My friend and colleague, Linda Poelzl, has been working as a professional surrogate partner for 17 years. As a local writer commented a few weeks ago after meeting both of us, what this means is frequently misunderstood.

Sometimes I think “sex” is the most powerful and misleading word in the English language! Call Linda a sex surrogate and people start imagining her writhing in coitus.  Call me a sex therapist and local readers post, “How sicko and disgusting that we have a sex therapist here in San Luis Obispo County!” on their Facebook walls.

Our local weekly (the New Times) was particularly excited to arrange an interview with Linda and me because of the flood of positive publicity surrounding The Sessions, a new film based on actual experiences in the late 1980s when surrogate partner Cheryl Cohen Greene worked with polio-disabled journalist and poet Mark O’Brien.

In the trailer, there is one scene in which two astonished hotel workers watch a nervous and paralyzed O’Brien being loaded into an elevator on a stretcher. When one of them asks why they’re taking him upstairs, the other explains that he has an appointment with a “sex therapist,” a misnomer that has Linda and other surrogates feeling frustrated.

“The public doesn’t comprehend that you and I work together to help people heal!” she says. Where my work as a therapist is psychological, Linda’s is physical, employing exercises focused on intimacy, body image, relaxation, and the giving and receiving of touch or “sensate focus.” Sexual intercourse occasionally does occur, but it is a minor part of her work.

Common presenting issues for men include rapid ejaculation, delayed ejaculation, and very often, simple inexperience—one of Linda’s current clients is a 32-year-old virgin. “He’s never, until recently, held hands, kissed a girl, had sex,” Linda says. “He’s a gorgeous guy! There are a lot of people around who are silently suffering.”

Some people refuse to differentiate what Linda does from prostitution, she explains. What they don’t comprehend is that she never works alone. After each session, she relates her impressions to me, which enables me to better assist clients through many challenges toward sexual healing.

I, in turn, communicate with Linda after each talk session in my office, and the three of us usually meet together to conclude the surrogate’s involvement. Legitimate surrogate partners always work in tandem with therapists who have an ongoing established relationship with the client they refer.

I was introduced to Linda by Cohen Greene herself, and we’ve worked together for much of this year. Her approach is gradual, with the first sessions devoted to getting acquainted, discussing issues, and building rapport. “I’m going to touch you, and you’re just going to relax and feel and enjoy it, and then we’ll check in at the end …”

“And that’s usually like hands and face and maybe a foot rub—the first couple sessions are with clothes on, usually,” Linda says. “And sometimes if the client is ready and I’m ready, we might take clothes off in the third session … to do an exercise called ‘Body Image’ … it’s more about being comfortable with each other nude before we get into being sexual …

“We answer questions. I talk about condoms and safe sex. Then we usually get into bed … and I ask them about their bodies, and how they like to be pleasured. After that, it pretty much gets into whatever their problem is. If they have rapid ejaculation, we do exercises to work on control and awareness. A lot of times people think it’s all about intercourse, and it’s not. That’s a small part. Usually by the time they’re ready to do a lot of that, they don’t really need me anymore.”

If the client is able to form a bond with the surrogate, this means the person is capable of falling in love with future partners “out in the real world.” After finishing work with the surrogate partner, the client generally continues ongoing intimacy work with me as “talk therapy.”

It’s natural intimacy work, pure and simple. Many people yearn for the physical experience, the orgasm, without the relationship, without the intimacy. One without the other never satisfies in the end. So the work that Linda does, in conjunction with the work that I do, is invaluable.

Family therapy can help families and couples overcome challenges with interpersonal relationships. Many issues that families and couples face become volatile and hostile without the help of learning how to constructively communicate and problem-solve. Relationship issues do not discriminate, and people of all cultures and races are vulnerable to family conflicts. This does not mean that people of every ethnicity embrace family therapy equally. In fact, African-Americans are far less likely than white people to seek out therapy for family problems. The reasons for this are many, and could include limited access to care, financial restrictions, mistrust of mental health professionals, and fear of stigma associated with counseling.

Cadmona A. Hall of the Marriage and Family Counseling Center at the Adler School of Professional Psychology in Illinois wanted to examine the specific barriers preventing African-Americans from seeking treatment. In a recent study, Hall interviewed nine participants and found that stigma presented the biggest obstacle to treatment. Resilience was the most common personality trait that helped the participants overcome the stigma. Hall believes that African-Americans are more likely to be resilient, having had to surmount the atrocities of slavery and the injustices of discrimination. This ability to overcome could have been an underlying force that led the participants to seek out help despite the barriers.

