GoodTherapy | Your Move, Parent: What to Do When Your Teen Is CuttingYou look over at your lovely daughter and think to yourself how time flies. Gazing at her with love, you notice red marks and lines on her youthful arms. Immediate panic sets in; you reach over with shock and say, “What is this?!” Your parental urgency sounds like terror, and your daughter pulls away quickly and rebuffs your concern. She retreats to her room, and you are left wondering where you went wrong and concerned that she’s in danger.

As much as it’s an unwanted membership, you’ve just joined with other parents who have children who cut. You may not even know that’s what you’ve exposed, but most likely it is. If your child has been acting more irritable, overwhelmed, and on edge, be aware of the signs of potential self-harm. Generally, the signs distinct to a person who cuts include:

The biggest question becomes, then, what do we do as parents? Here are some suggestions to help you parent through this challenging time:

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  1. Don’t freak out. This is the hardest part for parents, but a necessary one with teens. If you freak out, they freak out. They are just as afraid of their behavior as you are, and if they see you unable to control yourself and handle it, how is there hope for them to cope? Instead, breathe, think it through, and speak calmly.
  2. Check your anxiety. How do you handle your anxiety? Do they see you cope in healthy ways or do you create maladaptive behaviors as well? Are you stressed all the time, yell at everyone, and otherwise handle life poorly? Remember, they are watching you.
  3. Ask them if they want to talk about it, and create opportunities for them to talk. Forcing teens to talk is a recipe for disaster. Instead, be available and let them know repeatedly that you are there to listen if they want to talk. They will appreciate that they can choose to talk or not, and that you are accessible. Create time and opportunities to engage with them.
  4. Don’t embarrass them by telling all your friends. As much as being secretive is damaging, so is telling everyone you know because YOU can’t handle it. This is the time to put your teen’s feelings first and care for them without alerting the media.
  5. Know your limits. If this is too much to handle, seek help for your teen. Self-harm is relatively newly acknowledged and understood as a coping mechanism. A mental health provider can provide guidance and teach appropriate techniques to help your teen handle life.
  6. Don’t tell them to stop cutting. Telling your teen to “knock it off” or “don’t do it again” is simply asking for rebellion. Although that’s how we feel and what we want to say, it’s best to understand the behavior fully before seeking demands.
  7. Create a plan. This is a great time to create a plan for healthy coping mechanisms. Brainstorm with your teen alternative solutions during stressful times. Maybe they can go for a walk, call a friend, bake a cake, draw, listen to music, watch a movie, or journal. This can be a fun activity to do together—use your creativity!
  8. Spend one-on-one time with your teen. Kids spell love: T-I-M-E. Make time.

Discovering that your teen cuts may lead to panic and unease. How you handle yourself during this scary time can create a path to peace or leave a destructive wake. Checking yourself and your own anxiety can be a powerful tool to teaching your teen how to do it, too.

Your friend is going to be hurt. There is no way around that. When you made the choice to start hanging out with your best friend’s ex without telling her, that’s when you made the decision to hide your actions, and possibly your feelings, from her. On some level you must have known that she would be bothered by it, and you chose not to tell her. I don’t say this to judge or to blame, but I think it is important to be clear about what has been happening.

She will very likely be devastated and feel betrayed by her best friend and by the man she thought she had a lasting future with. I wish I could tell you otherwise, but I think you already know this.

In some ways, you’ve already made your choice. You feel this man could be the love of your life, and you’ve chosen to begin a relationship with him. I think what you are looking for is a way to share this with your friend without losing her friendship. That may not be possible. I think you are also hoping to alleviate some guilt you may be feeling about hurting someone you care deeply about. You can spend time and mental energy finding all kinds of justifications for your choices, but that’s not going to be helpful, ultimately.

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You believe this relationship could be serious and real, so why not stop hiding? Own up to your feelings. You can’t expect your friend to be happy for you, not right away, at least, and perhaps not ever. What you can do is honor your long-standing friendship by being honest with her about what is happening, and own the fact you know you have hurt her. Let her know you are sorry she is hurting, and allow her to react however she chooses to. She is entitled to be angry, hurt, and sad. I think you show wisdom in recognizing how you would feel were the situation reversed. Keep that in mind when you talk with her.

Your friend may have a hard time being around you or seeing the two of you together. That is understandable. Mutual friends may weigh in on both sides of the issue. There will be no shortage of people with opinions and judgment. She, or others, may try to make you feel guilty or ashamed of what has happened. You do not have to accept those feelings. Is it unfortunate that you have fallen for your friend’s ex? Yes. Would it have been better to talk with her before things got to this point? Sure. However, all you can do now is own your choices and move forward with honesty and integrity.

You also have the opportunity to use this experience as a chance for some introspection. Most of us have beliefs about ourselves and how we would react in hypothetical situations. I imagine you once thought that you would never choose a guy over a friendship. Those beliefs get put to the test when we are confronted with real-world feelings and experiences. When confronted by real and conflicting feelings, you chose the potential of a serious romantic relationship over your friendship. This may have been a really wise choice or a poor choice. Only time will tell if this choice was worth it. Understanding what led you to make the choice, and finding some peace around your decision, will be important for you. If you find you are struggling with feelings of guilt or sadness in the aftermath of your talk with your friend, I encourage you to seek out support from a counseling professional.

I will add one more word of caution. Consider how much you can and should trust a man who would break up with someone so abruptly after four years and within two weeks seek solace from her best friend. I am not saying that what you have isn’t real, but might you find yourself in a similar situation four years from now? I imagine your friend thought their love was the real thing, too. You are sacrificing a long-lasting friendship for an uncertain future. Make sure your confidence is not misplaced.

Best of luck,
Erika

office environment with four coworkers (blurred)Most of us experience work stress, but can too many responsibilities, unrealistic expectations, and personality conflicts at work lead to an experience of trauma victimization over time?

