Play therapy has become a very important element of my work with families and children. In this article, I hope to give you parents some idea of how powerful play can be as an intervention as well as some ideas of how to utilize play with your own children.

Play Therapy at Work

It is Father’s Day as I write this article and I am reminded of one particular case where play therapy had a profound impact on a family. This family had a child with severe autism. They were unable to manage him at home and he was living at the residential treatment facility where I worked. The child in question was very routine-oriented, and he had an extremely restricted range of activities in which he would engage. If he wasn’t repeatedly watching small snippets of Disney videos, he wasn’t happy.

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To make matters worse, if he wasn’t happy, he tended to throw tantrums, or hit and bite those around him. As a result of these behaviors, not only could he not live at home, but the family was challenged to even have him home for short visits. They had to put the entire house on lockdown to prevent their son from wandering away, and at least one of them had to take time off of work to stay up all night to supervise their son.

When this child came onto my caseload, another therapist and I decided we wanted to work with the family to improve the quality of their interactions with their son and make their time together less stressful and challenging. We decided to use a therapy called Theraplay to accomplish this. We did several sessions with the child in which we exposed him to various new activities. We made note of what he liked, what he disliked, and what he just didn’t seem to get (but didn’t hate).

We expected to see a lot of behaviors due to the change in routine, but that wasn’t the case. We quickly found that there were a number of activities that the child seemed to enjoy. Furthermore, we found that a number of activities that he didn’t understand at first he learned and started to enjoy in subsequent sessions. Pretty soon, we had a list of about 20-or-so activities that required minimal material (about $20 of stuff from the dollar store) that he enjoyed. We could easily keep the child happily engaged for over 30 minutes at a time.

We then started doing sessions with the family at their house. First, they watched as we played with their son. Then we started showing them how to do the games. During the course of this session, we were demonstrating a modified version of catch. The child tended to want to catch the ball when thrown to him, but would then walk over and hand the ball back to us instead of throwing it. We learned that playing catch over a table got the child to actually throw the ball back.

As we were demonstrating this, he started throwing the ball to his dad and playing catch with him. Dad immediately started tearing up. He said, “This is the first time I’ve ever had a catch with my child.” There was not a dry eye in the room after that. What father doesn’t want to have a catch with his son? Imagine having to wait 17 years to make that happen. It was an unexpected, but awesome outcome of our therapy.

The Importance of Play in Development

Play is one of the fundamental ways in which children learn. Through play, they learn to how to connect or form secure attachments to others. The quality of the relationships children have growing up will impact the quality of the relationships they form as adults. So it stands to reason that good, quality play as a child can lead to quality relationships in adulthood.

Through play, children learn how to self-regulate. We get excited as we play games with each other, but then we learn how to self-calm and soothe to continue to excel at the games we play. We learn when it is appropriate to get excited and when we need to calm. In fact, I find that using play with children who have problems with regulation is a fantastic way to teach them impulse control and self-control.

Finally, through play, we learn how to socialize. We learn such things as taking turns, cooperation, and competition. We learn about rules and creativity. Through play we develop the basic skills that allow us to navigate the challenges that life presents us. Kids who don’t play are often at a great social disadvantage compared to kids who play.

Guidelines for Play

Ok, so play is important. However, the best play has some structure. To maximize the impact of play on your child’s behaviors, here are some basic guidelines to follow.

1. Play with your child. When engaging in play, do things that involve interaction between you and your child. It’s not enough to simply be in the room (what I call proctoring). It’s great to sit with children as they do a puzzle, but it’s better to do the puzzle with them. You want to promote that social-emotional connection with you. You want to make yourself a source of never ending reinforcement in your child’s eyes. So, do activities that promote things like touch and eye contact (something the typical child with autism might be struggling with and need practice to do or tolerate). Make the time your child spends with you silly and fun; watch how your child positively responds to you in other situations.
2. Keep it simple and developmentally appropriate. Make sure the activities you do with your child are geared towards their mental and emotional age. In the example at the beginning of the article, even though the child was 17, he enjoyed things like holding hands, rocking, and singing “Row Your Boat.” He enjoyed the sensory nature of the rocking, as well as the familiarity of the song. Other teenagers might enjoy singing and dancing with you to music they like. Again, focus on enhancing the connection between yourself and the child.
3. It’s ok to be silly (in fact, it’s recommended)! The games I play with my kids (at home and at work) aren’t complicated. In fact, on the face of it they are pretty silly. I find that even with more resistant, morose children, silliness draws them in. There’s something about being silly with someone else that just brings down defenses. Besides, taking time to relax, laugh, and be a little silly is FUN! It’s a marvelous way to spend some time.
4. Inexpensive is better! It’s very easy to spend a lot of money on toys. Heck, expensive toys can be great (I adore my Xbox). but for the types of interaction I’m thinking about, expensive toys are unnecessary. Blowing a feather back and forth, blowing bubbles, playing clapping games, or playing “red light, green light” require very little in the way of materials. Be creative and see what kinds of things are sitting around your house and look to those for inspiration. Have you ever seen a young child at Christmas? They open up all their expensive presents and spend most of the time playing with wrapping paper and boxes. Tap into that instinct with your child and you will be well on your way to successful play.

Ways to Use Play Therapeutically

Here are some more ideas on how to structure play sessions with your child to get specific results.

Planned sessions to increase engagement: While my usual play style is typically to improvise with whatever is at hand and make things up as I go along, I find that planning out sessions can be helpful when trying to engage with a child. I simply make a list of 5 to 10 activities that I want to do before I do the session and try to at least get through those. I make note of what activities seemed to get the child to respond positively to me so I can use them again later. If I don’t do this, I tend to more easily get shut down by the child if he/she doesn’t immediately engage with me. I focus on activities that promote touch, eye contact, and positive sensory experiences. Good examples are singing/clapping games, blowing up a balloon while the child holds the balloon, and blowing a feather back and forth between your hands and the child’s hands.

