You may know someone who is depressed and not know they’re depressed. People expect someone who is depressed to cry a lot, stay in bed all day, mope, or sound like Eeyore from Winnie the Pooh. But depression isn’t always this obvious.

Some people can totally fake it. They can smile and laugh; they can act like everyone else, even while they are in excruciating emotional pain. Occasionally people who can do this end up killing themselves, and no one can believe it. People who are depressed but act like they are fine may not confide in anyone. Usually they find a way to spend time alone crying or letting down the facade and then go back to acting when they have to be with people. I’ve had clients who lived with their families and only found time to cry after everyone went to sleep, and only in the bathroom. The rest of the time they were acting like someone who wasn’t in pain. On top of the pain they already feel, acting happy is emotionally exhausting, and having this secret is isolating. So, faking it can even increase the depression.

Others funnel their pain into anger and people see them rage, abuse, shame, or react with annoyance or irritation to whatever happens around them. They may or may not themselves know they’re depressed, but others often don’t guess how much devastating emotional pain they are in. People may fear them, despise them, or dismiss them as mean. It is very difficult to feel sympathy for someone who is hurting people, and it is difficult to see their vulnerability, so their depression goes unnoticed.

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Still others are addicted to something, and the depression is obscured by the addiction. People with addictions spend most of their time and energy relating to the addiction. They plan to do it, anticipate doing it—these phases excite them and elevate their mood temporarily. Then they use whatever they are addicted to and it boosts their mood. But the thrill wears off, and they are depleted by the effects of the addiction and may also feel remorse or shame, so the depression descends on them, pulling them down like a cement jacket. They begin the cycle again to try to feel better; they plan and anticipate. Their whole life is about running from depression, but it becomes centered around the more dramatic force of addiction, and the depression can be unrecognized. I am not saying that all addicts are driven by depression—depression can also be caused by addiction. But addiction can be a form depression takes that is not easy to identify as depression. I include eating disorders in this category. I also include people who work most of their waking hours.

Depression isolates people. Whether they are hiding from the world in bed, preoccupied with an addiction, pushing people away with anger, or keeping their real thoughts and feelings inside while pretending to be okay, people with depression usually feel very alone.

Depression isolates people. Whether they are hiding from the world in bed, preoccupied with an addiction, pushing people away with anger, or keeping their real thoughts and feelings inside while pretending to be okay, people with depression usually feel very alone. Depression also has a built-in isolating fog quality that makes it very difficult to feel connected to people. Even when people feel safe to express exactly how they feel, it is very difficult for people who haven’t experienced a deep depression to understand how that feels. How can anyone who hasn’t experienced it understand a pain that is as intense as any open-heart surgery without anesthesia, with no cuts or bruises to show? How can anyone who hasn’t experienced it understand the complexity of pain that is not only unbearably intense itself but also complicated by many painful factors like the stigma of mental illness and the confusion of the fact that unlike other illnesses, depression causes behavior changes. People attribute behavior to the moral character of the person, rather than to the illness.

The pain is also complicated by the fact that depression attacks a person’s thoughts and feelings, rather than liver or lungs. Depression can cause a person to think she hates herself or is unhappy in her relationships. It can cause someone to believe everyone would be better off without him, or even that others would be better off dead. It can cause people to feel sad, angry, guilty, numb, or rageful, even when none of this is how they feel when they aren’t depressed.

So what can you do to help people you love who are depressed, if you can’t tell they’re depressed? Ask questions very kindly and listen to the answers very carefully. Empathize with their emotional pain—even if you have to guess at what it might be. Let them know you are there to listen and understand for as long as it takes, and you aren’t taking no for an answer. Of course if you aren’t trustworthy—if you judge them, or talk to others about what they tell you, or interrupt, get impatient, or misunderstand them, then it is better for them to talk to someone who can really listen without any of this. Being a reliable, trustworthy, patient, nonjudgmental listener is the best thing you can do in most cases with someone who is depressed.

A couple of caveats: I am talking about adults—children and teens require some variations. Also, addictions cloud the picture of depression and require their own, very different intervention. Nonjudgmental listening is still essential but may need to be combined with some firm boundary-setting and professional treatment for the addiction.

We are all familiar with the experience of good intentions having negative consequences. In my work as a therapist, I often encounter this phenomenon when I work with parents who, in their desire to make things better, easier, or less painful for their children, interfere with their child’s ability to develop the capacity to do for themselves. These are parents who feel an urgent need to fix their child’s problems. For the purpose of this discussion, “fixing” will refer to the intervening and usurping of problem-solving when one’s child experiences difficulty.