In my years of private psychotherapy practice, I’ve seen several cases where individuals experience signs similar to posttraumatic stress as a result of work problems. In the beginning, I found this slightly odd. I wondered: could negative work experiences really lead to reactions similar to trauma experiences, like war or sexual assault? Lately, in conversations with colleagues, I’ve discovered this is fairly common, particularly in certain professions.

How Your Work Environment Can Leave You Feeling Victimized

I recently interviewed Arkansas professional counselor Rev. Rebecca Spooner, an ordained minister who left ministry to become a therapist. She specializes in counseling pastors and their families, and said that feeling victimized and traumatized by their work environment is relatively common among members of the clergy. Rev. Spooner explained that the demands and expectations of modern ministry set pastors up for personal failure and emotional trauma.

“The paradigms in ministry are flawed,” Spooner said. “A hundred years ago, pastors had four jobs: marry, bury, baptize, and preach on Sunday. Today, ministers are expected to be marriage therapists and grief counselors, organizational leaders, facilities and staff managers, marketing coordinators, community relations specialists, bloggers, motivational speakers, spiritual teachers, salespeople (increasing membership and giving), budget managers, visit the sick, be a friend, and serve on regional committees! It’s completely unrealistic. It sets everyone up for disappointment.”

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These experiences are similar to what’s happening in private companies in recent times, particularly since the economic crash of 2008. Companies have laid off people and expect those who remain to do more work for less pay. New performance measures are adding pressure, and employees are micromanaged. Among the EAP (Employee Assistance Program) referrals I see in my office, stress related to new and unrealistic work performance expectations ranks at the top of the list.

The people who see me for help with work-related stress have complaints that are similar to what Rev. Spooner sees among clergy: insomnia, irritability, mood swings, anger, feelings of disappointment and disillusionment about their career and employer, confusion about why they are unable to meet the demands placed on them, hopelessness, anxiety and fear, fatigue, muscle tension, family problems, feelings of isolation, ineffective coping, and substance abuse. It’s a long list! Work stress is a big problem in America.

Many of us are familiar with trauma reactions after major catastrophes, but few of us realize that a work environment characterized by unrealistic demands, personality conflicts, and limited free time for leisure can, over time, create an experience of victimization.

3 Ways Cognitive Behavioral Therapy Can Help

Cognitive behavioral therapy (CBT) helps individuals shift from perceiving themselves as having little control over their circumstances to becoming empowered to either change outside pressures or learn to cope with and relate to them differently. With practice, CBT techniques can help reduce stress and anxiety, improve mood, and increase confidence.

CBT treatment has helped ministers reduce the experience of stress and trauma caused by the challenges of their profession. These same techniques can also help most people heal from various traumatic and emotionally difficult situations. CBT reduces distress and helps to restore emotional balance. Here are three techniques from cognitive behavioral therapy to use in your own life.

  1. Learn to identify the thoughts that increase your anxiety and your self-doubt. A large majority of individuals who come to see me for anxiety therapy are quite surprised when I mention that their thoughts are likely causing their anxiety. Most people believe anxiety is something that happens to them, something over which they have no control. But in fact, how we talk to ourselves about the situations we face has a great deal to do with how we feel. For example, if a minister tells herself that because her church is not growing she is not an effective leader and has failed God, she is likely to feel emotionally upset and believe that she is not capable of growing the church. By repeating self-defeating thoughts in her head, her self-esteem erodes. Eventually, she may just give up trying altogether and become depressed. This is the trick trauma plays on us: it tells us that something is wrong with us and that we are helpless, but most of the time our thoughts are not true.
  2. Dispute the thought. Once you’ve identified the anxiety-producing or self-defeating thought, it’s time to dispute it. Here’s an example: “If I don’t grow the church, I’ll get fired.” Let’s examine if that thought is true. In most denominations, firing a pastor takes effort. First, the leadership of the church has to vote that they have lost confidence in the pastor. Then, they have to bring the issue to a congregational vote. In many cases, a national mediator becomes involved to help resolve the conflict and improve the employee/employer relationship between the church and the pastor. So the thought, “If I don’t grow the church, I’ll get fired” is not exactly true. What’s much more likely to happen is that if the church is not growing and leaders are dissatisfied, a conversation will occur about why that’s happening. And hopefully, that conversation will lead to solutions. Notice your own thoughts and question them. Are they true? How do you know for sure? What are some alternative explanations that might be more true?
  3. Learn to relax. The third CBT technique that Rev. Spooner uses is relaxation training. When we learn to relax the tension in our muscles and reduce the speed of our thoughts, our brains function better. They see things more clearly. Gen. Colin Powell has a rule. He tells himself, “It ain’t as bad as you think. It will look better in the morning.” That’s partly because when our brains are rested, we see situations differently. Relaxation training can teach you to rest your brain. My personal hope is that one day, we will collectively learn to be realistic about our demands and expectations of people and be kinder to one another. Until then, if you find yourself feeling victimized, excessively pressured, or doubt your worth or abilities, try CBT. It really can help!

mother holding daughter and waving off fatherOver the past few years since starting my private practice, I have seen and worked with numerous families where a divorce was either in progress or had already occurred and child-custody disputes were in progress. Sometimes, one parent will alienate a child from the other parent out of anger, desire for revenge, jealousy, feelings of betrayal, rejection, etc. The child becomes enmeshed with the alienating parent and believes he or she must align with the alienating parent. The child may also actively participate in the process of alienating the other parent. This phenomenon is known as parental alienation syndrome (PAS).

When I observe families struggling with this type of dynamic, it brings to my awareness the victimizing nature of parental alienation syndrome for the child and the parent being alienated. The child wants to be loyal to both parents, and when he or she feels an “invisible loyalty” to one, it creates a high level of anxiety for him or her. This is a war the child cannot win.