Repeated sessions to increase skills: If I am trying to help a child acquire or improve a skill, then I want to focus on repeating activities between sessions instead of changing things up frequently. Repeated exposure is good for skill acquisition. For example, I often use play to teach deep breathing through things like blowing bubbles, singing, and a game called “monkey ride” (in which I put a stuffed monkey on the child’s belly and then have him take a deep breath in and give the monkey a “ride” up to my hand which I place a couple of inches about the monkey’s head). I will repeat these games and variations of them through several sessions until the child has mastered belly breathing.

Short sessions for planned breaks from difficult tasks (The head cooler): When a child gets upset, frustrated, or anxious during specific situations, play can be a great way to manage this. For instance, a lot of my kids have problems around homework. They get upset if there’s too much, or if they don’t understand it. Some can’t make themselves take a break before the homework is complete. These children then get so upset they couldn’t do the work even if they wanted to. The poor parents are stuck not only trying to calm an upset child, but also facing daunting task of getting the child to return to finish the dreaded homework. Hours of this every night can be a major stressor for the whole family.

To counteract this, I suggest trying many short spurts. The parent works with the child to do homework, but also watches the child for the initial signs of agitation, frustration, or upset. As soon as the parent or child notices those signs, they take a short break. During the break, they spend just a few minutes doing something fun and silly (no video games or other major distractions). The goal of the activities is to allow the child’s head to “cool off.” Once calm, the child returns to the homework with a clear head. Families that have been successful in doing this find that not only are there fewer fights and tantrums around homework, but that more homework is getting done in less time.

The bottom line is that play is important. The more challenges you face with your child, the more important it is to put time aside every day to have some positive interactions. Be silly and have fun. Please share in the comments section your ideas for play or any questions you might have. In the meantime, play more with your kids and remember to BREATHE. You’ve got this!

Thanks for your question. It sounds like there are a tangle of conflicts here and I empathize with what I think I hear in your question, which is that you are having feelings which are somehow “wrong” to have, which I imagine is very uncomfortable, even painful. Holding a secret you feel you can’t share with your spouse is often a tough place to be.

In fact, I almost wonder what might happen to your curiosity about men if your spouse heard and accepted this about yourself—or if somehow these feelings became less dangerous and more human. How do you feel about this attraction? You say, “I don’t want to feel like I can’t be myself when I am with her.” What about yourself, aside from the literal idea of sex with a man, feels “not OK” when you’re with her? Is there some ideal sense of manhood you’re trying to fulfill? Does this attraction for men symbolize something that is unsafe in the marriage or your social/cultural circle? Of course as a society in general, we are given horrifically limited identity choices for manhood. Any whiff of “sensitivity” can bring out the gay jokes, as if anything other than James Bond were unacceptable. (Of course, if you’ve seen the latest Bond, you know even he has some interesting inclinations!)

The fact is, our sexuality falls on a spectrum and some of us develop attractions for people of both genders. It’s normal to have fantasies of what sex with the same gender is like, at least occasionally, and some have them more consciously than others—and the very idea is more accepted in some cultures than others. (In ancient Greece, there was no eros more “noble” than love between men.) I’m not saying it’s always a “choice,” but for some of us it is; some folks are clearly attracted to a particular gender, while 3%-5% of us are more in the middle of the spectrum and attracted to both. In the latter case, it’s important to note that we find ourselves attracted to people rather than “men” (or women). For instance, is there a particular man you’ve found “hot” or fantasized about? (Our bodies are pretty clear about attraction.) Perhaps your curiosity about men carries some kind of psychological symbolism—i.e., that you’re hoping for greater emotional freedom and acceptance of “unmanly” aspects of you, especially if you feel pressured to be “strong” or “tough” (like your wife, it sounds like) in a conservative environment. If your desire for men were accepted, you might have wider emotional latitude. Or perhaps the idea of surrendering that strength in order to feel protected is part of the appeal; sometimes it’s nice for us guys to take off the Superman cape and let someone else drive, especially if we’ve lacked close male relationships.

Because us guys are so often prohibited from being vulnerable or “emotional”—which we are; in spite of what culture says about Mars vs. Venus, we’re just emotional in different ways—we can sometimes long for more intimate but not necessarily physical relationships with men, though sometimes that longing is physical; or we have sexual desires that contain emotional longings for connection. These are chicken-and-egg questions that are worthy of further reflection, I think, with the understanding that this might be frightening in the cultural context (and I live in liberal Los Angeles, so it’s easy for me to say) but which are nothing but human at the end of the day. Have you considered discussing this with a therapist?

As awkward and shameful as it might feel, each of us is unique in who or what we find desirable, and while sexual desire is often mysterious or even frightening, when you boil it down it’s related to longings for love, affection, and safety. In a way, all the sturm and drang about sexuality is a red herring and reflect our neurotic cultural bias; imagine if you substituted “other women” for “men” in your question. I find it admirable that you’re not willing to ignore something so vital in your psyche and are searching for answers, which to me indicates courage and integrity. Something tells me there’s a conversation that needs to happen between you and your wife (perhaps with the help of a couples counselor), when the time is right. My sense is that you have a longing to feel safer and less guarded where you live, in a psychological, emotional, and possibly sexual sense. There’s certainly no shame in any of that. You might want to do some research on bisexuality. There are some excellent online resources for people experiencing what you are.

After some sifting, it might become clearer what it is you’re needing from your wife, whether that’s a more emotionally flexible relationship, or even the opportunity to explore this topic in an open, mutually respectful way. Sometimes deciding between commitment and sexual freedom/ experimentation, regardless of gender, is a difficult choice, especially for men who marry young, as you have. And like it or not, our psyches, sexuality, and selfhood continue to evolve over time; thanks for writing, and bravo for having the courage of emotional self-assertion.

