Couples seek therapy to achieve better communication, increase trust, and enhance intimacy, among other reasons. Surprisingly, almost half of couples who enter relationship therapy do so with the goal of determining if the relationship is viable enough to continue. Although there is much research examining how therapy goals influence outcome, little attention has been given to the relationship between viability goals and outcome in couples therapy. To this end, Jesse Owen of the Department of Educational and Counseling Psychology at the University of Louisville led a study that looked specifically at how treatment goals expressed at the beginning of therapy affected eventual outcome with regards to maintaining the relationship.

Using data collected from 249 couples treated by various therapists, Owen looked at goals of improving the relationship compared to goals of clarifying the relationship’s viability. Owen examined intake paperwork to determine goals and discovered that the partners who had a goal of improvement had better outcomes than those who sought clarification. Specifically, couples who entered therapy to find ways to improve the existing relationship were nearly 80% more likely to be together six months after treatment than the couples who entered therapy wanting to know if they should separate or not. More than half of the couples who wanted clarification at the beginning of therapy had split up six months later.

Owen believes that these results underscore the impact of goal assessment, both for the couple and individual, at the beginning of treatment. Additionally, Owen emphasizes that the clinician has a significant influence on outcome, noting that even when a couple’s primary goal is clarification, they may consider other options as a result of the clinician’s hope and encouragement. The re-evaluation of goals throughout treatment is essential to achieve a positive outcome, even if that outcome is dissolution of the relationship. “The complex intersection of varied hopes, goals, and expectations, occurring often within an emotionally charged atmosphere, requires that clinicians ‘dance’ simultaneously with different partners.” Owen added, “Determining and tracking goals from the outset appears likely to help ensure that the therapist does not step on too many feet too often.”

Reference:
Owen, J., Duncan, B., Anker, M., Sparks, J. (2012, February 13). Initial Relationship Goal and Couple Therapy Outcomes at Post and Six-Month Follow-Up. Journal of Family Psychology. Advance online publication. doi: 10.1037/a0026998

There are many different paths one can take to healing through Expressive Arts Therapy. Let’s begin by looking at a major component of this process, which is allowing the creative process to begin.

Releasing the Creative Spirit
Our healing journey is made possible by opening to our creative process. We invite flow again. We say, “Ah there you are, I’ve missed you.” When flow is permitted, we open a channel to buried treasures just beneath the surface of our unconscious yearning. We wonder why we waited so long to let go to our creative spirit. Perhaps we were bound by obligations, commitments, stress, and mundane efforts to keep our status quo. Whatever the reason, we find some comfort in releasing to our creative process again. Not all releasing requires that you pick up a paint brush, write a poem, or perform a yoga pose. And process isn’t just for painters, dancers, or musicians; it is blessed upon everyone in unique and interesting ways. I often find wandering in a gourmet kitchen store or letting my mind relax while sipping tea on a park bench to be useful when in need of some flow. You may prefer a brisk walk, baking a cake, or perusing a secondhand store as adequate letting-go activities. It is the releasing to yourself that is beneficial. It is the simple act of saying, “I matter enough” to allow myself this moment of time to release to what wants to come through me. Find what works for you, and don’t be afraid to try something new. There are jewels awaiting you when releasing to the unknown.

Decentering
We instantly know the feeling of decentering when we’ve hit it. It may come across as a silly fit of giggling or a playful rousing of exuberant combustive energy while forgetting the worries of the day. Decentering lies at the heart of Expressive Arts Therapy. It is letting go to the “imaginal reality through play, art-making or ritual” (Knill, 2005). It’s as if time has passed and we have forgotten, at least for a moment, the demands of the day and have awakened to the essence of ourselves by dropping into our senses. It is here that we notice and say to ourselves, “I’ve forgotten you.” Here, we release our creative spirit, welcome ourselves back home, and find missing parts of ourselves again. We get there not by way of doing, tasking, or driving, but by way of letting go to our deepest self—the playful unconditional child. We step away from ourselves as we know ourselves to be—lawyer, chef, accountant, candlestick maker—and release to the part of ourselves that doesn’t know, doesn’t plan, and doesn’t perceive what is going to happen next. This is the essence of decentering. Here, Expressive Arts Therapy may act as a vessel, assisting in bridging the gap between this tension of restriction and the releasing to flow.

Aligning With the Soul
Once we have been able to decenter from the outside work and into ourselves, the opportunity arises to align with the soul—the spiritual or nonmaterial aspect of ourselves. This alignment breathes new life into our expression by recalling a weightless way of being that we may have been missing. When we align with the soul, we say, “I remember you.” The lost part of our true being settles in to the wanting, needing, and arising of forgotten passions that our soul has longed for. Here, utilizing expressive arts, we might play with wild abandon, release to dance, stomp our feet, shake a tambourine, and howl at the moon. We remember our essence and it feels good. Whirling about, we thrust into our forgotten freedom and free our soul to experience again. We drop our roles, egos, and worries and rest into the place that we know satisfies us the most. When we allow this to happen, new information arises that we were not privy to before. Our insatiable longing is satisfied for a moment. At last, we have come home again.

Integration
Integration is a gathering and trying on of the bits and pieces we discover as we align with the soul. We have an opportunity to reflect, bring together, reinvent, and make ourselves new again. We can discard worn out habits, shed old beliefs, and remove residual roles of the past. We embark on meaning-making and try on this new information. Reflecting, we might take moments to journal our thoughts and ask ourselves, “What just happened—what does this mean?” Here, our process becomes one of answers and questions. Like trying on new shoes, we wonder, how does this fit?

