Transitions: What Are They? Why Are They Difficult for Children with Autism?
A transition occurs when there is some sort of change to the parameters of an activity or situation, such as going from one activity to a different activity or changing plans. For example, going from playing computer to doing homework, riding the school bus home, going on vacation, going out for ice cream with dad when you planned on doing that with mom — all represent examples of transition situations.

The problem with transitions is that either something is ending, or something is beginning. Often, this means going from doing something preferred to doing something nonpreferred.  This can be problematic for just about anyone. For the autistic individual who is very driven by being comfortable, being obligated to stop doing preferred, comfortable activities is even tougher. After all, why would one want to stop playing a favorite video game just to take a bath?

As for all human beings, as well as for individuals on the spectrum, transitions mean uncertainty. Increased uncertainty means increased anxiety. New situations mean different rules and expectations. Rigidness and routine adherence are coping characteristics of autism, and these serve to reduce uncertainty, thereby reducing anxiety. These qualities tend to make transition situations that much more difficult.

Here are a few things you, as a parent, can do to make transitions a little easier for yourself and your child.

Scheduling: Planning Ahead to Reduce Anxiety
Since uncertainty and the anxiety that goes with it is a large part of the problem with transitions, it makes sense that reducing uncertainty might make transitions easier. Scheduling is an easy way of doing this.

Providing your child with a schedule does two things: It allows your child to have a better sense of what is going to happen in the future, and provides a better sense of control over his life (if you make him a part of the scheduling process).

Here are some tips to maximize the effectiveness of your scheduling strategy:

1. Schedules should be understandable. Make sure the schedule is written in such a way that the child can read/utilize it. Use pictures instead of words if that will make things more concrete for him/her.
2. Schedules need to be seen to be effective. Make sure the schedule is easily available or can be carried by your child so they can refer to it whenever they need to do so.
3. Scheduling should be a collaborative activity. Whenever possible, give your child both choices of activities and the order in which they will be done. This increases your child’s sense of control and reduces uncertainty and anxiety.

The “Ease-in” Proactive Warning Strategy
Give your child as much warning as possible about upcoming transitions. Instead of just springing change on your child with little or no warning, give him/her time to mentally process and prepare for the change. Making the sudden mental shift from one activity to another can just be too much for some kids.

Give your child progressive reminders of the upcoming change. So, 10 to 15 minutes before the transition is going to occur, tell your child of what is going to happen, when it is going to happen, and what they need to do. Do this again a few more times, maybe at five minutes and two minutes. You can also do this when the activity itself hasn’t changed but other details of the activity have changed (change in time, who’s going, order of activities, etc.) Giving repeated reminders of what is going to occur beforehand helps reduce uncertainty and alleviate anxiety for your child.

Priming: Setting Expectations ahead of Time
This strategy is simply a variation of the “ease-in” strategy. This is where you review what is going to happen and what the expectations are before going into a given situation. The difference between this and the “ease-in” is that this is done just prior to the transition. It puts your expectations forefront in your child’s mind and makes it more likely that they will remember them. It’s not a guarantee they will follow directions, but it stacks the deck in your favor.

I often use this for more familiar activities. For example, every time I take my kids to the store, I say the following:

“OK kids, we are about to go in the store. Let’s review the rules. We are here to buy [x] and [y]. If you are good, I may get you [z]. Please keep your hands and feet to yourselves. Follow my directions. We will use the bathroom as soon as we get in and that’s it. Finally, if you can’t see me, I can’t see you, so let’s stay together.”

I’ve said this or something like this before every shopping trip with my kids for years. They can sometimes recite it with me. My kids have learned to stay with me in the store. They don’t ask to go to the bathroom 15 times during a shopping trip. They generally behave well, and earn treats as a result. It was not always so easy.

“Grandma’s Law:” The Power of the Premack Principle
The premack principle, or “grandma’s law,” refers to alternating between nonpreferred and preferred activities. In essence, it’s “if you want dessert, you need to finish your vegetables.” By doing this, you can always give your child something to which to look forward, even when he/she has to do something they don’t like doing. This strategy both reduces uncertainty and increases compliance through increased motivation (people are more willing to do nonpreferred activities if this gets them access to or leads to preferred activities).

Incidentally, premacking works really well with scheduling. Alternating between preferred and non-preferred activities will increase the power and motivation of the schedule. This, in turn, will make it easier for your child to make the transitions.

One Last Piece of Advice
These strategies work really well together. Furthermore, the more consistently they are used the better they work. To get this to happen, it behooves you, as parents, to train the other caregivers in your child’s life as to how best to guide them through transition situations. When the child’s parents, teachers, babysitters, home health therapists, etc., are all doing the same thing, your child is going to experience less uncertainty and, therefore, less stress. This, in turn, should result in fewer negative behaviors and better transitions.

I hope you found this information useful and that it makes life with your child a little easier. As always, remember to breathe… you got this.