Hall also noted that eight of the nine individuals in her study were affiliated with the college where the counseling clinic was located. Having knowledge of and access to the services could have increased the willingness in this sample of participants. Another appealing aspect of the university clinic was the sliding fee scale, which was cited as a very beneficial aspect. Mistrust, which was listed as a barrier to treatment seeking, was addressed when the participants realized that their sessions were confidential and they felt comfortable enough to build rapport with their therapists. This was critical in setting them at ease and ensuring they would return to complete therapy. Although the sample size used here was small and lacking diversity, it was able to provide insight into the factors that prevent African-Americans from seeking out therapy. “As clinicians increase sensitivity and understanding of the unique features of African-Americans, they will have an increased ability to engage that population in therapy and increase quality of care,” Hall said.

Reference:
Hall, Cadmona A., and Jonathan G. Sandberg. “We shall overcome”: A qualitative exploratory study of the experiences of African-Americans who overcame barriers to engage in family therapy. American Journal of Family Therapy 40.5 (2012): 445-58. Print.

Two weeks removed from a Halloween that inspired thousands of people to dress as reality television’s Honey Boo Boo, child beauty pageants have again entered the national consciousness. From small festival- and fair-based competitions to elaborate, expensive, national endeavors, child beauty pageants are a $5 billion industry. Parents who enroll their children in such pageants fiercely defend them as the child’s choice, and many participants—particularly on pageant-centered shows such as TLC’s Toddlers & Tiaras—seem thrilled to be involved. But what effects do beauty pageants have on children and their impressionable minds?

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Why Children Enter Beauty Pageants

Children are the masters of fantastical ideas, so it’s no wonder that many girls involved in the pageant circuits relish spending a few days a year as Cinderella. But children can’t enter pageants without their parents’ blessing, so involvement ultimately hinges on parental choice rather than the child’s. In a new paper published in the Journal of the American Academy of Child and Adolescent Psychiatry, University of Arizona professor Martina M. Cartwright emphasizes this point. She calls the phenomenon “princess by proxy,” explaining that the real attraction of pageants is for parents who can gain social status, self-esteem, and money when their children participate.

Potential Effects of Beauty Pageants: Eating Disorders and Body-Image Distortion

Pageants, particularly those designed for younger children, focus primarily on appearance, attire, and perceived “cuteness.” Talent competitions occur in some pageants and often are a secondary component of the experience. Thus, pageants suggest to young children that there is value in focusing on their appearance as judged through the eyes of others. This can lead to significant body-image distortions, and adults who once participated in child beauty pageants may experience low self-esteem and poor body image.

As with most adult pageants, child pageants often require crash dieting. Parents may encourage children to quickly lose weight so they can fit into small costumes or display tiny bodies in swimsuit-centered fitness competitions. Some parents put their kids on crash diets designed to help them gain energy and enthusiasm. These diets may consist solely of sugary snacks and sports drinks for several days. This can harm both short- and long-term health and teaches children unhealthy approaches to food that can contribute to the development of eating disorders.

Beauty Pageants and the Sexualization of Young Girls

Sexualization is the tendency to view oneself as a sex object, and children who participate in beauty pageants are sexualized very early. Children may dress in highly suggestive costumes and learn that they gain attention and status when sexualized. This may lead to premature sexual activity and can teach the unfortunate lesson that women’s worth is determined at least in part by their status as sex objects.

The Unhealthy Values Built by Beauty Contests

While some pageants are brief events that require little preparation, the world of pageants can be cutthroat and extremely competitive. Children learn a host of unhealthy values, including the desire to defeat their competition at all costs. Tantrums and meltdowns—by children and parents alike—are common backstage at beauty pageants, and long-term participation in pageants can teach children that their primary source of worth is how many pageants they win and how “beautiful” they are perceived to be. Academic achievement, empathy, social skills, athletic pursuits, and other age-appropriate activities may take a backseat in the world of pageants. And because precious few pageant participants grow up to become models or entertainers, this early experience can stunt their development by focusing their attention on something they are unlikely to be able to do as adults.

References:

1. Giroux, H. A. (2009, May 11). Child beauty pageants: A scene from the “other America.” Truthout. Retrieved from http://archive.truthout.org/051109A
2. Sinpetru, L. (n.d.). Child beauty pageants foster adult body dissatisfaction, eating disorders. Softpedia. Retrieved from http://news.softpedia.com/news/Child-Beauty-Pageants-Foster-Adult-Body-Dissatisfaction-Eating-Disorders-302540.shtml

For children and adolescents with attention deficit hyperactivity (ADHD), Ritalin (methylphenidate) is typically the medication of choice. As a psychostimulant drug, Ritalin increases the concentration of the neurotransmitters dopamine and noradrenalin in the brain. These neurotransmitters are partly responsible for impulse control and attention, among other things.

Studies in both rats and humans have verified that Ritalin effectively controls the three primary symptoms of ADHD: inattention, hyperactivity, and impulsivity. When ADHD goes into remission, the person’s quality of life and performance in work or school measurably improve.