Whether it is an instant “aha” or a deep look at a lifestyle change, we ponder the new information and attempt to assimilate it through our senses. Although not an expressive arts requirement, we might create a collage of images to bring together a clearer picture, write a lyric to express our feelings, or choreograph a narrative dance piece. Whatever comes to us, this is where we try on “Is this me; am I you?” The ego and spirit join hands and ultimately decide the usefulness of the new information. This process, throughout our lifetime, returns again and again.

Reference
Knill, P., Levine, E. G., Levine, S. K. (2005). Principles and Practice of Expressive Arts Therapy: Toward a Therapeutic Aesthetics. London, UK: Jessica Kingsley Publishers.

Related articles:
The Benefits of Expressive Arts Therapy
Creativity as Innovation Combined with Utility (And How it Works in Counseling)
Active Mood States Encourage Creativity

After 5 years of sobriety, in 1985, I began to notice a pattern in my sexual relationships: Even if I really liked someone, I couldn’t go more than 3 months before my attraction to them fizzled. I would then find some reason to end the relationship, although I never really understood why, and it made me feel bad. Thankfully, while I was leading a weekend retreat on Spirituality in Recovery, one participant pressed for bringing the subject of sex into the process.

Although I was unprepared, it gave me the opportunity to address the issue, and I shared my struggles with the group. When I asked if anyone else identified with the issue, all hands went up. I immediately felt a sense of relief, having previously thought I was uniquely flawed. And then I felt angry that no one had told me about this before, which launched my enthusiasm to shift the primary focus of my work. I began to create healing techniques for underlying trauma and sexual challenges.

The sexual-spiritual split, a deep psychic schism within almost everyone, prohibits loving relationships from forming and enduring. The chasm between sex and love, caused by generational, cultural, religious, and early programming, planted seeds in our unconscious that makes merging with another virtually impossible without the specific healing that new perspectives and experiences can offer.

In the previous article (Part One), I describe the subtle powers of Source Energy, our innate intelligence, to direct us forward. I have chosen sexual healing as the next pathway for expanding our access to Source Energy, although there is no particular linear course. Sexual energy, primal and fundamental to our nature, fully awakens our sensorial nature that always knows our best next step in life. A shift in perspective in our relationship toward the life force in sex can expand our Source Energy.

Like most of us who grew up in the Western world, I internalized sex and all references to it as shunned experiences to keep secret. Many of us received discordant messages in our formative years: love, family, and good deeds provide a happy, acceptable life. Conversely, anything having to do with sex, or even our bodies, was cloaked in a wall of shame and secrecy. While experiences vary, our collective consciousness suffers from this split, locking us out of our own rich, informative, multidimensional sensuality.

There are five key elements to dissolving the sexual/spiritual split:

Shifting Concepts: S.E.X.

Our erotic energy pathways have suffered trauma and distortion. To heal those wounds by utilizing expansive Source Energy, we must gently put our old concepts about sex aside. Most of us never developed a healthy, conscious context for having erotic pleasure. We clumsily fall into sex, gradually shaping ideas about it from what we have observed, and from our own, perhaps awkward, experiences.

When barriers dissolve, we are more likely to have more of what could be called “sacred” or “transcendent sex” and an openness to meaning and purpose for all types of lovemaking, including with ourselves. In paying attention to old sexual identities, we can rediscover, or in some cases reinvent, a new meaning of sex. Our willingness to detach from outdated conditioned thinking is the foundation for transforming sexuality to the sacred.

To help us step out of the cultural box, my partner and I created the abbreviation, S.E.X., for Soul Energy eXchange. It suggests we can choose to enlighten our sexual experiences by focusing on energy that comes from our souls, not just our bodies, and thereby designing a new outlook on pleasure. For those who are willing, it does take a bit of work. It’s rare that I’ve met anyone with an ongoing rich and fulfilling sexual life who did not have to go back in their history to create new contexts for their erotic experiences. But the payoff is huge.

S.E.X. Primary Energies

There are four primary forces in Erotic Ritual’s Soul Energy eXchange (S.E.X.): love, pleasure, lingam, and yoni, which are Hindu Sanskrit terms for penis and vagina. Though lingam energy is typically male identified as drive, pursuance, initiation, and aggression, it’s an energy shared in both genders. Yoni energy, feminine, receptive, creative, and artistic, is also found in both sexes. Love is an energy transmitted from the heart. It can be felt through hands of a lover or from a father or mother to a child. It is gender-neutral. Love means losing ourselves in the beloved. Pleasure takes many forms, but erotic pleasure can be defined as stimulation of the pleasure centers of the brain through visual and tactile stimulation. While some have a low threshold for erotic pleasure, others may find everything erotically pleasurable.

The kind of love we are exploring is the love that moves us to listen and intuit what our lover wants, to care about the other person’s needs. It is best to have the constant energy of love as the foundation for everything in life. The energy of love can be triggered by the energy of pleasure, but it is at its greatest when love is present first.

We have all experienced limiting conditioning in the expression of our lingam and/or yoni energies. Most of us experienced some sort of trauma that blocks our love and pleasure energies as well. Unlocking trauma and toxicity of shame and melting frozen erotic energies are pathways to the sacred. Judgment- free experimentation, using all four of these soulful forces, leads us on a path to the divine, to earth energy, and to a greater connection with the universe.