Chances are most of what you think you know about therapy is misrepresented in the media. Why? Because pop culture’s idea of what goes on in the therapy room is largely based on fictional therapists. In short, good TV and movies depict bad therapy. The dramas—made famous by fictional therapists—that interest viewers portray the qualities that would be harmful to real-life people in therapy (and most likely would get those therapists in legal trouble).

Below are the top five lies that you may have learned about therapists on television and in movies, followed by a more realistic view of therapy:

Lie No. 1: Therapists can’t be trusted to keep your secrets or respect your privacy. Television and movie therapists are often portrayed as devious or self-serving. On Mad Men, Don Draper’s wife was seeing psychiatrist Dr. Arnold Wayne, who then reported the details of their sessions to Draper (this one tops the list).

The reality: Therapists are ethically bound to maintain confidentiality. What is said in a therapy session will never be shared with anyone else without your permission. The exception to this rule is when someone is in danger, as in the case of child abuse, for example. Legitimate therapists will explain the limitations of confidentiality at your first session.

[fat_widget_right] Lie No. 2: Therapists’ foibles, oddities, and mistakes are the norm. The media often portray therapists as incompetent, either because they are pompous or because they just aren’t effective in therapy. Sometimes they’re depicted simply as being off-the-wall. The most obvious example of an incompetent therapist is the delusional Tobias Fünke on Arrested Development—a failed psychiatrist with multiple phobias and a total blindness to the problems in his marriage and family. Mind you, Tobias is a hilarious character (and that is the point)—but there’s nothing therapist-like about him.

The reality: Therapists are highly educated, normal people. In general, therapists hold either a doctorate or a master’s degree in psychology or a subspecialty (such as marriage and family therapy), and they are required to take continuing education courses on a regular basis to keep their skills and licenses current—a license is required in most states. Therapists are bound by the ethical standards of their profession as well as by local and federal laws. While perfection might be desired by a person in therapy, therapists are human just like everyone else.

Lie No. 3: Your therapist will fix your problems. Fictional therapists on TV and in movies tell people in therapy what to do, taking for granted they “have the answer.” Even Dr. Phil (who is not fictional) primarily lectures and offers advice on his show.

The reality: A good therapist will assist you in finding your own answers. Your therapist might occasionally offer a suggestion about changing a behavior, or give you “homework” to try out between sessions (this isn’t advice, but a directive). It is much more likely that if you ask your therapist for advice, he or she will help you explore your own inner knowledge about what is best for you in a given situation. Each therapist has his or her own style. And there are different therapies that prescribe a more direct vs. indirect approach.

Lie No. 4: Your therapist will become very involved in your life as your on-call crisis manager. Many TV therapists are portrayed as being intimately involved in the day-to-day dramas of people’s lives, taking endless phone calls to help the client resolve a sticky situation. In the comedies Analyze This and What About Bob? this concept is taken to an extreme, as the therapists become overly involved and react defensively to people’s needy behaviors.

The reality: Therapists maintain therapeutic boundaries in order for therapy to be effective. The therapist will explain his/her policies at your first visit. Most likely, your interaction with your therapist will be limited to scheduled visits, which are typically just once a week, but short five- or 10-minute calls between sessions are usually not prohibited (this is an individual therapist courtesy). Therapists often do respond to crisis calls when deemed appropriate to do so. It is good practice to ask your therapist how he or she handles these issues if you are uncertain.

Lie No. 5: Your therapist might become romantically or sexually involved with you. It’s easy to think, from the examples we see on TV and in the movies, that most therapists end up in romantic entanglements with people in treatment. As an example, in the blockbuster romance The Prince of Tides, the psychiatrist played by Barbra Streisand begins therapy with her client’s brother and eventually has a sexual fling with him.

The reality: Therapists are ethically bound to avoid dual relationships or sexual contact with people in therapy. A dual relationship refers to a situation in which the therapist interacts with a person in therapy in a way that may be harmful to the person. In general, this is highly frowned upon by therapeutic ethics. No therapist should engage in a romantic or sexual relationship with you while you are in treatment with him/her.

“My therapist told me the way to achieve true inner peace is to finish what I start. So far today, I have finished two bags of M&M’s and a chocolate cake. I feel better already.”
—Dave Barry

So, how are you supposed to feel safe and keep pace with all these potential issues? First of all, it’s your therapist’s responsibility to handle sticky situations correctly and within the laws that govern them. Mental health professionals are required, ethically and legally, to explain these issues to you before the process of therapy begins. Typically, you will be asked to read and sign a detailed document (usually called an “informed consent” or “disclosure”) that describes the therapist’s way of practicing and his/her ethical and legal obligations. If you have questions, you can also contact your state licensing board, as it is set up to protect your rights.

Reference:

Squiddo (2013), Retrieved May 5, 2013, http://www.squidoo.com/psyquotes by Jaktraks.