Gloria wanted to fix her daughter Alice’s feelings. She worried when Alice was unhappy, angry, upset, or had any feeling she felt caused discomfort for her child. For example, when Alice got frustrated and tearful when she practiced piano, Gloria suggested she stop her lessons. In therapy, Gloria told me how disturbing it was to her when Alice was upset. She recalled, “When Alice was an infant, I couldn’t stand to let her cry even for a minute. My heart felt like it would break. When Alice gets upset because I say ‘no’ to her, I always give in. I can’t stand it. It always seems like I’ve hurt her when I say ‘no.’” Gloria urgently needed Alice’s bad feelings to go away. What Gloria eventually came to understand was that what was urgent was that she, Gloria, be rid of her own uncomfortable feelings.

[fat_widget_right]Fred had a hard time when his fifth-grade son Eddie brought home average grades from school. He told me that he felt Eddie was much smarter than his grades showed, and he felt his job as a parent was to help him do better. This sounds like a responsible, caring parent talking. Unfortunately, Fred didn’t just provide some assistance so Eddie could do better, like going over his homework and helping him with his social studies projects. Rather, Fred intruded in what Eddie needed to do every day. For example, when Eddie was assigned to do a book report and make a diorama about the life of the protagonist, Fred read the book, bought supplies, outlined what should be in the diorama, and essentially did the project for Eddie. Eddie got an A, and Fred was thrilled!

While Fred’s intervention did fix Eddie’s grades, Eddie was given little opportunity to figure things out for himself. In therapy, Fred became aware that “this isn’t helping my son. I’m really scared that Eddie could follow in my footsteps and repeat my terrible academic failures.” As we focused on Fred’s anxiety around allowing Eddie to become a separate, self-confident individual with his own strengths and failures, Fred was increasingly able to talk with his son. He was able to encourage Eddie rather than take over his academic life.

Pam, a 29-year-old woman had difficulty dating and forming relationships. When she started therapy she told me that she didn’t have much trouble meeting men, but there was always some difficulty in the relationships, and they never got very far. As we explored her life and dating experiences, she explained that her biggest help was her father. She described him as exceptionally loving and caring and her “go-to” person when she had trouble in a relationship. She explained that a typical difficulty when she dated was that she would feel very hurt and upset when someone she dated didn’t call or text her quickly enough. Pam said, “When that happens, I call my father right away and I know he will comfort me. When I was a kid, he would do the same when a girlfriend hurt me. He gives me the same advice with guys as he did with those girls. He always says the same thing: ‘get rid of them—you don’t need people who hurt you in your life.’”

As we explored this dynamic further, it became evident that Pam’s well-intentioned father couldn’t bear witnessing Pam feeling hurt or upset. He would fix her relationships by encouraging her to get rid of the person who hurt her. This would not only alleviate Pam’s hurt but would take away the feelings he couldn’t tolerate. As a consequence, Pam had not developed the ability to manage her feelings and correctly judge how others were treating her. She had not learned how to deal interpersonally with another person in a relationship.

When parents can’t allow their children to struggle through problems and feelings, it is often because they, themselves, can’t tolerate how watching the struggle makes them feel. Some parents identify with their child. They recall their own feelings, like frustration or hurt or anger, and may assume that their child is experiencing what they experienced in that situation (although it may be a very different experience for the child). The desire to protect one’s child is necessary and desirable in a parent. But when the protection stems from the parents’ discomfort around their own feelings, it can create issues that impact the child’s development of self.

Children who are never allowed to cry, for example, may not learn how to soothe themselves. When children don’t learn how to self-soothe, they are frequently unable to cope with the normal stresses and frustrations of everyday life. Very often a parent’s worry about their child’s feelings can be communicated to the child. When a parent anxiously steps in to help or fix, the child may feel (consciously or unconsciously) that the parent doesn’t think the child has the capacity to work things out on his/her own. Children whose parents take over their work and do it for them are deprived of experiencing “I can do it.” Their ego enhancement, self-confidence, and self-esteem are interfered with. Parents who interrupt whenever a possible failure lurks do not prepare their children for success, because one must be able to tolerate failure in order to achieve success.

While there certainly are times when it is useful and wonderful to be there for your child and be helpful, the “fixer” parents described here did not help their children. They made themselves feel better. They may have made their children feel temporarily better: Eddie got his project done and got an A, and Pam felt reassured that she knew what to do when a date didn’t respond the way she wanted. Alice was relieved of her painful feelings, but didn’t develop the ability to cope. Not one of these children was helped toward developing a strong sense of competence or the ability to manage his or her feelings in the world.

Rather than extreme fixing, there are alternative behaviors when the urge to fix things for your children is present. Trying to address the problem with your child—rather than springing into action to help—can allow a child to feel like a participant, giving him or her a sense of self-esteem. Leaving space for a child to be uncomfortable communicates that you have faith that your child can find a way to figure out what he or she wants, and how to get it. It is important to communicate that it is okay to struggle, that it is a human experience that we all must learn to endure. It has to be okay to be uncertain and not know what results efforts will bring. Parents have to be able to tolerate their own anxiety and not jump in to solve their child’s problems. This allows the child to develop a healthy separate self and become a competent, assertive, and confident person in the world.

