When trying to determine if a child or teen is experiencing attention-deficit hyperactivity (ADHD), it is important to obtain an accurate diagnosis and sense of how he or she is functioning in different domains. This can help guide treatment and other interventions.

As parents begin the process of determining if a child or teen has ADHD, many wonder what is entailed in a formal evaluation by a psychologist—and what benefits it may provide. As a psychologist who provides evaluations to diagnose ADHD and treats the issue through psychotherapy, I thought I could shed some light here. The methods used vary from professional to professional, but here is a general overview of a formal evaluation for ADHD, as completed by a psychologist.

In-Depth Clinical Interview

The time frame may vary somewhat, but on average this lasts one to two hours and provides the clinician with an opportunity to gather comprehensive background information about the child or teen, current symptoms, and other difficulties. The psychologist generally spends time meeting with the child or teen and his or her parents, together and/or separately.

Consultations with Relevant Professionals

Many psychologists consult with other service providers working with the child/teen, including mental health therapists, speech/language therapists, occupational therapists, and psychiatrists. In a lot of cases, the clinician will endeavor to complete a school observation and interview teachers. (Depending on the circumstances and the comfort level of those involved, this may not always be warranted or feasible.)

Formal Testing

The exact measures used and amount of time needed to complete testing vary, to some degree, for a variety of reasons. On average, formal testing for ADHD lasts between four and nine hours. Many clinicians opt to break up testing into two or three sessions on different days.

A variety of standardized measures involving direct interaction between the psychologist and child/teen—computerized measures, self-report and parent/teacher report questionnaires, and other types—are used to look at several areas of functioning, including cognitive functioning, academic achievement in a variety of domains, reading/language skills, attention/impulsivity, visual-motor skills, and emotional functioning.

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Completed Report/Formal Feedback Session

Reports can take several weeks to complete; it takes considerable time to carefully review/interpret results and document it all.

The feedback session is an opportunity to learn about the results of the evaluation and begin talking about specific recommendations to assist the child/teen in improving areas in which he or she is struggling.

Diagnosing ADHD in children/teens is often not as simple as one might think; many issues, such as depression, anxiety, sensory issues, learning difficulties, auditory processing disorder, and even autism spectrum issues, have symptoms that can mimic ADHD. A formal evaluation is helpful in ruling out other issues to ensure an accurate diagnosis.

Nonetheless, depending on the presenting issues, an evaluation doesn’t always lead to definitive conclusions about diagnoses. In these cases, a parent still would come away with a clear sense of how the child/teen is functioning, and would have recommendations to assist him or her.

Benefits Beyond Diagnosis

Aside from obtaining an accurate diagnosis, here are a few possible benefits of having a formal evaluation conducted:

1. Good understanding of the child/teen’s strengths and limitations
2. Recommendations for teachers at school
3. Recommendations for helping the child/teen at home (suggestions to improve organization, time management, behavior, etc.)
4. Information and specific recommendations to help current and future service providers (psychiatrists, mental health therapists, etc.) best assist the child/teen
5. Documentation of the issue that may qualify the child/teen for special education services in the form of a 504 plan or individualized education program (IEP). This may entitle the child/teen to accommodations such as extended time, private or small group testing environment to reduce distractions, use of a word processor in class, etc. Older teens may qualify for accommodations on college board exams as well as services in college. (Not all public school systems/private schools use outside evaluations in the same way, so depending on the school system, ADHD alone may not qualify a child for services.)

If you believe that your child/teen has ADHD and he or she is struggling academically, socially, or in other areas, it is important to get a clear sense of his or her difficulties, determine if it is indeed ADHD, and obtain appropriate treatment.

Disclaimer: The preceding article is intended as general guidance based on the author’s professional opinion, does not constitute an established professional relationship, and should not replace the recommendations of a psychologist or other licensed professional with whom you initiate or maintain a professional relationship.

So, if you’re stressed about something in life—whether it’s an upcoming presentation or performance, or a trip to an unfamiliar territory, or a big party you’re responsible for planning—it may bring you significant relief to, you know, talk about it with someone who has either been there or is going through it with you.

This may seem like a given—like something that doesn’t necessarily require research to confirm. But in the moments when stress and anxiety creep in and become all-consuming, it can be difficult to remember what helps to alleviate them.

According to a study led by Sarah Townsend, an assistant professor at USC Marshall School of Business, it is the specific interaction with a person who genuinely understands your emotion and response, and ideally is also experiencing it at the same time, that will provide measurable relief from stress.

For the study, Townsend and colleagues paired up participants who displayed “emotional similarity” and instructed them to deliver a speech while being videotaped. Each pair was told to discuss their feelings leading up to the presentation with one another, and as this was all happening, their cortisol levels were measured and documented.

They found that within these pairs, the simple act of talking with one another acted as a buffer from experiencing the high levels of stress typically associated with preparing for a speech. The results, which were published in Social Psychological and Personality Science, send the message that finding an emotionally “similar” partner may be key to keeping calm and carrying on when faced with potentially stressful situations.

References:

1. Townsend, S. S. M., Kim, H. S., and Mesquita, B. (2013, December). Are you feeling what I’m feeling? Emotional similarity buffers stress. Social Psychological and Personality Science. doi: 10.1177/1948550613511499. Abstract retrieved from http://spp.sagepub.com/content/early/2013/12/16/1948550613511499.abstract
2. USC Marshall School of Business. (2014, January 29). Two stressed people equals less stress. Press Release. Retrieved from http://www.eurekalert.org/pub_releases/2014-01/umso-tsp012914.php

I remember deciding to leave my marriage. After months and months of trying to make it work, I got to a point where I couldn’t stay any longer. It wasn’t my choice to end the marriage, but my partner made it impossible for me to stay. The decision to walk away from something I had been so committed to was torturous because there was a part of me that would not let go of the idea that it could be saved.

I knew the ship was sinking fast, and I tried really hard to scoop out the water, but ultimately I got to a point where I had to jump. With no life raft waiting for me, I chose to plunge into the deep, murky waters of a new life that would be completely different than what I had planned.