We all know an adrenaline junkie: the friend who jumps out of airplanes for fun, the sibling who spends her time traveling to war-ravaged countries, or the co-worker who spends her weekends speeding on a motorcycle. Adrenaline rushes are readily available at just about every turn. A number of factors can affect whether a person ends up a risk taker or a quiet homebody, but there’s evidence that a little risk-taking now and again is good for almost everyone.

Effects on the Brain

Risk-taking causes real changes in the brain, which might account for why risk-takers quickly seem to become adrenaline addicts. Major risks release adrenaline, which can lead to a quick rush, and dopamine, which causes intense feelings of pleasure. While these chemicals contribute to a powerful high in most people, the feelings can be especially addictive to people who are struggling with feelings of sadness or depression. Over time, risk-taking can function much like a drug. Risk-takers may need bigger risks to get the same rush, and mundane daily activities can start to seem boring and painful.

Personality

Personality plays a major role in an individual’s propensity for risk-taking behavior. While it might seem like those who worry excessively don’t make for ideal risk-takers, some studies indicate that people who score high on neuroticism – a combination of anxiety, moodiness, and worry – are more likely to become risk-takers. The data is not conclusive, though, and some studies have found that risk-takers actually score lower on measures of neuroticism than the general population.

Personality can also affect the kinds of risks a person is willing to take. The dedicated smoker might be terrified of heights, driving, or illness, without ever recognizing that smoking is a risky behavior. Some adrenaline junkies have a preferred risk-taking behavior, and this could be correlated with personality. People who love novelty, for example, might travel to dangerous locations, while people who are highly physical might get their adrenaline rush from rock climbing or mountain biking.

Culture and Peers

Cultural influences play a huge role in whether or not people are willing to take risks. As travel – particularly to remote locations – has become a part of the educational path of middle class students, more and more students are willing to travel to potentially risky locations. Peer pressure plays a huge role in risk-taking, and study after study has shown that people are more likely to take risks in a group setting.

Benefits of Risk-Taking

While some risky behaviors might not be worth their potential consequences, risk-taking in small doses is almost universally beneficial for your brain and mental health. Novel experiences can help to ward off depression and reinvigorate a stale relationship. Risk-taking is often a necessary prerequisite for starting a new business or launching a new career, and the excitement associated with uncertainty can be a powerful antidote to boredom and even depression. Because dopamine produces a natural high, risk-taking behaviors can help you get a positive mood and a new perspective without the risks associated with drug use.

References:

1. Adrenaline rush: The science of risk. (n.d.). Museum of Science, Boston. Retrieved from http://www.mos.org/imax/adrenaline-rush
2. Gardner, M., & Steinberg, L. (2005). Peer Influence on Risk Taking, Risk Preference, and Risky Decision Making in Adolescence and Adulthood: An Experimental Study. Developmental Psychology, 41(4), 625-635. doi: 10.1037/0012-1649.41.4.625
3. Park, A. (n.d.). Why we take risks — it’s the dopamine. Time. Retrieved December 30, 2008, from http://www.time.com/time/health/article/0,8599,1869106,00.html

This is a big topic. It may be at the core of why many divorces do not proceed well. The ability to forgive can be quite complex, depending on the events and issues under consideration. However, forgiveness may be one of the most important and perhaps most powerful experiences you may have when going through what can be a very difficult and painful event.

Some things to consider when thinking about what it might mean to forgive your ex-spouse:

1. Healthy boundaries: When we forgive, we are learning to have healthy boundaries so that we do not say or imply that what was done was OK. Holding a grudge is not the best way to make sure you are not hurt by someone again. Being clear about what you are and are not willing to do going forward is a stronger stance.
2. Ongoing experience: Forgiveness is an ongoing experience. It doesn’t happen once and then be done. It happens over time, allowing us to acknowledge our feelings and put them in perspective. Feelings such as anger and resentment take time to heal. Forgiveness is part of the healing process and important to our own health and helping to decrease stress in our lives.
3. Realistic view: When we can recognize other people for who they are and give up on the hope of changing them, this often has the impact of changing our response to them, our expectation of them, and our need to forgive them for being who they are. Having a realistic view of another person may help to minimize the things they need to be forgiven for if the expectation that they be someone other than who they are is not there.
4. Afraid history will repeat itself: We are sometimes frightened that if we forgive someone we will have to go back to being in the relationship in the same way we were before. It is important to remember we need not choose to be a victim nor allow ourselves to participate in something that is intolerable or abusive in order to forgive the actions of another.
5. Feeling powerless: We are sometimes fearful that we will feel powerless if we forgive a person who is asking for our forgiveness. We may feel powerful when we refuse to offer it to them. Forgiveness is not about power. It is about creating an internal sense of peace.
6. Continual forgiveness: We need to stay aware of choices we make that may put us in the position where we feel a continual need to forgive. This relates to being clearer about your boundaries of what you are willing to tolerate or expose yourself to.
7. Cycle of arguing and forgiving: During a divorce, disagreements and problems may arise that result in arguments and feelings of anger and resentment. We may feel an ongoing cycle of hurt, anger, argument, and forgiveness. It helps to be aware of the ways we engage that are about our expectations and disappointments that lead to anger and then a need for forgiveness.
8. It isn’t fair: One of the reasons we find it difficult to forgive is because we feel it isn’t fair that the person who has hurt us will not be punished or forced to make amends. Forgiving is not the same as thinking others should not be accountable for their actions. It is about coming to terms with what happened, allowing ourselves to find a calmer place in our hearts in understanding what happened, and letting it become part of our history rather than continually intrude in our lives.
9. Getting even: Getting even is a short-term experience. Moving on, forgiving, and living the life we want free of anger and stress is its own reward.
10. Avoid an uncomfortable situation: We can guard against forgiving someone so that an uncomfortable situation can be averted rather than because we truly feel we are ready to let go of our judgment of them. When forgiveness is given for a reason other than feeling ready to forgive, resentment will often emerge instead.
11. Not the same as forgetting: Forgiving is not the same thing as forgetting. We may have an experience which reminds us of what happened. This doesn’t mean we no longer forgive that person. It is often helpful to have these reminders as a way of remembering why we needed to forgive in the first place.
12. Forgiving yourself: It is as important to forgive ourselves as it is to forgive another. We can act in ways we regret, sometimes realizing it right after we do something. We are as capable as anyone else of transgressions and to hopefully learn from them. Sometimes, our unwillingness to forgive ourselves results in placing our anger with ourselves on someone else.
13. Private experience: Forgiveness can be a private experience with ourselves and does not need to be pronounced to the person you are forgiving. Many people have no information about the amount or nature of the ways in which they have been forgiven.
14. For your own benefit: When we forgive, it is an act for ourselves, for our own benefit, not the person we are forgiving. It is about our relationship with the self, our attitude about others, and our beliefs about what should be rather than what is.