Respectfully,
Darren

Alfred Kinsey reported that men hit their sexual prime in their late teens, while women don’t get that pleasure until their mid-thirties. But does the 60-year-old research that Kinsey conducted still hold true today? Was it even true back then?

According to Dr. Bella Ellwood-Clayton, a sexual anthropologist and author, the results of Kinsey’s research probably did not consider the myriad of other factors that influence sexual peak. Even though measuring the amount of orgasms a person has is a pretty good indicator, is not the only barometer by which to gauge sexual appetite.

Ellwood-Clayton says that at the time of the study, boys were masturbating and 30-something women were probably finding their own identities in stable relationships. For the first time in their lives, they were comfortable with their own sexuality. Today, women are finding this level of comfort at even older ages that extend well into their 50s, 60s, and beyond.

Opportunity is another factor that has a big impact on libido. When the opportunity for sex is unavailable, you can lose your desire. Raising children or being in a hostile or abusive relationship can cause even blazing sexual desires to smolder to ashes. But with the peak in sexual medications and the revival of sexual promiscuity in the older generation, it appears that sexual peaks are based more on social psychology than on physical ability.

Sure, men might have more testosterone than women and younger women might be a little more hormonally balanced than older women. But with hormone replacement therapy, physical health, and the right bed-fellow, people of all ages are reporting great sex drives. And there is an awful lot to be said about sexual maturity, which can add intense pleasure to sexual encounters (think Mrs. Robinson).

Overall, Ellwood-Clayton and other experts think that sexual peaks are not simply biological, but more the result of spiritual, physical, emotional, and biological components all aligning at just the right time. “Sexual prime, then, is the result of ‘sexiness.’ And that,” adds Ellwood-Clayton, “can peak at any age.”

Reference:
Ellwood-Clayton, Bella. (2013). Sexual prime: Fact or fiction. Huffington Post (n.d.): n. pag. Web http://www.huffingtonpost.com/bella-ellwoodclayton/sexual-prime_b_3424410.html

In my previous article, I touched on the subject of narcissistic abuse recovery. I decided to write a second article as a follow-up for individuals who wish to explore further how to move forward through this specific healing process.

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As mentioned previously, recovery from this form of abuse can take a fair amount of months (or even years in some cases), given the insidious and covert nature of the emotional abuse (Sokol and Carter). Individuals who exhibit malignantly narcissistic behaviors are predatory in nature and seek to “conquer” targets to fuel their narcissistic supply (NS), which is the emotional sustenance which drives and fills them. These people thrive on attention (negative or positive) and will do anything in their power to ensure that their primary and secondary sources of NS are working in concert to feed the insecure ego of a broken psyche. Although by no means exhaustive of the complexity describing the individual suffering from narcissism, the DSM-IV states that people with narcissism exhibit the following traits: inflated sense of superiority, grandiosity, attention-seeking, self-absorption, arrogance, entitlement, and limited capacity to empathize and reciprocate in relationships.

Trapping a Target

It would make sense that individuals pulling away from someone like this would experience tremendous loss and trauma (Brown). Initially the person with narcissism presents as a knight in shining armor, completely in sync with the target’s emotions and dreams. The target is unaware that the individual then hones in on the target, studying the desired love object so that he or she can then act as the target’s soulmate, in essence.

This “hunting” can occur on dating websites or in the initial stages of dating (Brown). The target, who generally has the capacity for true, mature intimacy and love, is intelligent, attractive, and successful, then falls head over heels in love with the person with narcissistic tendencies. Subsequently, that individual then feigns love for the target. And the moment the target is hooked, distancing maneuvers ensue, which serve to disorient and confuse the target.

The target then becomes incredibly confused and experiences what is called cognitive dissonance, or a state of confusion. The person with narcissism had expressed love, but is now exhibiting distancing and detaching behaviors, which are not in alignment with the initial honeymoon stage (Carter and Sokol). Eventually, the individual is fully satiated on NS and then becomes bored and tired with it, because the target is merely an object or a vessel to obtain NS.

The target is devalued and discarded when the individual exhibiting narcissism no longer feels the need to court the individual who is a source of NS (Carter and Sokol). Ultimately, the target is left wondering what happened, and how someone who seemed so perfect as a soulmate completely undid everything that the target worked so hard to build. It was the target who fell in love with that individual, not the other way around. The person with narcissism purely was “feeding” on the NS, and as soon as his/her ego was full, the target was no longer considered useful (Payson).

Motivations of Narcissism

At that point, the individual with narcissism will either vanish completely or will say and do certain cruel and emotionally abusive things designed to injure the psyche of the target. He or she actually seeks to cause harm, and straddles the line of sociopathy (Brown). Ultimately, the target has no way of understanding what happened and is left with confusion, shock, disbelief, and betrayal.

Because people who tend toward narcissism always needs newer and fresher sources of supply, they have a habit of devaluing and discarding targets (Hotchkiss). They may be incapable of true love, empathy, reciprocity, kindness, and compassion. In essence, they may have broken psyches, much like a broken appliance (Hotchkiss).

Studies show that there is very limited effectiveness in treating narcissism in psychotherapy, as it can be firmly hardwired to someone’s personality due to largely environmental circumstances that occurred in his or her early childhood (Martinez-Lewi), including parental abandonment and severe abuse. It could be that they had inconsistent sources of love as children, if any at all, and to survive childhood, they had to create an outward mask to the world of the perfect individual. Underneath, these children could be empty and lacking a core sense of self, prone to depression and anxiety without NS to fill a void. Adults who are narcissistic are often referred to as developmentally stuck at age 5, when their emotional maturity ceased (Hotchkiss).

So what is a person to do if they have been crossed by this kind of toxic personality? First, I would say that though the pain is initially intense, you are blessed that the person with narcissism left. And no contact with this person will result in any form of healthy exchange.