People in therapy often ask me how they can know when it’s time to stop trying and give up on saving a marriage. My answer is always the same: There may come a time when you know you can’t stand it any longer. It may coincide with a loss of integrity and a fear of losing yourself in something you intuitively know is not healthy for you. There is no set time frame; it’s different for every person and every unique situation.

It takes a great amount of courage to walk away from a marriage even if you have exhausted all avenues to try and salvage what’s broken. Even when one partner refuses to work on things, the idea of leaving a marriage dead in the water is beyond painful and hard to overcome.

It’s almost always fear and hope that keep people in a terminal marriage for a little too long—the fear of walking away from something too soon, and the hope that it can be resurrected.

The limbo of whether to work on something or walk away can last for weeks, months, or even years. It’s a personal choice that can come only from a place of deep certainty and a readiness to relinquish the fantasy of what could have been.

I have seen many people who don’t technically “leave the marriage” until well after they are divorced. A signature on a page doesn’t define an ending in the same way a marital commitment is much more than a piece of paper.

No one can ever tell you how or when to be done with your marriage, but here are a few indicators that you might be staying in a marriage beyond its expiration date.

1. Your partner blatantly does and says things that hurt you.
2. He or she disappears for long periods of time without being “reachable.”
3. Your partner refuses to end the relationship he or she has been having outside the marriage.
4. Your partner no longer includes you in his or her daily life.
5. He or she has moved out of the house into his or her own place.
6. You constantly find yourself wondering where the person you married has gone.
7. You rationalize his or her behavior as a “midlife crisis.”
8. You witness big discrepancies between what your partner says and does.
9. He or she refuses to go to couples counseling.
10. Your partner tells you he or she doesn’t love you anymore.

Some of these indicators may be hard to swallow or accept, but if they raise your awareness or give you a bar by which to measure the health of your relationship, perhaps it will be easier to put your marriage to rest.

You are not alone in feeling out of place in your family of origin. Just because we start in one place doesn’t mean that’s where we ultimately end up. As we get older, we often find ourselves spending more time with the family that we have chosen or created. Sometimes that includes the families we came from, but often it does not. It sounds as if your path has taken you in directions that your family members have not shared. It is only natural to feel out of place. It’s great that you feel so comfortable with your wife’s family. What a wonderful resource to have.

I wonder if some of the distress you are feeling comes from a sense of being responsible for the choices your family makes. You talk about not wanting to expose your wife to your family—is that from fear of what she will think of them, and by extension you? Do you believe they present a threat to you, your wife, or your relationship? You are not defined by your family, only by the choices you make. The fact you’ve chosen a path that differs so significantly from your family of origin makes a clear statement about who you are and what you believe. I wonder how much fear of judgment is contributing to the discomfort you are feeling when you are around your family.

Your intolerance for your family suggests that, whether you’re aware of it or not, you are likely grieving your emotional distance from them. I encourage you to identify the pain, fear, or vulnerability which colors the lens through which you view your family. If you can attend to the deeper vulnerability within you, this lens may become clearer, the distance you are feeling may diminish, and along with it—to some degree—your grief. (Of course, there may still be some grieving to do.)

You have many choices as to how you handle family situations. It sounds like it is important to you to retain a sense of your history, your roots, and where you came from. You also mention that your mother’s health is declining. Cutting off your family right now could cause you pretty significant distress. It doesn’t have to be an all-or-nothing proposition. You can insulate yourself from the discomfort you feel at the differences in your current life choices without cutting yourself off from them.

You seem to be focusing on the ways you differ. Are there things that you share? Even though you don’t share many of the values your family does (politics, animal rights, etc.), are there some things that make you feel connected? Was there something in the way that you were raised that allowed and encouraged you to forge your own path? Are there qualities about your family that you can appreciate?

You seem frustrated by your family’s unwillingness to change their ways when you are with them. Do they expect you to change your ways when you visit or do they accept you as you are? It is possible to love and accept others who don’t believe in what we do or act in ways we would. In fact, once we stop trying to change others and accept them as they are, it can bring significant relief. If we accept that we can love people by virtue of a shared history without necessarily liking them, that can make things easier as well.

If you focus on the qualities you appreciate about your family, on how your experiences in your family shaped the choices you’ve made, you can value your family connections for what they are—part of a shared history. You can also limit how much time you spend with them if being around them causes you distress. Ultimately the shift is not going to come from them—and may not even come from avoiding them. The most impactful shift will be an internal one. You may want to work through some of this with a therapist who can help you integrate your past and your present more peacefully.

Best wishes,
Erika

Mindfulness practices are quickly becoming an integral part of many people’s day-to-day lives, largely inspired by the belief that our thoughts and intentions have a significant impact on our overall health and well-being. Testimonies and reports are continually emerging to support the notion that rampant internal negativity may be associated with physical and psychological pain, while carefully cultivated positivity in the mental sphere is linked to improved physical and psychological wellness.

Of course, no matter the amount of personal belief and experience that testify to the power of positive thought and intention, the call for scientific evidence remains. This makes it particularly intriguing when researchers manage to validate what some might otherwise flippantly dismiss as “woo-woo.”

The positive intention studies of one researcher in particular, Dr. Masaru Emoto, have revealed that not only do our intentions have the capacity to hurt or help ourselves, but our words and intentions also have the capacity to significantly impact those around us.

Since 1994, Emoto has conducted several experiments in which his team of researchers observed the effects of spoken word, prayer, music, and images on crystals of frozen water. The photographs captured in response to these stimuli revealed “beautiful crystals” forming in response to positive words and phrases, music, and “pure prayer.” Conversely, when spoken to or influenced negatively, the water molecules appeared disfigured and broken in the photographs (Emoto, 2010).

Dr. Emoto chose to focus his research on water molecules because water comprises approximately 70% of the fluids in the human body, so the connection is obvious. For years, Dr. Emoto has been publishing the results of his studies in his Messages from Water book series, and a sampling of the photographs can be seen online at masaru-emoto.net/english/water-crystal.html.

Water molecule photos are also included in Dr. Emoto’s children’s e-book The Secret Language of Water, which can be viewed and downloaded for free at emoto-peace-project.com. Available in several languages, the book intends to educate young people of the importance of water on this planet and in our bodies.