Often, the parent affected by PAS will say negative things about the other parent to the child, with the objective of alienating the other parent from the child. The child can become virtually brainwashed into believing that the other parent deserves to be alienated, and may actively participate in denigrating the parent being alienated. The parent being alienated often feels protective, but is unable to stop the negative impact of PAS on the child and the relationship with the child. The biggest victim in this scenario is the child, as he or she will suffer the most from the fallout.

Parental alienation syndrome steals the bond and security that the child once experienced with the parent being alienated. In addition, PAS typically involves destructive behaviors such as manipulation, lying, and deprivation. Parental alienation syndrome robs a child of the ability to trust others as well as his or her own perceptions about life. In other words, he or she begins to distrust himself/herself as well as carry guilt. Parental alienation syndrome puts a child in a position of believing that the love and bond he or she has with a parent is contingent upon sacrificing the other parent, and they actively participate in protecting the parent responsible for alienating the other.

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If PAS is successful, the long-term emotional impact on a child may severely limit his or her ability to form healthy relationships and to develop emotional attachment to others. In addition, PAS may have a negative impact on a child’s self-esteem and confidence, which affects a child’s general attitude about life.

Parents must recognize that when they decide to divorce and children are involved, their relationship is not ending; it’s changing. Despite the charged emotions that often surface between parents who are divorcing, they must still collaborate about what is in the best interest of their child. The “tug of war” that PAS creates for a child with one or both parents should be avoided at all costs.

The following are some things parents can do to successfully challenge the alienating parent in the phenomenon of PAS:

Thanks for your question. I can only imagine your bewilderment and confusion; things are humming along fine and suddenly, out of nowhere, your wife is asking you to play the “keys in the bowl” game from the 1970s. It sounds like you have a strong marital connection and are completely taken aback by the question, which is understandable. I would feel the same in your shoes.

Here is the key quote, far as I’m concerned: “She says it would be ‘just sex,’ we would make the rules in advance, no feelings involved. It sounds so simple but I am not sure that is how it works.” Frankly, I’m not sure that it works, period. To my mind there is no such thing as “just sex.” We westernized, Cartesian types seem to think we can neatly separate mind and body, but this is a conceptual fantasy that I think has to be done away with. Emotion is irreversibly intertwined with every facet of our being. Even being extremely intellectual has emotional overtones; lack of emotion (coldness, sternness, etc.) is itself an emotion or affect, as we say in psychology. This “no feelings involved” doesn’t make sense because clearly your wife is expressing some desire (i.e., a feeling) for a new sexual experience. The question is, why?

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Because of the intensely physical nature of sex, we tend to think of it as outside the spectrum of the day-to-day relationship—its own special category. I find, though, that the couples who relate together mate together. Sex is on a continuum that includes the mundane interactions of paying bills, housework, schedules, and so on. It puts too much pressure on a couple to have a somewhat routine existence drained of spontaneity and playfulness and then expect sparks in the bedroom. My hunch—from a distance, of course—is that your wife feels something is missing and wants to go outside the relationship to find it. Why is that? What is she not finding between the two of you that she needs to take such an emotional risk of bringing another partner into it? And it is a risk, no matter what anyone says. Sex involves desires that are unconscious, and the latter is always a wild card (which is part of sexuality’s exciting appeal). Of course, my attitude would be different if you were in favor, but you’re obviously strongly opposed.

Are there ways in which she can express some of those desires with you? Is she afraid of hurting your feelings by not saying something or making a request for something new? Is this request for openness a round-about way of expressing dissatisfaction? Are there ways you two can “shake things up” a bit in the romance and sex department? A weekend away, a dance class, a vacation, a little role play? Is there a part of her she wants to let out but is afraid? (Not to be cynical, but I almost wondered when I read your letter if she already had someone in mind.)

You might want to have a serious talk with your wife or even seek some couples counseling to help her understand how unhappy this idea is making you, and how rattled and bewildered you are in light of it. I think you owe it to yourself, and the marriage, to do all you can to try and seek together, rather than separately, a solution or compromise that allows you both to find satisfaction; you have that rare successful marriage that has endured for many years, and that is definitely worth protecting. It would be tragic for it to slip away due to lack of understanding or withheld feelings or desires. Thanks again for writing.

Best,
Darren

checklist of things to doIn helping children, adolescents, and even adults with attention-deficit hyperactivity (ADHD), a checklist is a basic but extremely effective tool if used properly. Checklists are helpful in remembering to complete tasks, staying on track with budgeting time, and maintaining a record.

Here are a few common uses for checklists among those affected by ADHD:

Here are some suggestions on how to display a checklist:

Over time, individuals often learn to internalize the idea of a checklist and may be able to carry out routine tasks successfully without having to continue to rely on a physical checklist.

A sample checklist for a morning routine:

__ Brush teeth

__ Shower

__ Make bed

__ Get dressed

__ Eat breakfast

__ Pack backpack

One can include specific time-frame goals for tasks to be completed as well (i.e., “pack backpack – 7:45 a.m.”).

A sample checklist for homework assignments:

__ Math: worksheet (10 minutes)

__ English: chapters 4 and 5 (30 minutes)

__ Science: short-answer questions (20 minutes)

A sample checklist for daily work tasks:

__ 9 a.m. to 10 a.m.: Proposal project

__ 10 a.m. to 10:15 a.m.: Break

__ 10:15 a.m. to 11:45 a.m.: Meeting

__ 11:45 a.m. to 12:30 p.m.: Return phone calls/email

__ 12:30 p.m. to 1:30 p.m.: Lunch

__ 1:30 p.m. to 3 p.m.: Finish inventory

__ 3 p.m. to 4:30 p.m.: Review of accounts

__ 4:30 p.m. to 5 p.m.: Return phone calls/email

When creating a checklist, there are a few important things to keep in mind. First, make sure that the creation of a checklist does not take a large amount of time. Also be sure that the way the checklist is set up is easy to follow. It is important not to force the use of a specific checklist on a child, adolescent, or adult; this goes for most strategies and tools. Try to work collaboratively with the person, get his or her input, and figure out a compromise that includes his or her ideas. If you do this, an individual is more likely to use the checklist.