Despite these benefits, critics have wondered about the potential negative effects of this heavily prescribed medication. For one thing, no one fully understands how Ritalin functions in the brain. More importantly, little information exists as to the long-term effects of a psychostimulant drug on the developing brain. A recent study with rats highlighted a possibly adverse effect of Ritalin that had previously been overlooked.

Adolescent play behavior is important in terms of both mental and social development. Through play, children learn the basic “rules” of social interaction and receive the rewards of companionship. Isolated children often have difficulty adjusting to adult life and navigating social situations. Researchers investigating Ritalin’s effect on social play found that the medication significantly reduces the behavior in rats.

Adolescent rats treated with low doses of Ritalin were apt to ignore invitation to play, instead remaining focused on their general environment. The effect was surprisingly specific. Rats demonstrated the same overall activity levels as untreated counterparts, but less overt play behavior and social interaction. Some rats were isolated for up to 24 hours before release into a play area. Researchers believed a long period of isolation would enhance play despite the effects of Ritalin, but they were mistaken. Regardless of isolation period, Ritalin proved to be a powerful blocker of normal, social play behavior.

The beneficial effects of Ritalin for people with ADHD are inseparable from the possibly negative effects of inhibited play. By its very nature, play is a complex, dynamic, but not necessarily focused activity. One of the primary aspects of Ritalin’s overall effect is to inhibit “unfocused,” freewheeling behaviors—including play, apparently. This calls for more research and possibly long-term studies of the potential consequences of Ritalin prescription throughout childhood and adolescence. It’s possible that this medication poses more risks than previously believed.

References:

1. Attention deficit hyperactivity disorder (ADHD) – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518/
2. Vandershuren, L., Trezza, V., Griffioen-Roose, S., Schiepers, O., Van Leeuwen, N., De Vries, T.J., and Schoffelmeer, A. (2008). Methylphenidate disrupts social play behavior in adolescent rats. Neuropsychopharmacology, 33, (12), 2946-2956.

If someone is referred to as a perfectionist, it could be considered a compliment or an insult. Perfectionism is an ambiguous categorization, hallmarked by high standards and motivation for success. Being a perfectionist does not necessarily mean that an individual will have negative traits such as neuroticism. But it does not indicate that one will be highly resilient when goals are not met, either. Understanding perfectionism, and the subjective evaluations of perfectionism, is critically important for perfectionists and the clinicians who treat them.

Perfectionism can motivate someone to push themselves further in various domains. Having the desire to achieve something is not a bad thing in and of itself, but when that desire becomes an obsession, it can create problems. Because the definition of perfectionism is so unclear, Jeffrey S. Ashby of the Department of Counseling and Psychological Services at Georgia State University decided to evaluate perfectionism based on its positive and negative influences. In a recent exploratory study, Ashby asked 36 college students with significantly high standards how their perfectionist traits affected different areas of their lives. He also looked specifically at how high versus low levels of worry and stress were related to perfectionism.

Ashby found that although some of the participants did not describe themselves as perfectionists, they still had tendencies that would indicate otherwise. For instance, high worriers who reported stress as a result of their perfectionist traits exhibited less resilience than low worriers, even though they may not have considered themselves perfectionists. Although the levels of worry varied, Ashby found that worry was most closely related to high standards in professional, academic, and work domains. Interestingly, other areas, such as personal appearance, religious involvement, self-esteem, and relationships were mentioned as well, but had distinct significance for each participant. Thus, it seems based on the responses that perfectionism and its effects, positive or negative, could depend on the domain it is attached to.

This exploration into perfectionism also revealed a relationship to obsessive-compulsive traits. In particular, the participants with the highest levels of worry and negative outcomes related to their perfectionism also reported the highest levels of obsessive-compulsive habits or rituals. Also, Ashby found that those who experienced the most stress from their perfectionism were the least likely to call themselves perfectionists, and were for the most part unwilling to give that character trait up. “The apparent inconsistencies between the distress attributed to it, the benign evaluations of it, and the general reluctance to give it up, raise intriguing questions about perfectionism,” Ashby said. He believes that this finding suggests a deep-rooted sense of perfectionism that individuals consider inherent or ingrained. Future work should explore this nuance of perfectionism more thoroughly in order to better understand how this classification of perfectionism may impair change in those who experience negative consequences from their behaviors.

Reference:
Ashby, Jeffrey S., Robert B. Slaney, Christina M. Noble, Philip B. Gnilka, and Kenneth G. Rice. Differences between “normal” and “neurotic” perfectionists: Implications for mental health counselors. Journal of Mental Health Counseling 34.4 (2012): 322-40. Print.