In a more recent study conducted by Dr. Masaru Emoto and colleagues, some 2,000 people in Tokyo focused long-distance positive intentions on water samples contained in “a double-steel-walled, electromagnetically shielded room” at the Institute of Noetic Sciences (IONS) in Petaluma, California (Radin, Hayssen, Emoto, and Kizu, 2006).

On November 16, 2005, Emoto led the participants “in a prayer of gratitude directed toward the water in the IONS laboratory, some 5,000 miles away” (Radin et al., 2006). They were shown digital images of the bottles of water, and the prayer lasted for approximately five minutes. The water samples were then sent to Emoto’s lab in Japan. Specific measures were taken to ensure that the water bottles were kept separate and free from outside influence, and when the contents were examined, 40 unique water molecules were photographed.

The researchers then enlisted 100 volunteers to blindly evaluate the photographs based on aesthetic appeal. Basically, they wanted to see which water molecules were perceived as beautiful and pleasing, and which ones were not. Both “treated” and untreated molecules were included.

The results reinforced the idea that “water treated with pleasant intentions” results in “more pleasing crystal shapes” than water that did not receive this treatment (Radin et al., 2006).

In 2004, Emoto’s work received a great deal of attention when his photographs of crystallized water were featured in the film What the Bleep Do We Know? And through his ongoing explorations into how our words and intentions impact water molecules, and what that means not just for human life but for the bodies of water that sustain us, Dr. Emoto has become internationally known as “the water messenger.”

The video below, which you may have seen circulating around the Internet, features another of Emoto’s experiments, in which cooked rice was placed in three separate beakers: the first container was told “thank you,” the second one was told “you’re an idiot,” and the third one was completely ignored. After 30 days, the “thank you” rice remained white and began to ferment, “giving off a strong, pleasant odor”; the “you’re an idiot” rice turned black; and the neglected rice began to rot. Poor rice!

Several videos on YouTube reflect similar results when people have tried Emoto’s experiment at home with their own supplies.

Emoto’s work sends a clear message that what we feel and say to ourselves and others has the potential to alter the very molecules surrounding us; in other words, being mindful matters!

References:

1. Emoto, M. (2010). What is the photograph of frozen water crystals? Retrieved from http://www.masaru-emoto.net/english/water-crystal.html
2. Radin, D., Hayssen, G., Emoto, M., and Kizu, T. (2006, September). Double-blind test of the effects of distant intention on water crystal formation. Explore: The Journal of Science and Healing, Vol. 2, Issue 5, 408-411. Retrieved from http://www.explorejournal.com/article/S1550-8307(06)00327-2/fulltext
3. Spirit Science and Metaphysics. Did you know your thoughts can do this to water crystals? Retrieved from http://www.spiritscienceandmetaphysics.com/scientific-proof-thoughts-and-intentions-can-alter-the-world-around-us/

It is not uncommon for a man with high-functioning autism/Asperger’s to have a child who also has it, because there are genetic components to this brain structure variance that manifests as what we call HFA. These differences are in the prefrontal cortex and the amygdala.

High-functioning autism is not a mental illness. It is not a personality disorder. It is not ADHD, ADD, or oppositional defiance disorder. It is a physiologic difference in the brain with a spectrum of possible manifestations. A father passes on his genetic material to his son. Some of this material can contain the code for HFA.

In my practice, I often see neurotypical women in such a triad. Usually, the pathway for the wife is difficult, as she feels as if she is the outsider as she struggles to be understood and to feel that she is valued in her family.

It is a difficult challenge for a neurotypical woman to put herself in the mindset of the HFA husband or son. She can understand the differences intellectually, but when it comes to feelings, she inadvertently defaults to her neurotypical frame of reference. She tells me she can’t help it. She tells me it is exhausting and, most often, fruitless.

I tell her that I understand her position. We talk about feeling alone and alienated. But I also try to bring her to a place of being able to see what it might be like for her if she were in her husband’s or son’s position as individuals with HFA trying to make their way in a neurotypical world.

They are often exhausted, confused, and frustrated. They feel intense anxiety and fears about missing social cues, misunderstanding subtexts in conversations, and taking everything literally, missing the nonverbal aspects of communication.

When I see women married to HFA husbands whose children also carry the diagnosis, we work together on several things: the grief that attends the loss of her dreams and hopes, the reconstruction of her sense of self and the reinvigoration of her personal goals, and ways in which she can retain her newly-regained confidence. We also work on methods she can use so that she can communicate with her husband and son in such a way that they understand cognitively what she is explaining about her emotions.

It is not easy. But with support, the wife in such a situation can learn techniques and strategies for getting her point across that may not seem comfortable to her at first. Once she begins to see that they work, however, they can become second nature to her.

They will never be her first nature, however. Good support along her journey of discovery is of extreme importance for her well-being and for reinforcement that she is doing the best she can. She will also need help decoding things she does not understand and things she has tried which have not worked, or which have backfired. A good therapist who understands the unique position of the woman in this family is an ally in this journey.

The family dynamics are challenging, but they can be managed with care and with the intent to hold the family together.

Your anguish is palpable in your writing. It is also totally understandable; losing a partner after 21 years of marriage is utterly devastating. I don’t think anyone can ever really be prepared for such a loss. It is just too much to try to wrap your head around until it happens. Even then, it can feel almost unreal.

You commented that all you have done is sleep and cry since your husband’s passing, but you followed this up by saying, “at least, that is how it seems.” In reading your follow-up comment, I wondered if, as you were writing this, you realized that you actually have engaged in some other activities in the months since your husband’s death. If this is true, it might be useful to take a look at what those things are and consider what has felt best. Try to do more of those things when you feel up to it. If and when you do have lighter moments, it is possible (though certainly not guaranteed) that you may feel some guilt. This is not uncommon among surviving spouses. It can feel unfair that you are still able to be in this world having positive experiences while your partner is gone. Sometimes, people even feel like their grief serves as a connection to their lost loved ones, and they cling to it as a means of remaining connected.