If you try a checklist and it doesn’t work well, examine what did not work. It may lead to revamping how the checklist is created, displayed, or used. In other situations, it may mean finding an alternative strategy.

dice bouncingWhen your gambling gets out of control, it can be extremely destructive and devastating to you and to those with whom you associate. Because a gambling addiction develops over time, you, your friends, and family members may not notice that your behavior is compulsive or getting out of hand. However, just because you gamble and enjoy gambling a lot does not mean you are addicted to it.

There are ways to determine whether certain behaviors and activities related to your gambling suggest that you are enjoying a recreational activity or if your gambling has become a compulsive habit with potentially serious consequences. As an addiction psychologist and certified addiction counselor in Pennsylvania, which recently bested New Jersey in combined gambling revenue for 2012 and 2013, many people come to me to find help sorting through the interrelated mental health issues that may fuel gambling behavior in order to determine whether they have a mild gambling problem, a major compulsive and pathological issue, or just an expensive hobby that is all in good fun.

It’s rare, but possible, to develop a gambling addiction after your very first gambling experience. When problems develop, they usually progress over time. Many people participate in social gambling for years with no problems. More frequent gambling or life stressors can contribute to social gambling becoming a serious problem. Most casual gamblers can stop gambling when they have to because of losses; they can set a loss limit and easily follow it. People with a compulsive gambling problem feel strong urges to keep gambling to recoup their lost money. When gamblers are betting to chase losses, things can tailspin out of control, gamblers can lose touch with reality, and the issue can manifest in severe and exacting consequences. Over time, this issue can become more and more destructive.

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For many compulsive gamblers, gambling is about the thrill, not the money. Some begin to take bigger risks and place larger bets to keep getting more of a thrill; this can take a financial toll. When a gambler is trying to recoup losses, lives can be destroyed. Many folks with whom I work recount that their bottom was when this shift happened and they realized that they were gambling in the hope they could get back their losses.

A gambling addiction, unlike drug or alcohol addictions, often has no obvious physical signs or symptoms. Many people with problematic gambling habits deny that they have a problem. They minimize the problem or refuse to admit that their gambling is out of control. They often gamble in secrecy, not allowing friends and family to know about their behavior. They may lie, keep secrets, sneak around, or completely withdraw socially. They do this to make it difficult for anyone to interfere with or confront them about their detrimental behavior.

An important part of recovery from a gambling issue is to expose the gambler’s secrets—extra credit cards, hidden cash, unaccounted-for time, lies about income, etc.—over time to the right, supportive people at the right times. A therapist is a great start, and meeting other people who are recovering from gambling addiction can help a person to feel understood, supported, and guided into long-term recovery.

Just as substance abuse is characterized by uncontrollable urges to consume a particular substance, causing negative consequences to the addicted person and those around the person, a gambling addiction is characterized broadly by tendencies to gamble in ways that cause damage to the person who is gambling and those associated with that person. The urge to gamble can be especially overwhelming during episodes of stress or depression. A person may use gambling as an unhealthy way to cope. As the problem develops and becomes stronger, a gambler may become overly focused on gambling (gambling-seeking) and getting money to gamble.

What Are the Risk Factors?

Certain factors may put you at greater risk for becoming addicted to gambling or having a harder time stopping. These include substance abuse (alcohol abuse is common), mood (often depression) or personality issues or attention-deficit hyperactivity (ADHD); age (younger and middle-aged); sex (women gamblers usually start later in life and tend to have depression, anxiety, or bipolar and can become addicted quicker, although these differences are disappearing); family influence (having a parent with a gambling issue increases your chances); certain medications such as those which treat Parkinson’s and restless leg syndrome (RLS), called dopamine agonists, may have a rare side effect that results in compulsive behaviors, including gambling; and certain personality characteristics such as being highly competitive, a workaholic, restless, or easily bored.

The National Council on Problem Gambling, referring to a Harvard study, estimates that two million (or 1% of) U.S. adults meet the criteria for compulsive gambling in a given year. Another four million to six million do not meet the full diagnostic criteria for compulsive gambling, but meet at least one of them and are experiencing problems due to their gambling behavior. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a diagnosis of gambling disorder is made when someone meets at least four of the following nine criteria in a 12-month period:

  1. Tolerance: Needing larger wagers to experience the same “rush” (similar to the “rush” felt by drug users).
  2. Withdrawal: Restlessness or irritability when attempting to reduce or cease gambling.
  3. Loss of control: Repeated unsuccessful attempts to cut down or stop on his/her own.
  4. Preoccupation: Frequent thoughts about gambling experiences, whether past, future, or fantasy.
  5. Escape: Gambling to improve mood or escape problems.
  6. Chasing: Trying to win back gambling losses with more gambling.
  7. Lying: Hiding the extent of the behavior by lying to friends, family, or a therapist.
  8. Risked a significant relationship: Gambling despite damaging or losing an important relationship, job, or other significant opportunity.
  9. Bailout: Turning to friends, family, or a third party for financial assistance resulting from gambling activities.

Do You Have a Gambling Problem?

As with drug and alcohol abuse, it is often an indication that you have a problem if you are wondering whether you have a problem. If you are losing time from your everyday activities because you are gambling or thinking about gambling; spend more time gambling than you intended to; are gambling to escape worries or stave off boredom or loneliness; or spent money you needed to pay your bills or other expenses, you likely do have a gambling problem.