Perhaps more than in other rituals, through Erotic Ritual we learn that we are all expressions of a much larger source of communal energy. It melts barriers and we feel less isolated. Notice when you are having an erotic experience there is always giving and receiving of energy. Sometimes it’s reciprocated or sometimes one is consistently giving or receiving, and either is fine. Allow yourself to be really present in any prolonged erotic exchange and you will find yourself in a circle of energy. (The yoni expression fully experiences the lingam expression, and vice versa.)

Sexual Concerns

The very private issues that people have shared with me about sex have ranged from not feeling that they are desirable, to experiencing a sexual apathy, erectile and/or orgasmic dysfunction, or feeling detached from a loving partner. Sometimes it’s an obsession with body parts that they just don’t like or think something is wrong with.

Many people carry much the same type of burden, sometimes silently. The principles of Source Energy can have a very beneficial impact in renegotiating and resolving these hardships. With the right resources, including therapy in some cases, the barriers to erotic fulfillment will dissolve, creating possibilities for a blissful engagement with one’s self and with another.

When the sex in a monogamous relationship is unsatisfying, a substantial foundation is at risk. If the condition lingers, with sex becoming almost nonexistent, then the relationship is compromised. Often couples aren’t equipped with the tools to communicate sensitive issues. Their avoidance, sometimes lasting years, continues the downward spiral. Addressing these problems with the assistance of Source Energy can enhance those very skills.

Happily, mine is a loving, growing, and sexually fulfilling relationship, lasting many years. All of our efforts have paid off. Creating sacred time and using it for shame-free sex while opening our hearts, along with taking responsibility and respecting ourselves, have all been key. Sexual loving intensifies consciousness and pure love. In that vast, nurturing ocean there is no ego, nothing to defend, only a sense of just being and connection.

Communication in these sensitive areas can at first feel like hard work. With practice, it eventually becomes quite natural. When my partner and I explored having a committed relationship those many years ago, my primary request was that our sexual relations be the first priority in our union. Even in a number of long-term relationships I’d been in there was the sex-spirit split, along with undeveloped communication skills, causing sex and sensuality to wither. They were left with a sense of deadness in a potentially thriving relationship.

Instead, having made the commitment, we began a life of focalized conscious S.E.X. Expansiveness and sexual gratification became a planned, sacrosanct part of our time together. While it might seem to defy spontaneity, let me suggest that there is a significant payoff. Respecting existing realities—being tired, stressed, too busy, or distracted—doesn’t mean spontaneity is stifled. Rather, without earnest communication of our needs and desires, or without planning, we cannot build rich, enduring erotic lives.

Sexuality, Higher Consciousness, and Fantasy

Although it could feel clumsy, it is crucial to learn to express what we need and desire, as well as what we fantasize about. I like to call it reclaiming adolescent awkwardness, to allow people to go where it might be difficult, in order to heal the sexual-spiritual split, a requirement in forming intimate relationships that are authentic.

In sexual counseling, many are curious about where their fantasies come from, often feeling shame for having them. I tell my clients good fantasies are like rainbows, mysterious and beautiful, sometimes fleeting, and they are to be respected. Their origins may vary from abuses early in life to Freudian, or they may relate to recollections of pleasure from our past. Sometimes they mysteriously come from no conscious recollection whatsoever. Focalizing Source Energy filters the shame out of our fantasies and allow us to fall more deeply in love with ourselves. Self-love is essential to grow in sacred sexuality. Having fantasies doesn’t mean we’re bad or that something is wrong with us, as we don’t have to act on them. Only shame is Godless. Removing the shame from our fantasies transforms them, and that contributes to keeping a long-term relationship sexually alive.

Natural Resistance to S.E.X.

With all our knowledge we still encounter resistance to a loving fusion of our sexual and spiritual energies. The delicate nature of exploring repressed sexual history is likely to trigger that very resistance. When we appreciate the essence of our resistance to removing shame, our fantasies can be an entryway to joyous energetic harmony, where we can experience full-body orgasm along with deeply felt spirituality. Full-body orgasm refers to a burst of the four energies in S.E.X. that can take over every dimension of our physical and subtle energy being. When this happens, we can experience expansiveness and sometimes formlessness that is sublime. It is a full-body encounter that is uniquely restorative when we feel depleted and deeply relaxing when we are tense.

If we can consent to the reality that energy and its many vibrations and frequencies make up our physical reality, we can learn new skills to heal, with an efficient pathway to our inner wisdom. When we energetically experience resolution in our bodies from sexual barriers, we land in the divine center of Source Energy. As we tap into it, the more it begins to lovingly lead our lives.

Related articles:
Part I: Source Energy Optimizes Life – Finding Source Energy
What Do Your Sexual Fantasies Mean?
Fanning the Spark of Sexual Passion

Any caregiver is likely to be vulnerable to stress. However, parents who care for a child with a serious mental illness (SMI) are at increased risk for adverse physical symptoms resulting from stress. Those who care for an adult child with SMI are even more likely to experience the negative effects of stress because of the length of time that they have had to cope with the difficult task of caring for a loved one with mental health issues. Although there is a vast amount of evidence showing how caring for a child with SMI can negatively impact a parent’s psychological health, there is scant clinical evidence highlighting the deleterious physiological effects to the caregiver. Erin T. Barker of the Waisman Center at the University of Wisconsin-Madison addressed this specific dynamic in a recent study by examining the cortisol levels in individuals charged with the care of adult children with SMI.