Poor response to treatment is an unfortunate reality for many people with major depression (MDD). By some estimates, as few as 30% of people with MDD achieve complete and lasting remission of symptoms. Primary care physicians deal with this lack of treatment response in one of three ways: They may increase the dosage of an antidepressant medication, add a secondary medication, or switch to an alternative medication.

Dosage increases are often the first choice, assuming higher doses remain within reasonable safety parameters. Because of its unique chemistry, the selective serotonin reuptake inhibitor Lexapro (escitalopram) is an ideal candidate for dose escalation. Whereas other antidepressants reach a sort of effectiveness plateau, Lexapro’s mechanism of action becomes stronger in proportion to dose.

Lexapro is approved for daily doses of not more than 20 mg. In practice, however, doctors have prescribed up to 50 mg for patients showing no response to lower dosages. That said, little evidence exists on whether successively higher doses represent a good balance between efficacy and safety.

A recent investigation in Scotland sought to answer this question. A starting group of 60 people diagnosed with MDD was switched from Celexa (citalopram) to Lexapro for a 32-week period. At regular intervals, Lexapro dosage was increased up to a maximum of 50 mg or until remission of symptoms. Researchers employed standard psychological measures to quantify severity of depression and occurrence of side effects.

Results from the study revealed few problems with safety or tolerability of high-dose Lexapro. However, overall effectiveness was somewhat less than desirable. Of the 60 participants, 18 dropped out because of adverse effects or lack of efficacy. Most of these withdrawals happened earlier in the study, before reaching the higher dose levels.

Half of study participants experienced remission of symptoms. Thirty-eight percent of those required a dosage of 50 mg. At doses higher than 40 mg, side effects became more pronounced although not necessarily more severe. Diarrhea was the most frequent complaint for those at doses of 40-50 mg. Other common side effects included headache, nausea, fatigue, and dizziness.

Larger, more controlled studies will be useful in ascertaining whether the benefits of high-dose Lexapro outweigh the risks. The Scotland study indicated only marginal effectiveness, although participants generally tolerated the high doses of medication. It should be noted, of course, that the population in question has a history of poor response to treatment. It’s unlikely that any one avenue will prove beneficial to all.

References:

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Escitalopram. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000214/
2. Wade, A., Crawford, G., Yellowlees, A. (2011). Efficacy, safety and tolerability of escitalopram doses up to 50 mg in major depressive disorder (MDD): an open-label, pilot study. BMC Psychiatry, 11, 42. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068950/?tool=pmcentrez

Corrective learning is a process that occurs when existing conceptions and beliefs are replaced by more adaptive ones. For individuals with anxiety, panic, and phobias, exposure therapy is a common form of treatment that aims to produce corrective learning.

During exposure therapy, individuals are exposed to things they fear or that threaten them. Because these situations or things are usually avoided as a result of anxiety, the theory behind exposure therapy posits that being confronted with the feared item or event in a controlled environment will allow the individual to realize that his or her fears surrounding that item or event will not be realized. It is also believed that the level of fear or anxiety that is experienced during the exposure directly predicts the level of reduction in anxiety at treatment outcome. In other words, the more fearful or anxious someone is during a session, the more he or she will be able to overcome that fear in the long run.

This theory has been tested at length. However, Alicia E. Meuret of the Department of Psychology at Southern Methodist University in Texas wanted to examine this further. In a recent study, Meuret assessed the physiological and emotional responses of 34 participants with agoraphobia and panic as they underwent either a cognitive behavioral or breathing-based exposure therapy. She found that the participants all experienced increases in panic and anxiety during the sessions, as evidenced by physiological markers and emotional responses, but that these increases did not lead to better outcomes. In fact, the more panicked and fearful the individuals were, the worse their treatment outcomes. Additionally, in contrast to existing research, Meuret found that symptom reduction during treatment did not predict treatment outcome. In other words, even if the individuals experienced spikes in treatment severity during exposure and then were able to reduce their anxiety as the session continued, this drop did not lead to better overall outcome.

It has been suggested that allowing a client to experience symptom reduction during exposure provides a sense of self-control and mastery for the client and accomplishment for the therapist. And although this may indeed be true, the reduction of symptoms after exposure does not seem necessary for treatment success. In fact, the treatment outcomes were similar for those who left sessions with symptoms that were elevated as well as with symptoms that were diminished. Meuret believes that these results contradict the theory that fear reactivity is an indicator of treatment outcome, although her study was limited by sample size and the fact most of the participants were well-educated white females. “More research is needed to examine the underlying mechanism of corrective learning during exposure across therapy types,” she said.

Reference:

1. Meuret, Alicia E., Anke Seidel, Benjamin Rosenfield, Stefan G. Hofmann, and David Rosenfield. Does fear reactivity during exposure predict panic symptom reduction? Journal of Consulting and Clinical Psychology 80.5 (2012): 773-85. Print.