Attention deficit hyperactivity (ADHD) manifests with symptoms of inattention, hyperactivity, and impulsivity. In the criminal population, impulsive behavior is a common thread. However, few studies have sought to determine whether ADHD increases the likelihood that a person will engage in criminal behavior. The effects of ADHD are broad, varied, and long term. To accurately predict how ADHD will influence future behavior, one must look at other environmental and familial factors. To this end, Jean-Baptiste Pingault of the Research Unit on Children’s Psychosocial Maladjustment at the University of Montreal and Sainte-Justine Hospital in Canada recently led a longitudinal study involving more than 2,700 individuals.

The participants were first evaluated for ADHD, physical aggression, inattention, and family adversity when they were 6 years old. They were reassessed annually for seven years. When they were 25, criminal records and teacher and parent reports were examined in order to find any association between the measured risk factors and criminal behavior. Pingault discovered that in certain analyses, childhood ADHD was linked to criminal behavior. But in the most sensitive analysis, the association was weak at best. However, childhood physical aggression was directly predictive of later criminal behavior.

The findings revealed that while less than 10% of the total sample exhibited physical aggression in childhood, this small group represented 30% of the criminal activity in adolescence and young adulthood. Further, these same participants were responsible for almost half of the criminal charges on record and nearly 60% of all the violent criminal charges. Family adversity also increased the risk for criminal behavior in the aggressive participants. Pingault believes these results show that not all children with ADHD are at risk of engaging in criminal behavior. But children with aggressive traits, and especially those with ADHD and family adversity, are more vulnerable to criminal activities. Therefore, efforts to reduce crime may not be most effective if focused solely on children and young people with ADHD. “Crime prevention should instead target children with the highest levels of childhood physical aggression and family adversity,” said Pingault.

Reference:
Pingault, J-B., Côté, S.M., Lacourse, E., Galéra, C., Vitaro, F., et al. (2013). Childhood hyperactivity, physical aggression and criminality: A 19-year prospective population-based study. PLoS ONE 8(5): e62594. doi:10.1371/journal.pone.0062594

Have you ever been told that you can’t take a joke, that you overreact, or that you are just too sensitive? Well, sit back and find out that there is absolutely nothing wrong with you. You see, sensitivity to criticism is earned. Yes, you read that correctly. No one is born to be sensitive to criticism; one is groomed and nurtured in environments of emotional harm. If you have a history of family members being harsh, judgmental, or verbally cruel, you are more vulnerable to verbal slights, teasing, and criticism than the average person. It’s not your fault, and you are not weird.

Roots in Your Family of Origin
Since you may have grown up in this kind of family, you might think that criticism is normal. Truthfully, I believe any kind of criticism (other than artistic or professional constructive criticism,) is never acceptable, warranted, or okay. Healthy relationships are born of acceptance and tolerance. If a friend or partner can’t tolerate you or your behavior, then they shouldn’t be your friend or partner. If someone is often telling you that you’re too sensitive, that is akin to telling you over and over again that you are not good enough, that you are flawed or inadequate.

These statements wouldn’t make anyone feel good, but it’s especially destructive to someone who came from a family where they were put down verbally, or even silently with rolling eyes and demeaning physical postures. You, the so-called “overly sensitive” person, are actually having a normal reaction to a hostile comment.