The loss of loved one is a universal experience, but everyone’s grieving process is unique and there is not a one-size-fits-all approach. That said, many people find bereavement groups to be very healing experiences. Bereavement groups can foster a sense of connection because they allow you to see that other people are living with the same kind of loss that you are. They can instill hope. You may come to see that if the people in your group can make it through their losses, so can you. Group therapy can also be a forum for brainstorming coping techniques as members share some of the ways they have been able to move toward healing.

If a group feels overwhelming, or if you have trouble accessing a bereavement group, consider your own personal grief counseling with a therapist who specializes in this area. Right now you are very understandably suffering, but you do not have to suffer forever, and you do not have to do it alone. You can heal from this, and I wish you all the best in your process.

Kind regards,
Sarah

A woman who has experienced a traumatic event seeks counseling when she finds that symptoms related to the trauma affect her ability to enjoy life and function normally. She meets with her therapist once per week for 9 months, and she makes tremendous progress in therapy.

As she works hard and stays committed to the process of resolving her trauma, she feels very proud of herself and receives validating feedback from her therapist, who acknowledges her hard work and progress. She then notices that with the change of seasons, some of the symptoms she tried so hard to minimize or eliminate altogether come creeping back. She notices, as the time of year associated with her trauma approaches, her symptoms worsen still.

She becomes very frustrated. She fears she will experience the same degree of trauma she did immediately after the traumatic event. She wants to just give up. “What’s the point?” she asks herself and her therapist. “I have worked so hard and here I am, going right back to the trauma!”

Why Seasonal Change Can Reawaken Trauma

This case example illustrates a very common occurrence in trauma work. Trauma symptoms may resurface or worsen at certain times of year—it is almost as if the change in seasons is a catalyst that causes a person to feel as though they are regressing. It is easy at these times to dismiss the progress that has been made in therapy and focus, instead, on the reemerging symptoms. Rather than consider this a regression in therapy, I prefer to think of it as an expected occurrence in trauma work that should be normalized and discussed.

Several factors can be at play here. First, as the time of year when the traumatic event occurred comes around again, a very powerful reminder of the trauma often occurs. The brain is triggered and begins remembering. The body also remembers and symptoms reemerge.

Another consideration is that holidays can also trigger trauma memories and symptoms, especially if loss has occurred. The loss of a loved one is one of the most common and difficult traumatic events humans can experience. Even if the loss did not occur around the holidays, holiday times often serve as reminders of loved ones who are deeply missed.

Furthermore, according to the American Psychiatric Association, 80% of people who meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) also meet criteria for other mental health diagnoses. In my experience, one does not have to have an actual diagnosis of PTSD to become more susceptible to other troubling mental health symptoms after a traumatic event. Just experiencing a traumatic event can make someone more likely to experience symptoms related to anxiety, depression, and other challenges.

Certain times of the year can make symptoms worse. For example, with colder weather and less daylight during the winter months, a trauma survivor who also experiences symptoms associated with seasonal affective disorder (SAD) may encounter a worsening of both SAD and trauma symptoms. Similarly, someone prone to anxiety may find symptoms flare up during the holidays, when more cars are out on the road, malls and stores are more crowded, and financial and social pressures are mounting.

Unfortunately, many people are ashamed to talk about reoccurring or worsening symptoms, and this can cause symptoms to escalate even more, impacting well-being and functioning.

Addressing Reoccurring Trauma in Therapy

Unfortunately, many people are ashamed to talk about reoccurring or worsening symptoms, and this can cause symptoms to escalate even more, impacting well-being and functioning. Beliefs may surface that all the time and hard work one has given in moving forward from a traumatic experience has been wasted. Feelings of frustration and an urge to give up on therapy are very common during these times, as illustrated in the case example.

In addition, a fear of disappointing one’s therapist may come up, preventing some people from openly discussing new or reoccurring symptoms. Making progress in therapy is validating and rewarding, as the case example demonstrated. Returning to therapy when symptoms reoccur can bring up feelings of shame or guilt, causing one to feel as though they will somehow disappoint the therapist or that the reoccurring symptoms will suggest to the therapist they are not working hard enough.

Reemerging Trauma as an Opportunity for Healing

I find this point in trauma work is sometimes the most critical, when clients have a wonderful opportunity to make the most progress toward resolving their trauma for good. This is the time to talk to your therapist to let them know exactly what you are experiencing and how it is making you feel. A good trauma therapist will validate and normalize what you are going through and help you to confront the fear of reoccurring symptoms so that when other triggers come up, it is not so daunting to confront them. This is an opportunity to practice skills with your therapist that will reinforce that you are strong and capable of handling whatever may come up.

Going back to our case example: The therapist validated and normalized what the woman was feeling and experiencing. She reassured the woman that what she felt was very common in trauma work and presented it as an opportunity. The woman stuck with therapy, continuing to talk about her urges to give up on therapy and her feelings of disappointment as they came up. She continued working hard and trusting the therapeutic process.

She was able to overcome her reemerging symptoms. The time of year that served as a trigger passed, and she found that when she thought of that time of year rolling around again, she was not as distressed as she expected. She felt better and more confident as she moved forward. Eventually, she did not need to see her therapist anymore, although she always knew she could return if she felt the need. And when the next trigger appeared, she handled it beautifully, which just reinforced her strength and the belief that she could continue to move forward.

Reference:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

One of the common themes I come across when working with mothers experiencing depression and anxiety is perfectionism and people-pleasing. Moms get worn out when they are trying to make everyone happy all the time.

There are often good reasons for a tendency to be over-responsible for the feelings of others. Many of us come from families where there was an unspoken expectation that a child must be “good,” because one or both parents were unable to tolerate the challenge of even normal childhood misbehavior. Or sometimes, children develop an unconscious habit of caretaking for others as a way to get their own needs met.

However this pattern develops, it likely served a valuable purpose, which is why it became second nature. Children learn to intuit the moods, thoughts, and feelings of others. They modify their own behavior in an attempt to manage the responses of others. Often, this behavior is rewarded. Who doesn’t appreciate the helpful child who asks her mom if she needs a hug when she seems sad, or goes and plays quietly in her room when there is tension between her parents?

