providers could improve depression treatment by helping people in therapy set attainable goals, a study published in the journal PLOS ONE reports. Although lack of motivation often appears on lists of depression symptoms, the study found people with depression were not less motivated than those without depression. Instead, people with depression had more difficulties setting goals. They were also less likely to believe they could achieve their goals.

Goal-Setting Habits and Depression

The study followed 42 people with depression recruited from two clinics in England. Researchers compared this group to 51 people without depression from the same region.

Each group made a list of goals. People with depression had as many goals as people without depression, suggesting similar levels of motivation. However, people with depression had more avoidance goals and fewer approach goals. According to the researchers’ definitions, approach goals center around positive actions, such as showing more gratitude or taking more walks. Avoidance goals aim to reduce negative outcomes, such as quitting smoking or reducing angry outbursts.

[fat_widget_depression_right]People with and without depression assigned similar levels of importance to their goals. However, people with depression were less likely to believe they could achieve their approach goals. They were also more likely to give up on their goals when encountering challenges, and they had greater difficulty setting new goals. This pessimism about goals may help explain why people with depression have trouble achieving the goals they set.

Setting Goals to Treat Depression

The study’s authors say their research provides important clues about goal setting and depression. It may be beneficial for mental health providers working with people with depression to consider helping them set realistic approach goals. By encouraging people with depression to set clear goals, to believe in their ability to achieve those goals, and to persistently pursue goals, providers can help people in therapy move toward more positive outcomes.

References:

1. Could more effective goals be the key to treating depression? (2016, December 22). Retrieved from http://medicalxpress.com/news/2016-12-effective-goals-key-depression.html
2. Dickson, J. M., Moberly, N. J., O’Dea, C., & Field, M. (2016). Goal fluency, pessimism and disengagement in depression. PLOS ONE, 11(11). doi:10.1371/journal.pone.0166259

If infidelity has happened to you (emotional, physical, or both), you don’t have to go running to an attorney right away. Of course, separation or divorce is always an option, both now and in the future.

If you are like many people who have been betrayed, you may be in a state of shock and disbelief and feel as if your entire world has been turned upside down. Perhaps you have always told yourself you would never stay with someone who had an affair, that you don’t deserve to be treated this way and you shouldn’t have to put up with it. Perhaps you have always believed you would end your marriage in a heartbeat, simply out of self-respect.

And now the topic seems to be everywhere—on television, on the radio, or just among others who talk about “kicking a cheater to the curb.” If you have disclosed the infidelity to friends or family, it is not uncommon for well-meaning loved ones to advise leaving right away, or perhaps to offer a spare bedroom or the name of an excellent lawyer.

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But you also don’t instantly stop loving this person, and the word “cheater” does not encompass the complexity or entirety of who your partner is.

As a couples therapist, I am often asked for my advice in these situations about whether to leave. My answer is always the same: “This is a highly personal decision that is not mine to make.” That said, I do recommend that people give themselves permission to slow down and gather information in order to make a grounded and thoughtful decision.

We know from Dr. John Gottman’s research that someone who has been betrayed by their primary romantic partner very often experiences symptoms consistent with posttraumatic stress (PTSD). We also know it is unwise to make major life decisions when in the midst of a crisis and not thinking clearly. Among other things, these PTSD symptoms may include intrusive thoughts of text or email exchanges, disturbing visual images of sexual acts, mood swings, irritability, and an inability to experience positive emotions.

These symptoms can make it nearly impossible to continue to function. Betrayed partners often find themselves doubting what is real and what is not, especially when there has been denial and defensiveness from the person who did the betraying. There can be a loss of trust in their partner, and even in their own perceptions, feeling as if they have failed in their ability to judge the character of their spouse.

As with any trauma, safety and self-care need to be the priorities. Step one is to normalize your full range of emotions and pain. It is normal to want to leave, and it is normal to feel a whole range of reactions including anger, anxiety, depression, suspiciousness, and general overwhelm. It is also normal to want to stay to work things out.