People who drink coffee usually crave it first think in the morning. Similarly, individuals who enjoy a glass of wine or a cocktail after a long day of work may have physiological cravings during peak happy hour times. And according to a new study conducted by Lydia A. Shrier of Harvard Medical School’s Department of Pediatrics and the Division of Adolescent/Young Adult Medicine at Boston’s Children Hospital, young adults who crave marijuana also do so at specific times of the day. Persistent cravings are associated with high levels of relapse, regardless of the substance. People who crave sweets, alcohol, cocaine, or other substances tend to report that obsessions of cravings for their substance are what preceded their most recent relapse. Some reports suggest that the majority of individuals who receive treatment for drug addiction have cravings when they abstain. This is a primary symptom of withdrawal in drug and alcohol addiction and can lead to eventual relapse. To better understand what causes or increases cravings, Shrier gathered information from 41 young adult marijuana users over a period of 2 weeks.

The participants were cued six times a day, and they recorded where they were, who they were with, their level of desire to use, the availability of marijuana, and mood. Shrier discovered that even though the participants had all been selected because of their current drug use, just over half of them reported any desire or craving for marijuana during the study period. Of those who did, location, companionship, and time were critical triggers. For instance, the participants had more cravings when they were with friends than when they were with parents. Additionally, cravings were more common in the evening than in the morning. The participants in this study may have been engaging in more social activities in the evening and more academic or job-related activities in the morning. This would explain the increase in reported cravings during evening hours, a time that is often viewed as more social. Shrier said, “The association between times of day and increased desire suggests that intervention strategies recommending alternative activities be focused on vulnerable times.” She believes that marijuana use may decrease if individuals are able to reduce their desire for marijuana, especially in situations when cravings are strongest.

Reference:
Shrier, L. A., Walls, C. E., Kendall, A. D. , Blood, E. A. (2012). The context of desire to use marijuana: Momentary assessment of young people who frequently use marijuana. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0029197

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How to Control My Drinking: Techniques to Help You “Stop at the Buzz…”
Gambling—An Addiction for More Than Just Adults: One Teenager’s Story

A client that drops out of therapy is one who does not complete the recommended course of treatment. Many therapeutic approaches, such as cognitive behavioral therapy, do not have a specific treatment deadline, and clients are considered dropouts when they have voluntarily stopped therapy prior to resolving the issues and symptoms that brought them there to begin with. Dropout is a serious concern for the medical community and the general population. Individuals who drop out of therapy are more likely to have future psychological complications and seek services multiple times, which places an economic burden on society. Because they do not learn adaptive coping strategies and fail to address the issues that plague them most seriously, they are likely to be less than productive in their careers, families, and communities. Additionally, therapists who experience client dropout may begin to question their ability to help clients and their own adequacy.

Understanding the factors that contribute to dropout can provide clinicians with the information they need to address the problem. Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage wanted to explore this problem further and made it the focus of his most recent study. Swift analyzed over 650 studies that included more than 83,000 clients and looked at factors such as client age, therapy setting, therapist experience, type of therapy, issues addressed in therapy, and clinician definition of dropout.

Swift found that nearly 20% of all the clients in the studies ended their treatment early. He found that some variables, such as therapy setting, influenced the rates of dropout. He also discovered that rates of dropout were highest among the youngest participants and those seeking treatment for personality or eating problems. Swift believes that more work is needed to determine specific nuances that effect retention. He hopes efforts will be aimed at isolating psychological issues, such as anxiety or depression, and approaches, such as psychodynamic or behavioral therapy, in order to get a clearer idea of the different dimensions affecting treatment completion. Swift said, “By paying attention to these variables and making adaptations where needed, clinicians may be able to reduce rates of premature discontinuation in their work with clients.”

Reference:
Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology80.4: 547-559.

If you don’t get the right nutrients, your body won’t function to the best of its ability. Some general health conditions can be linked to nutritional deficiency, but it’s up for debate whether the same applies to specific mental health conditions. Some nutrition experts do claim that unique cases of social anxiety can actually be caused by a nutritional deficiency. In the condition several experts refer to as pyroluria, once the nutritional deficiency is taken care of, the social anxiety is relieved. Other experts are quick to dismiss the validity of this diagnosis.

Trudy Scott, a food-and-mood expert who said in an email that she has suffered from pyroluria, is a certified nutritionist, immediate past president of the National Association of Nutrition Professionals, and author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings.