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Roots in Mental Health Issues
Did you know that many people who are highly critical of others often suffer from depression and anxiety? Criticizing others is a means of making themselves feel better. They may go on and on about how awful someone is, in order to feel less empty, bored, or depressed. Often, unfortunately, those they criticize buy into these negative comments and end up feeling just as awful as the critics.

If you are in relationships with people who are hurting you with criticism or judgments, you might want to consider why you are surrounding yourself with these people when there are so many kind, accepting, and loving people out there. If you want to perform a little test, a good question to ask yourself after being with a friend or loved one is, “Does this person lift me up or tear me down?” If you have more “Tear downs” than “Lifts” you might want to consider getting some individual counseling. Allowing others to criticize you destroys your sense of being good enough, likeable, capable and empowered.

Roots in Self-Criticism
If you are tolerating this kind of criticism from others, chances are that you are used to talking to yourself like this. Your relationship with yourself could be more loving and accepting. For example, when you make a mistake are you constantly reaming yourself unmercifully for messing up or are you able to forgive yourself relatively quickly and move on?

Self-criticism is actually worse than being criticized by another, as there is no immediate escape from it. So, if you are relentlessly telling yourself that you are bad, flawed, fat, unattractive, stupid, uncaring, lazy, etc., you may have trouble even wanting to get out of bed. You may feel depressed, angry, helpless, or ashamed, because you don’t know how to get out of this cycle. But with guts, patience, compassion, and time you absolutely can change the way you talk to yourself. It is a huge commitment to constantly monitor your mind chatter, but well worth the effort.

History repeats itself, especially in our psychological lives and in our relationships.

Although this fact has been recognized for millennia, one of its earliest formulations in the field of psychology is called repetition compulsion. According to Freud (1914) repetition compulsion is a psychological phenomenon in which a person repeats a traumatic event or its circumstances over and over again, either in real life or in dreams.

Does this idea resonate with you? Are there patterns you tend to repeat in your relational life that you just can’t seem to break or, at the very least, have been slow in changing?

Although Freud attempted many explanations of this phenomenon, some more satisfactory than others, it was only in later years that we’ve gained a fuller picture of why these sorts of events are repeated.

Over the course of our lives, we interact with many different systems. However, our family of origin – the first system we encounter – has the most pervasive influence on our emotional and physical development and future relationships. As we grow up, our parents teach us what’s good or bad, valued or worthless, important or unimportant. In many cases, we learn this from what our parents say and do. In other cases, we learn more indirectly, impacted by our family’s emotional atmosphere [1].

Dorothy was a 45-year-old woman who came to psychotherapy knowing exactly what the problem was but with no idea how to solve it. Mostly, I was struck by her exhaustion – she had deep circles beneath her eyes and looked completely drained.

“I’m not living my own life anymore,” she quickly told me.

As we talked, I learned that Dorothy was exclusively caring for her aging mother, in spite of the fact that her two sisters lived less than an hour away. She visited her mother morning and night. Most days, they talked on the phone ten times. Dorothy’s mother was emotionally abusive, often calling her a terrible, hateful daughter; at other times, she phoned Dorothy’s husband to complain about Dorothy’s failings. Dorothy never confronted her mother or insisted that her sisters contribute to their mother’s care.

Dorothy experienced ongoing emotional neglect during her childhood. Although her mother was well intentioned, she’d suffered from severe mental health issues. Dorothy recounted innumerable incidents in which she sought, without success, to elicit her mother’s love. “I remember her lying on the couch almost every afternoon when I got home from school. She’d been crying and hadn’t changed out of her pajamas.”

After a brief pause, I asked, “You just wanted her to notice you?”

Dorothy sighed. “Yes,” she continued, “but no matter what I did, that never happened. I brought home artwork from school, cleaned up the house. Several times, I even cooked dinner. But my mother never got off the couch or thanked me for my effort.”

“I wonder,” I offered, “whether you’re still trying to get her to love you now.” Dorothy began to cry, a first lightly but then in more heavily, making contact with deeply held but rarely acknowledged feelings of disappointment and loss.

We all leave our family of origin with emotional baggage. Some people have more baggage than others, and some are more aware of what’s packed in their bags than others [1]. Learning what’s packed in these bags, and perhaps deciding to work through and leave a few items behind, is the essence of family of origin work.

Dorothy understood that she was repeating a pattern from her early childhood. But change did not come quickly. Over a series of meetings, we discussed the strong emotional pull Dorothy felt to recapture her mother’s love and attention – though she freely admitted that she’d never had these in the first place. Several months later, Dorothy came in and said, “My mother started insulting me again on the phone today.”

“And?” I said, waiting for her to respond.

“And I told her, ‘If you can’t speak to me kindly, then we’ll have to talk another time. Maybe tomorrow when you’re feeling better.’”

“What happened next?” I asked

Dorothy sighed. “She kept going, like we expected she would. But I rose to the occasion. I said, ‘I’m sorry mother, we’ll have to talk later,’ and I hung up the phone.”