I’ve been thinking about grief, mourning, and loss a lot lately. It shows up as a theme in my work as a psychotherapist all the time. I’ve also been studying the literature on methods of providing grief counseling and grief therapy. What I realize is that my sub-specialty in this area is not limited to working with individuals who have experienced the death of a loved one. It is more far-reaching than that. Judith Viorst wrote a wonderful book, Necessary Losses: The Loves, Illusions, Dependencies, and Impossible Expectations That All of Us Have to Give Up in Order to Grow, in the mid-1980s in which she described the losses we experience along the life cycle. It’s a must-read for people who are unfamiliar with it.

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I would venture to say that most of the work we as psychotherapists and spiritual counselors do is about coping with loss. We help our clients grieve about their losses, whether it’s loss of youth, money, job, socioeconomic status, or friends. They need to be helped to grieve the loss of hopes and dreams. They even grieve the loss of fantasies and illusions, although much of this happens unconsciously. In this case, our job as psychotherapists and counselors is to help them recognize that they are in mourning and provide tools to cope. The idea is that grief takes up a lot of psychic space in our beings, and it is only by coming to terms with our losses that we create room for the new.

The focus of this article is how many people typically grieve. The ways—which are not healthy—include:

• deny
• become anxious or depressed, or a combination of both
• engage in risk-taking behavior such as drinking excessively and driving, compulsive spending, and sexually acting out
• become an abuser, a victim, or a combination of the two
• over-eat or under-eat, and other “overs” and “unders”
• become controlling
• hoard

These are just a few of the many ways people attempt to fill the space loss creates in their psyches and spirits. With methods such as these, the loss is not completely grieved or grieved at all. The feelings may even become worse, leading to a cycle of self-harming behavior.

So what predisposes someone to engage in the self-harming and ultimately unsatisfying behavior described above? There can be many factors, including low self-esteem, a history of untreated anxiety and depression, an inability to express feelings—especially difficult ones such as anger—and the lack of a support system. There are also more complex reasons involving one’s family of origin, including trauma in early childhood and the absence of a secure connection with early caregivers.

This sense of emptiness and lack of safety makes loss intolerable rather than simply painful, and it is this inability to tolerate it that leads to the behavior described above.

In addition to these internal factors, society in general and specific cultures in particular make grieving difficult. Part of this stems from our lack of recognition of the universality of loss, i.e., as something that permeates all aspects of life and isn’t just about death. In addition, we have become a culture of short-term fixes—the “just-get-over-it-and-move-on” philosophy. This puts pressure on individuals to minimize their sense of loss.

Finally, there is the over-arching reason grief is given short shrift. It makes many, if not most, people uncomfortable because it touches unhealed grief in themselves.

Next month, I will discuss some effective and healing ways to cope with grief and loss.

When parents view their child’s “problematic” behavior, attitudes, or troubles as a reflection of them, it can be a terrible blow to the ego. For parents with positive self-feelings, anger, hurt, and disappointment can occur when they don’t see themselves reflected in their children. (“My child should be just like me.”) For parents who do not feel very good about themselves, seeing a child as being “just like me” can feel devastating. Parents who lack self-esteem often feel like their child’s problems are their fault. Their inability to differentiate themselves from their children can also result in guilt and painful feelings of responsibility that are often overstated and inaccurate. Many parents who struggle with the idea that their child is a reflection of them (for better and worse) have not separated from their children. These parents tend to feel some responsibility for their child’s situation. Most often they believe that, either in their early behavior with their children or in their biological contribution (or both), they have profoundly affected their child’s life and character.

“Peter” came to his therapy session in a rage about “Adam,” his 25-year-old son. He had just come from his son’s apartment and was disgusted about the dirt and disarray he encountered: “What is the matter with that kid? He’s such a slob. There is stuff everywhere. It feels so chaotic! I have the same feeling when I think about how he gets drunk with his friends on the weekend. He’s a mess!”

When I asked Peter what made him so angry about this, he began to express remorse about being so enraged. Choking up, he said, “I guess I’m really hurt. I feel like Adam is being disrespectful to me. He knows I hate his messes and his drinking behavior. I feel like he’s on a terrible path of disorganization and disaster. I keep asking myself, ‘How did he turn out this way?’ ”

I asked Peter what he thought about why Adam was like this. “I don’t really know,” Peter said. “But I honestly believe it’s my fault. You know I was a terrible workaholic during Adam’s first 10 years. I neglected him when he was growing up. Then I think, if I was a workaholic, will he be an alcoholic? I know I made him this way. I’m a mess of a father.” Peter was tortured by his painful feelings and disappointment that his son hadn’t turned into the ideal adult that Peter wished he could be.