“The person experiences shyness, inner tension, and social anxiety,” Scott said in regard to symptoms of pyroluria. “Symptoms usually start in childhood and are made worse under stressful situations. The wonderful thing is that the symptoms can be completely alleviated with taking these supplements: zinc, vitamin B6, and evening primrose oil. People typically start to feel less anxious, less shy, and more social within a week. The important thing is that if you do have pyroluria, you do need to take the supplements always.”

Generally only zinc and Vitamin B6 are recommended for pyroluria, but “gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, is also beneficial for those with pyroluria because its levels are often low, and supplementing with GLA improves zinc absorption,” she added. In her book about anxiety, mood, and food, she wrote a whole chapter about pyroluria.

“I am … very passionate about the subject because I have pyroluria myself and used to suffer terribly from social phobia and shyness, anxiety, unexplained fears, waking with a sense of doom and even panic attacks,” Scott said. “I have used the amazing healing powers of foods and nutrients to completely heal. I now help women find natural solutions for anxiety and other mood disorders.”

She has posted a questionnaire on her website for pyroluria. It includes a long list of symptoms, and if 15 or more items are checked on the list, it is likely a person has pyroluria: http://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/

She said that in research studies, pyroluria is also called “the mauve factor.” “Much of what we know about pyroluria is based on the work of Humphrey Osmond, Abram Hoffer, and Carl Pfeiffer,” Scott said. “Much of the original work was done with schizophrenic patients in psychiatric hospital settings. Although pyroluria was first identified in the 1960s, the medical and mental health communities have been slow to recognize it, and many mental health practitioners and physicians remain unfamiliar with this condition.”

She said she learned about the condition mainly from reading the following books:
The Mood Cure by Julia Ross
Depression-Free Naturally by Joan Mathews-Larson
Nutrition and Mental Illness (1988) by Carl Pfeiffer

Her own book goes into the specific details and biological/chemical/genetic aspects of pyroluria. In her book, she cites research prevalence rates from Joan Mathews-Larson, the author of Depression-Free Naturally. Pyroluria is thought to exist in “11 percent of the healthy population” and “40 percent of adults with psychiatric disorders,” according to Scott’s book. For people with alcohol addiction, pyroluria is thought to have a 40% prevalence rate. However, the prevalence rates do depend on the source. In her own experience as a nutritionist, Scott said about 80% of her clients who have moderate to severe anxiety have symptoms associated with pyroluria.

She added that stress can be a major factor for what age pyroluria develops and that it is a genetic condition that seems to affect more women than men. In addition, people who have pyroluria tend to also have gluten sensitivity, especially if they also are dealing with other issues like depression, anxiety, autism, alcoholism, bipolar disorder, and schizophrenia, according to the book. People with pyroluria may also have digestive problems, and they need to make sure to balance out an increased Vitamin B intake with a higher intake of magnesium.

In the book The Mood Cure by Julia Ross, the author includes a discussion of the prevalence, testing, and treatment of pyroluria, as well as a checklist similar to that offered by Trudy Scott. Ross states that the questionnaire was developed by Dr. Carl Pfeiffer, a clinician and researcher. He wrote the book Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry in 1988.

Ross states in her book that pyroluria is fairly uncommon in the general public, but in certain groups of people (like those who have experienced alcohol addiction), it is more common. “I am just getting familiar with this condition, but I can see that it is an important one for certain people, affecting stress levels and mood generally and preventing full response to nutrient therapy until it is addressed,” Ross wrote in her book.

There are a plethora of articles dedicated to nutrition, diet, and mental health in general, as well as multiple research studies suggesting that certain mental health issues can be improved through natural supplements and a healthy overall diet. “Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries and are exceptionally deficient in patients suffering from mental disorders,” according to an abstract from a research study in Nutrition Journal. “Studies have shown that daily supplements of vital nutrients often effectively reduce patients’ symptoms.”

Another abstract from a research article in the journal Alternative Therapies in Health and Medicine concludes the following: “Many patients will benefit from the use of specific dietary supplements, such as a multivitamin-mineral high in B vitamins and omega-3 fatty acid,” according to the abstract. “And no matter what the underlying cause of the mood disorder, patients should be counseled about the relationship between food and mood, for the evidence now substantiates what laypeople and medical professionals have long known intuitively: the way we eat affects the way we feel.”

The research, authored by Tieraona Low Dog, director of the fellowship at Arizona Center for Integrative Medicine at University of Arizona, added in the research abstract that the healthiest diet for improving mental health is a “low-glycemic, modified Mediterranean diet rich in fruits, vegetables, whole grains, and seafood (if not vegetarian) and low in processed, refined foods.”

Other experts remain unaware of the condition and are skeptical of its legitimacy. Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said in an email that he is not accustomed to pyroluria and had to look it up on Google to find out what it was.