This article will be continued in future installments.

References:

1. Brown, F.H. (2006). Reweaving the family tapestry: A multigenerational approach to families. New York: W.W. Norton & Company.
2. Freud, S. (1914). Remembering, Repeating and Working-Through (Further Recommendations on the Technique of Psycho-Analysis II). The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XII (1911-1913): The Case of Schreb¬¬History Repeats Itself

Surprisingly, studies show that some of the seemingly less dramatic kinds of experiences, such as neglect, in childhood actually do more harm than overt abuse such as physical violence. Neglect isn’t talked about as much as physical, sexual, or even verbal abuse, and depressed adults who experienced neglect in their childhoods often wonder why they’re depressed.

Even when people think about neglect, they picture parents who are too drunk or high to take care of their children, who prioritize adult sexual relationships over their children, or who don’t care about their children and thus don’t bother to feed them or provide clothes and other necessities. They may imagine parents who are irresponsible and who forget or don’t know how to take care of their children’s needs. All of this happens, but it can happen without such extreme dysfunction.

Sometimes neglect can happen even when parents are trying to be responsible, when they simply don’t have the resources to parent fully. For example, when one parent leaves and the other has to work two jobs to provide food and shelter, they may have to leave the kids to fend for themselves or let the older ones to do the best they can to parent the younger ones. I’ve had clients from families in which this happened when the older one was as young as 3, taking care of a baby or two.

But neglect can also happen in families in which one or both parents are depressed, have demanding jobs, or have so many children that there isn’t time to meet all of their needs. It can happen when one of the parents, siblings, or grandparents is chronically or gravely ill or dealing with mental issues. Often this requires the rest of the family to put most of their time, energy, and attention into that person. It can even happen in families that value individuality and independence. Thinking they are teaching these values to their capable children, parents may overlook concrete and emotional needs even capable children have.

Neglect can cause children to miss learning the skills they need to be fully functional adults. When kids have to teach themselves how to handle life, they often don’t learn the best ways. Neglect can cause children to feel profoundly lonely and empty. It can make it more difficult for them to form friendships, causing them to feel even lonelier and preventing opportunities to develop social skills. They may feel like they don’t fit in anywhere, and learn to cope alone. Perhaps most insidiously, neglected children often conclude they aren’t worth parental attention and care, or that their needs aren’t important or just aren’t ever going to get met. These beliefs, carried into adulthood, undermine the ability to develop loving, respectful, equally powerful relationships.

Not through parents’ intention or direct action or message, but through lack of action, children can turn in on themselves—blaming themselves for how bad they feel. They can grow up with these invisible wounds, not even associating them with their parents, who may be loving, well-intentioned people.

Clearly, there is a huge range of severity of neglect, depending on factors such as how young the child is when it begins, how extensive it is, whether there’s a basic foundation of love and respect from parents, whether there are other adults who provide at least some of what the child needs when parents don’t, what other abuse is involved, and whether other resources are available.

How people cope with neglect also varies, just as it does with abuse and trauma. Neglected children may cope by clinging and being dependent; by giving up and lacking motivation or hope; by withdrawing and resisting human contact; or by acting out with crime, dangerous sex, etc. They may experience depression, anxiety, self-attacks, eating issues, or addictions. Any or all of these results of the neglect can follow the child into adulthood.

If you don’t understand why you’re depressed and think you had good parents and no trauma, consider what you might not have had. Did you struggle with anything your parents didn’t protect you from or help you with—even things like unrealistic standards for yourself? Did you have to take care of yourself more than your friends had to take care of themselves, or that you would expect of your children, nieces, nephews, or godchildren? Did your parents show no interest in things that were important to you? Did you have to work at getting your parents’ attention? Did you get physically or emotionally hurt because your parents weren’t paying attention? Do you feel like your needs aren’t important? Do you not expect to have them met? Check in with yourself, your journal, your therapist, and maybe your siblings to see if you can find ways your parents weren’t there for you that others are for their kids … and look at how it affected you.

When a psychiatric client is in remission, it usually means that he or she is no longer experiencing clinical levels of symptoms related to the original issue. For instance, people with depression may be classified as being in remission when they have more periods of positive affect than negative affect, when they do not ruminate and when their eating and sleeping patterns return to normal. However, according to a recent study led by Rico S. C. Lee of the Clinical Research Unit of the Brain and Mind Research Institute at the University of Sydney in Australia, individuals who meet clinical thresholds of remission may not simultaneously achieve cognitive levels of remission.

Research in the area of cognitive remission is scant. Some studies show that cognitive deficits rebound at the same time symptoms decrease, while others reveal that clients who are in remission from symptoms still report feeling impaired in specific areas of their lives. To determine if cognitive deficits persisted in the absence of clinical symptoms, Lee assessed the cognitive capacities of 93 young adults with psychosis, depression, or bipolar at baseline and approximately two years later. The results revealed a direct relationship between cognitive and functioning and later impairment. In this study, the participants who had stronger cognitive abilities at baseline had higher rates of employment, better qualities of life, fewer disabilities, and more satisfaction in relationships than those who had cognitive impairments.