The No-Contact Rule

Experts on narcissistic abuse recovery all agree that contact with someone like this always results in pain (Payson). Maintaining zero contact is essential for you to be able to heal and cognitively and emotionally process the mental hurricane that hit. Some clients have likened the experience to like coming off a drug; it is so painful to go through the traumatic grief work in being abandoned that these feelings are akin to withdrawals. However, as you heal, you can be empowered, stronger, wiser, and more discerning and reclaiming of your own self-worth.

The target is capable of empathy, reciprocity, true and mature love, and growing in a relationship. People with narcissistic behaviors are generally not. They are only capable of deceptively seducing preselected targets to fill a psychological void. The same cycle may repeat every time. It is so imperative that the target understand the process of grieving the loss of the fantasy of the person who narcissistically manipulated him or her.

Those with narcissistic behaviors are usually hard-pressed to find a healthy connection in any relationship. When the masks are pulled off, they realize they cannot manipulate and seduce as they are accustomed to. Too many people have caught on and discovered who they really are.

Luckily, for those whose lives have been touched (or slightly marred), there is a path to healing. This process takes place through no contact, a compassionate and understanding psychotherapist, and a support forum (whether online or in person). Those who have been targets heal and move on to love others in healthy, mature relationships.

Resources:

1. Saferelationshipsmagazine.com:  Sandra A. Brown, MA’s website and resources related to abuse recovery from unhealthy relationships
2. Help! I am in Love with a Narcissist by Steven Carter and Julia Sokol
3. Women Who Love Psychopaths: Inside the Relationships of Inevitable Harm with Psychopaths, Sociopaths and Narcissists by Sandra L. Brown
4. Why is it Always About You? The Seven Deadly Sins of Narcissism by Sandy HotchKiss, LCSW
5. The Wizard of Oz and Other Narcissists: Coping with the One-Way Relationship in Work, Love and Family by Eleanor Payson, MSW

Avoidance is a behavior that can be seen as both adaptive and maladaptive. In psychological research, people with anxious personalities tend to avoid social situations and use avoidance as a way to circumvent threatening environments. People with depression also engage in avoidance behaviors.

In contradiction to these theories, attentional bias toward certain stimuli is also common in certain psychological conditions. Although avoidance is not always a bad practice, people who avoid emotional stimuli may internalize feelings and increase their risk for further symptoms of depression and/or anxiety. Existing research on emotional bias and avoidance focuses mostly on children, adolescents, young adults, and middle-aged adults. But few studies have looked at how emotional avoidance and processing changes with advanced age.

To address this, Ineke Demeyer of the Department of Experimental Clinical and Health Psychology at Ghent University in Belgium recently led a study that compared 25 middle-aged adult emotional bias to attentional and emotional bias in a group of 37 older adults between the ages of 75 and 88. Demeyer also looked at how the presence of depression or anxiety affected attention bias.

The results revealed that the older participants engaged in avoidant behaviors to all of the stimuli, regardless of whether the cues were neutral, sad, or happy. The middle-aged participants did not demonstrate any attentional bias. When Demeyer looked further, it was revealed that the older adults showed avoidant behavior toward the sad and happy cues more than the neutral ones. Demeyer added, “When taking a closer look into the role of mood and affective symptoms, we found that older adults who experienced more anxiety symptoms showed more avoidance of negative stimuli.”

Demeyer believes that these findings can be interpreted in several ways. First, older individuals may have higher levels of emotional regulation, which causes them to temper their emotional responses more than younger adults. Second, because older individuals are aware of their limited life span, they may choose to avoid any negative stimuli in particular, as they would rather only expend energy on positive things. Finally, their limited energy resources may cause them to have a blunted emotional response to all stimuli in general.

In conclusion, these findings show that there are differences in how older and middle-aged adults respond to emotional stimuli. Future work should explore these variances and their overall impact on well-being in more depth.

Reference:
Demeyer, I., De Raedt, R. (2013). Attentional bias for emotional information in older adults: The role of emotion and future time perspective. PLoS ONE 8(6): e65429. doi:10.1371/journal.pone.0065429

“Jeanette” and “Tim”—names and identifying information have been changed—have been married for seven years when they seek couples counseling. Tim complains to the therapist that each time the couple argues, Jeanette phones her mother, Barbara, to vent. Tim has become uncomfortable around his mother-in-law, feeling as though Barbara has formed a negative opinion of him as a result of these conversations. Tim also feels that the involvement of Barbara makes it more difficult for him and his wife to work on their marriage together. Jeanette insists that she has tried and failed to talk things out with her husband and that she needs her mother’s input in order to resolve her feelings.

“Kristen” is the 17-year-old “baby” in a family of three siblings. As each of her older siblings grew up and left home, Kristen sensed increasing tension in her parents’ marriage. Recently, her father began to confide in Kristen regarding the conflicts between himself and her mother. She fears that upon her graduation from high school, her parents’ marriage may dissolve and they will seek a divorce. She is worried that her father, in particular, will be extremely negatively impacted if this occurs. Kristen’s grades have dropped and she is procrastinating on completing her college applications. She is considering staying at home to work instead of attending her dream university because she is fearful of leaving her parents “alone with only each other.”

“Joe,” “Mike,” and “Eddie” are brothers in their forties. While Joe and Mike frequently argue and find fault with one another, Eddie subsequently receives phone calls from each of his brothers complaining about, blaming, and accusing one another. Eddie feels as if he is constantly being pulled into the middle of a decades-long conflict between his brothers, and spends long hours speaking to each of them in an attempt to move them toward resolution. He has begun to avoid family gatherings in anticipation of the stress of being his brothers’ referee. Eddie’s wife “Lisa” observes the stress he is under and is frustrated by the toll this family conflict has taken on her husband.

In each of these scenarios, a dyad (two-person relationship) has become taxed and communication strangled, which has resulted in the triangulation of a third party into the relationship.