“Once I saw that it is connected to orthomolecular psychiatry, which I have heard of, I knew it was in the pseudoscience realm,” said Carroll, who is also an assistant professor at the University of New Mexico School of Medicine. “Not surprisingly, it claims to be the cause of a number of unrelated psychiatric disorders, which is typical of pseudoscience disorders. Like so many ‘cure-alls,’ it sounds plausible, but there is no scientific basis to it, and it allows dubious practitioners to prey on desperate, suffering people.”

He said there are certain cases where nutrition can play a part in mood and mental disorders. “Inadequate amounts of Omega 3 fatty acids, especially from fish or krill oil, have been shown to affect mood and anxiety in a broad way of which social anxiety can be a part,” Carroll said. “Also, low folate, low Vitamin D, and low B12 have all been associated with negative effects on mood and anxiety.”

“However, in people with low folate, it is more often a case of a genetic inability to transport the folate molecule into the brain rather than a low blood level,” he added. “In those cases, which often present with chronic depression and anxiety that has never responded to antidepressants, there are folate precursors that are more lipophilic and can diffuse into the brain without use of a transport mechanism.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at the NYU School of Medicine, said in an email that she didn’t study pyroluria in school and hasn’t read about it in any research studies after graduating from her doctorate program.

“Based on current knowledge it does not appear to be a legitimate health condition,” Garcia-Arcement said. “Further research is required to further explore and understand whether social anxiety or any other mental health condition could be related to improper synthesis in the blood.  Although this theory seems appealing, being able to ‘cure’ a mental disorder with vitamins or supplements … is unlikely.”

“Causes of social anxiety that have been substantiated by research include chemical imbalances in the brain (i.e., serotonin, a neurotransmitter), inherited traits (genetic and through observing anxious family members), negative life events or experiences, and an overactive amygdala (a part of the brain that controls emotions, including fear response),” she added.

She said that good nutrition is important for overall health, but it’s not necessarily linked to mental disorders. “In my experience, the social anxiety could be traced to other causes, not nutritional deficiencies,” Garcia-Arcement said. “Having a healthy and balanced diet is overall beneficial, but it won’t cure social anxiety or a mood disorder. I am more likely to recommend my clients get enough sun exposure to improve their moods (seasonal affective disorder) than recommend diet changes.”

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

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

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

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

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

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

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

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

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

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

Related articles:
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If Only My Partner Would Change, Then Everything Would Be OK

A nationwide study will determine if Abilify (aripiprazole) has the potential to relieve the involuntary muscle movements, or tics, commonly associated with Tourette’s syndrome. Children aged 7 to 17 years old will be recruited for the study, with completion set for August 2013. To be eligible, participants must have a diagnosis of Tourette’s syndrome and tics severe enough to disrupt daily activities. Exclusion criteria include pregnancy, obsessive-compulsive disorder, mood disorder, suicidal thoughts, or another diagnosed mood disorder. As with most clinical trials, researchers have designed the criteria to isolate the condition (Tourette’s) and the intervention (Abilify) to the fullest extent possible.

Participants will be placed into one of four treatment groups. In group one, participants will receive a placebo pill that is indistinguishable from Abilify. Groups two through four will each receive various dosages of the study drug. Doses will be administered once weekly for a period of eight weeks. The Yale Global Tic Severity Scale will be employed at the beginning and end of the study to quantify any symptomatic changes. Study authors believe that both the study drug and experimental procedures represent little or no safety risk to participants. However, parents or guardians must provide informed consent before enrollment.

According to the National Library of Medicine, Abilify belongs to a class of medications known as atypical antipsychotics. Originally, these medications were developed as replacements for the first generation of antipsychotic drugs. Although schizophrenia and other psychotic disorders were the impetus behind the creation of these drugs, research in the last twenty years has revealed that Abilify, and drugs like it, can have beneficial effects on a number of mental health conditions. Abilify works by altering the level of certain chemicals in the brain, and doctors know that Tourette’s syndrome results from an imbalance of brain chemicals. These chemicals, known as neurotransmitters, are responsible for the regulation of mood and movement, among other things. It is believed that Abilify may restore some degree of balance for those experiencing disruptive tics because of Tourette’s syndrome.

Abilify continues to show promise as a multipurpose psychotropic medication. So far, it’s been used to treat bipolar disorder, severe depression, and aggression in autistic children. In cases of severe depression, Abilify is often combined with a standard antidepressant medication. Tourette’s syndrome only affects a small percentage of individuals, but those with severe symptoms often have trouble navigating in daily life. It is hoped that Abilify, combined with various modes of therapy, will improve their experience.