Over time, as we explored Peter’s feelings, it became apparent that he put all the responsibility for the person Adam was at age 25 on himself. He found it very difficult to see Adam as a separate individual with his own reasons for behaving the way he did. Slowly, Peter was able to consider that his influence hadn’t only been negative and that he wasn’t the only influence on Adam’s development. Adam’s mother was nurturing; Adam had many friends growing up. Peter could even recall some teachers who were influential in Adam’s life. He acknowledged, for example, that a high school teacher had encouraged Adam to stay with his music, and Peter admitted that Adam was a successful musician.

“I guess I haven’t focused enough on Adam’s successes, just on the ways I see him as a failure and blame myself,” Peter said. “Sometimes I still think that maybe Adam is punishing me when he messes up in ways he knows I hate. I guess I really have to admit that it isn’t all about me. Adam is a different person from me. It’s just hard to be OK with that. But I do want to get there. I know that would be best for our relationship.”

Peter is slowly beginning to separate from Adam and experience Adam’s successes and failures as more about Adam than him. He is also beginning to take Adam’s character and behavior less personally. Giving up the idea that “it was all my fault” makes space for Peter to see Adam as a separate individual.

“Rose,” another client, began to talk about her 10-year-old daughter, “Jessica,” in our therapy sessions.  Rose was obsessed with worry that Jessica, who had learning disabilities, would never have a successful life. She said with some sadness: “Her brain is damaged. How will she ever be OK?”

“What do you mean, ‘Her brain is damaged’?” I asked.

“You know that we had her tested and she has so much trouble focusing and organizing her thoughts,” she responded.

“Yes, I know she has some learning disabilities, but seeing her as ‘a person with a damaged brain’ seems a rather extreme way of defining your daughter,” I said.

“I sort of know what you’re saying is true,” she said. “But you know I had learning disabilities as a kid. No one identified them; no one did anything about it. I still struggle at work and in my life in general with being focused and organized. I get so depressed and anxious when I forget things or don’t get stuff done like I promise my husband or my boss. I know my brain is messed up, and Jessica is just like me. Why would I think her fate is going to be any different?”

Rose had a very strong belief that biology was determining her future as well as her daughter’s. She was reluctant to consider that her daughter’s life could take a different path from hers. She had a difficult time thinking about Jessica as a separate person with her own unique characteristics. I reminded her that she and her husband had been addressing Jessica’s learning problems and getting help for her. I also pointed out that this was very different from her own experience growing up. I emphasized that there are many influences other than biology that influence a person’s development. I also asked Rose to tell me anything she could think of about Jessica’s accomplishments. We both listened to the list Rose came up with: “Great piano player, really good artist, hula-hoop champion, kind person, good swimmer, and I guess other stuff, too.” Rose reluctantly acknowledged, “Yes, I suppose her brain works OK in some ways.”

Rose and I spent a lot of time talking not only about Jessica, but also about Rose’s negative sense of self. It was harder for her to take seriously that she has her own accomplishments. It was even more difficult to consider that Jessica was like her in some ways and not others. (Rose is a terrible artist and swimmer!) Our work has centered on Rose’s struggle to experience herself in positive ways and on seeing Jessica as a separate, differentiated individual. We have also been talking about how painful it is to see your child have areas of deficit, and even worse when you feel you are the cause. Helping Rose to talk about her impaired sense of self and its development has allowed her to make distinctions between her own experience and Jessica’s. I have tried to help Rose consider that while there could be some biology at work in regard to Jessica’s learning disabilities, so much more than being “just like me” is involved in what makes Jessica who she is.

We are familiar with parents feeling great pride in how they played a role in their children’s successes. But when parents boast incessantly about their children’s accomplishments to the extent it doesn’t feel like typical parental pleasure, we typically consider them to be narcissistic. For Peter and Rose, their great dismay in what they perceived as their children’s deficits, problems, and failures was also narcissistic.

The term narcissism comes from the Greek myth of Narcissus, in which Narcissus falls in love with his own reflection in a pool. The notion of reflection is pertinent to the experiences of Peter and Rose. Rather than experiencing narcissistic pleasure, these distraught parents experienced a narcissistic wound. They couldn’t tolerate the pain of looking into the pool (i.e., at their child who also represents the parent) and seeing something that is not “beautiful” reflected back. When they looked at their children, they saw a reflection of themselves. It was intolerable that the reflection they saw was “a mess” or had a “damaged brain.” It was not “beautiful.”

These parents are responding narcissistically, and they have not differentiated themselves from their children. One has to wonder how parents, who view their children as reflections of themselves, may have influenced their child’s separation/individuation process. As parents become more aware that their beliefs that their children are or are supposed to be “just like them” are assumptions, they will be in a better position to examine those beliefs. As a result, parents will experience less pain, and their children will be helped to develop into separate, unique individuals.

Eating brings pleasure, energy, and well-being to our lives. A disruption of this simple, often mindless, but important activity could lead to stress and anxiety.