Triangulation is a family therapy concept discussed most famously by multigenerational family systems theorist Murray Bowen. Bowen described dyads as being inherently unstable under stress, much like a two-legged stool. When in balance, the dyad is capable of functioning well and meeting the needs of both people in it. However, when thrown out of balance by conflict, stress, or transitions, the dyad will often pull in a third person, or “leg” of the stool, to help them stabilize the relationship.

According to Bowen, some triangulation is normal and even healthy in the course of a family’s interactions. Because dyads are inherently unstable, the involvement of a third party can assist a two-person relationship in overcoming impasses, meeting needs, and coping through stressful times. For instance, two children who are arguing over a toy may seek out a parent to help them resolve the conflict. This kind of triangulation occurs because both of the people in the dyad are looking for healthy and effective mediation. When the triangulated person gives input, it is accepted into the dyad and processed together in a way that moves the original dyad forward in their relationship. Healthy triangulation can also occur in the context of parents (or other family caregivers) who come together to meet the needs of a third member, such as a child.

Triangulation can become unhealthy in families when it causes undue stress on the third party and/or when it prevents, rather than invites, resolution of the dyad’s conflict.

In the case of Jeanette and Tim, the triangulation of Barbara is being sought by only one of the spouses. Furthermore, the input provided by Barbara is not being brought back into the marriage for joint processing by both spouses. It is being withheld by the wife for her own individual purposes. Jeanette’s conversations with her mother are essentially taking the place of the emotional process that needs to be occurring within the marriage itself in order to return the marriage to healthy functioning.

In the case of Kristen, the 17-year-old high school student, her triangulation into her parents’ marriage is both active and passive. Her father has actively placed Kristen in the role of confidant, replacing communication that should be occurring between husband and wife. Kristen has also been passively placed by her dysfunctional family system into a role in which she must sacrifice her own individuation and growth in order to serve her parents’ emotional needs. Although her mother and father may not be expressly stating this to Kristen, the message is clear: The parents are relying on Kristen’s presence in the home in order to avoid confronting the breakdown of their marriage.

Finally, in the case of brothers Joe, Mike, and Eddie, the triangulation of Eddie over the course of many years has simply become an ingrained part of the conflict-heavy dyad between Joe and Mike. Joe and Mike have become accustomed to being able to discharge the anger and tension of their dyadic relationship onto a neutral party. After they utilize Eddie to manage their emotions, they return to their battles with one another with ever-renewed energy. The triangulation in this case is a piece of the unhealthy cycle rather than an honest attempt to seek mediation. Eddie has begun to bear the symptoms of the dysfunctional relationship, and his own bonds with uninvolved family members are crumbling under the weight of his “referee” role.

It is predictable that everyone will encounter triangulation in their family relationships at some point, whether as one of the dyad seeking stability or as the third party who is being put in the middle. If you find yourself involved in a triangle, it is helpful to ask yourself a series of questions in order to determine whether this triangle will ultimately be beneficial or harmful to the family system:

• Are both people in the original dyad jointly seeking the input of the triangulated member?
• Is the input of the triangulated member being brought back into the dyad itself for mutual discussion and consideration?
• Is the dyad openly and directly communicating with one another before, during, or after the triangulation occurs?
• Is everyone involved, including the third party, able to speak frankly and express their own emotions and opinions authentically?

If the answers to the above questions are yes, then the triangulation is likely to be of the normal type which necessarily occurs in families over time.

• Does any member of the triangle feel overly forced, pressured, stressed, blamed, or manipulated by the interaction?
• Does any member of the triangle feel as if he or she is not allowed to speak freely, express emotions, or ask for needs to be met?
• Is the triangulated member being pulled into an inappropriate role (such as a child being parentified or overly confided in by a parent)?
• Is this part of an ongoing pattern of interaction in which the original problems never seem to be resolved?

If the answers to the above questions are yes, then the triangulation may be the type that is unhealthy and dysfunctional in the overall family system.

If you find that unhealthy triangles are occurring in your family, there are steps you may take to counteract the negative effects of such triangles:

• A triangulated person can decide to step out of the middle by refusing to speak about the conflict with the involved members. The triangulated person may inform the two people in the dyad that he or she will continue to have a relationship with each of them that does not include taking a referee, peacemaker, or other inappropriate role.
• Encourage the original two-person dyad to speak to one another rather than projecting their conflict outward. Open, honest, and direct communication between family members is the most efficient antidote to dysfunction in families.
• If a triangle is still needed for the dyad to stabilize, encourage the two people to seek a professional mediator, counselor, or therapist. The professional will likely become triangulated, but can step into the triangle with a background of training and objectivity which will allow the professional to work from his or her triangulated position to help the dyad return to healthy functioning.

Conduct issues are becoming a global problem for parents, educators, and children. They usually first appear and early childhood and can be identified through behavioral and psychological screenings, such as the Strengths and Difficulties Questionnaire (SDQ). The issues that arise from conduct problems include anger, aggression, hostility, academic challenges, social problems, and other behavioral and emotional issues.

Although the SDQ has been shown to be effective at identifying symptoms of conduct disorder, it is lengthy and time consuming. Therefore, Melissa E. Duncombe of the Psychological Sciences Department at the University of Melbourne in Australia wanted to see if an alternative brief assessment would be as effective and provide results that are equal to that of the SDQ.

For her study, Duncombe used the Conduct Problems Risk Screen (CPRS), a seven-item scale, to identify conduct problems in a group of over 4,700 elementary school children. Because traits found in oppositional defiance (ODD) and attention-deficit hyperactivity (ADHD) have been shown to be precursors for later conduct problems, the CPRS was designed to reveal any specific inattentive or aggressive behaviors as well.

Parents and teachers reported their evaluations of children, and Duncombe found that although there was a much higher rating of conduct issues in the parents’ reports, the overall consistency between the two groups was high. Duncombe believes that parents may witness more behavioral problems and may also incorporate family reactions, disciplinary consequences, and other factors into their assessments when filling out the CPRS. Teachers, on the other hand, can only report on what they witness and experience during the school day.