References

1. Aripiprazole – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved June 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000221/
2. Efficacy & Safety Study of Once-weekly Oral Aripiprazole in Children and Adolescents With Tourette’s Disorder. (n.d.). ClinicalTrials.gov. Retrieved June 22, 2012, from http://clinicaltrials.gov/ct2/show/NCT01418352?intr=%22Aripiprazole%22&rank=8
3. Gilles de la Tourette syndrome – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved June 22, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001744/

Many of the sex workers I’ve known refuse to let anyone but their spouse kiss them on the mouth. You would think that kissing “down there” would be more intimate but, surprisingly, it seems that for most people kissing a partner on the lips makes a more profound statement than kissing the genitals.

Frequently couples whose relationships are suffering report that they stopped kissing on the lips long before they stopped having intercourse. Why? Anthropologist Helen Fisher has pointed out that many of the major senses have their outlets on the human face. There is vision, taste, smell, and hearing (on the edges). So it may be that kissing on the lips or face provides a much more intense experience.

We also talk about someone “getting in your face” when they are being confrontational. To intentionally let someone get in your face is to allow yourself to be vulnerable in a very intimate way.

Recently a woman in her late forties lamented that her husband of 25 years had never asked her how she liked to be kissed. She likes delicate little butterfly kisses that are “dry…I just want to tell him to turn off the water works!” She decided during that session to tell him, or better yet show him what she liked, and reported later that their sex life had improved as a result.

I’ve heard it said that French kissing is the oral version of spelunking. One sex therapist colleague swears that it’s called that because French women found it to be an effective way to make French men shut up! I’ll never forget my first experience after a high school dance with “frenching.” The guy jammed his tongue deep into my throat like he was trying to reach my tonsils—a truly horrifying experience.

And can you remember hickeys? You know—the bruises that result when a lover sucks on your skin with a vacuum force that causes internal bleeding. Usually these show up on your neck, although one woman complained that her boyfriend had given her one on the middle of her forehead—who knew?

The neck actually is a glorious place to give and receive lots of tender kisses—most people report that they yearn for more attention to their neck as well as their eyelids, cheeks, ears, noses, and yes, even foreheads foregoing the vampire action of the previous paragraph!

Thorough and enthusiastic lovers will enjoy discovering and rediscovering their sweethearts from head to toe, finding new places their partner loves to be kissed. Here are a few suggestions….Skin folds or places where the skin creases tend to be exquisitely sensitive and love to be kissed. Examples include behind the knees, in front of elbows, under breasts, the nape of the neck, on eyelids, armpits, between fingers and toes, and behind ears. (One of my own favorite places since I wear glasses and get rather sore is behind my poor ears!)

Interested in a few more areas? The lower back and bum can be exquisite places to kiss and caress—and don’t forget bellies and navels. Some view the belly button as a tiny vulva, or equally sensitive point for men. These people love having their navels licked, sucked, and titillated.

The wisest thing that I suggest to people of both genders exploring a new relationship is to simply ask your partner to kiss you the way s/he likes to be kissed. You get to lean back and let them take over, and you get to learn all kinds of wonderful things! This type of deep surrender is what true sexual intimacy is all about.

Related articles:
Fanning the Spark of Sexual Passion
9 Secrets for a Lifetime of Like, Love, and Lust
Breaking the Cycle of Being TOO Comfortable in Your Relationship

In my practice as an addiction psychologist, it’s probably the most common question I encounter; when it comes right down to it, it’s what most people who are struggling with alcohol really want to know:

“How can I control my drinking or drug use?”

Only a small minority of people come to my practice with the expressed agenda of stopping their drinking altogether. Most seeking psychotherapy for alcohol dependence, misuse, or abuse have experienced some consequences due to their drinking and would like to minimize or stop those consequences but do not want to give up their drinking entirely.

For some drinkers, controlled drinking or moderate drinking is an option, and for a small portion of the population, about 5%, controlled drinking is nearly impossible. While many people believe “once an alcoholic, always an alcoholic,” many people diagnosed with alcoholism can learn to control their drinking and become social drinkers again. That said, if you have been diagnosed with alcohol dependence, most addiction psychologists, psychiatrists, physicians, social workers, and addiction counselors would strongly recommend abstinence. This is always a very personal decision that should be made with careful consideration of the risks and benefits of drinking versus abstinence.

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If one has never exhibited signs of alcoholism, then controlled drinking, a technique or approach that is a form of harm reduction, is a reasonable yet delicate first step. If one wants to pursue this approach, it is best not to go it alone. Talking to an addiction psychologist or other addiction professional can guide you through some generally recommended techniques.

Notice Feelings and Set Limits

Most addiction therapists will recommend two basic procedures that may differ in numerous ways but have the same central premise. The first is that you cut back your use of alcohol in whatever way you decide and that you then pay attention to what thoughts and feelings emerge. The idea here is that alcohol serves to mediate feelings by numbing, dulling, or blocking them entirely, and when you reduce your use or even stop drinking, your feelings will come back. As this happens, it is often recommended that you keep a journal or that you talk to your friends, family, partner, or therapist about these thoughts and feelings.