For her study, Barker asked 61 parents of adults with depression, schizophrenia, or bipolar to complete a stress diary and submit daily saliva samples over a period of several days. The cortisol levels of the participants were compared to the levels of 321 parents of adult children who had no mental health concerns. Barker discovered that the cortisol awakening response (CAR) of the parents of adult children with SMI increased less significantly half an hour after they arose in the morning than the control group. This suggests that the caregivers had a higher stress level upon waking than did the control group. Additionally, Barker found that the cortisol levels of the caregivers declined less throughout the day than did the cortisol levels found in the parents of adult children who did not have SMI.

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“The fact that a similar pattern of hypoactivated daily cortisol in response to stress has been found across studies of parents of individuals with different diagnoses (i.e., schizophrenia, autism, developmental disabilities, and in the present analysis, SMI) and that used different measures of stress (i.e., behavioral problems of the adult child with the diagnosis, time spent with the adult child, and in the present analysis, daily stress not necessarily associated with the adult child) provides strong converging evidence for this effect,” Barker said. She added that these findings underscore the importance of addressing the mental health, physiological health, and coping needs of aging parents who care for adult children with serious mental health issues.

Reference:
Barker, E. T., Greenberg, J. S., Seltzer, M. M., Almeida, D. M. Daily Stress and Cortisol Patterns in Parents of Adult Children with a Serious Mental Illness. Health Psychology 31.1 (2012): 130-34. Print.

Abilify (aripiprazole), manufactured by Bristol-Myers Squibb, was approved for use by the U.S. Food and Drug Administration in 2002. An antipsychotic medication, Abilify has shown noteworthy success in treating the symptoms of schizophrenia. Since its introduction, this medication has also been used for easing manic depression in adults. In people who have not responded well to traditional antidepressants, Abilify is sometimes prescribed as a secondary, additional treatment. As a result of increasingly diverse uses, this medication has entered the top 15 in terms of total drug sales. Like all psychotropic drugs, Abilify works by altering the levels of certain chemicals in the brain called neurotransmitters.

Determining the toxic dose of any new medication is essential in developing appropriate safety guidelines. According to the authors of a study published in Clinical Toxicology, “Limited data exist describing the characteristics of [Abilify] poisonings” (Young et al., 2009). Part of the reason for such limited data is undoubtedly the newness of the medication itself. In an effort to fill in these gaps in knowledge, researchers performed an analysis of Abilify overdose events recorded in the California Poison Control Center database. They excluded cases where the record was not sufficiently complete or other substances were ingested along with Abilify. After eliminating such results, researchers were left with 286 usable cases.

Slightly more than half of these cases were female, and the overall median age was about 19 years. The youngest recorded overdose patient was 6 months old. Researchers divided the cases into three distinct age groups (0-6, 7-17, 18+ years) to determine whether there might be an age-related response to Abilify overdose. A standard dosage for this medication depends a great deal on the individual case; however, dosage typically starts at 2 mg for pediatric patients and can increase to 15 mg for adults. It should be noted that Abilify is not prescribed for children less than 13 years old (PubMed Health, 2011). Researchers also placed each case into a group based on dosage level. Group 1 consisted of doses less than 20 mg. In group 2, dosage ranged from 21 to 90 mg. All doses of 91 mg or higher fell into group 3.

Results of the analysis showed that out of 286 cases, 128, or nearly half, showed no symptoms whatsoever. For those who did report symptoms, drowsiness was the most common complaint, followed by nausea/vomiting, muscle twitch, and tremors. In no case was the overdose considered life threatening, and none of the patients appeared to have experienced permanent effects. For adults, only those in dosage group 3 (91 mg+) were statistically likely to experience symptoms. In pediatric cases, symptoms presented themselves even at the group 2 level. In 176 cases of overdose, no treatment was required other than observation. When treatment was administered, activated charcoal given orally was the most common course of action.

While this was only one study of one database, the data seem to indicate that Abilify is not an especially toxic medication. However, the effects of overdose vary from person to person, and underlying conditions may play a role in an individual’s response. As always, keeping medications in a secure location and following dosage instructions to the letter are essential safety measures.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Retrieved February 19, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000221/
2. Mayo Clinic. (n.d.). Dystonia. Retrieved February 19, 2012. Available from: http://www.mayoclinic.com/health/dystonia/DS00684
3. Young, M. C, Shah, N., Cantrell, F. L., Clark, R. F. (2009). Risk assessment of isolated aripiprazole exposures and toxicities: a retrospective study. Clinical Toxicology, 47, 580-583.

People who are discriminated against can suffer significant negative consequences. General well-being, self-esteem, self-worth, and social relations can be severely impacted as a result of discrimination. But recognizing exactly how perceived discrimination affects an individual is much less understood. Previous research has suggested that perceived discrimination can lead to mental health problems such as increased stress, depression, and anxiety. In an effort to better comprehend the exact relationship between perceived discrimination and psychological health, Que-Lam Huynh of the Department of Psychology at California State University recently led a study that examined the effects of this type of prejudice on Latin American participants.