Another strength of the CPRS is that it only takes a few minutes to administer. Unlike the lengthy SDQ, the CPRS can be completed in under two minutes, and may be viewed as more applicable tool with younger children. This can be especially important for early identification of the children at risk for later conduct, ADHD, or ODD issues. Dunscombe added, “The CPRS is a valid and reliable instrument and could be used effectively as a screening tool to identify those children at risk of developing conduct disorder.”

Reference:
Duncombe, Melissa E., Sophie S. Havighurst, Kerry A. Holland, and Emma J. Frankling. (2012). Psychometric evaluation of a brief parent- and teacher-rated screen for children at risk of conduct disorder. Australian Journal of Educational & Developmental Psychology 12 (2012): 1-11. Print.

I think you hit on an essential element of your situation—it seems to be working for you. It’s very easy to get caught up in “shoulds” and external expectations and lose sight of the fact you and your partner may choose to create a satisfying life together that might seem unconventional to others. It matters less that you are a great feminist in the abstract, and more that you are feeling satisfied with the relationships in your life.

That said, I do wonder about your hesitation to talk openly about it with him. The fact you are worried about the “hassle” and “emotional toll” of talking about it says to me that perhaps something is not quite working for you. Right now, the affair is a “secret,” and keeping big secrets tends to undermine relationships rather than foster healthy, stable ones. It may work in the short term, but think about how much energy is going into each of you pretending the affair is not happening. That is hard work! At some point, one or both of you may just get too tired to maintain the pretense. Eventually, secrets tend to come out. What might happen if your husband were to discover months from now that you knew all along? What are you afraid might happen if you were to talk about it now? What do you fear you might lose? What might there be to gain? You may want to consider talking with a therapist to explore your fears and hesitation, and also to take an affirmative look at what you do want from your relationships and your life as you move forward.

You mention two positive elements of this affair—you get some alone time that you enjoy, and your husband has been more attentive and caring. It seems like that may be a place to start as you consider what it is that you want. If you are honest with yourself about what you want and need, then you will have the information you need to make the best decisions you can. Since you cannot control how your husband responds or what steps he chooses to take, all you can do is try to make decisions that feel right to you.

Best of luck,
Erika

Many people have problems with daily life that begin in the brain. There are many ways this can occur. High levels of stress over time can cause problems with sleep, energy, and mood. A mild traumatic brain injury from a car accident or sports injury may cause difficulty with memory and attention span, and may induce depression. Exposure to chemicals such as those used in chemotherapy can cause problems with mental clarity, leading to a condition referred to as “chemo brain.” Problems with focus, concentration, and attention can be related to a variety of psychiatric diagnoses or sleep deprivation. Is taking medication always the answer?

The Low Energy Neurofeedback System (LENS) was developed in the early 1990s by Len Ochs, PhD, a northern California psychologist. LENS was created as an alternative to medication for brain-based problems and is often used along with psychotherapy. LENS is a computer-based software program that is connected to an EEG box, which measures brainwaves. LENS directly stimulates biochemical changes that are thought to help the brain regulate itself.

The brain is both a biochemical and a bioelectrical system. Medication works on the chemical system, while LENS works on the electrical system. We might think of LENS helping the brain to reboot, like a computer that is no longer functioning optimally. LENS is just as safe and effective as traditional neurofeedback, and works much more quickly, saving both time and money.

Process of Treatment

The treatment itself consists of sitting quietly in a comfortable chair with your eyes gently closed, while the neurofeedback practitioner applies a tiny electrode with conductive paste to your scalp to both measure the brainwave activity and to deliver treatment. It is a completely painless and noninvasive procedure and most find it very relaxing.

Treatment consists of invisible radio frequency waves that are 4,000 times weaker than what your brain is exposed to each time you hold a cellular phone to your head. Not only is the feedback signal incredibly weak, but the length of exposure to it is extremely short. The duration of actual feedback during a typical LENS session is from one second to one minute per site on the head. It might seem impossible that a signal so weak could do anything at all, but it is effective because the brain can respond to the low-energy signal, whereas it would react and defend against a stronger one.

Neurofeedback clinicians have noticed a strong connection between excessive activity in the EEG, particularly in the slower brainwaves, and difficulties with mood, energy, focus, and mental clarity. Trauma and stress tend to cause EEG suppression, in which the brain protects itself from overload and seizure activity by reducing activity, which in turn limits functioning. In this case, the person doesn’t have the full range of emotions, thoughts and abilities they once had. LENS helps to normalize both excess activity and suppression in the EEG, and people feel better and are able to do more of what they want. Most people who receive LENS treatment report feeling more calm, relaxed, and in control of themselves.

Who Can Benefit from LENS?

We all know individuals who are rigid and inflexible, who are stuck in patterns of thinking and feeling that make them miserable, and yet they just can’t seem to change. Some people struggle because they seem to be perpetually stuck in overdrive — unable to wind down at the end of the day, or even to sit still for very long without excessive fidgeting, foot tapping, knuckle cracking, or frequent smoking breaks. Other people seem to be perpetually shut down emotionally and physically, with a sad, downcast appearance, low energy, and minimal interaction with others.

These patterns of thinking, feeling, and behaving are both psychological and physiological. Releasing suppression and reducing excess activity in the brain allows the person to begin to feel that change is possible, so they can begin to make new choices and form new habits. Psychotherapy combined with LENS neurofeedback treatment is optimal in these cases. LENS helps make the brain more flexible and therapy provides the support and coaching for how to make changes and develop new patterns in how we deal with our thoughts and emotions.