People-pleasing behavior is rewarded by friends and family, at work, and at school. A people-pleaser is there for her friends when they need support and earns the love and trust of her partner. She knows what to say and when to say it, at least most of the time. The cost of this unconscious caretaking is a loss of connection to the self. When your thoughts are focused on intuiting what others want and need, and your actions are focused on pleasing others, there is little space to experience your own feelings, thoughts, and needs. You may not even notice when your needs go unmet or when emotions are pulling for your attention. Sometimes, these unmet needs and unfelt emotions cause physical symptoms—headaches, back or stomach problems, or other tension-related difficulties. These symptoms temporarily draw our attention back to ourselves, making it harder to attend to others and focusing more attention on ourselves and our discomfort.

Having children can push what is already a difficult emotional burden into overdrive, creating anxiety, depression, exhaustion, and even worse physical manifestations. While you may have been able to keep your friends, employer, partner, and family happy before, when a baby comes into the picture, a whole new level of exhaustion ensues. Now you’re sleep-deprived, have a baby whose needs are never-ending, a partner who is stressed out, and it is truly impossible to make everyone happy. This is when, for a lot of moms, things hit a crisis point. Anxiety becomes unmanageable, or exhaustion leads to crippling depression. However, it is also an opportunity to address a long-standing pattern of behavior that has prevented you from taking care of yourself. It is a necessity to learn to increase your attunement to yourself and to let go of unconscious patterns of caretaking.

Looking at how these patterns play out in everyday life can be illuminating. You may discover that ways in which you are caring for others are based on assumptions of what people want or need from you, and that these assumptions are often wrong. You may find that your unconscious perpetual caretaking actually makes you less available when others truly do want or need something from you. So often, people-pleasing behavior leaves us resentful and feeling less generous to those we love. Compulsive caretaking can actually make us less available to others in concrete ways.

One way to begin to address people-pleasing is to become aware of how much of your thinking takes the form of “I should.” It is important to examine all the thoughts about what you should be doing/saying/feeling. Who says you “should”? What will happen if you don’t? What do you really want to do? One way of improving self-care and reducing people-pleasing is to challenge the “shoulds” whenever you become aware of them. Another is to check in with people about what they really do want and need from you, and more carefully balance the stated needs of others with what you truly need to do to take care of yourself. And making conscious choices to do for others is emotionally quite different from unconscious caretaking. It is done in the spirit of generosity, not because it is what you are supposed to do.

Learning to tune into your own feelings and needs and becoming conscious of making choices to balance them against your sense of responsibility to others is one of the most powerful ways to regain a sense of personal power. Regaining a sense of power in your life helps make you a better, stronger, and healthier mom and partner.

Over the course of a decade working therapeutically with adolescents and their families, I have observed countless young people as they reach a highly anticipated milestone in their lives: turning 18. I have also observed the parents of all those young people as they attempt to adjust to the transition that occurs when their “baby” officially becomes an adult. It has been my experience that a child’s 18th birthday is an especially potent event for families, and the ways in which families respond to this event, for better or worse, can form the basis for the launching of their child into young adulthood.

Of course, we all know why the 18th birthday is a really big deal: it’s the one on which Western culture bestows young people with most of the rights they will enjoy for the rest of their lives. These rights include moving about at will without restrictions, curfews, or the like; choosing friends and partners of whom the parents may not approve; signing contracts such as military enlistments, marriage certificates, and leases; borrowing money via loans and credit cards; obtaining or declining medical and mental health care; and quitting or enrolling oneself in educational programs.

Along with those rights, a number of new responsibilities are also bestowed upon each young person on his or her 18th birthday. For example, the young adult must actually uphold any contract that is signed, including paying back loans and lines of credit. Another new responsibility is that, legally, a person—even one who is still in high school—is treated as an adult rather than a juvenile within the legal system. The 18-year-old’s behaviors and choices carry consequences that are far and above what they have ever before experienced.

With all of the cultural and personal implications that hang on the 18th birthday, it is no surprise that navigating this milestone can challenge families. This is an event that can change, literally overnight, the power balances, rules, and expectations between parents and children. Families may spend months or even years nervously anticipating this change; conversely, they may be blindsided by the realities of parenting a child in this brand-new context, and find themselves dealing with unexpected consequences.

In some families, the 18th birthday is treated as a full stop to adolescence, and the newly minted adult is expected to (or believes he/she is ready and able to) immediately begin fulfilling many adult-like roles. The adult child may be expected to, for example, begin paying rent to the parents, purchase his or her own vehicle, or find a full-time job.

In other families, the cultural and legal implications of a child’s 18th birthday are treated as irrelevant inside the family fold; the family attempts to keep everything regarding their child, from rules and curfews to roles and communication styles, exactly the same as before.

In still other families, both the anticipation and actual event of a child turning 18 can become a flashpoint for family upheaval and conflicts. The newly adult child may use turning 18 as a springboard for rebellious or ill-advised shows of independence. Likewise, the parents may threaten the adult child with being kicked out, losing financial help, or other withdrawals of support in an attempt to enforce compliance with rules and expectations.

The “real world” is at once enticing and terrifying for emerging adults.

Many young adults have described feeling as if they’ve been thrown into the deep end of a pool once it sinks in that they are truly considered adults, and may often feel quite unprepared to meet the demands of the “real world.” At the same time, they are excited to flex some of their new independence and privileges, and may at times feel driven to act out adult-like roles and scripts the moment that they have the legal ability to do so.

One primary reason for this is that at 18, the young person’s brain is continuing to develop and does not yet function as a fully mature brain does. The brain’s reward system, governing the way that novelty- and pleasure-reinforcing neurotransmitters such as dopamine are released, peaks in activity in the late teen years. The prefrontal cortex—which aids with decision making, problem solving, and impulse inhibition—is not at its full level of function until the mid-twenties. The fact is, a young adult on his or her 18th birthday is not magically wiser, more resourceful, or more emotionally mature than he or she was the day before, and won’t think and act like a fully mature adult until a few years later.