Past studies have demonstrated that African-Americans report varying levels of stress relative to the context of the discrimination they perceive. Overall, research indicates that discrimination in professional settings is more stressful than discrimination in social settings. Additionally, studies have provided mixed results on how the effects of discrimination vary based on severity and frequency. To clarify these influences, Huynh analyzed data from 168 Latino individuals, who reported the severity and frequency of perceived discrimination. The study also evaluated the distress levels, specifically anxiety and depression, of the participants.

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The findings revealed that the higher the frequency of perceived discrimination, the higher the levels of reported anxiety and depression in the participants. The results also showed that participants who did experience extreme discrimination, although infrequently, were equally adversely affected. The research team was able to determine that, overall, the frequency of less stressful discrimination was more detrimental to the participants’ psychological well-being than less frequent high-stress discrimination experiences. Huynh believes these findings will help clinicians treating cultural minorities who struggle with mental health problems resulting from perceived discrimination. Huynh said, “Thus, it is important for researchers to examine both perceived frequency and perceived stressfulness, as the interplay between these two dimensions of discrimination has meaningful relations with psychological adjustment.”

Reference:
Huynh, Q.-L., Devos, T., Dunbar, C. M. The Psychological Costs of Painless but Recurring Experiences of Racial Discrimination. Cultural Diversity and Ethnic Minority Psychology 18.1 (2012): 26-34. Print.

Adderall (dextroamphetamine and amphetamine) is one of the preferred treatment options for adults with attention-deficit hyperactivity disorder (ADHD). The medication works by increasing an individual’s ability to pay attention and control impulsive behaviors. In people without ADHD, abuse of Adderall generates a euphoric sensation, included elevated feelings of confidence and power. When taken as prescribed, Adderall carries a risk of several unpleasant side effects. These include difficulty sleeping, nervousness, restlessness, and headache. Chest pain, rapid heartbeat, and shortness of breath are all signs of a potentially serious condition, warranting immediate medical attention.

Although the risk is small, there have been several documented cases of young people experiencing sudden heart attacks after taking Adderall without a prescription. The dosages were not especially high in many of these cases. In one such example, a young male suffered an acute heart attack after ingesting 30 mg of Adderall and drinking an unspecified amount of alcohol. He had no history of heart abnormalities. Still more troubling, cardiac events are possible even in the absence of abuse. A 15-year-old boy in otherwise good health experienced a heart attack in response to his usual dose of Adderall. He fully recovered, and terminating the prescription removed any signs of heart irregularities. Doctors are not certain what causes these effects in people. Currently, there’s no test to determine who will or will not develop cardiac side effects when taking Adderall. The best practice right now is to monitor an individual’s symptoms closely and intervene at the first sign of trouble. In addition, a history of heart issues may argue for a treatment plan that does not include a powerful stimulant like Adderall.

The extended-release formulation of Adderall was removed from the Canadian market for several years out of concerns about heart attacks and rampant abuse of the medication. It was eventually reintroduced with stricter guidelines for attending physicians. As always, those who abuse prescription medications like Adderall face far greater risks of dangerous, even lethal, side effects. Heart rhythm problems and heart attacks are the most troubling potential consequences of Adderall abuse. Even those who take the medication according to a doctor’s prescription face the small but real threat of cardiac problems. As research into ADHD and stimulant medications continues, safer drugs and drugs less prone to abuse will most likely be introduced.

References:

1. Centers for Disease Control and Prevention. (n.d.) Facts about ADHD. Retrieved from http://www.cdc.gov/ncbddd/adhd/facts.html
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Dextroamphetamine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000310/
3. Jiao, X., Velez, S., Ringstad, J., Eyma, V., Miller, D., Bleiberg, M. (2009). Myocardial infarction associated with Adderall XR and alcohol use in a young man. Journal of the American Board of Family Medicine, 22(2), 197-201.
4. Sylvester, A.L., Agarwala, B. (2012). Acute myocardial infarction in a teenager due to Adderall XR. Pediatric Cardiology, 33(1), 155-157.

Being considered a “perfect child” by one’s parents feels fantastic. Basking in the glow from parents’ approval and love can feel safe and special, like one is living in a magical world where everyone is happy and satisfied. These feelings are very seductive. The child is usually not aware that they pay a price in order to maintain the parents’ continued extraordinary approval. That price is the giving up of one’s unique sense of self in order to comply and be the child and then the adult that the parents adore. Being kept on a pedestal distracts from being aware that one has wants and needs that are not defined by one’s loving parents. This interference with developing an individual self can result in difficult and/or empty relationships as one becomes an adult.

Here is Grace’s story. After Grace and I said our goodbyes during our last session, after 5 years of working together in therapy, I began to think about her journey from the pedestal to the development of a unique self. Grace had become a person with her own separate, individual needs, thoughts, and feelings.

Grace came to see me for therapy when she was 28 years old. She was a pretty young woman who described herself as feeling depressed and confused. She told me she was unhappy with herself and her life. She expressed puzzlement about her feelings, as she described herself as having a successful job, good friends, and a wonderful family. She wished she had a steady boyfriend, but she dated and had been in two almost-year-long relationships. Those relationships “just sort of petered out” and she wasn’t sure why. She shrugged and said, “Something seems off about my life. Nothing feels satisfying; I don’t know what I want. I don’t know what’s wrong.”

As Grace and I worked together in therapy, Grace began to describe how she always felt her life was wonderful. She was an only child and was especially close with her mother, who always referred to her as the perfect child. She told me that she felt special to both her mother and father. They idolized her and believed she could do no wrong. In fact, she told me she did no wrong. She was happy to do whatever they asked: set the table, be home on time, practice piano, not hang out with friends they felt were not a good influence. Grace felt her parents knew what was best for her and she complied.