Are your friends and family expressing concern? They might be recognizing the ways in which your gambling is affecting you before you are. The sooner you seek help and treatment, the less damage to your finances, relationships, and work you will have to repair.

Would you like to stop? The first step to getting well is to accept that you have a progressive issue. It is so much easier to change when we want to, at least a little bit, and so much harder to change when we have to.

Quitting for a while or taking a break is a good indication that you have control over your gambling. It’s possible for some compulsive gamblers to go into remission where they gamble less or not at all. Without professional treatment, though, they will usually relapse.

Like other addictions, a gambling issue may wax and wane or come and go, just as different drugs become more in vogue depending on the zeitgeist. Many people who see me for addiction like to think of their compulsive behavior as the whack-a-mole game people play at carnivals. You can whack the mole, but it’s connected to something else and it will pop up again. It might pop up as a different gambling game, drug use, alcohol use, or shopping or food addiction. Whether it pops up in Atlantic City, Philadelphia, Las Vegas, or in a casino near you, gambling is here to stay, and so, too, is addiction. We must learn to live with these tendencies and become curious about how they work and what purpose they serve for us as individuals, our cultures, and society. With increased awareness and understanding, we can learn how to help ourselves and those we love and care about.

For help with an addiction issue, find a therapist.

Sleeping ChildSleep is not only important for your child’s rest and rejuvenation, good sleep is essential to healthy development. Sleep problems affect a child’s mood, ability to cope, and academic performance. Sufficient sleep can promote emotional resilience and keener senses.

Quality vs. Quantity

Sleep scientists tell us that preschoolers need 11 to 13 hours of sleep each night, while children ages 5 to 12 need 10 to 11 hours. Making sure your child gets enough sleep can be a demanding task, but it’s one that reaps almost instant rewards. Well-rested children learn better, play better, and even sleep better the next night.

However, sleep is gauged by both quantity and quality. Scientists view our nightly slumber in terms of the stages of brain-wave activity and physiology that punctuate the course of a night’s sleep. These stages progress in predictable patterns known as sleep cycles. Sleep quality is a way of evaluating the health of our sleep cycles.

Sleep Cycle

A typical sleep cycle starts when your child feels drowsy, resulting in light sleep. Next, he or she enters a longer period of deep sleep, which is followed by a shorter period of rapid eye movement (REM) sleep. He or she dreams during REM sleep, and then the cycle begins again, starting with drowsiness or very light sleep. Your child will go through four to six (or more) sleep cycles during the night.

If his or her sleep is disturbed mid-cycle, and/or he or she has incomplete sleep cycles, or if he or she sleeps too lightly or wakes too easily, his or her sleep quality will be poor, independent of number of hours of sleep. This may lead to mood swings and/or difficulty with concentration, and over time, long-term health can be threatened.

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Sleep Solutions

Here are five strategies that may help your child get the quantity and quality of sleep he or she needs:

1. Dim the lights.

Surprisingly, it’s not simply seeing light that wakes us in the morning. In fact, it is a specific wavelength of blue light that starts the process. Sunlight, as well as the light emitted by fluorescent bulbs, television, and computer and smart phone screens, contains blue wavelengths that trigger a waking response in our brains.

Exposing your child to these artificial light sources during the hour before bed can make falling asleep harder, and diminish the quality of sleep by curtailing the production of the sleep hormone melatonin. Even nonfluorescent lights can trigger this effect when the source is overhead, so avoiding the use of ceiling lights and tall floor lamps can help.

In place of watching nighttime TV and movies, have your child listen to stories. The tradition of reading bedtime stories out loud is perfect. If you are not in the mood to read, try an electronic book or gentle music.

For an older child who uses a computer or other electronics at night for homework, consider using an app or program that both dims screens at sunset and adjusts the output spectrum to include very little blue. The app will typically return the screen to its normal color mode and brightness at sunrise. The app described is shareware called f.lux.

2. Provide a calm environment.

A calming, soothing bedroom environment can be remarkably effective in helping your child fall asleep. To create a peaceful environment, reduce visual stimuli. If you are thinking of painting or redecorating, try using calm or soft colors. Set lamps on low bedside tables. Reducing clutter can help, too.

To provide a calm environment when siblings share a room, try a white-noise machine, or, if necessary, remove one child until the other can sleep well on his or her own.

If sleep is especially difficult to attain, stricter measures may be needed. Associating the bed with sleep can make a big difference and change how your child relates with his or her sleep environment. This entails pairing the bed with the activity of sleep, similar to how Ivan Pavlov paired a bell with meal time in his famous dog experiments.

Pairing the bed with sleep means that your child must use his or her bed only for sleeping—not to watch television in, eat in, or even play on. That way, whether he or she sees or lies in bed, his or her body will know the bed is meant for sleep. If sleep continues to be elusive, it may be time to seek the help of a licensed mental health or medical professional.

3. Establish a routine and stick with it.

A bedtime routine means consistently doing the same activities before bed, at or very close to the same time, every night. The activities can be as simple as teeth-brushing and pajama donning, as typical as a bedtime story, or as elaborate as a scented bath, followed by soothing music and a back massage. Whether simple or elaborate, a consistently applied routine will help your child have an easier time falling asleep and staying asleep.

A sleep routine also supports the circadian clock in your child’s brain. This is because over time your child’s brain associates the time of day and bedtime prep activities with sleep, so when the routine is started, the brain gears up for sleep while he or she completes the bedtime tasks.

One word of caution: a bedtime routine can be easier to establish than maintain. It helps if everyone in the household is on board. To set the stage for success, create a sleep schedule that can be consistently manageable, even if a parent is absent or the child is away from home.

An optimal routine starts the countdown between 30 and 60 minutes before bedtime. Timing is basic to routines, and while some flexibility is great, keeping bedtime at 9 p.m. or earlier is strongly recommended for children 12 and younger.