To complicate the picture, there are almost always needs and dependencies that persist between the 18-year-old and his or her parents. For example, an 18-year-old who is still in high school cannot work full time even if he or she wanted to, and even those out of high school usually continue to be financially dependent. Shared health insurance, car insurance, family cell phone plans, and other matters of money and information mean that negotiating the leading edge of your child’s independence can be tricky at best.

Although we in Western societies now experience a more extended period of adolescent development and dependence than ever before, and although we are now more aware of the realities of brain development, the fact is that 18 continues to be the age of majority in the United States. The mismatch between the legal freedoms and the young person’s capacity to exercise them responsibly can create rough waters for families to navigate. Power struggles that exist between the child and the parents around the time of the child’s 18th birthday can quickly escalate into the child threatening to leave, and/or the parents threatening to kick the child out. The child may choose to do things that are legally acceptable, but are not acceptable to the parents who support him or her.

Every family will handle this transition differently, according to its own unique set of strengths, expectations, and history. However, there are a few rules of thumb that parents can keep in mind which may assist them in managing this major milestone.

The boundary around the family must be flexible—neither too diffuse nor too rigid.

First and foremost, resist the urge to threaten to kick your child out. The subject of your young adult child leaving home will often arise sometime within the months around his or her 18th birthday. You may find your child saying things like, “I don’t like your rules. I should go live with my friend where they don’t have these rules.” Often, by talking about (or threatening to) move out, the child is testing out ideas about being an adult, without any actual intention of following through on those ideas. The 18-year-old usually does not have the experience, wisdom, or resources to leave the home in a safe or well-planned way—and he or she knows it.

If your child does threaten to leave home, as the parent it is imperative that your response be one of reassurance that the child is still a part of the family and that the family home continues to be his or her home. Remember that your 18-year-old is struggling to adjust his or her self-concept to include adult-like roles, and mentally trying some of these on for size is developmentally normative. However, when parents respond to limit-testing behaviors by threatening to kick the child out of the home, the child feels insecure about the stability of the family system and his or her role in it; the boundaries become diffuse and the child becomes unsure about whether he or she can count on remaining a part of the family on which he or she remains largely dependent.

Another problem with parents threatening to kick the child out is that systems under stress tend to escalate to the most intense point of conflict during each conflict cycle. Once parents introduce the possibility of kicking the child out, it is likely to become incorporated into every argument that follows—either by the parents or by the child in anticipation of the parents’ threat. This escalation pattern severely disrupts the stability of the family system.

So it’s important that the boundary around who is in and who is out of the family system remains well-defined so that the young adult child feels secure about his or her place in the world long enough to figure out his or her next steps into adulthood. However, it is also important that the family boundary not be so rigid that it inhibits the child’s necessary practicing of adult-like behaviors in safe and appropriate ways. Families who refuse to allow their 18-year-old to make an increasing number of choices and reach increasing levels of independence can inhibit the development of responsibility, self-sufficiency, and life skills that the young adult child will soon need. Therefore, ongoing adjustments to certain family rules, such as curfews, jobs/bills, and friend/partner choices, are essential.

Use negotiation skills to co-create a new set of roles and rules that meet the needs of all family members.

How, then, can parents approach these transitions? One way to help your child learn how to be an adult is to treat him or her like one—at first emotionally, and later more practically. Speaking respectfully to your child, accepting his or her opinions as valid, and encouraging him or her to do the same to you are ways to introduce your child to adult-like, egalitarian relating. Negotiating new rules, privileges, and responsibilities together—“family meetings” are helpful for this—allows both the parents and the child to mutually create adjustments to the rules that are thoughtful, sensible, and predictable. Many families find it helpful to write down the new rules and display them in the home so that all parties remember them (and remember that they agreed to them!).

If any family member feels that the current rules and expectations are not working, they can call a new family meeting at any time to review and possibly revise them. If parents and child reach an impasse, try to be as creative as possible to find ways to meet the needs of all family members. Young adults may be happy to agree to increasing levels of responsibility in the home in exchange for increasing levels of trust and privilege. The family members should keep in mind that flexibility, communication, and negotiation with a goal of mutual agreement will take them smoothly through this period of transition.

It can be helpful for these discussions to begin well before the 18th birthday, so that there is plenty of time for the family members to think ahead, anticipate, and become mentally ready for the changes to the power balance and expectations that will likely occur. A discussion that occurs over the course of weeks or months is more likely to involve all family members, cover more contingencies and “what-ifs,” and result in a smoother transition through the actual birthday.

However, it is never too late. If you find yourself with a child who is already 18, or even 19 or 20, and are experiencing a difficult family adjustment into your child’s young adulthood, it is still advisable to approach your child and create an open dialogue about the rules and roles in the family.

Even if parents seem OK with a decision to divorce, it does not mean that their children have to be OK with it. Divorce changes a child’s world in a pretty major way. It is OK and normal for a person in such a situation to feel sadness, anger, resentment, confusion, frustration, and anything else he or she might be feeling. It sounds like you are being asked to make some big decisions before you’ve had much of a chance to process how you are feeling about it all. It also sounds like you feel your parents have put you in a no-win situation. By making you choose, it seems you feel like you aren’t just choosing where to live, but taking sides. I’m sure that doesn’t feel very fair.

It is OK for children, amid divorce, to tell their parents what they are feeling. If any decision feels too big to make alone, it is OK to ask them for help. It is also OK to ask them if they can connect with a therapist or someone who can help a child sort through this situation.

It sounds like your parents are trying to figure things out, and maybe, by giving you the choice, they are trying to make you feel like you have some control in what seems like a situation that is so out of your control. They may be trying to help and let you have a voice in the process. That can actually be a really good thing.

A child whose parents are divorcing should feel empowered to let them know that it is making things hard and that he or she needs help, support, and guidance. Also, keep in mind that the choice you have been presented with might not have to be a permanent one. One option might be to try to finish the year where you are, thereby staying in your school through this year and then reconsidering in the summer what will work best for you.

I know this choice feels monumental—it doesn’t have to be. You also do not have to do this alone. By asking for the help you need, you will set yourself up to manage the changes that are coming without feeling as conflicted and overwhelmed as you feel right now.