Although recovering from an affair can be very difficult work, there are many times couples find themselves in closer, more intimate partnerships as a result of healing together. Mental health professionals witness this on an ongoing basis. Perhaps neighbors, members of your community, or family have overcome this ordeal and are now happier together, unbeknownst to you.

It is important to recognize you are not alone. Although 90% of Americans say adultery is morally wrong, many families have secrets behind closed doors. One study found that approximately 23% of men and 19% of women in heterosexual marriages have had sexual affairs. These statistics are consistent with many other studies, although it is difficult to gather data about affairs because of the inherent secrecy and stigma of the issue. It may be more prevalent than studies show.

As unbearable as this pain is, and as difficult as it may be to see a way to get past it, a common mistake is a belief you have to “get out quick.” It is rarely this simple. You might still be in love, have children, or be living a life together that is integrally intertwined. Whatever your situation, there is often a confusing mix of strong emotions and feelings of ambivalence.

As you are weighing your options, you might only be looking at two extremes: (1) separation or (2) trying to forgive and move on. We have learned from relationship researchers that these extreme options are too difficult for most people in the immediate aftermath of such a traumatic event.

A third option is to make the decision together with your partner. A couples therapist or other professional trained in affair recovery can help the two of you process what happened, provide education, and give you a safe space to explore your options. You don’t have to know what you want before asking for help. Much of what we do is to guide couples in the decision-making process. You might benefit from learning what the journey would look like and hearing more about where your partner is emotionally. Your feelings might change as a result.

Although recovering from an affair can be very difficult work, there are many times couples find themselves in closer, more intimate partnerships as a result of healing together. Mental health professionals witness this on an ongoing basis. Perhaps neighbors, members of your community, or family have overcome this ordeal and are now happier together, unbeknownst to you.

There are, of course, other times couples decide to peacefully dissolve their union. This can be done respectfully and thoughtfully, especially if they wait until after the initial shock of the trauma. Energy can be placed into co-parenting—if there are children—or amicably separating property, thus reducing the risk of harm for all parties.

Ultimately, this decision lies with you and your partner. If you take your time to find clarity and make an informed and grounded decision, you may be more likely to feel the sense of peace you desperately seek.

References:

1. Gottman, J. M., & Gottman, J. S. (2016). Healing a Relationship from an Affair-Research Training Manual. The Gottman Institute.
2. Gottman, J., & Silver, N. (2012). What Makes Love Last? How to Build Trust and Avoid Betrayal. New York, NY: Simon & Schuster, Inc.
3. Mark, K.P., Janssen, E., & Milhausen, R.R. (2011, October). Infidelity in heterosexual couples: demographic, interpersonal, and personality-related predictors of extradyadic sex. Archives of Sexual Behavior. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21667234

Sexual harassment is common in middle school, according to research published in the journal Children and Youth Services Review. Although 43% of middle schoolers reported experiencing verbal sexual harassment, few bullying programs address this highly prevalent form of bullying.

According to the U.S. Department of Health and Human Services (DHS), 28% of adolescents in grades 6-12 experience bullying, suggesting sexual harassment may be more common than traditional bullying.

Sexual Harassment in Middle School

The study followed 1,300 children in Illinois for five years, beginning in middle school. Verbal sexual harassment was the most prevalent form of harassment in the group. Twenty-one percent of students reported experiencing physical forms of sexual harassment, including sexual assault. Fourteen percent of students were victims of sexual rumors, and 9% had been the subject of sexual graffiti in locker rooms and bathrooms.

Sixteen percent of students reported homophobic harassment such as name-calling and jokes, and 5% said they frequently experienced this form of harassment.

[fat_widget_right]An open-ended portion of the survey asked students to report their most upsetting experiences with sexual harassment. Many students minimized the seriousness of their experiences, with 14% saying the bullying was “not really sexual harassment.” Many claimed the perpetrators were just joking. Despite this dismissiveness, students still reported finding their experiences very upsetting.