4. Substitute soda or hot chocolate with chamomile tea or warm milk.

What goes into your child’s body can impact how he or she sleeps, and understanding how different foods impact sleep can have life-long benefits.

Chamomile tea and warm milk each have ingredients that promote relaxation. Even if your child can fall asleep after drinking caffeine, his or her sleep cycles may not be as complete.

Teach your child to understand and respect his or her body. A healthy body supports healthy sleep. For example, he or she may need exercise during the day in order to sleep well at night.

Also, naps count. If your child still needs a nap, to have real value the nap must be at the right time. An optimal duration and time for napping is about 30 minutes between 2 p.m. and 5 p.m. Avoid napping between 7 a.m. and noon or after 6 p.m.

5. Teach your child how to self-soothe and relax.

Children get stressed too, and worries or tension can make it difficult to fall and stay asleep. In part, this is because stress is correlated with high cortisol levels, and high cortisol can inhibit sleep. However, when your child’s body moves into a relaxed state, cortisol levels reduce.

A healthy bedtime routine can reduce anxiety associated with sleep. Soothing and relaxation exercises don’t need to take a lot of time out of the routine. Adding just five to 10 minutes of a relaxing activity can make a difference. Relaxation techniques can include a muscle tension/relaxation exercise, a guided visualization, or listening to gentle music.

Massage and similar modalities can also help (for some children, a back rub is always welcome). Likewise, warm baths have long been believed to help induce asleep, and they’re a great part of the bedtime routine.

There’s another benefit to bedtime baths. They’re not only a way to keep your child clean and cozy, science has shown that a result of bathing is a drop in core body temperature, which helps to start the sleep cycle. An ideal bath time is first on the routine, at least an hour prior to sleep, so that your child’s body has time to cool down before he or she hits the sheets.

Research has demonstrated that a lavender scent can be effective at promoting relaxation, and thus works as a sleep aid. Try a drop of lavender essential oil in the bath water, or place a few on drops on the shower floor (scent will rise).

References:

  1. Abbott, S. M., Arnold, J. M., Chang, Q., Miao, H., Ota, N., Cecala, C., … Gillette, M. (2013, August). Signals from the Brainstem Sleep/Wake Centers Regulate Behavioral Timing via the Circadian Clock. PLoS ONE, 8(8), 1-11.
  2. BBC Worldwide Ltd. (2009). Films on Demand collection. 10 things you should know about sleep.
  3. Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 2, Sleep Physiology. RetrievedAugust 16, 2014, from: http://www.ncbi.nlm.nih.gov/books/NBK19956/
  4. Meltzer, L. (2010, Jul-Sep). Key procedural elements for the treatment of behavioral insomnia of childhood. Chart. Behavioral Sleep Medicine, 8(3), 177.
  5. Mindell, J. A., Meltzer, L. J., Carskadon, M. A., Chervin, R. D. (2009, August). Developmental Aspects of Sleep Hygiene: Findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Medicine, 10(7), 771-779.
  6. National Sleep Foundation (2014). Children and Sleep. Retrieved August 13, 2014, from http://sleepfoundation.org/sleep-topics/children-and-sleep

couple having communication issuesIf you are what is commonly referred to as a “neurotypical” spouse of a person who is diagnosed as being on the autism spectrum, you are probably accustomed to anxiety. I don’t mean to imply that you enjoy it, but I suspect you are accustomed to walking the line between your initial reaction to a conversation, for example, and the way you may come to sort it out afterward.

It usually falls to the neurotypical spouse to make these distinctions, because he or she is the person who has the capability of doing so. This derives from the differences between the brains of the partners.

You may know that Asperger’s (AS)/high-functioning autism (HFA) is a structural, neurological condition and not a mental illness. This is of great significance because there is always risk of shame around a psychiatric diagnosis. If it is clear to you and to your partner that this is not a mental illness, you will be able to manage it more readily. Secondly, you may realize that if you attribute intent to something your AS/HFA spouse said or did based on your assumptions about what you might have said or done in similar circumstances, you are winding down the wrong path.

This error of attribution, natural as it may feel at the time, is one of the sources of the anxiety you experience, but there is seldom intent to inflict pain in your life on the part of your AS/HFA spouse. There is a difference in the way your brains process information, and you are the one most capable of seeing and understanding these differences; you are neurotypical. But your spouse is not setting out to confound you, regardless of how frustrating conversational and situational conflicts may feel to you.

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Educating yourself about AS/HFA is an excellent place to start. You can learn about the neurological differences. You can learn about the difficulties your spouse has faced his/her entire life in trying to figure out social protocols and nonverbal cues for meaning in interpersonal communication. You can begin to understand that there is nothing wrong with you, and that your expectations have been normal and natural; they simply haven’t been met because your spouse is unable to meet them. You can also learn means of expressing your thoughts that are less likely to cause confusion.

For example, if you bear in mind that nearly 70% of interpersonal communication is nonverbal, and that your AS/HFA spouse is very literal in his/her approach to communication, you can quickly see the limits. And even that is compromised by nonliteral forms of speech, such as metaphor, analogy, or figure of speech, all of which can be extremely difficult to discern and comprehend for a person on the autism spectrum.

Tony Attwood is an Australia-based clinical psychologist who has made the study of AS/HFA his life’s work. I recommend his works for anyone setting out on the path of understanding this diagnosis.

Now I’d like to return to the first point regarding your anxiety. It is important to acknowledge your anxiety and frustration so that you don’t fall into the trap of assigning blame where there is none, neither on your spouse’s part nor on your own. Understanding AS/HFA from a clinical standpoint is an excellent first step.

The second step I recommend is couples counseling with a psychotherapist who understands both the world of the individual with AS/HFA and the world of the spouse. Be mindful of this as you speak with potential counselors, because you don’t want to find yourself in a situation in which one side or the other is advocated and the remaining partner is expected to do all the adapting.