Best of luck!
Erika

There is a range of both situational and organic causes of depression. Genetics can also play a role in depression; new studies in something called epigenetics have proven that it only takes one generation of mice to pass down a fear of something that parental mice had a bad experience with.

The theory which drives much of present-day pharmaceutical intervention, espousing that low serotonin is a cause of many depressive states, has not been proven. What we do know is that making serotonin more available in the brain can shift the depressive symptoms. However, it is now becoming clear that people who take antidepressants (most common are serotonin reuptake inhibitors) are more susceptible to recurrences of depression through their lives than people who do not use these medications.

I am concerned that this approach may be prescribing a life sentence of an ongoing struggle between depression and medication for people who take antidepressants rather than allowing a natural state to facilitate change and growth. Also of grave concern to me is the way that we have forever shifted culture by trying to rid ourselves of uncomfortable symptoms while perpetuating a belief system that only positive feelings are acceptable. This is not in sync with the cycles of nature in any way.

We forget we are of the natural world. This approach does not understand that symptoms are only a small part of what really needs our attention. Our culture’s classic symptom-oriented response leads to exactly what the word depression describes: a condition of “pressed-down energy”—-stuck energy that may be very important to look at, exploring the meaning of the situation and allowing it to influence our life choices, leading eventually to change that will re-establish and support the life flow.

The Role of Serotonin

Regarding current chemical trends in treatment, let’s look briefly at what we do know about serotonin: it (along with melatonin and other chemicals) is a neurotransmitter and neural protector that is incorporated into every neural network on the planet, as well as within the human body. Serotonin acts as an information carrier (neurotransmitter), a hormone transmitter, and a modulator of various tissues. It regulates neural networks that refine the communication between the brain and the heart, allowing them to work as a cohesive system.

Serotonin plays a huge role in neuroplasticity (growth of new neural networks in the brain), which is necessary for any living adaptive system. It helps to unify the entire brain into a cohesive biological system by modulating the brain and central nervous system, and continually altering the chemistry of target neurons. It influences form, influences sensory and motor neurons in order to track the source of stimuli from outside the system, and regulates the information that comes to us through our senses.

Serotonin neurons are in our heart, brain, digestive system, and immune system, and are activated by stimuli outside of the body. Serotonin exists (in the body) in any place we touch the outside world and the outside world touches us; it is the interface. As information touches the neural network the serotonin neurons coordinate our physiological response.

The serotonin chemical is highly reactive to any kind of change in the environment. It modulates the information received through our senses, the sensory gating channels. As sensory inflows occur it narrows or opens the gates to what becomes our awareness. In depression it would appear that these gating channels are narrowed and do not allow the sufferer to have a complete picture of his here and now situation.

The Body Connection

Over 70% of the serotonin in our body is manufactured in the gut, so I would assume this would be a good place to begin the exploration of dealing with depression—looking at the condition of the gut flora, the diet, and the overall physical health of the person with depression. Some depressions are simply caused by poor physical health which needs to be remedied.

For others, depression may be situational. In this case, I think it is important not to seek to suppress the experience, but to facilitate the cycle that one is in, so that the meaning of the mood issues can be perceived and lead to a new way of being rather than be pushed back to status quo. Herbs that can support this process as well as other etiology will be listed later in this paper.

These days, it is rare to find a person whose depression hasn’t been perceived from the perspective that to be “down” is an illness, rather than a part of the rhythm of life. And while I understand the extremely high severity and difficulty in some cases, I repeat that I think we have exacerbated depression through suppression of a natural cycle.

Situational depression happens for more reasons that we can count, and many that we don’t understand. Some causes are that a person might be recovering from loss or trauma, or dealing with unmet needs from another stage of life. Especially potent are the unmet needs of childhood that leave some aspect of the person stuck in an earlier stage of development, despite the progression of the body through time. This is seen as soul loss in some cultures.

Depression is often related to the feeling of helplessness that leads to a state of despair and of giving up. It is extremely important for the person to explore and acknowledge the meaning of the depression and take the difficult steps to remedy their situation—whether something is not working in their present day reality, or there are unprocessed stimuli from a past experience, as seen in posttraumatic stress (PTSD) or soul loss.

Often it may be a combination of the two, the present-day situation triggering the old issue and making it difficult to perceive the present accurately. When we look at the role of serotonin and how it modulates information from outside it is easy to see how, if we ignore either the difficult life situation or the old material, we can upset the inherent regulatory balance of the chemicals involved.

Depression: Physical, Psychic, or Both?

My main orientation to mental health and depression grows from a Reichian perspective—anything that is suppressed will come out in other ways, because energy needs to move. Energy is just information, something that comes to do the work of informing us of something. This is similar to the way electric currents run through a wire or water through a hose. Its nature is to move.

In my work at Body-Psychotherapy of Seattle, I look to open the compromised system and restore the flow of life on the five levels of existence: the body, emotions, thinking mind (thoughts), actions (will/ behavior) and the “big mind” (spiritual/etheric influence of a person). The point is to create an integration of a person’s life experience between these five realms so they work in coherence with one another rather than, for example, overusing the thoughts to justify one’s actions or to deny one’s difficult emotions.

Working physically with the body is important to me because whatever physiological and muscular reaction we have to the external environment become involuntary reaction patterns wired into the nervous and muscular systems. These responses are set into motion when the body senses something that remotely resembles a past compromising situation, even if that is not happening in the present. Over time, chemical reactions and the associated muscle memory create strong, overused muscles that become an actual physical armoring that keeps us stuck reliving our early life experiences over and over again.

One of the major challenges of depression in our culture is the necessity to be high functioning all of the time. I would approach depression very differently if we had a society that had built-in flexibility to allow people to adjust to these natural cycles when they beckon. Chronic stress and feeling a lack of meaning in life contribute to, if not cause, depression. This creates a real dilemma in finding healthy responses.

Putting Phytotherapy into Practice

Herbs can play a major role in supporting a person’s entire system to meet the demands placed on it while undergoing a difficult change process. It is important that an herbalist refrain from trying to be the sole health care provider for someone with serious depression. It is important to have a guide (or several) working together to negotiate all levels (body, emotions, thinking, behavior, etc.) into synchronicity.