Sexual Harassment and Bullying

Boys were significantly more likely to be sexual harassers, whether their targets were male or female. Boys who experienced sexual harassment often reported that the perpetrators were close friends. Harassment was most common in school hallways. Classrooms, locker rooms, gym class, and lunch rooms were also common sexual harassment locations.

African-American students often reported harassment from older students and romantic partners. White students experienced more victimization at the hands of their friends and same-age peers.

The study highlights the role of sexual harassment in bullying, while pointing to the dearth of anti-sexual harassment training in most anti-bullying programs. The study’s authors say the dismissive attitude many students have toward sexual harassment is especially troubling and should be addressed by anti-bullying initiatives.

References:

1. Espelage, D. L., Hong, J. S., Rinehart, S., & Doshi, N. (2016). Understanding types, locations, & perpetrators of peer-to-peer sexual harassment in U.S. middle schools: A focus on sex, racial, and grade differences. Children and Youth Services Review, 71, 174-183. doi:10.1016/j.childyouth.2016.11.010
2. Facts about bullying. (n.d.). Retrieved from https://www.stopbullying.gov/news/media/facts/#listing
3. Sexual harassment common among middle school children, study finds. (2016, December 9). Retrieved from https://www.sciencedaily.com/releases/2016/12/161209184825.htm

When a person is in need of an organ transplant, a process referred to in medical circles as a “transplant work-up” begins. This process is lengthy, as it is necessary to make sure the person is medically and psychologically fit for organ transplantation. Often, a social worker who works with transplant cases will conduct the psychological evaluation to identify any mental health issues the person may have that warrant consideration, as well as take stock of the emotional support network currently in place.

Typically, the emotional support network consists of family, friends, and the person’s transplant team. The transplant team includes doctors, nurses, and social workers. During the transplant work-up process, at the time of the transplant, and immediately after transplantation, the person has access to potentially dozens of people who can provide emotional support. The emotional support provided is almost ’round-the-clock if the person is hospitalized while waiting for transplantation. If the person is stable enough to remain at home while waiting for transplantation, they are in and out of doctor’s appointments so frequently that they, too, have consistent access to emotional supports as part of ongoing care.

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What happens after organ transplantation? In the year following the procedure, the person continues frequent visits to doctors’ offices and the hospital for invasive check-ups to control for rejection and illness, as the person is immuno-suppressed. These frequent visits allow for continued access to professional emotional supports. However, as the person begins to improve physically, the appointments steadily decrease and may decline to as little as once per year. With this decline in physical check-ups, the person gradually loses ready access to professional forms of  emotional support. The transplant social worker is constantly working with new patients, and the cycle continues.

Organ transplant recipients may not have identifiable mental health issues pre-transplant, but lifestyle changes, medications, and immuno-suppression—necessary for the organ transplant to be successful—can take a toll mentally. Transplant patients can experience depression, anxiety, grief, survivor’s guilt, and other concerns. Sometimes, life becomes much more difficult after transplant due to unforeseen complications, job loss/change, loss of insurance, and a shift in caregiver roles. Sometimes, people are not able to do the work they once did. Transplant recipients may not be accustomed to a daily medication routine.

How do we balance the “gift of life” that organ donation represents with the emotional toll a transplant can have on an individual?

Post-transplant, people may become hypercritical of their own thoughts, feelings, and behaviors, especially if those thoughts, feelings, and behaviors do not align with the “gift of life” ideology commonly associated with transplantation. How do we balance the “gift of life” that organ donation represents with the emotional toll a transplant can have on an individual?

Person-centered therapy can help transplant recipients by giving them more control, with appropriate guidance. Transplant recipients have not had control over their illness or their treatment. Person-centered therapy can help by allowing the transplant recipient to process their experience and develop a more cohesive sense of self.