In therapy, Grace began to talk about how it felt to be seen as so perfect by her parents. She told me she really liked it. She felt safe and loved when they would tell their friends what a good daughter she was. They were so proud of her good grades and her outstanding abilities on the piano and flute. When I asked Grace if she had ever felt like skipping piano practice or coming home later than expected, she looked surprised by the questions as if such behavior was unimaginable. Then she responded that she never behaved that way.

One day, Grace came to our session wondering about why she didn’t have any differences with her parents. She noted, for example, that most of her friends went away to college. She went to a local school and lived at home. She had no memory of wanting to go away to school but realized that now she regretted staying home for college. Grace’s sense of regret about her life began to pervade our work. Over time, Grace posed a number of questions to herself and to me.

Grace wondered if she didn’t consider the possibility of going away to school because she knew her parents wanted her to stay home. She wondered if she majored in music because her parents were so thrilled with her music making. She wondered why she went with her parents on vacations rather than taking vacations with her friends in college. One day Grace began to cry in our session. She was remembering her middle school friend Fran, who her parents didn’t like. They told her she should stop seeing Fran when they overheard her use a curse word. In our session, Grace became angry at herself and her parents. “How could I have agreed to such a thing? Fran was my best friend!” I asked Grace why she thought she should go along with her parents. What did she think would happen if she asserted what she wanted? Sobbing, Grace said she didn’t know. Her parents were good people; they loved her, why couldn’t she say what she wanted to them? Then, Grace stopped crying and gasped: “Oh! I would disappoint them.” I asked “What would be so terrible about disappointing them?” Grace looked very sad and was silent for a long time. Then she looked at me, tears returning to her eyes: “I wouldn’t be the perfect child!”

As Grace and I explored what it would mean to give up being the perfect child, it became clear that such an idea was frightening to her. She loved the feeling of making her parents glow when they saw her. She believed she kept them happy as long as she continued to be their good and perfect child. If she stopped being compliant and who they needed her to be, she worried they would become sad and hurt, and she believed this would harm them. She also would feel guilty. Talking about Grace’s concern and need to keep her parents happy led Grace to the realization that she not only wanted to make them happy, but she was worried that if she didn’t keep them happy, they wouldn’t continue to think of her as so amazingly special. Grace began to understand that to give this up felt like she would be losing their love. She was willing to consider, however, that in fact, she probably wouldn’t lose their love, but that maybe it wouldn’t continue to feel that she was quite so amazing.

Feeling less anxious about the idea that her parents would be hurt and that she would not be loved, Grace began to notice that the way she related to the people in her life was similar to the way she related to her parents. She didn’t like to disappoint or make anyone in her life unhappy. She considered whether the people in her life seemed to like her so much because she always went along. She realized that she didn’t express what she wanted if she knew it would conflict with others. One day she excitedly came into our session and said “I think the reason my relationships with men don’t work out for me is that they never really get to know who I am because I never know what I want and I am always avoiding conflict.” She said with a smile, “I am never satisfied because nothing that happens in the relationship is about me!”

Grace’s smile told me a lot. I congratulated her on the discovery she made and our work turned to focus on Grace’s wishes, desires, and needs for herself in the world. While Grace was eager to embark on a journey of discovery to learn more about herself, she was understandably anxious about how this would affect the relationships she was in. Would the people she was close to, her parents, friends, and new boyfriend, still want her in their lives? Would they love her? Would she hurt and disappoint them? Would it feel like love to her if she didn’t feel she was the most special person to the other in the relationship? These were all important and real issues that Grace would have to contend with.

Over the next 2 years, Grace gradually began to learn what she wanted and liked, what she hated, and what thrilled her. She discovered a passion for cooking and went to school to train as a chef. She weathered her parents’ disappointment that she gave up a career as a musician. And she came to believe she had the right to recognize and follow her own dreams. Her parents didn’t glow as much as they did when Grace first came to therapy, but they didn’t stop loving her.

Grace’s friendships changed. Over time and in spite of her anxiety, Grace pushed herself to reveal more of her wants and feelings as she tested the waters and developed more of a voice with her friends. Some welcomed this new Grace and were excited to learn more about her and make room for another voice. Others were not so welcoming to this new assertive Grace, and some friendships didn’t last. Grace’s dating life changed too. She felt more engaged with her boyfriend. She said “Now the relationship is about us because I am more of a whole person.”

When Grace described her new feelings and new ways of relating, she realized that she is much less compliant as a way of being in the world. She no longer felt perfect in her relationships. She knew she had to continue fighting her resistance to keep her needs quiet. Now Grace feels much more authentic with her family and friends.

Grace often smiles at me ruefully and sighs: “I do sometimes miss the feeling of being so special. Now I struggle to express what I want and it’s hard to accept that sometimes my needs aren’t met. But it is worth it. What I didn’t have, that I do have now, is I feel like a person. I usually know what I want and how to get it. I am not so scared that people won’t like me or that I will disappoint someone. In my relationships, I try to talk about what I want and feel. Sometimes it’s hard, like when I have a fight with my boyfriend or when I feel my parents disapprove of my decisions. But now I make decisions. I don’t go along automatically. I like me. How wonderful is that!”