Finally, I would like to point out that in my clinical experience, nearly every individual I have met with AS/FHA experiences constant anxiety often coupled with depression, due to the complex demands of coping with a world that seems as inscrutable to them as the world of the person with AS/HFA may seem to be to you.

A final word of counsel: be kind to each other. Remember that bridges can be built between you and your spouse with the help of a talented counselor who understands what lies on both sides.

Fearchild jumping into arms of dad is a pretty ordinary human emotion. When we experience it, though, it feels anything but ordinary. How we respond to our fears can shape the way we live our lives and the people we are.

As children, we learn a great deal about fear from our parents. A parent’s fear for the child helps the child learn not to run into the street, that the iron is hot, that the electrical outlet is dangerous, etc. However, a parent’s fear may also teach the child that it is scary to go down the slide, to stay with the babysitter, to go to school, to have a sleepover, etc. In these situations, the parent is often frightened, but he or she doesn’t want to feel afraid and doesn’t want the child to experience fear, either. So, to get rid of unwanted feelings, the message is “don’t do it.” This is a different message from “yes, it’s scary, but you can do it anyway.”

Taryn was a scared child who developed into a scared adult who makes safe life choices. She came to see me because she was unhappy with her life. At 29, she was a music teacher in a suburban public school, unmarried, who lived and worked in the town next to where she grew up and where her parents still resided. She had been an “A” student in high school, and went to the local state college where she got her master’s degree in music education. In our first session, she told me: “I really wanted to be a singer. But my parents always discouraged me, saying it was no way to make a living. They encouraged me to be a teacher. I got a scholarship for college, and it wasn’t hard to get my teaching job. I lived at home the first three years I taught, and now I share an apartment with a roommate. I feel so bored. I date occasionally, but every day seems the same as the last one. I just don’t know what I want; I just know I feel empty and blah.”

As Taryn and I worked together and I got to know more about her life, past and present, I could visualize Taryn as a precocious little girl: cute, smart, and lively. She had memories of happy times with her parents—being read to, singing in the car, feeling their pride in how well she did in school. She also had memories of sleep problems, fear of going to school, and a lot of worries. In particular, she talked about not being able to fall asleep on her own until she was 10 and her parents having to stay in her room until she fell asleep. She also had separation anxiety around school, sleepovers, and in general when she felt her parents were out of contact. She recalled: “When I was 12, my friends were going away to camp for two weeks and I started to think about going too. I remember telling my parents that I was worried that I would be homesick. They encouraged me not to go and said it was silly for me to put myself through the worry. When I decided to stay home, I thought they were more relieved than I was.”

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Taryn’s experience illustrates growing up with parents who are unable to contain their anxiety. To manage their feelings, anxious parents typically need their children to share their anxiety. As long as the child is anxious, the parent can feel less anxious and expect that the child will refrain from taking risks. The parent’s anxious demeanor and behavior communicate life lessons to the child: it’s not OK to take risks; it’s not OK to feel anxious; one must act in ways to get rid of the anxiety rather than feel the feelings and see what happens when action is taken.

Being a parent is by definition anxiety producing. No one teaches us how to parent. We have no road maps about how to respond to our children’s behaviors and feelings. Moreover, we have no set of instructions to help us manage our feelings. Frequently, we rely on our experiences in our families of origin to model what we should do and not do in raising our children. It is rare to hear of a parent who says to their anxious young adult child, “Don’t be an anxious parent like me. Try to contain your anxiety with your child and help him to get comfortable with all his feelings so he can go into the world and take risks. I didn’t help you with that, but maybe you can be a better parent.”

Some of us realize that it would be helpful to our children to provide them with an experience different from the one we had growing up. Glenn is the father of 4-year-old Callie. He is very aware of his tendency to worry and get anxious in the face of any possible danger. He is also aware that he is repeating with Callie the over-involved, hovering, scared demeanor that his mother had with him. In therapy, he wanted help with containing his anxiety and not communicating his fears to Callie: “When I take her to the playground, I can feel myself becoming scared and vigilant when she approaches the slide or starts running around. I think to myself, ‘Oh, no, she’s going to get hurt, I have to stop her.’ It takes so much self-control to keep my mouth shut and I don’t always succeed. I also am having conflict with my wife because I don’t want to put Callie in preschool. I keep thinking how sad and abandoned she will feel. My wife thinks I’m nuts. Maybe I am.”

Fortunately, Glenn has the ability to understand that his anxious behavior doesn’t serve Callie. He has been thinking about Callie’s future and his worries: “I can see myself holding her back in all kinds of ways. I know how scared I was trying new things. I can imagine going along with her fears. Like if she’s timid socially or nervous about trying out for a sports team, I know I’ll think of my fears as a kid and not be able to help her. I want her to be strong, able to go away to college rather than go to a commuter school like I did. I want a different experience for her.”

Even if Glenn is not yet able to change his feelings, he has been trying to alter some of his behaviors. We have agreed to work together to see if Glenn’s feelings can move closer to what he is able to know intellectually. Glenn is highly motivated. His ability to recognize the way his anxiety developed from his parents’ communications to him, his memory of his conflicts about wanting more but being terrified of the risks, and his desire to not repeat this pattern with his daughter are extremely motivating.

Worry, fear, anxiety—they serve as important warning signs that keep us safe. But if we think of the fight-or-flight continuum, parents who always signal their children to flee are, in many life circumstances, depriving their children of the diversity life has to offer. Not only are they being denied access to the wide variety of ways to participate in the world, they are being robbed of the ability to develop into individuals who are resilient, confident, and know what they want and how to get it. If parents can respond to a child with the reassuring idea that it is OK to be afraid and still choose to take risks and explore the world, they will be helping the child to learn that fear is to be respected and considered, but is not always a signal for saying no to the scary but exciting and fascinating new experiences that make us the unique individuals we keep becoming.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

GoodTherapy | Is Fear of Rejection Keeping You Single?You are single, feeling good about yourself, looking your best, and decide to go out for a night on the town. In the back of your mind, there is a small nugget of hope that perhaps tonight you will finally meet the person of your dreams and begin the relationship you have been fantasizing about.