People who have food allergies have to be extra careful about what they eat. A simple ingredient such as eggs or nuts could ruin a meal by causing hives or wheezing, and, in extreme cases, cause a reaction so severe that an epinephrine injection is needed to save the person from a life-threatening condition.

Food intolerances, or adverse reactions to specific foods, can also cause harm to a person, but generally lead to minor symptoms such as diarrhea or stomach cramps, according to the National Center for Biotechnology Information website. Celiac disease, for example, is not a food allergy but rather an autoimmune issue. People with celiac disease who eat gluten experience health problems as a result.

Elika Kormeili, a therapist specializing in food-allergy issues and founder of the Center for Healthy and Happy Living, says that she has suffered from food allergies and knows the stress and anxiety they can cause. She says certain social situations that involve food, such as birthday celebrations or work lunches, can be so stressful that people with food allergies might avoid them entirely.

“Sometimes children with severe food allergies (life-threatening) are so scared of being exposed to an allergen that it impacts their ability to participate at school,” Kormeili said. She goes on to say that “Food is a huge part of our socialization and when you are limited in what you can eat, it definitely causes anxiety.”

[fat_widget_left]Food allergies may lead to anxiety, but anxiety may or may not lead to issues with food allergies. Kormeili said stress and anxiety can weaken the immune system to the point of aggravating food allergies. People with food allergies might also experience changes in mood and behavior. Sometimes just getting on a diet to eliminate allergens improves mood, decreases irritability, and allows for better concentration.

She has the following tips for coping with food allergies and the anxiety that sometimes follows:

• Make a list or keep track of the foods you are allergic to and make sure to remove them from your kitchen cabinets. Add foods that your body accepts.
• Develop steps to maintain good mental and emotional health, not just physical health. Mental and emotional self-care can involve relaxation and breathing techniques.
• Strengthen and maintain a healthy support group. You can interact with others in person or via social media.
• Ask for and accept help with your situation. Seeing a health professional or therapist is an option.
• Have a plan for emergency situations involving food allergies. If reactions to certain foods are severe, it may be necessary to carry an EpiPen—talk to your doctor about this—and create an action plan with specific steps. Alert others about what to do in such situations.
• Understand that despite prevention efforts, you still could be exposed to an allergen. Don’t let that keep you from living a happy, full, and healthy life.

Stacey Antine, a registered dietician and author of Appetite for Life: The Thumbs-Up, No-Yucks Guide to Getting Your Kid to Be a Great Eater, says that the most important part of alleviating anxiety associated with food allergies is having direct control over the food you’re eating. She encourages growing, harvesting, and cooking your own food. She is the founder of HealthBarn USA, which hosts workshops and other programs on a family farm to help kids and adults understand the importance of natural, healthy food.

She suggests cooking your own food, talking to servers at restaurants to get more information about the preparation and ingredients included in foods, carrying safe snacks to eat just in case, and informing others of your diet restrictions in advance so they can accommodate you. “Cook your own food and rely less on packaged foods. It’s better for your overall health…Also, yoga and at least 20 minutes of meditation daily will help reduce anxiety,” Antine said.

Laurinda Kwan, a naturopathic physician at Arizona Natural Health Care, says that she decided to focus on treating seasonal, environmental, and food allergies because of her own suffering from food allergies and eczema. “If you repeatedly have adverse reactions to your food, just like Pavlov’s dogs, you develop a learned response,” says Kwan. She goes on to say, “We are not born having anxiety to foods. However, over time, if eating food consistently produces unfavorable feedback (e.g., hives, itching, stomach pain), your learned response is going to be that of fear or anxiety to foods.”

She believes that in some cases anxiety itself could create food-intolerance issues. For example, when a person experiences anxiety, sometimes he or she also has gastrointestinal problems such as bloating, abdominal pain, and diarrhea. “If the gastrointestinal tract is compromised, this could lead to intestinal permeability (or ‘leaky gut syndrome’). When the intestinal lining is compromised, substances pass through the lining of the small intestine that normally should not pass into the blood stream, and your body creates an immune response,” Kwan said. She said to keep in mind that there is some debate about leaky gut syndrome, and more information needs to be gathered.

Kwan’s suggestions for alleviating anxiety associated with food allergies include talking to a homeopathic doctor who can treat the whole person, not just immediate physical symptoms. She also said it’s necessary to pay attention to food labels to avoid allergens.

Anxiety is not the only mental health issue associated with food allergies. Kwan said depression could develop as a result of living a restricted lifestyle. Also, because people with food allergies have a tendency to focus on what they do or don’t eat, in some cases eating disorders can develop.