The genuineness, unconditional positive regard, and empathic relationship that is the nature of person-centered therapy can allow for deep healing among transplant recipients. Each transplant recipient has a unique experience to share. Some have been sick for years, some caught a fast-acting virus while on vacation abroad. Some are young, some are not. Person-centered therapy encourages the individual to choose the topics discussed in session, navigate and find solutions to their concerns, and decide how often to meet and when to stop therapy. For many, it’s the first step toward regaining a sense of agency in their lives.

Dear GoodTherapy.org,

My mom is nearing 70. She was widowed four years ago, and ever since then she seems to have given up on life. She barely leaves her house, doesn’t want to socialize or make friends, and has even started smoking again, despite being a lung cancer survivor. She falls asleep in her chair at 3 a.m., sleeps until after noon, feeds her dogs, then watches TV the rest of the day and night. She used to love cooking; now she eats cereal for dinner half the time. She used to love sewing; her sewing machine is collecting dust. She used to have many friends; some have died off, some are out of state, and she has no motivation to seek more. Yet she professes that she is lonely. Well, do something about it! Instead, she relies more on her children and guilt trips us if we don’t meet her needs—if we don’t call all the time or visit, to her we don’t care. (None of her kids live within an hour’s drive and we all have demanding jobs and families.)

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I’ve done some reading and I think she’s clearly depressed. I know she feels like her life has been gutted now that her husband isn’t in it. She has no one to take care of anymore, and probably feels a lack of purpose. That’s why my siblings and I are so adamant that finding one would be in her best interests: volunteer, go to church … something! But she refuses.

I really think therapy would benefit her, but (as you might imagine) she is opposed to the idea, saying there is nothing wrong with her. I tried to tell her that going to therapy doesn’t mean there’s necessarily something wrong with her, that it can support her healing from her grief and move on with her life, but she just isn’t buying it. I tell her that moving forward and living her life is what her husband would have wanted, and she agrees, but nothing ever happens. She is very set in her ways. I feel helpless, like I am watching my mother die right before my eyes. And I am angry she won’t help herself, since she is the only one who can. Any suggestions or advice for me? —Helpless Here

Dear Helpless,

The sadness, anger, and helplessness you feel are palpable. You are clearly very concerned about your mother, and based on your description of her, it does seem possible she is depressed and she might very well benefit from therapy. You can see all of this quite clearly, but she cannot—and that must be quite frustrating for you.

I imagine the feeling of “watching your mother die right before your eyes” evokes many feelings, even beyond feelings of concern for your mother’s health and well-being. You are likely dealing with your own feelings of loss of the woman your mother once was, and looking to the future with concern about your actual loss of her through death.

I wonder if engaging in your own therapy could be helpful for you. I imagine the feeling of “watching your mother die right before your eyes” evokes many feelings, even beyond feelings of concern for your mother’s health and well-being. You are likely dealing with your own feelings of loss of the woman your mother once was, and looking to the future with concern about your actual loss of her through death. Sometimes, these kinds of experiences can also raise feelings about your own mortality.

It also sounds like you are trying to change your mother’s behavior. While it is certainly understandable to want better for her, you cannot force her to do anything. Trying to force someone to do something, even if it is something that would be good for them, is almost always a recipe for frustration. Engaging in your own therapy might be helpful in accepting that no matter what you do, your mom might not seek therapy or take steps to heal. Once you accept that you cannot make your mom get well, you may be better able to identify what you can do to help her, and more comfortable stopping there and leaving it in her hands.

It sounds like your mom is expecting you and your siblings to do a lot, maybe more than is reasonable. When you’re unable to be what she needs at any given time, the “guilt-tripping” you describe can be a lot to bear. If you do, in fact, feel any guilt—reasonably or otherwise—therapy may also help you deal with that, along with any resentment the guilt-tripping behavior might elicit.

Finally, engaging in your own therapy might be helpful for your mom, too. You could be a good model of a healthy, functional person seeking therapy simply because you are struggling through a difficult life situation and trying to find ways to cope with it. You could talk to her about the value you find in therapy and how it helps you. She might even see it in potential changes in the way you relate to her.