The well-known acronym “HALT” captures this eloquently. HALT stands for Hungry, Angry, Lonely, and Tired. These are the types of feelings people will experience as they reduce their alcohol or drug use. It reminds us to halt, or stop, and pay attention to what we need. Somehow, we have to cope with those feelings or risk relapse. If you are hungry, then eat. If you are angry, then tell someone, vent, exercise, pound a pillow, or express your anger in a healthy way. If you are lonely, then surround yourself with friends or start the process of finding new ones if all your friends drink. If you are tired, then sleep. Many people with alcoholism have an inability to take care of themselves, and learning this new skill in recovery is essential even with such basic behaviors as eating and sleeping.

A second basic tenet to alcohol counseling for people who are attempting moderate or control their drinking is to pick an amount of alcohol that they will not exceed and to stick with it. The National Institutes of Health recommend that, to maintain “low-risk drinking,” men consume no more than four drinks per day and no more than 14 per week. For women, the number is no more than three per day and seven per week. My personal belief is that this is fairly generous; a man can drink four beers while at a party on Friday or Saturday night, three or four during the football game on Sunday, three or four at bowling or poker night with the guys, and still have two or three with his partner on another day during the week.

When we can learn to stop at the “buzz,” we are well on our way to having our relationship with alcohol fully in check. For most people, three or four drinks make them feel tipsy or buzzed. Alcohol is a central nervous system depressant, yet the initial effects of alcohol in these amounts are more stimulating and euphoric feeling. People tend not to get into serious trouble from these amounts, but since the initial effects feel good, many people continue to drink past these amounts, assuming more alcohol equates to more good. It does not. It takes time for alcohol to work itself into your system, so people don’t realize how drunk they are getting, and in larger amounts alcohol has a depressing effect. The alcohol you drink today can make you feel depressed days and weeks later, and these small amounts can contribute to depressive feelings over time. Rarely has anyone come into my office with concerns about alcohol abuse because of drinking three or four drinks a few times a week.

Other Useful Techniques

To stick to the above drinking goals, there are other moderate drinking techniques that you can employ, such as avoiding hard alcohol and sticking to beer. Beer has lower ethanol content, and the carbonation can fill you up, so it tends to take longer to drink. Switching from alcohol to nonalcoholic drinks and back can slow you down as well. Holding a drink with lime or lemon may deter others from thinking you are not drinking an alcoholic mixed drink, and they may be less likely to offer you another drink. Remember, you are more aware that you are not drinking your normal amount or that you have reduced your consumption, and others probably aren’t even aware that you made any changes.

One technique to help you be honest with yourself is to take four coins (or as many coins as you are planning to have drinks that night) and place them in your back pocket. Each time you take a drink, move one of the coins into your other pocket. This may be more important if you are planning on drinking larger amounts of alcohol, and many of the people I work with start out reducing their drinks per setting with numbers more like from 10 to five or six, for example, so counting drinks becomes more important. This way, when your coins run out, you can be sure not to exceed the previously determined limit that you imposed on yourself.

Many addiction therapists recommend one drink per hour as another way of limiting oneself. Since alcohol leaves the bloodstream at about .02 blood alcohol content (BAC) per hour, this will most likely keep your BAC at a reasonably safe level. In using this technique, it is recommended that you discuss your upper limit with a certified addiction professional or addiction psychologist.

It goes without saying that it’s important to pay attention to drink equivalents. A typical shot equals one 5-ounce glass of wine, which equals one 12-ounce standard beer. If your favorite bartender is pouring your drinks and he knows you are a big tipper who likes to drink, you might need to have a brief conversation with him. Believe me, bartenders are used to these conversations, and they will not hold it against you. In fact, most bartenders will be very respectful and discreet and will keep an eye out for you thereafter. If your buddies are trying to get you drunk, that’s another story. Watch how much they pour. A Long Island Iced Tea counts for three drinks, not one.

Don’t Try to Drink Away Emotional Pain

While I consider myself to be an open-minded therapist, what would an alcohol blog be without a major caution? Here’s my warning: Don’t drink when you are sad, anxious, lonely, worried, or in any negative feeling state. These are times when you should figure out healthy ways of coping. If you drink during these times, you are at high risk for using your drinking as a crutch.

What happens if you can’t control your alcohol use with these techniques? After trying these techniques and determining your level of success, you should be able to assess whether you can be a social drinker. To the extent that you break any of the rules that you set up as an experiment and exceed these drinking limits with resulting consequences, then it is time to reconsider lowering your upper drinking limits and decreasing the frequency, quantity, intensity (alcohol content), or duration of your alcohol use.