Grace terminated therapy with the ability to continue the process of discovering and growing her unique self. While she was not yet able to assert herself as much as she wished, she was committed to the struggle to tolerate her uncomfortable feelings and risk that others might not always have the feelings she wished they would have.

That is very wonderful!

Related articles:
The Undeveloped Self and the Difficulty of Relationship
The Pink Elephant of Perception
The Fear of Hurting the Other and the Inhibition of Self

According to a new study led by A.C. Burnett of the Department of Psychology at the University of Melbourne in Australia, children born prematurely and with low birth weights (LBW) are three-and-a-half times more likely to develop mental health problems such as depression and anxiety than normal birth weight (NBW) children. Children born prematurely are already at increased risk for physical health problems, learning disabilities, and other cognitive challenges. Some research has provided evidence that children who are born prematurely are at a higher risk for behavioral problems and even attention-deficit hyperactivity disorder (ADHD). But until now, there has been little evidence suggesting that these children are also more vulnerable to mood disorders and mental health problems later in life.

In order to examine the relationship between LBW and mental health problems, Burnett analyzed previous studies and looked specifically at prematurity/LBW and how it influenced the development of anxiety and depression in adolescence and young adulthood. Burnett assessed data that was published between 1995 and 2010 and included individuals born prematurely with LBW, ranging in age from 10 to 25 years old. After review, Burnett discovered that children who were born prematurely and had LBW had a significantly higher risk than NBW peers, for the development of psychiatric problems later in life. In particular, the study revealed that the LBW participants were three times more likely to develop an anxiety or depressive disorder in adolescence or young adulthood than those who were born full-term.

The results of this study, the first of its kind, have significant clinical implications. Burnett believes that professionals treating the physical and cognitive impairments in LBW children should be aware of the negative psychological predisposition that these children possess, paying particular attention to mental health needs during adolescence and young adulthood. Burnett added, “The studies reviewed here indicate that, in addition to monitoring and management of medical and cognitive sequelae, the psychological well-being of formerly preterm individuals should be a key part of ongoing care in collaboration between clinicians, individuals and their families.”

Reference:
Burnett, A. C., Anderson, P. J., Cheong J., Doyle, L. W., Davey, C. G., Wood, S. J. Prevalence of Psychiatric Diagnoses in Preterm and Full-term Children, Adolescents and Young Adults: A Meta-analysis. Psychological Medicine 41.12 (2011): 2463-474. Print.

Families need to be together. After all, the family as a group exists to provide support, nurturance, food, shelter, resources, and a stable future to each member. While most families have their ups and downs, even stressed, impoverished, chaotic families want to live with one another. When is it in the family’s best interest for members to separate from one another? Can leaving the family home for a short while ever bring healing to the relationships in the long run?

Family separations occur in American culture in formal and informal ways. Formally, families can legally be ordered to separate by the courts because of domestic violence, child sexual, emotional, or physical abuse or neglect, chronic drug or alcohol abuse, and/or failure to educate and when there is a threat to the life, health, and well-being of one or more family members. Typically, less-intrusive assistance has been attempted at many levels before a court order occurs, including weeks or months of child-centered school counseling, family therapy, marriage counseling, social work support, addiction treatment, spiritual community support, or elder advocacy.

All of these actions occur at local, county, and state levels because we as a society believe that we have a stake in supporting and sustaining healthy families. State laws vary but generally have been written with family reunification as the end goal of this intervention process, wherever possible. Violent fathers, neglectful or addicted mothers, and abusive siblings can and often do change and grow into healthier, happier parents, spouses, siblings, and grandparents. We want families to get along well and have what they need to contribute to the world. No one benefits when families are so chaotic and dysfunctional that it takes dozens of people and thousands of hours and dollars to try to help.

[fat_widget_right]More informal separations occur every day, particularly among highly distressed married couples. Unable to live in the same home without physical or emotional pain, one member of the couple leaves the home temporarily and lives elsewhere. Unlike a formal, legal intervention of family separation, this kind of separation is less likely to change the marital interactions at all. What it usually does is create less fighting and conflict in the home, while increasing the stress of the separating spouse and any children in the family. The only person who may feel any relief is the remaining spouse, and this relief is generally temporary. The focus is shifted to the dozens of life details that, once shared, have to be renegotiated, from grocery shopping and bill paying to getting a child to baseball practice.

Unless a separated couple gets professional support and assistance immediately, the family begins to reshape around the absence of the separated parent. Children feel neglected and forgotten, no matter how diligent the separated parent is in spending time with the children. There is just no adequate substitute for living together, and the children’s behavior often suffers. The couples will simply shift their conflict away from one another in the short term and have no real plan of action for getting everyone back together. Because separation only tones down conflict and doesn’t solve it, I almost always suggest that separated couples who want to remain married work at getting back together as soon as possible, and always with professional family or marital therapy. If this is not the chosen path, statistics predict this couple will end up divorcing.

Separation is often a necessary choice when family behaviors become violent, abusive, or dangerous. But in nearly all cases, families should be helped to heal and reunify as soon as possible. Separation is not the best course of action unless it is the only course left for health, safety, or stability’s sake. Every one of us needs to feel like we belong and to be part of a group of people who know, appreciate, sacrifice for, and value us most of all. At our best, these are our families. It’s worth the effort to make them as healthy, whole, and loving as possible.