Visuospatial, working, and verbal memory, along with the ability to switch attention at baseline, were all predictive of better global functioning two years later. Lee noted that cognitive functioning at baseline did not predict symptomology at baseline or later on, and baseline symptoms did not predict later symptom severity or cognitive functioning. This suggests that clinical symptoms and cognitive functioning affect the course of these illness in unique and independent ways. Lee added, “Taken together, these results strongly suggest that a traditional, or sole, focus on symptom factors is inadequate in characterizing prognosis and recovery.”

Reference:
Lee, R.S.C., Hermens, D.F., Redoblado-Hodge, M.A., Naismith, S.L., Porter, M.A., et al. (2013). Neuropsychological and socio-occupational functioning in young psychiatric outpatients: A longitudinal investigation. PLoS ONE 8(3): e58176. doi:10.1371/journal.pone.0058176

There is nothing like bringing home a close friend or partner to shine a spotlight on the unspoken rules by which every family, your family, lived and lives.

Every family that lives with one another for some time develops a set of patterns for emotional engagement that soon feels like the “family rules.” These expectations for behavior may start within a marriage and strengthen their grip as children are brought into the home. Once the children catch on to these patterns, they begin to live by them. Only family members know how that family works, even though no one may have ever spoken these powerful expectations out loud.

Many of these rules are quite helpful, and create a kind of emotional shorthand that members count on. Some rules families frequently live by are: this family lets one another know our whereabouts; this family goes to church/synagogue/mosque; this family values education; this family values friendship, and this family works hard. Others might be less helpful. They might be expressed as: this family avoids conflict; this family never questions mother/father; this family relies on men for money, women for support; this family doesn’t live outside our region; this family keeps secrets, and this family doesn’t trust anyone outside the family.

With these internal rules, members keep the connections of their family relationships, even unhealthy ones, intact. Once we bring another person into close relationship with this family system through marriage, the rules become more obvious; our new partner has no way of knowing or observing these internal rules except by bumping into them. Because they don’t have the years of unconscious training in working within the boundaries of these family expectations, newcomers invariably stir up distress and even conflict by disregarding these rules or even openly disagreeing with them. This is one way newcomers remain permanently on the outside of their partners’ family systems.

This is where the partner, whose family of origin is the one getting stirred up, has to bring his or her best self to the party or he/she will end up offending and damaging the new family and partner. If the rule is “no one can challenge the way Mom behaves,” Mom can run roughshod over the new wife of her son and her son gets caught between his loyalties toward his family of origin and that toward his partner. Because the loyalty to one’s family of origin is older and deeper, chances are that is the one that most easily wins.

In families where emotional connection has never been particularly intense or expected, this kind of division of emotional importance happens automatically. Parents have children, raise them, and expect that once their children marry, the old family changes. The new has come, and everyone has to adjust. In more emotionally intense, enmeshed, or distressed family systems, blending a new spouse and/or grandchildren into the mix may require an our-way-or-the-highway kind of behavior from the newcomer that can make for chronic distress for everyone.

I counsel couples who find themselves in conflict over family rules to think about loyalty as an emotional quality of relationships that can and must be shared unequally. One can be loyal to both one’s family of origin as well as to a new spouse, but the most successful marriages have partners who transfer their primary loyalties to their new partner. Mom or Dad may still be core relationships, but if there is any important conflict, decision, schedule, or issue to decide, the default must move to the spouse and couple.

If you and your partner seem to be in constant conflict over your visits back to visit your parents, your time spent with siblings, or the ever-present sense that you care more about pleasing your parents than you do your spouse, check in with yourself regarding that unequal balance of loyalty. If you feel miserably caught in the middle, it’s time to shift your focus. Unplug some of that urgency from your family of origin and give it to your new partner and children. And, of course, if it’s just not as easy as that for you, consulting with a local marriage and family therapist will help you more easily make that emotional transition.

Tantra is an ancient Indian practice that has a presence today around the world. Imagine, 5,000 years ago, this practice being developed, explored, and enhanced to promote sexuality, spirituality, and emotional interconnectedness. Tantra honors and celebrates our bodies, and enriches sensual pleasure, not just sexual pleasure. Breath, meditation, mindfulness, movement, and our environment can enhance intimacy with oneself and others.

Tantra encourages a full sensual and sexual experience with recognition of the importance of space and retreat to leverage and access desire. It is important to note that tantra can be an individual practice; it does not require a partner. Tantra may not even involve genital contact—it’s about energetic and spiritual contact between two partners (or with the self). Though genital contact or intercourse may enhance the energetic and spiritual contact, it is not necessary.

The word tantra has many meanings, including “the way,” “transformation,” and “expansion through awareness.” Though there is much debate, defining such a rich, historic, and important cultural entity may be impossible. For the purposes of this article, a general overview of breath and movement is provided to welcome readers to introduce components into their sensual and sexual experience.