I am less and less comfortable giving out lists of herbs for certain conditions. I think that an herbalist must have his or her own allies to call upon in order to promote health in another. It is our relationship and our experience with the plants that that charge the treatment. But I can suggest some approaches to choosing herbs.

First, be sure to think about the person’s constitution and match herbs to the unique disposition. In Ayurvedic medicine, there are three dosha, which are elements that make up a person’s composition. Everyone has a different combination of these elements, which may become unbalanced to unhealthy levels. Different substances can affect the traits of the dosha in different ways, so it’s important to tailor the remedy to the person.

For example, do not give a drying herb to someone with an aggravated dry (Vata) state; this is a person who might have dry mucous membranes and an airy personality, and be easily distracted. Nor should you give sweet herbs to a Kapha, a person who is overly earthy, lacking expression, and slow moving. They would do better with spicy or bitter remedies, those that might confuse and exacerbate the symptoms of a Vata person.

As you can see, the symptoms of depression will manifest differently in different constitutions; basically each constitution will be exaggerated in its imbalanced state. A Pitta person may be agonizingly irritable and restless, a Vata will demonstrate confusion and lack of concentration, and a Kapha will cover all of the windows and stay in bed for months.

All of these are common symptoms and may co-occur in one person, but look closely to see the subtleties and with practice you will be guided in choosing appropriate herbs. Overall, herbal remedies for depression need to be stimulating (to get things moving) as well as nourishing to the body and soothing to the nervous system.

More Tips for Internal Stability During Depression

People in any depression should avoid as many environmental toxins as possible; eat organic foods; and avoid caffeine, sugar, and processed foods. They should surround themselves with a natural, nonstimulating environment.

Promote healthy gut flora through the use of probiotics and regular elimination practices. If one’s feces smell strongly, be sure to take this as a warning sign from the gut.

For a period of time, promote good elimination through the use of herbs like Aloe, Rhubarb, Licorice, and Pasqueflower, or use bitters such as Dandelion or Gentian Root. This is going to be especially important in working with people with the cold, damp constitution, as they will tend toward a slower metabolism. But the Pitta and Vata may also have absorption problems for different reasons.

After creating a well-functioning environment in the gut, use alteratives (a category of herbs with tonic effects) to support the liver in removing toxins from the body. Dandelion and Pasqueflower, as mentioned above, are also categorized as alteratives. Many good blends are available. One I make for myself includes Ashwaganda, Burdock, Red Clover (for the blood), and Yellow Dock.

Extremely important is the use of nervines—beneficial plants—throughout the treatment course to soothe the nervous system and calm anxiety. Some of my favorites: Lemon Balm, Scullcap (especially helpful for racing or obsessive thought patterns typical of a Vata or Pitta person), Rosemary, Passion Flower, and Milky Oats (which would be good for a Pitta person, as it is so cooling and damp). And, of course, the use of St. John’s Wort should also be considered in depressive states—although studies suggest it works best in moderate cases. The sun herbs, like St. John’s Wort, Hawthorne, Rosemary, and Frankincense (as aromatherapy), are especially good in seasonal depressive states.

All depression treatments must include getting out into natural light on a regular basis; even if it is dark and cloudy, this will have a positive effect. Moving the body through walking or exercise is also crucial, but especially hard to facilitate in the person with a Kapha constitution.

After supporting the liver and the nervous system, look to adaptogens—stabilizing herbs—to put some zing back in the kidney and adrenal systems, as these are heavily taxed in depression. There are many wonderful adaptogens; I vary my blends regularly to get a sense how the different herbs work and work together.

Always use herbs you are familiar with, so you can sense how they are affecting you or, if you are a therapist, your client. I love Schisandra, Ashwagandha, Polygonum, Gotu Kola, Astragalus, Rhodiola, Dong Quai, Ginseng, and Motherwort.

Wisdom in Worldly Healing

For me, the most important treatment guidance is taken from the practices of other cultures. In South America and Africa, shamans travel between the worlds to resolve soul loss, some of which is described above. Much of the work I do involves treating soul loss of several types, but, different from the indigenous practices, I like to make sure that I have fully prepared all aspects of a person’s system so that they can retain the results long after the treatment ends. I do the scouting and the guiding, but my style also puts the onus of the work on the client: with my help they bring awareness to their old patterns and interrupt them via interventions (for example by thought-stopping, a cognitive behavioral therapy intervention).

I teach them how meet the old underlying need, building relationship and nurturing the young parts of themselves from within. Over time and with vigilance, the information that once ran through neural network systems in predictable, outdated, and problematic patterns can begin to pool as if in a dam, and finally overflow to form new neural networks that better fit the current reality.

Another model that I always have in mind with depression is from ancient mythology involving the underworld. Persephone is a Goddess who was abducted to the underworld by Hades. She faced many challenges there. But up above her mother Demeter searched and held ground for her until she was returned. Innana of the Sumerians traveled the same journey, having to face the fierce Goddess Ereshkigal in the underworld until her time came to be released. This is this same journey that one takes through the belly of depression. An herbalist working on these levels might consider using Spagyric Essences, alchemically prepared herbal remedies which can positively affect depressive states. They are prepared by first distilling the essential oil, the Soul, out of the plant; then leaving the hydrosol and plant matter to ferment and distilling the alcohol from that. This is the Spirit level of the plant. The remaining plant matter is purified through fire until it is reduced to white ash from which the mineral salts, the Body of the plant, is extracted. All three are put back together to form a remedy that works on the etheric levels to create change beyond the body. That change trickles down to the body and facilitates health. Organic Unity carries a line of Spagyric Essences that are made from wildcrafted plants, prepared according to corresponding astrological influences and infused with healing prayers and love. In my experience, this care makes a huge difference in the potency of the remedy and its impact on the client. I highly recommend them.

Finally, I think that the most important thing to keep in mind when working with a severely depressed person is that they must not be left on their own. Like Demeter, someone must hold space for them and watch for them from above, creating an anchor to the larger world. This space must be held by someone who is not afraid of the dark. Someone who is patient and kind, wise and strong. A practitioner with knowledge of the territory, a big loving heart, and good boundaries!