Related articles:
Three Truths Every Couple Needs to Know About Marriage
Want Family Therapy? These 4 Problems Should Be Treated First
Harness the Power of the Marriage Bond

Traumatic experiences and the trauma healing process can expose the shrapnel from what feels like perpetually open wounds. Time lost to history and recovery, missed opportunities, broken relationships, and a delay in building life’s foundation can be negative side effects of traumatic experiences.

Therapists and people who have experienced trauma are able to identify, with ease, what may seem like irreversible damage or pain. However, it is simple to overlook the pieces of people’s trauma stories that are peppered with traces of hope and with a certain innocence that runs counter to what many of them have survived. This article will reflect on what people in therapy have shared with me. Through their eyes, these are the gifts of trauma:

Gratitude

We can begin with the basics. Survivors regularly express gratitude, disbelief even, for the fact that they are still living. Operating from this premise provides a great deal of delight in each day received. While it may sound cliché, perhaps this is so because of the ordinariness of what is being conveyed; it seems natural that life would be lived with greater enthusiasm in the face of its uncertainty. However, near-death experiences do not appear to be a necessary condition for people to begin to appreciate each new day; rather, being confronted with suffering, fear, or an assault on one’s humanity appear to be more relevant to our ability to appreciate existence.

Enjoying Simple Pleasures

Despite the real struggle associated with trauma recovery, there is often a simultaneous increase in a person’s capacity to enjoy the mundane. A blue sky, a delicate fragrance, a small act of compassion, the subtleties of nature, and the innocence of children and animals are often noted as having significance. Perhaps the sweetness of normalcy is illuminated when confronted with certain kinds of darkness.

Enhanced Awareness and Intuition

Survivors of trauma regularly inform me of what they experience as something akin to having superpowers. The capacity to feel things other people can’t, to identify either the goodness or inherent evil in someone just by looking at them, or to “predict” interpersonal outcomes are some of the new-found abilities people have described. People who have experienced trauma often indicate that they are able to pick up on covert human behaviors, and there is a great deal of trust in their capacity to intuit. Oftentimes, these powers really do exist; survivors have developed a discriminating aptitude for picking up on environmental cues that may have significance to them. A clinical explanation could be hypervigilence; however, people do not necessarily experience this skill negatively and are often quite opposed to this capacity diminishing.

Sense of Surprise and Enchantment

Finally, survivors often work from the assumption that, at some point, things will go awry. There is a sense of something lurking, and they conclude that something will happen that will take them out emotionally (or physically). The consequence of being right is the devastation of experiencing their truth (i.e., the world is not safe, I will never be happy) as real. However, when things go well, even smoothly, a genuine sense of surprise and enchantment is rendered.

[fat_widget_left]Feelings of defeat, pain, and innocence lost can be simple to identify following trauma’s destructive trail, while the search for a trailhead to peace can feel insurmountable. Throughout the witnessing of people’s narratives, I have discovered that there are nuggets of their remaining truth that may linger under the surface. During the process of unfolding and unpacking their stories, honoring each component of truth can facilitate a sense of hope for those who have none. In addition, some people are fully aware of what their trauma has provided them and do not want to lose these new strengths; they may have concerns about admitting this to themselves or the therapist.

Identification of trauma gifts throughout one’s story provides a platform for discussing this in a nonpathologizing way. It may also allow therapists to assist people in letting go of vigilance while embracing intuition, releasing pain while maintaining gratitude, and experiencing safety while holding on to joy.

Autism is the general term for a spectrum of developmental disorders that begin in early childhood. People with this disorder may have difficulty socializing, understanding emotional cues, or functioning in daily life. People with autism are not, as was once thought, intellectually impaired. In fact, many children and adults with autistic disorder show remarkably high intelligence in a variety of areas. Despite years of research, scientists are still not able to explain what causes autism, much less develop preventative measures or cures. The best approaches we have for helping those with autism are therapy and behavioral counseling. The goal of such therapy is to keep behavioral symptoms under control and improve the overall quality of life.

Children with autism show different signs and symptoms. Some are completely withdrawn, seemingly trapped in their own consciousness. Others are very outgoing but oblivious to the social or emotional needs of those around them. Among all behavioral symptoms, aggression towards oneself and others is the most troubling. In two controlled trials, the antipsychotic medication Abilify (aripiprazole) was shown to significantly reduce aggressive outbursts and mood variability in children aged 6 to 17 years.

In most instances, Abilify represents a good choice for modifying aggressive behavior. Adverse side effects reported from the trials included sedation, fatigue, and vomiting. These side effects typically occurred in the first week or two of taking the medication and faded with time. About 10% of patients in the trials discontinued Abilify because of adverse effects, compared with 7% for placebo. In the long term, the most commonly observed side effect was weight gain, which also plateaued after several weeks. Physical activity and a well-managed diet may offset some of this weight gain. In a 52-week trial, the effectiveness of Abilify at reducing irritability appeared unchanged. This finding is encouraging, as the benefits of some psychotropic drugs have been shown to diminish after prolonged use.

Stabilizing the emotional states of children with autism is an important goal for therapists and parents. When the child is calm and responsive, talk therapy and other interactive activities can be more meaningful and effective. Aggressive outbursts and irritability lead to a poor quality of life for the child with autism. Although a cure may still be a long way off, Abilify has proven that it can help improve quality of life for autistic children who exhibit anger and aggression toward themselves and others.

References
Curran, M. P. (2011). Aripiprazole in the treatment of irritability associated with autistic disorder in pediatric patients. Pediatric Drugs, 13 (3), 197-204.