Creating a Tantra-Like Environment
I encourage you to consider the power of simply having a space in your home or office that can be devoted to taking care of yourself, relaxing, and being mindful. Whether it is a particular chair with a candle nearby or removing technology from your bedroom, if you incorporate nothing from this article but creating a sacred space in your life, you will gain health, wellness, and self-care.

Tantra-like space is a space in which you are:

• able to suspend rational thought, and suspend worry, planning, and analysis
• free of technology
• able to step out of your of routine, which often means slowing down
• out of your usual space; is there a room underutilized in your home?

Meditation 101  
Meditation is a way to be in the moment. Are you in the moment right now? As you are reading this article, what do you see, hear, smell? Where is your body touching your chair? Can you feel your clothing, your breath? I introduce my clients to the “five senses exercise” in which we each suspend discussion, slow down, take a full, cleansing breath, then slow our breathing to rate similar to how we breathe when we sleep. Once there is a shift to relaxation, simply access your five senses to notice the feedback each provides you: What do you see? Hear? Taste?  Smell? Feel? (The couch under you, your hands on your lap, etc.) Anytime you are in the moment, you are practicing meditation. You don’t need cushions, chanting, or the ability to sit in a meditation room in order to meditate.

Breath Basics
It’s fascinating that we need to breathe to survive, yet so few of us do so in a proper, cleansing, and nourishing way. Proper breathing provides each of our cells with what they need to function optimally, to support the tissues, muscles, and organs made up of those cells.

Breath is a gateway to enhancing your sexual energy. Try this simple exercise to be aware of your breathing habits. Inhale and “mark” your breath by placing your hand on your body to indicate how deep that breath is. Next, exhale and attempt to empty your lungs completely. On your next inhalation, lower your hand in an attempt to deepen your breath, and again fully empty your lungs before the third inhalation. Continue this exercise until your breath is deep enough that it is as if you are breathing into your genital and sit bones.

Adding Movement to Breath
Once you have done the above exercise a few times and can feel the awakening of your sex organs (this may be no to slight sensation for some, while for others this exercise may inspire desire), incorporate body movement. Lay on your back with your knees bent so that your feet are flat. Inhale long, slow breaths through the mouth, counting to five and expanding the belly, creating an arch under the small of the back. When you exhale, again count to five, bringing the small of your back to the floor, and tilt your pelvis slightly upward. Repeat until you feel the gentle-wave motion as your breath and body movements synchronize. Release tension in your face, feet, shoulders—anywhere you feel it. Be aware of any emotions you experience, which can range from empowerment, sadness, and vulnerability to joy. Finally, incorporate the “five senses exercise” to practice mindfulness once the wave motion of your breath and body is fully engaged.

Though tantra can be thought of as a lifestyle, or a commitment to learning we may not all have, this brief introduction in part or in its entirety can provide you enhancement to your sexual and sensual experience. Breath, meditation, mindfulness, movement, and your environment can enhance intimacy with yourself and others.

Individuals with Parkinson’s disease (PD) often have personality features that mimic those found in depression, anxiety, and even obsessive compulsion (OC). Behaviors such as extreme punctuality, perfectionism, rigidity, harm avoidance, and unwillingness to seek out novel experiences are common in all of these illnesses. New research has begun to explore whether or not any of these personality types are common in people with PD and, if so, whether any of these traits act as predictors of PD, or merely comorbid symptoms. To look at the relationships between PD and personality traits further, Alessandra Nicoletti of the Department of Hygiene, Public Health, and Neuroscience at the University of Catania in Italy recently conducted a study involving 100 clients with PD and 100 without. She evaluated the personality traits of all of the participants and found that OC was present in 40% of the PD participants and 10% of the non-PD participants.

Nicoletti noted that OC personality and Parkinsonian personality both present with similar cognitive and behavioral traits. She believes that even though there is an overlap in symptoms, it has not been shown that OC personality predicts later Parkinson’s. However, some research has suggested a predictive quality in OC personality for future OC. Nicoletti believes the shared traits present in both personality types are the result of similar neurological circuitry, rather than genetic predisposition to Parkinson’s.

The second most common personality type was depressive, accounting for 14 PD participants and four control participants. This personality is characterized by avoidant behaviors and negative affect, which can also be present in individuals with PD alone. Nicoletti added, “Considering the well known high prevalence of depression among the PD patients, we are aware that in some case distinguishing between these two conditions can be difficult.” She hopes that future work will examine this personality type and others more thoroughly in order to establish whether they provide an early indication of Parkinson’s risk or they merely exist as comorbid conditions.

Reference:

1. Nicoletti, A., Luca, A., Raciti, L., Contrafatto, D., Bruno, E., et al. (2013). Obsessive compulsive personality disorder and Parkinson’s disease. PLoS ONE 8(1): e54822. doi:10.1371/journal.pone.0054822