One woman I worked with, “Linda,” a middle-aged attorney, had suffered a mild traumatic brain injury ten years ago during a car accident. Her doctors told her, “this is as good as it’s going to get” when she complained of memory problems, headaches, insomnia, and the feeling that her brain “just didn’t work right anymore.” Since then, she was forced to give up her law practice because of these limitations. Her self-esteem and relationships suffered, leading to depression and a feeling of hopelessness about the future.

Linda began to respond to LENS within four or five sessions. Over the course of the four months I worked with her, I saw her twice weekly and each time we met, I noted and she reported improvements. She became giddy when she suddenly realized she could remember words that she had not been able to think of in over a decade without effort. As her limitations were eliminated, her mood brightened as well.

When I first met Linda she presented as someone who had given up and was just going through the motions, appearing disheveled, with dirty hair and stained and wrinkled clothing. She arrived smiling on the day of our final LENS session, her hair and nails freshly done, wearing a bright and flattering dress. As she left, she tearfully thanked me for “giving me my life back.” She had already announced to friends and family she was reopening her law practice and was open for new referrals.

For couples to communicate effectively and be able to address issues together, the partners need to focus on their respective roles and responsibilities as the listening or the talking partner.

In my GoodTherapy.org article published last month, I wrote about the responsibilities of the listening partner to ensure effective communication. In this article, I will be discussing the talking partner‘s responsibilities.

As the talking partner, or initiator, you have several options in addressing issues. One is to attack your partner with a list of complaints in a way that shows you don’t believe that anything will change. If this is your choice, your partner is most likely going to defend him/herself by returning fire with a similar list of complaints or shutting down emotionally to avoid further critique and escalating conflict. As you probably have experienced, attacking your partner is not conductive to the two of you achieving a real understanding of each other’s differences.

When couples run into a pattern of attacking and/or avoiding behavior, they are reacting emotionally to each other’s complaints and critiques. Partners often have mixed feelings of anger and hurt. Furthermore, they most likely feel disrespected and mistreated by the other partner while they behave disrespectfully in turn. In this kind of vicious cycle, there is little goodwill, understanding of each other’s thoughts and feelings, or willingness to discuss different perspectives or points of view.

I suggest that you look at another option: refusing to react emotionally, taking a proactive stance, and preparing yourself before initiating a conversation with your partner.

Below are questions to ask yourself before you initiate a conversation with your partner:

• What is most important to you? Choose one topic to talk about. Stick to your topic throughout the conversation.
• What is your intention with the conversation? Do you want your partner to understand you better? Do you want to feel closer to your partner? Do you want an apology? Or do you want to punish your partner? If you are very upset, you might want to wait until you have calmed yourself and thought about your intention(s).
• What is the message that you want your partner to hear? What do you want your partner to understand about you?
• How do you want your partner to feel after the conversation? Do you want your partner to feel closer to you and hopeful about your future together? Or do you want your partner to feel guilty, shameful, and/or angry or hurt?
• How can you deliver your message so that the probability of your partner actually hearing you is the highest? What would be the best way to talk about your issue?

Here are a few more points to consider before you sit down with your partner for a conversation about what is important to you:

• Use “I” language instead of “you” language. If the conversation is more about you than your partner, it is easier for your partner to concentrate on what you are saying.
• Don’t attack your partner. Talk about how you feel and think about your topic.
• Don’t defend yourself. Talk about what is most important to you.
• Try to have five positive statements for each negative statement. Don’t forget to say what you appreciate about your partner.

Basically, how do you want to talk about your issue? Write down your points to keep your focus. Choose an appropriate time and place to present your idea in a new and more effective way. Make sure you ask your partner when a good time is for him/her to start. Also, make sure to tell your partner that you want him/her to be the initiator at a later time, and that you are willing to actively listen to what your partner has to say.

Practicing initiating a conversation about an important topic can improve your ability to communicate effectively with your partner.

Come September, many young people will be leaving home to go away to college. Students and parents are excited about this new journey. But in addition to the excitement, there is often anxiety about moving out of the comfort zone of home and family. While the focus is often on the separation anxiety the student experiences at this milestone, too often we neglect the parents’ separation anxiety.

From watchfulness to surveillance, parents retain a varying degree of control over their high-school-aged children. But when a child goes off to college, the ability to know what is going on in that child’s life depends on the child’s willingness to communicate and share information. Since it is developmentally appropriate for college-aged children to be separating and individuating from their parents, we can expect that many children will share less than parents might be hoping to learn. Not knowing, in areas where there was previous information, makes parents more anxious.

Parents express many different worries about how their children will manage when the parent is no longer so present in their lives. Anxieties may be about drugs and alcohol, or there are concerns about social and academic problems. Parents with children who may already be dealing with emotional issues, eating disorders, or learning disabilities can feel especially anxious.

It is to be expected that a parent would worry about how their child will manage on their own in college. This is appropriate and shouldn’t be confused with a parent’s separation anxiety. When a parent feels the need to contact the child repeatedly, can’t sleep, can’t stop thinking and wondering how the child might be feeling or what the child is doing, the parent may be experiencing separation anxiety. When we think of the child’s separation anxiety we understand it to be about the feeling that “I won’t be alright without my attachment to my parent.” For the parent, it is much the same: “I won’t be alright without my attachment to my child.” Parents experience their anxiety as being about the worry “Is my child going to be okay?” But what they often fail to be aware of is that they may be even more anxious (consciously or unconsciously) about their own well-being. They wonder, “Am I going to be okay?”

Learning to Detach and Individualize

In my therapy practice, I have had the opportunity to work with many parents who have struggled with the separation and individuation of their children. One father, “Seth,” began therapy when his daughter, “Kristin,” was applying to college. He spent many of his sessions talking about Kristin and her college application process. He was very troubled about Kristin keeping him out of the decision making.

Sadly, with tears in his eyes, Seth told me, “She comes home and closes her door and goes on that computer and researches where she wants to go. Her mom and I ask her about her choices, we tell her we need to be part of the process; we remind her that we will be paying a good part of the tuition. She just gets irritated and says she wants to do this on her own and she’ll let us know what she decides.”