Some people become emotionally overwhelmed when they see or hold a small baby. They develop a longing to have a baby, even when they may already have children. In popular culture, this phenomenon is known as “baby fever.” This type of event can happen to virtually anyone. However, it seems to affect only certain people, while others appear to be immune. The curious nature of “baby fever” was of interest to Gary L. Brase at the Department of Psychology at Kansas State University, so he decided to conduct a series of studies to determine if there were biological causes for the phenomenon and why it occurs.

Brase recruited 853 nonstudent young adults and 337 college students and measured their desire for a baby, if this desire differed by gender, and how it related to sexual desire, emotions, and experience with other children. After an exhaustive examination, Brase found evidence for the existence of “baby fever.” “Three factors strongly and consistently underlie desire for a baby: Positive Exposure, Negative Exposure, and Tradeoffs,” Brase wrote. One contributing factor that led to “baby fever” was positive experience with children. Individuals who had bad experiences with children were less likely to develop “baby fever” than those who had only good experiences. Trade-offs also played a major role. Participants who were comfortable with trading time, intimacy, financial resources, and energy for a baby were at increased risk of “baby fever” when compared to those who were less willing to trade those commodities.

Although Brase discovered that the desire for a baby was present in men and women alike, it was more evident in the women. He also noted that desire for sex was quite different than the desire for a baby for both sexes. Despite the fact sex leads to babies, the reproductive/sexual desire is independent from the desire to nurture and parent. The results of this study clearly show that “baby fever” is a unique occurrence unrelated to sexual motivation and cultural expectations, but future research should look further at the psychological origins.

Reference:
Brase, Gary L., and Sandra L. Brase. Emotional regulation of fertility decision making: What is the nature and structure of “baby fever”? Emotion 12.5 (2012): 1141-154. Print.

I was recently told a statistic that didn’t really surprise me, but was kind of an eye-opener nonetheless: Married individuals daydream about being single at least once a day. Well, I’d argue that single people dream about being in a relationship once in a while, too. The point is that the grass is always greener.

The other point is that there is some truth to the statistic, and people should be aware of what is happening biologically. The chemicals in our brains when we meet someone, start dating and “fall in love” are akin to being on a cocaine high. Dr. Helen Fisher, author of Why We Love: The Nature and Chemistry of Romantic Love, coined this the “lust” and “romance” phases of love­—when things are exciting, albeit chaotic. This is not a sustainable way of living. Most people want to fall in love so they can settle down. A friend once said to me, “But isn’t doing your laundry on a Saturday with your partner what it’s all about?” Yes, a long-term relationship is comfortable, secure, stable, and, well, biologically speaking, perfect for raising children. You wouldn’t want to raise kids in a chaotic state of mind, would you?

Now, this final phase of love, which Dr. Fisher calls “the attachment phase,” is not that exciting, perhaps, but it really isn’t supposed to be. I think a lot of people get disillusioned by messages in the media, romance in films, and passionate sex in movies. It seems that if you want something exciting, you have to keep jumping from one relationship to another. And, trust me, many people do. Although many use the term serial monogamy, this can be a sign of a love addiction—people finding themselves addicted to the rush of romance.

Love addiction also has a flip side to it: It might cause you to stay in an abusive relationship. Love addicts often are afraid of being alone, and don’t like their own company. Love addiction can take over and cause people to make bad choices, fail to see red flags, and continue down a path with someone despite the obvious. Many love addicts have more than one partner.

We all have the tendency to be love addicts because, in the end, we all want love and connections with people, for that is how we grow, but a true love addiction is compulsive and obsessive in nature. A love addict may feel that true love will solve everything. A love addict may consume his or her mind with all things relationship-oriented. A love addict may fantasize about someone who is unavailable, believe he or she just can’t find the right one, or, once the early passion fades, fear he or she is no longer “in love.” Some may jump from one relationship to another in search of that excitement, while others stay in their current situation despite feelings of dissatisfaction, fantasies about leaving, or affairs both emotional and physical, and are prone to blame their partner(s) instead of addressing the matters at hand.

So how do we start to address a possible love addiction? Here are some guidelines I’ve come up with, for starters:

1. Stop blaming the other person. If you are in a relationship, take a close look at what is going on. Are you being fair? Are you being honest? Are you being clingy? A love addict may expect the other person to treat him or her special, make everything, and fix things for him or her. If you are single, stop blaming the ex, take a break from dating, stop interacting with the ex, get into therapy, and talk to someone.
2. Accept your feelings of sadness, fear, anxiety, and loneliness on a daily basis. These are common feelings that everyone feels, but a love addict may try to fight them by finding a relationship. Recognize that you will feel these feelings and it is OK.
3. Take responsibility for your life. This means your happiness and your successes. Take charge of your life, make healthy choices, and spend time doing the things you love.
4. Learn to accept yourself. Accepting your partner, if in a relationship, is key, too. In the end, without acceptance we are continuously searching, and that is at the root of any addiction.