If you are wondering whether you have a drinking problem, please read Do I Really Have a Drinking Problem?

An addiction psychologist or other psychotherapist specializing in addiction can help you answer any questions or develop a plan that, over time, will enable you to understand the role that alcohol plays in your life and make decisions about what, if any, changes you are ready to make. You don’t need to figure this out on your own. It takes courage to seek help for alcohol use. If you are reading this, you are well on your way to understanding yourself better and getting what you want and need in life.

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

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

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

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

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

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

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

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

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

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

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

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Face-to-Face Communication

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

Surface-Level Communication

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

Written Communication

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

Impatience and Instant Gratification

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

Social Boundaries

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

References:

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

“It is so difficult to put the complexities of the trauma recovery process into words—artwork does this much better!” – Joan Turkus, M.D.

Posttraumatic stress (PTSD) is a condition that is, unfortunately, quite common in modern society. Statistics show that 70% of adults in the United States have experienced some form of traumatic event at some time in their lives and that up to 20% of this population will go on to develop PTSD. If you have undergone trauma, you are not alone. While many forms of therapy continue to emerge to treat those who have experienced trauma, art therapy is one that has been proven by a number of studies to be effective in dealing with the aftereffects of trauma. Whether you are a survivor of abuse, war, natural disaster, or another traumatic event, art therapy will likely be able to help you heal.

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Breaking the Silence

A common occurrence after a person has experienced trauma is a hesitancy or inability to discuss the incident out loud or verbally, even with a professional therapist. Repressing all thoughts and feelings is one reason this can happen. In expressive arts therapy, words are not necessary; much can be achieved without them. Expressive arts therapy moves the client and therapist from the traditional talk therapy roles and into a process that may be less provocative. The medium serves as a bridge between you and the therapist, allowing exploration to occur at a comfortable pace.

Each medium is carefully selected by the therapist to support giving voice to your experience. You don’t have to strain to say the right thing; the medium can speak for you and act as a support for your experience. Some emotions may be better expressed through art than through verbal language anyway. While you may not be able to put what you feel into words, viewing your work in front of you is something else entirely—something that can lead to your healing.

Journey to the Unconscious

Repression, or the brain’s attempt to send difficult thoughts straight into the unconscious, supports clients in handling their trauma. This phenomenon is observed frequently in trauma victims, who claim to have no recollections of the disturbing events. Many experts view art therapy as a way to tap into these unconscious thoughts and memories and bring them to the surface, so that individuals can heal and reconcile them.

You’re probably familiar with the left-brain and right-brain theory, which has been common knowledge among the general public for quite some time now. The act of creative expression utilizes the right-brain hemisphere. What’s interesting is that the right brain is also where visual memories are stored. Many theorize that the two are therefore very closely linked and that this is one of the reasons that art therapy has been so successful at uncovering repressed, unconscious images.

Helping Children Heal

Although art therapy has been proven to be a successful treatment for people of all ages, research shows that it has been particularly effective in the treatment of children. Various developmental theories claim that children do not fully develop verbal skills until adolescence, and it is therefore no surprise that your child may better respond to a creative outlet for self-expression than a chat with a therapist.

Seeking the right treatment for you or your child following a trauma is often frustrating, particularly when you do not know where to turn. While it is important to read about all of your options, if you or your child has experienced any form of trauma, then art therapy may be helpful.

References:

1. Art therapy. (2011). Retrieved July 15, 2012, from Trauma Recovery Center: http://www.traumarecoverycenter.com/art_therapy.html
2. Art therapy. (n.d.). Retrieved July 15, 2012, from Casa Palmera: http://www.casapalmera.com/articles/art-therapy/
   Art therapy what is it? (n.d.). Retrieved July 15, 2012, from CRC Health Group: http://www.crchealth.com/types-of-therapy/what-is-art-therapy/
3. Clatch, M. (2012, January 1). Trauma recovery through art and play therapy. Retrieved July 15, 2012, from Courage to Connect Therapeutic Center: http://www.couragetoconnecttherapy.com/trauma-recovery-through-art-and-play-therapy
4. Malchiodi, C. (2012, February 22). Art therapy shows promise in treatment of PTSD & trauma. Retrieved July 15, 2012, from Art Therapy: http://www.arttherapyblog.com/ptsd/ptsd-treatment-showing-promise/#more-26
5. Malchiodi, C. (2012, March 6). Trauma-informed expressive arts therapy. Retrieved July 15, 2012, from Psychology Today: http://www.psychologytoday.com/blog/the-healing-arts/201203/trauma-informed-expressive-arts-therapy
6. Rosenthal, M. (n.d.). PTSD statistics. Retrieved July 15, 2012, from Heal My PTSD: http://healmyptsd.com/education/post-traumatic-stress-disorder-statistics