Recently, Seth came into my office for his therapy session looking very distressed. He immediately said, “I can’t believe that girl. All of her college acceptances have come in and she has decided to leave New York and go to school in Arizona. That’s much too far away. We’ll never see her! I told her she couldn’t go and she got so mad. She started screaming at us. She said she hated us, that we were terrible parents and never let her have what she wants! She was so mean!”

Seth started to cry softly and, almost in a whisper, said, “I’m so scared. I love her so much, I can’t stand this. It feels like we’ve lost her forever. She’ll never come home. If I don’t agree to pay, she said she would pay herself. She did get good financial aid from them and I don’t think I can play the money card. What am I going to do?”

I asked Seth, “What makes you think Kristin is lost to you forever?”

Seth answered, “We used to be so close when she was younger. She was daddy’s little girl. Her mom worked more than I did and I took her to soccer, to swimming; I helped her with her homework every day. She would tell me about everything — even the boys she had crushes on! Then in her sophomore year of High School, she got more secretive. She started going out with Jeremy and was becoming more social. I could understand that she needed some space from me. My wife and I used to talk about how grown up she was getting. We started to check what she was doing and who she was talking to on her cell phone and computer. There are a lot of scary possibilities out there. She never found out we were keeping tabs on her, but she started to become easily irritated and annoyed around us. She would get on my wife’s case about the food she was cooking and she gets annoyed with me when I ask her about almost anything.”

Seth began to sob, “I can’t eat, can’t sleep. What will I do without her? She is my only child. So much of how I think about myself has to do with my being a father. If I lose her, can I still be a father? What kind of a father could I be without my daughter?”

I reminded Seth that we had been talking about how it made him anxious to think of his daughter having a life so separate and different from his. A lawyer, Seth had followed his father into the law and joined his father’s practice after completing law school. After he married and Kristin was born, he moved into an apartment in the same building as his parents. He understood that his model of parent-child relationships was a reflection of his own experience.

Seth acknowledged what we had been discussing: “I know I grew up very close to my parents, especially my father. I would never talk to him the way Kristin talks to me. I always respected him and needed him for guidance and that gave me such confidence and comfort. It’s not like I thought Kristin had to become a lawyer, but I did hope she might. But she has no interest in it. She wants to major in art, which is fine, but I really don’t get what her art is about. She makes these things out of paper and wood. I try to act interested, but, really, where is that going to get her? How will she make anything of herself? How can I get her to pay attention to what I think? I’m her father.”

Separation Is Not Rejection

Seth’s struggle illustrates many of the issues parents have to contend with as they try to become less anxious about their children differentiating from them. Seeing one’s child as different, as having a separate self with separate desires and ideals, can give a parent the feeling of being rejected. When parents have this experience it is essential to be clear that difference does not signify a child’s rejection. What keeps parent and child attached is not sameness. Sameness can often give parent and child the feeling of closeness, but a very different kind of attachment occurs when there are two separate, different people who are connected by the feelings they have for each other.

For the parent who has felt this sameness with their child but now recognizes that their child is differentiating, there can be painful and frightening anxiety as they try to figure out how to understand and relate to this separate differentiated person. For parents who have not differentiated from their own parents, this can be especially difficult.

Seth is beginning to consider that he can come to know and appreciate his daughter with all her differences. As he begins to relax with the belief that he can know and love this separate person, he is becoming aware how scared he has been that maybe she wouldn’t continue to love him. Seth is only one example of a parent struggling with separation anxiety. One reason I believe Seth is less anxious now than when we began our work is that he has been able to identify that he is feeling separation anxiety.

Many parents who are worried when their children go off to college, are not aware that they are experiencing an emotion that is not simply based on the practical worries of safety or performance or the well being of their children. They have not recognized that they have been afraid that their children would move away from them emotionally, become different in a way to make their attachment feel less close and loving. Realizing this, thinking about separation and individuation as a developmental necessity, not a personal affront or wrenching loss, can help many parents resolve much of their anxious feelings.

Contextual information surrounding memories is crucial to memory encoding, storage, and retrieval. When a person experiences an event that is marked by vivid emotional reactions, they often are able to remember specific contextual facts related to that event. For example, a particularly joyous moment could be recalled with the exact details of where a person was when it happened and exactly when the moment occurred in life. However, this source discrimination of being able to isolate when and where appears to be diminished in people with attention deficit hyperactivity (ADHD).

According to a recent study by Anselm B.M. Fuermaier of the Department of Clinical and Developmental Neuropsychology at the University of Groningen in the Netherlands, people with ADHD show deficits in some areas of memory processing, but not in others. Fuermaier used a word paradigm to test memory induction, storage, and retrieval in a sample of 77 participants, 37 of whom had ADHD. The participants were assessed for memory encoding, memory retention, and memory recall with source discrimination.

Fuermaier discovered that although memory encoding, learning of new material, and memory recall or retrieval of information were equal between the ADHD and non-ADHD participants, source discrimination was not. Specifically, the participants with ADHD had much lower levels of source discrimination than the controls. In other words, they were less able to describe when and where a prior autobiographical event had occurred and were unclear about the context of their memories.

This finding is extremely relevant, as it shows that people with ADHD have impairment attaching contextual meaning to memories. Fuermaier said, “Inefficient source discrimination in adults with ADHD can affect daily functioning by limiting biographic awareness and disturbing general cognitive processes.” Identifying these deficits and empowering individuals with ADHD by teaching them effective memory retrieval techniques could improve overall functioning and increase well-being in all domains of life.

Reference:
Fuermaier, A.B.M., Tucha, L., Koerts, J., Aschenbrenner, S., Weisbrod, M., et al. (2013). Source Discrimination in adults with attention deficit hyperactivity disorder. PLoS ONE 8(5): e65134. doi:10.1371/journal.pone.0065134