As you arrive at the party, bar, or dance club, you settle in to the festive atmosphere and begin to enjoy yourself when you spot that potential mate across the room. Their physical appearance fulfills all your requirements and they appear to be witty, vivacious, and fun as you observe them interacting with their friends.

Suddenly, you find yourself unable to move, your feet stuck to the ground, and all of your desire to connect stymied by a sudden loss of will and resolution. As much as you may wish to follow through and walk the 20 feet across the floor, you find yourself unable to gather up the courage to make what now feels like a million-mile march.

This sudden shift is driven by a common fear among people both LGBT (lesbian, gay, bisexual, transgender) and straight: the fear of rejection. Rejection is a concern that many people carry in the dating world, as it can influence one’s ability to make a connection to someone who could potentially be a great friend, a fun fling, or even a partner.

The fear of rejection is often rooted in the misguided belief that we are not good enough for a person. We fear giving that person the power to make us feel foolish or less than in comparison to them. We build a construct around the person we are hoping to meet that makes them better than us, even though this is often not the truth.

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Here is the kicker to the fear of rejection: It is very possible that someone at that same party, bar, or club finds you to be the object of their attraction and is fearful of approaching you because they imagine you will reject them. It might even be that person you were attracted to, the one standing 20 feet away.

This ultimately leads to a room full of people, many attracted to others, and yet all equally fearful to step across the room and introduce themselves. Thus, the room is frozen in a static energy of missed connections.

There is a powerful means to counteract the fear of rejection—and that is by recognizing that almost everyone is being influenced by it. With this knowledge, you can choose to empower yourself and be the person who breaks the shackles of the rejection construct and risks crossing the room to say hello.

By taking this risk, you reveal yourself as someone who is not constrained by social encumbrance, someone who will take the time and energy to reach out for connection. This presentation of self-assurance and risk taking can be quite sexy to the person you are approaching. Confidence is a proven aphrodisiac.

It also helps to make the approach with a deep sense of curiosity about the person rather than being overwhelmed by your preconceived ideas of who this person is based on how they represent themselves in the moment. They may be projecting a little bit of attitude that is founded in their fear of rejection protecting them from harm. If you assume everyone is holding a tiny bit of fear of rejection, it can help you to be kind and gentle in your approach.

As you begin to release your fear of rejection, you will notice that other people begin to find you more approachable, and the potential for deeper connections will begin to blossom.

Child reaches for stovetop panParenthood makes worry inevitable, but the threats parents worry about change with each generation. The National Poll on Children’s Health, conducted annually by the University of Michigan C.S. Mott Children’s Hospital, is a phone survey that asks a nationwide sample of adults to list the top 10 threats faced by children in their communities, as well as for children across the country.

The most recent poll suggests that violence and health are ongoing concerns for most parents. Over the years, obesity tends to top the list of concerns among those polled, along with bullying and substance abuse, and this year’s poll brings gun-related injuries and school violence into the mix.

What Do Parents Fear?

When parents were surveyed on the biggest threats to children across the United States, 55% put childhood obesity on the list, making childhood obesity the greatest concern of all.

The top 10 “big problems” affecting children nationwide, according to adults surveyed, include:

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1. Childhood obesity – 55%
2. Bullying – 52%
3. Substance abuse – 49%
4. Smoking – 47%
5. Violence at school – 44%
6. Child abuse – 42%
7. Alcohol abuse – 41%
8. Internet safety – 40%
9. Gun-related injuries – 39%
10. Teen pregnancy – 37%

Adults frequently expressed different concerns for children living in their local communities. Childhood obesity still topped the list, with 29% of parents ranking it as a major local threat.

The top 10 biggest local threats included:

1. Childhood obesity – 29%
2. Smoking – 26%
3. Drug abuse – 26%
4. Bullying – 23%
5. Stress – 22%
6. Alcohol abuse – 19%
7. Internet safety – 18%
8. Child abuse and neglect – 18%
9. Teen pregnancy – 16%
10. Not enough physical activity – 15%

The Most Common Threats for Children

Parents’ fears can be influenced by media coverage of frightening events, such as mass shootings. In some cases, parental fear is reflective of common threats. Child abuse, for example, is startlingly common, with more than 6 million cases reported to state child protection organizations in 2012.

Parents don’t always worry about the biggest threats, though. Some leading causes of childhood deaths didn’t make the list. Among babies, the leading causes of death are sudden infant death syndrome (SIDS), developmental and congenital conditions, and low birth weight. Among children ages 1–14, cancer, developmental and genetic conditions, and accidents are the leading causes of death. Suicide, homicide, and accidents top the list among older teenagers.

Though parents’ worries might not always directly reflect the threats their children face, it makes sense that parents might feel anxious in general. In 2013, UNICEF rated child welfare in industrialized countries. The U.S. had the second-highest child poverty rate, and overall, the U.S. ranked 26 out of 29 countries on measures of child welfare.

References:

  1. Child abuse and neglect stats. (2014, August). Retrieved from https://www.firststar.org/library/national-statistics.aspx
  2. Death among children and adolescents. (2012, August 1). Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/001915.htm
  3. School violence, gun-related injury among top 10 child health concerns nationally. (2014, August 11). Retrieved from http://www.mottchildren.org/news/archive/201408/school-violence-gun-related-injury-among-top-10-child-health
  4. Schwayder, M. (2013, April 11). UNICEF report on child well-being shows U.S. near bottom of list. Retrieved from http://www.ibtimes.com/unicef-report-child-well-being-shows-us-near-bottom-list-1186975
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