I wish you peace and healing in this very difficult time.

Best wishes,

Sarah

Dear GoodTherapy.org,

My 5-year-old is a generally happy and sweet kid, but I have been noticing lately that her play can get pretty violent. She can be aggressive sometimes and say things like, “Let’s pretend to punch each other.” When we play together, she wants there to be “good guys” and “bad guys” and have them fight—and sometimes kill—each other. She builds guns and other weapons with Legos and uses them to have fights with her toys, gleefully informing me when one or another of her toys “dies.”

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Her dad and I don’t let her watch violent shows, so I don’t know where she is getting this—from other kids at school or from watching shows at her grandparents’ house, maybe? I’m worried whatever exposure she’s getting to weapons and violence is going to be harmful. I’ve tried to talk with her about it, but I’m not sure I’m using the right words. It’s really difficult for me to hear her play-act violence without saying anything, but I don’t want her to think she’s being “bad,” because I know she isn’t. How can I talk to her about this? —Puzzled Parent

Dear Puzzled Parent,

As a therapist, I want to let you know that this experience is common, and, actually, developmentally appropriate. As a parent, however, I remember being concerned myself when my happy (sheltered) kid started playing in this way. It may be that your daughter is hearing or watching kids on the playground, or perhaps has seen shows, but often it is hard to pinpoint a specific source of inspiration. Many kids, at some point, explore themes of aggression, violence, and death through their play.

I think in all of this it can be helpful to remember the true function of play. Children play to explore their world, to experience in fantasy things they might not experience in real life, and to try things out safely. It is not unusual for kids, particularly rule-following kids, to embrace the role of “bad guy” in their play. For young children who are not often in control of their world, what greater relief and excitement is there than to play-act as the ultimate rule-breakers? Also, children are naturally curious about life and death and how everything works. Play-acting the death of their toys is one way they process safely any fears or concerns they might have or try to make a big concept feel controllable.

The glee you describe in your little girl may simply be a reflection of the joy of being in complete control of her universe. She is all-powerful. How fun is that? As long as these impulses are expressed through play and not manifesting in aggressive, hurtful behavior beyond playtime, there is likely little to be concerned about.

There’s also a somewhat innate destructive urge that can be seen in any toddler on a beach relishing their demolition of a sand castle. The glee you describe in your little girl may simply be a reflection of the joy of being in complete control of her universe. She is all-powerful. How fun is that? As long as these impulses are expressed through play and not manifesting in aggressive, hurtful behavior beyond playtime, there is likely little to be concerned about.

You are right not to want her to think she is being “bad” by engaging in this play. One helpful approach is to express curiosity. For example, you might ask her why she wants to pretend to “punch each other.” You can engage in some complicated, choreographed, slow-motion “fights” that could actually be fun and enjoyable for both of you, while talking with her about why you would never actually harm each other in real life. You can also ask her what happens to a toy when it “dies” and explore her understanding of what that means. Asking her to tell you what it means to be a “bad guy” or a “good guy” can give you some insight into her developing sense of morality—and even if she chooses to be the “bad guy” in play, that doesn’t mean she actually embraces the dark side.

It is natural as a parent to worry about all that our children will be exposed to when they are not in our care, and yet, as they get older, more and more of their time will be spent beyond the walls of our homes. We can’t prevent them from hearing and seeing things we might not like. What we can do is equip them to handle their experiences. Ongoing conversations about what we believe is important, how we believe we should treat people, and what impact our words and actions have on others around us can help our children navigate the various messages they receive.

If your child remains generally happy, sweet, loving, and able to express empathy, it is likely she is using this play in healthy, developmentally appropriate ways. It is also likely a phase that will pass. If, however, you see some concerning behaviors going beyond the scope of play, you may want to consult with a child therapist to address those concerns. Your child’s teacher can also be a great source of information about how your daughter’s behavior at school compares with what you see at home, as well putting it in context with the other 5-year-olds in her school.

Best of luck,

Erika